Uganda Summer 2009 Final Chapter: The Lost Is Found

On my last day in Uganda, I woke up to french toast being cooked for me by the interns: a delicious way to start off 40 hours of travel. They were inspired to cook for me since the night before, I had prepared vodka sauce and pasta for the crew staying at the office (probably because it was heavy on the vodka). I had to feel a little bit guilty about this meal, because it cost more than most Ugandans probably spend on a week's worth of meals, but I wanted to do something nice for these interns, who were spending some of their last days in Uganda working hard on their final reports and helping to clean up our incredible mountain of random items in the storeroom.

After saying many goodbyes, I hauled my two large suitcases down the dirt path towards Igangatown, creating quite a spectacle. "Mzungu, those bags are too heavy for you!" "Madame, let me assist you!" "Mzungu byeeeee!"

It took me so long to drag them around all the potholes and over the uneven ground that I arrived in town at the time when I was meant to meet my ride to the airport, instead of early, as I had hoped. I was planning to stop at the police station to try to pick up some piece of paper to certify the situation regarding my lost wallet, for insurance purposes. Instead, I just waited at the main intersection of town for my ride to show up. After 20 minutes, I was pacing in circles around my bags. After 30 minutes, I had stomach cramps, convinced I had been forgotten but with no more mobile phone to communicate, since I had donated it to UVP. After 45 minutes, just as I was ready to toss my french toast up by the side of the road in a state of panic, my ride pulled up. I decided that I needed to join this man on Africa time, and stop being such an American. I sent him to pick up the other traveling interns, and stopped at the police station.

I walked in to a crowd of people staring at me, which has stopped seeming strange. "I'd like to report a lost wallet." I said. A woman in a police uniform, scribbling in a notebook at the desk, asked "when did this wallet go missing?" I felt rather silly, realizing that it had been nearly a month since the wallet was stolen, though Dad had stopped in the day after the theft and told me that the police did not have it. "Just recently," I said, bashfully. "I know I will never get it back, but I just wanted to make a report." The crowd stared at me some more. A man leaning up against the counter next to me in a suit jacket raised an eyebrow. "Alison, you did not lose that wallet just recently." He said. This time I stared at him. "Do you know something about it?" "We have recovered your wallet." The policewoman said to me. I was incredulous. "We have spent money on your case!" She emphasized, giving me a meaningful look. She led me to a side room in the station, where a man opened a locked drawer and pulled out my wallet. I burst into tears, and then felt even more foolish. "Why are you not happy?" The woman asked me. "I thought I was never going to see it again." I blubbered nonsensically. I had cancelled all the cards inside, and the money was, of course, gone, so I have no idea why I was getting so emotional about my driver's license recovery, except that I was emotional because I was leaving Uganda.

I found out that the local councilman from one of the district villages had arrested a man carrying my wallet just that week and brought him into the station. That man was still at the station and they planned to press charges for the theft. The police claimed that they had had to pay the councilman 20,000 shillings for the return of the wallet. I wasn't sure what to make of this tale, but I was willing to give up everything I had at that point. I pressed the 15,000 shillings I had kept for emergencies on the way to the airport into the policewoman's hands. "Please, take this, thank you." "What about my gift from America?" She asked. "You own me many thanks because I have worked so hard on your case." "Yes, next time I return you can have something from America."

When I finally finished making my police statement, I ran out the door, hopped into the car, and started the trek to Entebbe. We made it exactly 2 hours prior to my departure time despite the hours spent at the police station. I just couldn't believe that from some village out in the bush, my wallet had come back to me. I didn't realize until after I left that I should have urged for leniency for the thief, since stoning to death is a common local penalty for stealing.

Uganda Summer 2009 Part 11: We're Going To Die!

Jinja, the next city west of Iganga, is the location of the source of the Nile River. Though I have visited and paddled around the Source (which is often thought of in capital letters here), as well as spent some time enjoying the vistas of the Nile downstream, I have never taken part in its most famous pastime: rafting! This time I had pledged to myself that even though I was afraid to brave the rapids, I would raft the Nile. So on Sunday, my parents, my brother Brian and I took the plunge. The morning started in Jinja at the Nile River Explorers hostel, where free breakfast and trip preparation took place. I seized the opportunity to eat a mouthwateringly delicious bacon and egg sandwich for breakfast – yes, my vegetarian diet is on hiatus to some extent while in Africa, since most of the farm animals here seem to live a life of pastoral luxury. I still eat rice and beans and bread for most meals, but I have been partaking in the occasional chicken. While we ate, a video showing rafts capsizing dramatically as rafters flew through the air into the raging river played, and everyone watched nervously out of the corners of their eyes.

We donned helmets and life vests and joined the crew of Aussies, Americans, Brits, and muscle-bound Swedes for the trip to our starting point. Swedes love to show off their awesome abs, or so I have concluded after meeting several representatives of that country on this trip. We rumbled on a ‘lorry’ down the dirt road to the rafting start point. Although the kids who live along this road must see busloads of us being carted past every single day, they still run screaming like banshees towards the bus, crying out “mzunguuuu!” like it was their job. This adds evidence to my theory that we need more anthropological research on what compels the “mzungu!” phenomenon.

Upon forming a group with 2 Brits and a nervous Tanzanian, we met our rafting guide, Peter. Peter was a muscular Ugandan local with a penchant for dark humor and the use of a falsetto voice. Actually, I really need to conduct more anthropological research into why men in eastern Uganda find falsetto voices hilarious. I think it’s similar to the way Britons can’t get over transvestites in comedy. Anyhow, Peter introduced himself by saying “Nice to meet you all. I’ve never done this before, but I watched the video at the hostel very carefully, and it looks pretty easy.” The Brits looked at him with eyes like saucers. “REALLY?” Peter kept a straight face.

We floated down the peaceful initial portion of the river while learning all the rafting commands: “Forward! Harder! Lean in! GET DOWN!!!” “Get down!” means that you crouch in the bottom of the raft, clutching the side rope and your paddle. As we approached the first set of rapids, we learned that Peter’s favorite catchphrase is to scream “WE’RE GOING TO DIEEEE!” in his best falsetto just prior to the raft entering the rapids. For those who have not encountered the Nile Rapids, the class 6 rapids which are considered too dangerous to be run on a raft have names like “the Dead Frenchman” and “the Dead Dutchman”. The lower class rapids that we take on in the raft have more warm and fuzzy names, like “The Bad Place” and “Vengeance”.

Each large rapid, as we approached, was simply a crashing noise and a spray of whitewater that appeared just at the horizon line. Then just prior to falling down into the maelstrom of waves, you could see the entire rapid in front of you just in time to yell “this looks crazy!!” and be terrified. It was thrilling. As we cascaded down one of the falls, the raft crumpled underneath us and we were all thrown into the water. I felt like I was thrust down 20 feet into the water, and struggled mightily to no avail to reach the surface. It was the scariest portion of the trip, because although I could perceive through my closed eyes that the water was getting lighter, and therefore I must be approaching the sun, I had the horrible feeling I had no idea how far down I was. As my face surfaced, I tried to take a large gulp of air which became a large gulp of the Nile. I was submerged again and swirling downstream uncontrollably, unable to do anything but try to keep my mouth above water and flail and sputter and cough. Although rafting is amazing, flipping is not enjoyable to me.

We had several nice stretches of calm water where we could swim in the warm water, or observe the bird life: rows of cormorants in different colors diving underwater, stately herons and egrets, and little yellow birds that dart between a hundred nests hanging from the branches of one tree, like a hundred orbs of twigs. Of course, the bird life was punctuated by groups of women doing their laundry in the river. In most cases, it seemed to be one person doing the laundry, and twenty idle children spectating at the riverside, hoping to catch a glimpse of mzungu madness. We ate pineapple and buttery cookies called “Glucose biscuits” for our midday snack as we floated.

Finally, our group elected to walk around the last rapid, an unbelievable cyclone of water called The Bad Place, which is partially a class 6 rapid. Peter laughed at us and called our route the “chicken line”, clucking, of course, in his falsetto. We had a few regrets as we watched the rafts fly over the waves, but I did end up glad I was not trapped underneath again.

After rafting, we were taken for a banquet to the rafting company’s campsite. They had an array of amazing looking food, including – a tray of pasta! Would it surprise you if I told you I had a can of Parmesan cheese in my backpack for just such an occasion? Mmmm…. What a day.

Training For All

My last workshop was a resounding success. Aside from starting almost 3 hours late, which we can easily discount as expected, we had good turnout, we were able to get through the entire curriculum including all the hands-on skills stations, and the participants seemed to learn a lot. I noted at the beginning of the workshop that there seemed to be quite a wide spectrum of knowledge and skills amongst the participants. One participant in particular seemed to have a poorer command of English, so I tried to ensure that he had understood each point before moving on. I spent extra time with him at the skills stations. At the end of the course, I was gratified to see that his score had increased from about 20% on the pre-test to 55% on the post-test. Despite the language barrier, he had learned a significant number of the objectives of the course.

Later, I was entering in the data into my spreadsheet of participants, and I burst out laughing. Everyone working nearby stared at me. I helplessly continued to giggle while re-reading the sign-in sheet from the workshop: the participant I had struggled to train in neonatal resuscitation was the health center’s security guard.

Post-script: we had also trained the lab tech and the lab assistant. The lab tech scored 30% both before and after the course, but the lab assistant finished the course with a score of 80% (!)

Uganda Summer 2009 Part 10: The Fun Fair

As a final event to conclude my dad’s summer soccer camp for orphans, he organized a tournament between the two orphanages he worked with. The hosting orphanage has a fantastic property, a large farm with several buildings of classrooms, several dormitories, an art room, a volleyball court, and a soccer field. It houses about 40 orphans. The visiting orphanage has over 80 residents but has significantly smaller space, as well as the prior pictured soccer field, which is definitely not fit for bare feet, much less a ball that always tends to roll downhill.

Dad had an ambitious plan for teams to be made and split the day into time periods which the teams would rotate through to score points for their team by playing games against each other. Translate that into African time and African style, and we had 120 kids with a variety of colored ribbons on their heads running around squealing and having a good time and playing. The day opened with many welcome songs, so many that we started to think we would be watching performances until lunchtime. The performers basically had to be stopped to go play the games they had come to play. Mom was busy cooking banana bread on a sigiri, a small round charcoal stove. This is accomplished by placing the banana bread pan on top of two empty tuna fish cans placed inside a large metal pot, with another large metal pot placed on top to create a Dutch oven. This banana bread came out fantastically, but it took several hours to bake each loaf, so by lunchtime only one loaf for the 150 of us was cut into tiny bites of banana bread for everyone.

I was assigned to the four square station, which wasn’t a real station, it was just a four square court I drew with chalk on an uneven area of concrete and then tried to recruit wayward children. I realized as I looked at it that the squares were warped and 2nd square was far smaller than 4th square. I had to sweep the stones and goat detritus off the court before starting to play with a broom made of twigs. (The orphanage has a goat named Jennifer) After going to all this trouble, I was excited to gather several girls who had been pushed out from the volleyball court, until I realized I was trying to teach a fairly complex game to young children who did not speak my language. It took at least 45 minutes to establish rule #1: the ball can only bounce once in your square. I gave up and led them to the face painting table, where about five kids were getting each cheek, each hand, and their foreheads decorated with butterflies and hearts.

The day was a resounding success, and when it was time for farewells, we got a wonderful sendoff with many “weebales” (“way ba lay”: thank yous). Again we had singing, but this time we had special personalized songs and dances. “Mr. Dick Weebale, Mr. Dick Weebale!” was my favorite. The next best was “Mr. Dick, we are very sorry, that you are leaving, keep on remembering us!…” This was repeated verse by verse for “Maama Linda” and “Mr. Aa-rin” (which must be Brian, but we decided this might be some weird fusion between Alison and Brian since only 3 names were mentioned. We finished with some folk music and dancing, for which I would have loved a translation, since it really appeared to involve a man beating his wife with a stick, and then some children acting like monkeys and dancing in a circle. Overall, one of my happiest days in Uganda this summer. Mr. Dick weebale indeed, weebale nnyo.

Uganda Summer 2009 Part 9: The Delivery

Our resuscitation workshop started today despite only being able to rouse 2 midwives for the lectures. The positive side to this was that I was able to give them nearly one on one instruction. The negative side was that one of them was on duty and got called away to an imminent delivery, and the other one got called in to the district health office for some unknown reason. Rather than sitting idly in the classroom, I decided to attend the delivery to see what it was like. The patient who had just arrived was a woman having her 8th child. Most women do not give birth at health centers, preferring to give birth at home with a traditional birth attendant because of the cost of transport and the costs of the materials required at the health center. There is no charge for public healthcare in Uganda, but those who give birth at health centers are meant to bring mama kits, made up of things like a plastic sheet, a razorblade, clean cotton cloths, and ties for the umbilical cord. I have no idea what they do to substitute for these items if they give birth at home.

The midwife was a strong woman with a commanding voice. I had met her on a previous visit to the health center, when she politely requested an update in every aspect of emergency obstetric care. I liked the fact that she was so open to learning new things, and she also had a very entertaining way of using the Lusoga exclamation “eeh!” as she made stinging indictments of the Ugandan healthcare system. “No soap, no medications, eeh!” She said derisively. “At times we are just like a TBA.” (Traditional Birth Attendant) The midwife put on an apron, large white rubber boots, and gloves. I got the feeling that she was nervous that I was observing her.

The patient crawled onto the bed, which had a plastic mattress and metal frame and no further covering. She crawled clumsily. She was fully dilated. She didn’t make it into good position on the bed, and her head was propped up on the bare metal bar at the head of the bedframe. A plastic sheet like a garbage bag was laid underneath her. Her eyes were squeezed shut and she appeared uncomfortable, but she made no sounds except breathing heavily. The midwife grabbed her thighs and pulled them up towards her head, shouting “push!” in Lusoga. I grabbed a thigh, assuming the ‘husband position’ in American obstetrics and held the patient’s hand. The midwife continued to shout as she ruptured the membranes and tried to help the baby’s head down. “Push! Push more!” Her tone sounded like a drill sergeant’s. A few other patients peeked their heads around the screen to watch. The fluid from the ruptured membranes splashed everywhere. “You see the conditions that we are dealing with.” The midwife said, angrily looking at her wet arms. “She is a victim, eeh!” Meaning that the patient has HIV. The baby’s head got close, and the midwife grabbed onto it and started maneuvering it out. The cord was loosely around the neck. The midwife’s shouting reached a fevered pitch, and then she reached over and whacked the patient in the thigh as she yelled. The baby slid out, looking blue and limp. The midwife turned the baby upside down and gave it a little shake to get fluid out, then put her finger in the baby’s mouth and tried to sweep out anything remaining. I looked at the bulb suction sitting next to the bed, unused, which the midwives had told me they no longer utilize due to infection risk if it is reused. After some vigorous drying, the baby ‘pinked up’ and started crying, though not lustily. Perhaps he sensed that the circumstances in the room were less than joyous.

The baby was wrapped in a cotton cloth and placed on a nearby bed. The onlookers from the other part of the ward were still watching. The woman finally sat up and took her head off the metal bar it was resting against as she climbed out of the puddle in her bed to get dried off. The whole thing had taken about fifteen minutes. As I walked back to the classroom, I thought of my Ugandan teammate’s pronouncement that “women have to be strong, because they must endure labor.”

The midwife cleaned up and returned to my workshop, having sent the mother and baby to a bed in the maternity ward. “How was my technique?” She asked politely. “Can you give me feedback?” She has been a midwife for something like twenty years, and I felt a bit ridiculous, but I ran through what I had seen, starting with her protective gear, mentioning the Apgar score and what she had done after the baby was delivered. “One thing I would like to emphasize, though – please don’t hit your patients.” I said carefully.

Local Brew

The description of the trip to Sipi Falls would not be complete without including a postscript regarding the “local brew” experience. Our group purchased basically a vat of this concoction called “local brew” and held a bonfire with the Crow’s Nest staff to sample it. We were in a rather indignant mood, having just waited 4 hours after ordering dinner for our food to arrive. Seeing the mysterious local brew made us forget about dinner and gather around staring. It was a plastic bucket nearly filled with a substance that on first glance, was very reminiscent of vomit. The fact sounds so unpalatable that I hate to use it as a mental picture for you, but it really was an accurate description of this liquid. It was tan with some chunks of material floating in it. There were a number of multicolored long plastic straws in the bucket, which from our local group’s demonstration, you were meant to dip up and down in the bucket as you sipped it.

At first I swore to myself that I was not going to even sample the brew, but when teammates assured me that the taste was fairly inoffensive, I gave in and tried a bit. Hearing about an alcoholic beverage referred to as the ‘local brew’, I tend to picture an extremely alcoholic liquor that might cause severe burns your esophagus on the way down. This local brew only tasted sort of like warm beer. The other flavor was of strong yeast, giving the impression of drinking liquid bread. After everyone had tried the brew, we left it to the local group, who were pleased to help us drink it. We sang local songs, heard folk tales about why the chicken scratches the ground and why the eagle eats chicks (because the chicken lost the eagle’s needle, and the eagle couldn’t mend her clothes when she wanted to go for a holiday). We danced by the bonfire, and debated the relevance of cultural imperialism to the practice of female genital mutilation. It was worth every penny of the ten dollars we paid for our twenty liters of local brew.

Uganda Summer 2009 Part 8: African Life

Sipi Falls is part of a series of sudden mountain ridges that jump out of the ground just east of Mbale, near the Kenyan border. Up to that point, the eastern Ugandan countryside has some gentle rolling hills, but these mountains are like a wall built to block anything from passing further. The waterfalls have carved a steep valley into one of these ridges, and the Crows’ Nest faces a dramatic panorama of green cliffs and spectacular jets of waterfalls cascading down over rock caves. The Crows’ Nest is a tourist hostel catering to the tourist at the level of ‘village luxury’. It has electricity and quasi-Western food, so it is marvelous, but it also features pit latrines, giant larval-appearing moths, swarms of ants, rats, bats, a horde of skulking tail-wagging dogs, and a series of rickety huts that seem like they were constructed using some twigs and a stapler. I loved it. It was peaceful, cheap, and rustic. And it serves spaghetti (though the sauce is just cooked tomatoes), which you can eat as you contemplate the beautiful falls.

I elected simply to hike as much as possible, so I signed up for the ‘long hike’ as well as an afternoon ‘coffee tour’. As we set off on the long hike and I saw the tiny specks representing members of my group abseiling down one of the waterfalls, I did not regret my choice, though I think they enjoyed it. The hiking is very physically challenging because the valley basically drops straight down and then juts straight up. We carefully picked our way down one side, then crawled, climbed, and puffed our way up the other side. This is the rainy season, and the ground was mud. The trail was about as wide as a footprint, though it is frequently traveled, there are tiny tropical green shoots trying to overtake it every day. There was a lot of sliding and falling in the mud, and sweating in the heat. Little children would shame us by scrambling past as if the cliff were merely a swingset ladder they were scurrying up. We were basically hiking through many different properties, and I enjoyed this because we met many farm animals (I never seem to tire of greeting cows and goats as we go by), saw innumerable lovely traditional Ugandan banda-style huts, and basically got to wander through as the families were digging, harvesting, drying, sorting, and variously working on their crops, stopping to smile at us as we passed. Strangely enough, the children in the falls area do not say “mzungu bye”. They say “hello”! It was novel to be followed by cries of “hello”, though it is a more difficult word and often I heard “eh lo! Eh lo!” or “hewwo! Hewwo!” coming from toddlers. The native language is quite different from Lusoga, and it is frustrating not to be able to use this to communicate.

The falls were of course wonderful, particularly the final highest waterfall on the ridge, where you can approach it almost to the point of standing in the waterfall, and the mist engulfs you and soaks you if you stay to admire it. There is a local man with a little receipt book who stands in front of the waterfall and makes you pay a waterfall fee to get closer. We also stopped at a swimming hole on the way, and when we stuck our feet in, we were shocked to find that the water was frigid. It was not just cold, it was arctic. The guide estimated the water temperature at 10 degrees C. Despite that, myself and my teammate went for a full-on polar swim, which felt incredibly refreshing and fantastic, even though it was so cold I got pins and needles after about 30 seconds, and was painful after about 1 minute to the point I had to hop out. The water was rushing through the swimming hole, so I figured it was probably safe, though after I got out, I asked the guide "Do you ever see guinea worms?" "Oh yes! Guinea worms!" He smiled jovially. "They are there."

After a rest at the hostel, I set off again to learn more about coffeemaking. Myself and two other team members wandered through some of the fields where the coffee plants grow, and then visited a local house where the coffee is processed. They took the beans and pounded them with a mortar and pestle. The outer shells would crack off, and then the remainder gets shaken away from the chaff (is it still chaff if we’re not talking about wheat?) until only the beans are left. The beans are then roasted in a pan, we helped to roast them over a charcoal fire inside the home’s small, mud-floored kitchen hut. I think we burnt our batch badly. The hut was tiny and filled with thick smoke that was irritating to the eyes and throat. We huddled low on chairs, as our hostess bustled around the hut hardly seeming to notice. She grabbed the roasting coffee pan with her bare hands, dropping it after a few seconds and clapping her hands to dissipate the pain. Outside, rain was pouring down and washing through the courtyard (and leaking through the roof onto my head as well). She served us a pot of freshly brewed coffee, which we at first tasted doubtfully, but found to be delicious. As we quietly drank our homemade coffee, she came into the mud hut, soaking wet from the rain, and was drying her dripping face with a cloth as the smoke billowed around her. The rain was pounding on the tin roof so loudly that holding a conversation was impossible. She smiled ebulliently and looked at me and said “African life.” She hardly said much else during our lengthy visit, but her one simple phrase seemed to summarize the whole episode perfectly.

To be continued…

Uganda Summer 2009 Part 7: A Ugandan Odyssey

I would like, if I may, to take you on a journey across Uganda. I went traveling this past weekend, and had a fantastic time, though I had to wrestle through a hundred of the small frustrations that traveling in Uganda entails. This post will be a therapeutic way of trying to look fondly upon those frustrations as classic African time: it drags us out of our preoccupation with the future and into the present moment, to fight it is a struggle the mzungu will never win.

My journey to Mbale started in the Iganga taxi park, at the sign marked “Mbale” where taxis to Mbale do, occasionally, depart. “Mbale?” I inquired of one of the conductors. “No, madame, you must go to the road.” Rather than being frustrated, I was heartened, because picking up a taxi from the road assures you that the taxi will be full and en route, rather than sitting lazily half empty for hours as children poke you through the open window and repeat “Some money. Some money. Please, some money.”

When I reached the road, several Ugandan men fell all over each other to find me a ride. “Madame, I will get you a taxi to Mbale! Just wait here!” Sure enough, within about 10 minutes, a taxi, stuffed to the gills with traveling Ugandans, pulled over and I was wedged into place at the end of a row of seats. “Madame! Here, you sit! Banange, a mzungu, let her sit! Let her sit!” Was this, in fact, a taxi to Mbale? No, but unless you are learned in the ways of Ugandan travel, you will not expect to question that the taxi you embark upon, in which everyone inside and out is crying “yes, Mbale! You sit!” is actually going to that place.

We traveled for a while, and then we stopped in a random town, and I was told to get off. It was not Mbale, not even close. “Mbale!” The conductor shouted. “You sit here.” I was put on another taxi, this one nearly empty, which gave me a sense of foreboding. When the engine started, we immediately veered off the highway and into an alleyway between two roadside shops. The taxi pulled into a schoolyard and drove across the grass, passing over stone paths indiscriminately and between crowds of children. “Where are we going?” I asked, nervously gripping the door. “We are collecting,” said the driver opaquely. We pulled up beside the school, where some sort of event was just finishing. The taxi was slowly loaded with amps and other sound equipment until the back seats filled. This took something like 40 minutes, during which a crowd of schoolchildren pointed and laughed at me, and dared each other to touch me. Every few minutes, one little girl would grab the other and try to pick her up and forcibly drive her towards me so that she might accidentally touch me, at which point the little girl would scream, and maybe if she got pushed far enough, start crying and run away.

Finally, we were loaded and zigzagged back to the highway and in the direction of Mbale, though we continued to “collect” by stopping every few minutes to try to urge more passengers aboard. I asked a well dressed man the best way to get to Sipi Falls, explaining that I had never been there before. The man gallantly hailed me a boda (motorcycle taxi). “Sipi Falls, do you know the place?” I asked the man several times. “Yes, I know it,” he assured me, smiling, and because the well dressed man looked like he would be otherwise offended, I climbed aboard, ignoring the boda man standing next to me who said “he doesn’t know the place. No, he doesn’t know it.” This motorcycle took me around the corner, and then stopped in front of a van. “You sit here,” he said. “Sipi Falls.” He then demanded a large sum as payment for transport. At this point I had had enough. “Sir, you have cheated me!” I yelled. “I could have walked that distance in one minute. You lied to me!” He obstinately stuck his hand in my face, saying “the money, madame.” I handed him a coin, shouting “even this is too much!” and the rest of the van broke out in giggles. “how far did he take you and how much did he want?” All the van passengers were intrigued. Finally, I was headed for my destination. Though I was crushed in a backseat with only a percentage of my thigh on a seat cushion, I still spent the drive relishing the idea of a day off.

Uganda Summer 2009 Part 6: The Baby Is Flabby

This week begins a new chapter in my time in Uganda: my foray into teaching health workers. The past two weeks, my efforts on this front mainly involved scouring the internet for a curriculum on neonatal resuscitation, and adapting it for use in rural Ugandan health centers. Although I have participated in community education such as the safe birth workshops many times, this is my first time trying to teach other health professionals across language and cultural barriers. So I put on my best Ugandan accent, brought a borrowed baby mannekin and a bag valve mask, and started in a typically African way: stymied by a lack of electricity. I had been up late into the night putting the finishing touches on the curriculum, planning to print in the morning prior to departure. The electricity came on during breakfast, and I headed for the print shops, but large volume copying and printing, unfortunately, is much more difficult without the amenities of the USA. Dad performed admirably under pressure, getting multiple copy stands working simultaneously, and then launching on a bike trip to deliver the goods since I had to take off, being late for the workshop. Unfortunately, I was unsure of the distance of the health center from town, and it turned out to be about 15 goat-dodging, African miles away. The heat was sweltering, and town names in Uganda are frustratingly similar, thus he ended up crisscrossing Nakalama to no avail as I began my workshop in Namalemba.

The workshops seemed quite popular, with fairly good audience participation and many thanks given by the midwives and nursing assistants who joined us. As one of our mentors and friends here pointed out, the problem in Uganda is that the language that healthcare workers learn about health in is a different language than the one they practice healthcare in. This observation was particularly striking when I studied the pre and post test results from the initial workshops. Though particularly the midwives surprised me with their breadth of knowledge (though they seemed to struggle with the Apgar score while I was teaching it, actually both of them had answered my Apgar score question correctly on the pre-test), there were also various challenges presented by teaching in my students’ second language. First, the vagaries of British-Ugandan-English, phrases that seem to be common parlance here but make little sense through an American lens. Phrases like “the baby is flabby,” which I believe means that it is floppy. Then answers that I doubted to be true reflections of practice, i.e.
Q: “After your initial interventions, the baby is still not breathing. What do you do next?” A: “Refer to the hospital.”
Of course, there were also nonsensical items such as:
Q: “When should the baby first be given to the mother?” A: “Vitamin A”.

Some responses really gave me pause.
Q: “After your initial interventions, the baby is still not breathing. What do you do next?”
A: “Give bag ventilation, give chest compressions, then wait 30 minutes.”
(The curriculum specifies that each piece of the resuscitation lasts 30 seconds). Does this mean that my teaching failed? Was it simply a slip because the respondent is not answering in her primary language? Would she really wait 30 minutes in practice, staring at a blue, dead baby? I did change the pre/post test to multiple choice and specific numbered answers to try to clarify where the issues are. In case you are wondering, I did have a translator with me, but because the participants know so much English, they find the use of the translator frustrating because they are understanding most of what I’m saying already. It’s the other 10% of what I’m saying that I worry about.

I chose to take an optimistic perspective based on the fact that the midwives and medical officers really do have a surprisingly good knowledge base, given that they do not get reliable continuing medical education. They are not used to participatory learning, and thus they have a difficult time with giving me the sorts of answers I am looking for. Although I could see from our assessments and pre tests that the midwives knew the details of how to basically care for a sick neonate, I would pose a question to my audience like “So, what do you do then if the baby is not breathing?” After some silence, one midwife would whisper “Resuscitate,” and the rest would nod as if that said it all. The Basoga are a very soft spoken people and I have to walk up to the participants at times and lean towards them to make out what they are saying. Overall, it was a very interesting departure from my usual work in Uganda, and I am looking forward to pursuing this further and seeing what progress we can make. It’s exciting!

Uganda 2009 Part 5: The Goat Roast

The last safe birth workshop was today, in a village that took about an hour to reach between motorcycles and hiking down paths through maize and potato fields. We gathered a crowd of over 50 women under a big tree, who laid out huge patterned straw mats to kneel on. These women seemed to go to great lengths to chase away children and men who tried to join the audience, and applauded politely after each of us spoke. The only man in the crowd was an intimidating bald gentleman by the title of the “LC of defense”. I took on the role of the pregnant woman who had been in labor for more than 12 hours, and tried to wail as convincingly as the rest of my teammates, though I think I have lost my flair for the dramatic somewhat since reaching adulthood.

Today I learned how to make a necklace out of a cassava leaf. I found out that a cassava leaf actually makes a beautiful accessory. Our Ugandan team member, who made necklaces for several other team members, does not flirt with me, either because I’m unattractive or married or both. And so I resolved to make my own necklace. Next on the list is learning how to make a ring from a banana leaf.

I hurried from the village, as the sun set lower and lower, to try to reach dad’s soccer tournament match before dark. Dad has been working with 2 orphanages in the Iganga area, and today the larger orphanage pitted its dormitories against one another, and named each team after its respective dormitory. Thus the ultimate battle: “Grace versus Peace”. The orphanage houses 83 boys and girls. The boys took each other on in ‘football’, and the girls had a netball match. Grace and Peace each took one game, so everyone seemed to end up feeling somewhat victorious. I arrived after the game had ended, and dad had bought a goat for the teams to feast on. The goat was chopped into many small cubes and put onto sticks for roasting. When I arrived, the kids were clustered into four small groups around piles of charcoal, furiously blowing on the coals as billows of smoke rose up around them. I almost didn’t notice one very large ‘kid’ huddled with them, my dad, the ‘tournament sponsor’. As we chatted with the orphanage administrators, the kids proudly paraded around with their goat kebabs that had been grilled to a crisp. I finally saw the soccer field that they had been playing on, and only a photo can do it justice. I will try to post one. Favorite quote of the day: “Your dad is a very good man,” the orphanage administrator told me. “I know!” “The children love him so much, and I have found that I love him too.” “Oh… good!” I said, trying not to laugh.

On the weekends, my team members are rotating through cooking us dinner, so last night was ‘Pad See-ew” and tonight was tuna noodle casserole. It’s amazing what you can make here, yet the Ugandan menu is very bland. I was very excited tonight because my darling husband gave me a call, which unfortunately kept being punctuated by cries of “mzungu, bonga!” and “mzungu bye!” and even “mzungu, I love you so much.” I got so distracted as we made our way down the dark but crowded road that I fell into a ditch while I was talking to Geoffrey, and a sympathetic chorus of “oh, sorry! Sorry!” came out of the darkness from the bystanders who saw me go down.

As a final point, I will explain “mzungu, bonga!” Since I last came to Uganda, the infamous ‘terrorist fist jab’ has become the new trend in greetings. The government has apparently conducted some campaign to reduce infection that centered on utilizing the fist bump, rather than shaking hands. This campaign is fantastic because it means that I don’t have a million grimy hands grasping mine as I walk down the street. Instead, the giggling kids run up, fist outstretched, and delightedly cry “mzungu, bonga!” and are satiated with a simple touch of the knuckles. It amuses me that the gesture that became vilified in American politics was promoted in this country as the preferred politically correct way to say hi. And now I will bid you goodnight, with a virtual fist jab, as my teammates are having a late night snack of chapatti and Splenda sandwiches.

edit: the photo is of the soccer field next to Ekyaro Kyaife, the orphanage... can you see the slope?

The Middle of the Trans-African Highway

Yesterday, I was wobbling down the dusty roads on the back of a bicycle boda-boda, on my way to a meeting with one of the physicians here who is doing some fantastic research and community work locally here. We came to the main intersection in town, a bustling crossroads of the main trade road which is flanked by street vendors and crowds of locals, and the Trans-African highway, which passes through Iganga on its way across the continent.

My bicycle taxi man set off across the street haltingly, then realized too late that there were taxi vans and motorcycles coming and him from both directions. He turned east and started up the road in a desperate attempt to keep moving, wobbling more severely as he tried to peer over either shoulder to see how we could avoid the oncoming vehicles, and finally we collapsed in the dead center of the highway. Although the bike fell on me, I had been riding sidesaddle so I was able to kind of hop away unharmed and then I just ran for it because the vehicles had all slammed on the brakes.

Though this experience was terrifying, in retrospect it's sort of funny, because the same boda boda man approached me a minute afterwards, smiling and querying "we go?" I only then began to contemplate the fact that he might be drunk. Irritated, I yelled "I'd rather walk than die!" and ran in the direction of the district health offices to the giggles of the crowds by the roadside.

I also dressed wounds yesterday including Dermabonding an abdominal laceration, and ran a rapid malaria test, so I felt a bit more useful than usual.

Uganda 2009 Part 4: What About Artificial Insemination?

I have one week to prepare a curriculum on neonatal resuscitation for healthcare professionals, and submit two proposals to the Makerere University School of Public Health Institutional Review Board for research projects.

Today, I traveled to one of the first villages in which we are piloting our 'Healthy Villages' program. We are rolling out this program in 5 villages in 2009. The basic concept is that we created a list of the bottom 70 villages in the district for sanitation measures (latrine coverage and safe water access) and we are bringing a raft of public health and healthcare interventions, as well as bringing partner organizations to these villages specifically to try to improve health and poverty measures across the board. I'm extremely excited about this program. It does involve a lot of grassroots, tough organizing and advocacy. That means showing up for meetings that never happen, waiting 3 hours for an education workshop to start, going house to house to publicize a program, and other such challenges. I have nothing but admiration for people who do fieldwork full time. I'm far too impatient by nature.

We performed for our second safe birth workshop since my arrival, and it certainly is a performance. A lot of stuffing objects under our shirts for pseudopregnancies, miming of maternal health emergencies, and peals of laughter from the audience. This time the women got so involved in the skits we had designed, one of them even pretended to collapse into the grass and dramatically clutch at the skirts of the woman acting as the village elder. Unfortunately, our 'stage' was a patch of grass in between an irritable (and malodorous) cow, and a swarm of biting ants the size of scorpions. The crowd of men, women and children gathered there didn't seem to mind. In fact, they were our most involved audience, asking so many questions at the end of the presentation that we had to cut them off. They wanted to know what causes preterm labor? What causes hemorrhage? Why can a woman menstruate more than once in a month? What should I eat for protein, if I don't like to eat grasshoppers?

Then they moved on to the personal and sad questions. Why did I have a baby with terrible congenital deformities? Why can't I get pregnant even though I have been trying for so long? And, bringing up a common accusation: why have you brought us this education instead of drugs, or medical equipment, or something we can use?

After that, we moved beyond the personal to the incredibly personal, the how in the world is it OK for you to ask this in mixed company personal: why do I have foul smelling vaginal discharge? Why do I have sexual dysfunction? Is the reason I can't get pregnant because my husband isn't good enough at sex? And most bizarrely: but what about artificial insemination?

Everyone was dying to know why they were not as fertile as they wanted to be, even though to each one, we answered that we could not diagnose or treat conditions in a little field by the roadside and that they must visit a health center. But I am too poor to visit a health center, said one woman, and I am pregnant, so give me an antenatal visit here, right now! In fact, several audience members approached me after the presentation, hoping for a medical consultation. I suspected pituitary tumor in the first one, and traumatic skull fracture in the second one, but what could I do? I urged them to seek further medical care at the referral hospital, and I gathered all the medical students to come see the deformity in the second patient's skill. Underneath his skin, his head was pulsating, but the boy was smiling and seemed no worse for the wear. I cringed as he hopped on the back of a bicycle without a helmet and rode away.

We Get Published

I'm thrilled to report that a narrative describing our work in obstetric fistula was just published in the Yale Journal of Biology and Medicine. It's freely available - if you care about obstetric fistula, or would like to know more about this devastating medical condition and what impact it has here in Africa, please check out the article. It is written in a readable, engaging style, not in the format of a research paper.

Experiences with Obstetric Fistula in Rural Uganda, by Will Murk, YJBM June 2009

Maama Wange?

This morning was hot, and inescapably sunny. I was walking alone down the dusty dirt path that leads to UVP's office. Next door to UVP is a small building called 'Happy Hours Nursery School'. As I passed by, I saw a child about 4 years old, standing next to the road in tattered clothing that had all turned rust colored from being coated with dirt for so long. Chants of children in the school sounded like a high pitched song, but this child was clearly too poor to be a student, and was just outside listening from his post by the road. As I passed by, he held out his hand to me and said in a small polite voice: "Mzungu... oli maama wange?"

I was reminded of the story of the ugly duckling that wanders around the pond, querying everyone it meets because it has lost its family. The child's question meant, "You are my mother?"

I don't think I could make up something sadder if I tried.

Uganda 2009 Part 3: Hey, Obama!

In Uganda, it is customary for men lounging by the side of the street to yell things at white women passing by. The most vociferous are the 'boda boda men', the men gathered in packs on motorcycles or bicycles who are part of this country's complex transport system. One of the Ugandan team members for UVP commented last year that her least favorite thing about working with UVP was "knowing what the boda boda men are saying, because it's very rude." I explained this to my father last night, as we were walking down a busy street, and added that I continue to be blissfully unaware of what the boda boda men are saying most of the time. I did just take the time to look up one of the things that I had heard shouted my way a number of times just today, "mutesi! mutesi!" This apparently means 'one who is not trustworthy' in Lusoga, according to an obscure internet source I found. I prefer this greeting to kissy-face noises, or "you! you are my wife! hey, my wife!" These catcallers never seem to take no for an answer, nor do they ever seem to get discouraged by the lack of response. They continue to wail their mantra just as loudly until your white skin has receded from sight completely.

Sometimes the boda boda men try to use other means to get your attention. Since 'mzungu we go!' is old hat at this point, they try to elicit attention with other greetings. In the USA, I would expect 'hey, blondie', or 'hey, sweetheart', or something along those lines, but apparently I fall under different categories in the boda boda men's minds. "Hey, USA!" they shout, or "Hey, America!" as if I had an American flag tattooed across my face. Sometimes I also get "Hey, English!" and today, for the first time, "Hey, Obama! Yes, Obama!" Finally, the boda boda men got something other than a scowl from me.

In other news, I am in Jinja today at a fancy cafe catering to mzungus, drinking a mango lassi. Jinja seems bigger than I remember it 5 years ago. I feel old. I can't believe I was here 5 years ago. The only other change I have noticed thus far is that the souvenirs have become more sophisticated. Instead of simply being able to purchase a t-shirt that reads "MZUNGU", you can now also purchase a "MY NAME IS NOT MZUNGU" t-shirt.

Uganda 2009 Part 2: You Are Well Come

I tried hard to kick off my month optimistically, despite the challenges both ahead of and behind me. I spent the day yesterday with my team, trying to learn all that they have been working on in the past month. This was difficult, as I am working on a team of determined overachievers, who have certainly made me proud. It is never an easy thing to shoulder the task of helping to introduce a new program at a fledgling nonprofit, especially one that is trying to work within a broken healthcare system in rural African villages. They have been faced with the task of trying to improve healthcare delivery and utilization in rural clinics with bare bones staffing, no medications, and no supplies. I can imagine most people looking at this situation and trying to push along a few simple tasks, like meetings, gathering data, planning and executing basic maternal health education, and meeting with obstacle after obstacle, would be beyond daunted and give up. However, I think that the team has flourished despite all this, with much credit due to incredibly effective leadership prior to my arrival.

The team has developed some educational materials and a safe motherhood curriculum that I am very impressed with. I look forward to seeing them present this curriculum in a village on Monday. They have also been busy doing things that, though they are less tangible to picture, are even more valuable: making connections, data analysis, strengthening parterships, and developing assessment tools. This small sketch is a part of one of their education tools designed for an illiterate audience.

I traveled to one of the health centers today to help perform a knowledge assessment on the staff of the Labour Ward there. This rural outpost, despite its location very deep in the villages, has almost reached the designation of hospital by the Ugandan classification of medical facilities. It has small men's and women's wards, and the separate Labour Ward where deliveries occur. The midwives there were kind enough to take a break from their busy schedule and speak with my team about their skills and knowledge. They estimated that they attend 7-10 births per week, in addition to over 100 antenatal visits and a small number of postnatal care visits as well. As we interviewed the first midwife, she showed a very solid knowledge base that gave credit to her 27 years of work at the health center. "The best treatment for any problem is antenatal care, this is what I know," she said. As we ran down a list of topics that we were offering to give workshops on and asked which ones she needed further training on, she laughed. "Medical care is always changing, and we must always continue learning," she told us. "So how can I say that I do not need any further training on this subject?" As we read down the list she continued to smile and answered each time "I would like an update. I would like an update. Yes, and on that one, I would also like an update."

As I rode back on a motorcycle down the dusty road from Kiyunga, wedged between a sweaty boda boda man and a mother holding a child, I noticed a large, block-lettered phrase decorating the smooth tan side of a mud hut. "YOU ARE WELL COME TO THE SOURCE OF LIFE" I smiled. Things are looking up.

Uganda 2009 Part I: Do They Drug The Chickens?

My fourth trip to Uganda began inauspiciously with a dead battery on the way to the airport. After many, many hours of intermittently compressing my calf muscles on a plane, I thought my luck might be changing when an artist from Kampala offered my father and I a ride from the airport. We slogged through the muddy taxi park - Dad took this rather well for a newcomer to Uganda - and spent several hours dodging our way down the Trans-African highway towards Iganga.

I learned that my father, at 6'2", does not actually fit in the back of a Ugandan taxi (also known as a mataatu). He has to be wedged between the two bench seats, bowing out in the front due to pressure from his knees and the back as he tries to relieve the crushing knee pressure.

We stopped when jerry cans went tumbling off the back of the taxi, and while the conductor paid a social call to a woman standing beside the road, and of course, to drop off the 6 chickens who had been curled under our seat, who had been only occasionally been engaging in a seat-shaking protest. "Do they drug the chickens?" Dad asked seriously. You see, my dad may not yet realize that now that he is a fellow traveler to Uganda with me, he gets to become a character in my travelogue. He can be Katz, and I of course am Bill Bryson. Therefore he is charged with providing the comic relief, and I will make money for wandering around the world and doing whatever I please. Or at least that is my daydream.

Arriving in Igangatown after dark, we exhaustedly dragged our luggage off the taxi. I was too tired even to realize that the taxi driver had overcharged us for the fare, in addition to demanding further payment for the luggage. I argued with him for several minutes, then stomped off into the dark but busy streets with Dad, with cries of "mzungu we go!" echoing behind us. It wasn't until I arrived at the new Uganda Village Project offices that I realized the streak of unfortunate luck had continued: my wallet was missing. I'm still kicking myself for not arriving with money belt in place - instead the money belt was packed into my suitcase. I have been trying to reassure myself that I did not lose anything irreplaceable ever since. My final thought on this unfortunate episode was to comfort myself with the idea that I had disbursed an unplanned microloan to an impoverished entrepreneur. This briefly made me feel better. Please do not tell me that this does not make any sense. Bring on the stormy seas - I'm making lemonade from these lemons no matter what.