Nadia Cooper

Nadia Says Goodbye

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The problem with going anywhere new to visit and explore is that eventually you have to leave…

My time in Uganda has been one giant adventure. I’ve written about just a small portion of those adventures in order to share them but every day, virtually every moment has been something of an adventure here.

I’ve been in Uganda for 7 months and now, in 10 days, I’m heading back to New Zealand.

I’m looking forward to going home, to seeing family and friends, walking/driving in familiar places, browsing a super-market, no longer needing to boil water to drink, wearing jeans again! But I’ll miss being here too.

When you live in a place for a time it becomes a small part of you which you take away with you and will never forget. You also leave a small part of yourself behind. There’s no winning really, unless you always live in one place without moving or travelling, there will always be those other “homes” which at times you miss and yearn for. These places become part of your identity.

I’ll miss Uganda…

I’ll miss the lush green beauty of South Western Uganda with its many hills and volcanoes

I’ll miss the almost violent thunder storms where lightening illuminates the whole valley, thunder shakes the walls and the rain is so loud on the corrugated roof that you can hardly hear yourself think.

I’ll miss the laughter; I’ve never met people who so love to laugh

I’ll miss the phrases and words like “fair” “you are lost” “somehow” “sure” and “you are welcome!”

I’ll miss the music; there always seems to be singing or music here, even a drum to keep on schedule.

I’ll miss the strong women; seeing women ploughing fields by hand, carrying huge jerry cans of water and so often with a baby on their back.

I’ll miss the ochre red soil stark against the greenery (though I won’t miss constantly trying to wash it off my feet!)

I’ll miss the pace of life; sometimes hectic and very full but everything just happens eventually, in Ugandan time.

I’ll miss the children; who take pleasure in simple small things and so often create their own fun.

I’ll miss the friends I’ve made; black, white and brown – all dear to me.

I’ll miss the frankness of the culture, where things are stated as they are and it isn’t considered offensive.

I’ll miss the smell of heat and dust just as it begins to rain.

I won’t leave Uganda the same as I arrived. It has changed me, taught me and strengthened me, equipped me further for whatever God has planned for me in future. Uganda I will never forget you.

Ngaho, Wakoze Canye.

Kisiizi Hospital

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Kisiizi Hospital lies in South Western Uganda not 2 hours drive from my previous setting, Kisoro. Almost bizarrely it is really a hospital in the middle of no-where with the nearest significant town at least an hour’s drive in any direction. Despite this it has a name unto its self and has developed a good reputation for quality health care in the region.

Kisiizi is a Church of Uganda hospital with some government connection also. The hospital was first opened in 1958 and gradually grew and developed there. From early on, a huge advantage to the rural situation of Kisiizi Hospital was the access to the Omukinyata waterfall which, as well as providing the water requirements for the hospital, powers the hydro generator and source of power for the hospital. The waterfall itself has a morbid history in that historically, unmarried woman who were found to be pregnant were thrown from it. Despite this gruesome origin, it now powers not only the hospital, allowing for the care of so many, but also, through the Kisiizi Power Project, provides affordable electricity to the surrounding area.

The moto of Kisiizi Hospital is “life in all its fullness” from John 10:10 and, within that, comes the aim to care for societies most vulnerable. The hospital consists of 3 operating theatres, a surgical inpatient department, general medical inpatient ward, isolation ward, paediatrics, maternity, special care nursery and inpatient mental health. The inpatient mental health ward is particularly novel in being the only one of its kind in a non-government hospital. In addition to this Kisiizi has extensive outpatient facilities, community out-reach projects, child sponsorships scheme, clinics (HIV, Eyes, dental, antenatal, immunisation etc.). To further increase the accessibility of health care, Kisiizi Hospital has Uganda’s oldest health insurance scheme, a scheme which caters to 34000 people and means that sudden health-care needs will not reduce a family to destitution.

Education is also a key element of Kisiizi which runs the Kisiizi primary school – started for the purpose of retaining staff by providing quality education for their children – and the Kisiizi school of nursing and midwifery.

So… in this extensive project, where do I fit in?

I will be at Kisiizi for 3 months, until the end of January, during which time I will be working in the paediatric ward and special care nursery. Kissizi offers me a very different image of health care to my pervious location and, within that, valuable learning experience for how effective and quality health care can be provided in a low-resource setting, on a larger scale. In addition to some unique and very valuable learning opportunities which I will have in my time here, I am also hoping to contribute, particularly within the special care nursery, in staff education and practice development.

Please do pray that my time here in Kisiizi will be a fruitful one and thank you for your on-going support of my work here in Uganda.

If you get the opportunity please do have a look at the Kisiizi Hospital website to get a more vivid picture of my current location!

The work I am doing through NZCMS is strictly volunteer work – I am not paid by NZCMS nor by Kisiizi Hospital in Uganda. I am able to do this work through the generosity of every-day people who want to support me to be able to be here and help with this incredible work.

If you want to find out more about supporting me in this work please either contact me directly or click here for more details as to how you can support me. Every bit of support of every kind helps.

An Update from Nadia

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The last month has seen a lot of changes, a lot of challenges and a lot of achievements.

For the last two weeks I have been the only ‘Muzungu’ left at Potter’s Village as Sue and Mike have been home on leave and Rosie needed to head home to be with her family for a while. So how did that affect things? Well in some ways it didn’t… everyone has been as lovely to me as ever, though perhaps they check up on me a bit more to make sure I’m not too lonely! In the medical centre it has meant that we are a little tight on staff and I have been on-call the majority of the time which is draining, but it has been a quiet month which, perhaps, is for the best.

The medical centre still demands my creativity and I never stop learning new things. A recent bout of typhoid cases has taught me a lot about the management of the illness and an unusual case in the nursery had me researching for days!

In terms of my education projects, the staff from Kisoro hospital who have been selected to work in their new Special Care Nursery have begun to come over and spend some time with us and learn about how to care for neonates and run a nursery. It’s a little over-whelming trying to figure out where to start on teaching people when they need to know everything and there is so little time! I talked so much the first day my throat hurt! There is a long way to go with this but a start has been made and they seem very enthusiastic though which is encouraging.

Feeling a little over-tired I decided to get away for a weekend last week since I was rostered for a long-weekend off. I went and stayed at a lodge right on the edge of Bwindi Impenetrable forest. I admit, I spent most of the weekend just catching up on sleep, enjoying not having to cook and relaxing on my little veranda that was barely two metres from the edge of the forest, enjoying the view and reading books. I’m so thankful to have had the opportunity for this mini-break and also to see a little more of the exceptional beauty of nature here in Uganda.

Recently, with the medical centre staff, I have been going through neonatal scenarios looking at how to identify what is wrong with babies and how to decide on the appropriate treatment and management. It was, therefore, a big moment of pride across the board when, on getting back from my weekend away, the staff presented a complex case to me, which had come in over the weekend, and their management of the case which was spot on! I was so proud of them for their achievement and it was great to see their excitement and the growth in their confidence in neonatal care.

My time at Potter’s Village is fast coming to an end with my last day of working in the medical centre set for October the 24th, exactly a month away! After this I will have a week break to refresh myself and also renew my visa before heading to my next destination, Kisiizi Hospital.

Nadia the Nerd

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A lot of people who know me will tell you that I’m a bit of a nerd. I love learning! In fact, I’m so nuts about learning this is my first year since high school that I have NOT been doing some sort of tertiary study!

Over time I have also discovered that I love to teach. I really enjoy the challenge of helping someone to really ‘get’ a subject by not just knowing it well enough to explain it, but being able to adapt the information to suit the learning style of the individual.

Put those two things together – a love of learning and teaching – and I’m sure you can understand why I am really excited about the latest developments happening in Potter’s Village and in the town of Kisoro!

Part of my challenge while working here in Uganda has been to look at how I can be the most help possible here. Yes I’m a help as a nurse but I wanted to help in a more lasting way and decided to do this through… yup, you guessed it, education!

The last few months I have started slowly doing a range of training sessions with the staff, writing some guidelines and protocols and discussing what they feel their professional development needs are.  These training sessions range from group discussions to scenarios (yes I have played a dramatic mother and an anaphylactic patient!). Some of what I have been developing are just aids to support the staff, such as a resuscitation flow diagram designed to fit the context and an anaphylaxis response chart.  Needless to say we have had a lot of laughs doing this and the response so far has been great.

The last few weeks I have taken the next big challenge and started to design and write a self-directed learning programme to train staff in neonatal nursing. I am hoping that by the time I leave I will have completed a full set of 3 information booklets and accompanying workbooks ranging from basic to advanced neonatal care, the idea being that even without a specialist nurse available to them, the staff still have access to the information and a way to train and advance their skills and knowledge base. The draft for the first set is complete so far!

Finally, the local government hospital, Kisoro Hospital, has just received equipment to open their own Special Care Nursery. This was something we were both excited and nervous about. Nervous because no one at the hospital has any training or experience in neonatal care (doctors included!) and excited because if the nursery is a success it could do huge things for infant mortality and morbidity  rates in the region. Sister Jovia (our senior Ugandan nurse) and myself went down to the unit to have a look today and help them set up their incubators. What followed was a two hours question and answer training session on basic neonatal care, how to run a nursery and how to work and maintain their equipment.

Most exciting of all is that between us and the staff at Kisoro hospital the agreement has been made to build an education relationship between their unit and ours where we will visit about once a week to do training with their staff and their staff will visit us to get some hands on experience. I’m really excited for what this could mean for the development of neonatal care in Kisoro in the coming future and feel excited to be a part of it.

I have always been told that God uses not just our gifts but our passions. I came to Kisoro to nurse, feeling in many ways inadequate for the roles I was walking into, but God equips us as with the tools we need and I have been humbled continually by the gratitude of the medical staff for what I have been able to offer. Moving into an education role I feel truly privileged for the opportunity to use my passion for learning and teaching to benefit those around me in a lasting way.

Thank you God for the gifts you have bestowed on me to use for your purposes, for the courage you give me daily to use them, and the strength you fill me with to step up to each new challenge.

Giving Thanks

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Give thanks to the Lord, for he is good. His love endures forever. (Psalms 136:1)

Every Wednesday here in Potter’s Village we have a senior staff prayer meeting. It’s a time to bring the project to God with all its joys and challenges. One of the things which I have come to admire in this prayer meeting is the spirit of thanksgiving which flows so naturally from the national staff. I am often consumed with all the challenges and all the things which still need to be achieved here but their prayers are overflowing with thanks for God’s provision, for his grace, for his love and mercy.

It’s so easy to look at something and see how it can be developed and improved and this is important in any project. However, it is just as important to see what has been achieved, to pause in the striving and be thankful for what is, to see how this project has been blessed and, as such, is such a blessing to the community, and to thank God for it.

So, continuing on this line I’d like to tell you about some of the things for which I am thankful! I have been here for just over 2 months and feel settled now. I know the ins and outs and have created a little routine for myself. I have been blessed with good health and am continually amazed at how much I am learning.

Education One of the projects which I have taken up in the last month is staff education in the medical center. Jovia, the senior nurse, and myself agreed that it is important to equip the medical staff so that if the Muzungu (foreigners) had to leave, the medical center could still function smoothly. We have started small with education on a few new pieces of equipment (a syringe pump and suction machine), management of babies on CPAP and neonatal resuscitation but the response has been incredibly positive. The staff are eager to use their new skills and knowledge and I have been humbled by their appreciation.

Rutaka Clinic A few weeks ago Dr Mike Hughes, Beth, a medical student and I went to the rural clinic of Rutaka for the day. It is technically under the Diocesan umbrella but has few resources, few medications and few staff! We were only supposed to be going for the morning, taking a box of medications to treat what we could. Arriving at 11am, we finally left having taken no breaks, at 5pm and having seen 59 patients! Beth and I triaged the patients, obtaining all their details and symptoms with the help of the local vicar as my interpreter and then sent them in to Mike who treated them. Many of them had been struggling with symptoms for months and unable to afford to travel the 1 1/2 hours to Kisoro for treatment. Though exhausting, the day was very satisfying, to be able to achieve so much in so little time.

Cultural quirks: For a bit of humour before I sign off… A language quirk I have learnt since arriving here is in talking about time. If you ask someone to do something “now” that can mean anything from sometime soon to in the next few hours/days! If you want something done immediately, you have to ask for it to be done “now now!” … Guess how I learnt that!

Success stories

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One of the difficult things here is to focus on the successes. The difficult and tragic cases stick far more easily in our minds because of those very difficulties, but it’s important that the successes be remembered too. In light of this, I’d like to tell you some of our success stories.

Let me start off with some statistics:

Last month in the Potter’s Village medical center we treated:

– 257 outpatients: These range from anything from minor injuries, home manageable malaria, mild malnutrition, chest infections, skin conditions and gastroenteritis.

– 55 paediatric inpatients: These are the children under 12 who are too ill to be safely sent home. This includes the most severe malaria, typhoid, severe pneumonia, malnutrition, dehydration, meningitis and septicaemia.

– 15 neonates: These are newborn babies brought in for specialist care for prematurity, birth asphyxia, jaundice, respiratory management and poor feeding.

– Immunisations: I can’t tell you how many we see in a month but the numbers are huge. Immunisations are government funded and so free for the community and I can tell you, they have a much better immunisation rate here than in New Zealand!

– 2 abandoned babies: Timothy and Abigale were both abandoned at birth. People have come to know what Potter’s Village does so, when these children were found, they were soon after brought to us for care.

So in a month we have seen, treated and cared for a total of 327 children in this community and rescued 2 babies. Imagine what is done here in a year!

If numbers are not your forte, let me tell you some stories:

Nsabimana is 6 months old. He was brought here by his father because his mother died of TB and his father, having 7 other children, wasn’t managing. Nsabimana also has TB and is only 5Kg. He will be with us for 6 months for treatment before he is reunited with his family. Having been with us only 1 1/2 weeks, he is already much healthier, happy to demand attention from everyone and has put on 500grams!

Stuart is 1 1/2 years old. He came in severely dehydrated having had diarrhoea and vomiting for a week. He wasn’t feeding and has stopped walking. He was floppy and glassy eyed when he arrived and promptly vomited live worms everywhere (a surprisingly common thing!) Diagnosed with tapeworms and Guardia he was treated and three days later was feeding well, alert and up causing mischief!

Milia is 11 months old. She arrived one evening in her mother’s arms unconscious. After doing some tests me found that she had the most severe form of malaria and it had gone to her brain. Treating Cerebral Malaria is very touch-and-go and it was for the first few days. Milia was having difficulty breathing and was only responsive to pain. Almost 9 days later Milia is conscious and breast-feeding. She is still weak but making a slow and steady recovery.

There are many sad and tragic stories here but there are also awesome ones of recovery. Children who are so close to death recovering before our eyes and leaving with a smile (though some still terrified of our white faces!!).

The tragic stories may stay with you more, but please remember our successes. This is what I’m here for, to play a part in these stories both tragic and miraculous and hopefully be a tool by which some of these success stories are achieved.

Rachel’s story, Isaac’s story and ethics

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Ethics has always come up in health care, but in the past it has not seemed as complicated to me as it has become of late.

I would like to tell you the stories of Rachel and Isaac.

Rachel arrived at an hour old, I calculated her gestation to be 35-36weeks with a weight of 1.52KG. She was born in a hospital but they have no neonatal facilities. Born pale, floppy and not-crying, she was resuscitated and then transferred to us. When I was called to come and see her she was in her mothers arms, pale and cold, not breathing, heart rate low. With the help of our visiting student doctor I resuscitated her with bagging and cardiac massage and put her on oxygen in an incubator. Her temperature rose well, her heart rate was good and strong, blood sugar was fine, but her breathing was still laboured, she continued to grunt.

After an hour her oxygen saturation began to drop and, despite increasing oxygen, it continued to drop, then her heart rate began to drop too. I recommenced CPR and, after 20 minutes of effort, finally brought her back to a point of stability, but I could no longer ignore the issue I faced.

Rachel’s condition of respiratory distress leading to respiratory failure was going to kill her. The only way I could possibly prevent this would be to provide respiratory support in the form of CPAP as oxygen therapy was obviously not enough. We have one CPAP machine and Maureen is on it. Maureen is a tiny premature baby who has been with us for a week, she is fragile but doing well. To remove Maureen from the CPAP would mean her death, but to not give it to Rachel would be her death.

How do you choose who dies? from an emotional perspective? from a logical perspective? When both choices seem wrong, what is the right choice?

 

Isaac has been with us for a week now. When he arrived he was five days old. Born at home premature, his family believed he would die so kept him at home, they fed him a tablespoon of expressed breast milk twice a day but otherwise left him to die. After 5 days he was still alive, so they brought him to us.

The fact that Isaac was alive when he arrived was a miracle in its self. He was cold and weak and had respiratory distress. On top of this he had a severe umbilical infection, abdominal hernia, distended loopy abdomen and a loud heart murmur. His facial features were abnormal indicating the presence of a chromosomal abnormality. I was certain that Isaac would die in his first day with us, but he defeated the odds,  survived and stabilised. He is now stable, his infection settled. He still required 1.5L of oxygen and is tube fed. On assessing Isaac I have found that while he has some natural reflexes, his moro (startle) reflex is weak and he has no suck reflex. His pupils also do not react as I would expect them to. I suspect he may have brain damage.

Isaac has been unable to cope without oxygen, he is feeding through a nasal gastric tube as he cannot suck feed. If we can wean him off oxygen he can go home tube feeding but without health care readily available for severe disabilities he will likely die in the months ahead. If we cannot wean him off oxygen he will be unable to survive outside of our medical centre.

In God’s eyes all life is precious, no matter the age, condition, ethnicity or context. Both Rachel and Isaac are precious in his eyes.

As much as these decisions torture me, I think God would be glad they are torturing me because it means that Rachel and Isaac are precious in my eyes too. The day these decisions become easy is the day I should walk away, because then I will no longer care.

God give me the strength to do everything that I can, the wisdom to make the decisions that I must and the comfort of your love to cope with the consequences.

A Day in the Life of Nadia

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It’s always difficult to imagine what it’s like in a work place that’s different from your own, let alone one in a different country, so, bearing this in mind, I thought I would describe one of my days in the medical centre.

My day began at 0830 so I left home a measly 5 minutes before to walk the hundred metres or so to work. Like most wards, we begin with a ward round. The night staff hand over each patient, Dr Mike assesses each and we decide on the plan of care for the day. This morning was no different. We only had 4 on the ward, one was for discharge after recovering from malnutrition, one was a baby who had become dehydrated for unknown reasons but was recovering well, and one we were concerned about who has a resistant cerebral malaria. The nursery has just three babies, all feeders and growers and doing well, two will be discharged tomorrow. There is the usual joking among the staff as the kids on the paediatric ward start crying the moment Mike approaches the a stethoscope, making it all the harder for him to hear a thing.

Through the morning I did the usual drug round at 10am, make the daily plans for the nursery babies, increasing their feeds, checking weight gain etc. and review a few of the Potter’s Village babies who aren’t well, Amos has a sore on his leg that’s infected and Emmanuel has a flu that has been very persistent! According to the immunisation calendar, David and Daniel, the twins, are up for immunisations today and Jacinta needs to be weighed as she has lost weight recently. Throughout this time outpatients came in to be seen by Dr Mike and Olivah takes care of the government provided immunisations which we administer Monday-Friday.

Things are fairly quiet so I sat down at midday with a cuppa and my lap top to enter in some of the medical centre stats on flow charts, i.e. the income, expenditure and patient numbers, and finish typing up the next roster. My reprieve is short lived though as Mike pops his head out and announces a baby has been brought in, found abandoned in a field by the road. The baby, only a few days old by the looks, is very yellow, wet and cold. The recordable temperature is 28.7C. The incubators take at least 1/2 an hour to warm up and without that time available, I go for the next best option, kangaroo care, and just like that I am a temporary incubator. There is a lot of laughter as Mike and Jovia hold up a sheet so I can pull my top off, get the baby into position and wrap a blanket around us both. Winafred, our social worker, names him Timothy.  About 20 minutes after I have commenced my incubator duties, Joviah sticks her head into the office where I’m sitting to inform me a premature baby has arrived, weight 870grams, estimated gestation 30 weeks. Keeping hold of my precious cargo I head through to the nursery, sure enough, there she is, her name is Maureen and, she seems to be doing well though is quite cold so her mother becomes her temporary incubator. She’s breathing well on her own at this stage but we keep a close eye on her and give her a breathing stimulant.

I’ve just settled in the lab with little Timothy who has now reached 32C, when Vera, one of the nursing assistants rushes through beckoning for me to come quickly. Following her back to the office I find Mike with Niwarinda, the little 17 month old with cerebral malaria… he dies moments after I walk into the room. There was nothing we could do. I sit for a while with his mother Elizabeth. She speaks no English but sometimes words aren’t needed, she just rests her head on my shoulder and cries.

Timothy mean-while needs to be fed and is warming up well, but first I need to test his jaundice because he is a rich yellow! With the help of the centrifuge and SBR meter I soon have my results and, sure enough, he needs photo therapy. His temperature is at 34C so into the incubator he goes, goggles made of self-adhesive bandage with gauze inside, and phototherapy on. I decided to head out for lunch then, being 3pm I was pretty hungry and everyone seemed to be okay for the moment.

When I get back Maureen looks like she needs some assistance, we had already put her on 1L of low flow oxygen but she is working hard, so with Mike’s help we get the CPAP out and set up. Her little nose is so small the nasal prongs only just fit. I’ve just got her sorted when the power goes off! The incubators shut off, phototherapy off, CPAP off… blast! Usually it doesn’t go off for long but not wanting to take the risk we put the generator on. By the time I get back to the nursery to make sure everything is back on, Timothy catches my eye, his hand is twitching. Sure enough, when I get a closer look, he’s having a seizure and two more quickly follow after confirming that it isn’t because of his temperature of blood sugar we give him anti-convulsants and continue to monitor  him. By now it’s already 7pm. Maureen’s mother comes into the nursery now and, through an interpreter, tells us she wants to leave, to transfer her baby to another hospital, we have already explained to her that no other hospitals in the district have neonatal facilities and to remove her baby will be to kill her, but she is insistent. I can only conclude that she does not want her baby to live. Taking a deep breath I once again tell her, through the translator, that we cannot allow her to remove the baby. It seems she will let the matter rest for now.

I’m on call tonight so I’ll stay at the medical centre. Usually I just sleep in my house and they will call if I’m needed but with Maureen on CPAP and Timothy’s seizures I’ll sleep in the clinic tonight to be near if something happens. I’m rostered to work tomorrow so I hope I get some sleep.

Not every days is like this, sometimes it’s very quiet and drama free, other days it is non-stop, but it is always unpredictable. There is no such thing as advance referrals, people just show up and there is no telling when or in what condition, we just handle what-ever walks through the door in the best way we can.

Leaving on a Jet Plane

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Have you heard that song by Alanis Morissette about leaving on a jet plane? It’s been going around in my head a lot recently!

The time is almost here! I fly out in just under a week now. On the 21st of May at 1320 to be exact. The nerves have been coming and going, mixed in with the occasional panic, excitement, sadness, exhaustion, frustration and a million other feelings.

Every day has been full as I try to get the last things done. I spent 7 1/2 hours shopping yesterday which was a marathon and for those who know me well, a real feat, given that I am not the biggest fan of shopping!

Last week I packed up my home in Auckland and spent time with my various circles of friends there, saying goodbye. To be honest it felt surreal. On Saturday my folks came up and we loaded up all my things to take back to Hamilton and go into storage in my parents shed (lucky them!).

This week is tying up final lose ends, photo copying paperwork, final shopping, sorting through clothes and writing lists. Then, on Saturday it’s all the extended family goodbyes, Sunday is my commissioning at my church in Auckland and then my final two days just quiet days relaxing at home.

On the Wednesday I will be taken up to the airport by my parents. My trip will last approximately 36 hours, the first flight to Hong Kong (12 hours) with a 4 hours stop-over, the on to Addis Ababa (11 hours) with another 4 hours stop-over, then onto Kigali (2 1/2 hours) followed by a 2 1/2 hour trip by road and then I’ll be there… Potters Village… my home for the next 5 months!

So, in this next week, please do think of me and pray for me.