Thursday, June 26, 2025
I have been writing notes on the past view days, without posting, because no power means no computer battery and usually no Wi-Fi. I am also writing in between scanning patients and working on other projects. I'm hoping to get this out to you by the end of the day! 😁
We lost power Tuesday night around 10:00 p.m., which was unfortunate because it was particularly still and warm. I always bring a small foldable rechargeable fan with me, thank goodness or it would have been difficult to get any sleep at all. Power has continued to be spotty over the past few days. Once again, the roosters woke me up Wednesday well before the Sun. I love the mornings here; cool temperatures and I can see the sun rising through one of my windows with a slight view of the mountains. Our little village starts to wake up and get to work, sweeping out their huts and often the areas around it, making breakfast, getting ready for the day. It's so comforting to wake up in this community. I have a little routine now in the mornings. If I remember to bring a carafe of hot water to my hut the night before, I make myself a mug of tea and some oatmeal in my hut. If not, I have to wait for Zilla to start the breakfast process. My hut is very new, so the concrete floor still absorbs quite a bit of water from the ground. I lift up the floor mats, sweep the floors and open all of the windows and doors to dry everything out. There is a constant battle with the dust, especially if the wind picks up. Once my door is open, my adopted chicken family comes running. The chickens are free range and find food on their own, so they are quick to learn who the sucker is that will feel them cracker crumbs. It's me. I'm the sucker. I then usually start my day by checking in at the birth center, although sometimes they come find me with emergent patients, then wander up to the dining area.
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| This morning, my chicken family appeared magically as soon as I opened my door and they loudly ordered breakfast! |
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| All snacks that I keep in my hut are kept in Ziplock bags and also inside a bucket with a lid, to keep them bug and critter free. There is no shortage of bugs here! |
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| Goat shenanigans at the water spigot. |
Later that morning, I joined a couple of students, Rachel and Michelle and we drove to Pabo clinic. Pabo is one of the local clinics affiliated with Lacor (pronounced La-Cho) hospital and one of the first clinics I had visited when I began working with ITW in 2018. It was a relatively short drive, around 35 minutes, and we met with Brenda, a midwife I had trained last year. I was able to work with Brenda for most of the morning and afternoon, then we all drove back to the compound.
There is so much that I love about this work that I am doing, but there are also a lot of frustrations. I would be lying if I didn't say that there are times when I struggle to be patient, coming from a culture that is somewhat of a pressure cooker to get things done and the need to always be working on something or fixing something. This is also an internal struggle and part of my ADHD. I appreciate being in an environment that is more relaxed, but there are also times when a sense of urgency is necessary. It's also important to remind myself of the culture of learning here. Rote memorization, very little critical thinking, and very little encouragement to problem solve or take initiative, and a subservient attitude towards anyone deemed to be at a higher level, be it a job position or in education.
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| The ultrasound room at Pabo clinic. |
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| Brenda and a midwife student check in the first patient of the day. |
When midwives go through the ultrasound training, upon completion they are gifted an ultrasound machine and some basic supplies. When I arrived in Pabo, Brenda was using a different machine, because Lacor hospital decided to keep her machine for the main hospital. Brenda was given no training or instructions of how to use her machine, but she also did not take any initiative to learn anything about the machine beyond the obvious. The machines we use have the ability to show 4 images at once, which is convenient when measuring the 4 quadrants of a uterus for fluid, but her machine does not have that option, so she just stopped measuring fluid. It did not occur to her to just measure each quadrant individually, which is something I showed them all in training. We all struggle to teach them the importance of cleaning the machines and especially the probe, in between patients, and if they run out of the probe cleaner that was given to them, they rarely refill it on their own. Brenda had the probe cleaner in her scanning room, but a patient's child had broken the pump. It never occurred to her to just pour the cleaner into a different container or just replace the pump from another container. This is not an indication of their intelligence (on the contrary, many of these women are very smart and a quick study), but a clear indication of their culture and the role of women in that culture. Follow directions, don't venture outside of their designated box. I also give every student laminated biometry guide; these are photos and diagrams of the anatomical landmarks used to correctly measure the fetus. These are to be hung up or kept in the scanning rooms. Brenda was having some trouble remembering landmarks, yet her scanning guides were nowhere to be found in the clinic. So, I pivot, and problem solve. As we speak, Allan has once again come to my rescue, and I am printing laminated posters to be hung up in the scanning rooms. After a quick conference with Rachel, we decided that they LOVE hanging posters in the clinics (some of which make absolutely no sense!) and we would try these instead.
Sometimes it feels like I am constantly chasing a moving target, and I have to remind myself to look at all of the improvements that have happened since I have started this work. Just this morning, I went with Dinah and Monica (both have gone through my training) to ultrasound 2 patients. In both cases, Dinah was able to correctly and swiftly identify the problem, resulting in faster and better treatment. Even Brenda was able to maintain quite a bit of her scanning skills, in spite of the fact that she has received no mentoring since her training from last year. For those of you new to the program, MHI had hired a Sonographer mentor last year, who was found to be severely lacking in many ways. We terminated his contract and have been searching for the right fit ever since, which is why we are so thrilled to have met and hired Max.
Once a month, all of the traditional midwives come to the birth center for a group meeting, to discuss births and other relevant events, collect paychecks, share space with each other and join in dancing, singing and sharing a meal. Today was that day! The student midwives, along with Michelle, put together gifts for them, sturdy waist packs filled with salt scrub, candles, bracelets, and soaps. The midwives also received new uniform dresses, so there was a lot of excitement and joy. I was asked to join them for the introduction and was also asked by the midwives to join in the group photo. Although I do not work with them directly, the midwives are aware of what I do here, and they always welcome me with hugs and smiles, making me feel like a part of this community.
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| Students and Michelle distribute gifts to the traditional midwives. |
I have moved to the birth center, to mooch off of the stronger router and Wi-Fi. It's a quiet afternoon, very warm with intermittent breezes that feel like a miracle. The are 2 newborns here, sleeping off their full bellies, and the student on shift is resting in a nearby hammock. Periodically a small bat flies through the building, checking for snacks. Did you know bats can eat up to 1,000 mosquitos in an hour? I'm always happy to see them, especially here!
Allan, my miracle worker in Kampala, has already gotten my posters printed and they are on a bus headed our way. I have finished a few smaller projects and I'm waiting on feedback from Rachel to continue a few more. I can't believe I will be headed home soon! I will take the small plane from Gulu back to Entebbe on Monday, spend Monday and Tuesday night in Entebbe, and start the journey home on Wednesday.
This weekend I will be available for ultrasounds and try to organize the myriad of lists I have created, with ideas of how to plan for October. I will send my course evaluations to Max, along with progress notes on all of the midwives I have been working with. He will start working with MHI a couple days a week and join me for the big training in October. Even when it feels like a relaxed day, I always find something to do!
I will end on a happy note; the knitting project has been a success! The midwives are so excited about knitting and I have already been asked for more kits and teaching when I return. Dinah is the midwife on duty today, and she is sitting in a hammock, working on her knitting project and helping one of the village midwives with theirs!
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