Surgery in the night

A few days ago, Bwindi Hospital set a record for births: 12 in one day, four of which were Cesarean sections.  The next day the ward was again full of laboring mothers. Last night we had a going-away party for a VSO volunteer named Danny, who had helped with public relations and fund-raising. It was a gala affair; we watched the sun set over the Bwindi Forest and shared good cheer.

Later in the evening I ventured down to the obstetrics unit to check on things. I found that a very debilitated pregnant mother had just arrived. She had walked alone, with her two-year-old on her back, for two days from a remote village, the last 5 hours through the Bwindi Forest. She had been hemorrhaging all day. She collapsed when she exited the forest and was transported to the hospital by a passing motorcyclist. It was apparent that she was in extremis (near death), very pale and in shock from massive blood loss. She had no blood pressure and no pulse could be felt.

We started a central line in a neck vein and typed her for blood transfusions. After aggressively transfusing blood by squeezing the bags manually and forcing the blood into her body, we transported her into the operating theater. She remained without a blood pressure; her only hope for survival was to operate and stop the bleeding. It was obvious that her child had died many days ago, so saving the life of the mother was the only focus. The dead infant was delivered and the uterus closed in the usual manner but the bleeding from the uterus continued unabated. The difficult decision was made to remove the uterus—a procedure that I had never performed before.  A prayer for surgical skills and wisdom was offered and we proceeded. After another hour the bleeding was stopped and the mother was in stable condition. Her fortitude and Divine intervention resulted in her life being spared.

I made my way to the guest house at 2 a.m. and was surprised by the sounds of music—Danny’s party was still in full swing. Everyone was elated that the woman had survived the operation, and we danced until the wee hours of the morning.

Victoria awoke the next day and related her narrative. On her difficult, lonely walk through the forest, carrying her child on her back, knowing that she was about to die, she had prayed that God would allow her to make it to the hospital and that her life would be spared. All that she could remember from her arrival at the hospital was people trying to stick needles in many areas of her body and that prayers were being said for her.  When she awoke the next morning, she was very thankful that her son would have a mother to raise and love him.

“Joy comes in the morning…” The patient and Dr. Scott celebrate her recovery.

Resurrections

Hope happened by

It has been an interesting experience here at the Bwindi to witness folks seemingly raised from the dead. Recently a young woman was brought to our facility. She was found lying by the road unconscious. The villagers had considered that she was dead and were wondering what to do with the body. Thankfully Hope, a Bwindi Hospital nurse, happened by; she examined the woman and found that she indeed had a pulse. She loaded the patient on the back of a motorcycle and brought her to the hospital. The woman was in shock from anemia and a serious infection. Several hours later, after resuscitation with fluids, blood, and antibiotics she woke up to the great joy of her friends and relatives.

The dude’s not dead

Two years ago I was asked to attend the funeral of an elderly Mutwa named Kafumbiri. He lived at a remote Batwa settlement and apparently had succumbed to an acute illness. When I arrived, Batwa from many settlements had collected and were in mourning, singing their traditional songs of grief. Nearby, a coffin was being constructed with simple planks. I sat with the relatives for a while as they lamented Kafumbiri’s death. He would be sorely missed, but they related how he had lived a rich life filled with joy. Always cheerful, he never missed an opportunity to celebrate and could always be counted on for a good time. They asked if I would like to see the body before he was placed in the coffin. I entered a dark room in a dilapidated mud hut, where the still, small frame of Kafumbiri lay on a mat. He seemed at peace in his final repose. I reached over to chase away a fly away from his face and noticed that the body was still warm. I checked his carotid pulse; although it was feeble, I realized that “the dude’s not dead”!! He was indeed very ill but certainly not dead. I alerted the Batwa, who seemed very surprised, and we loaded him into our vehicle for transport to the hospital. Many of the mourners seemed chagrined by this turn of event, particularly the coffin makers. He received quality treatment at Bwindi Hospital and eventually recuperated. He is very pleased to have escaped the grave and lives on partying to this day!!! 

Kafumbiri--alive and smiling!

Emily: The Future Is in Good Hands

Emily Tumwakire is a student from the medical school at Makerere. She has been working at the Bwindi Hospital during a break from her medical studies. Emily is from the nearby town of Kihihi and is very familiar with the customs and language of the area. Emily hails from rather humble circumstances; her mother was aged 14 when Emily was born, and as single mother had difficulty in caring for her. Emily moved to Kampala at a young age to live with her grandmother. She proved to be a self-starter, excelling in school and obtaining academic scholarships at the best institutions. It is exceedingly unusual to have a young woman the first in the class, but she informed the young men that she was to be a force to be reckoned with and was always the top performer. She received a full scholarship to Makerere Medical School and continues to excel.

At the Bwindi she easily integrated into the flow of medical practice. We are fortunate to have numerous medical students come to study with us. This summer we have had one student from Vermont and two from the UK. It is interesting to see how the students compare with one another. It is abundantly clear that Emily is in the “fast reading class.” She dealt with the patients with compassion and skill and is well loved. All of the Ugandan doctors on our staff have been at the top of their classes and are exceptional physicians, comparable with any US-trained physicians. Medicine is still primarily the purview of men in sub-Saharan Africa, and Uganda is no exception. As a result, men dominate the medical staff and leadership of the Bwindi Hospital. Before Emily departed from the Bwindi, she signed a “letter of intent” to return to work at the Bwindi after she completes her medical studies. This agreement is predicated on us finding her a sponsor for her residency later in her career. With Emily’s spunk, drive and intelligence, I am sure that she will be heading the Bwindi Hospital in short order.

Emily and a friend, Queen Elizabeth National Park

Back in the O.R.

Last week I had a fine trip to Queen Elizabeth Park with my friends from Church of the Epiphany, Richardson, Texas; elephants, hippos, crocs and lions provided excellent photo-ops. The relaxing interlude was interrupted when I returned to the Bwindi, as I was required to attempt to replace Dr. Julius while I am here. Dr. Julius is our surgeon who is headed for a residency in Obstetrics and Gynecology for three years. Afterwards he will be returning to the Bwindi Hospital to head that department. In Uganda, unlike in the US, one is required to pay for a residency. Only the best and brightest are admitted into a residency. In return for the incredibly long hours dedicated to working at a government hospital, the resident has to pay a substantial sum and also provide for meals and lodging. Thanks to the generosity of Kellermann Foundation donors, he will be provided with funds for his training and accommodations. Dr. Julius will be difficult to replace for those three years, as he has incredible surgical skills and the intense attitude so needed in surgery: “Perhaps wrong, but never in doubt”!

It is with anxiety and trepidation that I returned to the operating room, as it has been eight months since I performed surgery. Due to construction in the existing operating theater, a cubicle in the waiting mothers’ hostel has been commandeered for surgery. Additionally, the maternity ward expansion has required that it be vacated, so the delivery suite has also been shifted to the waiting mothers’ hostel. The 28-bed Waiting Mothers’ Hostel is now a multipurpose facility. Although it’s overcrowded, we think of it as our local convenience store, where all surgical, gynecological and obstetrical needs can be met.

Earlier this week I was doing a difficult Cesarean section in this temporary, cramped, poorly ventilated operating theater. The baby was tightly wedged in the mother’s pelvic cavity. I became quite concerned when I couldn’t get the baby out. I worked up a great sweat, but no matter how much I pushed and pulled the baby wouldn’t budge. I finally closed my eyes for a moment and said a little prayer. I had a brief vision of praying with some close friends. I opened my eyes, and the next thing you know—presto—the baby popped out and gave a lusty cry!

Never underestimate God’s power to save lives, or the potent influence of prayer.

I’m grateful to all of you who are praying for the work at Bwindi Hospital—it makes a difference!!

Prayer aided in another successful delivery

 

P.S. I was up late again last night in surgery, feeling weary. As I sat on a chair resting after another difficult Cesarean section, I heard the women in the next room singing worship songs, in perfect harmony. My heart soared with their hymn. It brings me great joy to have the privilege to assist these people and to serve God in this capacity.

Epiphany Friends

Last week I was in Queen Elizabeth National Park with the mission team from the Church of the Epiphany (Richardson, Texas), visiting the lions, hippos, and crocs.

It was a well-deserved break after their busy days volunteering at the Bwindi.

The team of youth and adults from Epiphany had raised money to construct a home for a Batwa family at the settlement of Kihembe. One of the days was spent helping with the construction. Traveling in style down the dusty, pot-holed road to Kihembe in a large, comfortable bus (replete with three chandeliers!), we pass by grass-thatched mud huts outside which waving children line the road. We are warmly greeted by the Batwa, particularly the family who will be the recipients of the house. Of major interest to the Batwa is Bill Cavanaugh, a tall middle-aged man with a distinguished head of white hair.

Bill with his new friend Benon

Bill is the pastor of Epiphany and is an imposing figure to the Batwa; his added height allows him to mud the upper portion of the structure only accessible by ladders by the Batwa. The Batwa carry water up from the stream half a mile away and prepare the mud for the walls. Everyone assists in the process of mudding the house; we are joined by three of our medical students, two from the UK and one from the US. The mzungus (white people) are intent on completing the house but lunch intervenes, and as Africa is a relationship-based society, work is quickly supplanted by singing, dancing, and dialogue.

Batwa friends greet Susan and Penny during a work break

Toni Luc-Tayengo, the youth minister at Epiphany, relates a story revolving around her joy being complete by having a child after three previous problem pregnancies. The Batwa truly understand and nod in agreement, as they have exceptionally high rates of infant and childhood deaths. It is a time of intense sharing.

Toni holding a Batwa baby

The group puts on a skit of the parable of the Lost Sheep. When they assume the position of sheep, the Batwa run away, fearing some sort of demon possession, but they quickly return when they realize that it is just a skit.

A child is brought for prayers; this 2-year-old had been unable to walk due to an abnormality of the right leg. Neurologically, the child seems to be intact, and there is no bone or joint abnormality, but the right leg does not support weight. Besides the prayers, the child is referred to the hospital for further studies.

Building a home for a Batwa family is the “gift that keeps on giving.” It provides the Batwa a substantial house (by Batwa standards) that will provide shelter from the elements and a gathering place for decades, and the construction phase provides an opportunity for two disparate cultures to meet. The home-building process is the catalyst that allows both cultures to learn that there is much more that binds than separates. The Epiphany mission team seem to resonate with the Batwa, not only in song and dance and joyfully mudding the house (and mudding each other!), but also in an appreciation that the needs and ambitions of the Batwa are not too dissimilar from those of Americans. We all aspire for a better life for us and our children, and we all appreciate the joy of fellowship and a willingness to learn from each other. Above all we have an understanding that the God we worship loves us all equally and that we should do the same.

Compassion Comes in All Sizes

I attended yet another funeral recently at the Batwa settlement of Byumba, this time for Jacint, a 40+ year old female who died after a protracted battle with rectal carcinoma. Batwa from distant villages gathered for the burial. While I walked to the village, I was joined by a cluster of inebriated Batwa women. They greeted me effusively with long and protracted hugs.

I arrived to the hammering of nails into a coffin constructed of rough planks. The body was placed inside and the lid nailed shut. Jacqueline, the daughter of Jacint, wept nearby. The majority of the Batwa assembled were having animated discussions punctuated by bouts of laughter. A silence suddenly descended when a rather richly attired Anglican pastor emerged from a nearby house. A formal set of ritualized prayers ensued, interspersed with Anglican hymns. Eulogies were requested, and several Batwa expressed appreciation for the joy of having known the departed. Then another Mutwa woman stated that although they were neighbors, she never did like Jacint and they quarreled frequently. The Batwa responded with laughter and exchanged knowing glances. Jacqueline remained draped over the coffin, expressing her grief with protracted wails.

Suddenly the crowd surges forward en masse, terrified—a snake has been spotted. Men, women and children flee, panic-stricken, and bedlam prevails. Sitting next to me is Kera, the daughter of Michael and Jeanne Lipson (friends from California); she seems intimidated by the clamor. This is the first funeral that she has attended, and she is confused by the emotion and sudden alarm. I hold her frail shaking body next to mine and she relaxes.

The snake is quickly dispatched, the uplifting Anglican hymns resume, and tranquility returns. The coffin is laid in the six-foot deep pit and the Batwa throw handfuls of dirt into the grave. The juxtaposition of singing, wailing, ritual chants, laughter, and terror does not seem disconnected but rather bound together by a holy embrace.

Jeanne had told me that Kera was very timid, but I ask Kera if she would be willing to help me comfort Jacqueline. I press a small amount of money into Kera’s hand and tell her to give it to Jacqueline (as is the local custom). I also request that Kera say a few words to the grieving daughter. Jacqueline lies in a heap, a shawl covering her head, her body convulsed with sorrowful moans. Kera kneels down close to Jacqueline and quietly presses the money into her hand. The shawl is withdrawn and Kera peers into grief-stricken eyes and clearly says ka wa reeba (“I am sorry for your loss”). When Kera lays her small hand on Jacqueline’s shoulder, the sighs cease and she looks at Kera with an expression of wonder and gratitude. Kera’s simple act of compassion has been transformative for both of them.

Kera takes my hand in hers and we make our way up the hill as the sounds of singing and cries of grief slowly merge and fade away, replaced by the happy sounds of children playing at a nearby village.

Kera at Bwindi

 

Fourteen Days in Uganda

Fourteen days in Uganda: three funerals, two 5-hour church services (at one I was a happy godparent of Alvin, Richard Magezi’s son), many visitors, including mountain gorillas at my doorstep, and a celestial phenomenon.  Recently, the bright silvery light of a full moon obliterated all stars, and the jungle was alive with activity and sound. The moonlight was slowly darkened by the shadow of the earth. As the eclipse progressed, the night sky became filled with a myriad of shimmering stars, and the jungle became very still, like the pause between breaths. It was a magical event.

Friends and relatives at church

My nephew Walt Liebkemann came to the Bwindi, accompanied by his daughter Sarah. Dan del Portal, brother-in-law of Walt, also returned for his third visit to the Bwindi. Walt, a radiologist, assisted with our ultrasound diagnostics. Dan, an emergency room resident, helped in organizing our out-patient department. It has been a great joy to have these  relatives and close friends help at the Bwindi.

Jack and Sherwin, friends from Bakersfield, spent several days helping with the school at Byumba. We plan to open a vocational school at Byumba soon, teaching the trades of knitting, sewing, basket weaving, carpentry, and masonry. Jack and Sherman were able to engage the Batwa at a deep level and related incredibly well with them. The day they departed, a troupe of 16 mountain gorillas visited. Initially they were in the trees across the river, but as the day progressed they made their way to my doorstep. It was good to see my friends again, but I don’t think that they recognized me.

Bwindi Community Hospital is in the process of expanding the maternity ward, thanks to a very generous donation from the Japanese Embassy. The maternity ward will have ample space with its expansion to 40 beds.

I traveled the bone-jarring journey to Kabale; the 60 miles takes 4½ hours to traverse. The magnificent volcanoes in the distance mitigated against the multiple potholes and the slippery mud roads perched on vertical cliffs. The Bishop of Kabale was ecstatic with a computer donated by the Bishop of Northern California, Barry Beisner.  The computer now allows better communications between the two dioceses. It was also good to visit my friends at the Rotary club of Kabale, who are spearheading the 3H Rotary project providing clean water and sanitation to folks living around the Bwindi forest.

Missionary Sisters of Mary health clinic

The Missionary Sisters of Mary, a Catholic health center one hour drive from the Bwindi, were very appreciative of the donation of a water system for their clinic. Bids will be placed for the cost of two 5,000-liter tanks and guttering. It is sad that the majority of people living around the Bwindi rain forest still do not have access to clean water. Soon these Sisters will be able to perform deliveries in a cleaner manner.

A group from Imaging the World based in Vermont also visited the Bwindi Hospital. Imaging the World has a program where ultrasound images can be taken at remote locations and the images compressed using YouTube-type technology. The images are then sent via cell phone to a central location, where they are reconstituted, and a report is quickly generated regarding the severity of the medical condition. This technology is sure to transform ultrasound imaging, particularly for maternal health care in the developing world.

Thirteen students from the University of Scranton, led by Prof. Charles Pinches, visited a Batwa school that they have been supporting and had a “hands-on” experience of mudding a house with the Batwa. The students returned to the guest house in need of a shower but full of joy.

Sami visits with Batwa schoolchildren

Sami Bachir has come from Boston to assist in the schools. It is difficult for Batwa children to stay focused on their studies. Parental support is lacking, as no Batwa parent has ever attended school. Sami is a great encouragement for these children as they attempt to negotiate the pathway of education.

The plans for a school to train Registered Nurses have been approved and are being sent for engineering. We hope to break ground in a few months and will have an initial class of 16, progressing to 48 in three years. This will be the first Registered Nursing program in this area of Uganda.

Two anthropologists, Andy from Harvard and Vivek from Dartmouth, are currently studying the survival advantage of the pygmy phenotype (why pygmies flourished in the jungle). At a recent meeting with the Batwa they were discussing some of the results of their findings. They commented that the Batwa’s short stature and mobility allowed them to better tolerate the vicissitudes of the forest. They were asked if the anthropologists had noted any characteristics that would allow them to adapt to their new life out of the forest. Further study is needed.

Andy and Vivek joined me at a Batwa funeral that was held recently commerating the sad occasion of the death of a 5-year-old child. The mother of this child had 6 pregnancies but only two children survived–and now only one. Apparently the extended family was sleeping together the previous evening and the grandmother heard the child cry in the night. She wrapped her arms around her grandson and comforted him. In the morning the boy awoke inconsolable and it was then that they noticed a coiled black mamba at the bedside. The snake quickly slithered away; however, it had inflicted a fatal wound. The burial chants were overshadowed by piercing wails from the grieving family. I remained at the mother and grandmother’s side long after the child was buried, trying to provide some measure of comfort.

The following day I was one of several thousand well-wishers, government officials, and news media attending a gala event honoring Amama Mbabazi, who was recently appointed Prime Minister of the Republic of Uganda. Surprisingly, I was asked to speak at this event. Although still challenged by the indigenous language, I found it exceedingly more difficult to conjure up words of comfort for the mourning Batwa than it was to speak to a crowd of several thousand.

Although my first two weeks back in Uganda may seem rather hectic, it has not felt that way. The pace of life here is relaxed and peaceful. Events are shared in community, so that even grief is lessened. It is a great joy to return to be with my friends, both human and primate, and enjoy the privilege of sharing in their daily lives.

Dr. Scott with Batwa children