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Brenda Maldonado, a nurse from Colorado Springs, Colorado, reports from Uganda:
A typical house/shelter constructed from bowed branches with reeds interwoven. A tarp issued to them from the UNCHR is thrown over the top and tucked in at the bottom with dirt. (Photo by Brenda Maldonado)
April 24, 2009: Today at the start of clinic, I continued to teach the large crowd waiting to be seen. It is encouraging to have people asking pertinent questions and appreciating the information. It takes awhile to dispense just a small amount of information as Moses, my Congolese interpreter, translates the message twice, in two different languages.
A sad case today. I heard a woman attempting to cough, and it just did not sound right. I went into Kristoffer's exam room, and he pointed at the woman as she lifted her shirt. It was obvious just from looking at her that this woman had bilateral breast cancer and that it had already gone to her lungs. She came to us from another clinic that had diagnosed her with mastitis and were trying to rule out tuberculosis.
It is very common in these settings for doctors, clinical officers, and nurses to sit across a desk from their patients and make diagnoses based totally on what patients tell them. They often do not examine their patients, listen to lungs, or feel a hot brow. So, patients are frequently misdiagnosed and mistreated. This woman was clearly suffering from cancer, but no one at the other clinic had detected it.
Only a week left, and it feels like time is racing by. I have mixed emotions as I am looking forward to going home and seeing my husband, Mike. But again, I have made fast friends with Africans from different countries, and I hate to say goodbye...
Murabeho (goodbye in Kinyarwanda), Brenda
•••
April 21, 2009: It has been an interesting couple of days. Yesterday we seemed to have urgent care clinic most of the day. Immediately on arrival Steve had to suture a big gash in the upper thigh of an 8-year-old boy who had been run into by a bicycle. Before the clinic started, I stood outside with Moses, one of the interpreters from the Congo, and did education for the crowd waiting to be seen about how to properly take their medication. It was during this time that I noticed an attractive African woman in her thirties behaving a bit strangely, and everyone else giving her disapproving looks.
It was very overcast and started to sprinkle a bit, and the crowd of patients kept building. I went to the antenatal clinic and started to weigh the pregnant women and take their blood pressures. I then heard another disturbance outside and saw the same woman from earlier speaking very loudly and getting in people’s way. Her behavior became even more agitated, as she went in and out of each exam room, disrupting interviews. At one point she pulled on Ann’s stethoscope, choking her briefly. Thankfully Alex, one of the clinical officers, was right there.
It was decided that she needed to be sedated, so several men were called to subdue her, but first they had to catch her. She got a big grin on her face as she ran around one of the treatment tents, but it did not take long and they had escorted her to a corner of the antenatal clinic. She did not put up a physical fight but raged on in a long monologue that I could not understand, occasionally spitting at people. The men laid her on the ground and held her while Alex, our clinical officer, gave her a Valium IV push. She continued to speak loudly and rapidly moving her head from side to side. I went to keep her head from hitting the ground, trying to watch and make sure she did not bite me, but she caught me off guard once and spit in my face. I wanted to weep. Mental illness is so misunderstood and misdiagnosed here in Africa. Also, good psych drugs are not available. Her elderly mother was there, trying to help, and I could only feel sorry for all that she must go through with this adult daughter of hers.
Carrying heavy items on the top of your head is much more efficient and allows you to carry other things in your hands. Look at the woman standing farther away. She is pregnant, carrying a baby on her back, a hoe in her hand, and balancing a bunch of bananas on her head. The bananas probably weigh more than 25 pounds. (Photo by Brenda Maldonado)
It is difficult enough to be a strong and healthy person in the Third World, with corruption, war, famine, natural disasters, and so many other challenges. But just imagine what life is like for those with mental and physical challenges. There is no CPS here; there are no welfare services. There is no group to provide handicap access for public buildings. I have seen people dragging their bodies across the ground on a piece of cardboard, I have heard the Ugandans making light of a diagnosis of PTSD (post traumatic stress disorder) saying, “that is not an African problem.” And now, I have seen a woman that desperately needs to be on medications.
We finished seeing patients early, due to cold and rainy weather, so we hopped in the Land Cruiser to go visit the neighboring medical clinics. We had a nice tour of the MSF-Spain clinic (Médecins Sans Frontières, or Doctors without Borders) by Dina and Isabella (from Norway and Spain). Dina is a nurse and Isabella a doctor. They have the clinic and are also helping with water purification and distribution. We then drove about 10 kilometers to the AHA clinic (African Humanitarian Action); this group comes from Ethiopia. Across the street World Food Program distributed food, and long lines of people waited for their share.
When we arrived back at our clinic, there was a 7-year-old-girl with a splinted leg. She had been hit by a car as she ran to it asking for a bottle. Her leg was broken and had a deep gash. She was taken to the Nakivale Health Center, and then it was deemed that she should be transported into the Mbarara Referral Hospital. We were able to see the Nakivale Health Center, and then had to go to GTZ, a German agency in charge of referrals, water and sanitation. It was interesting to see all of the hoops that had to be cleared before we could actually take the girl to the hospital. When we arrived at the hospital, well over an hour later over the horribly bumpy road, we drove up to “Casualties” and Kristoffer accompanied them. As they walked in carrying the young girl with a bloodied, splinted leg, nobody offered to help or direct them anywhere. It was really sad to see this treatment in what was supposed to be an emergency room. Our team member Ann told me that if anything happened to her, to please not bring her to the hospital.
Every day I see so much that I want to write and tell you about. It is so beautiful here! But at the same time, life is so difficult for so many. I am enjoying my time in the pharmacy, and I think that there is some improvement in the quality of medication distribution. I have chosen to be subtle and consistent in my approach, and I know that the pharmacy staff is watching me, and I see them starting to emulate some of the things that I am doing. I have also enlisted their help in learning some of the local languages, and they love to hear me speak the phrases to our patients. It is always fun to catch our patients by surprise when I speak to them in Nyarwanda, and they smile and laugh.
Finally healthy in Mbarara, Brenda
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"A line of people wait to be seen outside of our clinic. They just press in together so that no one will cut in line. The previous team said that one time when it started to pour down rain, they would not take shelter as they did not want to lose their place in line." (Photo by Brenda Maldonado)
April 18, 2009: It was hot today, and we saw just over 200 patients in about seven hours. I worked in antenatal clinic, registering patients, and taking their weight and blood pressure. The antenatal clinic has a large holding/waiting room with a dirt floor, and then a smaller room to register patients, and an exam room. Every day pregnant women sit on a sheet of tarp about 5-feet-by-15-feet long and wait to be called. I find them in various positions, most sitting up with their legs straight in front of them, but some of them lying on their side. There are no benches or chairs for them to wait on, so they sit patiently, on the ground. It was so warm, that as I was registering patients and taking their blood pressures, I was at times overwhelmed by the odor.
The patients try to keep clean, and they bathe daily with what little water they can spare, but they have no access or money for soap, shampoo, or deodorant, and for some, the only clothing they own is what they are wearing. The women love bright colors and vivid patterns, and they appear so festive. But on closer inspection, the clothes are threadbare, with buttons missing, zippers broken and gaping open, and hems falling down. Because of the colonial influence many men wear suits, and in pictures they look very well dressed, but again their clothes are threadbare, stained, trousers and jackets mismatched.
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April 16, 2009: The rain came down in sheets all night long. It felt as if someone in the sky was turning a tap off and on. So, I wonder what our drive will look like today? I couldn’t help but think of the people in the camp as I lay in my warm bed at the University Inn. With all the rain that we have gotten the past few days, I am sure that the ground is saturated. How are the refugees keeping themselves dry as they sleep on the ground? How are they keeping their possessions from getting soaked? Yesterday was a cool day, and as we drove past some of the shelters, I could see smoke coming out. I hate to think of the people, especially the children staying in a smoke-filled environment. But what recourse do they have? It is cold and damp this rainy season, they are just trying to stay warm and dry, and they need someplace to cook out of the rain.
This is my 8th trip with Medical Teams International, and on each trip I try to see how we can be more efficient and improve on the quality of patient care we deliver. Some of the mothers come to us with three or four sick children, and we send them home with several medications. The challenge is for them to keeping the medications straight for everyone. The children rarely all receive the same medication, and frequently there are babies in the mix. I also recognize the fact that most of our refugee population do not read or write; so how do they know what is printed on each little plastic bag containing the meds?
Another woman carrying a heavy load of firewood on her head, packing a baby on her back, and carrying a hoe. She is enlisting the help of her young daughter to carry another bundle. At just a few years of age, children start carrying heavy loads on their heads. (Photo by Brenda Maldonado)
I happened to bring along on this trip some poster board and Sharpie markers for the purpose of making posters to educate our staff and patients on proper medication consumption. I thought, “How about putting a mark of a different color on the thumb of each person in the family, and then putting the same color mark on each medication packet for that person and on their registration sheet as well?”
So, I tried it on a mom with 4 kids. I placed a green circle on the daughter’s thumbnail, a green circle on each of her medications, and then also on her registration form. I then drew a blue X on the son’s thumbnail, his prescriptions, and registration card, and so on. The mom seemed to understand the instructions of which medication went with each child. And thankfully, the staff approved of the new method! They thought it made it quite simple for the mom to administer the correct medications to each person in the family. One small victory!
I am thankful for the time I am spending in the pharmacy filling prescriptions. We give out de-worming medication so liberally, but the reality is that the people here have little access to pure water and no clean areas to prepare their food. Every day the treatment room has several people with severe malaria hooked up to IVs. The last few days the room is filled with the agonizing screams as a small girl gets her burns debrided with no analgesia or anesthesia. With only open cooking fires on the ground, it is quite common for small children to fall into them. I am thankful for Moses and Alice and their persistence in giving good care. The wounds improve daily.
Tired but content, Brenda
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April 13, 2009: It has happened once again. I am in a developing country for just a certain amount of time, and things start to look normal. Things that if I were in the States would not look normal and I would be saddened and outraged by. Things like small barefoot children carrying heavy containers of water over dirt roads. Children running around half naked or in filthy rags, often with no parental supervision. Physically disabled people dragging themselves across the ground with no mechanical aids. People retrieving their drinking water in jerry cans and having to carry five gallons several miles home. People living in tiny shelters, sleeping on the ground with no indoor plumbing, no heating, only an open fire to cook over, and an outhouse to use for a toilet.
It also starts to become commonplace, treating people for diseases that are preventable and treatable in developed societies. But here in the developing world, people are out of luck if they don’t have the money to buy mosquito nets or medications. Also, severe malnourishment decreases their ability to fight infectious diseases. People living here in the Nakivale Resettlement Camp are lucky to eat one meal a day. And even if they do get a little food, it is not a well-balanced meal. Most of the people here now have their small subsistence crops planted, but the fields will not yield any food for a couple months. The World Food Program is providing less than a cup of food per day per person. Not enough to even kill the hunger pangs, I am afraid.
I have worked in the prenatal clinic the last two days. I call the women from the waiting area, and they always laugh at me. Their names are long and difficult to pronounce, but I am actually doing well at it. I weigh them and take their blood pressure. I always attempt to greet them, but occasionally they are shy, and at times they do not understand the greeting that I am using, so I try a different one. I think I am up to four different languages now. I find that people are validated when I even attempt to use their language, and it almost always elicits a smile or a laugh! And that to me is priceless. They don’t have much cause for laughter living in the conditions that they find themselves in.
These are a beautiful and enduring people. Today we heard the story of a 16-year-old boy, who at the age of 4 watched as his father and brother were hacked to death in Rwanda. Last year, his mother burned to death following an outbreak of Hutu-Tutsi violence in Congo. Now, he is living here in the camp with his 17-year-old sister, and that is all the family he has left. His is not an isolated story. Ester, one of our interpreters, is also from Rwanda, and many of her family members were killed 15 years ago. It is a wonder that people are able to go on and even start over. I have so much to learn and to be thankful for. I hope that I can in some way just share love and encouragement with the people that cross my path on this trip.
Sharing life with my African friends, Brenda
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April 9, 2009: We had a good day at the clinic. I continue to work in the pharmacy, helping to fill the prescriptions. Daily we have at least three or four people with severe malaria or dehydration needing IV therapy. We also have various diagnoses, including pneumonia, upper respiratory infections, syphilis, gonorrhea, and today we even had a probable case of Brucellosis. We have had cases of Tropical Splenomegaly Syndrome (TSS), Immunodeficiency Suppression Syndrome (ISS) and AIDS. We have also seen cases of post-traumatic stress disorder (PTSD). The stories are horrific.
I learn so much every day because we see illnesses that are so different from what we see in the United States. It is great training in tropical medicine. The refugees are grateful for the care and always smile when we attempt to greet them in their language.
Life is good, Brenda
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April 7, 2009: We have now been doing clinic for several days, and we are getting into the swing of how things are done here. Yesterday I worked in the Antenatal Clinic with Kristoff, and we saw nearly 30 women with bellies of various sizes. Kristoff even identified a woman with twins when he noticed a woman who had a belly bigger than what her dates said it should be. Fetal heart rates are listened to with an old-school feta scope, a small bell-shaped instrument that is placed against the abdomen and then you press your ear to it. It works quite well for low tech!
It’s good to be able to provide the women in the camp with this service to help make their pregnancies as healthy as possible.
I did stop to think about the conditions that these pregnant women have to live in. They do not have indoor plumbing and must use squat, pit latrines at all hours of the day and night. They sleep on the ground in shelters that may or may not keep out the rain and the wind. If they happen to go into labor in the middle of the night when the clinic is closed, they deliver their babies in their small shelters with the possible help of a poorly trained midwife. Heaven forbid any complications. But if the women are lucky they might get "transported" to the hospital in Mbarara, a very bumpy one-hour drive on dirt roads. I use the term “transported” very loosely because ambulances here are merely people wagons. The ambulances here lack the oxygen, medical equipment and medicines that we are accustomed to in the States. Also, I can't begin to imagine having to bring a brand-new baby back to a crudely built shelter. There is no luxury of a nursery with a theme, decked out with all of the latest gadgets.
Today I worked in the pharmacy with Patrick and Kristoff. It always takes me some time to get used to what medications are called in these different countries as they are manufactured in places other than the U.S. Also, it never fails, we cannot carry everything a normally stocked pharmacy would carry, so we inevitably can't give to patients something that they desperately need! Oh to have access to one of the numerous Walgreens' that are in my neighborhood!
I am enjoying getting to know the Ugandan Medical Teams International staff. They all have such varied backgrounds and come from different tribes. All of our translators are refugees from the camp and each have an interesting story of their own, of running from violence and even watching family members being killed. I hope to be able to have the rapport and the time to be able to learn more from them. It is a humbling experience to spend time with people who have endured so much and keep pushing forward.
Kwahere, Brenda
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April 5, 2009: It is just after 6 am, and I am sitting in bed under my mosquito net, listening to the Muslim morning call to prayer. We completed our travels on Friday with the very long five-hour drive here to Mbarara from Kampala. I was grateful for an unusual rest day in Kampala, which I desperately needed while trying to get rid of this chest virus.
It was very good to meet with the outgoing team. They were able to tell us what to expect, what kinds of cases they had been seeing, what kinds of medications and referrals were available and what kinds of things needed to be improved on. They also passed on to us their world phones and a list of good restaurants in Mbarara.
We landed in the country with the predicted and anticipated rainy season. It has been mostly cool and wet since we arrived, and the countryside that we drove through was made up of green and lush rolling hills with bright red earth. It is good to be back in East Africa! All the sights and sounds feel so familiar on my fourth trip to this part of the world.
We do not need to worry about safety and security here or at the camps. There is a high-ranking commander in charge and available at Juru camp, and he handles all of the situations that may arise. What most people don’t realize is that most humanitarian workers/missionaries are at greatest risk while driving on the road. Most who die in the field are killed in car accidents. Every day we will have an hour and a half drive from our accommodations in Mbarara to the camp. We are thankful to have good drivers and sturdy vehicles with seatbelts.
We had our first day of clinic yesterday, and the load was light. When we drove up, there were dark heavy clouds threatening to pour down. It was nice to not be overwhelmed with crowds of people on our first day so that we could settle in and see how the flow of the clinic went.
We are in a semi-permanent structure. It is a pole building with roof and walls made of heavy tarp stamped with the logo of the UNHCR (United Nations High Commissioner for Refugees). There are three exam rooms, a room for the pharmacy and a wound/treatment room. Staff register patients outside under a separate small tent. It is a nice setup.
My interpreter, Joey, is a Congolese refugee who speaks 6 or 7 languages and was a secondary school teacher in northern Congo before the rebels attacked his village. He is a lovely young man. I am thankful for his language skills as yesterday we saw patients not only from the Congo, but also from Burundi, Rwanda, Uganda and Kenya. And we were told that refugees from the Sudan and Somalia are also living in the area. Joey went with ease back and forth between the different languages. I tried to greet each one of them, but many did not understand my greeting in Swahili.
Nakivale district, where the camp is located, is an area of about 87 square miles. And it has been set aside by the UNHCR since the 1950s as a resettlement area. There are so many conflict areas in the surrounding countries that this is in its own way a little “no fly zone.” I am not positive what the numbers are presently here, and I keep hearing different things, but I believe it is close to 50,000 people. It is a lovely setting in these rolling hills, but it poses many challenges for the thousands trying to eke out an existence on the land, living in tiny shelters with only the few implements given them on their arrival. It’s amazing to see these people groups with the endurance to carry on after losing what little worldly possessions they did have, most likely seeing loved ones die, and then making a trek across mountains and rivers to arrive here. Some of these refugees, who were educated professionals in their respective countries, are now living in the worst kind of poverty because of tribal conflict.
I continue to take turns coughing with my patients, but I am thankful to be feeling better each day. Internet connections are slow and sketchy, so I will write as I can.
As always, Brenda
Randy Jacobs, a physician from Bend, Ore., reports from Juru, Uganda:
Photos by Dr. Randy Jacobs
January 30, 2009: We began our day with a visit to Mbarara Regional Medical Center hospital to check on our three-year-old patient with a snakebite. She is still alive and gave us a weak smile, but her arm is not looking good. She'll probably need a partial arm amputation. We prayed for this little girl—who is alive but for the grace of God.
We had 160 patients today and our work was very efficient because we had fewer emergencies. Our final patient came in with severe abdominal pain so we took the opportunity to mentor staff about the importance of pelvic exams.
The staff honored us this evening with a feast of roasted goat. We watched the Muslim butcher slaughter the goat, per the local customs, and were amazed to see every part, including the intestines, stomach, mammary glands, head and tail prepared. They wasted nothing, except for the hooves. They placed the meat on skewers, seasoned it with ginger, salt, garlic, onion and cooked the meat over charcoal. It was outstanding. They also served us warm cabbage, fried potatoes and sodas.
We enjoyed speeches expressing their appreciation of our work and for God's provision. We closed this magical evening with songs of praise and a prayer. We returned home late and will be back to work tomorrow.
Wishing you all a wonderful weekend. We will be home soon.
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January 29, 2009: This was an exhilarating and exhausting day. It began with a deep hand abscess, which required extensive cleaning, packing and draining. Then a three-year-old arrived with her entire right arm swollen to twice its normal size. A six-foot Black Mamba snake crawled into her family's tarp shelter and bit her arm during the night. These snakes are the largest venomous snakes in Africa and are the second largest in the world. They can strike up to 12 times and inject a lethal venom each time. Death usually ensues within two to three hours, but God is obviously protecting this child. She was bitten eight hours before arriving at our clinic and showed no signs of shock, hemorrhage or convulsions. We provided emergency care, removed the tourniquet and transfered her to the regional medical center at Mbarara for anti-venom treatment. She may lose her arm, but she'll most likely survive this usually lethal experience.
My next patient arrived in advanced labor and I delivered a healthy girl. It was a very rewarding experience with an excellent outcome—no lacerations or complications, but very messy as we have no drapes or cloths. She gave birth on the tent floor in a pool of blood and amniotic fluid. My pants are now soaking in soap and water! We used surgical tape as an improvised umbilical cord tie.
The other patients started getting tired, angry and frustrated having to wait while we took care of these emergencies and many others. Fortunately, we were able to establish order.
Then my little eight-month-old burn patient who had been near death returned dehydrated from vomiting and diarrhea. It took us an hour to start her IV, but she improved after receiving fluids. Our last surgical patient was a three-year-old who injured his left foot in bike spokes. He literally ripped through his entire heel pad, exposing the bone and Achilles tendon. Fortunately, the bone and tendons are intact. It was a long repair—about four inches—but everything came together surgically and we sent him home in a splint.
Today's kicker: four children came to the clinic alone. The oldest is a 13-year-old girl who is caring for her three younger siblings. The youngest is just three and they are living alone in a makeshift shelter. They fled Congo in November. Their father is either dead or stayed behind and their mother died in childbirth in last month. They have no food and have survived because an adjacent family with four children of their own has been feeding them from their rations.
We arranged for a children's protective service worker to come and check out the situation today. My heart was so touched. I so wanted to scoop them up and bring them home with me. They are so sweet and precious and the oldest girl is a wonderful "mom."
I couldn't believe how tired we all were when we packed up at 7 pm. We saw 165 patients but seemed like twice that. Such is a day in the Nakivale refugee settlement. The camp is now at 40,000 residents and nearing capacity. Thankfully, they are digging a garbage pit for medical waste. The staff have tried burning our used equipment, but kids find the leftovers. Empty plastic water bottles are considered a prize! Burying waste is a much better solution.
We hope to have a water tank installed too as water shortages continue. Plans have developed for building a waiting area, a teaching room and additional exam area. Thankfully, we had a safe ride home. There are so many road accidents here. I collapsed in bed after dinner at 10 pm.
Please keep up the prayers—they are working!
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January 28, 2009: We had a warm and dry day. My hand-laundered clothing is finally drying out. We had 165 patients today. Another U.S. nonprofit is building a nursery school adjacent to our site, complete with climbing sets for the kids. Our lead interpreter, Ibrahaim, is amazing. He's 25 and speaks seven or eight languages, including French, English, Kiswahili and Congolese tribal dialects. He is a strong leader and a hard worker. He doesn't share much about his personal history but he left congo about six months ago after being a military leader. He is respected by all the refugees here and is trying to support extended family on his wage of $3 per day.
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January 24, 2009: Doing well and loving the work, which continues to be busy. The refugee population finds that we offer dependability, quality and expanding services. The staff were sad last night when they realized we depart in two weeks. Fortunately, a new team is arriving to carry on the work.
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January 23, 2009: Clear, warm day today. We saw 165 patients, plus 35 antenatally. A three-year-old arrived with weight loss and is probably HIV positive. We offered an HIV test to both mother and child, but the mother refused and left the clinic.
An eight-year-old Congolese refugee arrived with extensive burns. The rebel troops killed his father and then poured boiling water on him. Part of his ring finger was badly damaged from a bore hole pump. We were able to shorten his finger and close the wound. He was so incredibly brave and did not complain for a moment. He expressed his thanks in French as he left. He was an amazing child. We trained the staff while we repaired his finger.
We've seen several cases of severe malaria in both children and adults. On the way back from the field, we passed an abandoned car. It is common to see broken cars simply left in the middle of the road. On it's back window, someone had placed vinyl letters reading, "No situation is permanent." Their car must have broken down before!
Wishing all a restful weekend. We will rest tomorrow.
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January 22, 2009: Heavy rain fell all morning and the roads continue to be a challenge. The rains prevented many patients from coming this morning, but we made up for lost time with a busy afternoon. The weather cleared and we were able to treat 120 patients after lunch.
We met an infectious disease and international health physician from Harvard who travels here for a week every month to coordinate HIV training programs for Harvard and MIT students. Good debriefing on services. The regional referral hospital here does not have functioning X-ray or ultrasound and he has found very poor quality in lab. Nearest CT and MRI machines are in the capital, but are only available if the patient can pay cash. I can't imagine trying to care for the complex referrals with such limited diagnostic equipment. So it is here...
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January 21, 2009: Jasper, our Uganda director and clinical officer, starts and ends each day with prayer with all our staff. Today he prayed for President Obama, for his wisdom and protection. He also prayed for the U.S., for our safety and provision and for the recovery of our economy. Obama was featured on the front page of all the newspapers along with the text from his speech and many inaugural photos.
Everyone here is so interested in all the details. Two teenaged Maasai-looking youth came to our camp and picked up the paper to read about Obama. We had fewer patients today because of the rain.
Were able to refer a four-year-old with mental retardation and probable cerebral palsy. A social worker came to camp to assess the child. We saw more pneumonia, malaria, PID, HIV, probable TB, dysentery, wounds, skin infections and pregnancies.
We treated about 120 people and returned home by 7 pm. It was nice to catch up on laundry.
May your day be blessed!
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January 18, 2009: It was a cool rainy morning and I appreciated this day of rest like never before. We attended the University Baptist church and met several people who work in the Nakivale refugee camp, including a UNHCR administrator and health district worker. The church sponsored a pastor's conference this week and a dozen pastors attended, including two from the refugee camp. These two looked especially worn out in their tattered suits, but a quiet and strong spirit emanated from them.
I hope to visit their camp later this month. We also met 15 Americans who are part of a mission from a Baptist church in Chattanooga, Tennessee. They may visit our clinic this week. After church, we sorted drugs and packed supplies with the staff. Took a "boda boda ride" (meaning on the back of a motorcycle) to town for a nice dinner. Spent the evening doing laundry and preparing for the week. We're healthy and well. Blessings to all back home.
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January 17, 2009: A 46-year-old refugee arrived from Kabahinda transfer center with his family today. His blood sugar was more than 500, but he refused a hospital transfer because his family in living in the bush without shelter. We have no diabetes medicine here, so he needs to head to the hospital. Hopefully, he will survive the weekend and return Monday for a hospital transfer. We continue to treat severe malaria and pneumonia. One patient arrived with a fractured hand and a splint worked great. We are all now known as the Medical Teams International Power Rangers--fighting disease.
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January 16, 2009: We saw 125 patients today. Many had severe malaria, dysentery and dehydration requiring IV fluids and antibiotics. One baby arrived with severe malaria.
We watched some UN trucks drop off 50 people for bush resettlement. They left them there in a crowd without significant support, just a tarp, plastic jerry can, pot, hoe, and a little food. Next, they'll move out into the bush to set up shelters and begin cultivating crops. My translater, Jerome, discussed his current situation with me today. His family escaped the Congo, where he worked as a tour guide in a national park. I am sure he was pretty well off there, but now he, his wife and their three children are living under a tarp. We did our best to encourage him, but it is a difficult situation.
Our director had a positive meeting with UNHCR today. They are very impressed with our services and asked Medical Teams International to submit a grant proposal for additional clinical services, including nutrition, HIV testing and counseling, and immuniztions. It appears that we'll continue to work here long-term. We also learned that Medical Teams International will send another volunteer medical team from the U.S. I am so thankful and so are the Ugandan staff.
Dr. Tom Martin, an emergency room physician from Portland, Ore., reports from Juru, Uganda
Dr. Tom Martin transports an ill child to the hospital. (Photo courtesy of Dr. Tom Martin)
January 3, 2009: We are into our third week of service here in Juru, Uganda. This region is called Nakivale and has been set aside for many years by the Ugandan government for refugee settlement. Over the years, Tanzanian, Sudanese, Rwandese and Congolese refugees have come to Nakivale seeking shelter and have received plots of land to cultivate. Though many eventually returned home, some have stayed to be permanent Ugandan residents.
Now the Congolese are here. They are intially housed in Matanda or Kisoro camps along the Congo border and are then transported by bus or truck to the Nakivale reception facility at Kabihinda. They stay there awhile in reception dormitories, which are large open shelters. They are registered by United Nations High Commissioner for Refugees (UNHCR), receive ration cards, some supplies and have access to medical care.
Once registered and organized, the refugees are given tools, tarps, cooking pots, and bednets and are taken to Juru to be settled on a plot of land. They are given 25 square meters to cultivate and most have turned the soil already, even though planting season is not likely until February. Unlike the reception center, the refugees in Juru are really quite spread out and the settlement is extending quite quickly.
Our tent clinic is now set up. Ultimately the number of refugees in the Juru region we might be responsible for could swell to 8,000 or more. We will meet again with the the camp commander and UNHCR.
As far as the medical needs of the refugees, malaria is far and away the most common ailment. We see cerebral malaria in children daily and almost always transport 3 or 4 to the health center for inpatient care. The team is great about getting IVs in these children. We haven't lost one yet. Our team has been doing all of the initial treatment at the clinic before transporting.
The cholera has died out but certainly could re-emerge since the water supply is all trucked and marginal at best. Sanitation is likewise less than ideal. Each family is given a latrine slab at settlement but I have yet to see an individual latrine put up. There is some dysentery but not much. Otherwise, we see the usual respiratory ailments and GI diseases.
I am concerned abut malnutrition. We have seen a few with severe malnutrition already and the rations from aid agencies are not likely adequate. We expect there to be more cases and most of the infants are mildly malnourished even now. In addition, there are 8,500 more refugees poised in Kisoro and Matanda who are expected in Nakivale in the next few weeks or months.
The local medical team has been great to work with and everyone here is working hard. We see an average of 140 patients a day, but saw 200 yesterday. The local team transition to new health staff the same time our new Medical Teams International volunteers arrive. Donate to our work now »
Kris Repp, RN, cares for a Congolese child. (Photo courtesy of Kris Repp).
Chris Repp, RN, reports from the DR Congo
December 14, 2008: The sun is shining and we just returned from a great church service at the Heal Africa hospital. The congregation consists of many of the hospital patients as well as the women being counseled and treated for gender related violence. These precious people who have suffered so much sing joyfully in the church choir. They sound angelic. Just to hear them is so moving: beautiful harmonies of praise lifted to the King of Kings.
The children in the Sunday school class are predominantly orphans, some are with the patients and others are from military families. They are extremely poor. The teacher told me that he has about 120 children coming to his class and only has one helper. I asked him where he was going after church, "To another church where I teach another Sunday school class," he told me.
The clinic work last week was a blessing but also heartbreaking. I was able to do several extractions and some minor surgeries as well as treat many illnesses. The patients are grateful for the care they couldn't otherwise afford. One little 7-year-old girl came in with a bad stomachache and tested positive for typhoid fever. She was sent home with the prescribed treatment but returned, carried on her mother's back, the next day. She was in terrible pain. Her stomach had become rigid. She was admitted to the Heal Africa Hospital and was operated on for a perforated bowel secondary to the typhoid fever. She died postoperatively at 1 a.m.
Later that morning, Lisa, with our team, was transporting another patient from our clinic to the hospital for emergency surgery and ran into the little girl's mother. She was able to bless her with the funds to provide a proper burial for her child. I am so aware of the fragility of life here in the Congo where so many people seem to be acutely challenged in so many ways: hunger, poverty, sickness, violence, war...
We plan to spend our last day giving care in the prison...and leave for the U.S. on Tuesday. It has been an experience I will never forget.
May this Christmas season be a time you draw closer to the One that came humbly, poorly, suffered violence and injustice to demonstrate true love...that you would find a place for that love in your heart though it be a 'manger' throne.
Innocent children in the Congo are often caught in the crossfire. (Photo by Kris Repp, RN)
December 11, 2008: Fighting in the Democratic Republic of Congo (DR of Congo) continues. Experts estimate 45,000 people are dying each month. Half of them are children.
Medical Teams International sent in a second US team today to care for Congolese refugees. They will join our staff in northern Uganda—mobile medical teams who will provide basic healthcare services to 20,000 refugees, mostly women and children who have crossed the border into Uganda for safety.
Volunteers Dr. Tom Martin, a Portland physician, and Anne Blaufus, a nurse from Camas, Wash., are taking nearly $15,000 in medical supplies, essential medicines and surgical supplies. Both are employed at Providence Medical Center.
Our volunteers and partners inside the Congo continue to treat seriously ill patients in a clinic serving 25,000 people in Goma.
Experts now call the fighting between government and rebel forces inside the Congo the worst loss of human life since World War II. Aid organizations estimate that nearly 5.4 million people have died in this decade-long conflict, nearly half of them children.
“The Congolese are literally running for their lives,” says Joe DiCarlo, Medical Teams International’s emergency relief director, who returned from the Congo earlier this month.
Medical Teams International recently sent more than $560,000 in medical supplies to help save lives in the Congo.
We have now committed to caring for refugees for six months. We will need help from our donors for this growing humanitarian crisis.
It takes $30 to provide emergency care for one family. To help, please donate now »
Deadliest Conflict Since World War II Continues Claiming Lives in Congo
Medical Teams: International Delivers Care and Medicines
Patients wait to be seen in the Congo. (Photo by Kris Repp)
December 1, 2008: Experts are calling current fighting in the Democratic Republic of Congo the deadliest conflict since World War II. Nearly 45,000 people continue to die each month—half of those are children.
Our volunteers and partners continue to treat seriously ill patients in a clinic serving 25,000 people in Goma, Democratic Republic of Congo—most of them suffering the effects of ongoing fighting between government and rebel forces.
Quite a few of the cases involve women who have been raped and mutilated in the war zones, children suffering from diarrheal diseases and pneumonia, as well as a few cholera cases.
“We lost a baby on Saturday,” says Dr. Bob Gibson, one of our physicians on the scene. “The mother came in bleeding. We did a C-section, but the baby had already died before we could deliver her.
“In most of the medical cases, though, we can make a difference,” Gibson adds. Our team of two doctors and two nurses sees 50 plus patients a day, providing free medical services. Before our teams arrived, patients would be required to pay for services at the clinic or go without treatment. Too often, families are too poor to pay and their loved ones die.
“This is tough,” Gibson adds. “It’s probably the toughest place I’ve been in.” That’s saying something since Gibson has been in several war-torn nations in recent years and worked in the Congo 25 years ago.
Factors contributing to the people’s plight include:
- Long-standing tribal fighting between Hutus and Tutsis, leaving 5.4 million people dead in the region. According to the International Rescue Committee (IRC), most of those people have not died from war wounds, but from illnesses they could not get treated during fighting. Others died of malnutrition because they could not grow or access food.
- A major volcanic eruption earlier this decade that destroyed roads and buildings, further restricting government and charities’ ability to deliver help to residents. Roads and old hospitals are covered in layers of volcanic lava flow.
- Trauma inflicted on families. Men killed; their wives raped and mutilated; their children in shock; survivors too scared to plant food to eat.
“I can’t believe how stressful some days are,” Gibson concluded. “But I am satisfied that we are making a difference...We are giving hope to the people, as hope is about the most valuable commodity here just now.”
Medical Teams International also is delivering more than a half million dollars in medicines to the scene tomorrow which will bring very tangible hope to the sick and war-scarred survivors of DR Congo.
With deaths so widespread, we will be sending teams and aid to the nation for some time to come, if you would like to support these teams, please give now »
Clock Ticking Down to Humanitarian Crisis
November 21, 2008: There’s still little in the news about ongoing fighting and the resulting crisis in the Democratic Republic of Congo, Africa. Yet, all the signs for a looming, catastrophic humanitarian crisis are on the horizon, says Joe DiCarlo, emergency relief director for Medical Teams International.
DiCarlo has been on the scene since Nov. 12. He leaves Sunday after turning over work to a team of medical volunteers who begin working immediately in a clinic near Goma that serves 25,000.
Until our team of two doctors and two nurses joined them, only one doctor and six nurses were on hand to meet the needs of 25,000 people. Cholera is a huge threat, DiCarlo said by phone today. “Six have died this week. Three yesterday."
“We could see more and more death as people have a lack of access to health care and shelter. The clock is ticking unless there is direct intervention to save lives,” DiCarlo concluded. “People are living out in the elements.”
The fighting, which has been intermittent since 1994, also is taking a toll on the psychological health of the people. “You have a generation of children growing up now who think it’s kill or be killed just to survive,” DiCarlo added.
Medical Teams International is working with two partners, HEAL Africa and Food for the Hungry, to provide care for people struggling to survive outside of Goma often where help is not getting through.
This week, DiCarlo and another one of our staff members, David Alula, a Ugandan health manager, traveled behind rebel lines for two days to see how we could best meet needs before volunteer workers arrived.
Alula and one of the doctors on our team leave tomorrow to see how they can immediately help in a camp two hours outside of Goma where little assistance has been received.
Our shipment of medicines, valued at more than $500,000, will help care for 10,000 people for three months. It’s been shipped from Europe and will arrive overland in a few days.
In addition, Alula and other health workers from neighboring Uganda will begin assisting the 200,000 displaced people now amassing along the Congolese/Ugandan border. Alula and others on our team have spent the past four years caring for war survivors through mobile medical health clinics throughout Uganda. They can offer the same lifesaving medical care to Congolese refugees now fleeing their country.
DiCarlo says even if people act now, the threats Congolese families face could take a year-long response to avoid a humanitarian crisis. If you would like to help families survive, you may donate here. It takes $30 for us to help provide a Disaster Survival Pack to a family desperately trying to survive this conflict.
Thank you for praying for these families during their time of need.
DR Congo Conflict Continues; Women and Children Victims of Violence
A displaced family carries all of their belongings on their backs. (Photo courtesy of TearFund - Belgium)
November 20, 2008: The United National Security Council voted to expand its peacekeeping mission in the Democratic Republic of Congo to 20,000 troops—the largest of its kind worldwide. Leaders authorized the increase to help ensure the safety of local people—especially women and children—who have become victims of continued fighting in the past month.
Meanwhile, two Medical Teams International staff recently returned from two days behind rebel lines. They took the risk so they could see where and how our volunteer medical doctors and nurses could best help the innocent women and children caught in the war’s crossfire.
“Rape is being used as a weapon of war,” says Joe DiCarlo, our emergency relief director on the scene. Others caught in the fighting also are suffering from cholera outbreaks, malaria and severe skin rashes.
Continued conflict prevents organizations from setting up camps to help people north of a line about an hour outside the capital city of Goma, DiCarlo reported. He was accompanied by David Alula, our Ugandan Health Manager. Medical Teams International plans to manage the health response in a camp of 20,000 people 15 minutes north of Goma. Our partner, HEAL Africa, will manage the overall camp operations.
People come daily to fill their jerry cans with drinkable water. (Photo courtesy of TearFund - Belgium)
Volunteer doctors and nurses arrive in neighboring Rwanda today to start responding. Our staff health teams in Uganda also may be able to help as 200,000 people on the run head to the neighboring nation.
Medical Teams International has been working in Uganda since 2004 in response to the civil war, providing lifesaving medical care to thousands of people recovering from the war and battling HIV and AIDS. Hundreds of local health workers are trained to provide mobile health clinic care as a result of that work.
DiCarlo concludes, “We slept in a convent last night because that’s the only safe place in this area at night. We wake up to a loud speaker with someone singing in Swahili, ‘nothing but the blood of Jesus,’ knowing that in just a few hours, there will be blood.”
“And again the violence, the atrocities committed on a mass scale are beyond comprehension.”
If you would like to support our volunteer doctors and nurses on the scene or help get medicines to people in need, please donate now »
Our Staff Now Moves Behind Rebel Lines to Reach Families in Need
November 17, 2008: Please pray for Medical Teams International Staff Joe DiCarlo and David Alula who now are moving behind rebel lines in the Democratic Republic of Congo to see how we can best care for families trapped without medical help.
Rebels have agreed to let in relief teams without harm, DiCarlo said. But the same fighters are not allowing families to leave their villages to go to Internally Displaced People’s (IDP) camps where they might have easier access to medical care and emergency supplies.
Medical Teams International has experience providing mobile medical teams, supplies and clinics in war-torn areas, like Liberia and Uganda. David Alula is a staff member assisting DiCarlo from our neighboring Uganda program office.
Our first team of medical volunteers arrives this week, and will cross the Congolese border from Rwanda to provide care to those who do not have access to medical care.
We continue to partner with HEAL Africa, a local agency that runs a hospital in Goma and has ongoing health work in the region to meet the needs of nearly 1 million people who have been displaced by recent fighting.
One of their workers, Joseph Ciza, was southwest of the capital, Goma, over the weekend. He reported he had picked up wounded people and brought them to the hospital for treatment. He also stopped at Bweremana.
There, he was taken to see two women, and said, “They were shot in the legs by rebel soldiers as they were retreating from Goma toward Bukavu. The women were in a car coming from the market; the soldiers stopped them to commandeer the car. They suffered severe injuries when they were shot in the legs by the soldiers.” The women are now at HEAL Africa’s hospital.
The number of wounded related to the present crisis today at the hospital is 127. This is in addition to the normal number of around 180 patients. He continued, “Eighty-two percent of the new cases are raped women. 45 women are victims of rape from Kibati refugee camp. 45 were raped in town. There are about 30,000 extra people in Goma town right now."
Thank you for praying for peace in the DR Congo and for safety for families and our Medical Teams International volunteers and partners as we care for those innocent ones caught in the crossfire of fighting.
If you would like to support our Congo Relief Ministry, please give now »
Temporary shelters in a muddy landscape. (Photo courtesy of TearFund - Belgium)
Nov. 14, 2008: “It’s such a contrast here,” said Joe DiCarlo, our emergency response director on the scene in Goma, Democratic Republic of Congo, on Friday. “There are these beautiful mountains around you...almost like Switzerland.
“But the minute you walk out on the street it’s utter misery...It’s like a war zone here,” DiCarlo concluded.
There are no bombs exploding but people are walking everywhere trying to find a safe place to hide from guerilla warfare...just running for their lives. Most are fleeing fighting that started last month and has pushed more than a million people from their homes. About 250,000 people already are in IDP (internally displaced people’s) camps.
Most of those people have little or no shelter. “It’s inhuman,” DiCarlo adds. “People are living in tiny grass huts they make, if and when they can. It’s cold here.
“Children are coughing. You can tell the elements are taking a toll on these families,”
Joe and another staff member from neighboring Uganda are seeing where medical volunteers from Medical Teams International—two doctors and two nurses—can have the strongest impact when they arrive in Goma next week. They will bring in emergency medical kits, packed with essential medicines, with them.
We also are organizing resources to fly in another $500,000 plus in medicines to help provide care for 10,000 people during the next month.
“You can see the strain on people’s faces. They are just in survival mode,” DiCarlo concludes. “They are enslaved by this conflict.”
A woman displaced by fighting sits at a feeding centre in the Don Bosco Shelter near the city of Goma in eastern Congo, November 4, 2008. REUTERS/Stringer (Photo courtesy of
AlertNet)
Nov. 10, 2008: Please continue to pray for families seeking shelter from rebel fighting in the Congo, Africa. We are speeding medical volunteers and supplies to the scene for arrival next week.
Meanwhile, our partners on the scene, HEAL Africa report the following from a church compound in Goma where refugees are crowded together for shelter: "They are sleeping in schoolrooms, in the church, but there are 1,550 families, many of them in dripping, cold rain.
"They've tried to set up shelters but they have nothing to keep the rain out. Local families are helping by sharing their food. (Can you imagine your neighborhood flooded with 9,000 extra people?) Later on there will be distribution of tarps from aid agencies, but right now there is not enough to go around. The school asked for help to have someone in charge of keeping the school toilets clean and disinfected, and essential medicines."
Please pray for the people's health until our medicines arrive next week.
Also, please remember the prayer of Virginia Mumbere, HEAL Africa's worker on the scene: "The biggest need is for an established peace so these villagers can return to their homes and fields."
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