Worms...

So yesterday I had an urge to write to you about the several worm situations I've dealt with while I've been here but didn't find the time. If you are a bit squeamish you should probably stop now...just a warning!

So story #1- I had probably been here about 1 month and little Augustinho came to us in the Bercario from the community. One day the tias showed me an odd "ferida" or sore on the bottom of his foot near his toes. It was nap time so I said I would come back and look at it after nap. Well before I could get back I was informed that Tracey (another missionary) had popped open the "ferida" and taken out 2 worms/maggots...and they were sitting on a tissue in the Bercario for me. Aleya and I went to investigate. All was true. There were 2 maggots sitting there...praise the lord they were dead!

Story #2- Aurelio is a little boy who attached himself to me as soon as I got here. He used to live in Laura's dorm but moved up in December. Anyway one week he showed Aleya (my roommate and another nurse) a sore on his chin. She was afraid it was the start of chicken poxes (they were going around the center at the time) so she came to get my opinion. I didn't think it was chicken poxes so we decided just to watch it for a few days. Well maybe 3 days later I saw Aurelio out playing and it looked like the sore had bust and puss was coming out. I said lets go to the clinic and get that washed out. Well something made me put gloves on (I know if you are a nurse or medical person at all it is shocking you that I usually don't wear gloves. But it's like I'm a mom. When there is blood involved I reach for gloves but if it's something else they usually just cause more tears for no reason.). Anyway, I put my gloves on and just started lightly pressing to get some of the puss out...well white stuff was coming out but then I realized it was not puss at all...but a LARGE VERY ALIVE MAGGOT! Seriously I pulled it out of his chin!!!!!!!!!!! A bit disgusted and not sure what to do I tried to ask the Moz nurses around what the word was for this so I could tell Aleya...no such luck...they didn't have a word for me. But that maggot was so alive that by the time I walked through the clinic and over to where the baby house tias were to ask them it had wriggled it's way through the gauze I had put it on and was actually in my hand! Nope that was it...I didn't need to learn the word...I killed it and left it at that.

Story #3- This happened just yesterday. I got a call from Erin...she said if you are bored or just want to give me a second opinion can you come up here and look in Chelsia's ear. Chelsia is a 1 1/2 year old who lives in the Bercario. So I headed up there and Erin handed me the otoscope and some normal saline and said have fun. She followed me over excited to see what I would have to say. Well I shined the light in her ear and the first words out of my mouth were, "It's a worm." Erin's reply was something along the lines of precisely. So we pulled out all the tricks in the book...we filled her ear with normal saline in hopes it would come to the service because it couldn't breath. We irrigated her ear with the only 60ml syringe we could find on base. We contemplated extraction but it was just a bit too far in. During all of this it kept changing positions and every time we would try to basically drown it Chelsia would squirm and wince like it was moving around. Finally we gave up and decided we would just send her to the doctor that afternoon. Then I get a text that says...we're next in line for the doctor if you want to come. I headed up to the clinic to walk in for the end of her consult. Erin had been told her ear looked "normal"...she said you are telling me a white thing in her ear is normal?? She walked out with a prescription for antibiotics and ear drops still with a white thing in her ear. So we called in back up...Jannie (another nurse) came to take a look as well. We decided that between the 3 of us we could probably hold her still enough to feel comfortable with extraction. So I held the light, Erin held Chelsia, and Jannie did the honors...and what did we pull out you are wondering...PAPER! Yep...Chelsia had stuff paper in her ear (or another little critter had). So we had spent all day convinced that our little friend had a worm really she is just a normal little one who thinks its fun to stick things in holes. We informed her this was NOT good and sent her on her way.

These 3 stories together speak wonders about what life is like here. Sometimes you miss the action, sometimes you are caught in the middle of something you would never have imagined you'd be doing, and other times you spend all day trying to solve a problem that you find out isn't that bad to begin with. It's just the way things go around here....

A Few Prayer Points...(and my schedule for time at home)

Prayer Points:
~Thanksgiving for all your prayers and the recovery of little Lucinda. She spent 2 nights in the hospital but now is back on our center with 2 black eyes and significant swelling but no long term damage!
~For 3 of our little ones who possibly have tuberculosis. There cases are being investigated as I write this. Also there is a new law in Moz that says anyone under 5 exposed to TB from someone they live with has to be treated as well. That is great when you have small kids in a family when a parent or neighbor has TB...but on our center this is near to impossible. Plus 95% of the cases of TB we see are extra-pulmonary so the kids cannot spread it through coughing as TB we see in the States is spread. Just a point of prayer that God would work this situation out for the good of all!
~For my last few days here (I leave in 4 days) to be filled with great kid moments and time with missionaries as well as all the work that needs to get finished.
~For safe and simple travels...my travel time is 25 hours plus 2.5 hours home from the airport!
~For my time at home, that God would be present and orchestrate all the days and moments. That in 25 days I could see and spend time with everyone who means so much to me, that God would give me the words, stories, and information to share in all my speaking engagements, and that I would be refreshed and ready to return by the end of my time at home.

Thanks for all the prayers I know you will send up!

And as for a schedule for my time at home...here's my current plan:
February 2nd-9th, Aiken with my family and friends
February 10th or 11th-13th, Charleston
February 14th-17th, back in Aiken
February 18th-22nd, Clemson/Anderson/Greenville
Then I'll be in Aiken until I fly out on the 25th.

As for speaking arrangements:
Feb. 14th-10:00, St. Augustine's Church in Aiken
Feb. 16th-evening, Bible study and prayer group in Aiken who has been lifting me up in prayer
Feb. 18th-5:30, dinner with freshman nursing students, Clemson
-7:00, Clemson nursing school
Feb. 19th-7:00, Greenville at The Summit, an elderly christian group
Feb. 21st-10:30, The Vineyard Church in Greenville
Feb. 22nd-6:30, FCA small group dinner, Clemson

I am so excited to see all of you!

Sustainability...

In the last 4 days I have thought more about sustainability than ever before. What does the word even mean in our lives and especially on the mission field...
Thanks to dictionary.com I have a definition for you: capable of being maintained with minimum long term effect.
So these are the questions I've been asking...What does a sustainable life in Jesus look like? Where do I find it? What needs to change in me and my life to make this a reality?
I don't have many answers but I will tell you what I've come to. It started probably 2 months ago. My prayer at that time (and it was prayed in trepidation) was...Lord make me desperate for you. I remember getting to that point several times and praying...Lord I'm nervous but I really want to know what it means to be desperate for you; I want to be on my knees begging for you because I can't do what you're asking of me. I firmly believe prayers like this are ones that God jumps on in his people...so what happened? I found out I was going to start working in the main clinic on the base, something I am not particularly passionate about but I accepted the challenge. From that moment I would say I've been desperate maybe without my knowledge most of the time. Many times I have in my human strength attempted to make things happen, solve medical problems, learn a system (or lack there of) that my brain can't seem to grasp. It has been a tough 2 months. Just last week when I hit exhaustion level and felt like I had absolutely nothing left to give I finally fell to my knees. That was only after a death and a birth, weeks of answering the on call phone, and 2 months of desperating attempting to figure out what I need to learn before I leave on Sunday (I will return from the States to be in charge of the clinic with one other nurse on base).
So what is God teaching me...He is the only thing that will make our lives sustainable. We have to carve out time for him to minister to us. We have to meet with others and mutually ask God to pour into us. We have to rest in him the days we are tired. It sounds like an easy concept, but for me it is tough. I love to see things improve, get to completion, and others encouraged...but that has always come at the expense of my sleep and my time. So looking back at the definition it has caused more than a minimum long term effect...it has caused exhaustion! So to something has to change....
I pray that during this time at home I am able to gain new perspective and figure out what a sustainable schedule and life looks like for me here with God as my sustainer.

5 Months Today!

I have been in Moz for 5 months today. It’s hard to believe most days. It feels like so much less time. I’m going to answer a few questions for you that you’ve probably been wondering about (or not but here it goes):

Are you fluent in Portuguese yet?

Far from it. I know they say if you are surrounded by a language you pick it up quickly, but the only issue with that here is I am not surrounded by Portuguese all the time. Most of our missionary staff speaks English (minus about 5 Brazilians) so we don’t attempt to communicate in Portuguese. It was about the end of 4 months when I was able to form sentences and usually get my point across (ok, sometimes get my point across). I still have lots of trouble understanding many people and have gotten really good at picking up main ideas in conversations. I will say that the Lord has blessed me with the understanding and words I do have because I certainly have found basically no time to study. I have done Rosetta Stone only a handful of times since I arrived and had about 4 lessons before I decided that was not going to work out. So praise God for what I have learned.

Are you excited to be home for a bit?

I am getting more excited each day that I am going to get to see my family and friends. It’s funny that when I booked the trip I thought I’m not sure I really need a break but after all the events in the last week I have realized how much of a blessing it will be to go home, get to process, see everyone, and rest a bit. I am aware that being in the US might be a bit tough and hard to understand/take in with such a short amount of time, but I can’t wait to see all of you. So I’m a bit nervous and excited all in one. The one part that seriously pumps me up is knowing I'm coming to share all God has done here in the past 5 months. I have seen miracles; I have seen transformation; I have seen our Lord at work!

What has become normal for you that you never thought possible?

So many things have become normal. Just last night I stopped in my tracks, stomped on a roach in my living room, and then kept on going with my night and thought a few seconds later…wow that just happened. Critters around has become normal. Having a fan consistently blowing on me and still sweating most of the time has become normal. I’m not sure my body will ever adjust to no air conditioner. Knowing that if I plan anything it won’t end up happening is basically a given at this point. A to do list is a joke these days as well. It’s just not the way things work around here. I never in my wildest dreams thought I would learn to not show up on time and never follow a schedule. It also is normal to wake up to a child banging at my door (and they usually don’t want me). Getting calls every few days in Portuguese about a sick kid, solving medical problems consistently, diagnosing, and playing doctor have become normal. Saying good morning, good afternoon, or good night to absolutely everyone I pass as I get my days work done is a norm. Knowing that as soon as I grow comfortable with one schedule it will change is expected. Leaving my house to kids running up with smiles yelling Mana Meghann brightens my day and reminds me of the love these kids have to give. Walking into the Baby House and never knowing what funny thing the kids will do is just a norm! It's my life; I love it most days; I get tired of it sometimes; but it's where God has placed me for now!

What has changed about you since you moved to Moz?

Ever relying on God is a must here. God has placed me here and asked me to work outside of my comfort zone. Many days I question why I'm here, what I'm doing, and why I have to put up with all the stresses and questions that come up daily when you live in a developing nation. I still revert to trying to plan things and get things done on my own sometimes...but I know in my heart there is a better way to live. I know that writing a to do list and having to add extra things on I've already done just to cross them off is ridiculous (that's how I lived in college). But being here could teach anyone that in our own power we can do nothing. Only God's awesome power and love working through us makes a difference. I get to see that daily. I get to see the miraculous medical healing that occurs; I get to see God transform hearts of youth all over our center; I get to see missionaries dedicating their lives to the children God has placed in front of them. That changes a person. That makes you want to challenge yourself to go deeper in our Father and continue daily to serve Him! Here I have seen overwhelming poverty. Something most people won't see in their lifetime. It's something I cherish. It's something I want to change. It's something that challenges me to live generously and continue to trust in our Father's faithfulness to provide for His people. It's something that points me back to my vision for being here..."you will weep no more...though the Lord gave you adversity for food and suffering for drink, he will still be with you to teach you. You will see your teacher with your own eyes. Your own ears will hear him. Right behind you a voice will say, 'This is the way you should go,' whether to the right or to the left."

That's what I want to see in Mozambique...God directing these people in their daily lives! How you've changed in 5 months is tough to put into words. I've learned to trust; I've learned to serve; I've learned more about medicine than most jobs would teach you in a year; I've learned about love....

What's your favorite part?

I think my favorite part is when I think back on how it all started. I remember thinking...I'm not so sure I can fall in love with African children. I'm just not sure I will attach to them the way I do US kids. I now think that is hilarious. These kids are my kids now. Many of them have no family at all and the ones who do cannot live with them for one reason or another. That is reason enough to love on them every single day. Do I get tired or children always pulling on me, asking me questions, and fighting for my attention? Yes, wouldn't we all! But then I step back and remember we are all they have. It's the moments that before I even reach the Baby House I can already here my name being yelled...Mana Meghann! Those are the times I know exactly why I'm here loving on the kids God has placed in front of me. Those are my favorite moments.

Prayers please...

So every Monday morning we have a clinic/medical staff meeting. We were wrapping things up as there was a LOUD knock on the clinic door. One of the tias was at the door with a BALLING little girl, Lucinda. Turns out she had been playing with a ball and fell. She knocked the bridge of her nose on a cement step. OUCH! There was only a bit of blood so I washed her up quickly but by the time I was done with that her face was beginning to swell. We decided she probably needed to head to the hospital because her nose was certainly looking broken, and she was showing possible signs of a concussion also.
I just found out that they are keeping her in the hospital for observation over night at least. Please be praying for her doctors and nurses and the tia that is with her. The hospital here is not a welcoming place, and it's just tough to be there with a hurting child. Also just pray that God heals her, whatever is going on, and gets her back here quickly and safely!

One other prayer request for me is for grace, wisdom, and understanding as I continue to learn the clinic system and look to being in charge for 3 months (March, April, and May) once I return from the US. It's a HUGE stress for me at the moment, and I would love God to be working in me and through me in this situation.

A day of BIRTHS!

So as you all know it has been quite a sad and tough week around here. Well today I had vowed to spend some time relaxing, processing, and sleeping. All was well other than an allergic reaction Erin helped me diagnosis, until Heather (another missionary who works with the girls on base) frantically came to get me. I got the babies off my lap where I was out playing in the sand and headed with her to the girl's area on base. I took one look at her pregnant tia sitting very unhappily on a mat on the ground and asked how many months along she was. She didn't really answer and then came the wince. Her face crumpled up and she just said I have pain here pointing to her lower belly. I waited after looking at my watch...the next wince came 3 minutes later. I said...Heather we need to get her to the hospital. We started trying to call our drivers and after mcell (the phone company we all use that doesn't let you call people most of the time) finally let us get through we found out there were not drivers on the center. So I went to find Iarra (another nurse) knowing that at least if she was here she could drive our ambulance. Well after some discussion we decided that Heather and another tia would ride up front (so the tia could give Heather directions) and I would ride in the back with our friend in labor. I thought at least once (ok that's a lie...the entire time) on the ride...Lord, I really don't want to deliver a baby in this car (and I don't really know how!). By the time we pulled into the hospital after bouncing her down a dirt road for several minutes she seemed to be having almost continual contractions. The nurse came out and said she was just fine to walk in. Well that took some convincing because she did not want to move from her place in the ambulance. Once we got her out, the nurse told us to wait right there. So we did. Not even 10 minutes later the nurse came back outside and said...would you like to see the baby? We were in shock...she had already had the baby (what a close call!!!!). As we walked into the maternity hospital the nurse laid the baby on the bed for us and we got to put his first clothes on! Here's the little one...
The biggest miracle was that the whole time the other tias kept saying she wasn't really 9 months along. Here women hide their pregnancy for as long as possible and it's usual for a woman not to know she is pregnant for quite some time, so I wasn't convinced that she wasn't already full term. But, I also wasn't sure if we were walking into a devastating day where a premature infant would be delivered something that doesn't usually turn out very well here...but instead look at the blessing we all experienced! Here's baby with his mommy...
I stood there over this little life this afternoon and thanked God for his sovereignty and faithfulness. In one week I have experience death and life! Only God could have orchestrated this day to bring me joy and show his love for all of us here.

I titled this "A day of BIRTHS"...the other births came in a different form. Many of our youth have spent the last several days on outreach at an Encounter God retreat about 3 hours from here. Tonight at church we got to witness and experience their transformation...the Lord has filled them with new life. Several of them shared about the new life God placed in them during their time away, the sins He forgave, the healing He did, the life restoration they experienced. Praise God!

I will not say my heart is not still heavy for little Dino's life and that I don't miss him...but God has restored me in part today. He has shown me life...something only He creates and only He takes away.

Matt Redman's song Blessed Be Your Name is exactly where my heart is at tonight:

Blessed Be Your Name
In the land that is plentiful
Where Your streams of abundance flow
Blessed be Your name

Blessed Be Your name
When I'm found in the desert place
Though I walk through the wilderness
Blessed Be Your name

Every blessing You pour out
I'll turn back to praise
When the darkness closes in, Lord
Still I will say

Blessed be Your name
When the sun's shining down on me
When the world's 'all as it should be'
Blessed be Your name

Blessed be Your name
On the road marked with suffering
Though there's pain in the offering
Blessed be Your name

Every blessing You pour out
I'll turn back to praise
When the darkness closes in, Lord
Still I will say

Blessed be the name of the Lord
Blessed be Your name
Blessed be the name of the Lord
Blessed be Your glorious name

You give and take away
You give and take away
My heart will choose to say
Lord, blessed be Your name

I cooked dinner tonight as our worship team sang this song in warm up before church. All I could think was Lord, blessed be Your name in my life and in this place!

Priviledged Pain...

Mr. Dino! What a boy!? I don't have pictures of when he entered the center but he was extremely malnourished and as you can see God performed a miracle in him over the last 2 years while he lived with us. I met him just like this...happy, healthy, joyful, playful, sweet as can be, jolly, and adorable. I have written about the vision I had at a youth conference before I came here (you can read about it here: http://nurseinmozambique.blogspot.com/2009/07/one-gauntlet-story-for-tonightand.html). Dino is one of the boys who has made that vision come true almost daily. He never failed to see me across the playground or Baby House and come running (in only the way a very chubby 3 year old can) toward me. It didn't matter if I was busy and just passing through or coming to play for awhile...he came running yelling...Mana Meghann...got his huge hug, gave me a big smile, and headed off to share his love and joy with another. What an amazing boy!? Truly a blessing from the Lord.





Tonight all the missionaries gathered for home group, our weekly time to worship, learn, and pray together. We worshiped for a bit and then all headed to the Baby House to pray with the tias who work there. Our tias are the Mozambican women who give their lives daily to spend every other 4 days living on our center with our kids. They are saints. They do the job of a mother, foster parent, cleaner, day care worker, and father all rolled into one. They do a job I could never hope to have the strength, patience, love, or care to do. They literally amaze me daily. We got to pray over them and watch the Lord begin to heal their hearts tonight. They all cried right along side me who balled my way through the entire night. We then headed back to view pictures of our dear friend (much like the ones I've uploaded here) and just share about his life and what he's meant to most of us. I've already told you a lot about him but one conclusion we all came to is that it has been a privilege for all to have him in our lives. We have each received countless e-mails from others who have been impacted by this little guy through pictures and stories over updates (me included). He was just a light to all those who knew or saw him. He truly was full of God's love and joy.





My other realization is that I am not just grieving over my first lost patient. Dino was not just a patient to any of us (as all the kids here on the center are not just patients). They are our kids. I never in my wildest dreams thought I would have children at 22 needless to say have to bury one. Instead I have been blessed with about 40 under the age of 6 and about 250 others who roam the center I live on. In the last few months I had become Dino's family. He was abandoned at 17 months old and from that point on all he knew was our Baby House. The only people he knew who loved him were tias, missionaries, nurses, and our Lord. He was our child here on earth and now he's with his heavenly father.

Please continue praying for our staff, missionaries, tias, and children as well. We did share with the Baby House kids yesterday that Dino was sick and went to the hospital. He will not be coming back to live with us but instead is in heaven with Jesus. There will be countless times we each answer their questions as they process the fact that Dino really is not coming back. Just keep praying for strength, peace, comfort, and healing for us all.

And to keep you posted the funeral has been moved to Friday at 10:00 because Thursday is the Presidential Inauguration here in Moz.

Sadness, Confusion, and Exhaustion...

Last night I wrote to you about my day basically in awe of the hospital system here. All I could think to do was poke fun at the decisions made and the things I witnessed. Today it's with sadness, confusion, and exhaustion that I write you this news.

Dino, died suddenly this morning in the Maputo hospital in their version of a pediatric ICU. Saturday he started with high fevers and was started on antibiotics Saturday afternoon. Sunday he began vomiting but his malaria test was negative and he began drinking mistura (a rehydration fluid) through everything his fevers continued. Monday morning he started vomiting everything even small sips of mistura or water. He also had severe problems breathing, started becoming agitated, confused at times, and at one point had trouble speaking properly. He went to the hospital at this point with myself and another missionary who works in the Baby House.

We sat in the ER for 5 hours with him before he was finally admitted to the ICU and put on an oxygen mask. A tia stayed the night with him and apparently kept trying to tell someone he wasn't getting any better but no assessment was done until the doctors did rounds this morning. Early today I received a text message saying he was in the same condition but some time before 9:30 he passed away. I was in the city trying to learn the buying system for our pharmacy (something I will be doing when I return at the end of February) when we received the call. We went over to the hospital to comfort another missionary and the tia who had been with them. I am praying that God wipes my memory clean of the next few hours as I helped get him to the morgue, prayed over him, and left his little body until the funeral could be planned.

To tell you a little bit about this dear boy...Dino was almost 3 1/2 years old and one of our HIV+ boys. He came to live at the center almost 2 years ago after being abandoned by his parents at the hospital. We don't have a last name or a birth date for him...just a first name and approximately how old he is. He was severely malnourished and has untreated HIV and tuberculosis when he came to live with us. He could barely sit up let alone crawl at age 17
months. God has performed many miracles in this little boy over the time he's been at the center. He transformed into a joyful, chubby,adorable character full of life. He was our "Mr. Dino" because of his ability to dance, laugh, and play through every minute of life. He's been relatively healthy after his initial recovery until I arrived. Since then he has been sick on and off pretty regularly usually with recurring chest infections. That being said he has made a full
recovery from each and his death for us was very unexpected. We even had a visiting emergency room doctor see him yesterday and when I talked to her after returning to the center today she was in shock by the news just the same as us.

Many of us are comforted today by the idea that Dino was prepared for his death. Children have a sense about so many things and yesterday Dino continually asked to go to sleep. To all those who know Dino well he would never ask to sleep. Even when he was sick and we would tell him he needed to rest or not go outside with the other kids he would cry and get upset. But yesterday he must have asked me 25 or 30 times if he could go to sleep. I pray in thanksgiving for this little life that brought so much joy to many. I thank God that he is now full and healthy in heaven. I ask that you pray for our center, missionaries, and tias as we cope with this death. His funeral has been planned for Thursday morning, a final farewell and thanksgiving for his joyful life. There are many tears, hugs, and sadness around the base tonight. Thank you for the prayers I know you will each send up.

For now the internet won't let me load pictures of our beloved Mr. Dino...I'll try again later.

Multiple Choice...

If a three year old comes into your ER in respiratory distress would you:

A. Give him paracetamol...US tylenol (without knowing if he has a fever or how old he is/how much he weighs)

B. Decide we should try normal saline nebulizers every 20 minutes for an hour (when you have been told that salbutamol nebulizers did not help him this morning)

C. Start IV fluids but when they stop halfway through just leave them that way

D. Wait 5 hours until you decide oxygen is needed

E. All of the above

In the best hospital in Mozambique today I watched them choose E before ever thinking oxygen or an oxygen saturation might be a good idea. Here's how my day panned out...

It's been one of those days. My alarm went off and I decided I'd sleep a bit longer and take a shower later in the day. Apparently that was a mistake because before my alarm could go off again there was a faint knock at my door. Aleya (my roommate) was on call for the baby house last night but knew I'd was working today. She had just taken a call about one of our little guys who wasn't breathing well and needed to go chase down some other kids for GATV stuff (the program that sees all of our HIV+ kids on a regular basis) so wanted to see if I could help out.

So I threw on some clothes and headed up the baby house to find Dino in respiratory distress. I had seen him yesterday after church, and he wasn't looking great but wasn't terrible and certainly did not look how he looked this morning. I tried salbutamol nebulizers...2 in a row didn't change a thing. Next I called Jannie (another nurse) to come take a look at him and we decided together he probably needed to head to the hospital. In the midst of getting all of that sorted I discussed the situation again with Erin and Jannie together. We decided since we do have an ER doctor on base at the moment visiting that it would be good to have her look at him.

So I found Kim (the ER doc) and brought her to see Dino. We decided waiting an hour to see if we could get rehydration fluids into him and see if that made a difference (he hadn't held anything down without vomiting since yesterday morning really) was worth a try. About 45 minutes later I had gotten a little over 200mls of rehydration fluid in him but he started not making great sense. Erin took a look at him and we just decided the hospital was our best bet.

So, Tracey (one of the missionaries who works in the Baby House who has a great deal of experience at the hospital), Kim, and I headed into the city. The hospital is a good 35-45 minutes from our center. Upon arriving I quickly learned that you can't just sign in you have to go be seen in the treatment room (where I think no medical people work)...they gave us a small square of cardboard that said asthma (not his problem but at least they got it was a lung issue right) on it and asked if he had a fever. I said yes and they promptly gave him paracetamol...I have no idea what dosing they used considering they hadn't weighed him, didn't ask if I had already given it to him (which praise God I had given him ibuprofen in the car not paracetamol).

Next he went to go see the doctor. I did not go on this adventure because Tracey's portuguese is much much much better than mine. But, he was seen by 2 doctors, oxygen was discussed, along with nebulizers, blood work, and a chest x-ray. Ok...sounds pretty positive right? So Tracey called me because in the midst of blood work Dino decided he needed to pee...and soaked the exam table. I sunk my little way back (because only one person can stay with the kid) with diapers for Mr. Dino. Well they had started an IV (in his hand praise Jesus...usually they just go for the neck), drawn blood work, then we were taken back to another area (I guess I could describe it as our ER rooms). They started giving him normal saline nebulizers and inhalers of ipratropium. Here comes the best part...they weren't using a spacer for the inhaler...instead their make-shift idea was to use a cut in half water bottle. So they had cut it and were using the cap side for the inhaler to go into and had put tape around the cut off part so it wouldn't cut your face when they put it on you like a mask. WOW! Well he never got any of the meds because they would spray the inhaler and immediately take the "mask" if you could call a cut off water bottle a mask off his face immediately.

Alright so for the next 4 hours we sat...they gave him nebulizers...which really meant we held him down and held the mask on his face and then inhalers (where he got no medicine). Absolutely nothing changed. His respirations remained 60/minute, nasal flaring continued, he was grunting sometimes...altogether not good. Oh and another situation...they started an IV drip of glucose but about halfway through it stopped. I even asked the doctor/med student/intern that was attending to Dino, "Doesn't he need that?" His answer was only one time...WHAT? Well in another hour or so we got another attending doctor/med student/intern who finally noticed it had stopped, had a nurse flush out his IV (which was infiltrated), and start a new one so he could get the rest of his fluids. Starting the new IV was a situation...I'm pretty sure the first nurse stuck him 5 times (several times with the same needle) before she finally called someone else who got it on the first try. But I was amazed that after stick #3 she went to get me gloves since I was holding Dino's arm for her and cleaning up the blood from the other sticks was not her strong suit. So on we continued with no change. This new doctor also noticed his fever was up again and ordered 4mls of paracetamol...I got a little excited thinking they are actually going to give this kid liquid, a novel thought. Well they did give him liquid but who knows what the dosing in 4mls is because liquid means yet again another water bottle filled with crushed up paracetamol in water/sugar water. Yea...great idea. Anyway we got that down him...ok no I got that down him because of course the nurses don't give medicine they just pull it up.

Well then a miracle of God happened...someone called a pediatrician!!!!!!! Praise the Lord! She walked in and immediately said...he hasn't changed...why's he not on oxygen and where is his chest x-ray?? So we were rushed back to the baixa (or ICU), he got his chest x-ray taken (something that usually you would have to walk to the adult hospital, wait in line, wait for it to be printed, and return with) right there in the baixa. AND HE GOT STARTED ON OXYGEN...only 5 hours after we arrived. Mind you it was 10L of oxygen...a bit much for a 3 year old but oxygen nonetheless. What a situation?!

So I'll ask your prayers for Mr. Dino who is still in the hospital. He was admitted, and we assume will at least stay the night in the ICU and possibly be moved to the peds floor tomorrow. One of our tias is with him...her name is Tia Sandra if you would pray for her as well. The care takers in the ICU are not allowed to sleep or keep any personal belongings with them. They just have to sit at the patient's bedside and wait for instructions. I have also heard they are not allowed to sleep. So please keep them both in your prayers. I will keep you updated as we hear more this week.

Blessed by the pequeno (small) things...

First...I'll admit you are probably going to laugh at this but I had to share. I've had a rough few days...all I can say is that I think I am beginning to understand what "culture shock" really is. Up until this point I've been able to pass everything off in my head as...well that's just how they do it...they aren't Western and I can't expect them to be...what did I think was going to happen coming to a developing nation. Anyway this week I've just gotten frustrated. It's the little things that make me boil over.
Perfect example- Last night I jumped in the shower. It was cold because of course we're out of gas and the center doesn't have any more right this minute. So I'm trying to go as fast as possible because last night it wasn't really that hot outside so a cold shower was not that exciting of a notion. Anyway I looked down at one point and there was a ROACH on my leg. Ok, I can deal with a lot but the fact that a roach could have crawled half way to my knee without me feeling it just pushed me over...tears rolled down my face.
Ok...so that's what it's been like. The little things just do me in. But tonight I was in my bathroom getting ready for bed and there was a pequeno...I mean smaller than my big toe...gecko on the floor. It was maybe the cutest little thing (other than adorable African children) I've seen in a long time. All I thought was...what a blessing?! So all of that to say...thank you Lord for blessing me with a baby gecko!
Good night to all!

Eu sou uma enfermeira.

I am a nurse. What a HUGE statement to make? Some days it overwhelms me, others it makes me feel accomplished, others it brings about fear and worry, others I sit at the Lord's feet in utter surrender or thanksgiving...today it brought about questioning...

I just spent some time looking up the definition for nurse:
n. a person formally trained to care for the sick or infirm
v. to tend or minister to in sickness or infirmity, to look out for carefully so to promote growth and development, foster, cherish, to keep steadily in mind or memory, to bring up, train, or nurture, to clasp or handle carefully or fondly

How many times in school did we define what/who a nurse was? I can't even count (yep that's right I did listen all those days!). Someone who cares; the number one trusted professionals in the US for so many years running. The one part of the definition I'm stuck on today is...a nurse always does good and never intentionally does harm. What does that mean when you live in a developing nation? What does that mean when you have access to some things and not others? What does that mean when you live, eat, and breath your work place and therefore your patients?

So this afternoon I was called and asked to fill a few prescriptions for a community lady (a mother of two boys here at the center) who had just given birth. She had a c-section a few days ago and has had no antibiotics or pain killers since she left the hospital yesterday. I headed over to get her prescriptions and encountered about 4 drugs I had never heard of, amoxycillin, and no pain killers (at least none I recognized).

So let me just throw some stats at you about Moz:
~Only 2% of births are done by c-section and over 50% of deliveries are done at home.
~Less than 50% of births are attended by a skilled delivery specialist.
~Infant mortality rate is 11%
~1 in 45 women will die from childbirth during their lifetime.
~Contraceptive use is 21% (much less in some populations).

Where I struggled was in the fact that a nurse who has been here much much longer than me and knows this particular lady from previous issues wanted to send her away until tomorrow when we specifically see community members and the clinic is open. So where does my responsibility as a nurse come in? What call do you make? Do you send her away and pray that she has the money/energy to come back tomorrow and that antibiotics tomorrow will be enough to fight against whatever infection she already has (I'm just assuming her incision is infected after seeing the hospital the other day)? Do you follow leadership or the gut feeling you have that this particular lady needs antibiotics (she surely didn't look great) and is not going to adequately feed her baby without some painkillers as well?

Here's what I've learned so far as a nurse. You go with your gut. The Lord has given each of us that still small voice that speaks to us and nudges us in one direction for another. When in doubt go with the safest route (the one covering all bases) and just go with your gut initial reaction. So...for those of you wondering...I packed up 7 days of amoxycillin, ibuprofen, and paracetamol (that's US tylenol) and let her know if she did want to take the other meds as well to come back tomorrow. As for those wondering...the baby was GORGEOUS! And he weighed 3.61 kg (almost 8 pounds) on delivery!!! So great; praise Jesus!

So...that was my day...I still don't have answers to my questions but I'm praying God will reveal them in His time.

Border Run Adventures...

So tomorrow it will have been another 30 days that I've been in Moz. And since every 30 days I have to be out of the country, Sharon (another missionary) and I took off at 6am (stupid o'clock if you ask me) for the border. All was well for the first hour of our trip. Then we decided to stop to pull some money out of the atm on the other side of the city before you're pretty much in the middle of nowhere for awhile. Sharon got her money just fine...but I put my debit card in and the machine said processing and I got nothing in return...
I turned to Sharon and said, "That machine ate my card!" I've heard of this many many times from other missionaries but prayed it wouldn't happen to me. Well we pushed cancel, clear, and anything else we could think of to rectify the situation. Nothing helped. Finally, we decided since it was 6:50 in the morning and obviously the bank was not open we would just head to the border and come back to deal with this. We did stick around to watch another man attempt to use that machine...I wanted to make sure that the next person wouldn't get my card back with their own or something strange like that...I mean this is Africa after all.
At the border our only adventure was the fact that we ended up on the wrong side of a rope barricade. I ended up taking it down, letting Sharon drive over it, and then putting it back up! When we got back to the back about 2 hours later the line filled the ENTIRE bank. I'm not exaggerating at all! So I stood in the back of the line for a few minutes and finally decided that if someone who worked their squeezed by me I would ask him if I even needed to be in this line. Well it turns out me and the rest of the world didn't have a debit card. The bank guy started handing out these packets of pages and pages of information you needed to fill out...but somehow me the white girl, who didn't speak great Portuguese didn't need one. He just took my passport and starting trying to look up my debit card information. Then he thumbed through a stack of debit cards higher than a deck of cards...RIDICULOUS! None of them were mine. Finally, I told him it was blue and said Wachovia on it...he said, "Oh!" and left for a few minutes. He came back with 2 blue debit cards...neither of them mine. Fail!
Next we were ushered into a little side room and someone who spoke English started asking me questions. After another time of waiting...the guy showed back up with nothing. The whole time I was thinking, here we go I'm going to have to figure out how to cancel my debit card from Moz and go through getting a new one...what a hassle. He said..."Could you just look in your wallet one more time and make sure you don't have?" Sharon and I both said..."I don't have it...the machine ate it". He insisted I look again. And...THERE WAS MY DEBIT CARD RIGHT WHERE IT ALWAYS IS. I still have no recollection of it coming out of the machine and putting it back into my wallet. I think that proves I'm exhausted and stressed. What a day?!