Dry season

Dry season--hot, dusty and smoky.  We ride to work every morning on dirt roads through great clouds of dust every time we pass another car.  We die of heat if we don't open the windows and choke on dust if we do. The side of the road is either charred or burning.  Everyone burns everything in sight so "there will be new grass for the animals".  Most of the trees survive but apparently they also manage to burn houses and electrical poles (fortunately we have our own generator as the electricity around here was off for a week).  For awhile it was hotter during the day and colder at night.  Now it is hotter during the day and hotter at night--a bad combination.  At least the cold showers are now a welcome respite from the heat. The most comfortable place is outside in the shade so we spend most of our free time sitting on our porch (as opposed to the dorm which is like an oven).  Sunday afternoons we retreat to the air conditioned pharmacy to watch movies.  At work I find it hard to move in the afternoons except for when emergencies come in. The things we are seeing in the hospital have definitely changed.  There are far fewer children with malaria and many more dehydrated from gastroenteritis.  Skin infections and abscesses are common. There has been a huge outbreak of chicken pox in the camp and we see many cases everyday in the outpatient department.  There was also an outbreak of Rubella (German measles) but that seems to be dying out. Chicken pox has not been much of a problem except for a mother who delivered with it and we were quite worried about the baby.  We only had the medicine for the baby in pill form although IV medication would have been better.  The nurses crushed the pills to give to that baby and another 2 week old baby with chicken pox.  Both did well.  I took care of a 6 year old boy with a hugely swollen hand from an infected rat bite.  He had been chasing and trying to capture rats which is a game he and his friends play.  In the bed next to that boy was a girl with a snake bite she got while playing behind her hut. A five year old child was brought in who had been hit by a motorcycle and had a femur fracture. We splinted her and sent her to the hospital in Adjumani--a bumpy one hour ride.  At Adjumani they are not able to do traction and tried to send her on to Kampala.  At that point the parents just picked her up and left saying they were taking her to Juba in South Sudan for treatment.  Not an easy trip for the child. 

Malnourished child in recovery 

The dry season has caused a small increase in the number of SAM cases (severe acute malnutrition).  The ones that are sick with additional problems are hospitalized, started on therapeutic milk and eventually transitioned to Plumpy Nut, a peanut based paste.  Most of them seem to really like the Plumpy Nut which they eat right out of the packet. When they are doing well on that they are discharged with a weeks supply and come back weekly to be weighed and pick up more.  Once their weight has risen to the normal range for 3 weeks they are discharged.

In the afternoons when it's quiet the staff will often tell me about life in Northern Uganda and South Sudan.  The translators have lots of stories about escaping from the rebels and traveling south to Uganda. Another popular topic is wives.  Most of the South Sudanese expect to have 2 or 3 wives.  Many of the Ugandans, at least in the north, also expect to have 2 or 3 wives or a wife and a girlfriend.  The translator in the picture is 24 and working on his third wife.  The first was at 19 and not really a wife as her older sibling hadn't married yet and they couldn't marry until that happened. While waiting for that she had his child but met a man from Nairobi and moved to Kenya.  The child is with the mother now as he has allowed this but the child belongs to him. When she gets older he will claim her. The second wife is one he inherited when his brother died and she is still in South Sudan with an infant.  He is looking for the next wife, the one that will really he his.  In the meantime if things quiet down in Sudan he will try and go back to the University where he was studying economics.  

Ugandan nurse, South Sudanese translator and me

I find it interesting that how well dressed we are seems to be inversely related to our circumstances. The refugees that live with no running water or electricity look the best, then the national staff, who also lack running water but some have electricity,  while we just wear MSF t-shirts and scrub pants.

Refugee Food Distribution

Line for sticker needed to get food

Getting thumb printed and receiving the sticker 

Last week I had the chance to visit the refugee's monthly food distribution site.  Jacob, one of our South Sudanese surveillance officers who lives in the refugee camp, offered to show me around.  The surveillance officers visit every household in the camp, (~16,000 people) over the course of a month looking for malnutrition and illness, and documenting home births and deaths.  The food distribution takes place in a large field with some temporary structures on the edge of the camp. There were long lines of people and groups of people everywhere.  Each family is given a refugee registration card at the transit camp they are taken to when they first enter the country and it is used to get food. The lines are all organized by family size with a separate line for each number from 1-7 and another line for those with 8 and above in the family. At the head of the line there are a couple of people examining documents, collecting thumb prints and handing out the food sticker.
 Once they have the sticker there is another line to get the food--10 kilograms per person.  This month they were given sorghum,  CSB (corn soy blend) and cooking oil.  After spending several hours under the hot sun collecting food they are now faced with trying to carry the food home.  Some package it in smaller quantities and make several trips.  Others pay someone, with part of their food, to help them transport it.

Food!

Party (Ugandan style)

We were invited to the Christmas party put on by the District Health Officer for all the Ugandan health clinics in Adjumani district—about 35 small centers and a 200 bed hospital (staffed by 3 doctors who do all the surgery). The party was held in the courtyard of a bar/night club in Adjumani with chairs set up for the staff  in rows (~150 people) and chairs for the dignitaries set up in a U in front.  The invitation was for 3 o’clock.  The two Africans on our staff said, "we will go at 7 or 8 to avoid most of the speeches."  We arrived at 8, tried to sneak in and sit in the back, but were taken to the dignitary area up front where speeches were still going on.  The guest of honor, a member of parliament, arrived just after us.  The speeches went on for another two hours before dinner was served! For dinner there were two buffet tables—one for dignitaries and another for everyone else.  Before the buffet table there were hand washing stations with soap and water—a woman sitting pouring water over your hands from a jug.  The food, roasted goat, kasava and rice, was served on a plate and everyone ate with their hands.  From a western perspective it was quite odd to see women in fancy gowns eating with their fingers. After dinner there was drinking and dancing although we had to work the next day and left by midnight.

For our staff end of the year party we took over a “bar” in the nearby little town of Dzaipi.  The bar consists of a small shack where drinks can be purchased, a large fenced outdoor patch of dirt for dancing, sound system and stage. We gave all our staff (~100 people) 2 tickets for beer and 2 for soda, and provided dinner—roasted goat, rice and salad.  Having meat to eat is quite important for any special occasion here.  (I was told that only if you were very poor would you not eat meat on Christmas).  The most serious of my clinical officers at work turns out to be the funniest of MC’s and agreed to be MC for the party.  We tried hard to avoid speeches and were pretty successful—just a couple of short ones. The expats prepared a dance to one of the popular songs here which we did up on stage much to everyone’s amusement.  The first part of the evening was similar to a talent show—a lot of staff wanted to sing, dance or lip sync up on stage.  I tended bar for a couple of hours and then danced until I was exhausted. A big crowd gathered just to watch our party.  They sat, in the dirt, for several hours happily watching everything going on on stage and the dancing.