Return to Random Uganda
on Random Uganda (Uganda), 16/Aug/2011 18:19, 34 days ago
Yes, I understand, this blog is beyond resuscitation.What is the saying about flogging a dead blog?Well.I am sure I won’t be the first.Or the last.But, as some of you know, I am back in Uganda.And a few of you (a polite few) have asked for an update.And since I’m too lazy to figure out how to mail a postcard…About three weeks ago, I found myself sweating anxiously in the passport control line at Entebbe airport.A few things have changed since I left Uganda in May of 2010.For one thing, $50 dollars (despite the Chinese berating us for our fiscal irresponsibility, the US dollar is still Africa’s currency of choice) will only buy you a 30 day visa (instead of 90).And for another, a man that I pissed off to the point of apoplexy in the waning days of my last placement has recently become thefirst mzungu elected to publicoffice in Uganda since the colonial days.So I was half expecting to have my passport stamped“persona non grata” (or the luganda equivalent) and to be escorted back onto the KLM flight returning to Amsterdam.Fortunately, organization is not one of the changes that has struck Uganda since my departure.Soon Robert, our driver, had us racing along Entebbe Road, and the familiar smells of smolderingmatookepeels and meat-on-a-stick roasting over a charcoal fire were bringing tears of remembrance to my eyes.It was after midnight when we reached Kampala and the suburbs were dark.Load sharing.The newdam on Bujagali fallsthat was supposed to come on line in 2010 to satisfy the growing energy demand is a little bit behind schedule.After a restless night reacquainting myself with the joys of sleeping under a net (and the joys of trying to struggle through said net to get to the toilet while diuresing the fluid overload of 20+ hours of travel), I woke to the cawing hadada ibis and the hammering of rocks outside my window that signals morning in Kampala.And before I could even sayNile Special, we were informed that we’d be moving upcountry (every place outside of Kampala, even if it is south, or of a lower elevation, as isMbarara, is upcountry) in a few hours.Since we weren’t going to start work until Monday (3 days hence), I was hoping to spend the weekend tracking down a few remaining VSO buddies and reacquainting myself with the Kampala pub scene, but, alas, it was not to be.I made the suggestion that maybe we travel on Sunday, but it was declined.The Mbarara team, we were told, was waiting to welcome us.The Kampala-Mbarara road has gotten somewhat better since last I traveled it.Still a bit sketchy starting out as it winds through the papyrus swamps en route to Masaka, the seemingly endless stretches of speed humps that marked road construction during my road trips of 2010 have yielded a nice wide highway that even has, wait for it, wait for it, a few passing lanes.Mbarara is much as I last left it.A dusty confluence of roads with a town center crowded with electronics shops, banks and NGO offices.A giant cement Ankole bull marks the roundabout onto High Street.Just down the road a sprawling slope of dilapidated one-story wards makes up the Mbarara Regional Referral Hospital, with the Mbarara University of Science and Technology (MUST) just across the street.Our accommodation is quite plush.Hot water, refrigerator and satellite TV (when the power is on).And Sheila (our cook) and Opio (our housekeeper).Shortly after our arrival, the director of the Mbarara office popped in to introduce himself. He said that he was here to give us our orientation.When we looked up, he was gone.We figured he must have gone out to get his notes.We haven’t seen him since.We sat around waiting for everything to be made clear, but, when it became apparent that that wasn’t happening, we did what was necessary.We went on safari.A few hours later we were atLake Mburo National Park, walking through the woods with an armed ranger, stalking zebra, impala, waterbuck, buffalo and the elusive eland.While we were off in the wilds, the Mbarara team was staging a‘prayer fast.’We must have missed that item on the itinerary (which, like the orientation, was still in the anticipatory stages).Several of our team, on Monday, let us know how our presence at the prayer fast was missed…Okay.You should probably know.I am here working for an FBO (faith based organization).As an aspiring Buddhist and recovering catholic, my grasp on faith has always been a little tenuous, but, if you are going to work in Africa, having faith on your side is probably a good thing.When you don’t have some of the things you take for granted (for instance, electricity, clean water, medicine, aseptic working conditions), it can be good to have a little faith.Monday.An hour drive on a dusty washboard track into theNakivale Refugee Resettlement Area—a good-sized chunk of the Isingiro district that has been under the control of the UNHCR (UN High Commission for Refugees) since the 1950s.Some of the refugees that have been resettled here are on their second and third generations.Some of the Rwandese refugees cannot return home because of potential political persecution…if they were to return home they might face prosecution for their part in the genocide of 1994.Refugees are trucked into Nakivale from the regions bordering on war and famine.The camp is gearing up to receive 30000 Somali refugees (trucking in from the Kenyan border) from the latest drought in the horn of Africa.When the refugees arrive they are registered and given the usual ubiquitous white and blue UNHCR tarps, a source of clean water, food from the WFP (world food program) and a small plot of land on which they can build a shelter (most build huts by driving a palisade of sticks into the ground, weaving a basket of twigs and grasses and then smearing mud into the structure to make walls topped by a tarp roof) and grow food.The UNHCR tarps and the WFP food can be bartered at the‘trading centers’ for more essential items… like Nile Special and airtime.Our little part of Nakivale is the Kibengo Village Level 2 Health Care Center—HC2.(An HC 1 would be staffed by lay people.An HC3 would have inpatient beds, but no operating theatre, etc., so an HC2 is basically what you might think of as a clinic, except for the tent out back—left over from the cholera epidemic—where we can hold patients overnight for ‘observation’)Kibengo Village area houses predominantly Congolese refugees that fled the resurgence of violence by the‘rebels’ in 2008-09.They walked across the border to Ishasha and Busanza, managed to make nuisances of themselves by dying from cholera and malnutrition and were resettled into Nakivale.Our HC2 provides primary care services (including childbirth) for the Congolese refugees as well as the local Ugandan population from the Isingiro district and from as far away as the Mbarara district.You might ask why someone who lives in Mbarara, home of the Mbarara Regional Referral Hospital might take a taxi or boda on 60 miles of bad road out to a refugee camp to seek health care.And the answer would be that our HC2 has a few things that you might not find at the MRRH or your standard MOH (ministry of health) run HC2 or HC3.Like medicines.Or staff that comes to work.Or a functional lab.The Ugandan constitution guarantees the right of free health care to all its citizens.But what you get for free might scare the health right out of you.So when word gets around that an HC2 is actually dispensing medicines free of charge, well, you can see the attraction.You would probably drive to the Walmart in the next town if you heard they were giving away flat screen TVs, maybe even for drugs.On a side note.And this is entirely hearsay.But during the elections this past spring, I am told that suddenly all the HCs out there had all the medicines they were supposed to have and, owing to the fact that their paychecks were rumored to arrive any day, the medical and nursing staff actually showed up for work…Shorty after Yoweri Museveni of the National Resistance Movement was re-elected, as he has been since 1986 in what was suggested might not have been a‘free and fair’ election, the medicines disappeared from the shelves.It turns out that Museveni had other plans for the funds.Alavish re-inauguration for instance.And a few fighter jets.In any case.Every morning at the Kibengo HC2, about 200 or so people line up to be seen.First come first serve.Triage is done by consensus.If your child is having a seizure, chances are good that you will be urged forward.If you look like you are cutting the queue for a fake injury, chances are good that you will receive a real one.I sit in an office with Micah, a clinical officer (a 3 year diploma that allows him to do just about everything short of brain surgery), and Alice (or Iris, I’m not really sure, the Ugandans have this thing about Ls) my translator.Alice is pretty much running the show.Every 5 or six minutes a new patient will sit down.The patient and Alice will talk for a few minutes.She will take the patient’s temperature.If it is normal she will roll her eyes, if it is high she will raise her eyebrows and nod at me.Alice:‘Fever, cough, headache.3 days.’Me:‘any other problems?’Alice:‘that is all’Me:‘no vomiting or diarrhea…?’Alice (rolling her eyes to imply what part of that is all didn’t you understand): ‘no’Me:‘does the patient know her HIV status?’Alice (rolling her eyes to imply like what does that have to do with anything, but not asking the patient anything):‘negative, 3 months ago.’Alice is already getting out the rapid malaria test kit.It will be positive.If the patient is a child and starts crying, Alice will scold the mom.Heaven forbid the child coughs in my direction.I just know Alice is yelling‘don’t let your child cough on my mzungu doctor, you know how weak they are, he might get a cold and die!’Strangely enough, aside from the fact that my entire patient note can be scribbled in a space the size of a beer bottle label, the work here is much the same as at home.There are a number of really sick people mixed in with some people who are just overwhelmed with the aches and pains of living (of course living here involves cultivating your own food in red-clay soil using your hands and a hoe).And then there are some folks in line because we are giving away free medicines.And medicines can also be traded for airtime.These folks are trying to figure out what to tell Alice (before she tells me‘that is all’) that will get the most medicines.They compare notes.Lower abdominal pain, dysuria and vaginal discharge were last week’s favorite.This week, after we instituted a rule that anybody with a complaint that might be an STI (sexually transmitted infection) has to bring their partner in in order to receive treatment, it seems to be epigastric pain and body itching.With careful sifting, or maybe even some halfhearted sieving, it is amazing the kind of pathology that walks into the office.OK.Maybe not so amazing for the folks with filiriasis (elephantiasis).But amazing for me as one used to spending much of my workday sorting out problems directly related to the stresses and excesses of life in the developed world.In a few short weeks I have made my career’s first diagnoses of brucellosis, schistosomiasis, and congenital syphilis.Cool stuff.Unless you’ve got it.It doesn’t take much diagnostic prowess to spot the sick kids.Their moms carry them in looking like half filled WFP rice sacks.It’s almost always malaria.Or malaria with malnutrition, or malaria with pneumonia or malaria with diarrhea.Moses, our procedure nurse, has outrageous skills at getting an intravenous line into the slack skin of dehydrated infants.And with a little fluid, some dextrose, some IV quinine and a random antibiotic or two, miracles happen every day.A child that was near death in the morning is sitting up eating a banana in the afternoon.This afternoon a visiting Ugandan doctor chided me for giving IV medicines to a child who could clearly have been treated on orals…I just smiled.This morning, when the mom unbundled the baby from her back, I was surprised to discover the baby was still breathing.(the other morning, another baby, same waxy look, wasn’t)The news has been full of footage from the UK rioting and looting.My VSO friends from England have been calling home to check on their families—instead of vice versa.Uganda put out a travel advisory, telling its citizens planning on overseas travel to avoid England as their safety could not be guaranteed.The Ugandans are puzzled.Where is the tear gas?The water cannons?A peaceful march to protest the high cost of living (there has been 20% or more inflation in the year since I left) in Kampala a few months ago was met with gas and armored personnel carriers.The leader of the marchKizza Besigye(who lost to Museveni in the election) had to be hospitalized.In Kenya.Also in the news.Starving children in Somalia.On the BBC, a Somali woman who has been a refugee on the Kenyan border for over a decade blames the UNHCR for the conditions in her country.(through an interpreter)‘They (UNHCR) should stop feeding us here, then the people would have to go home and work out their problems…”Sustainable seems to be the development catchphrase I keep hearing.Is this sustainable?A refugee camp where the refugees never leave? A country that receives more than 90% of their health budget from foreign donors and then uses the savings to buy fighter jets?An NGO that brings in a doctor to work who is so weak that he requires 3 or 4 Ugandans just to keep him alive.I wonder.Tomorrow will be my last day at Nakivale.The month has flown.In a few days I will be back to work in an emergency room in the states.Talking about unsustainable.It has been a good month.For me at least.In the grand scheme of things, perhaps akin to putting a hello kitty bandaid on the gaping wound that is Africa, but what are you going to do?