The Pearl of Africa...

… is how Winston Churchill famously referred to Uganda, and based on our most recent travels, we understand exactly how he felt.

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.

Some friends we have made...

I have done a lot of reading since arriving here and Lynn and I have met a quite a few locals. One thing I notice more and more is that the personal stories of locals we have met often mimic the very story of Africa itself. This is a story typically rooted in misfortune or tragedy yet, at the same time, full of promise and potential and hope for the future. My story is about four friends we have met in our short time here who all have their own stories to tell that are extraordinary from our perspective, but unfortunately, all too common from theirs.

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.

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.

The kids are incredible. My husband is amazing.

Surviving Malaria

I suppose it was to be expected. When you spend time around sick people, you will get sick. So, yes, I spent most of this week suffering through a nasty upper respiratory infection. A typical virus that came in with a sore throat and left with a stuffy nose. Although, if you ask anyone around here, it could have been 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.

Runyankole and other mind numbing tidbits

I’m pretty sure “Wasibota” means good afternoon. I was very excited to arrive in Uganda and continue working on the little bit of Swahili I picked up in Tanzania and Kenya. To my dismay, however, it turns out that no one speaks Swahili in Uganda. Several native languages are spoken in Uganda including “Runyankole” which is spoken here in the southwest corner of the country where Mbarara is located. Runyankole is no where near as easy as Swahili appeared to be, hence my confusion in using Wasibota. As a matter of fact, after being here for 5 weeks, I am still not sure exactly which hello to use in the morning, afternoon, night, or in general for that matter. I bought a cheap phrase book in town, but it was useless because it taught me how to say things like “my leg is paining” or “my neighbor is thievery” yet still did not give me a word for hello. Lynn and I have decided to find a tutor to try to teach us a couple of times a week for a month or so to see if we pick it up at all or to at least learn some of the basics.
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.

Lake Mburo

So, after a rough 2 whole weeks in the daily grind of life in Mbarara, we decided we needed a vacation... We escaped to the beautiful Lake Mburo National Park for a couple of days wildlife watching, hiking, boating and generally enjoying the beautiful surroundings.

Mbarara Hospital

You just have to be comfortable not knowing.

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!