Classroom time!

Met 10 of the 40 students today...... these were some of the best students I have ever spent time with. They are 2nd year BSN students and I got in the habit of quickly asking them to repeat back what I had just said to them as I wasn't quite sure that I was actually getting through. That blank, "Huh?" look is very universal. In all we communicated well and I had two emails from them this afternoon. Nice, quiet, well behaved and very soft spoken.  The University is so far out there that I honestly don't know how anyone could have made it without wheels, hats off to those who did it last year. 12 kilometres from home to University and then quite a bit more if you are in the mood for a bottle of water from town.

The students arrived with pen and paper today and were all ready to begin taking notes. Hard to even imagine that all of this information is passed without visual aids, or many visual aids and that they have spent most of their life studying without books. I would not have been able to do it, I'm not altogether certain that I can even teach without books! The library is okay but the students are restricted to when they can use books and that seems to be during the class room hours. They have nursing books that were donated through books to Africa and there are a few copies of many subjects. My super duper projector plays about zero in the class room. I am going to have to get very creative in the days to come, it is a fantastic projector but there is so much light in the class room. From what I hear it is going to get much "lighter" in the days to come. Sunshine in abundance. I came home from the University and began working on a lesson plan that does not involve them having a text book or me having electricity, wi-fi, or power points. Seed came through and I did get the printer to work yesterday but not this evening. Adam fortunately was able to help me get some cords for it for the Mac and I printed out some nonsense yesterday but haven't been successful tonight as I prepare for the next lecture.

Why ten students? That's the way it is here I am given to understand. The students do not all show up to begin classes when the University opens. Of the ten who were here today only a handful are local and the rest have moved up here to attend University from various places. This starts with a trickle of students which could make the first week of classes boring for those who come late. My host family explained that in some cases this is because the family is struggling to get the financial means to pay tuition and boarding for their children. I am going to ask their permission next time to take pictures and will introduce you to these lovely people. Fortunately almost all of them also have a "western" sort of name, which makes things infinitely easier for me. There are some bright, eager faces in the crowd and I look froward to spending time with them. I cannot say that I am terribly eager to go back to the hospital but hopefully we can do some good. My last few visits were very sad and I am never going to become accustom to bigger kids dying, or at least I hope not. It is awful.

 My car had a leak of some sort today and that appeared to be water... I need superglue. Went to the post office and nothing there as yet, it has been almost a month since the first box was sent so maybe soon, that one has all of my text books! All is well except the internet has been very sporadic at best. I usually have to walk around the room with the laptop to log on. Actually I was spoiled by the several weeks of near perfect internet I had. I continue to ramble on offline and then post it so sorry for grammar, half completed thoughts, etc.  Things are "okay" ...... Janet is still here with me. She has a very sad and amazing story, to think that she has had such a life at about 16 years of age is something to give me pause. Mother is gone and those who have been her caretakers have all died, that being a father, an uncle and her grandparents. She has had a difficult time and one would not know it from the way she glows. Her English is so good and she only attended school up until class 6.  I will post pictures of her as soon as possible right now neither of us are at our finest.  This girl anticipates everything long before I realise that we might need or want it. We are cooking on a charcoal stove inside the kitchen as they are still waiting for gas to arrive in Lira. It is rare to see Janet without a big smile on her face.  Her goal seems to be to make sure that I eat at least two square meals a day ..... That is a challenge my friends. It isn't that I don't like the food here, I just haven't been able to get past all of the potato's, rice, and more white foods, so far. Living on an Ayurvedic diet wouldn't be possible here although we ate smoking of green veggie today.  Love this Kid.  Adam continues to be very dependable and I hope things will stay just as they are, except I want my internet to come on whenever I need it, spoiled!

This kind of summed up a bit of how I am feeling today...... complaining about not having instant wifi, the printer not doing what I want it to right now, the projector not projecting as well as I wish and others have kids laying in a hospital bed up the road. I am grateful for what I have.

Returned safely to Lira

We had a safe ride up here and the car made it although there were moments when it seemed best to replace the tires sometime soon, that needs to wait though for now. We picked up my bag from my host families home and one of the young girls who lives with them, Janet, came to spend a few days helping me settle in. The house is "okay" ......pretty dusty and needs some cleaning but I will manage that tomorrow. For now I am just settling in and hoping that things work out here. There is no gas available in Lira for the store, GHSP sent the printer they had been promising me since DC somewhere else and in general I have been getting so "cha-cha-cha" about it. Bonnie called with one story which was the exact opposite what Irene told me.  I was reminded I hardly needed a printer yet as my classes don't start until Tuesday, why bother setting things up 24 hours earlier then I need to seems to be the attitude. Lira seemed bright and happening today and I am so happy to at last be able to take my clothes out os the suitcase after a month of living on the road. Can't wait for the University to open but whether or not I will have a printer feels doubtful at this point. I was given some gloves and some other supplies to bring up here with me and can't wait for classes to start. 

"Never buy shoes in Uganda after dark" Robert, GHSP Nurse Educator

Robert was born in Uganda but raised in the US and allowed me to share his quote. I am hopeful that it doesn't extend to cars as well!

And this friends is what happiness feels like. I got my car. This was the one that I found on Sunday (dream car pictured previously). I have been wading through parking lots, met at least twenty sincere owners and sellers of cars, walked through mud and dust, discussed tax ID numbers, log books, insurance and heard hilarious stories about how Ugandan’s “don’t use AC because it is too hot, radio’s in cars are not safe, etc.” It was in the end a great cultural experience as people selling cars are pretty much the same everywhere. I know having just sold one. As it was I ended up with all of those unnecessary things.  Bargaining on a very short budget helps. I had nowhere to go but down. The fact that this car was on a website advertising cars in Uganda gave me a baseline to bargain from. 

For now, I love my car, which has been affectionately named: Lefty 2. In America, Brian and I named the car Lefty 7 which was on my vanity plates, me for political reasons and 7 is his favorite number and I thought this new one should also be a Lefty. This car is sweet, or as sweet as a 1999 car that started out in Japan and ended up on a lot in Uganda can be. The fact that changing the oil filter and making all other repairs is on me is okay and standard practice.

The chance that I could have purchased and can have this car brought back to drive without Adam is zero.  I most certainly won’t drive to Lira on these roads.  They aren’t as bad as Viet Nam or India but I’m not driving there either. Adam the driver accompanied me through three car sale adventures yesterday, all done in the parking lot mainly with three or four people crowded in the vehicle while I sat there saying, “Sir I really don’t want this car at any price.”  When we went to Western Union to pick up my funds that Sue sent Adam, who isn’t exactly a small dude, and three other guys running from large to larger, accompanied me. The man at WU asked me if I wanted an escort to the car with my three thousand bucks I shrugged and told him I was going in their car. He nodded with a bit of a perplexed look. Who goes inside WU with 4 people?

Shout out to my sister Sue for always, always being there for me though Viet Nam, India and now Kampala, she hopped on line and transferred the money so I could buy this baby in record time. Sue, I love you.

We went out to meet the regular volunteers yesterday; they are a great group and some of them referred to themselves as the “fossils.” They are above 50 and joining volunteers who are mostly in their 20’s. Met some great people who will join us for swearing in today.  I moved on to the important things and met a Bronco’s fan that is going to a site in Southern Uganda.  He is also from Colorado and found a café in his village where they live stream Bronco games. The owner has returned to Uganda to live and brought the spirit with her, he tells me that she shows every game and that she airs them at any time day or night, he is worried about his curfew as he is outside the city. My data plan is exploding so I need to try to change it before heading back to Lira tomorrow. Clark family members when in Viet Nam, Indonesia, Thailand, Mexico, India, the UK, the US, Costa Rica, Palestine or Israel don’t let other family members miss the game.

As for this “privilege” of buying a car in Uganda. So grateful that Lefty 2 and I are on this journey. The University is at least 10 kilometers from my house and despite my passion and my desire to make this work, I can't manage that. The idea that I have arrived, that I can do this, that I can make this happen is so real for me. The fact that one of the great enemies that I face is Malaria and HIV I am ready to get out there and make try to make a difference. I have already seen one kid too many die of something that should not even be on the radar. To ask me to come fight malaria was a great idea and I am so blessed to be here. Seeing several children arrive in wards when it is already too late is jut not acceptable These kids do not fir the profile of what you might imagine, they are well nourished children who arrived for care too late, most with something viral that should have been prevented.

I met young PC volunteers yesterday who will be far more vulnerable that I am who are going to be living way outside of Lira without a walled compound surrounding them, even though I feel that even with my limitations I could scale that wall. Easily. The PC volunteers are the people who are making an amazing contribution and will utilise public transport and live at a very local level as I worry about if the radio on the car is working. (It does).   I can make this journey happen in part because I have wheels. I am so fortunate that my time came just as SEED was developing this program. To quote Hesse in Siddhartha,  “there is no such thing as chance.”   

We took out oath this morning, it was touching and we will swear in after just a few more hours. I am excited, happy, expectant, ready and willing to move in to whatever position now awaits me.  We had a Skype call with Seed yesterday; I summed up how things are going.  It was great to hear the voices of those who have been following our journey. Much has happened since then, I have jumped into the owners seat while preparing to be the driver.

Our GHSP group swearing in at the US Ambassador's house. 

My brief introduction to Lira gave me the opportunity to meet some students and this is all incredibly important. Our visit to the hospital here in Kampala was informative and taught me a few things.  I can walk for four hours, climb steep slopes, and not lag behind or fall over in the Kampala sunshine.  We actually made several trips up and down the same flight of stairs and … I made it. My internal thermostat is no longer working at optimal condition, so it took me a bit of time to cool down after the time spent in the hospital but I wasn’t alone.  I am enjoying this journey so much and it has only just begun.

Buying a car in Uganda, 101

First of all, the fact that a Peace Corps volunteer can even thing of buying a car is a bit remote for most people to grasp. The GHSP volunteers have a bit of an advantage in that our host group. Seed has negotiated and worked hard so that we can buy a car. So from there......the fun starts. And no matter what I say this has been fun, and a great cultural experience. I might at the end have a car, and maybe not.

When we were in DC, Dr. Bonny the GHSP rep told me I could buy a car for around $1500. that seemed amazing, and doable. I know for me the fact that transportation is a major concern that actually having "permission" to purchase and drive a car was huge. Next things was to arrive here with destination Lira, check it out, and move forward. The options that the University have seemed sketchy at best. PC provided me with a local driver and car and everywhere we met, sometimes 10 to 12 km. outside of town ended up with me arriving and waiting for them to arrive in the hospital ambulance, which seems to function more as the hospital transportation vehicle. My goal was to become as independent as I can at my age, within my budge and with what might be available. As luck would have it I seemed to have stumbled upon a driver who was willing to work with me toward that goal. Cautious optimism, at best. Steven the PC guide and language instructor has also been helping as has Jesse one of the drivers for PC that I happened to meet who is also an Iraq survivor having worked for the UN.

And this 

Onward and upward. Anyone can go online and find cars for sale in Kampala, an abundance of them. Finding your car and finding one that will suit the roads of Lira even when it is flooding and finding one that suits your budget (extremely tight) begins the highlight of the search. We went out today with a driver who picked us up. I am leaving Lefty 7, my 2012 vehicle far behind and now looking at cars made in Japan circa 1999. I have tried to forget that the Japanese team obviously wasn't utilizing a female design team back then and have tried to forget that I really dislike that boxy look. I don't care about the style of the car much, what I care about is what is under the hood. We have found slipping fan belts, which I am told can be fixed and with one Honda I was told that Honda manufactures cars so that the door has a distinct clicking sound when you open it, two of them in fact but only on the left side. This I am told is a particular Honda design. To have perfected this on the left side but not on the right is a fete that I applaud Honda for. I have not seen a single Hyundai in all of the parking lots I have been through. The brokers are nice, but let's face it I am a foreigner looking for a cheap used car. Transferring the money to buy said used car from my almost non-existent savings is quite another fete that I am tackling. The rest of the group I am here with are off to a cultural show again tonight. They went last night but it was closed due to some wedding or something. I had a good day, Jesse the driver and I spent some time swapping war stories about Iraq, as a UN troop member he was on the side that was at the check points and hopefully not shooting at us civilians. I was once in a convoy, took out my camera to take a picture of an incredibly long line of tanks and saw the gun barrel moving toward me as the person in the carrier noticed a silver flash. Maybe Jessie? Wish me luck in this adventure. My goal, Wheels by Thursday. But, I am resigned to whatever happens, happens. If I can't accomplish this it isn't from lack of effort.

Spent the day at the hospitals, even though this was one of the best in Kampala many departments were lacking in significant interventions. We saw one little girl about five years old who had been brought into outpatient at the nutrition ward and moved to ICU, there was no truly no hope for her. Very very sad.

All that separates us is $$$$$

Sobering

Thursday Evening:

Met up with the Gulu group yesterday and made the trip back down here to Kampala. The less said about the ride the better. Hot, dusty and crowded sums it up. The only thing I wanted to do was to take a shower but ended up going outside to sit with Jennifer and heard about her trip to Embale (phonetic). Her experience was similar to mine except the hospital she is in seems to be a joint venture with Korea and has all kinds of equipment, which isn't used or useful, at this point it seems. She didn't exactly say that but it was my summary of events. We were joined by others who shared their experiences and in all we seemed to have a similar feeling of the scope of the challenge.  I left Lira happy and hopeful and after a few hours was beginning to feel as though nothing would ever change. I finally made it back to the room. Steven and helped me get some plugs so that my cords are a bit more organised and I can charge more than one thing at a time.......progress.

In all it was good to share my experiences and to hear from people that the poor kid I was worried about back in Lira probably just laid there and died which I suspected but didn't know all along. Transfer him to where? we were in the best place they had. No blood? no blood.

I woke up with one thought, that is to remain focused. I came her to train nurses and that is really all that I can do. I can work with a group of nurses and do my best to make sure that they know the best technique and that they can take care of patients with dignity. As Dan always tells me, "lead by example"......other than that I can't re-write this chapter of the Ugandan Health System. I can only do what I can do or would quickly run out of steam, sharing experiences is great but there experiences are what they are. I can't get into group think or begin to think of this as impossible. I just have to do what I can do.

Friday afternoon:

We actually had a very productive round table discussion today with Bonny and I felt some powerful issues were raised. I was also able to have a private chat with him this afternoon and to lay out more of my feelings I actually feel a bit more upbeat. David the GHSP volunteer is turing into a powerful ally for us and is able to assist us in being a bit more direct. You know how American's are, always evasive. Which is sarcasm, we keep hearing that Ugandan's do not like to be confrontational, neither do most Amreican's.

Success

Last week I was brought up to stay with my host family to experience life, food, and the culture here in Lira. It was a wonderful experience and the family who hosted me will always be part of me now that we have found each other in this great big wide world.

Steven and I started the day by going to meet with local authorities in three different departments. We were warmly received everywhere and did quite a bit of line jumping everywhere we went. The police had many people waiting to see them, but as usual the crowds parted as we walked in. Steven will have a hard time after he leaves me and the waves no longer part for him wherever he goes, the advantages of being an older person is not lost on me. 

They actually received a certificate for taking care of me with my picture on it. 

Steven is the man 

Host family, Elizabeth and Felicite

Ann from Peace Corps Uganda 

We met the top official in the area who is appointed by the President, his name is George and he is a very well spoken and interesting young man who studied in Switzerland and has worked for Oxfam in the Philipines and traveled about in India. This is a bright, rising star for Uganda. Very delightful to meet and talk with him.  The local police officer suggested that I might want to purchase land in Lira and build a retirement home, might be a good suggestion as this might be the only place I can ever afford one!

On to meet up with Ann of Peace Corps Uganda, what a lovely and delightful woman. She works very hard to make sure that all PC volunteers are happy in their families, that would be quite the task with over 150 volunteers in country.  Ann had an interesting thought to share with me, some African wisdom. She said that in Uganda they believe that if you always eat at home you will believe that your mother is the best cook in the world, it is only when you go outside that you might come to know something different. She wrote down my favourite saying of mine  about "ships in harbour are safe but that is not what ships are made for." 

I had a conversation with a nice gentleman this morning who gave me a call. He is an American who has resided here in Lira with his wife for many years. There was dead silence on the phone when I told him I would be living alone. He said they have an armed guard and have had their house broken in to twice in recent months. I started to ask if the guard was sleeping but did not. The house I am going to reside in appears to be quite safe with good locks and a wall around it that anyone who is of the least mind to do so can easily scale but hopefully things will stay locked up well enough that there won't be any reason to come inside the compound. The previous volunteers did not seem to feel that there was any danger. Other than his admonishment that he would not leave his wife alone here for one night we carried on discussing other such things, such as his recent case of malaria. He is very well informed and a nice guy and I hope to meet him and his wife in the days to come. They have a literacy project and teach inside the jails. In all it was a good chat and I am not going to dwell on what might happen.

I am at last adjusting to the anti Malarial medication but it still hits me right after I take it with nausea, no appetite and I can almost guarantee a bit of a headache. I know that it is the medicine as I have not had any symptoms until I take it and have taken it at various times of the day, if I take it at night I would be crawling the walls. I must continue though as yesterday we went to a level 4 hospital about 20 minutes outside the town and again the place was filled with Malaria patients. The sister on duty informed me that this in her mind is an "epidemic" and that on one 8 hour shift they had admitted 40 children. Keeping in mind that they only admit the sickest of children who go on IV medication this appeared to be a very serious problem. While we were there we met up with five of the nursing students and gave them an "examination" this consisted of observing them brining in pregnant women who have arrived for pre-natal care. The two nurses from the University, Nancy and Agnes and I watched the student and the patient as they went through the assessment with the mothers, to be honest at times it was very awkward. The room was tiny and the mothers were uncomfortable with the crowd and the students were almost unbearably nervous.  I don't think we saw their best effort and they were very comfortable with the women prior to our taking them out individually and I was brand new for them. For first year nursing students they did pretty well. One was lagging far behind and the scary part about that is she is a trained mid-wife. The others obviously were doing their very best and it made me more at ease about the relationship I will have with them as these will be the students in my classrooms and I will have a chance to work with them in the clinical setting.

There was the perfect picture moment as we were leaving of an outpatient clinic with mothers and children out under the trees that I was reluctant to snap. I don't want to be one of those American's that always has my phone out to take pictures. When I asked later they said that it would have been fine. Sounds like I will be visiting that hospital frequently with students so,  next time. Agnes and Nancy told me from the moment I put on that white coat I will be "doctor" and expect to be grabbed to assist with deliveries or whatever else emergency comes along.  Should be interesting times ahead.

The family came to the hotel and we had a farewell luncheon, before I returned to their home with them. They are lovely people and were even given a certificate from the Peace Corps thanking them for caring for me. I know that the most difficult part for them has been that I am a very picky vegetarian and I think for them that is just flat out insane.

Anyway, we made it. Back to Kampala tomorrow for more training. I cannot say that I am happy about it but as the days have passed here I have come to know how much I don’t know and look forward to a closer look at how the health care system works. I look forward to seeing the rest of my group and hearing how they have fared in their host families and with the University's where they will be working,

Wake up call

Today was a reality check on who I am, where I am, and what I am doing here. Steven, Adam and I met at 8 and then went to the hospital. I had a chance to spend hours on the pediatrics ward and to get to know some children, some families, and to review medical charts and observe procedures. It left me overwhelmed and when it comes to hospitals and medical wards that is something I didn't think I had left in me. I walked through this section of the hospital last week but only saw children lying in beds and spent less then a few minutes inside the ward. Today was entirely different. I had to re-evaluate just about everything I think I know and to be honest it has left me almost speechless, although thankfully not wordless as I need to at least sit down and write about my feelings. Such a great tragedy is taking place, some times right under our very own eyes and we can only see it when we slow down enough to actually observe, to see children, not numbers.  I feel almost "guilty" about my pleasant day off in the cool breeze on Saturday when right here, practically next door, when so many are waging a battle for life.

The interns were welcoming as was the sister and we arrived as their rounds were taking place. There are about 40 children under the age of 5 and more children are on general wards and several arrived while I was there. There is ONE nurse taking care of all of these children who are very ill, there were two students, one was looking through charts and the other was running errands. The interns were seeing an endless line up of children waiting in their mothers arms. Some things that surprised me was that no vital signs are taken and recorded and that the doctorgot up at one point and weighed a child. I suppose with only one nurse who was at that time drawing blood, that's the way it is. The first few children were very sick and I saw several with sickle cell, one who had been in the hospital a few weeks ago and was discharged but then ended up back having had no treatment at all since he was discharged. He is a beautiful little two year old and you could almost feel how painful it was when the physician moved his swollen limbs. What was a bit more painful is that he kept moving them to show me how painful it was for the child. Ouch! My goal is to study far more tonight about SC as I haven't exactly lived in places where we see an abundance of it and suddenly there were textbook examples right before my eyes. The next three children were suffering from malaria and so ill. Fevers, pain, anorexia, and so the list went. For the doctors it was an almost endless line and stretched across the ward as one tired mother after another carried her child up to them. I was looking at the mothers faces and thinking that I would have no idea at all how old they are. None. For the most part they looked too old to have a child to me. After some time a boy of about 7 was carried in by his mother and grandmother. He was limp and the intern who had spent the most time talking with me jumped up and ran to a cot to examine him before I realized what was actually happening. He was coming in from the out-patient department. He was unresponsive and three staff members tried to get blood from him until at last one was successful, I am sure that on top of all else he was dehydrated as they simply could not get the vein, one doctor ended up poking his own self and had to wash up and take anti-HIV medication while others continued to work on the boy, they finally got blood through the femoral artery as best I could tell and the child cried out in a very hoarse voice, to be honest I was happy to hear at least a sound from him. Although I would still classify him as "unresponsive" throughout the rest of the time I saw him. The mother and grandmother appeared to be almost numb and said that he had only been sick since last night which might not be possible.  I wonder what kind of obstacles this family faced trying to bring little Steven in, transportation, arrangements for children at home, and of course money even though the treatment at the hospital is free no doubt there are many expenses involved. The doctor did not even have a guess to what was going on but the blood work came back very fast and they was some rushing about and exclaiming over the results. I got a fast enough glance at the lab paper before it was whisked away to say that I  have never seen blood work that was this out of whack. WBC was three times above normal, his platelets were so low that a student nurse was rushed out to go get blood so they could start it immediately. Then the bad news, No blood at all in the blood bank. The boy was moved to a bed, the doctors went back to other patients, they had a few laughs and discussed some other items and the child and his family seemed to have been left behind in the thought process. The most that I could glean without being intrusive, as I was only there as an observer,  was that they were going to try to transfer him to another hospital, and whether or not he could even survive a transfer remained a question to me. And what hospital? We were at the Regional Referral.  In all it looked catastrophic and for an older child who appears to have been a healthy child with adequate nutrition prior to this event I think I could venture a guess what will happen but I might not be told immediately. I said good bye to the staff shortly thereafter and wrote down his name as I want to follow up on him when I return from Kampala. There are so many like him who I didn't truly see the other day and it all became more real for me as I saw him come in, for the rest they are just lying in their cots in the heat and with family members caring for them. It was all there, I just didn't really see it until I came to know the children's names and saw their mothers faces. That poor, poor, family. There are tough days ahead.  There is no chance that I can imagine that this child will survive the event and I feel frustrated, tired, and ready to get to work.

I had some mixed news from one of the nurses who I had met in the Neonatal until. The little 1 kg baby did not survive, I didn't honestly think he would but had hoped, he died not long after we left and the mother is doing a bit better and has been released and the malaria is stable. When the nurse came up to me she spoke in Lango and I answered and for some reason at least 5 words came rolling out of my mouth, which is sort of the beginning and end of my Lango so far but it was nice to at least be able to speak and to see that this helped bring at least a few smiles to some faces.

Only one nurse on duty in the children's ward seems so impossible because these children are all so very, very sick. Another nurse came in for a few minutes but was dispatched off to somewhere else and the two student nurses were busy with their own tasks, one is training in public health and recording something in a book which is no doubt important statistical data.  We are going out to another hospital tomorrow which I understand will be smaller and maybe with "less" resources.

Agnes and I had a long chat after we finished on the ward and I was able to get a better idea on what I will be doing, in addition to teaching I will also have about 5 students with me on this Pediatric ward at least one day a week. It would be helpful to have a few more hands around I am sure but I need to keep our nurses on track as to what they are there to learn and best practices in that environment. I came home eager to start doing more research on malaria in children. I knew that this is the way it would be on an intellectual level but most certainly was not prepared for the strong emotional reaction I saw these children, these aren't tiny babies, these are real kids who were learning their first words, toddling about and laughing and playing perhaps just a few days ago.  It would have been a stretch to imagine the hospital before I got here, no matter what I had heard. I can't even totally grasp what it is like to work with with no blood, and children lying about without intervention and with one nurse. I am sure that there is much more going on then what is visible with my limited knowledge of the language or the care which they are trying to provide but it isn't going to be easy.

 I had a very positive glimpse of what USAID is providing to the people here through the website "Sustain Uganda" when I got home as I wanted to read more about the hospital and ended up writing my therapeutic journal/blog. The boy in our home seems to have broken his thumb playing ball at school today. He is about 12 and they had no tylenol or aspirin for him and seemed to be upset about the fact he would have a hard time writing his exams, meanwhile the boy was tearing up and trying to be brave. I feel like I am at the bottom of a great big hill looking upward and wondering how on earth I can make a difference in the lives that touched me so profoundly today. I can't change anything today, or tomorrow but I most certainly am going to be doing my very best to help train some nurses to relieve Susan's duties as she had her hands full. Time to study Lango so I can actually develop more sentences. Feeling a bit deflated and overwhelmed but also feeling like I still have a great deal that I can contribute, and will.

In the meantime I found this article from a local newspaper on line which probably sums up much of what I am trying to say far better than I ever could. It is from 2012 and I hope that things have improved since that time, I haven't been in the hospital on a weekend so time will tell.

"Lira Regional Referral Hospital is facing a crisis as it has only nine doctors offering medical care to more than 500 patients per day. According to the principal administrator, Mr Henry Lwigale, the hospital requires 39 doctors. “It means that we cannot provide some specialised services because the clinicians are not there,” Mr Lwigale said on Wednesday.

Being one of the only two regional referral hospital in northern Uganda, many patients are stranded at the hospital. Some are forced to travel several kilometres to Gulu Referral Hospital for specialised treatment. “That situation has made service delivery a bit difficult because some health facilities are overworked while others are redundant,” he said. 

The District Health Committee chairperson, Mr Moses Ogwang Adonyo, said due to the shortage of health professionals, sometimes patients are not attended to on weekends.
“They (health workers) work only on week days; when a patient reaches the health facility you have to wait up to Monday but it is not even guaranteed that when it reopens on Monday, you will get help,” Mr Ogwang said.

“The few doctors cannot do much to help us in case of an emergency. I took my wife to the hospital in September last year but unfortunately she died before seeing a doctor since it was a weekend,” said Mr Denis Obang, a resident of Adyel Kisubi, Lira Municipality.

Lira Resident District Commissioner Susan Akany confirmed the challenges the hospital is grappling with.

Ms Akany said recently she got information that some babies died at the hospital shortly after they were borne. She blamed the incident on the crippled healthcare system. “Power went off all of a sudden and by the time they could start a generator, the babies were already dead,” the RDC said, without offering details of date of the incident and the exact figure of the victims."