A few days ago, I decided that I might as well get an African hair-do while I am living in Uganda. I asked two of the girls downstairs if they would be willing to plait my hair in little braids. They agreed, and directed me to a shop where I could purchase blond extensions. When I came back with two packets of fake hair for less than two dollars, I asked how long it take for them to finish my entire head of hair. The answer I received was “around one hour.” Four hours later, my hair was still not completed. Although, I suspect having this new style of hair will eventually be worth it because it’s easy to maintain. Hopefully I will make up the four hours I lost now that I won’t have to spend much time getting ready in the morning! Even so, I have new-found respect for girls who have their hair braided like this on a regular basis.
This is the story of a 7 year old girl named Doreen. Unlike many of the other stories I have shared, this one has not really come to a conclusion. Doreen is part way through two separate surgeries, spaced about 6 weeks apart from each other. I met Doreen a week before her first surgery, along with her grandmother (her caretaker) and baby brother. About a month ago, she was brought into a clinic located in Jinja for an initial assessment.
Since birth, Doreen has never been able to have a proper bowel movement. She has a serious birth defect known as an imperforated anus, meaning she has no opening at the end of her colon. Because of her imperforated anus, her body forces the fecal matter to find other ways out of her body. When people struggle with this problem, their excretions find the closest opening to discharge out of. In girls, the feces often uncontrollably discharges out of the vagina. Needless to say, Doreen has had to live with a great amount of discomfort throughout the first 7 years of her life.
This problem not only causes physical unrest and numerous health problems, but it also triggers many social disadvantages due the reaction of peers when they realize the overwhelming smell of feces is coming from a person like Doreen. It is very difficult for Doreen to attend classes because most schools shun her away. Although not allowing Doreen to attend school at all is not the right approach, teachers are not intentionally trying to make her an outcast, they simply receive too many complaints about her recurrent foul smell. Schools simply do not know how to deal with this problem. There is no easy answer when it comes to dealing this digestive defect because the surgery is very expensive, and there often has to be two separate procedures.
Doreen is a quiet, happy girl and loves to help take care of her little brother. Upon our first encounter, she was quite shy (as most kids are around unfamiliar white people) but warmed up to me quickly. She has a hesitant, but warm smile and a loving nature about her. She is very respectful toward her grandmother and the nurses. Doreen’s grandma dresses her in fancy clothes when she comes into the clinic, which I can tell have been worn many times as they are ripped and torn in many places. Nonetheless, Doreen’s face lights up when someone comments on her frilly dress or shined black shoes.
Doreen has recently gone through the first of the two surgeries that is needed to correct her digestive problem. The first procedure created an opening in her abdomen so that the healthy part of her colon can excrete feces through a functioning colostomy. Until her next procedure, her excretions will no longer be able to find harmful ways out of her body, but instead can be caught in a bag which is placed over the hole on the right side of her abdomen. These bags are referred to as “colostomy bags” and will be the means by which Doreen will ‘go to the bathroom’ up until the time of her next surgery.
We had visited Doreen the day prior to her surgery and she seemed surprisingly relaxed. She was still smiling despite the circumstances. I am sure that Doreen was not completely aware of the events that were about to happen, but being at the medical clinic did not seem to frighten her much. I left the clinic that evening optimistic about the following day’s events.
The next afternoon, we received the news that the surgery had been successful. It was time for us to visit the clinic and check up on Doreen. We walked into the room where she was resting and my heart sank. I always try to mentally prepare myself for the transformation that I will see in a child pre-surgery compared to right after the procedure is finished, but that does not mean it doesn’t hurt to see our children in so much pain. I watched as the doctors tried to shift her body to re-dress her wounds, causing Doreen to wince and scream in pain. Tears slid down the sides of her face, dampening the sheets surrounding
her head. Doreen was lying limp, with her legs lifelessly lying half curled towards her stomach. A blood soaked cloth was loosely wrapped around the new opening in her lower abdomen area.
I have very limited knowledge of the medical field, so it was a horrible feeling to watch Doreen suffer and not possess the ability to help her in any way. I simply sat across the room, foolishly clutching my camera, waiting for the appropriate time to take the needed pictures of her surgery wounds for her progress file. I find it so hard to know the right moment to take a picture at times such as this. Realistically, there isn’t a right time to take a picture of someone in pain. It is as if I am documenting someone’s weakest moment. No one wants to be seen in their weakest moment. But, pictures are essential in order to visually track a patient’s healing process, so I waited for the doctors to undress her wound and quickly took a few photos.
During the next five days, we visited Doreen at her bedside. Each new day that we saw her, she became a little stronger and increasingly more responsive when we walked into her recovery room. Naturally, as she became healthier, we began to visit her less. After about three days of not seeing her, we received the call that she might be able to go home! When we arrived at the clinic we were so glad to see that she was walking around comfortably. Doreen was beginning to become accustomed to wearing the colostomy bags and her mother had been informed of the changing and washing procedures of the bag. That evening, Doreen was given permission to return to her village.
Then, just two days ago, we were informed of some tough news regarding Doreen. We were told that something had happened and Doreen had been brought back to the clinic. We rushed into town and found Doreen back in
her previous recovery room, crying in pain. At this point in her stage of recovery, there should be little or no pain. After talking to her grandmother many times to figure out the complete story, we learned that Doreen had been climbing a stone wall and her foot had slipped, causing her to fall the ground. The impact damaged the part of her colon which is outside of the abdominal wall and disconnected it from its original position, therefore harmfully pulling more of her small intestine out of her body. This is called a prolapse. Doreen is still recovering in the clinic today and will remain there until the doctors are sure that the colon is secured into proper position. Luckily, Doreen will be fine, but this incident could have been a major setback in her healing process and is both physically and mentally tiring for Doreen. She will have use the colostomy bags for at least another five weeks before she is able to undergo her next surgery.
After the second surgery, Doreen’s colon will hopefully be able to be connected to her anus in such a way that her digestive system will excrete waste in a normal and healthy way. This will not only give her the comfort that her body has been craving her whole life, but bring her and her whole family a peace of mind about Doreen’s health. Doreen will be able to go to school and live her life without the fear of constant ridicule about her condition. People will stop teasing Doreen about her foul smell and she will be able to go to use bathroom without worry. This next surgery is very expensive, but we know that it is very necessary. She has been struggling to live with this difficult condition for so long. Nobody deserves to live a life of fear and discomfort like she has. I cannot wait for the day Doreen is able to say that she has fully recovered!
Ugandan Advice: Never underestimate the number of passengers who are able to fit into a taxi van.