October 2009
on Random Uganda (Uganda), 05/Dec/2009 12:29, 34 days ago
October 1stLast weekend was the gorilla gala.Gorillas are big business in Uganda (and Rwanda). A 3 or 4 hour excursion into the mountains on the Uganda-Rwanda-congo border for a 30” visit with the endangered mountain gorillas costs $500 for the permit (that’s not including your travel and lodging and the change of underpants). Some of that money actually is used to protect the gorilla and the habitat and to support the communities whose land has been taken away to continue protecting the gorilla. And some of that money goes for the minister of tourism’s brand new range rover…In any case the gorilla gala was contrived to launch the new friend a gorilla website (www.friendagorilla.org). For those of you who can’t fly to Uganda and walk into the woods to pester the ‘habituated’ gorillas, you can now buy a gorilla friend online and put that gorillas face on your facebook page and your gorilla friend will send you periodic emails (‘had some really good shoots and leaves yesterday, still can’t get rid of the @#$%^ing tourists’) and you can check on his gps coordinates…To add substance to the event they even recruited a couple of minor Hollywood celebrities to go check out the gorillas and grace the gala with their charm. Jason Biggs was the headliner and Brenda Wu (from Buffy the vampire killer, I’m told) and her boyfriend who is so minor his name escapes me also showed up… Initially I thought, ‘well that’s nice, the Hollywood types are supporting the wildlife efforts.’ But then Donna, one of the vso volunteers, who works at UWA (Uganda wildlife authority) told me that UWA got agrant from USAID to pay for these characters to come to Uganda and see the gorillas… So you will be happy to know that your tax dollars paid for a filthy rich American actor, known worldwide for a scene in which he masturbates into an apple pie, to come and participate in gorilla tourism.So that about catches me up to date.Tonight I am catching the night bus to Nairobi to participate in the Naivasha relays with some of the Kampala Hash harriers… No, I have no idea what I’ve gotten myself into this time.October 6thReport on the Naivasha relays long weekend trip to Nairobi: bus time—27 hours; sleep—only in 5-20 minute intervals; kilometers run—11; energy replacement drink—warm tusker beer; wildlife spotted from the bus—flamingos, zebra, impala; SVUs stuck in the mud—17.So the Naivasha relay covers about 100km of inhospitable terrain between Nairobi and Lake Naivasha in legs of 5-6km. Most of it is Masai land (the Masai, like their cattle, have been fenced in), dry and rock and dusty with sad looking cows scrabbling for the bits of vegetation. Some of the legs of the relay were so rocky that the herd of support vehicles made such slow progress that they were overtaken by the runners. And at one point we crossed a plain covered in 6 inches of fine as flour dust unable to see more than a foot in front of the bumper of the 4WD. Watching the runners approach through the shimmering heat waves in clouds of dust was like a scene out of some post-apocalyptic epic.For some inexplicable reason, dirty dick (his hash name) our team leader, put me in the second seed. So I got to run with several Kenyans and a Ugandan capable of running 30 min 10ks over impossibly rocky tracks. Needless to say, I didn’t see too much of them. Fortunately there was one older Kenyan in the bunch, maybe in his 40s or 50s. Unfortunately, even though he walked the uphills, he still managed to sprint by me in the end, much to the delight of the crowd.The Kenyans were all pretty much mad (mad, in the UK sense, as in crazy, not angry). We arrived in Nairobi about 10am after the bus ride (many of team kampala, sipping on pints of waragi for the road). The Kenyans had already started drinking. The night before the relays there was dinner and dancing at the Impala club (the Nairobi hash travels with their own DJ, so nothing is accomplished without the accompaniment of ground shaking bass and afrofusion/eighties disco/hip-hop music). The hardcore hashers (myself, and the top Ugandan and Kenyan teams, not included) stayed up til 5am and then got on the bus.As would be expected, the start was late, even though the race director said it was imperative that we made it over the hills before the afternoon rains came. Naturally, the rains came just as we hit the bottom of the hills… and the dust turned to mud and the SUVs, most with bald tires, driven by people who had been running and drinking all day, turned into lethal weapons.One by one, the vehicles (ranging from full on land rovers to little rav4s) went screaming up the hill with tires spinning and mud flying, and, one by one, they got stuck in ditches… The masai people wandered out and stood by the fences and watched and smiled. Our driver (we were in a 4WD matatu, also with bald tires) walked over and talked to the old masai man leaning on his stick, wrapped in a red tartan like cotton blanket. ‘he says that in an hour, the rain will stop, in two hours we will be able to drive up the hill.’But we got out. And got covered in mud pushing land cruisers piloted by drunk men whose idea of finesse is gunning the motor and flipping the steering wheel back an forth out of ditches, only to have them go into another ditch. And as soon as we got one vehicle to the top, another 2 would come and get stuck…And in one hour the rain stopped.And in two, the road was dry (albeit permanently scarred by the ruts we had just created). And our driver took his matatu to the top without spinning his wheels once.So they had to cut the relay short. But there was no reason to cancel the post-relay party. We drove to captain crawdads lakeside resort on Lk Naivasha. (in the last decade, lk Naivasha has gone from being a mazungu resort haven and wildlife sanctuary to being part of the booming flower agribusiness—as you drive into the crater, all you can see are miles of huge plastic sheeted greenhouses. All those roses getting shipped to Europe drink a lot of water, and the lake is on the run—captain crawdads lakeside resort is now almost a kilometer from the lake). And, shockingly, there was more beer (at least it was cold). And we got to hear from each and every driver ‘yeah, I had it all under control, I would have made it up just fine if X hadn’t gotten stuck in front of me…’ it’s the same the world over.The DJ didn’t stop the music until 3pm the next day.Somewhere in the endless stream of tuskers, I’m chatting with a very inebriated but still quite articulate young man reminiscing about his days at Boston College. Topics change and we talk about Liverpool football, and then the recent unrest of the baganda. And he says something like, ‘well, (pres) Musaveni was right, my brother (the kabaka, king of the Buganda, Ron Mutebe) isn’t a private citizen, he can’t just go where he likes.’ Turns out I was drinking with Prince David, the kabaka’s little brother, bugandan royalty.And I got a hash name from the Kenyans: kigelo (sp) home village of Obama’s dad (I guess they haven’t run with many Americans). The Kenyan hashers were quite gracious to me—given that I was running with dirty dick, peeping dick, roughrider, vodka, loose comer and sad term…And then we got back on the bus. The road from Nairobi to the border is under construction. So the first six hours consisted of accelerate, brake, swerve, rumble, swerve, accelerate, repeat… Dirty dick and the prince had achieved alcoholic coma. Somewhere out in the wasteland the bus blew a tire. There was an explosion under the bus and the cabin filled with dust. Dick and the prince didn’t stir. There have been reports of armed bandits robbing buses, so I went about the process of hiding my camera and my passport. But the bandits never came. And an hour later the driver and the conductor had changed the tire, and 4 hours later we were at the border. And dirty dick is asking, ‘so, how was your sleep?’Highpoint of the weekend: I’m running somewhere out in the plain. Spindly thorn trees are just getting buds from the fall rains, a few disgruntled cows are milling about in the wavy heat, the runners ahead of me are just puffs of dust on the horizon and the sweep car hasn’t caught me yet. Movement catches my eye on theleft. 3 giraffe, two adults and a young one, come up out of the scrub and cross the road less than 50 feet in front of me. I stop. They trot off across the desert and disappear in the haze and dust.0ctober 7thMonday at the hash, Ian says something like,‘Robert, MTN is putting on a 10k run to benefit Hope Ward… you interested?’ Since I was standing there in my running shorts and a sweat soaked tee shirt that says ‘end child sacrifice’ I kind of figured he meant, was I interested in running it… so I said, ‘sure’.Yesterday he pops his head into my office and says‘we’ve got a meeting with X (name I don’t recognize) at MTN at 10:30 tomorrow. I’ll pick you up at 10’MTN, in case your wondering, is a south African phone company that has put more phones in the hands of Africans than all other companies combined. They are a major sponsor of the world cup in south Africa coming up in 2010. They are sponsoring the Kampala marathon on 22 Nov and have graciously allowed us to use the 10k a couple weeks before as a fund raiser for Hope Ward(and as a dress rehearsal for their volunteers who put on the marathon). Hope ward, in case I haven’t mentioned it, is the charity ward at IHK.So today he picks me up, we drive across town to MTN tower. We get frisked, my laptop gets impounded, we’re ushered upstairs to a board room with no less than 20 Mtn executives in it, and the gist of the 15 minute meeting was that the run is on the 15th and there will be another meeting next week to figure out the logistics…MTN, by the way, is where IHK gets it internet. Internet which, by the way, has been down all day today. Now we know why, all their workforce is planning a 10km run…And Ian says..’so, Robert, you want to take the lead on this one?’Cholera has come to kampala… there have been 10 cases so far in Namuwongo (the slum below our hospital) and 2 fatalities. The 2 people died in the taxi park trying to get across town to Mulago. I suspect that there passing was not without a large amount of transmission of the vibrio bacteria…We are setting up a tent in the yard to stabilize cholera patients from the slum and are setting up an ambulance to transfer them to the cholera ward at mulago.Most of the cafeteria workers here at the hospital live in Namuwongo. I don’t think I’ll be eating lunch here for a while. Life in the time of cholera._________________________________________________________October 11thWilberforce told me the rainy season would be over the end of September.I’m sitting here on what passes for our veranda looking out at the gray clouds gathering on the other side of the wall. There’s a rumbling of electrical activity in the cloud bank, but no flashes to speak of. The church down the hill has finally stopped with the megaphoned hallelujahs.Spent the weekend in wakeso. The suburb/village I described in an earlier passage where we went to hear Dr. Jose Chameleon, uganda’s biggest pop star. (incidentally, Dr. Jose has gone international, we saw posters for his gigs when we were in Kenya). Wakeso is, among other things, also the home of the Peace Corps training/indoctrination center. At some point, Liam and some of the peace corps kids floated this idea that afriendly little football (that’s soccer if you live in the states) game between peace corps and vso would be a good idea… yeah. Right.So this weekend, 13 uber fit young peace corpses showed up in matching soccer jerseys with the peace corps logos (your tax dollars at work) and soccer cleats (or, as the brits would call them, footie boots). And 10 hung over, old, out of shape vso volunteers in sneakers and blue tee shirts… We were holding our own for the first half of the first half (partly ‘cause the pool lifeguard we pulled over to play on our team was actually a pretty talented striker). And then it started to rain…And the field turned into a muddy swamp, and suddenly cleats seemed like a pretty good idea…Because its Sunday, Wilberforce, our usual askari (gate boy) is out, and the weekend askari gets up from a perch under a tree and runs to the back yard and runs back with a pile of laundry that has been hanging on the line since Friday (through at least 2 rain storms) and hands it too me and runs back to the back yard, presumably for the rest of the laundry.And the skies open up. I can’t begin to describe the water that can fall here in a few minutes. By the time he returns, he is soaked to the skin and the laundry needs drying again. I don’t have the heart to tell him to hang it back on the line. There is a bare dirt patch about twenty feet from where I sit. The dirt turns to mud. And I have to move because the rainfall is splattering me with this seemingly impossibly distant mud.Over the wall, a 30-40 foot palm tree becomes top heavy such that the waterlogged roots will no longer support it. The arc of the trunk shortens its radius, the lean picks up momentum, and the tree crashes behind the wall, beyond my sight.October 12thWoke at 3am to my phone going off… pretty much nothing good can come from a phone call at 3am. It was from Tom Kyobe, team leader of transport and ambulance service. They are sending a helicopter to Gulu for a medevac. Can I be on it? At 8am? (when I usually am already at the hospital) Sure, Tom, I’ll be there. Let me just lie in bed awake for a few hours wondering what I’m flying for, so I’ll be at my very best…The morning newspaper, The New Vision, gave me a hint… there was a picture of Professor Osengo Latigo, leader of the opposition in parliament, in the ‘ICU’ at Gulu Independent hospital about 150 miles north of Kampala (a 5-6 hour bus ride). At 3am the morning before, he, his driver, and a female college student reportedly named Inocent, collided with a bus. His driver and the young woman were killed.As I think I mentioned, for most of my first 3 months here, we have been without a pilot for the helicopter we keep on the back lawn here at IHK (the helicopter belongs to a Kenyan company, everet helicopters, the owner is a FOI—friend of Ian). But the FOI has recently assigned a pilot to Kampala and they’ve been busy trying to drum up some business for what is otherwise just a huge misrepresentation (as I think I’ve mentioned—the insurance arm of IHK is known as IAA—international air ambulance—but one of themany things that IAA medical cover will not buy you is any kind of air evacuation, and especially not a ride in the chopper). Last weekend Dave, the pilot, ex British Army, flew the bride and groom into a wedding… if you browse my gallery you will see one picture of the helicopter getting readyto fly 3 people in gorilla suits to the gorilla gala… Needless to say, Dave has been looking forward to some real flying.So. After waiting around for GPS coordinates of the football field they wanted us to land in, and not receiving them. And after receiving a briefing from the doctor in Gulu who assured us that Latigo was‘out of danger’ and would be able to ‘walk to the helicopter and sit in a seat.’ We took off at about 9am… and flew through the dusty haze that is the Kampala skyline and into the north country. We flew over Wobulenzi, one of the villages we walked through on Roses walk…Our route took us over the scattered villages ringing Kampala and into the forested plains with great swaths of grassland running through them—probably the remnants of even greater rivers than the Nile off to our east, flowing out of Lake Vic at Jinja. We flew over the western end of Lake Kyoga where the Victoria Nile makes a rest stop before exiting and heading for Murchison Falls and Lake Albert. The morning sky was nearly cloudless, letting the sun reflect on the serpentine Victoria Nile at the beginning of its 4000 mile journey across the top of Africa to the Mediterranean.And by 10am we were flying over a landscape chopped into a green chessboard of rectangular plots. Every few fields were centered by a brown spot of tamped earth sporting 3-4 circular thatched roofed huts. And at 10:30am we were lining up to land at Gulu International Airport…The gulu airport maintenance crew—3 shirtless young men wielding pangas (machetes) with the tips bent at 45deg angles stopped their sisysphisean (sp) task of cutting the grass alongside the landing strip to watch us land.Naturally, the ambulance wasn’t waiting there for our arrival as had been communicated. And, as you probably have guessed, professor latigo wasn’t able to walk, or even sit. There were no stretchers to be found in Gulu. And, given our preflight briefing, we didn’t bring one. So, after reconfiguring the seating of thehelicopter, and after physically throwing a number of photographers and gawkers off the helicopter, we managed to position the professor on a mattress on the floor of the chopper.http://www.monitor.co.ug/artman/publish/news/Prof_Latigo_survives_death_new_92824.shtmlhttp://www.newvision.co.ug/D/8/12/697677October 13thHappy to report that the professor and his wife (if not the 3 pieces of luggage they wanted flown down—apparently they thought they were flying business class…) made it safely to Kampala and onto the front page of the New Vision. (See links above.) As we were flying back, the thought crossed my mind, does Musaveni consider this man enough of a political threat to knock down an unarmed helicopter and have it declared an accident? So, in addition to scanning the patient’s sat monitor and respi rate during the flight, I kept a lookout for RPGs and green helicopters. Apparently, however, Musaveni isn’t running that scared. But, talking to Dave the pilot later, he was having the same thoughts as I. He said, ‘yeah, I figured if they were going to try anything it would have been over the lake…’The professor is doing fine, by the way. I wouldn’t go so far as to say he is ‘out of danger’ (‘cuz I don’t think he’s going to be out of danger until he gets out of politics or joins Musaveni’s National Resistance Movement party).I thought the press coverage of the whole incident quite interesting… Aside from the fact that I managed to get my pic on the front page of Uganda’s two main newspapers wearing an aloha shirt. And one of the papers called my a pilot and the other noted me as one of the paramedics… But I mean, if this had been an American politician, the emphasis on the event would have been: who was the dead girl in the car and what was she doing out at 3am with a middle aged married politician? But apparently the Ugandans don’t think that way. The only quote from the dead girl’s family was something like ‘we thank god that prof latigo was not more seriously injured…’October 15thWent out to Mulago today to tour the‘cholera ward’…So far the outbreak has stayed at the outbreak stage and not progressed to an epidemic. Thank god for that. We have seen a few more cases and have gotten them stabilized and transferred to mulago. So no more deaths in the taxi park. A good thing. As far as I know I haven’t managed to contract it yet. Also a good thing. Alison, who lives down near Namuwongo and has three children who play with the slum kids and can’t keep their mouths shut in the shower, has been fighting with VSO to get her kids vaccinated. There is a cholera vaccine (oral, two doses a weekapart, about 85-90% effective with immunity for a year or two, but too expensive—about $25 a dose—for routine use in Africa), but VSO didn’t want to pay for it.Cholera is a nasty disease. You can basically poop and vomit yourself to death in a small number of hours. With proper treatment (fluids, antibiotics) the mortality is less than 5%, but without treatment, much higher…The cholera‘ward’ of mulago hospital is actually a collection of semi permanent tents in a field down below the hospital. Fenced in with barbed wire. Most of the tents bear the logo of various aid agencies. Kind of telling is that the cholera ward, a disease noted for profound diarrhea, of the nationalreferral hospital, does not have one flush toilet… (It does, however, have a number of cots with holes in them and buckets underneath—I’ll leave that to your imagination)I had tagged onto a bus from IHK with 10-12 of our first year nursing students (if the shit really hits the fan, so to speak, they will be manning our‘cholera camp’). They are basically just kids, happy to get out of class and go on a field trip. But they hadn’t expected to be greeted by the senior sister (most of the qualified nurses here are still called sister, even in the non-missionary hospitals) in charge of the ward, who, in my assessment, is a nasty piece of work. So, in addition to the tour of their facilities, I got to watch the senior sister bully the nursing students and call them stupid because they didn’t know the proper ratio of sugar to salt in oral rehydration solution (neither did she, actually, the WHO (world health org.) has recommended hypotonic rehydration solution (ORS)in cholera for at least the last 5 years, but, frankly the lady scared the piss out of me, so I wasn’t about to tell her that she was wrong—although it was a moot point, since they had boxes of the WHO ORS that you mix with the enclosed scoop in the can, so nobody has to measure out salt and sugar…).She also seemed to think she was dealing with the ebola virus instead of cholera (which is, as I’ve mentioned, a nasty bug, but still a bacteria that needs to get into your digestive tract to make you sick), so she had the little nursing students whipped up into a froth of hysteria by the end of the visit.All in all, the cholera ward is clean, well ventilated, and all the buckets (each patient gets 2) are getting emptied expeditiously. The patients seemed well cared for, and since the site is funded by USAID and DFID, they can receive antibiotics and IV fluids at no cost, unlike patients up the hill in the main hospitalOctober 18thStacy drove us out to lugogo mall yesterday. Stacey is one of the UK VSO volunteers. She is nursing director at one of the other hospitals—Case, not related to Case Western. Case has been trying to suck up to VSO to get more volunteers, so they treat Stacey pretty well. I’ve had to write multiple emails and hunt down personnel in far corners of IHK just to get a chair for my office and a key to my desk drawer, whereas Case gaveStacey a car…. Stacey got in a disagreement with the hospital’s managing the director a week or so ago, so they fired him…Anyway. Out to lugogo. I needed to shop for an anniversary gift. (yep. Spending another anniversary out of the country. Yeah, I know, I suck. But… will be meeting Nancy in Amsterdam next week, so hopefully that will sort of count… Nancy has her IADMS (intntl assoc of dance med and science) meeting in The Hague, so I’m going to meet her in the Netherlands and continue my quest for the VSO record for being the volunteer with most daysout of country in one year…)There is an African craft shop at lugogo (there are African craft shops everywhere in Africa, mostly with the same stuff… as well as several large craft markets, also with the same stuff…. Lots of carved animals, paper beads, authentic masai cloth made from acrylic, boatloads of carved salad utinsels, and piles of garish shirts and batiques (sp)… put your order in now) that sells more upscale African jewelry, so I found a sufficiently chunky ethnic looking necklace. The shopladies couldn’t tell me which region of Africa it is characteristic of, but its nice enough looking. I hope she likes it…Also at lugogo is a coffee shop where you can order the mammoth cappuccino for 4000/=. Unlike at the Itaiian gelateria where you order a cappuccino and they use the Italian espresso machine to heat the water to mix with the Nescafe instant and pour a little warm milk on top… And there is a Game (kind of the Kenyan equivalent of Target) and Shoprite (the South African Safeway).On the way home Stacey went to make a U-turn across the median on Jinja road and got a bit too close to the truck that was doing the same thing, but got caught with his nose too far into traffic and had to back up suddenly—performing some after market modifications on the plastic bumper and grill of Stacey’s Toyota corso…The guy driving the truck got out and started screaming… Being the only guy in the car, well, the only guy in the car not counting Paolo, but that’s a long story… anyway I had to get out of the car and do the screaming from out side.I haven’t taken the official Ugandan driving test (slipping a 50000 shilling note to the DMV official without his supervisor seeing you), so I don’t really know who exactly is at fault when both vehicles are making an illegal U-turn, but I do know that in Uganda, no one ever puts their car in reversefor anybody, so I figured we had the moral high ground. His vehicle wasn’t damaged. I’m screaming at him, flapping what’s left of the bumper, telling him that we have 2 injured women in the car… He’s telling me I owe him money, I’m telling him why don’t we both drive down to the police station, he offers 20k, I demand 200k, we settle on 75k, the money changes hands, and we drive off.No, I have no idea what 75000 shillings worth of body work will get you in Kampala. Stacey gives me a hard time about being a weak bargainer. I ask her if she’s going to give the money to the guys at the hospital to fix her car. ‘No.’October 18thThe church down the hill wakes me at nine… God must be hard of hearing in Uganda, ‘cause all the preachers have sound systems that can chip concrete…‘alelu…Alelu…ALLELU….ALLeLUGAH!!!’ (sp) and then a painful mix of lugandan and English shouting, some offkey singing, more shouting… I’m lying in bed (okay, so I was at the Iguana til almost 3, so I might be just a wee bit hung over) praying for a power cut and trying to put the incessant noise out of my head and then it happens, the power goes out, there is a god, and the church goes from being an oppressive pounding to a dull irritation…but I still can’t go back to sleep. So I go for a run.I stagger up the mud track (Lubwamma close) that we live on up to Kironde road and uphill til I hit Tank Hill (Muyenga) Rd. Up Tank Hill, turning onto Yusef Mutuvi Dr., the road that actually goes up to the water tanks, I run by Ian’s house and the US ambassador’s residence to the guarded gates at the top (I don’t know who lives there). On top you have a lovely view of Murchison bay (Lake Victoria) and the hills south and west of Kampala—a lovely view if you’re not panting so hard so that your head shakes and the sweat obscures it…Heading down the hill, SW on tank hill road, I make my way past café roma and my previous little bungalow. About a kilometer down the road, the ritzy suburb peters out into a series of shacks housing small shops and large families selling airtime, cold beer, warm juice and the green bananas for matooke. And the paved road turns to dust and winds around the quarry and gravel pit from which comes the rock of which so much of Kampala is built. The rock is blown off the walls of the quarry using dynamite. But the several large machines for crushing the big rocks into little rocks sit idle. Some of them are obviously rusted in a fixed position. Instead, people come take the rocks in homemade wheelbarrows and make their own little piles around the site.Around the piles, entire families gather, using hammers (or pieces of metal tied to sticks or other big rocks) to bash the big rocks into little rocks and the little rocks into smaller rocks and so forth until gravel or sand is achieved. No one wears eye protection. I tried to ask a couple of kids pushing a wheelbarrow full of sand what the would get paid for it, but they just laughed at me. But I suppose its one way to have some family Sunday togetherness and earn a few extra shillings along the way.I run down the hill away from the clunking of metal against stone. Down to Bukasa road which is where the city ends and the slum begins. Large stucco houses look out over a sea of tin roofs to see the Luzeero prison on a hill in the distance. The city has been moving through the slums with a mandate to tear down any‘house’ that doesn’t have its own pit latrine… pit latrines that, during the rainy season, fill with water and comingle with the water supply… hmmm. Realistically, every shack in Namuwongo has a pit latrine, it just depends on how many other shacks you have to walk around or through toget to it. Either way it stinks. And the KCC is using the cholera mandate to knock down houses closest to the road (easier to do, better resale potential) as opposed to the shacks down in the swamp. Hmmm.I run past a group of boys ripping open garbage bags. Most people deal with their own trash here—food scraps to the animals or garden, bottles back to the shop for deposit refund, paper and plastic burned at the corner of their lot to send an acrid black smoke into their neighbors windows. But some of the affluent subscribe to the ‘BINS’ service and put their garbage on the corner in conspicuous bags. Naturally the trash of the wealthy is a treasure in itself in Namuwongo. Two bony urchins in cinched up shorts fight over a rubber band they both spotted. It reaches the limits of its elasticity and breaks. Both the boys scream.On bukasa road I run past the bota stages and past the chapatti and rolex stands and past 4 or 5 huts that advertise nursery schools and daycare… I run past boys pushing bicycles loaded with impossibly balanced huge bags of charcoal or 3 huge bunches of green bananas… I run past a group of shirtless men digging a ditch… I run along a trail of chewed up and spit out sugarcane…And I run past‘neighbors pub—the company of cultured folk (once a hang out of Dr. Richard and Dr. Pete, but now somewhat abandoned by the expat crowd due to a mosquito problem) and to the corner of St. Barnabas road where I can see the shining grey and white of the IHK. I don’t run up to IHK, but I cut into the backroads, past the Rank Inn and up past a small field of banana trees and up a steep tarmacked hill back to kironde road and home. It takes me an hour.Time for some coffee and a bath.October 22ndI was up on IPD2 (inpatient dept 2nd floor—where most of the sick people who have escaped the ICU are) talking to one of the doctors about the CME (another thing Ian dropped in my lap—seeing I’m one of the few senior doctors that bothers to show up for the 8am M,W,TH sessions). I have convinced Dr. Carol that she wants to the coordinator.One of the patients’ family members comes to the desk and says something in Lugandan that I don’t catch. Carol asks me, ‘do you want to go see t patient?’she hands me her stethoscope. I ask her who the patient is and what they’ve got, but she doesn’t answer and I follow her behind curtain number 6 where there is a dead lady. Carol freezes there and starts to cry. I ask her whats wrong and she mumbles ‘HCC (hepatocellular carcinoma—not a readily obvious acronym to me at that time) and palliative’ So I assumethat we aren’t calling a code and I listen to her chest for a heartbeat and, as expected, there is none. OK, all well and good. Then a woman sticks her head in the curtain and asks what is wrong. I tell her the patient has passed on. ‘Is she dead?’ ‘Yes, she’s dead.’ And then all hell breaks loose. The patient has many children and at least 6 of them throw themselves to the floor, wailing at the top of their lungs and tugging out their hair extensions.Carol has disappeared. The nursing staff is amazingly absent. All of the other patients and their families are surrounding me and yelling questions at me about a patient I have never seen before.‘what did she die from?’ did she have swine flu?’ ‘why did you just let her die?’ Finally the security guard for the ward comes to see what is the problem that the mazungu doctor has caused—with his help I manage to get the 3 or 4 ululating women off the floor and into an empty private room, and manage to find the patient’s chart. Metastatic liver cancer with pneumonia and sepsis. Her vital signs on the morning round (the last vital signs that had been done) were not compatible with life—something about temp(in C)BP didn’t bode well... But apparently no one fully explained to the family that she was going to die…Or what the word palliative means…I am told that the wailing is a healthy part of the grieving process and I couldn’t agree more (and I’ve certainly seen similar demonstrations by some subsets of our population back home), but, given that death is not uncommon here (even at IHK, sadly enough), and given that I would have thought the family would have been a little prepared for the event, I guess I was a little taken aback by the demonstration. And why did all the nursing and medical staff choose this precise moment to disappear?Sigh… I guess we’ll have to schedule a CME session on end of life care.