July 2009
on Random Uganda (Uganda), 05/Dec/2009 11:58, 34 days ago
My commute:I walk to work. It takes about 30” at a brisk walk (and, if its hot out, which it usually is, arriving soaked in sweat) or 35-40” at an African saunter…I start by walking up the back to tank hill (there are big water tanks on top) on tank hill (or muyenga, people call it either) road which is a fairly wide and paved road with a generous shoulder for the motorbikes to scream by inches from the pedestrians who fight for the last few millimeters of macadam.In the morning I am joined by a large number of commuters as well as a few obese middle aged African men in jogging shoes (‘development’ has brought chronic diseases such as diabetes and hypertension to Africa), so I am glad to see that my ugandan colleagues are prescribing exercise to their patients… (I think prescribed, ‘cuz I don’t see much in the way of enjoyment in the eyes of the joggers)Sensing a possible tired muzungu, the bota bota boys that don’t have a fare slow the down on the hill and offer me a ride into town: ‘hey, good morning, hello, we go to town?’ but, not having the courage to ride the back of the boda boda just yet, I just smile and wish them a good morning. The matatus zing by, already loaded with the 14 passenger limit that is upheld in Kampala as opposed to other African capitols.Cresting tank hill I have some great views of kampala, as well as of the muyenga club and the hotel international. There is a smaller road that continues up to the tanks and some very large posh houses (one of them is Dr. Ians) as well as a few shacks that have‘this is not for sale’ signs on them.Also in the morning I get to witness the trucks picking up loads of private security guards. It would appear (to me) that the second largest industry in kampala (the first being the collection and disbursement of international development money by the various NGOs) is private security to protect the compounds of the NGOs from the people they are here to help. Every evening truck loads of thin young men (and a few women) in the paramilitary colors of their respective companies are unloaded at gates around the city. Some of them are handled rifles. A few are even handed a bullet for the ancient weapons. Every morning the trucks swing by to retrieve their charges. Some of the trucks have trailers full of snarling dogs. This evening as I walked home I passed a large pack of the falcon security boys in their midnight blue being led in kung fu exercises by a small asian man.July 2The rest of my commute…Once I crest the road’s path over the shoulder of tank hill I pass the athletic club (?name) on the right and look down toward reste corner where, I’m told, there used to be reste corner hotel. But reste corner is home to VSO headquarters as well as the ever important Italian supermarket and gelateria where you canget really bad Italian wines for only 20000/= ($10), authentic prosciutto, and mango gelato that hits the spot after a hot dust walk up the hill.You can also buy toilet paper, deodorant dishes and small appliances…Rest corner turns to the left down into Kabalagala which, besides being fun to say, is a tight packed strip of bars, restaurants, internet cafes, and street food vendors—unknown meat on stick, yummy, and, my fav, Rolexes (greasy fresh cooked chapatti bread wrapped around an omelette for 600/=).If you take a right off reste corner onto St. Barnabas road you wind steeply off the hill on a narrow potholed piece of asphalt fought viciously over by trucks, cars, motorcycles, bikes and the large number of pedestrians (myself included) silly enough to risk life and limb in the melee. Unfortunately, this is the road down to the hospital…First Bota Bota ride today!We were supposed to be at a meeting at 0730 at the KPC clinic across town… we were told there would be no way to take a car across town at that time in the morning because of what, in Kampala, they affectionately call the jam… so we were advised that we would need to take botas ‘cuz they can weave in and out of the ‘jam’. So we dutifully picked up the helmets VSO mandates and made phone contact with a couple of hand picked bota boys recommended by Irene who met us at neighbors pub in namuwongo near Alison’s house (having to get up at 0600 and skip breakfast to make the rendezvous).Joseph and Jamal were waiting there for us. Allison rode side saddle in the manner of the kampala women whereas I chose to straddle the bike and hang on for dear life (but apparently it’s poor form to wrap your arms around the driver and scream like a little girl…)Will have to say it’s actually kind of fun. And didn’t have to yell mpola (slow down) once… but did feel the proximity of my exposed shins to the other vehicles as we wove our way as we wove through traffic on bukasa, mukwono, and jinja roads…Of course we got there late at 0740. And of course, we were nearly the first ones there. The rest of the people we were meeting with came in over the next hour, noting how bad the jam was.Personally I find it refreshing how unapologetic they are about showing up late.But, note to self, stop setting alarm clock.July 4, 2009Happy independence day. Had the unpleasant opportunity to visit the US embassy the other day… wanted to register with the embassy and try to get on the email list for the American expats… and maybe score an invite to the 4th of July party and fireworks at the embassy…Since the bombings of the Kenya and Tanzania embassies, however, American missions abroad have become less like putting a friendly face on the USA abroad and more like fortified bunkers. They moved the embassy from downtown Kampala to a hill outside of town surrounded by multiple layers of barricades and armed guards. To even approach the embassy you have to get patted down by the Ugandan military police and then go through an airport like screening to get into the building and even then (as someone carrying a US passport, mind you—I’m sure if you’re not, you are subject to even further humiliation) the embassy staff addresses you through a window of bullet proof thickness via a speaker.And she’ll tell you that you could’ve registered with the embassy on line (which is only half true—travel.state.gov is a piece of crap and when I tried to register online it never sent me an email confirmation).And, as far as an invite to the fireworks. Yeah, forget it.July 8thIan is proving an interesting boss.He calls me periodically.“Robert. I’m talking to some people who need a doctor to fly to Gabon and help medevac a patient to south Africa… “ “Robert, there’s a couple of guys from the British Army in my office… they’re planning a live-fire exercise in X jungle… they want to know what our trauma capabilities…” “ Robert, what do you know about swine flu… I want to you to organize our response…”and as immediately as one crisis arises, his attention to the previous one evaporates, so when you present him with the swine flu protocol or talk about flying to Gabon a few hours later he looks at you with a blank face.Am finally finishing up a two week orientation for the hospital… had a rescheduled appointment with the Navision guy from IT (Navision is the electronic medical record system that is soo bad they couldn’t even manage to sell it in the US…) at 0830, for which he never showed up (and didn’t return any phone calls, and nobody in IT knows where he is or how else to reach him… apparently being the only person in the system who understands this antiquated piece of shoddy software that they have pawned off on the third world puts him in a position of power…) But did manage to attend the multiple sessions on mission statement and customer service…hmmm.The A and E (accident and emergency) ward seems like it will be a fun place to work, but am still in the process of deciding on and developing what that work will be. My thought was that I was going to help the doctors assigned to A and E develop their emergency medicine skills, but whenever I come down there to see patients they have a tendency to disappear… this may take some time.Went bota-ing downtown last night to get some rather disappointing palak paneer at an Indian restaurant all the expats rave about and to meet some of the vso volunteers who are down from bwindi (sw Uganda, where the gorillas are). Went to the National theater, to see the percussion discussion Africa—kind of like a mix between a jazz quintet and 6 person traditional African drum band. Not too bad. Didn’t buy the cd. Didn’t feel the need to get up and dance and demonstrate my complete lack of rhythm.July 9thWent back downtown to the vso‘cluster’ meeting… chaired by Marcel, a dutch volunteer who works improving the lives of the people imprisoned in Ugandan jails.The cluster is supposed to represent volunteers located in the same general vicinity. Apparently the word cluster doesn’t carry some of the same military induced connotation that it enjoys in the US, at least in ER circles. Most of the volunteers in Uganda are located in Kampala (because, as I think I mentioned, the main industry in kampala is the generation and distribution of foreign aid, and this is what the majority of the volunteers are involved in), so we have a really big cluster—in more ways than one…So 15-20 volunteers wander into the masala chaat house and order 15-20 pints of nile special… and the whinging begins. I guess I feel pretty lucky that my expectations are pretty low and so are those of my employer, so I don’t feel as if I was set up for failure, as a number of my colleagues seem to feel…Joanne and Liam (English) were sent out to wakesa, which, I’m told, is a northwestern suburb of kampala (but apparently in the suburbs they have to haul their own water in jerry cans…). She is a fundraiser for a british medical charity at home and she volunteered to work here as a fundraiser to raise money for an ngo that works for people with disabilities. At least on paper. Joanne showed up at her posting to find an empty office… no phone, no computer, no internet, nothing. But they are very anxious for her raise some funds, so that they can buy some office equipment. The first order of business was her new boss asking her for a loan…TimTim, from the phillipines was also quite distressed. Pretty much every third sentence out of his mouth was‘they will cheat you.’ (the other two sentences, in case you were wondering, would have been asking for another beer and ‘the vso in Uganda does not care about us.’ HmmmMet a lovely irish couple. Jo (short for Josephine), a nurse who basically walked away from her assignment with a private orthopedic clinic to start working with the nurses at Kibuli (Ki is pronounced Chi here) Hospital which is the muslim funded mission hospital where things are apparently desperate. She’s asked me to come hang out in their OPD and teach their doctors manners… hmmm…Her husband Larry, works in management for another NGO that works with hiv patients. He just scored them a 2.5M USAID grant which means that the NGO will be able to pay the salaries of its employees for another 2 years. Which I thought was a pretty big score. And should make him a hero where he works… but he has described it as a double edged sword. Now that their income is secure for another 2 years, he feels his coworkers are doing even less than before… and he’s a little miffed that he had to pay 30000/= (which isn’t that much money, but looks more impressive in ug. Shillings thanpounds) in back fees on the ngo’s postoffice box, so that he could get his mail, because his boss (who reportedly drives a bmw) said that they didn’t have the money to pay the fees…Jo and Larry were robbed at knifepoint in their apartment the other night. They swear that they feel this was a totally random event and have chosen to remain in their apartment.July 11thToday was Rose’s walk. Rose is Ian Clarke’s adopted daughter (he has a large number of ‘adopted’ African children—4-5 of them were here today). 20 years ago, an orphaned Rose walked away from the village of Bamunanika and walked 52km to the village of Kiwoko where the Ugandan church has a mission hospital and where the Clarkes were working in 1989. Rose has since gone on to nursing training in Uganda and in the states (she worked as a neurotrauma nurse at Baylor) and now she’s in a PhD of nursing program at Yale.So today we walked the 52 kilometers (I think it was probably in the mid-forties, but in high sun and heavy dust, it was plenty) to raise money for the IHK nursing scholarship fund and to raise awareness about the ongoing practice of child sacrifice (apparently witch doctoring is still happening in Uganda and if you need really powerful magic then you’ll want something with some child parts in it).Hannah from HR said she’d pick me up at 0450. I told her I’d walk to the hospital to meet the buses, but I think she thought I’d flake. So something completely startling happened… she came early. I would have been ready to go at 0450, really I would have. (but then, naturally, we got there before 5am and thebuses that were supposed to take off at 0530 so we could get out there walking before it got hot, didn’t leave til almost 0630 once again, stop with the alarm clock stuff)So it was my first trip out of kampala, and I was pretty excited (even if I slept through most of the drive up to Bamunanika).We walked from Bamunanika to Wobulenzi, wobulenzi to Luwerro, and Luwerro to Kiwoko. The way from Wobulenzi to Luwerro is on one of the main N-S highways (the Gulu road), so it was hot, choked with diesel fumes and not a lot of scenery except the occasional roadkill. I jogged the middle section with an irish lady named Irene who, even half winded, was able to keep up both ends of the conversation. Her husband sean, hungover from a party at the irish embassy the night before (their embassy invites them to parties, Hilary, just to let you know), so he took it out on us by telling us we had 5 miles to go when really it was less than 2km.The other 2 segments were packed red dust roads through little villages of mud huts and brick houses with children that would run out to the curb to wave“Bye” (because, apparently that is easier to get off than ‘good day, how are you?’), and buses and matatus and determined looking men and boys pushing bicycles loaded with impossibly big bags or charcoal or bundles of sticks and boys herding cows with horns 2-3’ across and motorcycles whipping by with entire families of 5 or 6 balanced on the limited seating and nonseating areas.All in all, a nice walk. Wound up at the Kiwoko hospital where the nursing students sang and danced for us and we sat in the grass and had tea and chapati and cold stony ginger beer (it is, after all, a church compound). And I got a tee-shirt that says‘End Child Sacrifice’. Won’t see too many of those in Noe Valley…July 12thOh. Forgot to mention that some friends of Hannah gave me a ride home from kiwoko. Not exactly sure where they fit into the whole IHK/IMG/extended family of Ian bit, but they are apparently doing okay‘cuz they’re driving a newish Toyota landcruiser and they live in Muyenga. So on the drive back home they stop (literally) to do a little shopping. They pull over at the luweero markets, which are all roadside and open air and roll down the window and yell and point at the vendors. I am toldthat there is no word for please in Lugandan. Its basically ssento meko (how much?) and mpa (pronounced oompah, which is give me) that.Edith and Charles complained bitterly that ever since they got the new car the vendors in the market want to cheat them and charge them the mazungu price. So they have to haggle twice as hard and this slows down the roadside shopping experience. Edith did buy me a big bag of mangos for only 2000/=, however, for which, given my poor market skills, I probably would have come home with only two mangos.Ugandan mangos, by the way, are pretty amazing. They pick them ripe from the trees and the kids will eat them peel and all. I could pretty much eat them until I’m sticky all over and have a pile of mango pits bigger than my head (and I have to spend the rest of the day in the potty).Today Sanyu, my landlady, made matooke in the backyard, okay, actually Mukwaye, one of the servants, peeled the green bananas, wrapped them in banana leaves and steamed them over a charcoal brazier. Sanyu added salt and spices and mashed it up to its usual off yellow mush consistency. Maybe because it was fresh, but this was the best matooke I’ve ever had (the matooke they serve us at the hospital has started to cool and takes on the consistency of rubber cement left with the lid open).July 13thCaught a Bota after work across town to Ntinda for a run with the Kampala Hash House Harriers. Hashing is sort of a group run where the course is poorly marked with bizarre symbols and only really known to one or two of the crowd (the hash masters) and the goal seems to be trying to get people irreparably lost in an unknown part of town (not hard for me) and then gathering at the end to sing drinking songs and chug lukewarm club beer (actual warning label on club—‘don’t drink and walk home, you might fall into the road and block traffic’). Needless to say, I have found my people.Hashing apparently is a worldwide phenomenon hitherto unknown to me. I’m told, by Jo and Larry (irish vsoers, see above) that typically hash clubs are made up of expats, but what makes the Kampala group special is that the bulk of the hashers (including the has master) are Ugandan.Regardless of whether I was participating in a worldwide phenomenon, it was fun to get out and see another neighborhood of kampala and follow a papertrail (literally piles of shredded paper were used to mark the route) over hill, through swamp, through the back yards in the slums, across fields occupied by cows and strung with barb wire, across the grounds of a catholic school and winding up at the headquarters of the ASFU (acid survivors foundation of Uganda—now, coming from san Francisco, I was pretty sure this had something to do with Tim Leary and lsd, but actually here it is a form of domestic violence…) So I was running (and drinking) for a good cause, and have added another teeshirt to my collection: ‘Hashing to support victims of Acid violence’July 14thWalked to the corner store for a nile special (singular, as I don’t have a frig, I don’t have the luxury of purchasing 6-paks). I know you think all I write about is beer, but I feel pretty righteous about walking a half a mile for a cold beer. And I remembered to bring an empty with me. Some places won’t even sell you a beer without an empty and some will charge you 1000/= for a deposit on a beer that costs 1500/=… but it is one thing they do right here. Reuse, not recycle. Now if they could just figure out what to do with all the plastic water bottles—personally I think they need to start selling bottled water to the mazungus in glass bottles with the same deposit. I could probably walk 10 miles across kampala and put my foot on a flattened plastic water bottle for every step…Reason for beer (okay, do you really need a reason?): I am supposedly here to help the IHK develop a trauma system which might, eventually, translate to better trauma care for greater kamplala and Uganda. I have been asking myself just how bad could trauma care be? Today I found out. It is bad. Really really really bad.I stood in a trauma room choked with nurses and watched a man die. Granted, he had been hit by a speeding minivan packed with people, and his chances of survival were poor from the get-go. But he could have at least died with a functioning IV in place, or some oxygen, or connected to a heart monitor, or an airway tube, or a chest tube or two, or, how about this, some pain medicine to ease his suffering… but none of this happened. The larygoscope (the metal thingy you use to place an airway tube) was not in the crash cart (it turns out the dentist borrowed it), the monitor leads in the crash cart are for a different brand of monitor, the oxygen tank had been moved out of the room, and the nurses were more interested in restraining the patient (‘cause he and I were the only people in the room who knew he was dying) than putting in an intravenous.I suppose that I should be glad that there is plenty of room for improvement, but when I tried to engage the medical officers and the nurses later about what had happened and what we could learn from it, I got nothing. Nothing but blank stares and what I perceived to be just a bit of attitude: You’re the great mazungu trauma doctor and you couldn’t save him—what do you expect us to do? And I guess that is the question. Sigh. I’ll have to figure out an answer for that.Note to self. Don’t get injured here. IHK reportedly is Uganda’s best hospital.July 18 and 19This past weekend the kampala cluster did a public service project… obviously something planned well in advance of my arrival, but, according to rumor, apparently a bunch of vsoers were sitting around at a bar and someone said, ‘hey, all we ever do when we get together is drink beer and bitch about out placements, so why don’t we get together and do something constructive for a change?’So Marcel and Nicola put together a project to paint the wards at the Mwanamugimu nutrition center at Mulago hospital (Mulago is Uganda’s state referral hospital and teaching hospital and mwanamugimu wards are where the malnourished kids are treated). They hired a local artist to sketch cartoons on the wall that we would paint, along with the walls, etc…So 12-15 of us descended on the ward this weekend. They moved all the kids from ward 2 to ward 3 and we scraped and sanded and aerosolized all sorts of nastiness, not to mention uncovering several hordes of mice and roaches (the roaches are bigger than the mice) and then started to paint.Kind of amusing watching 12-15 doctors, nurses, speech therapists, accountants, project managers, fundraisers, etc—none of who could paint a straight line on a wall to save there lives (and this is in a country whose greatest resource is cheap labor, where nurses work for $150/month—on the months where the government actually pays them and you can hire a ‘gate-boy’ for 24hours/day 6.5 days a week for roughly $25, so my guess is there are lots of guys/gals in kampala who can paint and would be happy to work for a pittance) while Stevie Wonder plays on the ipod doc, high on paint fumes, accompanied by the relentless crying of 20-30 starving children down the hall.Fortunately I was able to keep my hyperactive sense of irony to myself.I will say that I have done my fair share of painting (with various results) over the years of our home improvement fiascos—but I like using masking tape, and I prefer water based products… but the plan came with painting big swatches of color around the room with oil-based paint done over two days so that there wasn’t enough for the paints to dry so that masking tape could be applied without ripping off the fresh paint… and the project manager ‘thinned’ the paints with a bit too much terpentine… (also we were using donated paints… like pepto bismol pink, camo green, traffic stripe yellow and other soothing pediatric colors), so despite out best efforts there were drips and splashes everywhere (even the toilet seat came away with a swatch of cornflower flue—don’t ask me…)When we got too high from fumes, we went and visited the ward and held the babies whose mothers were too sick (mostly hiv) to do so. The babies looked like little old men with wrinkled foreheads and huge, nonblinking, relentless eyes (and matchstick limbs). Then the nurses hit us up for money… We were told that the World Food program feeding supplements (soy products for the kids that can’t absorb milk) had run out and they weren’t due another shipment for a month)… I don’t know what to think of this… the administrator we talked to (he came through and told us not to usethe blue paint next to the purple (duh)) said that that was not the truth, that there was plenty of food supplement… (but why do the kids look so sick? Why don’t they have feeding tubes? How can this be the country’s referral center for malnourished kids?)Ch3July 23Have been working nights this week 8p-8a… just to change things up a little bit. And to see if the A&E is any more happening at night.The jury is still out on that. What does happen in A&E at night is the mosquitoes come up from the namuwongo swamp and roam the hallways. And not just your average buzzy little black things. You swat one of the mossies here at IHK and invariably its full of partially digested blood. And you wonder, hmm… has this little anopheline been feeding on the malaria babies on the paediatric ward, or has she (boy mosquitoes don’t suck blood) been feeding off the HIV/TB patients on the Hope ward. (Or was it the one that bit me on the scalp last night while I was trying to catch a little zzzz time?) Either way, makes you think twice about swatting the little buggers. Tonight though, I’ve brought my secondary mosquito net just in case I want my nap to be undisturbed by some pathogenic insect.Gave a lecture to DFID (the british development aid agency) and the staff of the British high commission. Managed to put together a 30 slide powerpoint prez in the middle of the night last night while fighting off mosquitoes and a really pushy Indian patient with an entourage of no less than 13 people (3 of them claimed advanced medical training… the patient had been on no less that 6 different antibiotics (2 of the intravenous) in the past 10days, none of them for more than 2 days… and, lo and behold, he was not getting any better, naturally when I tried to explain how antibiotic resistance develops and tried to get them to choose one antibiotic and stick with it they looked at me like I was the one on drugs)Anyway, the topic was swine flu, a topic on which I have little of no expertise, but, in keeping with the general idea of powerpoint, that fact matters very little—I kept with my basic strategy of downloading lots of funny images from google image and putting in as few word slides as possible. It appears to have been well received, but not so well received as to encourage more lectures.Tonights little fiasco was a women who’d been in the hospital for 10 days earlier in the month and had been given several conflicting but equally devastating neurosurgical diagnoses by the medical officers, but hadn’t seen the neurosurgeon…Tonight she came in with a severe headache, proceeded to have a fit, and stopped breathing…. The nurse said, we’d better take her to the trauma room (given my previous experiences with the trauma room, you can imagine I was a bit reluctant to go back) Fortunately the dentist had been kind enough to return the laryngoscope, so I was able to intubate the patient. But the O2 tank wasmissing. The nurse went out to get the tank… And never came back…. After bagging the patient for what seemed like eternity, and pretty much exhausting my extensive collection of curse words, another nurse comes in. Not to help me with the only critical patient all night, mind you, but to remind me that my guy in room 3 with the sore hip is waiting for me to come and read his x-rays…Manage to get the neurosurgeon Dr. Kirubwere (sp) on the phone. Says to get a CT scan and he’ll be right in (this is a miracle by the way, in the states if you call the neurosurgeon before the CT has been done all you’re gonna get is a chunk taken out of your butt). Unfortunately, they cannot find the key to the CT scanner room. I am not making this up. Dr. kirubwere, who unlike hiswestern brainsurgeon colleagues has the patience of a saint, shows up about the same time that security finds the unlabeled key, out of a box of 300, that opens the door… So we put her on the CT table and my nurses disappear, again, and I find myself bagging this poor woman for another hour while the tech futzes with the scanner… and gets no images… so we go to the ICU, where, blessedly, Dr. Kirubwere takes over managing the patient, and, will miracles never cease, there is a ventilator and I can stop bagging…Best thing about the whole experience—documentation—my note summarizing the entire encounter on a 4 x 6 notecard…. With a little space left over.July 25thUpdate on the unfortunate 37 yo woman above.The reason that the tech was unable to get the CT scanner up and running the other night—the memory was full… The printer (the machine that puts the images onto film like they used to do at home before digital x-ray became the norm about 10 years ago) for the CT scanner doesn’t work and they haven’t bought the software package that would allow them to store the images on a CD,so they don’t dump any of the images…Anyway, Dr. Kirubwere was finally able to get his CT 20 hours later: huge bleed. 24 hours later he took her to the OR to decompress… prognosis: poor. Had she gotten out of the country (she’s Chinese) 2 weeks ago, her chances would have been better.So I finished a string of 4 -12 hour night shifts, Friday morning. So, after a little nap, I had Friday off to wander into town…Caught a matatu (15 passenger minibus) into the downtown taxi park. Had to go into town to pick up a plane ticket. (some of my Liverpool trop med buddies are in Rwanda and the congo and are converging in Kigali in a couple of weekends, so thought I’d pop over). Rwandair Express is the only airline on the entebbe-kigali route—so I go to their website and book a flight, just like you’d do on alaskaair.com, etc, until you get to the part where you click on the purchase ticket button and it takes you to a screen that says—‘go to rwandair express office. Rwenzori courts, lumumbu avenue, kampala, pay for the ticket in US dollars.’ ..So I wandered downtown and stopped at the Standard Chartered Bank (where, I’m told, I have an account, even though VSO has yet to deposit any of the living allowance promised me…) I thought I could cash some traveler’s checks to get the US dollars needed. I thought this because of the big sign that says “we accept American express travelers checks” above the teller booth. But, the teller tells me, no we don’t cash traveler’s checks. So I ask if I can deposit some of the checks into my account… No, I can’t deposit into the account because the account isn’t active yet. And the reason the account isn’t active yet? Because no one has deposited any money into it yet. I start to get a headache. The manager comes over to explain things to the silly mazungu who looks like he’s about to stroke out at the teller booth and is holding up the long line of nice people who actually know what they want. She kindly explains that my account is at the Lugogo branch (wherever the heck that is…) and that I will need to take at least 100000/= over there to fund the account….Go to ATM, take 400000/= out of US acct. Go to forex bureau, change money back to USD, go to Rwandair and purchase ticket, and wander back down hill to old taxi park.2 taxi parks in Kampala. Picture an area smaller than a safeway parking lot seething with a thousand minibuses moving as if by Brownian motion. Generally, if you want to go to the southwest of town you make your way to the SW corner of the old (south) park. The buses are all running, filling the space with diesel and gas exhaust fumes as they jockey for position. A conductor for each van is trying to load his van with the maximum number of passengers… by screaming out his route and hustling people into the van. I find one yelling kabalagala (which is the closest I can find to my place) which already has 10 or so people in it (score, it will be leaving soon) and crawl to the far back corner (people get in, grab the best seat available, then future passengers have to scramble over them..)Our matatu takes off out of town, through the roundabouts and up the hill on nsambia road. Still full, the driver pulls over near one of the alleyways… the passengers look at each other as the conductor hops out and runs down the alley. (None of the passengers are getting off, so they start grumbling to the driver) The conductor comes running back carrying 2 plastic bags—the local gin (waragi) is sold in little 60cc bags called tot packs (or, given that the Ugandans like 2 syllables, totter packs). The conductor hands one to the driver who bites into it and starts sucking on it. I crawl over the people again and get out of the van. The conductor wants my full 500 shillings for the ride. I tell him that I don’t mind if he drinksgin on the job, but I won’t ride if the driver drinks with him… we settle on 200/=.26 JulyHad dinner last night with Conrad and his wife Katherine (sp). Conrad was in my trop med course in Liverpool. Conrad works for The Surgery, which is IHKs main competition (although they don’t pretend to be a hospital, they do have 6 overnight beds and 24 hr medical coverage). The surgery is where most of Kampala’s expats go for their first round of medical treatment before they get the hell out. It sounds like they are working poor Conrad pretty hard: 10-12 hours a day, 6-7 days week. He does say that they pay him by the hour, though, so I think he may be taking some extra hours to earn a few extra shillings.He says that he’s been using the DTMH (tropical med diploma) stuff quite a bit. He says that in medical school in Kampala they tend to rush through the infectious diseases (which is mostly what trop med is)… just like in the states.Katherine is also a physician. She works at an HIV/aids clinic out toward Entebbe. They have 2 kids, Matthew (18mos) and Joshua (3mos). They have a‘house-girl’ who watches the kids during the day (and cooks and cleans). At night Katherine works on her MPH from Makerere university. The goal is to get hired by an NGO as a project manager—pays a lot better and better hours than doing clinical work…Conrad and I reminisced about our trip to Snowdonia. A couple of the Norwegians took us hiking up‘Bristly Ridge’ into a freezing rain storm. The Norwegians were decked out in full goretex ad hiking boots while Conrad and Simon and Rocky (from the tropics) were wearing varying degrees of unsuitable clothes… I remember looking back at Conrad, soaked to the skin, his non waterproof hood tight around his face with this look of amused disbelief on his face. I caught up with Hege and Hilde on a big rock which offered no shelter from the wind or the rain and offered the opportunity to fall to one’s death in 3 directions. I tactfully suggested it might be time to turn around.Conrad fondly remembers the weekend as the time we took him into the mountains and tried to kill him. (we got back to the chalet and he shivered for a good 2 hours, then fell asleep, and woke briefly for dinner, but otherwise slept the rest of the night). He also remembered a berry crisp I made for dinner that night… We talked about if it would work with pineapple, mango, and jackfruit.Conrad says that Mulago sent one of friends from med school to Italy to study emergency medicine. His friend came back with the task of organizing the emergency department… His friend worked at Mulago for a few weeks when he got back… then left the country for a better paying job in Botswana…Conrad is going to get me a few contacts at Mulago.July 28thMonday night, hash night, was going to bota over, but Ian said he’d give me a lift, so hung out at the hospital until 5:40p (hashing starts at 6) waiting with Charlotte (another vso) and patricia (manager of ian’s construction co) who he also promised rides to. Ian screams up in his bmw x5. He had just driven cross town in traffic from a meeting with parliament about providing health insurance to parliament members and staff (the big new item this week in Uganda—aside from the famine in NE Uganda due to crop failure—is that the government purchased new 100,000,000/= ($50k) SUVs for the MPs… not too bad. Better for running the muzungus off tank hill road with…)Ian drives like the Ugandans, except with a bigger, faster vehicle. Was kind of a fun ride, as things go, except the part where you’re begging whatever higher power you beg to that the little kids stay out from under his wheels.But despite his best efforts we were 20 minutes late for the start. Couldn’t catch the running masses. Jogged up to the top of the hill with the radio towers and watched a great sunset. Jogged down and had a beer. In consolation Ian invited us to Rose’s birthday dinner at one of the nicer Italian restaurants in town. Ian, however, had a change of clothes… Roseand all of her friends are there dressed to the nines and I’m wearing a tee shirt and running shorts… I can just tell from the looks: ‘@#$%ing mazungus, you cannot take them anywhere.’But it was a nice dinner. Had my first wine in a while and a very nice piece of tilapia completely buried in mushroom and cream sauce…Ian had a couple of beers and became a little more voluble, went into a long tirade about all the medical aid etc that goes to mulago and doesn’t do anything ‘cuz the place isn’t organized well enough to accept it. Tactfully hinted he could probably get some of that aid if IHK was willing to provide more charity care. But then he counters with, “I’ve never asked for any of their help.” Okay then.July 29thWould swear I walked by a young man on tank hill road today who was wearing Justin’s boy scout uniform shirt from the early 70s, with the eagle scout badge sewn on. Troop 129. Similar bad haircut and black framed glasses as well, but of course this young man was black. Wanted to give him the secret boy scout handshake, but, of course, I’d forgotten it. Saluted him instead. Probably thought I was an idjit.July 30thSanyu (my landlady)’s dad died this past week. He’s been sick since I moved in. First at a public hospital, then a private hospital, then in a private hospital in Nairobi. Sounds like diabetes, hypertension, and then stage 4 colon cancer to top it off…. Not good. Sounds like he had surgery for the colon caand then never made it out of the ICU in Nairobi. One of the hardest things to learn about intensive care medicine is when to say goodbye. And I’m afraid, from my limited exposure, that they haven’t learned this in Africa. If the intensive care medicine works, then they are too happy to keepit going to think about turning it off… sanyu’s dad had been on dialysis and a ventilator for something like 3 weeks, she kept telling me she didn’t understand why he wasn’t getting better because he was ‘getting the best of care’. This is kind of the thing in africa, I’m afraid. Because they’ve had crap for health care for so long, they assume that all they have to do is get better care, and then they’ll live forever…Anyway, as someone stressing about a sick relative and , now, in mourning, she hasn’t paid her water bill… so I am now without running water. Fortunately, mukwaye is kind enough to bring me a jerry can of water every couple of days, so that I can sort of bathe and wash dishes and flush the toilet… Not really sure exactly where sanyu is, or what her # is, but don’t thinkit would be too appropriate, at the moment, to call her up and say sanyu where’s the flippin’ water, so have been suffering in righteous silence.