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.