Week One

I regret to report that Internet access is not very reliable and is a hot commodity. I had hoped to post more frequently, but this will have to do. Thank you for understanding the reason for the long post. It is seven days in a single post. More pictures may just have to wait. They require just too much data. Check my Instagram for a few others (Nommelt).

Saturday, my trip got off to a strange start. The loneliness of traveling by myself was compounded when I arrived at the airport and found no one to greet me. Once my Ugandan telephone SIM card was activated, I sat for awhile in the courtyard of the airport, sending messages to everyone I knew at the mission I am visiting. Finally, though it was 4:00 AM her time, Cindy finally found the number of a local one of the mission drivers. I called him and he promised to arrive in an hour. 

Jeremiah is a skilled driver, as one has to be to navigate the busy streets of the capital city, Kampala. Traffic laws are just a suggestion, and traffic lights, which are fairly new to Uganda, are almost completely ignored. Motorcycle taxis, called “boda-bodas” sweep every which way, in and out of traffic wherever they fit. I knew I was in Uganda when I saw a cow standing on a raised median inside the busiest intersection through which we had to go. Jeremiah was gracious and told me to make myself at home, so I slept through most of the trip, waking briefly to see that we stopped at police checkpoints at which it was likely a good thing I was lying out of sight. Though he picked me up at 11 AM, Jeremiah delivered me safely to the visiting missionary "Team House" at about 3:30 PM, time which I’m sure could break records. 

At the Team House I met Missionaries Todd and Di Strader of Indianapolis, who were very gracious and welcoming. By this time, word was out everywhere that my arrival had been missed, and everyone was very apologetic. Todd is an environmental contractor and Di a retired nurse. They sit on the mission board and are a wealth of information about all things related to the mission. They have been coming here since its inception, and know practically all 220 kids by name. They told me they would be leaving at the end of the week, so I picked their brain any chance I got. 

The Team House patio overlooks the Nile River. As I toured the house, I was amazed at the Western amenities. There are four dorms in the house, some with eight bunks, each neatly made and ready for guests. There are three bathrooms, each with European commodes (like you are used to) and not the African toilet (which is a porcelain hole in the ground with feet placements). This, and the hot water were my two most welcome surprises of my arrival. I was prepared for the absence of both of these. Each dorm room is equipped with a fan, and the house itself runs primarily on solar power, but has the option for switching to the hospital’s generator if the need arises. 

The mission’s current family-shelters are set up in four pods of seven houses each, with a house mother, called “Auntie” at each house. In addition, there are two houses of children who have reached adulthood, but who are still completing secondary school. The boys’ house is situated between the Team house and the secondary school, with the girls’ house on the other side of the school. The adults are extremely well mannered and welcoming. I was called “Uncle” upon arrival, as apparently most men are. Since there was already an “Uncle Todd” (Strader), I agreed to be called “Uncle Toddrick,” a variation which includes my real first name, Richard. 

Sunday, we attended church services which have been held outdoors since Covid restrictions began. The congregation likes it outside so much, they may continue to meet that way as long as weather permits. The worship was lively and the sermon fiery. Pastor Robert, who is also the campus I.T. wizard, gave the sermon just before departing for the week. Eunice, the Spiritual Director oversaw worship and gave the offering call. The worship team was talented and full of joy. 

After church, the older boys played a basketball game. They play hard and a few sustained injuries. They went to “Momma Di” who directed them straight to me. So, I became sort of a campus nurse right away. Once young man presented to me with a surgical wound that needed a dressing change. I had brought some first aid supplies with me and, between Di and I, we managed to make him more comfortable. Normally, for serious concerns, the kids go to the mission hospital and the cost is included in their sponsorship, but for minor things they report to one of the house mothers who acts as a nursing assistant. At least for now, they see Momma Di and me as more knowledgeable alternatives. 

I met a missionary named Jessie Washburn, who lives here most of the year round and serves as the librarian. She lives in one of the pod houses rather than in the Team house. We made friends quickly, and I am glad she will be here after the Straders leave. 

There is a staff Hospitality Team, Michael and Robina, who bring me my dinner and clean up once a week with laundry services provided at that time (excluding underwear, which visitors are responsible to wash and dry themselves). The other couple living in Team House are James, who is in charge of procurement, and his wife, Judith, who manages the restaurant and cooks most of my meals. Judith is an amazing cook! At about 6 PM each day, meals appear on the dinner table in plastic containers. There is always more than enough, so I usually have the leftovers for lunch the next day after preparing some eggs or oatmeal for breakfast. Ugandans do not eat breakfast when they wake up, but later, about 10:00 AM. When the nurses receive their tea for the morning, they usually include me, occasionally even offering me some of their restaurant-bought breakfast treat — Mendazi. Mendazi is a sweet triangular cake pastry, like a cake doughnut without icing. 

Sunday, after the ball game, several of the older girls were going into the bush to harvest Cassava. You may know it by its Spanish name, Yuca. It is a root that, when cooked, tastes like fresh, warm bread. I accompanied them, and they laughed at me as I stumbled through the brush, as we all made enough noise to scare the wildlife away. The girls warned me that the Forrest Cobra is the worst thing we could come across, but we found none of those, and someone had already harvested any of the good Cassava. Still, the experience of tromping along with the girls was rapport-building and memorable.

Monday morning, the Hospital Clinical Director’s wife, Maryanne Cessnun, escorted me to the hospital and introduced me around. Her husband, Dr. Colby Cessnun was out of the country on an unexpected errand. The two of them live down the road from Team House, and have ten children, so it was a special blessing for Maryanne to spend time with me. 

At the hospital, the Primary Nursing Officer, Sophie, made me right at home. She briefly showed me around and introduced me to the Hospital Managing Director, Dr. Godfrey Lewo, who was also very welcoming. Sophie then led the staff in a devotion and worship that lasted about a half hour. Every morning at 7:30 the staff begins this way, except for Wednesdays, when that time is used for continuing education presentations by one of the staff. Around 8:00 AM, the staff takes their places. I went on rounds with the doctors, hospital clinicians, nurses, and of course, Sophie. 

There are two wards open: a general ward and a maternity ward. Several others are built, but funds are not there to open them, so they are used for storage or isolation patients. Since I have no maternity experience, I stayed in the general ward. Nurses Harriet and Samuel made me quite welcome and were very patient as they taught me how to make do with the limited resources at the hospital. Harriet paid me a high compliment. She said she likes me because I am not like others who visit, who act like they know everything, telling Ugandan nurses what they are doing wrong. She said, “You are not proud, but teachable. I like that.” I reaffirmed that I do not know enough about what she does to be proud, and we got along famously. 

There was one blood pressure machine per ward, but each was in disrepair. The pulse oximeter did not work on the one in the general ward. I happened to have brought one, so we used it and my infrared temporal thermometer to check vital signs on nursing rounds. I changed wound dressings, and assisted the doctors with the placement of nasogastric tubes. Samuel showed me his method of applying a urinary catheter, since I was so spoiled with my experience with only full pre-assembled kits. He pieced together what he needed out of what was available and, while best practices may dictate differently, practices with limited resources are what they are. American nurses reading this will be surprised to know there are not even pre-filled saline flushes (10 mL syringes of normal saline used all day every day in the life of an American nurse). Instead, when a flush is needed, a syringe is filled from a 500 mL bottle. 

I treated my first ever pediatric patient, a six-month-old baby with malaria. She cried every time I accessed her IV cannula, so I tried to spend some time with her that was not related to care. By the time she was discharged a few days later, I even got a smile. There were three critically ill patients, one of which was move to isolation for suspicion of tuberculosis or Covid. 

The nursing shifts are morning, from 8:00 AM to 2:00 PM; evenings, from 2:00 to 8:00 PM; and nights, from 8:00 PM to 8:00 AM. I left at 2:00 with the morning shift. 

English is the national language of Uganda, but few people in this region speak it. The local language is Acholi, or a variation dialect called Alur. I am trying to learn some words, but the dialect of English is hard enough to understand. One of my favorite doctors is named Robert, but we went round and round before I realized he was not saying “Robot.” I was accused by one of my new friends of using “lazy speech,” so I am focusing on trying to annunciate all my syllables, rather than saying, “wanna” or “gonna” like Americans tend to do. In the meantime, I can say “thank you” in Acholi, “Are you in pain?” “Does this hurt?”, “God bless you!” and, more recently, “How are you?” Everyone giggles when they hear me speak Acholi. I have been told it is not because I am doing it wrong, but because they are amused to see a Mzungu (white person) learn their language. 

Tuesday, as I arrived at the hospital, everyone was busy working on an infant malnourished because of poverty. I was surprised to see measures I had never seen before. When the nurses could not initiate intravenous (IV) access, the doctor attempted to access the temporal vein in the side of the baby’s head, even before attempting the external jugular access, which I have seen. Ultimately, access was obtained in the child’s hand, and the other nurses and I administered blood and dextrose, a kind of sugar water solution to help sustain him. 

Our 71-year-old isolation patient took a bad turn, and when I went to assess him, I found him lying on his sleeping mat on the floor instead of in his bed. His pulse oxygenation, which should be between 93 and 100 percent was a horrifying 35%. When I asked the doctor what measure we would take, he said a nasal cannula oxygen delivery system was all there was for adults, and there was nothing more we could do. I suggested an anti-inflammatory steroid to help increase his lung function, but it was not enough. Our patient died by afternoon, and the girls and I performed what they call “last office,” which is preparing and securing the body for transportation. We covered him neatly and expressed our concern, as best we could, to the grieving wife who watched all our activity with saddened interest. 

When we gave report to the oncoming evening shift, we found there was only one nurse in the General Ward that night, and she felt overwhelmed with eleven patients, so I agreed to return after lunch to help her. I stayed until she said, “We are done,” at about 5:00 PM, and went to Team House for a big, goodbye dinner with the Straders and all their sponsored kids. These kids were amazing! (I say “kids” but all are adults except one who was ten.) All of them are perfectly well-mannered, interested in each other and others, and devoted to God. Several took to me like family right off. We feasted on barbecue goat and chicken, and 10-year-old Batista ate more than any of the adults. 

Wednesday morning I left for work early, so I wouldn’t be drenched in sweat by the time I got there and could sit quietly reading my Bible for awhile before morning staff devotions. It was a slow day at the hospital, so I left early, hoping to see the younger kids play their football (soccer) tournament. However, I closed my eyes to rest and woke up two and a half hours later, as everyone was leaving the pitch. Many were headed to a prayer meeting in the gym, so I joined them. Outside, I was privileged to meet one of the kids Cindy and I sponsor, and I recognized her right off. She joined me for worship and made me feel at home. 

The Straders had dinner with the directors, so it was just Jessie and me at the dinner table. We got along great, and were like brother and sister in no time. We made plans to visit Gulu in a couple weeks, where Jessie wants to do some shopping and I have a friend I would like to meet. 

Thursday, I worked with a nurse I had not yet met, but who had heard of me through one of the house mothers. She told her that I was very nice and that she hoped I come back. Apparently they don’t think that about every visitor here. The other nurse, Mirriam, with whom I had already worked a shift, shared her breakfast with me. Lunch, which I thought had been a provision for the nurses who pay for it, was extended to me, and I enjoyed my posho (like grits only from fine corn flour), black beans, and Silverfish (which are not the bugs you think of, but are tiny sardine like fish). Dr. Robert, who is always happy to share with me the clinical conditions and answers for my questions, was even more happy to have me around when I applied my penlight to his suture procedures. It is not very light in the hospital, and he is used to working in shadowed conditions. It was another slow day, so when Mirriam was sent home, I left too. 

At the Team House, I found Todd and Di Strader planning their farewells, accompanied by Jessie the librarian. We walked around the property, a distance of a little over two miles, talking about life in Uganda and the history and workings of the mission organization. It was good exercise, but I will value the walks like this for the friendships I made. 

Dr. Colby Cessnun, recently returned from an unplanned trip, greeted me as I came out of the washroom from doing laundry. He said he looked forward to meeting me at the hospital the next day. 

That evening, several of the kids came over to bid the Straders farewell. One brought mulberries she had picked and made a cobbler, which she called “pie.” No one had heard the word “cobbler” before except as a fixer of shoes. The kids were a delight, and I cannot remember when I laughed so much. We ended the night with the girls braiding each other’s hair. It was funny to see the Ugandan girls try to braid Mzungu hair. 

Friday morning, I said my goodbyes to Todd and Di and then rushed off to join the morning staff devotion already in progress. (Also known as: I was late.) It was bad timing, since the Clinical Director was eager to see me at work. 

Rounds went well, and for the second time, I was able to make a recommendation to Dr. Robert he gladly accepted on behalf of a 17-year-old critically ill meningitis patient. It was another uneventful shift so, at shift change, I went to the Maternity Ward. The nurses there, including Rose, the head maternity nurse, and Brenda, were amazingly welcoming, especially considering my lack of experience in labor and delivery. I was never so welcome! The two of them coached me through caring for the neonates, one of whom was in an incubator at 2.1 kilograms (4.62 pounds). I obviously didn’t get to cuddle these babies, but I got to administer their dextrose solution by IV and pray over them. I swear, they were the most precious little miracles you’ve ever seen! Brenda, who graduated from nursing school the same year I did but as a midwife, taught me about documenting labor according to the government chart. 

There are a couple of secondary school students who shadow at the hospital, for interest in pursuing healthcare professions. One, a 20-year-old girl named Janet, works both the General Ward and the Maternity Ward, floating back and forth, depending on who needs her help. She and I have become friends, and she has walked me home a couple times. She told me that the nurses on the evening shift, when faced with a busy workload, have asked her, “Where is your friend, Todd? Go and get him so he can help us!” They delivered seven babies this week without me. I am determined to get some labor and delivery experience! I stayed there Friday until about 6:00 PM, when I heard the doctor say no one is expected until the morning, when he will induce labor that may take all day. I was too tired to commit to coming in on a Saturday too, so I told them I would see them Monday. 

Janet walked me home, and as I considered that I would be by myself tonight, I invited her to come over and bring friends if she wanted. Most people have left the compound, either for a youth rally in Kitgum, or a wedding in Gulu. Just as I sat down for supper, Janet came to the door, so I was not alone for dinner. One of the boys, K-Morris, arrived shortly after Janet did, and the three of us sat around talking until Uncle Todd announced he was bushed. Shortly after that, Michael, from the Hospitality Team, asked me to move into the front room where Todd and Di had been staying, because the larger dorm was needed for a group that would be arriving Sunday. 

It is now Saturday, the 8th of May, and I am still in my pajamas at 3:00 PM. It is raining, and it has been a great Sabbath day of rest. I stayed in bed well past the rooster crowing, fixed some eggs, and went back to bed. When I got up, Gloria, my house guest in another dorm, was up, and offered me her leftovers from the night before for my lunch. Later, she made popcorn for her friend and for me, and I am sitting here eating it while I journal this entry. 

I still do not know in what capacity or for what purpose God has called me here, but I am more than comfortable here, recognizing it is a God-protected oasis in country that needs just that. There is so much poverty everywhere in Uganda. Even those with jobs struggle to feed their families, and many do not have jobs. People 65 and older are forced into retirement, whether they have savings or not, and usually turn to gardening to feed themselves, as many younger people here do too. This organization is a 700-acre mission compound with a farm, husbandry, hospital, primary and secondary schools, a library, and a multi-purpose building that serves as a worship center. They hope to add a mechanic shop at the border of the property, so people can get their vehicles fixed without entering the compound. One visiting missionary, an arborist, planted Teak trees, which will be an income resource for years. Hearing that, I was impressed that everyone brings something. Whatever your passion is, it can matter to the kids here. While I augment a busy nursing staff, they do an amazing job here without me. Every kid and staff member have heard the Gospel and have access to worshipful fellowship every day of the week. The name of Jesus is on the lips of almost everyone I meet. (It’s Yesu when not speaking English, a closer variant of Yeshua than even we use.) What they lack is personal interaction with someone who cares about them. The house mothers are employed to keep them safe and fed, but often the kids wander around the campus playing under the supervision of each other, with the older ones keeping the younger ones in line and safe. There is even a German Shepherd named Stoney here, who provides protection for the kids, though few care much for him. (Dogs are a necessity here, not a pet.) In fact, he is sitting on the porch of Team House, staying out of the rain, as I write this. 

Pray for Uganda. Pray for me. Pray for God’s will for me to be revealed. I am eager to matter here and to involve myself as much as I am welcome. I am already making a “wish list” for my next trip here. At a minimum, it will include children’s clothes (especially baby clothes), adult oxygen masks, books of any kind, and maybe pocket notebooks for the nurses. They love mine!

Lubanga omedi gum! (God bless you!)