Mission accomplished, #4

I would never have imagined how much we could accomplish in just a few years. On our first trip to Mulago in 2005 there was no PICU and no cardiac ICU to speak of. This year there is a fully functioning cardiac ICU with staff that have exceeded in everything we have asked of them. The PICU was full when I went to visit, and although their staffing ratios are much more dire, with acute shortages, there were children there that were to thrive because of the more intense monitoring available.

This trip was characterized by our toddlers, Joan, Hellen, Joachim, Babu, Jesse, Reagan and Anna Grace. The largest volume of two and under, I think I have ever taken care of in one sitting. This appeared to have a whole new set of challenges for our team, not least how were we to keep them all in bed, (we had no cribs available). Their bravery and stoicism was every measure of their teenage counterparts, Peter, Ruth and Mary. To see the little ones sitting up in bed, playing, and walking with chest tubes , wires and a sternotomy dressing, made me realise how pampered we all are.

Rounds had the added entertainment of these little ones, always watchful and serious, (our night shift nurses Susan and Jeannie were the only ones to consistently get smiles.) But their antics were a delight to watch. Hellen who could see us rounding on Joan, the team gathered around her bed. Joan was sitting quiet and regal in her stunning knitted pink hat, looking for all the world like the Queen at a gala. Hellen was watching everything very intently. I then noticed that Hellen had taken a washcloth, from the end of her bed, and was doing a wonderful job of fashioning it into a hat for herself, first trying to put it on her head and tie it around the back, then realizing that it wasn't quite big enough, she placed it squarely on top of her head, and sat just as proud and regal. While we rounded on Anna Grace she took her beanie baby that had been given to her and a towel, wrapped her baby and rocked it in her arms, looking down at the baby as a doting mother, so very precious. Joan was by far the most talkative and even after some analgesia and sedation, she was giving Karla down in the country as she had her tubes and wires removed. Goodness only knows what she said all I could catch was "muzinga" ("white person") but the Ugandan nurses were highly amused. They recovered nicely as you can see by the pictures of our toddler troop, where Joan is still to be seen in her wonderful pink hat.

On our last trip to Mulago, I had spoken in the blog about Matron Jolly. She is the head nurse in the pediatric acute care and PICU. On a trip to Bangladesh last year where she was at a conference on malnutrition, she fell and broke her hip. She was walking on crutches when we were visiting in 2008 and in a lot of pain. She has since had her hip replacement surgery, performed at Mulago. She suffered a post operative complication of foot drop and is now undergoing physical therapy. I went to visit her at home and she was in excellent form. She can walk short distances, is pain free and hopes to be back at work in the New Year. She wanted me to thank everyone for their generous donations and was very grateful for all the prayers and good wishes.

I cannot express with any justice how proud I am of the Ugandan nurses. In the three years we have been to Mulago and taken care of the post-op cardiac children they have become confident and autonomous. Setting up bedspaces to receive a post-op, noticing EKG changes, giving medicines and understanding their uses. Even the nurses that were new to this "camp" such as Lillian and Edith performed exceptionally well and presented in rounds better than some Residents, having the confidence to ask questions and challenge the modes of treatment that were to be followed. I am so looking forward to seeing them again next year, to know how much further they are in their practice.

There is always a great deal of sadness when I return from Uganda, my jet-lagged body may be here in Chapel Hill, but my heart stays in Kampala for a long time before it is ready to be back.

Katherine Desrochers, RN