Many of you are probably wondering what kinds of things I am doing and seeing in the hospital here, so that is the purpose of this update. I want to preface this with a warning that this is a long message and there are more sad stories than happy ones, as that seems to be the unfortunate reality in a hospital in a low-resourced setting. I have been debating on waiting to share some of these stories because they have been quite heartbreaking, but I want to share them now so there are more people praying over this community. If you could, pray for miraculous healing and change for Uganda, that this community would know the love the Lord has for them and the joy that can be found in Him. I also ask that you pray for me as well. The days in the hospital have been emotionally difficult, seeing that there is so much pain, and many of these situations would be very different if only resources and advanced care were accessible. I can tell you with certainty, that your prayers are very comforting to both me and these patients when I can tell them that they have a lot of people across the world praying for them individually.

If you know don’t know much about medicine, I am going to try my best to explain each story as simply as I can. Feel free to respond with any questions you may have. I don’t exactly recommend Googling photos unless you are extremely curious to know more because some of these conditions are difficult to see. For each of these stories, I am going to give some of the patients’ names, however, the names are not their real names and some of the details are slightly altered for privacy’s sake. I want to keep their stories as human as possible because they are real, hurting people and tell their stories accurately and respectfully.

A general overview of some of the conditions I have seen many of here include organophosphate poisoning, pregnancy complications (ectopic pregnancies, preterm births, intrauterine deaths, postpartum hemorrhage, etc.), birth defects, malaria, motor vehicle accidents, complications of chronic conditions (i.e., heart failure, COPD, sickle cell anemia, diabetes, HIV), and many more.

Organophosphate Poisoning

Organophosphate poisoning is something I learned early on in medical school which is just a fancy way of saying “pesticide poisoning.” With this you may see a patient who comes in and is producing secretions from every orifice of their body. They will be puking, sweating, producing mucus in their airway, have diarrhea, their pupils will be extremely small, their airway will constrict, and ultimately, they will lose a lot of fluids and have a hard time breathing. As you could imagine, this can kill someone if it is not managed quick enough. When the patient comes in you must strip them of their clothes and begin treating them with atropine inhibit the organophosphate from causing any more damage to their body. You also must manage their airway and suction any of the mucus out to make sure it doesn’t go down into their lungs to cause aspiration pneumonia or infections. In the past month, there have been 3 cases of organophosphate poisoning with one of those cases being a child who did not make it the next day. One young patient, Janie, came in with organophosphate poisoning as an attempt of suicide. We found out a couple days later that she is pregnant with another baby, and thankfully both her and the baby are doing well. Each day I see her on the wards, all she can understand is when I ask her how she is doing, and I always get the response, “I am ok.” Her 1 y/o daughter is always there in the bed next to her, as sweet as can be, and I will spend some time playing with her each day to see her smile and hear her giggle.

Motor Vehicle Accidents

We currently have a few patients who are in the wards that were in various motor vehicle accidents. One is a girl, Jill, who collided with a man, Joseph. They each sustained multiple injuries including head injuries that we are unsure of the extent. It is very difficult here to fully evaluate these patients with head injuries because there is only one CT scanner on the entire western half of Uganda, and it is located in Kampala which is 4hours away. Many of the patients who need a CT scan must be referred to Kampala for care which includes a multitude of expenses on top of what they are already having to pay for medical care. This leads many patients astray from seeking medical attention because most of the community is low to no income. If they feel ok, that means they are ok, so they don’t need to pay money that they don’t have. We are currently watching Jill and Joseph to make sure they don’t have any neurological damage and to make sure they recover well without any infections before sending them home. They each have their entire families who come spend the day with them sitting on the floor on mats with the kids. There are two other patients, Noah and Moses, who are father and son that each were in motor vehicle accidents. Moses was riding down the road at night on a boda boda (motorcycle) and a sugar cane truck was coming towards him with their bright lights on. He was unable to see, and the roads are not well developed, so he hit a pothole and fell off his bike. His father, Noah, got in an accident rushing over to his son at the hospital. They both seem to be doing fine right now, but the same goes for them. There are many uncertainties when it comes to their conditions, so all we can do is watch for any physical decline that may indicate a brain bleed or other neurological issues we can’t detect right now.

Sickle Cell Anemia

Many of you may have heard of sickle cell anemia and know it as that condition that primarily affects black people or the random blood test that they do on many college athletes but don’t really know what it is. For me, it was something that I learned in medical school and have always heard about it but didn’t know what it really meant for a patient. Sickle cell anemia is a genetic condition that is a defect in the hemoglobin of red blood cells. Hemoglobin carries oxygen from your lungs to all the cells in your body by your blood. When someone has sickle cell anemia, their hemoglobin can’t carry oxygen as well as normal hemoglobin and can cause their cells to “sickle.” The shape of the cell changes to a crescent moon-like shape in response to different stimuli such as cold temperature, stress, or infection and can get stuck in small vessels throughout the body. Most of the time, the cause of the sickling is unknown. This may cause many complications but specifically something called pain crises when the clots form and restrict oxygen from getting to the tissue (ischemia). This can happen anywhere and will cause immense pain in the ischemic tissue. They may even develop stroke, heart attack, or most commonly asplenia where the spleen is damaged and nonfunctional due to all the misshapen red blood cells. Patients are then at risk for more infections because the spleen plays a big role in the immune system, so patients must get more vaccines and get them yearly. We have had two patients so far that have come in with pain crises due to SCA. One was young guy, Patrick, and he did not know about the need to get these yearly vaccines which has caused him to get many infections in the past few years. He has also been on hydroxyurea to promote the production of more red blood cells and limit the pain crises but did not know that he needed to see the doctor more often to avoid liver and kidney complications from the medication. In addition, he also didn’t have the money to travel for these checkups. The other patient was an 8 year old boy that was just hurting all over. All that can be done in these situations is manage the pain with pain killers, but it can get bad enough that morphine doesn’t help.

Pregnancy Complications

Since getting here, the things that I have seen the most have been pregnancy complications. I have notice that much of this has been due to the lack of prenatal care, not because it is not available, but because the mothers don’t see the need for it. As I said earlier, when they feel ok, they believe that everything is ok. I strongly believe that the best form of birth control is to see the outcomes of a mother who does not seek prenatal care. It will scare you away from having children because there are so many things that can go wrong. Without the proper diet, education on how to keep yourself and your baby safe during pregnancy, and monitoring of the baby in the womb, birth defects can develop, infections may be passed to the baby, the pregnancy may result in a miscarriage, or the baby can be born too early. In most cases, the babies that I have seen have been born premature, but there is a lack of resources and expertise here on keeping these babies alive. Since their lungs and immune systems are not fully developed, they can have breathing problems that lead to long term brain damage or fatal infections. There are not the proper resources to detect, correct, or prevent many of the birth defects here, though if they were in the States in a NICU, many of these babies could survive. Many of the families also see it as a financial burden to care for the babies that have low chances for survival or expected developmental disabilities as they will be no use for the family to work on the farm or get jobs. I have heard cases where the mother will refuse to breast feed, remove the oxygen from the baby at night, or even smother the baby so they can be discharged from the hospital to save money. Other mothers may have twins or triplets unexpectedly and are unprepared to care for that many children at one time, so they leave them at the hospital and don’t return. However, it is a huge cultural thing to have large families, so they have more kids to work and provide, so the kids don’t end up going to school if the financial situation is poor enough.

One new mother, Sophia, just had her baby by C-section and is currently in maternity post-op. She came in earlier this week for a consult with the doctor to interpret her ultrasound scan. It had shown that the baby had some sort of spinal defect, hydrops fetalis (abnormal accumulation of fluid in the baby’s body causing massive swelling), and polyhydramnios (too much amniotic fluid which may indicate the baby has a problem with the digestive tract and cannot swallow the fluid). A culmination of all these complications is incompatible with life. An elective termination was scheduled to prevent further complications for the mother; however, she came back in with pain the next day. We went ahead and did the surgery, and the baby was born at 32 weeks premature. Turns out the ultrasound readings were incorrect, however the baby still had hydrocephalus (too much fluid on the brain) and syndactyly (fused fingers). Even with these outcomes, the baby’s likelihood of survival is very low due to the extensive amount of medical care that would be needed to keep the baby alive and the lack of access to that care. To complicate things further, the mother is deaf and cannot speak (referred to as “deaf and dumb” by the local community). The baby is still alive last I saw her, but there has been difficulty trying to provide this baby with nutrients and fluids. Her veins are so small that we could not place an IV with the smallest IV that they have, so we had to place an NG tube (tube through the nose into the stomach) to attempt to get breast milk to the baby. The mother was having a hard time producing milk and was discouraged to try due to the situation, yet without stimulation of the nipple, the right hormones will not be produced for the breast to make milk. The doctors and nurses don’t seem place their concern on the baby as their expectations are that the baby won’t make it anyways and it is only more money for the family to try to keep the baby alive. To see this has been extremely frustrating and painful to watch as it has seemed like there is not much emphasis for the kids and babies, and they don’t have many people advocating for them, especially when born with birth defects.

The story that absolutely breaks my heart the most is this story about a girl named Maria. When I got to Masindi, Uganda, Maria was sitting in the maternity ward after just giving birth to her two premature twins, Ira and Myra. They were born at 32 weeks, Ira weighing 1.4kg, and Myra weighing 400g. Both were born at severely low birth weight, and Myra’s weight was so low that he is considered an abortus because at that birth weight there is a very poor likelihood of survival. These twins were a result of something called twin-twin transfusion syndrome where they share a placenta, but the blood supply is not even split. Therefore, one twin is born much larger than the other due to an uneven distribution of nutrients. With the right prenatal care and resources, this could have been caught on ultrasound and an operation could have been performed to ensure an even share of blood supply, but that is not the case here. Every day I would see that incubator on the wards, and I would take a peek inside to see how Myra was doing. Maria would say, “Anthony, you coming to check on your little buddy?” So small and working so hard just to breath and stay alive. There is no surfactant to give these babies to support their lungs, and with them being so small, an IV could not be placed easily to provide nutrients and fluids. One morning, I walked into the maternity ward and saw Maria with a somber look on her face and the incubator was gone. She made eye contact with me and just shook her head. Myra didn’t make it through the night. She showed me pictures she took of me with Myra as I checked on him and made sure he was getting oxygen the days prior. I prayed for her and continued to come see her and check on Ira. Thankfully, a week later, Ira was doing well, and Maria got to go home with him. As happy as it was to see that she got to go home with Ira, it’s tough knowing that she was supposed to go home with two babies, not one.

Happy Stories and Prayers

To end this message on a happy note, I did want to share a couple happy stories. The first is of a mother, Anna, who I first saw in maternity while in labor. When we were rounding, I would smile and wave at her, and I introduced myself to her. I would check in with her and see how she was doing periodically. She had her baby by C-section and was held overnight to make sure both her and baby were healthy. The next morning, I came to check in with her and see how they were, and she was having some headaches and pain from her incision site. I helped her sit up in bed and asked if there was anything else I could do. Later in the day, she was feeling better, and her husband was there this time. She sees me and tells him, “This was the guy I was telling you about.” To which he responded, “Anthony! Thank you so much for all that you have done. I will remember you.” After she was walking around and feeling better, the baby was doing well, and she named him Noah. Though this sounds like a typical birth story, it was just one way I got to see someone who was happy and felt like I made some sort of an impact. I didn’t do much. I just tried to make her feel seen and cared for as much as I could. This story served as a reminder that sometimes it’s the small things that make the biggest impact.

After spending a full week in Uganda and seeing primarily sad things going on, I was feeling isolated in an environment of sadness. I hadn’t had much of an opportunity to venture out, I felt pushed to the back in the clinical setting, I miss my support system back in Charleston, I felt left out and uninformed on what was going on, and people were hurting everywhere I looked. I’ve been reading a book called “Dark Clouds, Deep Mercy” by Mark Vroegop that talks about how to truly lament, so I gave this a go. I cried out to God asking what my purpose is here. There were so many times that this trip could have just not worked out, but God kept opening the doors to make it happen in the right way. He showed me this over the weekend. On Thursday, the pediatric emergency medicine fellow that I am working with arrived and has been so fun and exciting to work with. He has been teaching me so much, has a very evident passion for kids, and has even stepped forward and advocated for them in times that the doctors and nurses weren’t. We got to go see the rhinos this weekend, and then the Med-Peds resident, Sophia, came in on Sunday and is one of the sweetest people I have ever met. The night prior, I had prayed to ask God for just one opportunity to witness happiness after having seen so many unfortunate situations. As Chris and I gave Sophia a tour around the hospital, the door to the labor suite was cracked open enough for nurse Jane Jean to see me and shout, “Anthony, come in here.” We all walked in, and she said to the patient who was in active labor, “This is Dr. Anthony, and he will be delivering your baby today.” Next thing I knew, I was gloved and gowned and catching a baby as it entered the world for the first time. Chris and Sophia, both, taught me how to do a newborn exam, determine APGAR scores, and swaddle the baby. As we were taking care of the first baby and the midwife was delivering the placenta, she goes, “Alright now, someone come over here and catch baby number 2.” Come to find out, the mother didn’t bring in her ultrasound and failed to inform us that she was having twins! Both babies were born happy and healthy and discharged the next day. I didn’t even plan to step into the hospital on Sunday. Incredibly, God is a God who loves. He loves so much that He saw the sadness that I was being filled with and granted me the moment of happiness I asked for to remind me that He is here through it all. He is listening, and prayer is powerful.

There are so so so many more stories that I could continue to share and am excited to share both the happy and sad ones with you all as they continue to impact me. Just as I have seen, prayer works. The baby that was born with birth defects that has a very low chance of living is still fighting and doing well currently. After a few days of monitoring, the baby has been taken off oxygen, the residents and I counseled the mother on breastfeeding as the baby was having difficulty latching, and the mom and baby were discharged. God sent Maria home with a healthy baby. He provided for a safe and healthy birth of two beautiful twin boys and gave me the chance to be a part of their story. I ask that you pray and pray hard for this community. God is doing big things in the hearts of these people beyond all that I am here to witness. Be a part of their story by praying for them. Each and every one of these stories specifically if you can. The battle is not over for many of them, and they need the power of prayer.
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