Project Uganda 2013, June 7th - Village of Kidusu:
The clinic was in full swing – our medical staff was treating patients, I was working on Raymond, the dentist was extracting teeth - everyone was busy ministering to the needs of the sick, when all of a sudden there was a horrific noise!  It stopped the clinic dead in its tracks.  As I was getting up from the floor to see what had happened, I heard someone yell, “Shut the door, shut the door now!”  I stood momentarily dazed as I watched the events unfolding before my eyes.  It was as if I was on the set of TRAUMA: Life in the ER!  Our team member and EMT, James Singleton, had leaped from his station in response to the apparent accident that had taken place and was outside the little church where we were holding the clinic in a matter of seconds.  While I was still trying to ascertain what had happened, James was entering the church with the blood soaked victim of a boda boda (motorcycle taxi) accident, a young boy, around the age of ten that I believe was called Ronald.

The trauma center was now in full swing!  The boy’s clothes had been removed and Dr. Eileen Weibley was examining him to determine the extent of his injuries.  The obvious head wound was requiring immediate attention to stop the bleeding, so my search for the appropriate sutures began in what I lovingly call the black hole!  All of our supplies are “organized” in black crates to allow for easy transport to and from the clinic each day.  We travel with 6 – 8 of them and do our best to separate items for effortless retrieval – one crate for wound care, one for antibiotics, one for pain relievers/stomach meds, one for malaria and worming meds, etc.  Sounds like a well-organized plan and it works great, until you need to find something STAT!  Nevertheless, God is faithful, just as Eileen was getting up to help me look I found them!

I know our medical staff is trained to respond to emergency situations in a calm and professional manner, but can I just say that I was amazed and so proud of each of them!  Everyone worked together to stabilize that little boy like it was a scene from a well-produced movie – I guess I shouldn’t be surprised since we had the greatest Producer and Director of all times on the scene, not to mention the Great Physician!  

While she was suturing the boy's head, Eileen notice a large hematoma at the base of his skull, indicating a brain bleed.  That fact, along with a possible skull fracture; she knew a neurosurgeon was needed.  We began making plans to transport the boy to Kampala –  a four-hour journey at least from our location and probably longer given the traffic jams resulting from the futbol (soccer) game that was taking place!  Realizing the futility of the situation, we opted to go to the Jinja Hospital in hopes of receiving an ambulance or police escort.  Silly Americans for even thinking such was a possibility!

Most of you probably know that moving a trauma victim must be done with extreme caution, with the head and neck immobilized to prevent brain and spinal cord injury.  In the U.S., this would be done with a cervical collar and a stretcher following a precise trauma management protocol.  Of course, out in a remote village of Uganda those resources are not readily available.  Not to worry, James found a small bench that was missing its legs on one side – an incline to help relieve pressure and blood pooling in the brain!  Ronald was carefully moved to our makeshift stretcher and duct tapped to the board to immobilize him.  Once again, I am amazed at the resourcefulness of our team!  Ready for transport, the team carries him to our emergency transport vehicle – otherwise known as the bus!

James prepares an emergency medical kit needed for transport, Eileen continues holding Ronald’s head in place as she gives instructions to the men who will lift the stretcher, and I quickly give a jigger extraction lesson to those who will continue the work on Raymond.  Once loaded on the bus, we begin the arduous journey to the hospital in Jinja Town.  Eileen sits in the floor of the bus, holding Ronald’s head, while James continues taking vitals.  Ronald's mother sits quietly staring out the window, obviously in shock.  Our interpreter, Abraham, quietly speaks words of comfort to Ronald as we drive down the long, bumpy dirt road from the village. As our medical staff did throughout the clinics, Eileen seized the opportunity to tell Ronald about Jesus.  While she was sharing the Gospel, I called Bill, who was teaching Life Principle’s to the professors at the Baptist Seminary in Jinja to ask them to pray.  I must admit I was surprised when he answered the phone as he usually turns it off when teaching, but God knew Ronald would need prayer so he “forgot” to turn it off.  

Ronald accepted Jesus as his Savior before we reached the hospital, so regardless of this emergency’s outcome Ronald now had the gift of eternal life and was secure in the care of his Master!  We arrive at the hospital’s emergency room only to discover the doctor was at lunch.  Really!?!?!  One doctor on duty in the emergency room and he leaves the hospital to go to lunch!  We are directed to an exam room and instructed to wait.  
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In the meantime, I call the God Is Grace team and ask if they would bring us their van so we can send the bus back to the clinic.  Taylor, Jon, Laura, Kerry and Zan leave Beth and Ms. Mary in the village and join us at the hospital.  At least this way it was only Beth and Ms. Mary stranded and not the entire medical team right?!?!  (They were actually able to take a taxi back to the hotel, so they weren’t really stranded.)  We try calling everyone we can think of, including the hospital director, to try to circumvent the process, to no avail.  I’m told we must be patient and wait – we must follow hospital protocol!  We’d hit a brick wall and I was beyond frustrated!!!!!  While Eileen and I stayed with Ronald, the others gathered outside to pray.  I’m so thankful that while procedures and frustration had rendered me ineffective, my brothers and sisters in Christ were pleading with the Sovereign God of our universe to intervene.

While we were waiting, Ronald’s mother kept saying, “Why?  Why did she send my son when she had her own children?”  Apparently, a neighbor had sent Ronald to fetch water.  He was running across the road with a jerry can when the boda boda hit him. While I don’t know for certain the reason God allowed this terrible tragedy to happen, I do know that God used it for Ronald’s eternal good.  Had it not been for the accident, he may never have heard the Gospel and surrendered his heart and life to the Lord!

After at least an hour and a half, the doctor returns from lunch.  Seeing we had already provided emergency treatment to stabilize the patient, he merely wrote orders for us to take him to Ward 9, without even examining the boy.  Just a side note, at no time during our wait in the emergency room did anyone come to check on Ronald, take his vital signs or make sure he was still alive.  Really makes you appreciate the health care system we have in the U.S.

Because Ward 9 is around the backside of the hospital, we load Ronald into the van and drive to the ward's entrance.  We are immediately ushered into an exam room, where a doctor actually examines him.  They agree to keep him overnight for observation.  They instruct us to go find him a bed on the ward, which we do.  Then they want US to remove him from the makeshift stretcher.  Eileen and I remove the duct tape and carry him to the bed we had picked out.  Remember his clothes were removed to examine him back at the clinic, so the poor little thing was draped in only  the small blue towels we had covered him with – the hospital doesn't provide gowns!  The beds have no sheets, pillows or blankets – there is no charge for the hospital stay or the staffs services, but patient or family must provide the items needed for their stay.  The same is true of food and any medicine that might be necessary.   The family has to go buy or bring those needed items to the hospital.  Needless to say, we had to take a trip to town to buy those few necessities before we could leave Ronald in the care of his mother and the hospital.

When we returned we dressed Ronald as discreetly as possible in an open ward, made his bed and gave his mother a little money to buy breakfast, phone time to call her husband, and for transport home when released from the hospital.  As we left, Ronald was sitting up in the bed eating the chicken and chips we had bought and even talking to his mother a little.  The swelling had gone down and he seemed happy and alert.  There is no doubt we witnessed several miracles that day as God’s sovereignty was displayed in such a might way.  While I was upset that the hospital was doing nothing to help this boy, our amazing God was at work and in complete control!  In Psalm 121 he psalmist asks, "where will my help come from?"  My help will come from the LORD, who made heaven and earth."  This scripture has never been more true - when no one else could help Ronald, his help came from the Lord!    

Project Uganda 2013, June 6th - Village of Kidusu: 
While not the same Raymond as the TV show, you can't help but love this little boy!  Raymond was found in the crowd at our medical clinic in Kidusu by one of our team members. He had one of the worst cases of "jiggers" I have ever seen!   The chigoe flea or jigger (Tunga penetrans) is a parasitic arthropod and is NOT what we southerners call chiggers.  Breeding female chigoes burrow into exposed skin, usually on the feet, and remain there for two weeks while developing eggs, during which time they swell dramatically, sometimes causing intense irritation (condition called tungiasis). After this point, the skin lesion looks like a 5 to 10 mm blister with a central black dot, which are the flea's exposed hind legs, respiratory spiracles and reproductive organs.  Heavy infestations may lead to severe inflammation, ulceration, and fibrosis.  Lymphangitis, gangrene, sepsis, the loss of toenails, autoamputation of the appendages, and death may also occur.   If you think the description sounds bad, you may want to forego looking at the pictures, which will follow!  The sad reality of jigger infestation is it could be avoided with basic hygiene and shoes! Raymond was not wearing shoes when we found him, and dirty doesn't even begin to describe the condition of his feet.

As I said, Raymond was discovered by one of our team members, Wade, who recognized the severity of the boys condition.  Wanting to bypass our medical clinic protocol of waiting in line to see the doctor, Wade took me outside to see the boy and confirm the need for immediate treatment.  We soon located the boy and also encountered an angry mob of villagers.  At first I thought they were angry because we were allowing him to break in line, but that was not it at all!  They were angry at the woman who cared for the boy, because the other children in the family were relatively clean and well taken care.  They couldn't understand why this child was so infested and seemingly neglected.  Someone had sent for the woman, and as she approached us the crowd began yelling and screaming at her.  While I had taken the boy inside to begin treatment, Wade and other members of the team seized a teaching opportunity.

When the woman caught in adultery was brought to Jesus, His response to the crowd was "If any one of you is without sin, let him be the first to throw a stone at her."  (John 8:7).  One by one the crowd began to drop their stones and walk away.  Jesus then asked the woman, "Has no one condemned you?" . . . "Then neither do I condemn you," Jesus declared.  "Go now and leave your life of sin." (John 8:10-11)  Our team tried to teach the crowd that rather than condemning the woman, they should show her the same mercy and compassion that Jesus shows to each of us. While we understood they were appalled by her lack of concern for the boy, we suggested that by showing her love they could encourage her to take better care of the boy.  As the James 2:13 says, mercy always triumphs over judgment; and love covers all sins (Prov. 10:12).  The crowd soon calmed down and the woman was brought inside to wait for Raymond to be treated.

We discovered that the woman caring for Raymond was not actually his mother, but the wife of his uncle. His mother had basically abandoned him and was living in Kampala.  Unfortunately, this is a very common occurrence in Jinja.  We frequently encounter people raising children not their own, and this explains the discrepancy of treatment between Raymond and the other children. Yet another reason why the village should pull together to encourage this woman to take reasonable care of all the children God has entrusted to her.  As you read this post and as the Lord reminds you, please pray for Raymond and his family!

Treatment for jiggers requires that the parasite be extracted. The pictures below this post will show the infestation and the removal process, which took two days. (Please be advised the pictures are graphic)  At the end of our first day, we told the aunt that treatment would need to continue the next day and that she should bring Raymond back first thing in the morning.  I bandaged his feet and placed a new pair of shoes on his feet - the smile on his face was priceless!  He was sent home with antibiotics to clear the infection, soap, gauze and antibiotic cream.  We also gave his aunt the pesticide needed to treat his sleeping area and instructed her on its proper use.  As we left for the day, I wondered if we would see him again! 

When we arrived the next morning, Raymond and his aunt were there!  I was beyond excited that he had returned and began work to continue the extraction process as soon as we set up the clinic.  We gave him
peanut butter crackers, protein bars and bottled water with Hawaiian punch drink mix, along with a mega dose of ibuprofen to prepare him for the long, painful ordeal.  I worked for several hours and seemed to be making little progress.  Every so often Raymond would put his hand on mine, indicating the pain was unbearable and I needed to stop for a few minutes.  I would stop and pray for him, but I knew we had to continue in order to save his feet and possibly his life.

This process reminded me of how our lives can become infested with sin without us even realizing what is happening.  Much like the tiny chigoe flea burrowed into the flesh of this young boys feet, sin burrows deep into our hearts often from one tiny moment of indiscretion or one bad choice.  Satan convinces us there is nothing wrong with a little sin and one thing leads to another. Before we know it, our hearts are callused and repugnant, not only to those around us, but most of all to our Creator.  Our life is infested; our flesh is decaying; our only hope is for God to perform the painful extraction process.  Times of discipline are painful, but I am so thankful God doesn’t give up no matter how many times I ask Him to stop.  He lovingly continues until I willingly turn from my sin!  "If we confess our sins, He is faithful and just to forgive us our sins and to
cleanse us from all unrighteousness."  1 John 1:9

I continued working on Raymond, while the rest of the team worked diligently on other patients.  As time was approaching 1:00 pm and we were preparing to break for lunch the unthinkable happened!  My next post will try to describe what felt like being part of a trauma center reality show.  

Click on pictures to enlarge