I had a glimpse into the lives of some Uganda refugees this week, my 3rd week outpatient rotation in Pediatrics.

My 3rd week consisted of mostly morning nursery and afternoon outpatient clinic within the hospital. On the first day, also my first time stepping into the nursery, my resident showed me how to examine newborn infants.

Boy R was the first Uganda baby that I examined from head to toe. He was the second baby that I got to see that very 1st morning. He looked completely different from the 1st baby that I saw in the sense that Boy R had a very broad forehead, squarish face, and attentive eyes. His eyes also seemed to have some sort of nystagmus...that made him look a bit scary. He was otherwise a normal healthy baby... very quiet and very good. Didn't cry at all when I examined him, felt for his belly, tested for his reflexes... Such a sweet little thing with the unusual look...

Later, I learned that his mom refused to breast feed and preferred to use the bottle to feed him. On Tuesday, I learned that his mom speaks Acholi when the resident showed me how to discharge patients and give discharge instruction to the mom... We used the translator via the phone.

In that same afternoon in the clinic, I met Boy R's aunt G and his half-aunt A who didn't speak any English... Apparently, A, Boy R's mom and 12 others just came to the United States a month ago from the refugee camp in Uganda. The 12 children came with their parents because G was able to get to the United State 3-4 years ago. I also learned that Boy R's mom was a victim of rape a few years back and unfortunately got pregnant as a result. The child product of that rape is still in Uganda with G's brother... A's physical exam was all normal except for a few large dental cavities... By the look of it, she must be experiencing A LOT of pain... I know how toothache feels like. It's a constant throbbing pain that never goes away even with ibuprofen...

Just today, G came in with one of her other sister (or maybe half-sister) and her neice who is sick to the ped clinic... The poor 8 month old had subcostal retraction and tachypnea and Tetralogy of Fallot... She's the tiniest 8 month-old that I've ever seen... She's been off her medication for 1 month now ever since she got to the US w/ the rest of the family at the end of Feb... Her heart murmur was loud enough for me, the unexperienced med student to hear. It was quite a murmur! The scary sign is that her liver is way below her ribs when I felt for it. I felt that all I could feel in her tommy is this hard mass that occupied 1/2 of her abdominal space. I had to use the scratch test to make sure I wasn't mistaken for the size of the liver. I've never really felt a liver edge...and today was the 1st time for me to feel a liver edge... So is her liver enlarged? Or displaced due to a sick heart that's worked too hard and gotten too big? or is it displaced because her lungs are hyperinflated trying to breathe? The little girl got admitted right away...

I can't imagine how this family is pulling through their first month together with the long journey from Uganda... They not only have to learn about this crazy American culture and lifestyle, they are dealing with 12 kids in the family + 1 addition baby. These kids go to school, likely all deal with insanely large dental caries that are likely not going to be resolved and be seen by a dentist any time soon due to lack of access, likely all deal with parasites, learn about the language, and take care of one another. Now, one of the younger children is sick in the hospital, and likely will require a heart surgery some time soon... I really hope that she is not going to decompensate because of this respiratory problem that's adding an extra load to the already compromised heart. I wish I have the knowledge and ability to do a little more for the family, but I know that I am only a student. The doctors certainly are trying to do whatever they can to help. They prescribed the kids with antiparasitics/immunizations, found SW and public health workers to help them finding access to the dentists through the cracks in this horrible US health care system, and admitted the sick baby to find ways to cure her...

This family must be very strong... I admire their abilities to get to where they are now. I can't imagine going through all the trauma they had experienced in the refugee camp in Uganda and now coming to the US to deal with a new set of challenges. I hope they'll do well at the end...