back to gulu
on Random Uganda (Uganda), 18/Dec/2009 04:45, 34 days ago
December 12thYet another trip to Gulu with a side trip to LiraAs I was fighting car-sickness in the back of the ambulance last Friday, one of the thoughts that kept crossing my mind was that on Monday I was going to get to turn around and do the whole thing over again. At least this time we did it in a Land Cruiser and the driver wasn’t bent on setting the land speed record.Alison and I headed to the IMC clinics in Lira and Gulu to do a little teaching to the staff there… Irene from the recently dissolved IMC clinical directorate went along. Steven from pharmacy was supposed to join us, but apparently he didn’t ask proper permission from his boss, and his participation was cancelled at the last minute. (as such, I got to spend some of my time in Lira and Gulu checking out the pharmacies and auditing their records)The road north crosses the Nile at Karuma. I wanted to stop and take some pictures, but Satchi, our driver, said that it was illegal to take pictures from the bridge (despite there being not a single sign to suggest this) and that the soldiers hiding in the woods would jump out and confiscate my camera or at least demand a healthy bribe. I suppose the bridge, as the only significant road link between northern and southern Uganda, has some strategic value, but I’m thinking that the GPS guided smart bomb dropped from 30000 feet isn’t really going to care what the view of the Karuma falls as seen from the bridge is going to look like.At least the baboons sitting on the guardrails didn’t try to charge me for taking their picture.Lira is a rabbit warren of shacks and old colonial buildings laid out along paths that were once probably wild animal tracks. Lira has tripled in size in the last decade or so, and the lack of community planning shows. The clinic in Lira is tiny and staffed by the usual up-country clinic contingent: a doctor, a clinical officer, 2 nurses, a lab tech, front desk/customer service representative, a security guard, a cleaner and a cook. The pharmacy, where I was to spend several hours trying to make sense of the medication record keeping (3 different books and an excel spread sheet with no correlation whatsoever between them), is the size of a coat closet.While in Lira, we paid a visit to the Charis Health center, a 2 year old facility built by the UK charity, Fields of Life. Charis is a bit off the beaten path, but then, most things in Lira are. It is set on a nice lot, although parking seemed a little skimpy for the size of the clinic—but ours was the only vehicle there. The medical center consists of a spacious and empty waiting room, 3 consultation rooms, an emergency room (being used for staff meals and to store the donated ultrasound machine and EKG machines), 4 6-bed inpatient wards (with 3 patients), a labor and delivery area, office space and a lab. The senior medical person on duty was the lab tech (he said that the clinical officer who was supposed to be on duty was in Kampala on training, but proudly admitted that he was the one seeing patients that day) who was happy to show us around the clinic, and, when Irene wound him up a little while we toured L and D, allude to the fact that he had delivered babies (and might be able to do a C-section if he really had to). Fortunately he didn’t have many patients this particular day. I think he assumed we were potential donors, so he made a big point of showing the ‘room for expansion’ out back and suggested it would be a good place for a theatre (OR). We asked him if he was planning on expanding his practice to include major surgery, he just smiled.What Charis amounts to then, is one of the nicest and best equipped health centers in Lira, and a horribly understaffed and underutilized resource. And the reason? NGOs like to build things. But sticking around to run them gets messy. So it’s better to cut the ribbon, shake a few hands, get the picture of the happy children on the opening day, and then get the hell out. Fields of Life mostly builds schools. Their website says that there are 34000 students attending schools built by Fields of Life, and I have no reason to doubt them. Their website doesn’t say how many patients are being cared for at Charis Health Center.Gulu, like Lira, has also tripled in population in recent history. But at least it has grown in sort of a grid, and some of the streets have drainage gutters (even if they are full of trash and sewage and are located where one might expect a sidewalk to be).Most of Gulu and Lira’s growth comes in the way of IDPs (internally displaced people) from the rural north battlegrounds of the civil war between the UPDF (Uganda’s army) and the LRA (Joseph Kony’s Lord’s Resistance Army). All in all there were over 1.5 million IDPs from the North. Gulu is where the ‘night walkers’—the 15000 rural children that would walk in from the villages each night so as not to be kidnapped by the LRA—walked to. Now that Joseph Kony is somewhere hiding out in the Democratic Republic of Congo, and Gulu is thought to be fairly safe, NGOs have flooded in. You cannot spit in Gulu without hitting a sign with an acronym on it. (my favorite acronym of the trip was SLAP—serving the least advantaged people) Nor can you cross the street without looking both ways for a speeding white SUV with some NGO logo plastered on the door and the trendy ‘no weapons’ (an ak47 in a red circle with a line through it) sticker in the window.Our clinic at Gulu is a nice facility, with living quarters on the floor above. The Gulu staff come from all over Uganda (and Rwanda) and they work and live together roughly 24/7... so, naturally they have developed deep seated contempt for their co-workers. Fortunately, this was Irene’s problem. And one that a deep cleansing breath and a group hug wasn’t going to cure. We will see how my suggestion to pay them more and make them find their own accommodation will go over…