Monday, August 18, 2014

Africa Part 2: Clinic Days

Each Morning we left the hotel to go to a different clinic site. We visited four villages in five days. We were greeted with anywhere from 70-500 people in line. In most cases, the first 100 or so people had slept there over night to insure a ticket to see the Doc.

On the way to these sites we would pass small towns and villages. It was early morning so they were ghost towns at that hour. We would see nothing for miles and miles, then all the sudden masonry / mud strip mall type buildings would line each side of the road for a quarter or so mile. On the way back, these businesses would be packed full of night markets, people cooking, drinking, selling goods and just hanging out. Our driver pointed out hanging out together by the few lights or bonfires was much better than in the dark at their home. 


Every morning once we got to the clinic site (a church or school) we were greeted by a major figure in the community. Usually a preacher. He would show us around and introduce us to our prayer team and translator team. These teams were compiled by people the preacher had brought to us. They were volunteers, and PMI gave them a "free pass" for them or one family member (but not both) to go through clinic. These patients were in addition to the "magic #" Dr. Bolt gave us. Dr. Bolt was our head doctor.

Upon arrival everyone would scope out the location and determine what space was best for each station. We started registering people as soon as we could. Patients would start clinic once Triage was set up and gave the ok. In Triage they took vitals, temp, urine samples if needed and gathered information as to why they were there. 


350 people in line 
At first Triage would ask a series of questions trying to pull information from them. It was quickly learned that wasn't the best away to approach it. The Providers would have to analyze each complaint/ reason for the patient being there- based on what Triage wrote on their sheet. Providers were learning that it was rather time consuming to analyze/ treat 5 or more points for each patient. Dr. Bolt brought this our attention at our first Team Leader meeting. The solution was to ask why they came. Do not provide them with the answers as to why they came. They traveled here to see us for a reason, lets ask them why was Dr. Bolt's approach. He calculated if we could narrow it down to 3 key complaints instead of 5 or more, we could get more people through clinic each day. Some people just needed meds refill, had back pains (rightfully so, if they were farmers) or were there just because a doctor was in town and some were extremely ill and very sick. The team learned it was important to ask questions, but ask the right ones for the circumstances. Once this adjustment was made, we could really see a change in the patterns of the day. It all seemed to run smoother. While it was still organized chaos...it was mucy more organized chaos. 

Jimmy Angodia is a special gift to PMI. He is so great to have on the team. He travels with us each day and speaks a hand full of languages. He walked down the line of people with Katie and the registration team and one by one asked the key questions we needed before they started clinic: Who is with you (it was hard to tell who was with who), Who is here to see the doctor, What is your name and "how many years do you have" aka what is your age. When it was their turn to start the clinic rotation, we weighed them and they went on through clinic.


Jimmy and I: Day 1 Clinic
We had three scales. We would each take a patient and bring them into triage and weigh them. If there was an infant we would have the parent stand on the scale with the child, then without, so we could get both the weight of the parent and child. I very much liked the holding the baby part! You would not believe the number of people who would not know how to properly stand on a scale. We would have to have them watch us, to show them how. To us this act seems mindless, common sense even. Throughout the week we had many moments of wow. Experiencing that was one of them.




Clinic had multiple stations, in order: Registration, Triage, Providers. From Provider they would go to PT/OT, glasses, Family Planning or Pharmacy. The providers determined where they would go when the left the Provider's station. At each station I placed a registration team member. They were called runners. They were to walk patients from point A to point B and hand off to the next station. Seems mindless for us, but you would be surprised how many people would wander off, go chase children, go sit, etc.. instead of just going to the next location.


Each morning Dr. Bolt would determine how many patients we could see that day. He based it on the set up of the site and how far we were from the hotel. Our goal was to be back at the hotel by dark each night, for safety reasons. The hardest part of my day was turning people away. Once we had met our max of patients we could see each day, we had to tell people they could not go through clinic. 





Katie registering patients
As Registration Team Leader, that was one of my roles. I was aware of this role prior to arriving in Africa, but it doesn't prove to be difficult until you actually have to look at these people and tell them they could not see the doctor. Luckily I had Group Directors to help facilitate some of these tough conversations. We did however offer prayer time, tell them where we would be the next day, and directions and information about the MKMC. It doesn't seem like a lot and it's almost a grantee that none of these people will go to the next village or MKMC... but options are better than a flat no. After reaching the final #, myself along with Stefani and Katie McKenzie (Group Directors) would walk through the line and pull out severe cases to be the exception to the rule.

These people were at the back of the line on day 2. We stopped about 100 people in front on them. These people did not go through clinic.
The prayer team set up shop under the tent by pharmacy. While people waited for their medications or for those who had been turned away, they could come to the tent and pray for healing, blessings or just give thanks. Our translators were our life line. Without them, clinic could not exist. There are so many languages spoken in just Uganda alone, they played an essential role for keeping the day moving.




Once we had registered everyone, the registration team had some free time. This was great to be able to walk around the area we were in, play with the kids, lend a helping hand to where it was needed, or just take a few minute personal break. After the last few patients were through the providers we started with the prayer team and translators. Without fail every day, we had people not understanding or just trying to do what they can, to get them and a family member to be seen, despite the rule: it was them OR a family member. Not both. By day two we had a system to help regulate this. Prayer team and translators had names tags made of duck tape. When it was their turn to go through clinic we would pull their name tag off and stick to the back of the registration form. If there were not seeing the dr, but their family member, we would still take their name tag and write actual patients name on the form. This helped with passing of the name tags. It sounds brutal, but with so many people, there had to be a way to regulate it. There wasn't enough hours in the day to see all the people that would show up, so we just had to be as fair as we could, in the safest way. Day 3-5 I had my game face on and those tough rigid stopping points and conversations of "we are done taking patients" became a little easier. Confusion would come when we started registering the prayer team and translators. They would know they had just been told no more, but yet soon after, we would let 30-40 more people through. It would then have to be explained they were getting to go through as a Thank You for helping PMI that day.

While in Africa I was surprised, humbled and felt loved more times than I can count. The pure happiness everyone has is overwhelming. It is a joy no one I know in the US would have if in the same conditions. Spending time in such a poor country really helps remind you of what is important. Not be surrounded by "stuff" helps you understand how they can be so joyous and happy. 


They literally have nothing to compare their life/ condition to. Everyone they know is in the same position: poor, hungry, thirsty, sick. But they are thankful for what little they do have. Children go to school, women work, men work. They may not get paid and it may not be the same level or capacity of work we know but you got the sense people were working and doing the best they could. They are working in the sense they are raising multiple children. They are working in the sense they are carrying gallons upon gallons of water on their heads (even children as young as 5). They are working when they pick fruit and put pounds of it in the basket on top of their head.They are working with what they have. They are working to stay alive. The will to live that I witnessed is something I'll never forget. I don't think I would stand a chance. 

I noticed women still have a sense of pride. If they had it, they came to clinic in their "fly rags" as my Grandaddy Hall called Sunday best. They would nurse in public, but want to be in private for urine samples and would even hide the cups when walking outside to the latrine.




The communities really had a sense of community. It seemed that everyone helped one another, everyone pitches in when needed and everyone trusted one another like family.

When we would ask how old they were.. we got more than a few 40,50,60,70... after thinking about this... they probably do not know how old they are for sure. I didn't see one calendar. I have no idea how they would keep up with the days/ years, especially when you get on up there. Some of the elder would really had to think about how many years they had. 

While I've never forget the love, hugs and smiles of the children, I'll hold forever with me the depth of life I saw in the adults. I swear, even if we couldn't speak to one another, when you looked into some of these people's eyes you just felt you could see the world. Stories to last a lifetime. Some of the kindest, most sincere, intriguing eyes I've ever been looked at with or looked into. 

















It was most interesting to see the reactions to the photos. Almost every time I took a photograph, they had a stern, strong and serious face. After showing them the shot, they would bust out into laughter and smiles.





Another thing I noticed is that when I would show them the picture, it would take several seconds to figure out who was who. They didn't go straight to themselves. They used context clues, like the colors they were wearing and would look for that in the picture. They would look down at themselves, look in the picture and look at their friends. When the spotted themselves, well that was the most magnificent thing to witness. It was really an eye opening experience. We look at ourselves a dozens times a day and there is no telling the last time these people saw themselves. Once they figured out who was who, it was followed by a warm and welcoming smile of gratitude and then pointing and saying "me! me!" 



Here are clips of each day:

Day 1: Bweyale - 1.5 hour drive
*Devotion Verse: Matthew 22:23-40 and Luke 10:25-28 How does love play a role in what we are doing. While yes this a medical mission, we also have a responsibility to make these people who are strangers to feel loved and welcome and safe. I felt loved by everyone I met and just as much so by the culture. I tried to give back the same feeling each day.

-Katie and I couldn't sleep after getting up to pee at 3:30 am, so we finally got up at 5:30 am to start our first clinic day. Even though we were / are both non-medical and wouldn't actually treat patients, we were still so thrilled to get going!
-Breakfast: eggs, toast with PB
-When we arrived to the church in Bweyale, we were all very surprised about the # of people in line. It was under about 60, which we were told is unheard of. After pulling in and setting up we were told the reason why the numbers were so low was because there was a public hanging 1/2 mile down the road! Apparently a man killed several people in the community some years ago and had been waiting death by hanging in the local jail. That Monday, May 12, 2014, was the day he was to be hung in public. The community members made the choice to witness this before coming to clinic. 
-We traveled a red dirt road to get there
-Lots of kids
-They played soccer with tombstones surrounding them. 
-236 people were seen Monday
-One lady had 6 kids. She could not walk. She literally had to scoot. Her children would help pick her up when needed. This woman came to clinic last year and PMI was out of wheelchairs, but told her if she came back this May, they would have one for her. And we did. She somehow held on to a small note from the Dr. for an entire year. 
-A 65 year old lady received a walker, and now she was "driving"
-20ish prayer leaders
-30ish translators
-Mary: she was 11 and showed up with out a parent. Her mother was at the hanging. The rule is you have to be 12 or older to go through clinic alone. She had a dress on, and we could only see one leg, she walked with a stick. Once her mother came, we registered her. As she went through clinic we learned she had done some sort of damage to her ankle/ foot and had bandaged it up and it had grown into the front of her leg. It was heart-wrenching to see he gaze at the other children running around jumping and kicking the soccer ball.
-We turned 42 people away Monday
-Ring around the Rosie was played
-Duck Duck Goose was played
Meet Mary
All these children belong to this lady. 
He was playing duck duck goose and every time he got tapped on the head he would run back to his mother belly laughing!








The kids loved high fives




Guards were with us everywhere we went

Katie registering patients
"We have been knowing each other all our years"


That toooosh.









Day 2: Mirima Kawala- 1.5 hour drive
*Devotion:Matthew 22: 36-40, 24-28. How are we leveraging the gifts and talents we have been given to serve the world: This one was a great one to start the week off. Already I had a sense of guilt, pity and worry for the people I had met Sunday and the people I had not even met at clinic days. The point is, don't feel sorry for these people. They don't feel sorry for themselves. Don't feel guilt for the things you have. Use those blessings to help the greater good. And that doesn't mean you have to go to Africa. It simply means give back, help out, be kind, share your time, share your talents, reach out, smile to a stranger. Basically, be a nice human!

-Breakfast: Eggs and toast
-Farming Village is where clinic was being held. 
-Traveled for an hour on the main dirt road, the took a right onto another dirt road. In the thick of farm land. 
-Mud huts everywhere
-Clinic is in a school, each station has a room/ building
-400 people in line
-Property is clean, well taken care of
-Property is green and lush
-Saw 207 patients, 267 with prayer team and translators
-Turned about 150 people away.
-Film crew John and David are with us now- end of week shooting footage for this PMI video they did and The College of Hope Video 
-Storm rolled in as we were closing up clinic- down pour just liked we get in the South
-We thought this villages was the healthiest, turned out they were the sickest, another example of you can't just a book by it's cover. 
- Health Department here with banners and teaching about Malaria. Of 100 deaths of children in Uganda, 30 are children
-Treated a child with Hydrocephalus. His father came up to me, after the cut of point and begged for a "ticket" to see the doctor. I could see the worry in his eye. I asked the translator to ask him what was wrong. The father responds by uncovering his child. It was like nothing I had ever seen before. I took him with me and registered him (he is the little boy in the PMI video). Patty Cooker Bolt  & Cindy are the PT/OT leaders. They teams worked wonders for this little boy. The PMI volunteers rasied enough money for Baby Sadrak to have surgery and also cover the cost of transportation. The father noticed something was wrong when he was a couple months old. Once the mother did, she abandoned them. It's believed that mothers often do this, b/c they think the devil / evil spirit now lives within the child. The father works 13 hour days in the sugar kane field and leaves Sadrak with villages when he is away. He told us he feeds him as much as he can, but he doesn't know how much he eats during the day for the simple fact, there is barely enough to go around for the family he stays with let alone an extra mouth. 
-Lots of children with Malaria
-103 temp on an infant, my arm was hot when I handed her back to her mother.



















Cows and Clinic



Day 3 & 4: Butyabe. 2 hour drive. 
*Devotion day 3: Romans 12:3- being humble missionaries. This helped us to remember we are all the same. We are all humans. Don't go into the day thinking we are better. 

*Devotion day 4: Philippians 2:3- How do we value the people we are serving and how will we honor them when we go back home? I found value in the people I met b/c without knowing they were helping me grow in more ways than one. They were teaching despite the obvious barriers of language and lifestyle. I came back home eager to continue in my volunteering. Exited to share my experiences with anyone who would listen. I found value in their day to day lives. Their simpler way living. I found compassion I didn't know could resonate within me. 

-232 patients- day 3
-200 in line on Day 4 upon arrival.
-246 patients seen on Day 4
-We drove 2 hours. It was a beautiful drive. About 45 minutes of it was through the sugar kane fields. 
-Passed people loading up on back of trucks to head in to the fields. They were packed in there.
-Workers all had Machetes to take with them into the fields. 
-People washing themselves and clothes in the streams
-Village is a few miles away from Lake Albert. 
-There was an HIV/AIDS convention going on so only about 100 in line.
-Only have to tell 5 people to come back Thursday. 
- It was a great feeling to be able to tell people to come back the next day. Since Day 4 clinic was at same location.
-A boy about the age of 12 slept over night in line. He needed a wheel chair. His buddy waiting for him all day. At the close of clinic, his buddy watched how the medical volunteers helped him / showed him how to use the wheelchair then wheeled him off!
-We exchanged money for Uganda Dollars. I traded in $200 USD
-Pastor gave up his wrist band for a lady who walked 7 miles to get there. We were past our limit. 
-Simon and van 6 stayed in town so the film crew could get footage around town. We ended up in van #3, not as great at #6
-5 people today couldn't walk
-Several feverish children
-Learned some home roofs are made of surgar cane stalks
-I fell in love with Fiona. A baby I held while mother got weighed and well, continue to hold for 1.5 hours 
- Fred Mo took Katie and I on motor bike ride! 
- Saw the most beautiful moon on the ride home. 
- Slow ride home 
- We filled out our laundry sheet to get clothes washed, dried and folded. ($20)




















Of course his name is Elvis
PMI gave this child a wheelchair. His friend waited all night and say with him.What an utterly amazing friendship, and especially at this age.







Fiona.

Day 5: Biizi. 30 min drive
*Devotion: Romans 12:1-2. What will you take away from this trip and what will you leave behind. I took so much away from this trip. A few of those things are: a little more insight to what really is needed and important in life, gratitude, thankfulness, humbleness, how many hands really do make for lighter work, the importance of serving others, the reality of how big this world we live in is and how a simple thing such as a hello or smile can brighten someones day. I tried to leave behind judgement, worrying about what others think of me and negativity. 

-Day 5 clinic was like a dream. We were nestled up in a church sitting among hills. 
-It was cool
-It was shaded
-Another Jimmy, who is translating for us at this site, heard that translators only get one ticket. He got up before the sun to put his 4 children in line. He stayed with them until he had to begin volunteering. Once registration began he pointed his children out to Katie to make sure they would get a ticket, even without a parent. He wanted us to know he was there. One of his children had a Michigan sweatshirt on. This provided us with the perfect photo opp to send to our Michigan fan friend, Megan!
-Two brothers with Elephantiasis 
-Balloons were made from surgical gloves. Kids played and laughed for hours. 
-PT/OT needed a pair of size 8.5 shoes for a patient. They didn't have any left. Katie Rothwell gave her shoes. Right off her feet. Cindy gave her a shout out at dinner Friday night. 
-Elizabeth ran the glasses station. That day, our Registration was in the same room. When I went to get more forms, I heard a man thanking her. " Thank you! I can now read my bible, instead of having people read it to me!"
- I walked up to Dr. Bolt to ask how many more patients we could see that day, but when I found him, he was with a patient. So I watched and waited until he was done. It was a older man, prob 60s. Dr. Bolt was pulling something out of his ear while sticking a syringe full of fluid in his ear. You could see the pain on his face, it was like he was screaming, but no noise came out. Once Dr. Bolt got it (no idea what 'it' was) all out of his ear he showed it to the man. The man let out a sigh of relief, pointed to his ear to indicated he could hear! Once he saw what was pulled out of his hear he put his head in his hands as if he was a little embarrassed. Dr. Bolt put his hand on the man's shoulder, once he did, the man looked up smiled put his hands together like he was praying and said Thank you, three perfect times. 
-Local vendors came to the hotel Friday night to sell goods: blankets, paintings, t-shirts, bangles, bowls, baskets, aprons, pillows, etc. 
- Wabeoyona was one of the drivers & he's an artist. He had some paintings that Katie & I bought. We really liked the ones painted on local cowhide and local tree bark
- Tribal Dance! We saw a tribal dance!






























Friday was a pretty superb day. A rather perfect way to end the long, hard work week. 








2 comments:

  1. Africa is one of my favorite region as tourism point of view in the world. I have been there few months ago after my Boston NY bus tour with my friends. It is a nice state for animal lovers. It supports a rich diversity of animals, birds, and plant-life. It is also one of the most diverse and enchanting countries in the world. It has a best combination of landscapes, people, history and culture.

    ReplyDelete
  2. Howard, I agree! I hope to go back one day!!

    ReplyDelete