Health Care in Uganda

I've been meaning to sit down and write this for a while, but the holiday season has been a busy one, filled with dear friends, lots of baking, and a litter of kittens.

A couple weeks ago I got my first real glimpse of the medical system here. Don't get me wrong, it's not like I didn't know what kind of crazy stuff happens here, but this time I was right there in the middle of it. When I first got to Jinja in September, my roommate Kate introduced me to a pregnant 16 year old girl (Sandra) she was working with because she was concerned for her health and safety once labor started. I first came to see her in the small shack she lives in in one of the villages down the road. She told me that she thought her baby was due sometime in October but wasn't sure of the exact date. One look at her belly and it was obvious that her baby was not coming anytime soon. After a bit of digging in her medical records (with was nothing more than a notebook with a few bits of chicken scratch in it) and asking her a bunch of questions, I gave her the due date of December 4.

On December 10 the call came that she was in labor at Jinja Main (the main hospital in town) and they were wanting to do a c-section because she wasn't dilating. Luckily, Kate was smart enough to recognize the giant red flag and asked me to come and see her. Upon my arrival I found a very comfortable Sandra walking around the grounds with Kate hoping that labor would pick up.

A few little details for my OB friends....

• She was 2 cm since the previous night when she arrived at the hospital
• She was not contracting other than the occasional mild one
• She had a possible ROM but no tests had been done to confirm and no further fluid was coming
• Positive fetal movement and good heart tones by fetoscope
• No ultrasound had been done (despite the fact that they had an u/s machine there)

After I got there we waited for a few hours for the doctor who was supposed to come and assess her and decide whether or not to do a c-section. We waited and waited and I did everything I could to try and bring some contractions. Finally, after seeing that the doctor was not going to come and see her and that we would be sitting in the hospital all night waiting for something to happen and would then most likely go to c/s in the morning, we decided to check out of the hospital. I spoke with the nurse and told her we would like to leave and would bring Sandra back when her labor picked up. Of course, the nurse was not particularly happy with this plan and said that we needed to wait for the doctor to see us... in the morning. So we left.

Labor ward in Jinja Main Hospital

After bringing Sandra home for further assessment I determined that she was indeed 2 cm and that her water had most likely not broken. So I sent her home for the evening with instructions to call if anything changed. That night, unbeknownst to us, her roommate brought her back to the hospital for fear that she would not be treated later since she left the hospital against the doctor's advice.

The following morning we received a call that Sandra was there and the doctor's wanted to do a c-section because the baby was too big for her pelvis. She was 16, after all, and everybody knows that teenagers can't push out babies (note the sarcasm in my voice). After debating whether I should even get involved again since things were all ready in motion for surgery and I didn't want to risk making the staff angrier than they already were (the supplies were being purchased already... because in this country you have to go and buy everything that's needed for surgery at the pharmacy before it will happen. So basically, there's no such thing as emergency surgery and if you don't have the money you're not going to be treated) I finally, with Kate's encouragement, headed back to the hospital.

“Be nice. Be nice. Be nice.” That's what I kept saying over and over again in my head. Anyone who's ever worked with me knows that when it comes to my patients and disagreements about their care I tend to come at it with fists flying and that's not the way to get things done in a country like this. One wrong move and they would torture and abuse Sandra to get back at me. So as I entered the OB ward I just kept saying to myself, “Be nice!”

And, I'm proud to say, I was. I didn't insult anyone's intelligence or tell them they were a bunch of idiots who had no idea what they were doing. I calmly stated that I would like to take her to get an ultrasound to get an estimated weight on the baby and check his condition before we made any decisions. At first, the doctor agreed, though not particularly happily. I'd discussed the plan with Sandra and her mom, who both agreed. But somehow from the time I walked over to talk to the doctor to the time I returned, Sandra had changed her mind and decided she wanted to proceed with the c-section. She was terrified. Terrified that the doctors and nurses were going to abuse her out of anger.

And so back to the doctor I had to go to tell him her decision. At this point, he's pissed. I mean really mad. And so I got to stand there while he yelled at me, while the head of the OB department yelled at me, and while a big angry nurse both yelled at me and physically was trying to drag me through the ward. “Be nice. Be nice. Be nice.” And so I stood there and I took it. Madder than I've ever been because I knew everything about the situation was wrong.

And so a c-section it was, later that night.

I wasn't going to go back to the hospital because of what I knew would happen if any of those doctors or nurses saw me. But I got a call that morning saying the baby was on oxygen in the nursery. I still debated going, but my plans for the day had been cancelled due to rain so I decided to just go check on mom and baby to make sure everything was OK. They told me the baby was doing well, just weak. So when I walked in and saw a dusky, blue-tinged, barrel-chested baby laying there struggling for breath, I was shocked.

Meconium aspiration.

My theory: At birth his apgars were 5 and 7. Which meant they had to resuscitate. But, as I discovered later, the entire town of Jinja is without a neonatal sized laryngoscope. So how could they have properly resuscitated him (OB friends.... that question's for you)? Most likely, they just put an O2 mask on him and pumped the meconium right into his lungs.

So, to spare you the minute-by-minute account of what happened that day, I'll summarize. After many phone calls and running about town to try and find a western-trained doctor to help, Sandra's baby was finally transferred to Kampala where he could be properly treated. We managed to get one of the only ambulances in Uganda that had oxygen on it, found the only place that could intubate a baby, and sweet-talked our way into getting transferred to another hospital.

All I can say is that when that ambulance pulled up 7 hours after I'd arrive at the hospital that morning with a well-trained doctor on board who immediately started properly treating the baby, I felt like I could finally take a breath again.

I am happy to say that baby Hansel returned home from the hospital on my birthday (the 27th) and is doing very well!

Those few days were a fight, a struggle, both for decent medical care and for life. I saw the corruption. The bribes. The lack of equipment. The horror that is Jinja Main and having a baby in this country.

So for my medical friends who have been wanting to know what it's like here, here are a few notes for you...

• Even though some of the technology is here, doctors don't want to use it
• If you don't have the money to pay a bribe, you aren't going to be treated well
• The OR smelled like urine
• There isn't a neonatal sized laryngoscope in the entire town of Jinja
• You can't ask questions about your care
• C-sections are possibly more common here than in the US
• You have to bring your own medical supplies to the hospital if you want treatment
• They can refuse to treat you if they want, even though they aren't supposed to be able to

*Side note: Another friend here just went into labor last week and they tried to do the same thing to here. The doctor's told her the baby was too big and she needed a c-section. She was smart enough to run and went to a village clinic where she delivered a healthy baby boy.   

Triplets

So, as it turns out, having 3 babies is hard! About a week ago I started helping with a set of triplets born to a mom from one of the outlying villages. Three little girls! Aside from the fact that triplets survived, were born relatively close to term, and were delivered via normal delivery without any prenatal care, mom had no idea she was having triplets. Can you imagine? Going to deliver your baby and having not one, not two, but THREE babies come out? I'm thinking I wouldn't be so happy about that one.

Mom and babies are doing so well though! They seem as though they are slowly gaining weight. They generally feed pretty well, except for the biggest which is a total pain in the butt and refuses to suck her bottle with any vigor, but overall they are thriving.

The first couple nights I stayed there with them, sleeping my teeniest girl on my chest. I use the word "sleeping" loosely as it turns out that trying to fall asleep while you have a tiny human life tied to your body is a bit difficult. I also got about 30 mosquito bites that night, so if I end up with malaria next week we'll know why. The second night that I was with them there were a total of 3 Ugandan women sleeping in the room with me. I'm not sure if you knew this, but Ugandan women are loud! Actually, this entire country is loud. They talk and laugh and cough and do everything you can imagine to make sleeping in the same room incredibly unpleasant... this, of course being, because they can sleep through anything! Boy how I wish I'd managed to develop that trait.

But mama is doing well. Feeding her babies, cuddling them, and helping them to grow big and strong.

It's been such a blessing to be apart of these small ones lives. Hopefully a redemptive story, a second chance after Lokute. A chance to help 3 little ones thrive and grow. 

I love how God redeems what was once lost, how he makes new what I thought was beyond repair. He is a God of redemption, and for that I am thankful!

A visit to the doctor...

Sometimes Uganda makes me want to scream. Or bash my head up against the wall. Like when I walk into a clinic with a patient and the receptionist gives me a script and lets me write out the doctor's orders. Because my skin is white I can do that. There are times when this is an advantage, but it also just goes to show how corrupt and ridiculous things can be in this country. On monday it meant that the girl I brought to the clinic was seen quicker. It meant that she got the tests that I knew she needed. But really!? I can't find a doctor that knows on their own what sort of tests should be done! And was the diagnosis because the doctor knew or because it was what I wrote on order sheet?

Today I was back in the clinic with another girl and for 1 1/2 hours I sat in the exam room waiting for the OB who was supposedly coming from the other hospital sometime that day. Over 3 hours of waiting occurred before we finally gave up and left. For my OB friends... 3 hours of sitting and waiting for a specialist for a partial placental abruption at 20 weeks only to leave without being seen. And then I had to send the patient home on the back of a motorcycle out into the village in hopes that she heeds my warnings about bed rest. Those are the things that make my heart ache and make me long for a place here where women get proper treatment.

Did you know that it only costs 5,000 ugx to see the doctor? That's $2. And for an ultrasound... 20,000 ugx ($8).

Eclipse

This Sunday there was a hybrid solar eclipse. I happen to be in one of the best places on earth to see this awesome sight.

So we ended church a little early and gathered around a few old x-rays with some of my favorite friends and watched as the sun disappeared. 

So cool to be able to see this once in a lifetime sight!

Because Ugandan Women are Awesome...

I happened across this video today (while working incredibly hard on something very important, of course) and thought it was too awesome not to share. A little glimpse of this place that I am living right now...

Dreams

Four years ago I sat with my friend Tamara and told her my dreams of opening a birth center here. A place where women could come and safely deliver their babies. Where medicine is practiced well and doctors and nurses know what's safe. Where sick newborns would be cared for in something other than a metal basket.

But sometimes dreams feel really big. Like they could never be accomplished because they would require too much money or the help of too many people or there are just so many pieces that would have to fit together in order for that dream to be a reality that it could never be done.

A few days ago I met with Vanessa, a labor and delivery nurse that I met 2 1/2 years ago when I came here for Karis' birth. It turns out Vanessa has the same dream, only she has way more of the pieces in place. She's dreaming of a place much the same... with delivery beds, and an OR, and a nursery, and nurses that know what they're doing. And fetal monitoring and baby warmers and IV pumps. It turns out that a place like this may only be a couple years away from being up and running in Jinja. All that's needed right now is the funding to buy the land and build the building (And I use the word "ALL" loosely, because what that roughly translates to is $250,000).

I'm not quite ready to up and move myself to Jinja, but if this place really happens, it just might be the boost I need to make the move over here for a couple years. But for now it means going home and dreaming and talking to hospitals and doctors and nurses.... helping to raise the money for this place. It means getting to be a part of this amazing dream.

And for all of my amazing OB nurse/doctor/midwife friends... now is the time to start thinking about how you'd like to help bring better care to Uganda. Because we would love your knowledge and your skills and your connections to people with lots of money who want to give it away. :)

Old Folks

I love old folks. Just wanted to share these little gems...

Time to live

One of the things that I love about being in Uganda is the pace of life and the unique and authentic relationships that happen here. There is a depth to friendships here that I seldom experience at home. Friendships that are formed here stick, even after you're gone, because of that depth.

All the girls for Kate's birthday

There's something here called "African time." It basically means that nothing every happens at the time you decide. If you say 10am, it generally means sometime between 11 and 2. While this aspect of life here often makes me want to scream, it also creates a culture of relationship. There isn't always something to run off to do. There's just more time. Time to sit and talk. Time to listen. Time to welcome people into your home and invite them to stay for lunch, and maybe even dinner too.

One of my favorite things about being back here is the time I'm getting with my dear friend Tamara and her family. I've spend hours sitting and laughing with her. I've sat on her couch and read an insane number of books to her kids. And it isn't scheduled. It just happens. Because when you live here (whether you are Ugandan or you're an American in Uganda), life takes on a slower pace and isn't so overbooked that you don't have time for the people around you. And when you stop looking at your watch or wondering if there's something better you could be doing, you will find yourself immersed in conversations and relationships that are so much deeper and richer than you could have ever imagined.

Sweet Karis

Honestly though, I don't know that life will even happen like this in the states. Not because it isn't possible, but because both parties have to take off their watches and just live a life of community... And it doesn't seem likely that many people would be willing to do that. And that makes going back to America seem like a pretty hard thing to do, because right now, this place and these people... they seem a whole lot more like home.

Home in Jinja

My awesome roommate, Kate

I've finally settled into life here in Jinja. I'm working on developing a website for the pregnancy center and will possibly be doing a half day class on pregnancy/birth (assuming I can develop such a curriculum). It's been such a blessing to spend time with my dear friends here and get to know their kids again... and to meet lots of new friends. Already I am anticipating how hard it will be to leave, just as it always is. I love my life when I'm here. I love the person I am here. And I love the people here.

 

Much of my life is similar to home, though life in Uganda is it's own breed of crazy I bake delicious treats for my friends.... only here you have to pick the ants out of your cake batter. I watch movies with my friends.... though the power may go out in the middle. I go to the market.... only the floors are made of mud. I go to a cafe to get work done... only the internet may go out in the middle of my blog and the person with the login code has wandered away. I hang out with awesome kids... only we sit in the chicken coop for fun. Life is just different here, but it's still life. It's still full of laughter and fun and friends.

But then there are parts of my days that are so different from home.... Like when I sit in the small one room house of a 16 year old girl who is pregnant. Or when I use the microphone on my phone to try and hear the heart beat of her baby. When I measure her belly with a scrap of paper to see how many weeks pregnant she might be. When I photograph plump little babies who would have died without the help of some amazing women here. Things here are both incredibly simple and infinitely more complicated than life in the US.

And I love it.

Rwanda: Days 1 and 2

For me, visiting East Africa is like going home. The landscape of Rwanda was possibly even more beautiful than that of Uganda. Stepping off the plane onto the runway my lungs were filled with that sweet, warm air. It's a place that feels familiar... the red dirt, the waving children that run alongside your car, the beautiful faces of the people.  Being crammed in the back of a car and bouncing along the unpaved roads suddenly becomes an adventure. Rwanda felt like a place of joy, where a simple wave out the window would lead to broad smiles and cheers from those standing alongside the road.

Rwanda, however, has a broken past, filled with hate and murder and terror. Our first day in Rwanda we visited the genocide museum. My heart broke as I looked at the faces of the children who were brutally murdered, who were sliced and stabbed and beaten. I read the stories of those that tried to help and those that stood back and did nothing. I can't help but feel that we, the rest of the world, is nearly as guilty as those holding the machetes, because we knew yet stood back and did nothing. If you don't know anything about this part of Rwanda's history I would encourage you to go learn about.

The museum was a heavy place to begin our time in Rwanda, but it created context to the place and the people that we were stepping into. But the people were a people of joy, who are learning to work together for the betterment of their country. Our second day was spent at World Relief Rwanda where we learned from the staff the roles that they had in the community. There was Mobilization for Life, where teaching to youth and families was done on the value of faithfulness and HIV prevention. There was the Orphan and Vulnerable Children (OVC) programs where volunteers in the community partner alongside those children and families. And there was the Savings Group where men and women in the community come together to save their money, creating small loans and spurring each other forward to move up out of the poverty they've been in for so long.  More to come on all these things.

It is a privilege to be a part of a church that partners with such an organization!

*Photos will be added upon my return... unfortunately I am unable to upload any of them while traveling* 

Jinja

After two amazing weeks in Rwanda with my team from Bethany, I ventured off on my own a few days ago and made my way to Jinja, Uganda. My journey started off in a tiny little airplane so small that it was powered by propellers, which sent me into a full blown panic attack, yet I somehow managed to survive the journey. That followed by a short stay at a backpackers hostel that decided lining the floors with contact paper was a good idea. I then made the hour long journey to Kampala where I was planning on catching a taxi to Jinja. Instead I ended up crammed into a huge coaster bus with herds of people, though I somehow managed to bargain my way into paying even less than the locals, which I'm pretty sure was the first time in the history of Uganda for such a deal to happen.

Anyway, I arrived safely in Jinja and settled into a house with a couple other girls. I still have yet to figure out what i'll be doing here, but I've happily been visiting with dear friends and enjoying some of my favorite Ugandan treats.

More updates to come on my time in Rwanda after I've had a little more time to sit down and process....

A brief overview

We’ve been in Rwanda and Uganda for 10 days now (or at least I think… to be honest, I’ve lost all track of time here and literally have no idea what day it actually is). Internet is spotty here and it turns out that writing a blog post on your phone is actually much harder than one would imagine.  There are so many stories to tell, and I wish I’d been able to write them as they happened, but I’ve needed both time to process as well as slightly more reliable internet. Even now as I’m sitting down in an attempt to write something about our time here, I’m looking at the clock and realizing that I am supposed to head to dinner is 7 minutes… but I promise, many more stories to come as soon as my team heads home (tomorrow!) and I settle in to Uganda.

An incredibly brief overview of our time…

We’ve spent time learning about World Relief and their work in Rwanda.

We’ve visited the homes of families affected by the amazing staff at World Relief.

We met a girl names Josephine and her goat, whom she was incredibly proud of.

We have danced up a storm (literally… the dust cloud was huge) in a mud and stick church.

We’ve bathed in swamp water while learning about the lack of water sources in Uganda.

We’ve heard the stories of pastors who have devoted their lives to bringing together local churches to better the lives of their community.

We’ve eaten multiple forms of potatoes for every single meal for the past week and a half.

I have so many stories that I cannot wait to tell here, but alas, it is time for more potatoes, so I must sign off for now. 

Post Card

So, I had great intentions to have this made in to fun little postcards to send to all of you so you could keep this on your fridge, but obviously that didn't happen and I leave in 4 days and don't anticipate that happening before I go. But at least I have the digital version for you, right? Thanks for all you prayers and encouragement... I can't wait to update you all on the happenings of the next couple months!

The Journey: Part 3

In case you haven't already figured it out, I'm giving a brief synopsis (or not so brief as seen in the previous post) of each trip leading up to the upcoming one. My third trip to Uganda was very different from the first two. This trip has so many emotional memories tied to it, though none of them have anything to do with where I was.

The second time I'd gone to Uganda I was introduced to a fantastic couple who I adored from the first time I met them. Before I left we joked about how cool it would be if I would be able to come back for the delivery if they ever had a baby. And sure enough, a few years later, there I was, arriving just in the nick of time to help their sweet little girl enter the world.

That trip was also about bringing someone I cared about very much to this place that I loved. About showing them this place that I hoped to one day return to, perhaps to live. But I also cared about this person so much that I would have been willing to give up Uganda if they asked me too... and though they never said it directly, I always felt as though I'd have to do that for them. And that changed the way I felt about this country. I loved somebody more than I loved this place, and I hadn't experienced that before.

Uganda slipped into the backseat of my life for quite a while after that last visit. It became a place that left me feeling bitter. I blamed it in part for the loss of that person. I tried hard not to think about it for a long time, pushing it further and further out of my mind. But it always crept back, finally forcing me to look it in the eye and to figure out where we stood, me and this far off land.

The Journey: Part 2.1

I pulled out that old blog post about Monica and my adventures with bringing her back to the states, but there was a lot more to that second trip to Uganda that's worth revisiting. Especially this little guy...

Lokute's story is a longer one than I'm going to retell here, (You can read old blog posts about him here) but it was an important one. It gave me my first real glimpse of village life. My first real heart break at not being able to care for someone the way they deserved. It was a new kind of heartbreak and a new passion. I was just starting to step into my role as a nurse, just beginning to find my niche. Uganda was where I first began to develop a passion for moms and their babies. That was also the first time I was called to come help deliver a baby (of course, I had no idea what I was doing yet and was completely terrified).

One of the things I'm most excited about for this trip is the fact that I now am experienced in my field of expertise. I know my stuff. And I cannot wait to see where I'm going to get to use that experience. 

The Journey: Part 2

My second trip to Uganda ended with a fantastic story that I feel like needs to be re-posted due to the absolute hilarity of it. It was originally a 5-part series, but I'm going to post the whole thing here. I know it's long, but it's totally worth reading!

Part 1:
It was a week into my trip when I finally got a chance to check my e-mail, a rare joy in Uganda. There in my inbox was a message from Judy Kleis. There was a lady named Jody adopting Monica and she needed someone to fly back to the states with Monica. Judy thought of me.

The timing was perfect. Monica's papers would be done right around the time I was leaving (we ended up getting them the day before we left). After brief consideration, I decided there was no reason why I shouldn't bring Monica back with me, other than the obvious of course: she was 2 and we would have 30+ hours of travel!

I'll spare you all the details of what happened between me saying yes and our actual departure. The journey home is where the good stuff is.The day we left was a sad one. I had to say good-bye to my all my kids who were spread out around Jinja. I had to say good-bye to my friends, both new and old. And then I had my final lunch at Amani with Judy, Andrea, Malia, and Monica. We sat on the clinic steps, much like we used to, while the mamas said their good-byes. And then off we went. 

The journey to the airport was over 3 hours, thanks to lots of traffic, and Monica clung to either me or Andrea until we finally got her to sleep. Then it was another 5 hours at the airport before our plan left. I wish I had a picture of the scene that ensued after our arrival at the airport. I had my two bags plus a big bag of Monica's, her backpack, my camera bag, the stroller, and her. After tying her to my back with a scarf I managed to load everything onto a push cart (thank goodness they had them!). I then immediately had to unload it all onto the x-ray machine, which you had to go through if you wanted to go to the waiting area, and then load it all back onto the cart. By this time, Monica was getting cranky and hadn't eaten dinner, so we went in search of food. Of course there was only one place to eat and it had a limited selection. We ended up with fruit, a samosa and a juice box. Half way through the meal I realized Monica couldn't drink with a straw. After brief consideration I decided that she probably would freak out if I walked away from the table, so I scooped her up to bring her to the counter with me. Big mistake. She thought I was taking her away from her food and thus the screaming began. This was not just a regular child's cry. This was top of the lungs screeching. We were already a spectacle enough, white girl/black baby, without the screaming. At this point everyone in the airport was staring at us.

Next came the waiting game. I arranged Monica on a bench and attempted to get her to sleep. Eventually, she passed out and I was able to rest next to her, which was difficult considering I was trying to keep her from falling off the bench at the same time as making sure none of our stuff got stolen. Eventually we were able to go through security so I carefully lifted Monica and put her in the small basket on our cart. I loaded everything onto the x-ray machine again, gently lifted Monica out of the basket to walk through the metal detector.

This is where things get real good. The security guard was apparently quite fascinated by us and obviously had no idea what to do with the fact that Monica was obviously not my child. The other guard started yelling at me to get my stuff off the belt as I stood there holding Monica. In that moment I got a glimpse of what it feels like to be an overwhelmed mother. I was pissed and i would have done anything in that moment to get what I wanted. I started barking orders at the guard, instructing him on how to open the stroller so I could put her down. He, of course, had no idea what to do and couldn't follow instructions to save him. And, to make matters worse, he was trying to ask me to marry him as he did all this. Had I not been holding a sleeping child, I think I would have socked him in the face. 

Eventually all of our stuff was sorted out, I got Monica into the stroller (though she was now awake), and convinced the guard to walk me to the counter because I couldn't push both the luggage and the stroller. After what felt like hours at the counter, we finally made it through customs and into the waiting area, though we couldn't go to our gate yet, which meant sitting on a hard chair while Monica whined in her stroller (I discovered quickly that she doesn't sleep in a stroller).

Two hours later we got to go to our gate. When I got to the check in counter there, the lady tried to take our strolled and check it all the way to SFO. At this point, I was running on very little sleep, and here is this woman telling me I can't take my stroller! I kept trying to explain that strollers are usually put under the plane and returned upon the plane's landing, but she just was not getting it. "Look, I have to wait 8 hours in the London airport with a 2 year old. You are not taking my stroller away from me!" After she realized that there was no way I was handing over my stroller she agreed to let me talk to the flight crew before we left. 

Exhausted, I lay Monica on the floor and collapsed next to her.

"Excuse me. I need to take your stroller now."

I jumped up, grabbing onto my stroller. "You are not taking this away from me!"

Once again the struggle began with a new person, where I once again explained that I would not be handing over my stroller.

Finally, we headed for the plane. Being a person traveling with a child, I got to go first. So off I went, Monica in one arm, camera bag, backpack, and stroller in the other. No one offered to help, of course. Standing in line I saw that the woman in front of me had a stroller too. I asked her if they were letting her keep it. She had the same story as me. When we arrived at the plane door, together with our strollers in a death grip, the flight crew tried to take them away.

At this point I was nearly in tears. "You cannot take my stroller!"

I guess the lady realized that if she took it, I might seriously have to hurt someone, and agreed to let me try and find a place for it. So there we were, me, Monica, and our stroller, sitting on a plane bound for London.

Part 2:
I left you with us having finally relaxed into our seats, ready to fly from Uganda to London. Luckily, that route is not particularly popular, as Uganda is not exactly a booming destination, and I was able to snag us an entire middle row to ourselves. As soon as I set Monica into her seat she tipped over and fell asleep. I was able to stretch out next to her across 4 seats, using my legs to keep her from rolling off the seat, and rest. I couldn't sleep because I was worried about her falling/waking up/crying/and a number of other possible scenarios. Thus, I remained awake for the entire day and all through the night (we left uganda at 12am and flew for 9 hours). Monica slept almost the entire way and woke up just 2 hours before we landed. She sat patiently in her seat watching cartoons and munching on some crackers. We got up to wander the plane a few times. It was completely uneventful. No tears. No whining. She was perfect.

'Man I have it lucky,' I thought. 'She is so good!'

Words that were spoken too soon!

Part 3:
And so the story continues, because remember, we are only just arriving in London and there are a long 18 hours to go. When we got to London it was cold. We had to walk off the plane onto the ground, which is no fun when you're toting a child, an unopened stroller, and 2 bags. I'm lucky we didn't face plant on the way down the stairs. Out into the icy air we went... Monica's first taste of a true winter.

Upon walking into the airport they were checking passports, which of course means we got stopped. I informed the security guard that he was going to have to let me get Monica settled into her stroller before I could show him our papers. The second Monica's toes brushed the stroller, the screaming began. Top of the lungs, piercing screams. I'm sure everyone there was thinking I must have kidnapped this child or something.

So there i stood, rummaging through our extremely small backpack trying to find the papers I needed while she shrieked. (And remember, I was running on NO sleep) As I handed over the papers, it became clear to me that nobody in the airports know what to do with adoption. The papers went from person to person. Confused looks promptly appeared. Glances were exchanged and then they would shuffle off out of ear shot to try and figure out what to do. Eventually they would give up trying to understand and send us on our way.

So off we went, the screaming echoing through the halls, to spend the next 8 hours wandering Terminal 5 of the London airport. Monica became more adventurous and would wander around beside me as we waited in the security line (if you remember that same security line caused me to miss my flight to France). We made a few laps around the place, investigating all the possible places to hang out and finally I settled on a seating area that had semi-comfortable chairs and finally got Monica down for a nap. She didn't sleep long and when she woke up, she was in a nasty mood. 

We had pancakes for breakfast. But no blueberries! If I so much as suggested trying one, the screaming began again. And of course, as soon as I put her back in the stroller, she began to wail. So there we were, walking back and forth through the airport, Monica shrieking, and me on the verge of collapse. I wanted nothing more than for her to fall asleep in the stroller so I attempted to lean it back (it had an adjustable seat), but no matter how hard I tried, I could not get the stupid thing in place. At one point I had removed Monica from the stroller and proceeded to attempt beating the stroller into submission. Eventually it worked. But the change caused more screams.

The story continues like this for another 4 or 5 hours.

Once again I finally got her to sleep on a cozy chair. It was blissful for all of 15 minutes when our gate number finally appeared on the screen and we had to move to a different part of the airport. I attempted a gentle transfer back into the stroller in hopes of keeping her asleep until we got on the plane. But no such luck. We arrived at the gate crying (her, not me), swiftly boarded the plane, as I prepared myself for the true horrors of traveling with a 2 year old.

Part 4:
We shuffled down the aisle to the back of the overcrowded plane where we took our seats in a 2-seat row. Monica began howling moments after we sat down... she was both starving and exhausted. There was no quick fix for this one though. We had run out of our stash of food and thus had to wait until the plane food was served, of course this takes ages because we had to wait until we had safely been in the air for at least a good hour. And remember, we were at the very back of the plane, which meant we got served last. 

The exhausted and frustrated cries of my 2 year old were heard loud and clear by all of those around us. Thank goodness for the girl sitting across the aisle who was able to entertain Monica for at least a little while, because there was nothing I could do to pacify her at this point. 

At last our food came. Feeding a 2 year old Uganda child is a lot harder than I had ever guessed though and finding suitable foods on the tray was a challenge and was met with more screams as each offer was rejected. I think she finally settled on some strawberry yogurt and a roll. (P.S. Jody... Monica might have a slight allergy to strawberries because after that she started compulsively scratching herself and rubbing her nose) I of course felt a sudden panic, thinking that she was going to go into anaphylactic shock right there on the plane. Thank goodness I had some Benadryl just in case. Did I mention how handy that sleep-inducing drug was?
When the food was finished and I was finally ready to get Monica to sleep (a good 2+ hours into the flight) the flight attendants disappeared and we were stuck with her tray, making it impossible for me to get her comfortable in her seat. After hitting the call button and nearly screaming for someone to come and help me, I finally collected all of our things and trudged down the aisle to hand them over.

Then the challenge of sleep began. I've picked up a few techniques for getting kids to sleep over the years so I implemented my favorite. My friend Genevive calls it "beating the baby to sleep" because it involves laying the baby on their tummy and patting their bottom in a somewhat aggressive way. Works like a charm... usually. Of course, Monica made it more difficult and fought me every step of the way. So there I was, pinning her to the seat, patting her bum, and pushing her head back down every time she tried to sit up. I'm sure it looked terrible, but I'm telling you, best sleep technique I've ever learned. Eventually she fell asleep, stretched out across her seat and about 70% of mine. For fear of lights waking her up I created a tent out of blankets that stretched from the top of the seat and into the tray and then over to my seat. 
Of course, this left me precariously balanced on the edge of my seat, at the point of absolute exhaustion (having now not slept for 2 days) but unable to sleep due to my lack of space. At one point I nearly climbed down to the floor to sleep, but figured I'd get yelled at for not having my seat belt on. I tried to lean my seat back a little bit but got cursed out by the guy behind me for the inch I'd moved it. I should have punched him. Instead I sunk down into my seat to endure the miserable 8 hours left before we landed.

The story of this flight continues very much the same as the paragraph above and consisted of me trying to find a comfortable position for 8 hours while not waking the sleeping child next to me. 

Our trip was not over though. We still have to make it off the plane and through Immigration.

Part 5:

One thinks that when you get off the plane the journey is over, that the exhaustion will end, that the crying will cease, that you will stroll down the aisle to be met by the freedom of handing your temperamental two year old over to her mother. 

It's a lie.

We were the last people to get off the plane because trying to collect all of our things and set up the stroller was harder than it looked. I had to wake Monica to put her in the stroller so we could wheel our way to freedom and by the recommendation of a flight attendant, we backed off the plane (apparently you get caught on less things that way). Of course, this caused an uproar because Monica had to look at said flight attendant who followed us off. We also lost a wheel half way down the aisle. That's what I get for buying a cheap stroller: One that periodically loses its wheels. 

We finally reached solid ground. Smooth sailing from here, I thought. Until we hit the line. Yes, the customs line that wrapped itself around the room a million times and all the way down the sterile hallway where we placed ourselves at the very, very end. I'm pretty sure there were at least 500 people in front of us and that is not an exaggeration. 500 people, and then me, the one with the screaming child. We were out of food. All airplane food had been rejected. The sandwiches were thrown aside. The granola bar evoked louder screams. There was nothing left.

Thank God for the first kind soul I'd met on my entire journey. The woman in line in front of me was traveling alone with 2 kids and kindly pulled out some alphabet cookies, which miraculously soothed my screaming child. 

It was about 20 minutes later when we finally made it into the actual room where customs was and that is when I saw the small line off to the side marked "immigration." It hadn't occurred to me before that this child was immigrating into the U.S. My dear friend in front of me offered to hold my place in line while I went to investigate. The flight attendants in the line next to immigration looked apologetically at me as I wheeled myself to the front to inquire about where exactly I was supposed to be. 

The man I asked quickly shuffled me forward, taking my paperwork and asking me questions. Freedom at last! Someone was finally going to give me a break. I was going to the front of the line! Take that 500 people who don't have screaming children! I'm going first!

Then he handed me back my papers. I've put you in the system, now go back to the end of the line.

What!?!? Are you kidding me? Please say this is some cruel joke.

No. It wasn't. Back to the end of the immigration line I went, walking past the flight attendants who questioned me as to why I was returning (You see, they were on my side. They thought I should get to go first too). So there we stood, at the back of the line once again. The screaming had died down... temporarily. But soon they started up again. 
Fine. Cry as loud as you want. If you want to scream a little louder, that's fine with me too. Come on, let them hear you Monica. If they're going to make my pour, exhausted, hungry child wait, they'll at least have to listen to her scream. 

I was hoping that our little melt down would get us bumped forward, if only for the sake of shutting us up. Then another lady with a cracker showed up. I was slightly less thankful this time because the cracker caused quietness, which completely ruined our chance of getting to the front of the line.

So there we stood for another hour while all 500 people passed through and the 20 of us in the immigration stood, waiting. After a while I whipped out my phone and turned on some music. I figured if we all had to wait, we might as well have something nice to listen to. The music played and the line dwindled, and finally it was our turn. The last of the last. I once again pulled out our stack of papers and presented them to the far too chatty man at the desk who insisted on telling me of his cousin's story of adoption and discussing Monica's future. How I kept from grabbing him by the throat and yelling that he had better hurry up so I could go home and sleep, I don't know.

But we made it through. We had a U.S. visa in hand and only one last obstacle to tackle. Baggage claim. Once again it was me, a child, a stroller, and a cart full of luggage, struggling through our final steps of the journey until....

We reached the end of the road. The final two to wheel through the doors to be greeted by our moms.

A sweet reunion.

And a smile.

And a good-bye.

The Journey: Part 1

It's been a while since I've really committed to sitting down and blogging. I've had a few that have come and gone over the years, but as I sit here preparing to go back to Africa, I feel I owe it to my community of supporters to force myself into sitting down long enough to share the stories that are sure to come.

Those of you that have known me for a while know that Uganda is a place that has been calling my name for years. It was a place I fell in love with when I was 21 years old. A place that I have visited 3 times over the past 5 years. A place that breaks my heart and also makes it whole.

The first time I went there I was young and naive and I all I knew was that there were babies there that I loved. But who doesn't love babies? Who doesn't want to cuddle a sweet orphan? It's in our DNA. We can't help but love those pooping, crying, useless little people. Seriously, if they weren't so cute there's no way the human population would have survived this long. The point is, that trip was about me. That's all there is to it. I didn't understand the culture or what it means to "look after widows and orphans." I had no idea how to make a lasting impact. I only knew how to be present in that moment. And I don't want to diminish that ability to just be  present with people. That in itself is a valuable gift. But when it comes to traveling across the world, that's just not a sustainable way of caring for people.

That first summer in Uganda was, however, what planted a seed. It gave me a heart for the rest of the world. It began to teach me how to live in a culture that was not my own without seeking to change it.

First trip to Uganda, 2008