- Written by Tom Miles Tom Miles
- Created: 22 August 2017 22 August 2017
African mornings typically begin with 6:30 AM sunrises, roosters crowing and villagers beginning the day at dawn. Here at the Panaora Hotel in Nakapiripirit our team began the morning with a breakfast of eggs, bread and coffee or tea before loading the bus with all of the medications for clinic for the week and food supplies for lunch for the team. This included packing the stoves, charcoal and all of the groceries.
The drive to the clinic site was far less eventful today. We did stop in Amudat for our team hosts and leaders to meet with the local health officials to discuss plans, personnel and logistics for the week. The team remained on the bus and was able to socialize and learn much more about the local healthcare and education systems as well as the languages spoken throughout the country.
There are over 56 different tribes in Uganda, and each tribe speaks its own language. The universal language for the country is English, which children begin to learn early on in school. However, not all Ugandans speak English. With the different tribal languages, there are times when even Ugandans are unable to converse with each other. In the region where we are serving this week, the people speak Pokot, which is the tribal language, and some speak Swahili as we are very close to the Kenyan border. This means that we need local translators this week who speak the Pokot language.
In the Pokot village where we are serving this week, there is some access to health care. In Amudat there is a hospital, which is about a fifteen-minute drive from the town of Nabokotom where our clinic site is located. However, there is no public transportation in this area, so transport to the hospital is very difficult. In Uganda, there are different levels of health care centers to help provide medical care. Level 2 health care centers are found in remote locations. Level 3 health care centers have only one nurse providing care to the region and then referrals can be made for further care. Level 4 health centers offer more services and have more staff.
Government health centers and hospitals offer medical care that is provided through taxes. For example, while waiting today we observed children at the hospital receiving immunizations. Here in Uganda, proof of immunization is required for children to attend school.
In these health centers and hospitals there are different levels of nursing practice. The nursing assistants wear purple uniforms (dresses for women and pants/top for men). Enrolled nurses who complete a two-year program wear a pink uniform. Registered nurses wear white uniforms with red belts, and bachelor's prepared registered nurses wear a white uniform with a blue belt. Nursing caps are still a piece of the common uniform here. Nurses can seek specialty training in areas such as midwifery as well.
By the time we arrived to the town of Nabokotom it was almost noon. The clinic is being held at the local Lutheran Church of Uganda congregation where Pastor Moses serves as the pastor. In Uganda, there are over 100 Lutheran churches and only eighteen pastors, so not every congregation has a pastor each Sunday.
Upon arrival we began setting up the flow of the clinic and the stations in each area. The bus went back to Amudat to pick up the local healthcare workers, extra tables and chairs from the hospital and a tent to place outside for extra working space. Local villagers began to slowly arrive as we were setting up. It was interesting to observe the segregation of the Pokot people. The men sat in one area, and the women and children were on the opposite side of the church property. Many of the men sat on stools they carry with them so they are able to converse and socialize all day. It seems this is normal practice for them as the men in the Pokot culture complete minimal work while the women spend their days very busy with cooking, cleaning, agriculture work, selling products and other domestic tasks.
The flow of the clinic is similar to other Mercy Medical Team clinics. A local worker assists with registering the patients with name and age. At the time of registration, Pastor Dave from the United States works with Pastor Moses to provide a Gospel message to the groups of twenty registering at each time. Patients then move to the vital sign area where Lorrie weighs the patients and Nelly, Kimberly and Stella work to obtain vital signs such as temperature, pulse and blood pressure. The patients then move to the nursing triage area where Katie, Mary and Rachel work with local nurses as translators to obtain patient histories and chief complaints for the day. The patients then move to the tented area outside to see a local clinical officer, which is similar to a physician's assistant or nurse practitioner, to obtain diagnoses and needed prescriptions. Patients at this time can be sent to laboratory for testing that includes malaria, HIV, blood sugar and urinalysis testing as well as a local test for Kala Azar, which is a common disease here caused by sand flies. Patients can also be directed to the treatment area where Sarah, a LCMS career missionary and nurse, provides wound care, antibiotic injections, IV fluids and other needed treatments. The patients are then sent to the pharmacy where Violet (our Ugandan host from the Lutheran Church of Uganda), Shara (an LCMS career missionary), Sydney (an LCMS intern), Ted (one of our MMT members) and a local dispenser fill medications ordered by the providers.
Overall the day ran smoothly. Though we did not begin seeing patients at the clinic until 1:30 PM, we were able to provide care for 178 patients throughout the afternoon. Today we provided medical care for many patients with positive malaria tests. Other patients were diagnosed with upper respiratory tract infections, urinary tract infections, back pain, generalized pain and ear infections. One malnourished five-month-old child came through who was referred to the local hospital for free government resources, which may include a feeding program. The team was able to provide health education through individual consultation regarding the need to drink water throughout the day. Amazingly, only one adult patient had high blood pressure. The local diet, which consists of sorghum and other grains and healthy Pokot genes are the assumed contributing factors to this. We also observed that none of the people seen today are overweight.
The team made it back to the hotel later this evening for dinner and team debrief to recap the day and discuss next steps for tomorrow. We are anticipating a full day of clinic to begin in the morning.
“Hesed” is a Hebrew word that means “kindness,” “mercy,” “loyalty,” “loving-kindness” or “steadfastness.” It’s the way God intends us to live together—a “love your neighbor as yourself,” active, selfless, sacrificial, caring-for-one-another brand of living contradictory to our fallen natures. The “Heseders” are continually looking to work together to share some small measure of God’s extraordinary love. Won’t you join us?