Week of February 5

This week, I tried to buckle down and actually get some tangible work done. I’m feeling very comfortable at the hospital and enjoying my coworkers a lot. They’re still so welcoming, nice, and funny. Ugandans have a good sense of humor. (Maybe it’s because they eat things like minnows and meat smothered in fat – they need it!)

I finished gathering questions for the take-home book for the mothers; now I need to find answers to these questions that they will understand! I’ve gathered tons of information from spina bifida and hydrocephalus association websites, so I need to sift through it all and make it understandable.

I’ve tried to be aware of needs that I can help fill. The intake doctors and social workers are constantly explaining hydrocephalus, spina bifida, shunts, and ETVs and drawing pictures to accompany them. I’ve gathered simple diagrams outlining each condition or procedure and will print them out on a two-sided page, have that laminated, and provide each department with a few of these sheets.

Another problem is that the bathrooms are constantly misused by the mothers who are from villages out in the bush. They will stand on the toilet seat (and often miss), will go to the bathroom outside the toilet, or will put bags, diapers, gauze, etc., down the hole because they may be used to pit latrines or holes. To make the mothers aware of the workings of the modern toilet, Aubrey and I found signs online that show how to correctly sit on the toilet and not to stand on it. I spent so much time looking online for a good diaper picture! We wrote instructions in English, and I had staff translate into Luganda, Swahili, Luo, and Ateso.

I also discussed what sections need to go into the orientation video. There are so many rules of which the mothers are unaware; I’m hoping that I can make the video interesting and effective.

Miriam and I spent some time watching videos about hydrocephalus, spina bifida, and CIC (Clean Intermittent Catheterization), since children with spina bifida are most often incontinent. These videos are helpful, but we both agreed that we need to make them more culturally sensitive and relevant to our clients. She’s hoping to use parts of those videos in conjunction with videos we make ourselves. (I just don’t want to take on too many projects!)

After reading and looking at so many pictures of the conditions we treat, I feel that I know a great deal about them, enough so to explain to parents effectively. A few days ago, Miriam was busy doing an intake, so she put me into an office with an English-speaking couple. I could tell right away that they were well off, and this was apparent even in the fact that they could understand my English very well for the most part (what a relief!). The father was an accountant, and the mother works in a hardware store. I recorded their socioeconomic information, asked them where they’d heard of the hospital and if they understood their child’s condition. They did for the most part, and I expanded on the parts they left out. Then came the worst part: telling them they have to pay for the service. What the intake sheet says is,
"Our services are specialized and highly qualitative, hence not free. Well wishers from abroad, especially the USA, have helped cover the biggest part of the bill; we therefore request you to make a financial contribution of shs 750,000 to cover the rest of the bill towards the treatment of your child. How do you hope to meet the bill?"

I tried to pretend that I didn’t hate the fact that I was asking an African family for money and told them the surgery cost shs 750,000 and asked how long they needed to pay. The father said, “I can pay 500,000 now and 250,000 when the baby leaves.” That never happens. So I got extremely lucky for my first real intake. I took part in a few other intakes this week, but it usually ends with Miriam explaining things in their native tongue because it’s too hard for them to understand me. Sometimes Miriam will translate for me, but I feel like that’s a waste of time since she can do it perfectly well by herself. And I certainly don’t want to compromise the quality of service for the clients just because I’m in my practicum!

I’ve been concerned about figuring out case loads, but Charles suggested that when patients come in from Mbale, I make sure to spend time with them, check up on them, help them look for resources, and then do a field visit after they leave. Even though this is not what the social workers do here, it should give me some experience with case loads. I think it will help me focus on and get to know some of the mothers better, because there are usually at least 20 mothers in the ward at any given time, and it is hard to get to know them when there are so many.

Here’s a side note: I barely dodged a baby’s pee yesterday. I don’t think it will be long before a baby pees while I’m holding him. I’m pretty sure that’s inevitable.

Living where we work gets more difficult for Aubrey and me the longer we are here. It’s our home, but people can walk into it anytime without warning, especially our coworkers after hours. Of course, we like them, but sometimes they stay late, and I have work to do and just want to be alone. When Aubrey and I are here by ourselves, we usually are in our rooms relaxing or doing work. We certainly have our times to talk about life, though! It’s nice to have someone here all the time. I think we’re doing a good job of being together a lot but having our own space and times alone. I’m enjoying having her around.

Tomorrow (Saturday) I am going to Kampala for Dr. Rita’s wedding! Then I’m taking a long weekend and traveling to Mukono to be with Greg and the USP students until Tuesday afternoon, when I’ll travel to Mbarara for a clinic until Thursday. So I won’t be home for a week! It should be exciting.