A Journey to Serve Uganda's Poorest
Essay – October 2012
Tex Med. 2012;108(10);51-53.
By Petra Kelsey
As the sun breaks into the sky, the arriving staff enjoys a morning tradition: enjoying local loose leaf Ugandan tea and scones while standing outside the kitchen in the fresh morning breeze. When the meal is complete, our driver, Richard, uses his straw brush to sweep out the inside of our van while we carry down the day's supplies tightly packed in suitcases.
Today, we also are transporting a mother, her baby, and her mom back home to Aukot. We are more packed than usual. No one complains.
As our van crawls over the dirt road, over potholes created by the recent rainy season, I smile as I think of the people who "off-road" for sport. A cell phone appears and out crackles the lively local music I've grown to love. Jokes and conversations switch from Ateso to English. Within a single sentence, the language switches three or four times.
We pass through downtown Soroti and enter a brief swarm of cars, bicycles, and foot traffic. At intersections, oncoming traffic slows, but there is never any real "stopping."
Driving further into the countryside, we settle into a slow and steady pace. Richard navigates down the road with full concentration. The grass grows higher. We pass the peanut fields (Gnuts in Soroti) filled with small mounds of dirt, erupting with bright green vines. Women with hoes and long patterned skirts pause as we pass. As we travel further, the sight of a vehicle becomes a rarity. Villagers pause ever longer to peer at us with curiosity.
Finally, we make a right turn near a large boulder and enter the village of Aukot. Down the road we pass "downtown," which consists of several mud brick houses with thatched roofs. Half of a goat carcass hangs waiting for a buyer. Some old men sit outside in chairs and wave to us as we lumber through the village. A dog lying in the dirt briefly considers getting up but decides to beat his tail into the dust instead.
We enter an expansive field. The grass has been freshly "slashed," whacked with a machete. We see about 100 of the deep purple dresses and shirts of schoolchildren sitting in their open-air classrooms. The instructor fights for their attention as we roll in, but the battle is futile. These strange white-coated people are a source of excitement and curiosity.
We park in front of a classroom that is reserved for today's clinic. One room with low walls will serve as a dispensary, another as the doctor's room, another as our antenatal clinic. The malaria, vaccination, and family planning departments set up under trees outside.
A large crowd of mostly women and children has already gathered. I overhear Dr. Eriamu Nathan, a local physician with more than 35 years of experience as a family physician, say, "There are three times as many people here as we will be able to see."
For every outreach, besides the supplies for the pregnant mothers, we bring enough supplies to treat about 70 children: 70 rapid malaria tests, suitcases of medications for 70 children, and 60 of the valuable "white sheets" the doctors pass out to the neediest during triage. White sheets guarantee treatment.
"It's the hardest part of our job," Dr. Nathan says. "We have to walk through these crowds and decide who will get treatment."
A small mob erupts as women hand their fevered, crying babies to Dr. Nathan and Emmanuel, a young local nurse practitioner, begging for a white sheet. They must patiently, yet briefly, assess each one for high fever and other important signs of serious diseases. Richard organizes the crowd, helping to form a line for those who have received the coveted white papers.
Each department gradually gains a line of patients and all begin working, calmly and deliberately, patient by patient.
As I roam through the crowds, I am pleased to meet a woman who is the mother of three sets of twins. I capture a couple family portraits (only one set of twins is present) and contemplate the probability of this occurrence. Twinning occurs here in central Africa twice as frequently as in the United States, I later read.
Mothers with babies come with their vaccination cards and sit on the grass outside Joyce Aedeke's makeshift table and wait for their name to be called. (Joyce is the head of the Family Planning/Vaccination Clinic for International Midwife Assistance.)
A large group of women sit with babies ready to receive vaccinations. Joyce begins with polio. When she gives the two pink drops, the babies' little mouths pucker. Fortunately, the drops stay in. As I work with her, I notice a growing crowd of young, wide-eyed schoolchildren silently standing around us.
The reaction to a Muzungu (me, the white person) in the village is varied: Some young children immediately burst into tears out of fear, others smile wide-eyed and then run away giggling. Older children stand around silently, just watching. But the distraction also causes them to be late for school, and this prompts one of our staff members to yell periodically, "Hey kids, you must leave. Get back to class now!"
We all worked so efficiently that we were able to see all our patients by midday. We pack up the van, saying "Apwoyo tich" ("Good job") to each other. "We'll see you again next month" the mobilizer says to us. "And God bless you all."
Riding back to town, the mood is light. Sweaty, laughing bodies are thrown from side to side as we climb over the dirt road again. I am smiling and laughing along, even with the words I don't understand. These weekly outreach trips remind me of field trips from my elementary school days: the excitement, the escape from the usual surroundings, the bus, even the bananas and snacks. The trips are satisfying, sweaty, sometimes gruesome, and sometimes overwhelming, but the staff has taught me how to work with steady persistence and how to enjoy the sweet fruits of life.
Editor's Note: Petra Kelsey is a first-year medical student at The University of Texas Medical Branch at Galveston. She spent two months in Uganda this summer as a volunteer for International Midwife Assistance.
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