Monday, December 29, 2008
A chat on the way home
So, yesterday, as I was greeted by a man walking next to me I responded...
"I am fine. How are you, Ugandan?"
He laughed, "You can not call me Ugandan! I call you Muzungu, because that is the language you speak. The language of the Muzungu. But there is no language of Ugandan."
"Ah", I said "but my language is not called Muzungu. It is English. And I am certainly not English! Perhaps I should call you Ankole, then, for Runyankole is your language". I end with an eye brow raise and a smile (half of my communication now involves my eye brows).
"Okay, then it shall be. You can call me Ankole. Do you know some of our local language? Agande (how are you)??", he said.
So, I responded, "Ndijay (I'm good). Agande sebo (how are you sir)?"
He laughed again, with eye brows raised. "So, what other words do you know in our language?"
"I can count...". And, so I counted to ten with only one mistake by substituting six for seven.
"Why do you know this language?" he asked, probably now curious as to why this strange muzungu woman had not simply answered his first greeting with "I am fine" and walked away.
"I work in the hospital, so I speak a little Runyankole to my patients."
"Do you like working there?", he asked. We are now long past the muzungu-debate.
"Yes, I very much like it, but it is difficult sometimes when we do not have the medicines or the resources that people need"
"Yes", he said knowingly, "money is always the problem".
"But I like my patients very much," I say, changing the subject.
"Of course," he says. It is well known, even amongst themselves, that Ugandans are very nice people.
There was a short pause in the conversation as we continued walking. By this time I was half-way home.
"Me, myself. I am a patient," my new friend says abruptly. "I have 'slim' (common East African reference to HIV)". He looks to me for a response.
I said, "ay" with an eye brow raise. A common response that I have learned here to mean neither shock nor dismissal. Simply acknowledgment.
He continued, "my wife, too, she is a patient. And I have one child. We are all three patients".
"My boy, he is six months. We just tested him and he is positive".
"I am sorry to hear that," I said without eye brows. Somehow it never surprises me to discover someone here is positive, but the thought of a couple finding out that their child only child is also infected seems too much to bear.
"Do you go to one of the clinics? Are you on ARV's?" I asked.
"Yes, and my wife's CD4 counts is 500 and mine is 380. We are lucky. We feel well and are not sick yet. The baby takes liquid medicine."
I said, "that is great. You sound very educated, and are taking your medicines. I suspect you and your wife will do very well for a long time," hoping he does not notice the omission of his son's prognosis.
By now we are at the gate of my house, and I tell him that I am home.
"I have one question for you, doctor," he says. We have now stopped walking. "If I take my medicines on time every day and stay healthy, how long do you think I will last?"
Was it only 10 minutes ago that I was trying to decide between Season 3 of Boston Legal and Season 2 of Ugly Betty? How do people go about their lives with these problems? I have been here 5 months and this continues to be one of the hardest things to get my mind around.
"Sebo, I do not know. But I do know that if you take care of yourself and your family. And take your medicine everyday. And go to the doctor as soon as you have a cough (too many of our HIV patients succumb to TB), or malaria (synonymous with any fever). And eat healthy food. And live healthily. (and, and, and...how are all these conditions ever possible in any setting???). Then I truly believe it is possible that you will live many, many years and become an old man."
With a very formal turn to face me and shake my hand, he said, "Thank you for your advice, doctor," and turns and walks on down the road.
Friday, December 19, 2008
Genocide
Rwanda has made an astounding economic recovery, but I cannot even imagine the physical and emotional scars that will linger for generations from this pinnacle of human tragedy. Kigali (the Capital) is a remarkably clean and orderly city that achieved 10% economic growth last year; they have even gone as far as banning the use of plastic bags in the entire country, both of which are unprecedented on this continent.I am desperately trying to believe in some leader, or some government, here that actually cares about the people more than enriching themselves or their cronies. They are hard to come by and Uganda’s Museveni is certainly not one of them. I have admired the practicality and confidence that the President of Rwanda, Paul Kagame, has shown in reviving his country, yet it is almost certain that much of Rwanda’s recovery has occurred through the systematic raping of the Democratic Republic of the Congo’s vast mineral resources. Don't even get me started on the idiotic African policies that the United States has implented: pick any corrupt leader past or present, and guaranteed the US has backed him at one point or another. It's truly detestable. The problem with trying to believe in someone or something is that there is always another version of the story that is far less appealing than you wanted or expected. I will keep searching in hopes that other countries and other leaders will follow the example of Ghana, for instance, who is in the midst of completing another free election, the third since 1992, where the former leader actually stepped down peacefully upon completion of the allowable two terms. Go Ghana!!
Tuesday, December 16, 2008
"It's a small world" is not just a cliche!
This story begins way back when I lived in China in 2000; one of my best friends was a Rwandan guy named Virgile who was dating this great girl, Alyssa. I always talked about how great it would be to visit him in his homeland of Rwanda, but had no idea if or when that would happen. Fast forward eight years, Virgile and Alyssa are still living in Beijing, but are recently married and planning a honeymoon trip down to Africa including a visit to his family in Kigali, Rwanda, which just happens to be a five hour bus ride from where we are living in Uganda.
Meanwhile, my brother Corry decides to go visit my dad in Australia, but take a 4-day detour in Dubai to compete in a surfski race. I figure Dubai is as close as he is going to get to us for a year so I decided to go meet him. Not only did I get to visit Corry in Dubai, but I was also able to hang out with two fun friends that Lynn and I met while climbing Kilimanjaro in June who happen to be currently living in Dubai. Corry paddled a great race considering that he competed against, probably the 50 best paddlers in the world (minus one or two who didn’t show), including 6-7 Beijing Olympic medalists and numerous other national and world title holders and he would have won if not for the 68 guys who just edged him out. I certainly miss racing when I have to witness a race of that magnitude as a spectator, but I did get to take 5 spectacular showers in 3 days at the hotel: sometimes one must enjoy the small things in life. Pictures will be coming later as, unfortunately, my camera (the old one not my good one) was stolen in Nairobi airport by the good folks at Kenya Airways.
I flew round trip out of Rwanda so as to avoid an 11hr bus ride from Kampala and Lynn showed up in Kigali the next day on a bus from Mbarara, so after eight years of dreaming about this, we spent two great days in the beautifully clean city of Kigali with Virgile and Alyssa. Virgile works for the Rwandan Embassy in Beijing, which, it turns out, means he knows a lot of important people in Rwanda. In one day, I met the Minister of Sports who invited us to attend a hugely popular concert that night at the football stadium as VIP guests, and, at the concert, was introduced to the President of Rwanda’s bodyguard. Getting in to the concert was quite a spectacle because the show was one big promotional campaign for a new cell phone company in town. The tickets were dirt cheap so every kid in the city tried to get into this show, headlined by “Sean Paul” who apparently is very popular in the US if you’re not old like me. We showed up at the gate and the police were standing there with fire hoses keeping kids from rushing the entrance as the show was completely sold out. Our group consisted of five locals and five muzungus with Virgile at the head working his magic to get us in while we tried not to get separated. It was quite a wild experience just getting to the front door of the stadium and we decided it was worth it just to get there even if we did not make it all the way in to the concert, but Virgile got us in and we enjoyed a great show with local singers from Rwanda, Congo, and Uganda belting out tunes as hundreds of bats raced around overhead chasing grasshoppers. It was very cool.
My story of a small world ends with the imminent arrival, in Uganda, of my old roommate Kathi who I have not seen in about 4-5 years. She is spending a year teaching in Cairo and decided to come down to spend Christmas with us. Lynn and I will also be spending a week with her in January when we head off on our big trip to Egypt and Ethiopia…and this is why I love to travel.
Merry Christmas and Happy New Year!
Monday, December 8, 2008
Mmmm....grasshoppers
Wednesday, December 3, 2008
Friday, November 28, 2008
Obama-land
Despite the delay, I want to tell the story of our experiences here in
As a preface to the rest of this blog, I ask anyone reading to name the president of
The reasons for the interest in the election varied, but there was one commonality: people here loved Barack Obama. There was the boda boda (a motorcycle taxi) driver who Danny uses daily and spent every trip debating politics in an incredibly sophisticated manner. There were my colleagues in the hospital, who harbored perhaps a more common, educated skepticism of the Bush administration and knew the latest election updates before I did (right down to who won the previous evening’s debate, or how much Palin’s wardrobe cost). There were those who equated the possible election of McCain with a continuation of the war- the war where their loved ones (Ugandans) have been recruited and trained to serve as poorly paid “security forces” for private American interests located in
Our election night party in Mbarara was a mellow affair, and centered around CNN coverage which luckily was shown on the one and only available channel. The only interruption in CNN coverage occurred in true Ugandan fashion when for 30 minutes the local TV station decided to show footage of people in Kampala at an election night party who themselves were watching CNN (yes, we watched people watching CNN for 25 minutes- seriously). But the coverage returned, and so we huddled around the television in the wee hours of the morning as McCain conceded and Obama was elected president.
Now I’ll admit that I was delighted at the result, but was not prepared for next couple of days… It began as I walked into the hospital, where friends and colleagues were filled with emotional and heart-felt congratulations. As I walked through town, in lieu of the usual “how are you muzungu?” (common greeting to a white person), I instead had shouts of “Obama!!” directed at me from inside shops, from across the street and even from boda boda stands. If I smiled and gave a thumbs-up, an excited chorus of cheers and handshakes would follow. The buzz continued for many days, with such demonstrations as free large Obama posters inside the daily newspaper (we’re definitely bringing one home…). It seemed that East Africa itself had actually won the presidency of the
And, at the end of the day, I admit to really enjoying telling people that I now come from Obama-land.
Friday, November 7, 2008
Golfing Uganda Style
It's a 9-hole course that is ridiculously cheap(about $2.50USD), but the balls are 4x more expensive than the greens fees and since we are all huge cheapos, we bought one box for the three of us(for those who don't know, that's one ball each). They don't provide rental clubs or bags, but they have a pile of clubs that people have left over the years free to use. All we could find in working order was a 3-iron, 6-iron, 8-iron, 3-wood, and a wooden driver. The putter was bent in half, but we found a fringe iron that worked fine. The manager assured us that we would not be able to find our own way around the course and so hooked us up with a 12 year old local kid, named Joseph, as our caddie. Joseph was a slick dude as he right away called over one of his friends and handed him all the clubs to carry(all 6 that is).
When we got to the first tee we already had six more caddies, which it turns out we really needed. It started drizzling but we teed off anyways. On my second shot with the driver, because my first shot only went 20yds, the wooden head broke off and went flying further than my ball and then it started dumping rain. We were just about to head to the clubhouse when it let up so we ventured on with our 3 balls, 6 clubs and 8 caddies. The next few holes were fine except that whoever set up the course had either never done it before or secretly hated golfers because you constantly have to hit across other fairways directly over the heads of other golfers while other peoples balls are landing around you. You also have to hit across roads about 7 times. I now refer to hole #4 as the bat-hole because the tee box is underneath a tree that is home to about 6000 bats and they never stop squeaking during your backswing...who knew bats were so rude? I almost had to quit on hole #5 because the three of us, our 8 caddies, and several locals walking around could not find my ball, but luckily Josh found another ball in the grass after a 15min search. We ran out of luck, however, on the 8th hole when Josh lost his ball on his second shot and had to disqualify himself from our super competitive Ugandan Skins Game at 100 shillings per hole. JJ and I battled on and I was sure to win a triple skin on the 8th when JJ sunk an impossible 30ft putt that bounced 9 different directions on the uneven grass on its way to the hole. Inconceivable!
We finished up with the 9th hole, paid our caddies and made definite plans to play every week. Golfing Uganda Style was another unique experience that I will not soon forget. Oh yeah, and then I got malaria later that night and thought I was going to die for about two days.....all better now.
Saturday, October 25, 2008
The Pearl of Africa...
Last week we went down to the far southwest corner of the country to a Lake called Bunyonyi. The lake is nestled in a group of variously green colored hills from the dark green of the old forests, to the light green of the grasslands, all continuously dotted by the radiantly, fluorescent green matooke (banana) fields. The locals work their fields while the little kids run up and down the dirt paths laughing and playing. The camera sometimes captures the beauty as it really is, but most of the time does not do it enough justice. Bunyonyi, sittting at about 6000ft, is home to numerous large and small islands and there are two modes of transportation available, the dugout canoe and a few tourist boats with outboard engines. Half of the eleven of us paddled one of the dugout canoes to where we were staying, an island called Bushara, which is practically the only spot that still has all of its old growth forest.
The irony in the beauty of the surrounding hills, unfortunately, is the wholesale clear-cutting of a majority of the old growth forests for fuel and timber purposes. Every square inch of available land is now used to grow food, which makes for a spectacular landscape of multi-colored, terraced fields, but at the same time leaves it vulnerable to massive erosion. Bushara Island has a circumference of about 2k and hidden within the tall trees are 15-16 luxury camping tents complete with beds, a patio, an eco-toilet and even an outdoor shower that they will fill with hot water upon request. Every site is isolated and has a great view of the lake. Lynn and I both agreed that this was the most peaceful place we had ever been as all you ever hear are the birds and some occasional drumming calling the people to church on neighbouring islands.
The great thing about this lake is that we were able to swim in it due to the lack of things that would kill us such as waterborne diseases, crocodiles, and hippos. Best of all, though, was the rope swing which started from a high wooden platform and forced us to swing across the walking trail through a channel cut in the reeds and finally whipped us to a nice high jump into the water. Our group sustained only a few rope burns and one foot-dragging face plant into the water.
On Saturday morning we took a boat to a swamp at the far end of the island- only one large hill away from the Rwandan border- to see many different kinds of birds and quick glimpses of the lake otters. Africa tends to turn the most normal person into a completely nerdy birder and although I continue to deny that I am becoming a birder, I do enjoy using the strength of my camera to zoom in on some pretty amazing winged creatures. We ended up seeing 24 different kinds in only two hours.
As you can see from the pictures, the water was perfectly glassy the whole weekend- only adding to the grandeur of the place. The small island (below) with the lone tree is called Punishment Island, which is where they used to exile woman who committed adultery. Lynn amusingly quipped that she could mess around all she wanted in this place because it would take her no more than 10 minutes to swim back from the island each time.
The second adventure I speak of involved an assignment I am doing for school. The assignment is to assess a community project and since I already have connections at the UN Millennium Villages Project (MVP), I chose their school feeding program for my assessment. A short background is MVP was borne out of the Millennium Development Goals, which was a pact made in 2000 by the leaders of 192 countries to eradicate poverty by the year 2015. In 2006 MVP was created and 12 villages from all over sub-Saharan Africa were chosen as sites to implement a model development program. One of the villages chosen, Ruhiira, happens to be 45 min. from Mbarara and the main office is here in town. I have been volunteering there for a couple of months trying to help them with some inventory management problems, hence my connection. MVP is a huge project so I chose one aspect, the school feeding program, which I found most intriguing. There are 21 schools feeding over 11,000 students in the program and on this past Thursday I was able to ride along with the MVP education officer and the head driver as they delivered food to 11 of the schools in one of the two sub-counties.
Imagine the bumpiest dirt road you have ever been on and then imagine that we drove for ten hours in a truck filled with 5 tons of food on these roads, up the sides of mountains, through endless banana tree fields, and past settlements that surely had seldom or never seen a white person before. I unfortunately did not bring my camera on this outing (I will next time), but it was some of the most extraordinary landscape I have ever seen. Most schools were perched on the tops of these giant hills with views that western developers would die for. One school looked across an entire valley with the border of Tanzania at the far end.
The kids would gather around the truck while the food was unloaded and mostly stare at me in wide-eyed wonderment as I would ask the headmaster some questions. Some of the less shy girls would come and shake my hand, curtsy, and say “pleased to meet you”. It was very cute. The advantages of the feeding program are twofold as it allows more children to attend school knowing they will receive two hot meals, while at the same time allows the parents to spend more time growing food, some of which they can now sell for a little bit of income. There are many challenges also, but I will not go into detail as my main focus for this story is the beauty the place.
Africa is a huge, diverse place and we are lucky to be living in the tiny pearl that is Uganda.
Friday, October 3, 2008
Some friends we have made...
David is the first local I met here and he has been mentioned in our blog already. He is a 31 year old who has devoted a large part of his life to reaching out to kids in need. He does this because, as a child during the Idi Amin years, his parents were thrown in jail and he became a street kid. He lived on the streets for several years before a Nigerian missionary took him in. Luckily David’s story does not become more tragic as his parents were released from jail when Amin was exiled in 1979, but that experience convinced him that he needed to do everything possible to keep other kids out of that situation. He moved to Nyamitanga village three years ago because he heard that it was a chronically under served area of Mbarara. He rented a house and opened it up to the kids as a place to come and socialize, have fun and stay out of trouble. He has taken in eight orphans; two of which were infants abandoned on the floor of his outdoor latrine. His mother was kind enough to take the infants to her home to raise them as hers was more accommodating to such young kids. The other six live with him and are part of a group of about 40 boys and girls that make up the “Nyamitanga Kid’s Club”. This club is the beginning of a dream that David has to eventually build a clubhouse/orphanage to accommodate either abandoned or orphaned children as well as any kid that just wants to come and hang out. Lynn and I have a rule that we don’t like to give out cash for a couple of reasons: First, is that we don’t have much and second is that giving out cash sets a bad example that fosters a complacent attitude of entitlement. We, instead, like to help in other ways. We give them soccer balls, I help coach them and Lynn gives the girls health talks. David and I are currently working on how to acquire funding for the long term dream and we recently submitted a proposal to the local Rotary Club to help fund our research. We look forward to hearing from them.
Moses is a 24 year old kid who is the official coach of the “Kid’s Club” boy’s soccer team. I help him out and, as of late, I have starting coaching the girls. Moses grew up in the Capitol city of Kampala. His father had many wives and many kids and Moses often lost favor based on which wife was in favor. He was treated very badly and so he took off to live on the streets. He ended up in Mbarara where David found him and counseled him to get off the streets. David found him a job with a friend and Moses became the kids’ coach because he is a good soccer player. Unfortunately, as is typical here, the friend employing Moses shut down his business a couple of months ago putting Moses out of work. With no education and few skills, he is now living off of David, which means he walks 10K round trip to David’s house for one or two meals per day. Surprisingly, Moses’ English is very good and he was telling Lynn a couple of weeks ago that he was very interested in learning how to use computers. Lynn and I felt that with his English skills he would be able to find a job as long as he had another skill to go along with it, so we are funding him to take computer classes at a place that will also try to help him find a job.
Dennis is a 22 year old kid who is actually from Rwanda. His father was killed in the 1994 Rwandan genocide which forced him, his mother and siblings to flee to Uganda to live in a refugee camp just outside of Mbarara. These camps still exist today and his uncle continues to live in one. His mother was finally able to repatriate and go home to Rwanda in 2004 after ten years in the camp. It turns out Dennis is a pretty smart kid and he was given a scholarship through a UNHCR (United Nations High Council on Refugees) program to go to college in Kampala. He started veterinary school there, but decided that he would rather do pharmacology and so he ended up back in Mbarara where I met him at school. Receiving a scholarship is obviously better than not receiving one, but I could not believe the small amount of money given to him and how he manages to live off of it. He is given 590K shillings per semester for books, room and board. His books and room cost 450K leaving him with 140K to live and eat for four months. 140K is about $90USD so typically he eats one meal per day at a cost of 800-1000 shillings (50-60 cents) and then supplements that with some fruit and juice, and yet he always manages to bring us at least one pineapple when we have him over for dinner. Dennis is a great kid, very friendly and outgoing and determined to make his mom proud by finishing college.
Finally, we have Henry. The Henry situation has been a difficult one for us as well as our other expat friends living in the compound. Henry’s tragic story is a recent one that involves his sister. She had traveled to Kampala to do some shopping and was robbed not too long after getting off the bus. Unfortunately, these robbers not only took her money, but for some deranged reason also threw acid on her, which severely burned her face, arms and upper chest. This was almost a year ago and she has not been able to come home from Kampala because that is where the best hospital is. Henry has been on a mission ever since to raise money for her surgeries, but she mainly just stays there waiting for foreign doctors to do free procedures when they come through town. Henry is very persistent in asking every new white face for money which becomes everyone’s dilemma. This is a case where you realize you cannot solve every person’s problems and you have to just be OK with that. So we stuck to our money rule and, instead, have turned him into our banana bread connection. His other sister makes unbelievable banana bread which he typically gives to some of the newly arrived expats as a friendly gesture before asking for money. We love this banana bread so I asked him how much it costs his sister to make one and he said it was 5K, so I told him we would pay him 8k per loaf and order one per week. Banana bread day is easily my favorite day of the week and I have convinced 3 other people (after tasting it of course) to set up the same deal with Henry. This way he makes some extra money for his sister and we get a weekly treat. I work on every new arrival to help Henry expand his business and we are adding eggs to his delivery route this week. My next goal is to convince him that it can become a small business and that he should pressure his sister’s suppliers to sell her cheaper ingredients. So much for getting away from business….oh well.
Saturday, September 20, 2008
The kids of Nyamitanga
I tease Danny that he had an entire social network established in Mbarara before I even arrived, but have to comment on how amazing one of these particular connections has been- The Nyamitanga Kid's Club.
Danny met the kids while out on a run during his first week in Uganda. He came across a field of kids playing soccer. A week later was one of their coaches. A month land a half later he is regular in the village, and spends a few days a week hanging out at the kids club, which doubles as a home for four orphans. I've joined him on a few occasions, including last Saturday, and took a couple of pictures to share.
Surviving Malaria
I survived my cold without any trouble, but got a great insight into how deeply held the common, "catch-all" diagnosis of malaria really is. It makes sense, I guess, if you live in a village where most women aim to have at least 5 kids, as they know that there is a good chance they may lose 1 or 2 to malaria before the age of 5. Although tragic that these women are probably correct with their diagnosis, the subsequent common labeling of every febrile illness as malaria goes undisputed in day-to-day life. The examples are endless. In an article today by the BBC about the violence in Northern Uganda, there were only 2 reported reasons that people died. They were either victims of the LRA, or... "malaria". Another example came from some of the residents in the hospital. These doctors can list every malarial symptom, stage in the parasite's lifecycle and side-effect of the treatments, but still admit to putting themselves on empiric anti-malaria medication at the first sign of just about any illness. Who can blame them, I suppose. The stakes are high, and the treatment is cheap.
In any case, I survived my cold and am feeling much better. But maybe I'll stock our bathroom with some new medication. Just in case.
Sunday, September 14, 2008
Runyankole and other mind numbing tidbits
In addition to trying to figure out the language, we have been very busy meeting new people, expats and locals alike. I already have about 25 contacts in my phone including the kid who promised to ride me on his bicycle any where I wanted to go. The locals here have been great; everyone from the students and teachers to the doctors and medical students at Lynn’s hospital. We have at least one dinner party per week, and sometimes more. Overall, the locals have been very kind and easy to talk to. However, aside from the constant Mzungu…Mzungu (white person in Runyankole and Swahili) we do get the stares from some people which are neither curious nor friendly, but instead say, without the need of words, “What are you doing here whitey?”
School (pictured above) is going well and looks to get more interesting as we progress. There are 10-12 of us in my class and we complete the year in 2-4 week modules. For instance, I just finished my first three week module, which was Intro to Development and now move on to a two week module in communication skills with a different professor. Going to school here is a quite a different experience than when I lived and studied in China. In China I was one of three hundred foreigners from all over the world living and studying together. Here I am the only “Mzungu” enrolled in the entire school. I’m hoping they get bored with that fact real soon. The other difference is that here I am involved in a serious and complicated program, development, which is fraught with myths, perceptions, and misconceptions on both the “developed” and “developing” sides of the issue. Already, after my first three weeks of class and having lived here for five weeks, I have had to totally transform my own definition of “development” and learn that the word can at times be presumptuous and at other times downright arrogant. However, the greatest part of the class is that as a group we get first hand knowledge from each other regarding our respective countries socially, politically, etc… so there are less assumptions being tossed around. Oh yeah, and one other difference, there are no textbooks here; at least in my program as far as I can tell. We get "a" handout or "a" book to look at, but we have to pay to make photocopies for ourselves. The other day my change for the photocopies was paid to me in candy. We love it here!
Well, I could write for hours about the things we are doing here, but I know that no one would come back to the blog if I did......so more later.
Thursday, September 11, 2008
Wednesday, September 3, 2008
Mbarara Hospital
This is the most important lesson I have learned in my first week of work at Mbarara Hospital, and one that I suspect will cause me strife throughout my time here. It's really unnerving to be making important clinical decisions about a patient's care with virtually no hard information outside of my clincal exam. In the US, I frequently didn't even meet my patient until after I had the results of a complete blood count, a renal panel, a liver panel, an Xray, often a CT scan and sometimes an MRI. Things are different here. But let me start at the beginning, by describing the hospital...
Mbarara Hospital is a public hospital, meaning it is funded by the Ugandan Ministry of Health and general care in the hospital is free. It is affiliated with the medical school (MUST), one of only 2 med schools in the country, and so the hospital is staffed by med students and residents. The med students are good, and the residents are really excellent.
There are a few different wards in the hospital: a pediatric ward, an OB ward, an emergency ward, a surgical ward, and our medical ward. The medical ward is split into a men's and women's side and there are a total of 56 beds that lie in 2 rows about 2 feet from each other. Despite there being 56 beds, the ward is usually over capacity with many patients in spaces on the floor. There are 2 nurses for the whole ward, and very few other staff.
One of the most unique aspects of the hospital that struck me on my first day and continues to astonish me as I go to work everyday, is the presence of "attendants". Every patient is expected to have family tend to ALL their non-medical needs. This includes feeding, toileting, laundry, providing bedding. Everything! As you can imagine, a hospital full of patients creates the need for many, many attendants, and so the grass outside the ward is filled with women doing laundry or preparing food, other family members sleeping, and many just sitting. Waiting.
As a place to work, the hospital is great, but this is in part due to the rather sad dichotomy between the well-read, very intelligent, hard-working med students, interns and residents and the stark lack of resources, medications, and investigative abilities of the hospital. For my purposes of trying to gain broader clinical experience, my past 2 weeks have been the richest of my short career, but the tragic disparity between the impressive brain-power that you find in a good clinical training program such as this and the lack of tools available is apparent everyday, with almost every case. Having said that, no one here sits around complaining! They are creative, resourceful and able to provide impressive quality of care to the whole ward for the cost of a single ER visit in the US...
So what do I actually do? I am formally a volunteer teaching attending in the department of medicine (Yes- I actually have my Ugandan Medical License- can't wait to put that on a CV!), and am assigned to one of the 4 medical teams. It is surprisingly like any other residency program in the US or the UK, in that we have post-call intake rounds every morning, and I lead a combination of bedside teaching rounds with medical students and work rounds with the whole team when we see every patient together. The resident I work with is wonderful, and steers me back to Uganda when I fly off on a diagnostic tangent that is feasibly impossible.
As I said, you just have to be comfortable not knowing exactly what the diagnosis is. Be thorough. Make your best guess. Then treat, treat, treat!
Tuesday, September 2, 2008
Holy Thunderstorms Batman!!
Monday, September 1, 2008
Life in Mbarara
For anyone we haven’t bored with our pre-trip lectures… Mbarara is a bustling town on the main road between the capital of Uganda, Kampala, and the Southwest regions of the country, and Rwanda. The presence of the university and medical school, means that there are plenty of students around, although the vast majority of Mbarara’s population of 100, 000 has no tie to the university, and outside of the immediate city center, life is very rural and centered in small villages. Thanks to these local farming villages, there is an absolutely amazing vegetable market where we are able to fill our bags with huge avocados, tomatoes, eggplant, bananas, cucumbers, papaya and bell pepper for less than five US dollars total!
We are living on the campus of the university (Mbarara University of Science and Technology) in a set of houses reserved for visiting ex-pats to the university. By East African standards the houses are great with running water, toilets and a reasonably well-equipped kitchen. The location is fantastic, and my “commute” to the hospital is a 50 yard walk, while Danny’s development classes are held in a building 50 yards in the other direction. We are about a mile from the center of town, so also have easy access to shopping and the market. Our neighbors are wonderful, and although we feel well and truly submerged in African life, the presence of a few fellow-Mzungus (Swahili word for “whitey”) has definitely made the adjustment easier!
Despite being virtually on the equator (check out Mbarara on Google Earth and you’ll see what I mean!), the climate is really quite pleasant. The middle of the day is usually in the high 80’s, but most of the time the temperature is in the 60’s or 70’s. And yes, most importantly, I am able to sport my Yater hooded sweatshirt in the evenings! The region is at an altitude of around 4500ft which helps keep things cooler, as well as reducing the number of mosquitos- although they still seem to find poor Danny, and I never seem to get bites. (For all my teasing I’m sure I’ll be the one who comes down with malaria!) As for rain, we are now entering the rainy season and have had a few spectacular afternoon thunderstorms, during which seemingly impossible quantities of rain seem to come from the sky. Okay, maybe not much like Santa Barbara afterall…
Monday, August 25, 2008
Soccer can save the world!!
Wednesday, August 13, 2008
Back to Africa....
So back to reality. After 23 hrs. of flights and a very bumpy 5 hr. drive, I arrived in our new home for the next 10 months, Mbarara (which is pronounced Mbarara). It was so much easier to arrive in Uganda after having been in East Africa the month before. The drive was brutal as I kept getting woken up by gigantic potholes and sometimes cows blocking the road. Halfway to Mbarara you cross over the equator where you can actually stand with each foot on one side Then you buy a coke and move on. Driving through the little towns and villages I was struck by how much they reminded me of movie sets, western movie sets in particular. A typical village consists of anywhere from a half mile to a mile of store fronts of various colors and various stages of disrepair. The road and the store fronts are always bustling with people and commerce, and cows, but there is usually nothing behind the row of stores except for miles of hill and tree filled land. The other striking aspect is that there is clearly not enough commerce to keep everyone milling around busy and so I noticed many folks just lounging around trying to stay cool in the hot sun. Although, maybe they were indulging in some early retirement as well...I don't know.
Mbarara is a medium sized city with about 100K residents. It sits at about 4500ft so the weather is very moderate considering how close to the equator we are. It is a very hilly city with some nice views when not too hazy. From my limited knowledge so far, I believe it is a trading town (I think they export some coffee and vanilla but not much) and a big stopover for folks who are headed to the beautiful national parks within hours of the city. It is a bustling city with boda boda's (scooter taxis) zipping around everywhere spewing their toxic 2-stroke oil clouds. The city seems to be a bit more on the developed side due to the presence of the University (which I will be attending) as well as the medical school and hospital that Lynn will be volunteering at. I am in a temporary cottage right now where several other expats live who are either volunteering with Lynn's organization or doing collaborating research projects with schools such as Berkeley and UCSF. I have someone looking into securing a bigger place for Lynn and I and hope to move in and get it set up before she arrives.
I spend my days navigating or shall I say circumnavigating the supposed requirements, which literally change minute to minute and person to person, for me to register for school. After stapling my picture to 100 separate forms with the same information on each, I believe I finished registering yesterday, but one never truly knows. My sleeping pattern is totally screwed up because I keep taking naps in the middle of the day...I have to quit doing that! There is a tennis and basketball court close by and some locals play soccer every evening in the field right next to me so there will be plenty to do activity wise as well as jogging the hills.
Well that's about it for now...I'm gonna go buy some fish and try to figure out how to cook it.
Cheers from Uganda,
Sunday, August 10, 2008
Some wedding pictures...
Sunday, July 13, 2008
The island paradise...
Jambo everyone! Thank you for all the nice comments- amazing that people are actually reading the crazy things we write! So lovely to hear from everyone...
We are now back in Nairobi after an indescribable week on the Island of Lamu in the Indian Ocean (Kenya). I actually just finished reading Danny’s entry from last week, during our first layover in Nairobi and after the Kili climb It seems like a decade ago. On our flight from the coast to Nairobi yesterday we had a cruising altitude of 18000 ft, and after take-off saw only a bed of clouds far beneath the plane... until the twin peaks of Kilimanjaro, Kibo and Mwanza, appeared to the South. It was an abrupt snap back to memories of the incredible climb, how challenging summit day was, and how long ago it all seems after Lamu. (And yes, at 18000 ft, we were cruising at an altitude below Uhuru peak).
I think the summit day was the single hardest physical thing I've ever done (yes, including marathons, ironman, half-ironman). Jules was a champ but probably walked 1000 ft higher than she should have given the nausea she started having at about 17000ft. My guess is that she got to almost 18000ft (yes- the same height as our cruising altitude!) before the dry heaving and overall feeling terrible finally convinced her that it was time to turn back. She's convinced that she took on Kili and Kili won. I, on the other hand, think she took on Kili and she won 18000 of 19300 of the battle, which represents 93% and clearly a victory for little-J. (you have to put it into numbers to convince these stat-types...) And I don't think that a tendency towards altitude sickness above 17000ft will limit her future travel plans substantially... (!).
Anywho, we were all destroyed after the summit day, which involved an ascent from 15,100ft to 19,300ft over 7km, followed by a descent down to 10,200ft over another 23km.And Jules, who did all but the top 1300ft, and 2km, had to do it all despite the nausea and illness. So...yes, we were DESTROYED! We slept one last night on the mountain then returned to the town of Moshi where a trickle of luke warm water at the hotel felt like the greatest shower of our lives, and beer never tasted so good...
But still no real rest as we were up at 5:30am the next day to catch a bus to Nairobi. We decided it was worth taking the earlier one so that we would arrive in Nairobi during daylight hours- well worth it. Beautiful bus ride around the base of Mount Meru, then across the Tanzanian/Kenyan border (complete with storybook-type African border-official drama...), and then into the city center of Nairobi. Danny had booked a hotel within spitting distance of the shuttle stop, which was a fantastic base for the 24hours that we spent in Nairobi until our flight to Lamu.
One scary aspect to our time in Nairobi last week was the discovery that the Gap Fire was within a quarter mile of our parents’ home in the Goleta foothills, and that they were evacuated for several days. The good news to report at this point seems to be that although the hillside behind their home burned in a spectacular fashion, all the homes on the hill were saved, and they have mentioned how overwhelming the kindness of friends and neighbours has been over the past week. And so, after sitting in cyber cafes in East Africa during a somewhat terrifying few days last week, it seems I should say THANK YOU, THANK YOU, THANK YOU. To the firefighters, to the Goleta/Santa Barbara community that has been so kind to my family, and to the Independent for keeping us up-to-date from Kenya. Thank you.
And finally, the challenge of trying to describe our last week... I should start with my best friend from high school, Alice, who lived in Kenya as a young child for several years (actually the birthplace of her sister, Heather). Her parents maintain a close bond with an old group of friends from those days, as well as with the island paradise of Lamu. So...to celebrate Alice’s 30th birthday, her mother, Sally’s 60th, as well as the recent addition of Heather and Taylor’s engagement (woohoo!!!!) and Julie Nis’ 26th (wooohoooo!!!!!), Alice arranged a week-long party on Lamu. We rented 3 huge, beautiful houses, complete with staff and cooks (crab, lobster, shrimp, calamari... with EVERY lunch and dinner!), and 36 people made the trip from California, Washington, New York, England, Nairobi, Macau.... for the most indulgent week of my life! 80 degree water, white sand beaches, ancient Swahili architecture in tiny villages, a floating bar, a dhow regatta (of which we were on the winning dhow!), wind surfing, and drinking continuously for a week... I think the pictures will tell a better story than I ever could, so I will wait until next week when we will post our trip pictures (with a link from this blog-site).
As for what is next- we have returned to Nairobi for a quick layover before flying home (yes, home- crazy thought...) on Monday and Tuesday. We had a final hurrah at a fantastic, and very unique restaurant in Nairobi last night named appropriately, Carnivore. I’m not sure I have ever seen my husband enjoy a meal so much (and let’s be honest- danny enjoys his food...). We were first served with a pyramid of dipping sauces, and the “carvers” proceeded to circulate with a variety of beautifully cooked meats on stakes. Beef, lamb, sausages, chicken, pork ribs, ostrich meatballs, and even crocodile! All-you-can-eat! Yes. Danny enjoyed it.
And so, we are on our way home. So many more stories to share and pictures to show you all. It’s been a once-in-a-lifetime adventure- but we can’t wait for the next one!
Luv, Lynn
Saturday, July 5, 2008
Pole Pole!!!
Thursday, June 26, 2008
84 Cups of Tea
To sum it up, the second half of the Scotland trip was filled with family visits, and trying not to spread what we will now label “the California-summer-death-upper-respiratory virus” that has spread from Lynn, to Julie, to Danny, further. We left Edinburgh after renting a car and headed up to Dundee, where we did 4 relative visits in 2 days (read as- 84 cups of tea between us in 2 days). After the final cup of tea, we drove across the River Tay to St. Andrews which is famous for two things- golf and the university where Mary and Roger met (thus an entire town which can be blamed for creating Lynn, Clare and Julie). Danny chilled at the Museum of Golf, and then we walked around the cathedral and castle before having a very good fish supper (fish and chips), irn bru and an early bed.
Our last day in Scotland was spent driving through to Glasgow via Stirling, the home of Stirling Castle and the Wallace Monument. After checking out the Wallace Monument, including the stunning views over Old Stirling Bridge where the English army were defeated by a clever tactical move led by William Wallace in the 1290’s (a common theme in any Scottish history- “here is the site where we fought/killed/made-fun-of/embarrassed the English”- but always fun to hear about, nonetheless…).
So, we said goodbye to Scotland on Wednesday morning and arrived at Kilimanjaro airport in Tanzania 12 hours later. A classic introduction to Africa began with our inability to find our ride to Moshi amongst the 50 or so touts, taxi-drivers and legitimate drivers at the arrival hall in the airport. Kudos to Danny for finding a little sign, held by a little guy reading “Todd, pax 2”, which we clearly should have recognized as being for us…
And so, we are here. In Africa. In a crazy little cybercafé with slow internet. Weather is nice. Overcast. Not too hot. The climb up Kili begins tomorrow and seems to be looming over us both psychologically, and literally (it’s 19000ft height is impressive from our current position at it’s base). My friends Juli and Todd join us this evening, and then we are off tomorrow morning. So, no blogging for the next week- but will be in touch again on the flip side. Hope you are all well. Lynn