January 20th, 2016
In Gulu, Uganda, about halfway to Moyo, we met our friend Denise Carlson of Missions 1040 and World Outreach. We shared a lovely dinner outside the restaurant on the grass – made more memorable by the 23 mosquito bites I sustained on my upper arms, neck, shoulders and forehead. (A day or so later the count was 32.) Neither Ajah nor Denise received a single bite. Mosquitoes single me out in a crowd in spite of bug spray because they hunger for my tasty O-negative blood. The skeeters here are so tiny I don’t see them, and I don’t hear them buzzing, not like the bird-size mosquitos in ND and MN.
In the morning, Ajah and I took a dip in the hotel pool while Denise shopped for her own program. We were on the road by mid-morning. The road leaving Gulu had been improved since I was on it in September, but the trucks and cars compete with pedestrians and bicycles and carts pulled by donkeys or cattle.
A few hours into the drive, we spotted a Matatu (small taxi-van) turned on its top. Passengers spilled across the ditch and there were injuries. Denise pulled over. A middle-aged Ugandan lawyer – David, and a teenage Sudanese girl, Akuot, were bleeding and needed to go to the hospital. Our car was fully loaded. We shifted our packages and bags as well as we could into the back of the vehicle – I squeezed one of my bags under my feet. A fan Denise purchased hung over the back seat and Akuot, the tall young girl, sunk low in the seat under the fan.
They told us other passengers had flagged down a passing car with three open seats, but they refused to take these two injured people. The driver had been speeding, hit a big stone on the road, and lost control. He ran off after they turned over.
Akout’s brother, Reng, suggested we take her to the hospital in the next town run by the IDP (internally displaced persons) camp. He said he would find us there. We had no room for him.
Both our new passengers had head injuries caked with blood and bleeding. Neither cried out or complained, but David was vocal about traveling further – to the hospital in Adjumani. Denise was worried about Akuot’s brother finding her, since he had requested that hospital. David said – it’s about saving lives. Akuot remained silent throughout. We determined to go to Adjumani rather than delay with a stop at a lesser hospital.
Akuot’s brother didn’t have a phone, but she knew a phone number for her sister in Gulu. Ajah called her to let her know what had happened, and that we were taking Akuot to Adjumani hospital. She called other relatives near the camp to meet Reng on the street and let him know where to find his sister. He walked from the accident to the town – probably two hours or more. With pain in his chest. And then he hired a Boda for the fifteen or twenty-minute ride to Adjumani.
When we arrived at the hospital, Ajah took charge of Akuot. I held David’s arm as we walked very slowly to the intake area. There are no wheelchairs to meet incoming sick or injured patients – no gurneys – no greeters at all. I hadn’t been able to see the extent of his injuries until we walked arm in arm. He was missing his ear – and the open wound was an inch wide and longer than his ear. His shirt was covered with blood. He complained of pain. When we got to the reception, a lone nurse met us and showed us into their stripped down version of an emergency room.
The room had a single metal gurney with a short plastic mattress. She directed David to sit there and then to lie down. I helped him to do so, but his head hung over the mattress and would have landed on the metal edge of the gurney. I held his head in my two hands. It was at that point that I saw he had a serious injury on the the other side of his head as well. He complained of pain and was uncomfortable laying down, so I helped him sit. His shirt was covered in dried and fresh blood. The nurse directed me to take off his shirt, which I unbuttoned with difficulty and removed. His t-shirt, too was bloody. I had reached the limits of my medical expertise, so I just held his hand.
As I did this, Ajah told the nurse she was a licensed pharmacy technician in the US, and she could help with the girl. There were no other nurses to help. Initially, we had thought Akuot’s injuries were less severe, but Ajah could tell upon examination, that they were likely far more serious. She sat her in a chair as there were no other gurneys. The girl complained of pain so Ajah from her hand wound and was to sit up in the chair. Ajah helped her sit on the floor and lean on the plastic chair. Gloved, Ajah began to clean her wounds. The obvious bloody wound on Akuot’s forehead was the least of her problems. The girl had struck something which had penetrated her skull – there was no blood – but the wound was about 1″ in diameter in a funnel shape revealing her brain. Ajah removed small pieces of stone and sand embedded in the wound by flushing it with disinfectant. The girl remained silent and did not feel any pain from the skull wound. Other wounds – her hair on one side of her heads was scraped and some skin scraped off. She had a scrape on her upper shoulder. Both hands were injured but one, the skin was cut by window glass and ripped off. That was the wound where she felt the pain. Both palms were skinned as well.
In school, Ajah said she chose pharmacy because she wasn’t comfortable with blood and injuries and patient care. They told her she had to learn all that – because you never know what you will face. And so she went about the business of managing this drowsy, seriously-injured girl, keeping her awake, and cleaning the wounds like a professional nurse.
I’ve been know to grow faint – once, to actually faint when holding down a struggling deaf child I was fostering as the ER personnel tried to stitch a head wound he suffered falling from a tree he climbed in our yard. Here I managed to keep it together because I didn’t know this man. However, beyond removing a shirt and holding a hand, I am fairly useless in medical situations.
There was no doctor here, no X-ray or MRI equipment – nothing beyond what might be available in a school nurse’s office. Outside the ward, families relaxed on the grass. At many African hospitals, the patients’ families provide the food, the bedsheets, and much of the patient care that would be supplied and managed by nurses and aides in an American hospital.
David’s sister and nieces and nephews showed up – but somehow they all stayed outside the treatment area, whereas we were in the room. David’s sister lives in the area, and she brought him bedsheets. There were no sheets for Akuot, so Denise, Ajah and I went to town with her brother. We bought sheets and a pillow and gave him small change to take a boda back to the hospital. He demurred about the small change, and we had to insist. We left, fearing that the outcome for Akuot, could be dire.
January 24th Update: Ajah has been keeping in touch with Akuot’s family. Her brother moved her to a better hospital in Gulu on Friday, the 22nd. No doctor saw her that day. The following day a doctor came and removed the bandages and dressed the wound. No other treatment or scans or anything were performed. The forehead wound is now swollen to the point of covering her eyes, and she cannot see. She was sent home with antibiotics. This is the health care available to most people in Africa.