Night Terrors and New Years Resolutions

A cormorant in a tree outside our cottage on Bushara Island in Lake Bunyoni.  All photos are from our trip to Uganda but not necessarily related to the text.

To try to capture a visceral experience in words, that is the challenge here.  Perhaps the scenario will resonate most with those of us who are, or have been ex-pat. parents in a place where urgent care is not readily available.  I will say that among the private anxieties that we as parents harbor here is what we will do in the case of an emergency medical crisis with one of our children.  Where would we go?  Who could we call?  How reliable is the treatment?  I admit that we are far more privileged than the average Burundian here, as we have the resources and connections to access the best medical care in the country.  But in a place like this, that may still be far from sufficient.  

I admit that I have on my cellphone, the number of the air ambulance service that supports MCC, based in Uganda, they can get to us in as little as 4 hours in Bujumbura, and can get us to Kenya in under 8 from the first dial-up.  But that assumes that I am in a place with phone service or a landing strip for a plane for that matter.  Probably my past experience as an EMT makes me a bit hyper-conscious about urgent care.  We spent our Christmas vacation on a small island in a remote part of Southern Uganda, a great get-away, but imagining a need for emergency medical care from there, at night, say, is the stuff of nightmares.  I honestly would not know where to begin.

I am reflecting on this because we had, the day before yesterday, such a night.  Actually our vacation was at an end and we were returning from lake Bunyoni in Uganda to Burundi.  We had spent the vacation with our friends Tim and Jeanette Van Aarde and daughter Isabel. I will go back and fill in more of the details, but on the way home we stopped in Kigali to spend the night at the Amani guesthouse--  a familiar haunt to Rebecca and I as we are often there on our visits to partners.  We had been passing around a virus beginning with Oren on Christmas day, and eventually hitting David then Rebecca during the vacation.  Rebecca was miserable on the drive back but David was on the mend when we got to Kigali on New Year's Eve, or so it seemed. In fact when we arrived we spent the afternoon at a small playground where the kids enjoyed playing on some broken-down carnival rides that were set up as playground equipment.  (not very child-safe)

When we got back to the guesthouse after dinner, Rebecca went to bed early and I tried to put David down as well shortly thereafter.  He had been fine, but as he fell asleep he began to breathe in short laborious grunts and something definitely seemed wrong.  Hoping he would improve and not sure what else to do, I went to bed next to him and listened to his his halted panting.  I fell asleep for what turned out to be an hour when David began 'waking up'.  He is going through the 4 yo phase of night terrors where he will wake up without actually regaining consciousness.  It is a bit eerie, but even worse on this night.  His eyes seemed to bug out, he was babbling nonsense, breathing laboriously, and crying.  It was obvious he was in great pain but did not seem to be able to articulate anything.  We asked him about his ears, nose, and throat as an infection seemed possible, but he seemed to indicate that this was not the problem.  I did a simple assessment of him checking airway, breathing, pulses, then felt his abdomen.  To my alarm it was extremely rigid, and he nearly screamed when I touched it.  This was the first time David had ever complained of abdominal pain in his life. 

Kigali City

It was 2 am, on January 1st, and I realized then that this was not something we could leave until morning.  I told Rebecca we had to find a way to get him to a doctor at this hour.  We had a phone number of a doctor in Kigali but were not able to contact him.  For better of for worse we actually had considerable experience with urgent care as Oren had broken his arm on one occasion and gashed his head on another in Kigali.  We knew about King Faisal hospital and decided to go there.  

It is interesting to consider the calculus that went into our plan to go there.  First we had to get the car keys from Tim, sleeping in an adjacent room.  We thought of what we should bring and passports and health cards were high on the list.  Neither of us had to articulate to each other what we were both thinking: one of us might be accompanying David on an air ambulance to Kenya before we returned to the hotel.

Scenes on the road.

We woke the night guard to open the gate of the guesthouse and headed to the hospital.  We were glad to find the ER was pretty empty and there was a doctor on duty!  (Not something you will find in most hospitals in Burundi after hours.)  She ordered an abdominal X-ray.  It was weird that David had no fever, but did remain doubled over in pain.  

As children and siblings of doctors, we were quickly on the phone with Rebecca's dad and brother to get an idea of what to look out for or rule out.  Our worst fear was a bowel obstruction, appendicitis, or maybe meningitis (he was holding himself very rigidly).  The X ray did not show any abnormality in the gut and we did remember that he had had a bowel movement earlier in the day.  She also ordered a blood test.  The doctor gave him a large dose of Tylenol and suggested we either admit him into the pediatrics ward for observation overnight or to bring him back early in the morning to see the test results.  We opted for the latter as he seemed more calm after the tylenol suppository.

He slept somewhat better the rest of the night, although it was 4:30 am by the time we got back to the guest house.  We slept as much as we could then had breakfast with our friends and Oren and made a plan to stay in Kigali rather than return to Bujumbura before we felt David was stable enough to travel back with.  There was a deadline if we were to leave that day which was 1pm in order to avoid driving upcountry in Burundi after dark.

We went back to the hospital to get the test results which showed there was some kind of infection and now David had spiked a very high fever.  He was given IV tylenol as well as rehydration fluids and slept peacefully in the ER.  We were able to call Joel Miller, our physician friend in Burundi and get his advice.  He concurred with the ER doctor that this was not a surgical emergency and that we should be able to come back to Bujumbura.

The anti-climactic ending to the ordeal was a great relief to us.  But we were still under some pressure to get David released from the hospital before 1pm so we could drive to Burundi.  The problem is, that unlike in the US, no one here is particularly anxious to get someone out of the hospital.  By 10am on New Year's Day the ER was quite busy.  The one doctor was not really available to write out an essential discharge form and give us a prescription for an antibiotic and anti parasitic medication.  I had to almost impede her in the hallway after sitting for several hours by David in one of the ER beds.  I did succeed, but finding a nurse to remove the IV was an even bigger challenge.  (only 2 on duty.)  The hardest step though was to pay.  Although the bill for everything (tests, Xray, ER visit, consultation) was under $50, the cashier was no where to be found for another 45 minutes after I was ready to go.

Taxi boat from Bushara to Mainland

Rebeca had gone back to the guest house in the meantime and packed our stuff and she and the Van Aardes pulled into the parking lot at 12:45.  I finally got out just before 1 and we headed out to Burundi.  We had to make good time to avoid driving after dark but had to stop for some gas. 

The border, a potential place of delay, was going well until the last step.  I saw a familiar customs officer and greeted her in Kirundi with a cheerful "Umwaka Mushasha Mwiza!"  (Happy new Year)  She answered and asked how we were (in Kirundi) I told her Rebecca and David were both very sick (playing on her pity to avoid being searched to thoroughly.  She responded (all in Kirundi) that since it was New Year's, maybe I had a 'gift' for her.  I told her I could not give her any money.  (I know if I ever do that once I will have to do it every time I pass.)  She was not very happy and pointed to the covered suitcases strapped down on the roof rack and asked to see the contents.  It took some time for me and Tim to unstrap them get them down, let her inspect 2 large bags of dirty laundry then put them back up and baton them down again.  We lost about half an hour there.

Nonetheless we did make good time the rest of the way and got in by 6pm.  Sadly, as soon we got back, it was Rebecca's turn to go to the ER as her condition had deteriorated.  Jeanette and I took all the kids to our house while Tim dropped Rebecca over at BUMEREC, the hospital that is most convenient to us.  She was happy to find a decent doctor there that did a series of tests including malaria and typhoid and found she had an infection as well.  She and David are both on antibiotics now and doing better.

David's condition improved markedly the moment we got home.  He barely moved on the car trip and was a pale and unresponsive as a corpse.  But as soon as we got in the driveway and he saw the dogs he jumped out of the car and asked Isabel if she wanted to go on the trampoline.  A remarkable recovery!

I slept well the night we got back when everyone was finally back at the house, car unloaded and Tim and Jeanette back home as well.  Despite the stress of the past 24 hours I felt fairly peaceful.  I am grateful that this does not happen often, and that we have been able to cope and make good decisions when it has, and that we do have friends and family that can give us good advise in the moment.  The one thing it is important not to forget is that we don't face these crises alone, even at night, if we have taken the time and effort to build a community around us.  We have felt very supported by our friends and family near and far in all the ordeals we have faced in the past year.

Tim, Oren, Paul on Taxi boat.

Backing up, it is worth saying something about the vacation itself.  I would say that because of illness and other factors, it was not exactly the best vacation we have had, despite the fact that we were really looking forward to be spending the time with our friends the Van Aardes.  Bushara Island Camp, on Lake Bunyoni is a very rustic getaway, maybe one step above Gilligan's Island.  It is not the first time we have been there.  We were there with Bridget and Zachee in 2010 for New Year's as well.  The tiny Island located in Lake Bunyoni near Kabale Uganda, is a charming get-away as long as one is not too attached to electricity or running water.  It does feature some of the best bird watching in the region though and all of us were equipped with binoculars and cameras.  Swimming is also possible but the lake is fairly cold.  

Besides illness, which hit just about everyone in our family during the 4 days we were there, the weather was not great.  It was quite damp and overcast most of the time we were there so it was actually cold.  We did prepare with warm clothes and at dinner the open air restaurant always had a roaring fire going in a large fire place.  The food was not bad, especially if you are a fan or crayfish.  They offered it prepared in about 10 different ways from Mexican tacos to curry and chowder.  Despite the lack of electricity, I was pleased to find that hot showers were available on demand.  These are provided by the staff who bring down several gallons of hot water to one's cabin to fill a bucket with a shower head attached in a small stall next to the house.  It is quite labor intensive but very enjoyable for the guests.  Toilets are an eco-friendly 'long-drop' that are kept clean with some advance methods of biodegradation.  (You pour a spoon of ash in after you finish your business.)

David and Isabel on the dock

When the weather was not nice enough to walk around we did some reading and played games.  We particularly enjoyed playing Carcisone which we taught to Tim and Jeanette.  The 3 kids played fairly well together as there was a small playground there.  David also loved to go down to a dock where there were crayfish hiding among the rocks and roots in the shallow water.  I kept a close eye on the little kids as I did have some anxiety about them going off somewhere alone and falling off a dock.  All the kids did like walking around the island which could be circumvented in about 30 minutes.

To save money we did bring breakfast and some lunch food for the firs 3 days and cooked them on Tim and Jeanettes portable gas grill.  (They are South African so they have all kinds of great camping stuff!)  We did birdwatching together most mid-mornings, and saw a number of interesting species including, cinnamon chested bee eaters, various varieties of iridescent sunbirds, boubouls, cormorants, kingfishers, kites, crowned cranes, robin chats, and more.

Despite the darkness at night without electricity, we did enjoy story time in the evenings with David and Oren (by flashlight).  Oren is definitely old enough to appreciate longer chapter books and we brought The Lion, the Witch and the Wardrobe along with us.  The kids really loved to listen to it before going to bed.  It was nice not to have other options like movies and TV there.  

We did the trip in two days both ways, staying the night in Kigali both times.  On the way there we did see our service workers Janelle, Alyssa and Matt briefly to wish them a Merry Christmas and make sure they were OK.   The drive was generally not bad either way, especially having done it before.  

I am sad to say that illness prevented us from staying up for the New Year, but I did take some time to think of some New Years resolutions--nothing new really.  I resolved to read the One Year Bible again, (11th time?) and to continue to write this blog on a weekly basis.  Happy New Year to all who share in our lives by reading.  I especially thank those who supported us in the small crisis with advice prayers and direct help:  Tim and Jeanette Van Aarde, Drs. Paul and David Sack, Dr. Joel Miller, and our parents.  I do trust that our New Year's Eve will not be the precursor to a difficult year, but even if it is we feel equipped to face it because we know we are not alone in this world.  IMANA IDUHEZAGIRE, TWESE!  (God Bless us, everyone!--in the words of Tiny Tim.)