The Work is Growing!

A few personal responses to being in Uganda and then a brief update on where the work is at.  I leave our staff, our kids and the always adventurous work as I return home tomorrow after being here for the past month.

If you want to quickly get to the heart of cultural differences you could do it by looking at the way in which each culture approaches a ‘line up’.  I’m referring to a ‘line’ that you’d expect to find at any place where someone has come before you to get service from the same place you’d like to get service and…in likelihood someone will again come after you also in search of the same service or to head in the same direction.  For reasons that I can’t quite put my finger on the african ‘line up’ be it in traffic, a line in a bank, a line to get served by a shop keeper, etc is fraught with trouble for the westerner.  It seems to evoke amusingly strong reactions in me.  I think I live with a subconscious belief that the line up is at the heart of social order.  If it breaks down it seems to me that there is nothing stopping the whole thing from coming apart.  I would rather try my luck at a shop keepers where there is no line and it’s an ‘everybody for themself’ kind of situation than in a place where there seems to be a line but not everyone is following the same rules.

Here’s a common scenario.  I’m in a line up at the bank and there’s a well laid out partition on each side and there is next to no room between me and the guy ahead of me or the woman behind me and then the person in front moves forward an inch.  If you get the picture the line is going no where.  The tellers that we are all dependent on are moving at a glacial pace.   I finally get an ever so slight bit of space with the guy ahead of me only to find that then the woman behind starts nudging me forward!  Ideally I’d have a foot of space in front and a foot behind but no I only get a couple inches.  I then begin to enlargen myself so as to create more space than I really occupy so that I get the needed personal space. Given all the time I have in the line to reflect on this phenomenon I wonder if the reason Ugandans balk at line ups in general is because they don’t trust ‘the line’.  In other words am I supposed to press myself up into the personal business of the guy ahead because the others behind don’t trust that someone won’t try to come and bud in if I leave a little opening?  This is the only conclusion that makes any sense.  One time while I was enjoying a full stride’s length between me and the person ahead of me it vexed those behind me so much that an armed security guard came over from his post to tell me to move a foot forward.  I feel myself drawing so many conclusions regarding cultural beliefs from the ‘line up’.  The sanctity of the line up is so deep that it is quite rare for someone to bud in line at home.  If it does happen all our machinery of justice gets quickly activated or we are so taken off guard that we can only assume that the person has an emergency to attend to.  My working theory is that the ‘line up’ is not equipped as a social mechanism when people are hungry.

The other phenomenon I’d like to mention has to do with the experience of being overcharged by a boda driver.  These are small motorcycle taxis where the drivers are grinding out an impoverished living making $10 per day if they’re lucky.  Yesterday a guy took my 5000 schilling note ($2) when I got off his boda and didn’t want to give me any change at all.  The ride should have cost 1500.  That means he was trying to take me for 3500 ($1.50)!  I was outraged and just about lost all human decency.  Our sense of justice is a funny thing.  We think we have some kind of claim on it meanwhile if I take a step back I have never been hungry due to lack of funds a single day in my whole life and I have so many forms of privilege compared to my boda driver it’s embarrassing.  Traveling helps tease out hypocrisy and bring it into the light of day.

Each time I come here I have the clear realization that I laugh more, feel satisfaction more, get frustrated more, and am brought to tears over the suffering of others more than in any other place or any other time.

The work is growing:

Our staff receive a call for help from a new parent almost every day.  During the month I’ve been here we’ve operated on 12 kids and just this week we’ve had 15 new referrals of children with these conditions: inability to control stool, major burn contractures of neck and arms, 3 with clubbed feet, bladder exstrophy, cloacal exstrophy, 2 with femur osteomyelitis, severe malformation of the head & cleft palate, TB Spine, knee contractures, cataracts & keloids, umbilical hernia, and knock knees.  Of these there is one condition that is untreatable and the life expectancy is very brief.  The dear baby is 4 weeks old and his name is Eden.  The need can be overwhelming at times and every so often we have to close the doors for the day and turn off the phones for a  while so we can regroup and not lose sight of managing one child at a time.

A few shots of what’s happening:

Our goal is on getting good outcomes like you see here with Umaru.  The transformation from the ‘before’ to the ‘after’ represents months and months of appointments.  The surgery is a major event but it is one day while all the days that follow are what get us where we want to be.  We are always honing our process in order to make the follow ups successful.  As you can imagine there are any number of obstacles to consistent follow ups including the most common which is parents not having a phone and the problem of having no money for transportation.  To get to some of these kids homes is an unbelievable trek so when they have to come in a couple times a week it is a major commitment.


This is ‘gallows’ traction to treat a fractured femur in this boy, ‘Chosen’.  I show you this so you can see what the conservative treatment and our first option for treating fractures looks like.  For young kids it is 3 weeks in this position.  The first few days are pretty rough but after that the kids seem to adapt if they have good parental care.


These dresses are made by one of our supporters and they have turned into the perfect gift to go along with our care of the O4A girls.  Our own Dr. Moses has recently described them as, ‘highly functional and universal’.  The girls love them and we often see them show up for all their reviews wearing their dress.


The grinning bear-like man is Pastor Timothy who referred our very first patients to us back in 2012 and has been sending us patients from the islands in Lake Victoria ever since.  Here he has brought Rose (white skirt) who was severely abused by a step mom three years ago such that to this day she can hardly walk.  She needs surgical care for a bone infection in her femur that ensued from her injuries.   Winnie, the girl in the orange dress, came with a badly curved spine which was diagnosed as TB spine.


This is Roses’ right thigh.  Since osteomyelitis is our second most common condition that we treat I wanted to show you what an infection sinus looks like.  This is not a wound but rather the channel created by the pus to find an exit from the bone where it builds up and eventually breaks down the bone into fragments.  Many kids in Uganda break bones due to an underlying condition of osteomyelitis which weakens the bones significantly.  By the time a child has a drainage sinus like this the infection is deep in the bone.

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Our great orthopedic guys carefully positioning their castings so the feet end up in the right place.

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When we show up for home visits it’s never clear what we’re going to find especially for the patients who have completed their treatment.  It’s very satisfying to see kids like Shahadi with their feet maintaining their neutral position.

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Willy was a patient from late in 2012.  He needs these colostomy bags in order to go to school.  Thanks to the Friends of Ostomates Worldwide (Canada) we can bring bags to last him 6 months at a time.  Willy was assessed by our Pediatric Surgeon who is doing some tests to see if he can join the intestinal colonies, close the colostomy and see if he can pass stool normally for the first time in his life.  Willy is pretty excited about the possibility.  He asked me today if I could be there for his surgery.  It would be thrilling to be with him for this.



Raphael and his little buddy.  Raph is healing up from a sequestrectomy (removal of dead bone) from his tibia.  We wondered why it was his older brother and not a parent that stayed with him in hospital during his operation until we found out his dad has four wives and 20 children.

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Aisha was burned by a gas lantern that had caught on fire, was thrown out of a shop, and hit her on the right side.  She has burns all down her right side and developed contractures of her underarm, her elbow joint, and her wrist.  Thanks to some great plastic surgery she now has almost full range of motion in her arm.


A remarkably resourceful and bright young mom who traveled from the very northern corner of Uganda to our clinic to have her son assessed.  When I think about the trouble I have just getting myself from the house to the car I am confounded by these moms.  In case it’s not clear she has a baby on her back not to mention that her little boy next to her is incontinent due to having his bladder on the outside.  So, yes, she’s got her hands literally and figuratively full…so…she balances her suitcase on her head.


In conclusion: the work on this side has grown substantially and we’re so grateful for the support from back home to make it happen.  Also…Africans are amazing and I always leave feeling blessed by being here.