August 2009
on Random Uganda (Uganda), 05/Dec/2009 12:03, 34 days ago
August 1stCannot believe it’s august already.Went out to fuego’s for a beer to celebrate. Have switched to Club beer as opposed to the better tasting and slightly more alcoholic Nile specials. Have found that the clubs (in a reasonable amount) don’t give the hangover of the niles—the niles must have a secret ingredient not on the label (sterno or ethylene glycol or something)Fuego’s has a lovely garden to sit in with an open fire pit and a 70s music soundtrack. How can you argue with that?After that wandered down to kabalagala for Chinese food at 7th heaven (or something like that). You have to wonder about a place that has a 103 item menu and the kitchen the size of a portopotty. But, my fellow vsos said this was the Chinese place to beat on the south side of town… I think we ordered six different entrees and, surprisingly enough, they all came out looking like sweet and sour pork. None of us, mind you, ordered sweet and sour anything… but, I will say, it was pretty tasty sweet and sour pork…August 2ndWashed my underwear today. Mukwaye doesn’t do underwear. It is good to know that even in this land of cheap labor, money can’t buy you everything. But just the simple act of hand washing a few pairs of underwear makes you realize how much work it is to stay clean in this land of dust and dirt (and no running water, at least at my house at the moment). So doubly more impressed when I do my Sunday morning run down through the slums and see the women walking with their 5 or 6 children to church each dressed in a perfectly white and clean and pressed shirt.Went down to movie night at Al and Alison’s. Richard’s wife Pat was supposed to give a lecture on Friday (but was canceled at the very last minute because the director decided she needed to address the group instead) so she took the ngo’s computer projector home. Watched a pirated copy of ‘state of play’ replete with soundtrackfootage of someone in the audience talking back to russel crowe and slurping on their soda.Alison had cute story. Standing on the corner with her 3 daughters (amy7, zoe5, bella almost 3). One of the Bota drivers stops and asks what country they’re from. Alison says England. The driver gives her a look and asks: ‘don’t they teach family planning in your country?’August 3rdStill no running water. Getting a little stinky around my house. Use the shower in my office after the hash tonight. The pipes haven’t been used in a while, so the water came out rusty and choked with debris. Sigh.The hash was good. Out at the dateline guest house in luzira (southwestern suburb on the way to port bell—where the shipping traffic across lk Victoria comes in, also where the ganda kabaka, king of Uganda, use to keep his fleet of getaway canoes). Nice night for it. Good course they put up. Some of the nicest trash heaps I’ve run across in my day, some good hills, a nice sunset, out to the swamp canals and wound up sprinting through this village to the finish with all the children laughing at pointing at us (me… couldn’t tell if they were laughing at me for breathing like a freight train or laughing at the young black men for not being able to drop the mazungu). But couldn’t drinkbeer at the end as was coming in to work, so had to lay low during the drinking song part of the event. But they did have a nice stewed goat meat for dinner.Speaking of the kabaka, the crown prince of Buganda (the traditional kingdom which involved most of southern Uganda when the Brits showed up and misnamed it Uganda because they were using Swahili translators and in Kiswahili, the Bu or Lu is just U) was at the hash tonight, getting warm beer poured on him by his royal subjects who would otherwise have to approach him crawling on their hands and knees with their eyes averted…August 4thGave a lecture on trauma in the trauma room to the nurses today. Actually packed the room. Was a little surprised. Managed to get a little audience participation, but really had to work for it. Mostly just 20-25 pairs of eyes staring at me.Went to great length to try to extol the benefits of keeping the trauma room prepared for the trauma patient at all times… will see how that takes. Justine, the head nurse (or, senior sister, as they like to say), didn’t make it.But managed to draw them into an imaginary patient scenario (by physically dragging 5 of them out and around the trauma table and assigning them a letter in the abcd’s of trauma assessment) which seemed to go well and, at least the nurses whom I didn’t pick on, everyone seemed to get interested and show a little enthusiasm.We will see how this translates into trauma care the next time….August 13thLet’s see… where was I?Spent 5 days and 4 nights in Rwanda (except for a day trip across the border to the DRC)Didn’t take the computer (can’t write without the macbook). Went to visit a few of the folks from the Liverpool course. Sat around and ate Indian food and drinking expensive beer (the cost of living is high in Kigali—beer is almost 2$ a bottle—and it only comes in small bottles, what kind of acountry is this, anyway?) and bitched about our respective placements…But otherwise Kigali is a beautiful city, aside from the high price of beer, smaller, cleaner, greener and more organized than kampala. Kigali cabdrivers actually stop at traffic signals and the botabota drivers (in Kigali they’re called motos) all wear helmets and have to carry a helmet for their passenger.Stayed at the Hotel Mille Colline in the city center. Mostly‘cause when I got to the Kigali airport (I chose the one hour flight over the 12 hour bus ride) I didn’t have any money (okay, a little disorganized ‘cause I worked the night before I caught the plane and I figured that, being neighbor countries I could exchange Ugandan shillings for Rwandan francs at the airport, but no, the Rwandans want nothing to do with the Ugandan currency) so I needed to stay at a place that took Visa and had a hotel airport shuttle. Unfortunately, the Mille Colline is in the process of a major renovation and there is early morning jackhammer work and the pool area is fenced off. Fortunately they did give me a good rate and the coffee at breakfast (not to mention a hot shower with real running water) made it all worthwhile. The Mille Colline is the hotel that was the basis for the move hotel Rwanda (but not the hotel filmed in the movie).On Friday I wandered through the Nyabugogo market and then caught an impromptu hip hop concert in the taxi park.Saturday I did the genocide tour… walked up to gisozo where the national genocide memorial sits overlooking the city. Pleasant grounds with a nice garden, but you kind of, initially, wonder why there are so many huge concrete slabs in the garden, until you come to the understanding that all the slabs are mass graves and that roughly a quarter of a million bodies are under there. Long black wall runs the length of it, with only about a tenth of it covered in names. If they knew the names of everyone buried there, the wall would be completely full of names…Then caught a matatu out to Nyamata. The matatus in Rwanda go 4 to a row, as opposed to Uganda where its only 3. I think the Ugandans must have bigger butts. But you don’t want to be the last one on, ‘cause you wind up sitting on the little bar in between the real seat and the jump seat.In Nyamata there is a Catholic church that has been left empty since the genocide. Several thousand people sought sanctuary in the church and were killed there. Blood stained piles of slashed clothing line the benches. The altar and the baptism fount have blood stains as well. Downstairs there are skulls and the coffin of a young woman who was raped and killed and thrown down the latrine. Legend has it that when she was pulled out of the latrine she was clean and dry (but apparently still dead).Sunday I caught the bus to Gisenyi. Gisenyi is in the far NW corner of the country on Lake Kivu on the border with the DRC. Pav, one of the Liverpool gang, works in the DRC in Mweso.The bus ride was very beautiful and painful at the same time. The Rwandan countryside is beautiful. Winding road through the foothills of the Virungas (volcanic mountain chain separating Rwanda and Uganda). Lovely terraced hillsides, nice little roadside villages and markets. Small children seemingly daring the bus to crush them…Painful in that one of the previous passengers in the bus had thrown up. Someone had pointed it out to the driver, whose response was to take a mildewed rag and dip it in a bucket which must have contained urine and spread the vomit around a little bit. Unfortunately, as we went up into the mountains, the passengers all closed their windows (because everyone knows that cool air is going to give you a cold or the flu… not the nice man with the tubercular cough next to you), so the last half of the bus ride was a pretty trying olfactory challenge of vomitus, urine and mildew….Gisenyi is a tired old colonial town on the banks of lake kivu… aside from the methane gas platform about a mile off shore, it could be a tropical town from the turn of the century anywhere…Winding palm tree lined shore path with neglected houses, closed and dying hotels and banda bars… Bar Bikini tam tam, next to the fish market, seems to be the place in Gisenyi to watch the sun go down while you drink your Mutzig or Primus and gnaw on a tough but flavorful chunk of barbequed chicken.The beach is nice enough, and the lake warm. Wasn’t able to get a straight story about the presence of schistosomiasis (so may have to pop some praziquantel), but was told that there would be no crocodiles or hippos…Being the travel geek that I am, I did feel the necessity to walk across the border to the DRC to the city of Goma. Goma has a distinctly different feel. Dirtier, dustier, with almost no living vegetation. The people seem beat down and suspicious. I was the only muzungu walking on the streets. The UN is mounting their response to the conflict in the DRC (Dem. Republic of Congo, formerly Zaire) from Goma, so there were big cargo planes flying in/out and many armoured vehicles moving in convoys through the streets carrying Indian and indonesian troops.In Rwanda the people speak a patois of French and English in addition to Rwandan, whereas in the DRC, only French and pidgin French. So I got to use what little French I could remember… Je ne comprende pas. Et Je n’ai pas d’argent….Flew back to Kampala Tuesday night. (was fortunate enough to get a clean smelling and not totally packed bus) Joseph, my preferred cabbie, was only about an hour late in picking me up (and still had to stop in Kabalagala on his way into town to pick up dinner from‘I feel like Chicken tonight.’)Wednesday I gave part one of an ACLS type lecture to the medical officers and then that afternoon we headed out to the Ridar hotel in Seeta (east of Kampala on the jinja road) for the annual planning session for the health programme of the VSO… more on that later.August 15thThe VSO Uganda PAP (programme area plan) Health session was interesting. Most of the health volunteers from around the country came in and gave reports on their placements. I did not need to give a report because my placement is so new and I am so obviously clueless. So the part where I got to hear from all of my fellow health volunteers was good for me. Even some of the ones in the kampala area, I guess I hadn’t really figured out what it was exactly they were doing. There is some interesting stuff going on out there.Enjoyed the presentation by the volunteers in Masindi (NW of here, on the way to Murchison Falls Park) on their work putting together village health teams. But even there, working in the sub-district of Miireya, they ran out of money for their mosquito net program (they had committed to getting nets out to 5000 households) and there was no money from the VSO or the health district they were working in and so Pam (one of the volunteers) had to fly back to the UK and raise 15000 pounds from her family and friends in order to finish the project (I can just see you all changing your phone #s right now). From their follow up, the numbers suggest that they have decreased childhood malaria in the sub-district (in africa, aside from muzungus, almost all severe malaria happens in children—adults who live in malarious areas develop partial/temporary immunity to malaria) by 40%. So the project was a great success. And the MOH (ministry of health) officials have basically demanded that VSO ‘roll-out’ the project to the entire Masindi district…But of course the MOH wasn’t going to commit any funds to the project, nor was VSO Uganda, so apparently Pam was supposed to go home and now raise 150k more…Unfortunately, after the project reports, then came the small group sessions to work out the VSO Health PAP for the coming few years. And decide on the aims and objectives. (I always thoughts that aims were objectives, but, apparently, I am mistaken). Sigh.I really really don’t want to sound too cynical here. Okay. But. The reality is that VSO is placing about 20-30 health related volunteers into Uganda in the coming years. None of these volunteers will be placed in the ministry of health or in any policy making position. Most will be placed in positions of minimal influence and with minimal if any control of finances or resources. So, maybe our aims and objectives should be kept in line with our influence—for instance: keep our volunteers healthy and well-fed, try to teach the health care providers we come in contact with the best way to practice medicine given the limited resources at hand, and try to show by example the value of health care workers and how compassionate care is possible even under less than ideal medical circumstances…But, no. VSO Uganda’s health care aim is a little more grandiose: improve the health and quality of life of the disadvantaged people of Uganda. And the objectives: 1)increase the access to and quality of health care delivery in Uganda; 2) increase the recruitment and retention and quality of training of health careprofessionals in Uganda; and 3)improve the advocacy for health rights for the disadvantages, especially women and children.All very admirable. Don’t get me wrong. But achievable? On the level we’re working at?August 19thRe: the above. I suppose what is important here is that I determine what my aims and objectives are here as I amble into my third month in Uganda. Hmmm.. will have to give that some thought. Maybe over a cold nile at the palm café.And, even though, their aims may be a little beyond their means, they did take me to a nice hotel with a pool for a few days… I know, as donors, what you’re thinking… couldn’t those hotel and conference and banquet fees be better put to use buying mossie nets in masindi? Enquiring minds want to know. Well, just feel thankful I haven’t send this email list to the vso fundraising staff.So I have moved into the‘posh house’ as some of the other volunteers call it. The house actually belongs to Ian’s adopted daughter Rose (see prior) or the hospital, I’m not sure. But it’s a nice 4bdr 2.5ba house with thick walls and a cool interior. The house is off of kironde road and about 10-15” closer tothe hospital than my last place. The walk is also nicer, mostly backroads with less traffic. Although, mostly dirt, so we’ll see how nasty they get in the rainy season. The house also has hot water and a refrigerator. It used to have an oven, but one of the previous volunteers set a fire in it… or something like that. Also included in the package is daily housekeeping from Grace and an askari (gatekeeper) named Wilberforce. I think I will be more comfortable here, and, since I now have roommates, I will be less able to continue my antisocial ways. Also, strangely enough, the hospital buys food for the house as well (nobody ever offered to buy me food at Sanyu’s place…). Now if I could just get them to stock the fridg with niles…Went to Entebbe over the weekend. Aside from being the country’s only international airport and an international incident from the 70s to boot (do you remember what happened at Entebbe? There will be a quiz later), Entebbe is a sleepy little town on lake Victoria. Nicola, one of the English vso volunteers, had her birthday at the sailing club. Plans wereto spend the afternoon sitting on the beach, but the rain came all day so we spent the afternoon huddled in the bar… and the extra water trashed some of the roadways, so our trip back took twice as long.Apparently the much talked about fall rainy season that everyone feared wasn’t going to come due to global warning is here.Okay. Pop quiz time. What day did the Entebbe raid take place?Mulago hospital played a small role in the Entebbe incident. One of the hostages, a 75yo woman named Dora Bloch, was taken to Mulago with a presumed heart attack before the raid occurred. After the raid, Idi Amin’s soldiers came to the hospital and killed her and the doctors and nurses who tried to protect her.Answer to pop quiz: July 4th, 1976.August 25thDon’t really know where august went….This past weekend I played in a netball game on Saturday. One of the volunteers coaches a netball team and they have been getting their drawers blown off in all their games, so Becky thought that it would be a confidence builder for them to play a bunch of overweight old muzungus, many of whom had never played the game before…Netball, in case you’re wondering, is a UK game played mostly by school girls which is probably most similar to being a cross between basketball and ultimate Frisbee…It’s played on a basketball sized court, but the hoops at the ends have no nets and no backboards… you also cannot dribble the ball. And once you catch a pass, you can only pivot on the foot you landed first on… Additionally you have to stay a step away from your opponent when they are shooting. And, when you are shooting, your feet need to stay on the floor.Weird. But we did accomplish our goal and get beaten badly by the team of schoolgirls. I was particularly embarrassed on numerous occasions by anna the 5 foot nothing barefoot girl guarding me…Also, over the weekend. One of our volunteers had a syncopal episode and fell off the toilet and split his eyebrow open. He went to the IHK and was evaluated by one of my young doctors, had his eyebrow shaved (usually we don’t recommend doing this because in a fair number of people eyebrows don’t grow back), had some rather large gauge stitches put in in a random and haphazard fashion, had a blood count done of which his white count was slightly elevated as would be compatible with falling off a toilet in the middle of the night, so he was immediately diagnosed with bacteremia, but never once was the question asked why he passed out and struck his head… sigh… guess I have to put together a lecture on wound management and syncope…Saturday night we went on a road trip out to wakeso where joanne and liam live. Joanne is the fund raiser I think I mentioned… her ngo still hasn’t paid their rent or their power bill… but anyway.We were in wakeso because Dr. Jose Chameleon was playing at the wakeso recreation center. Dr. Jose, just in case you are one of the uninitiated, is Uganda’s premier pop star. You may have caught with worldwide smash ‘angelina’ which, surprisingly enough, is not available on iTunes…First off, I should note that Uganda is a highly musical country. Little girls and boys sing in school. Young people are often singing as they carry their jerry cans of water home. Even Dr. Rose sings religious songs to herself as she plays solitaire on her computer… But. In the clubs of Uganda, instead of singing, or even karaoke, the favorite is lip-syncing or miming to other people’s music with a fake microphone…So we filtered onto the recreation center grounds along with about a thousand other Ugandans and drank the new official drink of VSOUganda: waragi gin and fanta orange…And we were expecting to have a few warm up acts before the great chameleon appeared, but instead we were treated to lip syncing kids prancing around on stage and a Ugandan comedy quartet complete with dwarf. Unfortunately they did their schtick mostly in lugandan, so much of the humor was lost on us, but, suffice it to say, I suspect very little of it would have been considered politically correct…Finally, after midnight, Dr. Jose made an appearance on stage for exactly an hour. His voice sounded like it had been trashed by too much singing and cigarettes, and, although he was surrounded on stage by his entourage of folks dancing and waving a german flag (?) and road flares, his singing was accompanied by a drum machine and taped backup vocals…Very camp. Probably would have been very annoying were it not for the waragi.August 26thWent for my first real ambulance ride in nearly 20 years. Lights and sirens, the whole works.There was an industrial accident at one of the factories IAA (international air ambulance—the insurance arm of IHK, even though we really really don’t have an air ambulance—even if we had a pilot for the helicopter, its not really rigged out for patient transport) insures. In Jinja, about 75km down a busy 2 lane road from kampala. But, a first for me, before we could get on theroad, we had to stop at the petrol station to put 12 liters of fuel in the ambulance. Yes, even the ambulances are kept with their fuel gauges on empty and only enough gas for the trip is put in… So we go screaming out of the ambulance bay with lights and sirens, up the hill in the middle of theroad, rip around the corner to kibuli road and screech to a halt… in the petrol station.Our ambulances at IHK are basically souped up matatus with the rear seats ripped out and a siren on top. Moses, my driver, was pretty stressed about the whole thing. Apparently they had asked for the helicopter and he had had to tell them the pilot wasn’t available, then they had demanded a plane (which would have been pretty silly given that the airstrip is half way to jinja and then they would have need another ambulance on the jinja end…) and he had had to tell them no on that one, too.Anyway. It was a pretty wild ride. A real E ticket. (e-ticket Disneyland from the 70s, not e-ticket on an airline) Driving impossibly fast for the conditions down the middle of the road with botas, bicycles, matatus, and pedestrians diving into the ditch on both sides. On several occasions, with a truck on our left and another bearing down on us from the other lane, I looked for the lever to make the ambulance thinner (like on the night bus in harry potter), only to find that it hadn’t been installed first.I probably would have enjoyed the ride a little bit more (aside from the very real threat of death and dismemberment) if I hadn’t picked up a bit of a stomach bug, and if the ambulance didn’t leak exhaust fumes into the passenger compartment…As it was, I had to keep fairly focused on the road to keep from vomiting.Jinja, in case you were wondering is where the headwaters of the Victoria Nile is, and looks like a nice little town, from what little of it I got to see… They run rafting trips down the Nile out of jinja, I’ve been meaning to get over and do a trip, but haven’t had a free weekend yet.The patient had been caught in some sort of turbine apparatus and partially transected. I was never able to get a clear idea from the factory management exactly what happened. They pulled him out of the machine and brought him by truck to the MOH (ministry of health) hospital in jinja where he was pronounced dead on arrival. We arrived about 15 minutes later. In my rough assessment of his injuries, he wasn’t going to survive even under the best of conditions.August 29thCame down with my first gastro bug of my time in africa. Little bugger was probably a few weeks overdue. But nothing like hourly trips to the loo to remind you that maybe you’ve gotten a little lax in your eating and drinking habits… (I guess I may have to rethink the unidentified meat on a stick in kabalagala) can’t really moan too loud. At least I don’t have to haul the water to flush my toilet. At least I have a toilet.By near the end of day on Thursday, I was pretty weak and feverish. So I visited the lab and got tested (negative) for malaria (maybe just a wee bit on the paranoid side—charles, the lab tech looks at me… ‘do you not sleep under a net?’... and looks at my slide… ‘you do not have malaria, but you do have neutrophilia… go home, take some antibiotics…and some painkillers… you’ll feel better’ ). So I took my lab techs advice.