Images from an African NICU

I walk in, the tall, white American wearing gray scrubs. Everyone thinks I am a doctor because the nurses here wear dresses and white caps like British nurses from sixty years ago. 

There are metal, wheeled cots in rows. The basket part of the cot rocks gently when pushed. I'm the only one that employs that method of calming the babies. I'm the only one that bothers to calm the babies by any method, for that matter. 

There are babies everywhere. The cots are full. The incubators have two or three 1 pound babies each. The plastic lawn chairs are lined up in the aisles, each with a baby in its seat. I'm afraid to sit anywhere.

There are babies in rows on the tables, stashed on both levels of the carts, in corners and on shelves. It would be so easy to forget about one of them. Or ten of them. 

There are no blood pressure cuffs, no heart monitors. Three pulse oximeters are in the room, but rarely used. There are a few oxygen attachments on the walls, and tubes sprout from them like a monster with multiplying heads. One tube becomes two, becomes four, becomes eight. 16 liters of oxygen are pumped through them, and the assumption is each baby gets 2 liters. Sometimes we trip over the tubes that lie all over the floor, and I just pray that we discover which baby's oxygen was removed before any permanent consequences arise. 

All the tubing and bulb syringes are reused. Every morning on the unit begins by washing them with soap and cold water. "Can I boil them?" I ask. "No. Just wash them." I do as I'm told, using a needle to scrape out any dried gunk from the previous patient inside the nasal cannula.  

There is no such thing as giving report. All the nurses have all the patients. At one point I counted 62 babies, with me alone, while everyone else had gone to have tea. 

The medical "charts" are just pages stapled together and laid on top of the baby's blanket. They are frequently mixed up, as the patients are all lying together. The medications are given the same way. All meds and flushes are drawn up into syringes, and then each babies' pile of meds is placed on top of their blanket. None of the syringes are labeled. I could be giving saline. I could be giving phenobarbital. I could be giving the neighboring baby's meds. 

The IVs are covered in thick white tape. I can't see if the cannula is infiltrated or not. I do my best to check for swelling or leaking under the tape. 

Every two hours the mothers come in a long, sore and tired parade. They are all barefoot, as shoes are not allowed on the unit. Even I have to change into special shoes when I arrive. They each carry a small plastic bucket with diapers and a wad of cotton wool, which they wet and use as baby wipes. The baby does not get a diaper change, a feeding, or a change of clothes until the mother comes. Even if they are messy. Even if they have thrown up. Even if the mother has not come in hours. 

Some of the babies have feeding tubes. There are no breast pumps. I watch the mothers struggle to hand express their milk into a plastic cup.

They all want my attention at once. It is the perfect scenario for those "prioritization" NCLEX questions. 

 

"Doctor, my baby won't eat."

"Doctor, my baby is very hot."

"Doctor, my baby is throwing up blood." 

I'm not a doctor, but they don't know or understand. They just see someone in scrubs, and they take everything I say as literal fact. 

Every morning when I show up, I look in the death records first. I count how many died in the night, and if I can remember their faces. I shouldn't do it to myself but I have to know. 

I decide to start smiling and greeting the mothers. If nothing else, I can smile. They always look up, startled, at my greeting. They smile and greet me back. I always hope that the baby I'm particularly worried about isn't theirs. I always hope that the mother of that baby will come, so she can see him alive, just in case. 

I will never complain about nurse to patient ratios again. I will never take for granted the Code Blue button, or the Code Blue team. I will appreciate the meticulous requirements of electronic charting, frequent vital signs, and alarms on monitors. I will gladly double identify my patients and label their meds. 

I will never be the same. 

Choosing Melanie

After a series of disappointments, dead ends, and divine miracles, I was finally given permission to complete clinical hours at Mulago Hospital (I've literally been trying to get into that hospital since May). It came through in the final hour. If not, I would not have passed the classes for nursing school required to begin my next semester in the Fall. I'm very grateful.  

I chose to spend my first rotation in the Special Care Unit, the equivalent of the NICU. News flash: Uganda is not America. It has been a physically, mentally, emotionally, and spiritually exhausting week. Some of my experiences have been very sacred and some very painful. Actually, most of the sacred ones were also very painful.

Yesterday, I walked out of the hospital with dragging feet. In my mind I was saying, "I have had it with this place. I'm sick of dying babies and hurting mothers and hopeless doctors. I want to go home. I want my mom." 

A little niggle of thought told me that I had heard those lines somewhere before, and into my mind rose the image of Scarlett O'Hara fleeing from the Civil War hospital in Gone with the Wind:

Dr. Meade: Scarlett! What is this? You ain't planning on running away? 

Scarlett: And don't you dare try to stop me. I'm never going back to that hospital. I've had enough of smelling death and rot and death. I'm going home. I want my mother. My mother needs me. 

As dashing and sassy as Scarlett is, I've really always wanted to be Melanie. Melanie is forgiving, kind, patient, unassuming, and Melanie stayed with the dying soldiers and helped them write letters home. Even though there were thousands of sick and hurting men, she knew she could make a difference for one. And then one more. And then one more. 

So even though my heart and my mind are being Scarlett, I'm trying to make my face and my hands be Melanie. I can smile at these mothers. I can show them how to change a diaper and swaddle a baby. I can teach them the importance of breast feeding and keeping the baby clean. I can sing, like my mom suggested. I can't keep every baby alive, but I can help one. And then one more. 

Culture and the Yoke

I was upset when I first came to Africa because the culture of the Church was different. I felt that everything in this country was so different, "why can't church at least be the same?!" I would leave church on Sunday irritated, confused, and overwhelmed because I was focused on the few members who didn't dress modestly, the few children who ran wild in the halls, the way they sang the hymns, and the way they taught the lessons. I was so focused on how I'm used to Church, in Salt Lake City or Provo Utah, that I thought the differences in Uganda were "wrong" and Utah was "right".

The truth is, the culture is not what is true. The Gospel is true, in it's purest forms of faith, repentance, baptism, obedience, hope, charity, and love. As I've opened my eyes to the Gospel, instead of staying narrowly focused on the cultural differences, I have been humbled and moved. The Saints here seem to understand those pure parts of the Gospel better than many of the Saints in America. They come with their faith and their testimonies, continually eager to learn more and make small improvements every week. They come for God and they come for Christ. And, the Gospel is the "same" no matter which country you're in.

The Savior said, "take my yoke upon you, for my yoke is easy, and my burden is light." He said that at a time where the religious leaders were more focused on how many steps the members took each Sabbath than on the devotion of their hearts. When I was first in Africa, I was not yoked with the Savior. I had chosen a yoke and a burden that was heavy, like the Pharisees and Sadducees, too focused on minor details instead of the great and pure vision of the restored Gospel. 

Now, I'm striving to be yoked with Him again. When I was baptised I made covenants to take upon me His name, Always remember Him, and keep His commandments. I also promised to mourn with those that mourn and comfort those who stand in need of comfort. No where in those covenants does it say "judge those who should be judged and criticize everything worth criticizing." He just asks me to try and see people through His eyes and extend love to them. That's all.

I know many people leave the Church because they feel offended or stifled by the culture. They, too, have confused the Gospel with the culture. But all of us, no matter which country or region we may be in, have a responsibility to return to the pure aspects of Christ's perfect Gospel. I believe that when we are yoked with Him, it naturally becomes easier to find the similarities between people, rather than the differences. And truly, when our focus is restored, the 'burden' becomes light.

The Man I Married

Benji is a good man. Let me show you some examples:

Whenever we need to ride the boda boda's anywhere, Benji flags down two boda guys and then quickly assesses which one seems more gentle. Then he looks him sternly in the eye and says, "You will drive slowly and carefully with my wife."

Once, we were walking up a steep, busy African street. There was a man who had loaded many long wooden slats onto his bicycle and was pushing it slowly up the hill. It was an obviously heavy and cumbersome load, and the slats extended far in front and behind of the bike's length. The man was taking slow, laborious steps up the steep hill. Benji walked up behind him and said, "Let's go" and began pushing. They made it up the hill in record time, with many Africans turning to stare and laugh at the site of a white Muzungu man helping an African with hard labor.

He always greats the African men as "Sir" or "boss" which shows humility and respect. He often greats the older women as "mama." He has made huge efforts to learn their language so that he can greet them and thank them in Luganda.

When we were in Barlonyo, the women told us they do most of the labor. They wake up early, tie their babies to their backs, do the gardening, chop the wood, and cook the food. Several of the women were preparing lunch and one began to chop wood. Benji went over and said "Chrissy, let me try." All the people in the school house crowded around the windows to see not only a man, but a white man, doing the women's work of chopping wood in the heat of the day. When he was finished and we were walking away, we saw an African man pick up the ax and began chopping. One of the women said, "he is doing that because he saw you doing it."

He is naturally and continuously positive, he lifts me up day in and day out when I feel discouraged and low, he never looks for an opportunity to put anyone down or tease them about something they can't change, and he has a natural ability to see the beauty around him.

 Yesterday I told him "sometimes I'm even jealous of myself."And it's true. Whomever gets to be Benji's wife is one blessed woman, and I'm continuously amazed that I get to be her.

making french toast over a coal fire

Proud to Be an American

I think every American should spend a period of time living outside of America. Anywhere is fine, but especially in third world countries where the contrast is stark and poignant. Maybe if every American did that, America would be a better place.

On May 28th, we were invited to the U.S. Embassy in Uganda for a "Town Hall Meeting" as they called it. It was an opportunity to meet the Ambassador, hear him speak, and ask questions. They also served pizza, hot dogs, and chocolate chip cookies. (What's more American than hot dogs?)

When we arrived, we were escorted through security that rivals an airport. Benji's dreams of using their internet were squashed as they confiscated all our possessions before entering.

It was dark, and we were directed to follow a sidewalk around a building to the meeting area. As we rounded the corner, a tall flagpole with a bright light illuminated the beautiful stars and stripes in the darkness. My breath caught in my throat and my steps halted for a moment. "Benji. That's OUR flag!"

Benji squeezed my hand and we kept walking. We sat down amongst a gaggle of Americans, all in Uganda for various reasons, and all different races. (I love that about America. You don't have to be white to be American. America is in your heart.) The ambassador stood up to speak. He was diplomatic and charming and was from the Midwest and sounded like it. He made jokes and small talk and then turned serious.

He said, "I hope you had a moment, when you saw the American flag tonight. I want to wish you a welcome home, because literally, right now, you are on American soil."


The tears came then. Not fifty feet away on the other side of a heavily guarded fence was Uganda, with a beauty all its own, but right there in that moment, I felt totally secure and completely grateful. It is so easy to take our freedom for granted. Maybe the phrases and songs are too common and we forget. But when you come to a country where there is no 911, the police aren't entirely trustworthy, the infrastructure is shoddy, voting is an option but the citizens don't have much confidence in it, you start to realize what freedom has brought to you.

On the way home, we talked to our driver, Ibra, about some of our thoughts and feelings. We asked him if he made a good living as a special hire driver. He said he did pretty well, he always had enough for his needs, but then he said this: "There is no money in Uganda. We just survive, we don't become."


America gives its people the ability to become something. And as my mom pointed out, not just once but over and over again. No, our country and government are not perfect. We have issues and struggles and weaknesses, too. But we can become. We have confidence and hope and pride. Those are things that freedom bought.

This is my second year in a row that I am not in the USA for the 4th of July. I hope to be home for it next year. Amongst your barbecues, pool parties, and fireworks, please really stop and think. It is a privilege and an honor to be an American, and I hope I never take it for granted again.