Happy Holidays

December 25th

Merry Christmas.

Those of you still in Kampala will know that I have proven myself unworthy as one not to be counted among the hardcore volunteers. I have flaked out and gone home (to San Francisco) for the holidays to snuggle Nancy, and to throw slobbery tennis balls for my increasingly obsessive labarador retriever (Bailey), and to wrap (and unwrap) presents, and to decorate trees and cookies, and to listen to one of the longest playlists of Christmas music ever compliled on iTunes, and to indulge myself in long warm showers where I can actually open my mouth, and to generally be amazed at just how good food and wine can taste.

With Nancy’s permission. Chances are good I’ll be back in Kampala in January. Until then, here’s wishing you and yours a holiday season full of joy and delight.

on a sad note

December 17th

On a sad note. According to today’s New Vision, 5 people died in a bus ‘accident’ when the night bus from Kampala to Kisoro struck some large rocks on the Mbarara-Kabale road at 3am Wednesday near Ntungamo. The rocks had been placed there by the men who then entered the flipped bus and robbed the dying and injured people.

Among the dead was Moses Munezero, clinical officer from the IMC Lira clinic, on his way home to Kisoro for the holidays. Moses had been on leave from the Lira clinic during my recent visit, so I had not met him, but his loss has left a cloud of sadness over the hospital, particularly in the IMC/IMF offices where this is the second death in less than a year (Judy, one of the nurses from the Jinja clinic died of a ruptured ectopic pregnancy in April).

“In this Christmas period, we expect a lot of robbers targeting vehicles moving at night. Drivers need to move with a security person to ensure the safety of the passengers,” The Ntungamo police boss is quoted as saying.

It is unclear what the security person would have been able to accomplish as the bus drove up on the rocks. Merry Christmas.

New Vision Article

more adventures with the Ugandan legal system

December 15th

I managed to get my wallet stolen over the weekend. I won’t mention the name of the club, because I would hate to give them bad publicity (but it’s spelled I-G-U-A-N-A). In their defense, they do have a sign up over the bar saying to be on the lookout for pickpockets—right next to the sign saying that effective Dec. 1st they will be ‘improving’ their drink prices (raising the price of a bottle of beer to 3500/=, outrageous, absolutely outrageous, this simply will not stand).

I had read the sign and moved my wallet to a front pocket where, if you know me, I usually keep my hand. But apparently I removed my hand from the pocket long enough to carry a few beers through the crowded bar, and, in my concentration not to spill the beverages, failed to notice the wallet lift itself out of the pocket. Fortunately I had just purchased a round of beer, and, also fortunately, I had enough loose change in my other pocket to cover the bota home.

There wasn’t much in the wallet aside from my VSO ID, the atm card for my Ugandan bank account, and enough cash to have purchased maybe another round of beer. So not a huge loss. But, given the vagaries of the Ugandan banking bureaucracy, a whole new world of hassle.

Naturally you have to go to the bank. No phone-in cancellations of your card. Then, at the bank you have to write them a letter telling them how you carelessly lost the bank’s property and begging them to forgive you and block the future use of the card. But in order to get them to actually cancel the card and issue you a new one, you have to go to the police station, file a police report, and bring a copy of the report back to the bank. You try to reason with the nice lady at the desk. What difference is a note from the police going to make in this whole process? And the nice lady says, ‘try and look at it from the bank’s perspective, if we didn’t make you get a letter from the police, then anyone could just get a replacement card anytime.’ It is hard to argue with logic like that.

So you make your way to the nearest police station—nearest to your house (at the bottom of the hill in Kabalagala). As you enter the station you see several dozen men milling about. The only activity you can detect is two men supervising a shirtless young man who appears to be mopping the muddy cement floor of the police station with his shirt. You brace yourself for what could be a long session and ask where the queue starts—only to find that they are all police officers and ready to help you. But really you should have gone to the police station nearest the Iguana. But after a little whinging and hand-ringing, the nice police officer agrees to take the police report even though it really really isn’t his job. Provided you are willing to ‘facilitate him a little something.’

So 15000 shillings later he hands you the form for a police report. You reach for your pen and he says no. ‘Photocopy.’ He directs you to the shop across the street with the sign ‘Fotcopi’ and tells you to make 10 copies. Ten? Yes, ten. And 5000 shillings and another 30 minutes later you return with the 10 copies. Of which he takes two and painstakingly staples them together over a piece of well-used carbon paper that he unfolds out of his jacket pocket. And then he proceeds to ask you a host of seemingly irrelevant questions (what is VSO, how much do they pay you as a volunteer, what do you think of Arsenal’s chance at the premiership?) while carefully printing your name on the form.

‘What did the man look like who stole your wallet?’ You try to explain that if you had been paying enough attention to see who took your wallet, you probably wouldn’t have to be having this discussion… But finally he gets to the bottom of the form and signs it. You sign it. He takes it over to another officer who signs it and stamps it. He carefully picks the staples apart, retrieves the precious piece of carbon paper, hands you your copy and shakes your hand. You have a little trouble understanding what he is saying, but the jist of it sounds like he is thanking you for losing your wallet and making a Ugandan child’s Christmas a little brighter.

And you take your copy of the police report back to the bank. And the nice lady at the bank tells you they only make the replacement cards on Tuesday.

back to gulu

December 12th

Yet another trip to Gulu with a side trip to Lira

As I was fighting car-sickness in the back of the ambulance last Friday, one of the thoughts that kept crossing my mind was that on Monday I was going to get to turn around and do the whole thing over again. At least this time we did it in a Land Cruiser and the driver wasn’t bent on setting the land speed record.

Alison and I headed to the IMC clinics in Lira and Gulu to do a little teaching to the staff there… Irene from the recently dissolved IMC clinical directorate went along. Steven from pharmacy was supposed to join us, but apparently he didn’t ask proper permission from his boss, and his participation was cancelled at the last minute. (as such, I got to spend some of my time in Lira and Gulu checking out the pharmacies and auditing their records)

The road north crosses the Nile at Karuma. I wanted to stop and take some pictures, but Satchi, our driver, said that it was illegal to take pictures from the bridge (despite there being not a single sign to suggest this) and that the soldiers hiding in the woods would jump out and confiscate my camera or at least demand a healthy bribe. I suppose the bridge, as the only significant road link between northern and southern Uganda, has some strategic value, but I’m thinking that the GPS guided smart bomb dropped from 30000 feet isn’t really going to care what the view of the Karuma falls as seen from the bridge is going to look like.

At least the baboons sitting on the guardrails didn’t try to charge me for taking their picture.



Lira is a rabbit warren of shacks and old colonial buildings laid out along paths that were once probably wild animal tracks. Lira has tripled in size in the last decade or so, and the lack of community planning shows. The clinic in Lira is tiny and staffed by the usual up-country clinic contingent: a doctor, a clinical officer, 2 nurses, a lab tech, front desk/customer service representative, a security guard, a cleaner and a cook. The pharmacy, where I was to spend several hours trying to make sense of the medication record keeping (3 different books and an excel spread sheet with no correlation whatsoever between them), is the size of a coat closet.

While in Lira, we paid a visit to the Charis Health center, a 2 year old facility built by the UK charity, Fields of Life. Charis is a bit off the beaten path, but then, most things in Lira are. It is set on a nice lot, although parking seemed a little skimpy for the size of the clinic—but ours was the only vehicle there. The medical center consists of a spacious and empty waiting room, 3 consultation rooms, an emergency room (being used for staff meals and to store the donated ultrasound machine and EKG machines), 4 6-bed inpatient wards (with 3 patients), a labor and delivery area, office space and a lab. The senior medical person on duty was the lab tech (he said that the clinical officer who was supposed to be on duty was in Kampala on training, but proudly admitted that he was the one seeing patients that day) who was happy to show us around the clinic, and, when Irene wound him up a little while we toured L and D, allude to the fact that he had delivered babies (and might be able to do a C-section if he really had to). Fortunately he didn’t have many patients this particular day. I think he assumed we were potential donors, so he made a big point of showing the ‘room for expansion’ out back and suggested it would be a good place for a theatre (OR). We asked him if he was planning on expanding his practice to include major surgery, he just smiled.

What Charis amounts to then, is one of the nicest and best equipped health centers in Lira, and a horribly understaffed and underutilized resource. And the reason? NGOs like to build things. But sticking around to run them gets messy. So it’s better to cut the ribbon, shake a few hands, get the picture of the happy children on the opening day, and then get the hell out. Fields of Life mostly builds schools. Their website says that there are 34000 students attending schools built by Fields of Life, and I have no reason to doubt them. Their website doesn’t say how many patients are being cared for at Charis Health Center.

Gulu, like Lira, has also tripled in population in recent history. But at least it has grown in sort of a grid, and some of the streets have drainage gutters (even if they are full of trash and sewage and are located where one might expect a sidewalk to be).

Most of Gulu and Lira’s growth comes in the way of IDPs (internally displaced people) from the rural north battlegrounds of the civil war between the UPDF (Uganda’s army) and the LRA (Joseph Kony’s Lord’s Resistance Army). All in all there were over 1.5 million IDPs from the North. Gulu is where the ‘night walkers’—the 15000 rural children that would walk in from the villages each night so as not to be kidnapped by the LRA—walked to. Now that Joseph Kony is somewhere hiding out in the Democratic Republic of Congo, and Gulu is thought to be fairly safe, NGOs have flooded in. You cannot spit in Gulu without hitting a sign with an acronym on it. (my favorite acronym of the trip was SLAP—serving the least advantaged people) Nor can you cross the street without looking both ways for a speeding white SUV with some NGO logo plastered on the door and the trendy ‘no weapons’ (an ak47 in a red circle with a line through it) sticker in the window.

Our clinic at Gulu is a nice facility, with living quarters on the floor above. The Gulu staff come from all over Uganda (and Rwanda) and they work and live together roughly 24/7... so, naturally they have developed deep seated contempt for their co-workers. Fortunately, this was Irene’s problem. And one that a deep cleansing breath and a group hug wasn’t going to cure. We will see how my suggestion to pay them more and make them find their own accommodation will go over…

another trip to gulu

December 6th

Ambulance ride to Gulu, and back.

My second trip to Gulu (a month or two back I flew on the helicopter) and I stayed for even fewer minutes than the first.

Friday morning, the sounds of the Soroti brass band still ringing in my ears, I show up at IHK. As it typical, whenever I have been gone for more than 15 or 20 minutes, Justine (senior sister in OPD) greets me with a smile and, ‘doctor, you’ve been lost.’

‘Yes, Justine, you have no idea how lost I’ve been….’

Technically, I am still excused from work by VSO for conclusion of the IVD (International volunteer day) festivities: a cocktail party at the Imperial Royale Hotel and the Volunteer of the Year Awards (VOYA). Surprisingly enough, I won’t be getting the VOYA this year. It will be going to an UNDP volunteer who goes by the moniker of ‘the Bushman’ who managed to design mud huts using nothing but a laptop and Microsoft excel! (A feat which, apparently, has brought the mud hut into the 21st century. I don’t know why they didn’t think of using an excel spreadsheet before.)

I pop my head in the ambulance/transport office to talk to Tom about a series of ambulance protocols we’ve been trying to put in place. Emma, one of my doctors is on the phone. With Gulu Independent Hospital. They have young man who crashed his motorcycle the night before. They want him to come down to IHK for a CT scan. He’s ‘stable.’ Glasgow coma scale of 13. Sure, we agree, send an ambulance with a nurse. I set a meeting with Tom and go on with my day.

A couple hours later I run into Tom again, talking nervously with Moses, one of the drivers. Apparently Gulu just called. The patient is getting worse. GCS 10. Gulu Independent is going to put him in their ambulance and head south to meet our ambulance heading north. I think out loud, ‘well, if our rig left 2 hours ago, they should be half way to Gulu now…’ Tom and Moses smile and nod, our ambulance is still in the driveway…

A few minutes later, I’m strapped into the front seat and we are driving like bats out of hell across town to the Gulu Road north. Flopping about the back of the rig, trying to take a nap, is another OPD nurse named Justine.

The ride to Gulu was 3 hours and 45 minutes of adrenaline rush and the metal on metal smell of disk brakes on their last legs. Naturally we did not see the Gulu Independent ambulance on the road. When I was finally able to locate the physician caring for the patient (who had been left in the ICU with 20 family members but no medical personnel to speak of), I was told that the patient ‘was too unstable to transport in an ambulance.’ Well thank goodness I had been planning on teleporting him back to Kampala.

GCS 3. (the Glasgow Coma Scale is a 15 point scale developed in Scotland as a predictor of morbidity in head injury based on a few simple brain function—you get 3 points just for showing up…)

As horrifying as the ride up to Gulu was(and as horrifying as was the reception at Gulu Indepenent), the ride home was exponentially more frightening. For one thing, I did much of it riding backwards attending to the last rites of my patient, while being thrown side to side like the scarecrow and the flying monkeys. When I did force myself to look forward (in a desperate effort not to hurl), what I saw through the doorway into the drivers’ compartment looked like a video game based on Death Race 2000:

Winding red-brown road threading its potholed surface through electric green foliage to the sound track of warbling siren and blaring horns. Occasionally the foliage would disappear and roadside trading centers garishly painted in the puce of Zain or the yellowgold of MTN or the sky blue of Uganda Telecom would flash by. The back ends (and occasionally the front grills) of buses and trucks and matatus would loom large and deadly on the view screen and then disappear. Targets would fly by on the periphery: motorcycles carrying 30 live chickens, tall thin men on tall thin black bicycles, women carrying jerry cans on their head, children carrying jerry cans on their heads, women carrying children and jerry cans, a baboon, (a baboon? Sitting on a guardrail), a baboon carrying a baby, two men pushing a bicycle with a coffin balanced atop, matatus disgorging floods of people, six foot high bags of charcoal on the side of the road...

The boy’s auntie rode with us, holding his hand. I had told her we would be very lucky if the patient was alive when we reached Kampala. He made it to Kampala. And got his CT scan. He was declared brain dead and taken off life support 2 days later.

VSO Roadtrip to Soroti

December 4th

VSO Roadtrip to Soroti

December 2nd was international volunteer day. Or some such sort of event. About a week or so before I received an email from Daniel at VSO saying they were looking for 10 volunteers to take a bus trip to Soroti to take part in the festivities—which were to include tree planting, a march down mainstreet, and some media interviews to encourage international volunteering. I had mixed feelings on the invitation. On one hand, I haven’t been to Soroti yet (Soroti lies about due north of Kampala about 15km from the south shores of Lake Kyoga, but to reach it you have to drive northeast to Mbale and Mt. Elgon and then hook northwest for a couple more hours) and I try not to miss any opportunities to check out new places in Uganda. (The Bradt guide for Uganda doesn’t say much about Soroti except that the only thing to do in Soroti is to climb the large rock that looms over the center of town—sounds pretty good to me. We would also be driving fairly close to Sipi falls, so we had hope that we might persuade the busdriver to take a diversion.) But, as one of my fellow volunteers commented, the VSO program office would ‘have trouble organizing a piss-off in a brewery,’ so it would be likely that a fair amount of milling about aimlessly would be written into the agenda. True to form, the email said the bus would depart at 11am so we could make the radio interviews at 5pm, and we left Kampala at nearly 2pm and got into Soroti about 8pm.

On the bus: Geoff and Sabrina from Kamwenge; Hazel, Stacy and myself from Kampala. Agnes and Amelia from Kabale. Peter, one of the Kenyan volunteers. Wilson and Dunstan and several other returned Ugandan volunteers. And Grace, Rose, Harriet and several other members of the VSO program office staff. (Benon, the VSO Uganda country director, drove one of the VSO SUVs up to Soroti, despite empty seats on the bus, thus effectively negating all of the carbon offsets of our entire tree planting exercise)

On International Volunteer Day (IVD), after a suitable interval of sitting about the hotel, we went to Independence Park near town and watched the brass band warm up the crowd while we waited for the organizers to go buy hoes and shovels and watering cans… This years IVD had the theme of ‘saving the environment’ and ‘combating global warming.’ VSO Uganda, aside from a few volunteers working in wildlife conservation, does not have any ongoing projects involved in saving the environment from global warming. (VSO international does list environmental conservation as one of their core programs—so all emails from VSO do say ‘please don’t print this email unless you really have to’ at the bottom). UNDP, the other major group of volunteers attending, also doesn’t have any ongoing environmental projects in Uganda—unless you count the environmental impact of their large fleet of white SUVs.

But we got to listen to a speech from the district chairman about how he expects Uganda will stop global warming in its tracks given the success Uganda has had fighting HIV/AIDS… ‘it used to be that AIDS was a terrible disease, but now it is just like getting a cold, you take the drugs and you get better…’ (which may be why, after years of the HIV incidence falling—from nearly 20% down to about 7%--the incidence in Uganda is starting to creep back up.)

And we got to plant seedlings in Independence Park and in the mayor’s garden. Using a hoe with a metal blade precariously attached to a peeled stick, I managed to dig 20-30 holes and get blisters on my hands. It gave me newfound respect for the women I see every day wielding their hoes, turning over their fields one clump of dirt at a time. All together we planted 200 and something seedlings. I asked the man from the mayor’s office when we could expect rain. He said he hoped in April or May. (He mentioned quietly that, yes, it would have been better if we could have planted the trees a few months ago at the beginning of rainy season, but, then, it wasn’t IVD a few months ago, the time was not right for gesturing and speeches.) I don’t think things bode well for our little trees.

The next morning I jogged into town and climbed the rock. The nice soldier on top, once he finished putting his trousers on, told me that I wasn’t supposed to be up there. But he didn’t point his AK47 at me and he politely accepted my excuse that I wasn’t carrying any money in my running shorts to give him.

Rose, a little miffed that she had to ride the bus back with the volunteers, instead of in the luxury of Benon’s vehicle, nixed the side trip to Sipi falls.

I was waiting for my eggs at breakfast when the busdriver came and told me that ‘everybody was waiting’ for me on the bus and that I should come. It was 0855 and we had planned to leave at 9am. I told him that I’d be on the bus at 9… (those damned mzungus, always making you wait!)

November 2009

November 4th

Another month has disappeared here.
Just got back from a week in the Netherlands with Nancy. Nancy had the annual IADMS meeting in the Hague and I got to sleep in a real bed and take real baths and showers and eat good food (with the exception of a couple of IAMDS buffet functions…) for a week. The Dutch, it seems, drink cheap south African wine, so the wine was the same. And Heinekin v. Nile Special… got to say they both rank firmly in the bottom 50th percentile of the world’s beers, but I’d have to give the nod to the Nile Special (at about a buck for 500ml) on the cost differential. Nancy and I had a very lovely belated anniversary celebration in a wonderful little inn outside of Amsterdam in the village of Broecke in Waterland. She liked the necklace.

Not too much has changed in the week I was gone. Carol, the doctor I had conned into being ‘team leader’ for the CME was transferred to one of the clinics… so I have to start all over again for that. Ian has been letting it be known (but not to my face) that he’s disappointed about the job I’ve been doing with the fun run… not feeling too bad about that. (apparently he’s miffed because I haven’t been spending my free time out at the lugogo mall signing up runners—but he seems to overlook the fact that I got the main corporate sponsor to double their contribution this year so that even if no one shows up to run, Hope Ward will still make twice as much money as last year). And Bob from lab came to the morning doctors’ meeting to rant about the fact that some of us don’t trust the lab results… apparently someone on the medical staff has been recommending to patient’s to get their labs done somewhere else (not me, I wouldn’t know where else to send them, but, even I notice that the lab values can oft times be hard to believe)… So Bob was haranguing the doctors not to voice their lack of confidence in the lab to the patients (apparently its okay not to trust the lab, just not okay to let your patients know about it). I tried to suggest that maybe instead of telling us to shut up, maybe the better approach would be to get some stricter quality control going in the laboratory… Nope, got shouted down on that one.

My roommates are off on safari, so I have the ranch to myself for a few days. Me and wilburforce the scary night guard.

November 5th

There were a trio of scroungy looking guys hanging at the compound gate when I got home from work last night. Grace, our housekeeper, wasn’t letting them in, so naturally I feared they were up to no good. But it was worse than that. They were musicians. Turns out last week, while I was up in the low country, my roommates signed up for drum lessons… and this week they are gone on safari… but a couple of the other volunteers straggled in on Ugandan time and by 6pm or so we had a little drum circle going (actually it was more of a drum semicircle).

Rhythm (along with musicality and talent with ball sports) was not something I was imprinted with genetically or picked up in early childhood or adolescence..

The African drums are hollowed out tree trunks with some dead animal skin stretched over the cavity. You beat on them with your hands. The edges of the drum head give the best reverberation (thonk) while the center gives off a more muffled beat (thunk). You want to smack the drum such that your hand kind of bounces off the drum, unless you want to punctuate your drumming with the flatter beat of your hand deadening the drum head. The drumming, traditionally, at least, has to do with the dances of the various tribes. Jonathan, who is a teacher during the day, in between swigs from the gourd in his pocket, told us how the 56 tribes of Uganda originated from the 5 main ethnic groups, and how the dancing evolved among the different groups. But naturally I forgot all that. I did remember the names to a couple of the dances, the Elongay, amagongway, oowingay and the Robert. (I think they made the Robert up just to make fun of my complete arrhythmia) As far as I can remember from the stories, all of the dancing basically comes down to proving how strong you are (and it sounds as if they gauge strength along the lines of endurance) so that the pretty young women (and, more importantly, their crusty old aunties) will be impressed and think that you would be an appropriate mate.

Fortunately I didn’t have to dance.

But, despite, my obvious lack of talent at the activity, I will say that it was quite cathartic. And the crazy drunk guy that lives over the back fence enjoyed it, he was clapping along and shouting encouragement (along with his usual ‘I love you mami.”). And for a good hour or two, we added our own blend of noise pollution to the neighborhood—drowning out the church down the hill with the microphoned hallelujahs. My hands were sore this morning.

November 6th

Tough day today. Dangerous medical missions.

Had to go to the malls. And try to convince shop owners that they should sully their bulletin boards and windows with posters advertising the upcoming Hope Ward (the charity wing of our hospital) fun run. Reminded me of being back in boy scouts about a million years ago trying to ‘sell’ jamboree tickets or some other sort of embarrassing shit. Fortunately, instead of being one of a host of skinny snot-nosed white kids lost in the trailer park selling useless crap, now I have the distinction of being a mazungu with a title… so at least the shop owners would talk to me (it must be important if IHK is sending around a doctor to hang posters—right?). But, for the most part, none of them really want to get stuck a week from now trying to get baked on masking tape goo off their glass… But I did manage to get a few of them stuck up and a couple of promises to do so when they found the proper adhesive…

Additionally, I had to line up volunteers to go to the malls and register runners. Our community outreach (the Touch Namuwongo Project—namuwongo is the slum off the foot of our hospital and the TNP provides free care to the people there as well as HIV/TB/STD screening and outreach in the schools) relies on community volunteers, so I had a number to choose from, but somehow I am supposed to gauge how honest they’ll be in a position where they need to collect money… And then I was left to negotiate how much they would need to be paid to ‘volunteer’… After some pretty intense haggling we settled on 10000/= plus an extra 2000/= for transport (6 dollars a day, 3x as much as the $2/day that 75% of Uganda survives on, but a little low for living in Kampala)… Jemimah, from TNP, laughed at me and said I got robbed… sigh… so I got to go down to the MTN shops and settle our team in to register runners.

And the day wasn’t over. Remember that I don’t have car, so I’m out with one of the ambulance drivers, because apparently I’m the only one at the hospital with this special expertise at poster hanging and table and chair setting up. So then I have to go to the MTN warehouse to pick up the tee-shirts. Because they aren’t going to release them to just anybody. I must say, at the very least, it was educational just to see what 600 tee shirts looks like (3 large bags weighing about 50-60 pounds each—in case you’re wondering). Naturally we are already behind the curve in getting the hope ward logo added onto the MTN tee-shirts, so we had to express the shirts to Tony the tee-shirt guy, and then I had to beg him to do a few of them tonight so the ‘volunteers’ can wear the shirts tomorrow. Which means that I’m going to get to spend at least part of my day off schlepping around to malls again. Whoo hooo. Wonder how many of the posters will still be in evidence.

November 16th

The ants invaded our bathroom over the weekend. It was horrific.

Living in Africa you get used to the fact that small creatures (ants, cockroaches, mice) share your kitchen. If you leave food out, you expect that it will be eaten, or at least swarming with insects by the time you get back. And it’s a good way to tell which of your housemates does a poor job washing the dishes—because if traces of food are left on a plate in the drying rack there will be a small horde of microants chomping away at it in the morning…

But the bathroom?

I should note that rainy season is still going on. Part of the global warming thing. There was no spring rainy season this year, so now the fall season is lingering on, turning everything to mud and washing away huge chunks of the road network. So apparently one or more of the ant colonies near the back of the house flooded and they decided to take refuge in our bathroom.
On Sunday morning there was a tiny trickle of the little warriors marching up the wall and on Sunday night the tub was so covered with them you could barely see porcelain… they also swarmed the toilet, the sink, and completely overwhelmed my toothbrush…
Fortunately these little guys are only a millimeter or two long, so we weren’t quite talking a Lennington vs. the ants situation, but my toothbrush had to go…
And, probably choosing a large white slipperly surface with a drain and a hand shower probably wasn’t the correct evolutionary choice to make as far as taking refuge from the flood….


November 17th

Despite all the signs pointing to doom and despair, the ‘fun run’ went off relatively smoothly. I showed up as I was told, sharp at 5am, otherwise, ‘security’ wouldn’t let me in. At 5am I was the only one there except for a few sleeping security guards. I just don’t learn.

But by 7, the essential truck with the sound system had pulled up, and the runners were marshaled around to the correct places and by 0730 we were on the road.

We had about 300 registered runners (about twice as many as last year) and a number of unregistered ones (apparently some people take the meaning of charity fun run to mean that its free).

I took 3 phone calls while out doing the 10k: one from our ambulance crew, one from Jemimah from hope ward (she was late), and one from Medi (my registration volunteer—he doesn’t really call me, he just ‘flashes’ me—calls and hangs up, calls and hangs up, until I get pissed off enough to call him back—most Ugandans have at least 2 phones… but no (prepaid) airtime, so they can receive calls, but not actually make them) Fortunately I started off pretty slow. So I was still able to get enough breath to talk on the phone.

The course started out roughly downhill for 2k then flat for 5k and then uphill for 3k. What’s wrong with this picture? Still, because of the slow start and the phone calls, I was able to pass people all through the race and this boosted my morale. For those of you who are into 10k times, I ran it in 47 minutes and change. Or, roughly, the same pace I ran my first marathon in 34 years ago…

I had managed to persuade one of the stores at Lugogo Mall (Game) to donate some gift certificates for prizes. Because we didn’t have official timing, or numbers, or even know who had paid their donation or not, we decided to give the prizes randomly (best looking shorts, sweatiest tee shirt, last finisher during the awards ceremony) as opposed by finish order. Mistake. Apparently the concept of ‘fun’ run and ‘everybody is a winner’ does not sit well with the Ugandan running populace. There clearly had to be a winner. But I was out running, so I had no idea who it was. One fierce looking gentleman was in my face and demanding a prize and, when it was not forthcoming, telling me that I had ‘cheated him’. I noticed that, unlike almost of the runners he was not wearing the official 'I am running for Hope' tee-shirt. But he did have one in his bag. I wound up having to pay him 80000 shillings to keep him from ruining the 'fun-run' atmosphere.

Given the early start, we were pretty much wrapped up by 10am. So I and my fellow Vso volunteers (I managed to get vso to sponsor a ‘corporate team’) went to La Foret and had the only breakfast available there (beer and chips). La Foret is a scroungy old hotel from the colonial era that is slowly being renovated by a Dr. Apollo (who also has his clinic on the grounds, and, unbeknownst to us, also rents the place out to a church congregation on Sundays).

So we are lounging at the pool with our beers. One of my housemates, Cara, an Australian physio, is doing laps. And this large group of people filter in wearing Sunday go to meeting suits and dresses. They sing a little, pray a little, rant a little (fortunately, unlike the church down the hill from our house, they didn’t bring a PA system), sing a little more. And then they stand at the edge of the pool looking nervously at Cara doing the butterfly leg of her individual medley… until Cara finally finishes up her laps and gets out of the pool. Then they wade fully clothed into the pool—to hold a baptism for a few newly converted sheep… I guess they didn’t read the sign behind them that read ‘all bathers must shower and wear proper swimming costume before entering pool’

November 19th

As part of my ongoing education into all things Ugandan, yesterday I had the privilege and honor to spend a day observing the Ugandan court system…

Now, as an emergency physician in the states, it’s not that uncommon to get a subpoena from the local prosecutor demanding your presence in court as a witness to some sort of evil or stupid thing that people do to each other. But here in Uganda things work a little differently. I was coming out of the morning cme meeting when Joel, Jackie’s assistant at the clinical directorate grabs me and says I need to go to Mpigi and testify at an attempted murder trial. The victim was stabbed in the abdomen with a steak knife by a friend in an incident that involved the over use of alcohol. I saw him ever-so briefly on his way to the OR, such that I didn’t even leave a note in his chart. I mentioned to Joel that probably the court would want the testimony of Dr. Ben the surgeon, or Dr. Michael the medical officer that actually provided his care… but Joel said no, that Patricia had asked for me. Patricia (it turns out I know her from the hash, and from some salacious locally circulating gossip) is the manager of the IMG’s construction company (and owner of a dress shop in kabalagala) and the sister of the man who was stabbed…
It takes us some time to find the medical record. This should not be a surprise given that our medical records consist of green 4 x 6 note cards, stapled together and lie around the registration area in huge piles. Her brother is called Emmanuel. She calls me while we are searching and tells me that I don’t need the chart and that I need to be in Mpigi in a half an hour (as it turns out the medical record was not much help—the medical officer’s note suggested that the wound was in the right upper quadrant, the surgeon’s note didn’t note a location, while my recollection—and the patient’s—had it on the left flank). I ask Joel where Mpigi is. He says ‘on the other side of town.’

Mpigi is actually almost 30km west of Kampala. It is its own district (roughly the same geopolitical unit as an American state). By the time I arrange a driver and we fight cross town traffic and make it to the Mpigi district court, it is 2 hours later.

The courtroom is a large concrete space with a high ceiling, open windows and two aisles of six or seven creaky wooden pews. Where we got to sit for another two hours while people chatted in lugandan and I smiled and nodded and put the occasional bullungi and kale out there. (fine, or okay).
And then a line of eight sullen looking young men and two young women filed in accompanied by a very large woman in combat boots and the beige uniform of the national police. I thought maybe the jury, but no, these were the defendants.

I’ll just note here briefly that typically, when I am forced to testify, I have managed to make the prosecutor think that I am so overworked that I might just go postal at any moment, so when I do have to testify they usually pick a time for my testimony where I don’t have to sit around a lot.

I’ll also note here, that because the justice system works so slowly at home, I rarely get subpoenaed to testify about something that I actually remember, whereas Emmanuel’s wound still hasn’t healed.

And then a couple of lawyers wander in. The prosecutor, a young woman with highlighted hair extensions and a tight blue suit, and the public defender (?), a slight man with a shaved head and a shiny green pinstriped suit a few sizes larger than its occupant. And they chatted for awhile. Patricia went up and talked to them and pointed at me. And we waited some more. And then we stood up. And then the Honorable Lady Justice Elizabeth Musoke came in.

Unfortunately, the stabbing case was not first on the docket. The rape case was.

The honorable lady justice sat at a slightly elevated table with the two lawyers facing her. To her right was a uniformed bailiff and the court clerk. The judge and the lawyers would grunt questions to the court clerk who would translate the questions and answers to the witnesses. I don’t pretend to understand everything that went down, because my lugandan is weak and my hearing is pretty poor and the sound of the shirtless man sweeping the lawn with a handbroom under the watchful eye of a stout woman in a webbing belted beige dress toting an AK47 with the butt broken/sawed off it was the loudest thing I could hear.

The defendant (the accused, he was called) stood in a box to the judge’s left—a young man of 18 or 19 in a blue checked shirt with an angry scowl fixed on his face and his eyes fixed on the girl standing in the box to the judge’s right. The plaintiff (the victim, as she was referred to in court), wore her school girl’s uniform—a pressed white shirt with emblem and a tan skirt. Mostly she looked at the rail she held tightly to.

‘and then what happened?’
‘mumble’
‘speak louder.’
‘mumble’
‘you must speak louder’
‘the accused used me’
‘tell the court how he used you’

I won’t bore you (or enrage you) with the details. Suffice it to say it was pretty painful to watch the lawyers and the court clerk berate the underage girl and make her recite in fairly anatomic detail the event in question in front of a tittering audience.

I will point out a few interesting bits of the proceedings that I might not have otherwise considered:

Quite a bit of the testimony (from her family and his) centered on exactly how old they were. Her family testified that she was 16 and that they had known the boy for over 20 years. Whereas his family insisted that they were both 18. Very few Ugandans have birth certificates, or even documents to prove their ages. It makes proving statutory rape kind of problematic.

The defense attorney also spent quite a bit of time questioning the girl about her bicycle. How often did she ride it? What kind of seat does it have? Because, apparently, everybody knows that young women can often break their hymens riding bicycles.

And then there was the question to the girl’s father about what he did after he found out about the rape. Did he go to the police? Well, no, it appears he first went to the young man’s family with an inquiry about the young man’s intentions—was he going to marry her? Was he ready to pay the bride price? I guess when he refused, that’s when it became rape.

The honorable lady justice scheduled her ruling in the case (no jury at this level in the justice system) for the following week. The stabbing case was postponed as well. Stay tuned.



November 20th

Phone log:

17:45 call in. (just home from work, Ben and Rachel coming over to cook us a Ugandan dinner) Ian: ‘Robert, are ye in the hospital?’ Two Belgian police officers were involved in a roll over north of Masindi. They’ll be flying in by police helicopter about 7pm. They have head injuries and one of them has a ‘dislocated shoulder’ ‘Can ye handle a dislocated shoulder Robert?’ So much for dinner plans.

17:46 call out. To IHK ambulance to have them give me a heads up when the helicopter is landing.

17:48 call in. from IHK ambulance (moses), our helicopter just left for Tanzania. I explain that its going to be a police helicopter. He says he’ll look into it.

17:50 call in. yep. A police helicopter is coming.

18:08 call in. nope. The police helicopter doesn’t fly at night. They’ll be coming by ambulance from Masindi. They’ll be here about 9p. I ask that they call me when the patients get there.

20:15 call in. ambulance still hasn’t left masindi. Eta 11pm) Reiterate request that I be called when the patient gets there. (rush dinner, excuse self early to go take nap—could be a long night

22:06 call in. from Ian. ‘Robert, they’re bringin’ ‘em down from masindi by ambulance…’ ETA 1am. ‘I gave y’er number to the supreme chief inspector of police, he’s a good guy, that’s okay, isn’t it?’
‘you’ll be there to meet the ambulance, won’ t you?’

(still trying to take a nap)

22:34 call in. from the supreme grand chief inspector of police. Just wanted to make sure the number ian gave him was correct. It is. He thinks the ambulance will be here about 1am. I thank him for this piece of information. He goes on about head injuries and broken bones and unstable patients. I reassure him that the men will be okay (because I know that if these men were seriously injured they will be long dead before they reach IHK).

(woken from early dream sleep)

23:02 call in from IHK ambulance. The ambulance has just left masindi. Eta 2am. I again repeat my request to be called when the patient gets there (ok, maybe a bit testy this time). Reset alarm for 2am.

(woken from sound sleep)

01:00 call in from supreme inspector ‘I am at the hospital. Where can I find you?’ I explain that, slacker that I am, I am still in bed. I ask is the ambulance from masindi there yet? No it is not. I explain that I live quite close and that a driver from the hospital will come pick me up when the patient gets there.

01:15 call in from chief inspector. He really thinks I should come and be at the hospital to meet the ambulance. I ask him to talk to his policemen on the ambulance and give me a call when the vehicle reaches the outskirts of town.

01:30 call in from chief inspector. ‘I have it on good authority that the ambulance will arrive at 2am’ sigh. I tell him I’m on my way in.

01:31 call out to IHK ambulance asking for a driver to come pick me up

01:32 call out to the driver

01:50 call out to wake up the driver who hasn’t come to pick me yet

2am—I arrive at hospital.

3am—2 ambulances arrive at hospital. Each with a single patient (in doing so they have removed 100% of the functional ambulances from the masindi district as well as maybe a tenth of the medical personnel, who, in hopes of a big payout from the foreign power, choke the ambulances). None of the medical personnel on the ambulances, by the way, know how release the wheeled gurneys from the locked down position in the ambulances (in their defense the lock down mechanism was one I have never seen before and couldn’t figure out either—but, then, it wasn’t my ambulance), so, in the end, the Belgians had to get up and walk into the hospital (thus effectively ruling out the diagnoses of hemorrhagic shock, lower extremity fractures, serious head injuries and the need for 2 ambulances).

6am—finally get the xrays confirming that the only injuries are a broken rib and a broken collar bone in one and a third degree acromioclavicular separation in the other. Get them checked into the hospital and curl up at desk for a nap.

At least now I have the chief of the Ugandan national police’s mobile number on speed dial—might come in handy some time. You never know.

November 23rd

Sunday the 22nd was the 6th running of the Kampala International marathon. About 500 people started the marathon and about 200 finished under 6 hours when they pulled the time clock and went home… I think many of the registrants felt chose to continue with the 10km route 5km into the race and were disqualified. About 1500 people were entered in the half marathon, while 16400 were entered in the 10km race and there were thought to be another 4000 ‘rogue’ runners in the 10km as well…

No, I did not run the marathon. I flirted with the idea of running the half, but IAA (IHK’s insurance arm) signed me up for the corporate team for the 10km, plus I had told the red cross I would provide backup for the medical tent (and I figured that I wouldn’t be much good to them if I was flat on my back with a saline drip…). So I ran the 10km. The same 10km as the week before. Just with twenty thousand more people on it.

Each of the mobile phone providers in Uganda have their own particular color: Zain is purple, Warid is blue, Orange is, well, orange and the color of MTN, the marathon’s corporate sponsor (who still haven’t coughed up the donation for Hope Ward), is yellow gold. Sunday, the streets of Kampala were awash with yellow-gold. Most of the 20000 runners were wearing their race t-shirt as were all of the course volunteers. It was fun for me to see this huge river of yellow in front of me (as well as the massive tsunami of gold behind me trying to run me down) out on the course—until my breathing got so ragged that my vision became blurry. I wore a blue shirt. As if being white wasn’t enough to make me stand out.

Aside from the sight of the yellow ‘nile’, the fact that they had 20000 runners in a race with a scant fraction of that number of officials and volunteers was problematic at best and downright scary in reality. The race start was on the same narrow 2 lane street as the week before. I managed to maneuver myself somewhat near the front of the bunch when they were lining up in the holding area, but before we were done ‘holding’ Brownian motion and general mayhem had put me back a few thousand spots. Then there was a sprint from the holding area about 200 meters to the line where I tried not to be trampled and I lost another 1000 places as I ran smack into the thousands in front of me with the weight of 10000 behind me driving me forward. Suddenly it became hot and smelly and difficult to take a full breath. At times the pressure actually took my feet from the ground. I thought about the Liverpool football fans being crushed against the fence at Sheffield in 89 and wondered if this was what it felt like. Fortunately, there wasn’t a fence between me and the start line, just a few beleaguered race officials (at least one of whom was curled in a ball on the ground still when I made it to the line) who rapidly decided to fire the starters pistol and run for their lives. For what seemed like ten minutes but what was probably a minute or two we shuffled forward like some sort of thundering amoeba. Inching forward with tremendous pressure behind. And finally, as the runners in front gradually broke from shuffle to trot the force from behind suddenly became unopposed and a few runners near me were thrown to the pavement.

By the end of the first kilometer I could finally run free and gradually pick my way through the pack. Given the dead sprint down the first 2-3 kilometres, most of the race I spent gradually passing thousands of runners (which is much more heartening than having thousands pass you as per my experience at Boston in 89…). The cheering as I went by almost invariably went like this: ‘blah blah blah mzungu blah blah…ha ha ha ha’ At which point the two or three guys ahead of me would look back in fear and put on a burst of speed. (So I think in lugandan the fans were saying don’t look now but there is a big fat white guy behind you) One gentleman in very short shorts and very tall stripey socks repeated the sprint process at least ten times before he finally dropped into a walk on the hill. ‘you shame me mzungu’ he muttered as I jogged by.

The actual marathon was won by a trio of Kenyans in about 2:18. Not only was the course hot and hilly, but they also had to contend with thousands of the 10km walkers in their way for the last 2.5km of the run. The half was won by a Tanzanian who managed to lose the local Ugandan favorite in the horde of fun-runners in a sprint to the finish in 1:03. My time was not nearly so competitive, but was a few minutes faster than the week before, so the training program appears to be paying off.

Fortunately there were no major resuscitations in the medical tent. Aside from a few dramatic, fling yourself to the ground finishers, most of the injured were security guards and race officials. Near the middle of the packs’ finish, the rumor went out that there were not enough of the coveted MTN water bottles (cheesy yellowgold plastic bike bottles, of course) to go around. The race officials were trying to trade the bottles for the ‘disposable’ timing chips tied to peoples’ shoes, but they couldn’t get the chips off fast enough and the crowd make a move for the bottles—a couple of volunteers and security guards tried to stop them and things didn’t go well for them.

But by noon everything was under control and it was time to hang out at the kampala hash house harriers tent and test the properties of nile special as a recovery drink.

The hashers were fairly impressed with my run. Parasite (I know most of these folks by their hash names, Parasite got his because when he started hashing he was mooching heavily off an expat girlfriend), fresh from his 1:15 in the half, summed it all up: ‘given your age… and given your weight… and given you don’t train… and (wave hand in front of Rob’s physique) given your body type… you should be very happy running a 43 minute 10k.’ (!)

A couple of related links:

http://www.newvision.co.ug/D/8/12/702026
http://www.monitor.co.ug/artman/publish/sports/Kampala_marathon_The_good_bad_and_ugly_95040.shtml


November 24th

Update on the trial…

I spent almost all of Monday with Patricia schlepping to Mpigi and back once more on the stabbing thing. Travelling with Patricia gave me even more insight into the Ugandan justice system.

For one thing, it wasn’t a rape case I was observing, it was a defilement case. The judge still hasn’t ruled.

It turns out, that, except in high profile cases (http://www.monitor.co.ug/artman/publish/news/Shock_as_Gen_Kazini_is_murdered_94417.shtml for instance), the burden of seeking justice falls on the victim or the victim’s family. After the stabbing, Patricia’s family went to the stabber’s family to ask for apology and restitution for Emmanuel’s 1.6M shilling hospital bill, but apparently they were rebuffed and the defendant went into hiding at his sisters. So Patricia had to find out where the boy was and bribe the police to go arrest him. She had to ‘facilitate’ the arrest by paying for their gas, their lunch, their airtime (prepaid mobile calls), etc… She then had to ‘facilitate’ the witnesses to come forward and make statements and facilitate the clerk in the printing of the documents for the trial.

Yesterday she had to pick up the two arresting officers and drive them to the court house, but not until we stopped at the mpigi dry cleaners and Patricia had to pay for one of them to get his go-to-court suit back from the cleaners. They reminded her that they would need facilitation for lunch, and then the one with the suit extorted another 10000 shillings from her saying he needed a bota back into town to get the fingerprint cards which, after pocketing the money without so much as a webale nnyo (thank you very much), miraculously appeared in his pocket…

(I should note, that I love the use of the word facilitation as it is used in Uganda for a payoff or bribe or a perk that you need to give in order to get someone to do their job. Partly I derive pleasure from this use because much of the last 4 days of pre-departure training I had from the VSO in Ottawa was based on participatory facilitation and how to be a good facilitator… and I’m sure that this may be one of the VSO—and other similar organizations—lasting impact on Uganda and the developing world: the gift of the word facilitation.)

After waiting around for another 3-4 hours, I did get to give testimony. I got to go stand in the little booth. That’s when things kind of got off on the wrong foot. The bailiff looks at me and says, ‘church.’ I say, ‘excuse me?’
He says, ‘what church do you belong to?’ You can see where this is going, I didn’t feel that my typical response of ‘recovering catholic’ would be appropriate, and I didn’t think that secular humanist would fly, so...
‘I don’t belong to any church.’
Stunned silence on the bench and in the courtroom. Patricia is pretending to look at something in her purse.
Finally
‘Do you believe in God or Allah?’
tough question. ‘Uhhh… yes?’
more silence
‘Will you swear on the bible or the Koran?’
‘Either is fine your honor.’
‘Pick up the bible.’ There are 2 books on the rail. Neither of which have any words on the cover. I choose the paperback.

It turns out that shortly into my testimony, the defense attorney decides that they need to talk to the surgeon. Not me. Patricia is a bit miffed. She knows that it will take many more shillings to facilitate the surgeon…

October 2009

October 1st

Last 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 a grant 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 6th

Report 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 the left. 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 7th

Monday 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 11th

Wilberforce 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 a friendly 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 12th

Woke 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 the many 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 ready to 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 the helicopter, 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.shtml

http://www.newvision.co.ug/D/8/12/697677

October 13th

Happy 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 15th

Went 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 week apart, 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 national referral 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 hospital


October 18th

Stacy 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 gave Stacey 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 days out 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 reverse for 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 18th

The 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 to get 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 22nd

I 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 assume that 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.

September 2009

September 1, 2009

Have a lot of lectures this week… yesterday put on an ACLS practical for the doctors. Went pretty well. Almost got a couple of them engaged with the whole ‘mock code’ concept… got off to a rocky start, though. Had booked to have it in the trauma room. But the trauma room was locked. And the night nurse with the key (the only key, as it turns out—back to the big box of unlabeled keys) had taken it home—to the other side of town. I could only laugh.

Today Alison and I went out to Mukono (halfway out the jinja road) to the IMC clinic at the RVZ flower farm. Rehima is the clinical officer (roughly the equivalent of a nurse practitioner, maybe) who runs it, and simon is her nurse. Very bright, inquisitive, fun people. Of course my lecture was on basic emergency care. So I tried to limit it to pretty basic stuff and pretty basic interventions.. like oxygen… oh except they don’t have oxygen… or a bag valve mask…. Oh, except they don’t have one of those either. Here they are, in the middle of nowhere, 15 miles from the mukono hospital, and they have no basic emergency equipment. At all. Okay, she did have one vial of epinephrine. I told her not to use it all in one place… So I don’t know if my lecture enlightened them, scared them, or just depressed them. (we are working on standardizing the emergency response equipment of all our outlying clinics, so maybe I will have to go back and repeat the lecture in 6 months when they actually have the stuff….

Tomorrow, lecture at KPC…

September 24th

Somehow most of another month has slipped past me.

In my defense, I have been away from the computer for 2 and a half weeks.

One of those weeks was spent on the chianti highway in Tuscany with Nancy. It definitely did not suck. Its nice when the most important decision of your day hinges on which beautiful little hilltown you are going to have your 3 hour lunch in…. enough said (this is private stuff, folks).

Those of you who were tuned to the BBC for the 5 minutes on September 11th when they showed the riots in Kampala know that while I was in Italy there was shooting and mayhem in my adopted city. Armed youths stormed the city center and burned police stations, stopped traffic and turned over matatus. The police fled and the army was called in. 20-30 people were killed and another 80-100 injured. 300+ people were arrested. The city center was pretty much closed for 2 days and the boda drivers were charging 10000 – 20000 shillings to take people home (1000% rate hike). A couple of the volunteers were stranded, but no one I know was hurt. IHK got one patient—an expat reporter—so we were guaranteed our fair share of media attention.

It all came down kind of like this…

Uganda, like all African countries is composed of several kingdoms. Each kingdom is made up of a number of tribes. In Uganda’s case, the traditional kingdoms were manipulated by the British during the colonial days and abolished by Obote during the early years of independence. Yoweri Musaveni, Uganda’s current president (since 1986) allowed the traditional kingdoms and their leaders to re-establish during the 90s. 3 of the 4 major kingdoms, Buganda, Bunyori and Toro were allowed legal recognition, but the Ankole kingdom was not. While the traditional monarchs were recognized, they don’t have any political power, although they do have a tremendous amount of popular support, especially within their traditional kingdom (except for the Ankole, who, apparently, could really care less if they have a king or not).

The kingdom surrounding Kampala is Buganda… so already you can see that the other kingdoms might be a little testy having to live in a country that was (mis)named after an opposing kingdom. The monarch of the Baganda (people of Buganda) is the Kabaka. The current kabaka was invited to speak at a youth ceremony an hour or two outside of Kampala in Kayunga—an area with many Buganda people, but maybe not necessarily within his rightful kingdom. If I understand it correctly, one of the local clan leaders (from the Mengo clan?) demanded that the kabaka ask permission to visit the area, and the Kabaka wasn’t ready to stoop so low as to ask permission of a mere clan leader. So there were clashes between the kabaka’s advance party and the Mengo students and the kabaka appealed for police or military assistance and apparently Musaveni told him that he couldn’t go. This was a big slap in the face to the monarch and his supporters. Kings aren’t supposed to have to ask permission to travel within their kingdom (perceived or otherwise), so a few supporters of the kabaka descended on downtown Kampala to protest and were quickly joined by some of the tens of thousands of unemployed or underemployed youths that occupy city center. And a well meaning protest rapidly descended into looting and pillaging and tipping over of matatus and burning police stations. The police forces were caught mostly off guard, and for the most part, ran for the hills. But a few of private security guards and some of the police fired their weapons randomly in the air to dissuade the rioters and, unfortunately, killed or injured bystanders who had come out onto the first and second story balconies to watch the fun. Shortly thereafter, the military moved in with armored vehicles and restored order.

A few of my fellow volunteers got cut off on the wrong side of town and had to hole up in a hotel, but no VSOers were hurt.

Apparently the peace corps had some sort of warning from the American embassy that things were going to blow. The 80 or so peace corps volunteers in the area were put on lock-down and evacuation plans were drawn up. VSO didn’t even send me a text. (and neither did the US embassy to which I’d recently gone through the trouble of registering with).

By the time I flew in on Sunday, all the mess had been cleaned up. Entebbe road was moving along nicely… Joseph, my driver, said that the city had been ‘busy’ but it was better now. In 2011, Musaveni comes up for re-election again. I think I will plan to be gone by then.

September 29th

Still reminiscing here… will let you know when I make it back to the present.
So after I skulked back into the country from italy, I caught a few hours of sleep and got up and caught the post bus to Mbarara. The post bus leaves the downtown post office at 8am with the mail. (there are actually a number of post buses… surprisingly enough, I caught the one to Mbarara). The post bus is generally thought to be one of the safer forms of overland travel in Uganda (where some of the other bus companies have the nickname ‘flying coffins’). Apparently the mail is more valuable than the people who sent it. On the bus as we passed lk mburo I had my first real wildlife spotting: 3 zebras were grazing with a herd of ankole cattle (the real big horns) on the verge of the highway. I nudged my seatmate and said ‘look, zebras.’ He looked at me as if I’d just asked him to pull my finger.

Even though I was headed southwest and downhill, Mbarara is considered ‘up-country’. Alison and Al and the kids (amy, zoe, bella, in case I haven’t introduced them) had spent the weekend leopard spotting at Lake Mburo and they met me in mbarara where Alison and I had arranged to do a clinic visit and some teaching at our clinic there. We had dinner with the VSO contingent at the Mbarara University of Science and Technology (motto: succeed we must…) and stayed at the lakeside hotel and resort (with its own manmade mosquito breeding pond) and woke to the army sealing off the hotel and unloading the bomb sniffing Alsatians for Pres. Musaveni’s surprise visit to the west country.

Spent a night perched on the edge of the great rift valley at kingfisher lodge…
The night was made interesting by the fist sized rhino beetles that apparently had it out for the lamp inside my screened window. The beetles would take to wing (making the sound of a piper super cub on short final—really, the first time I heard the noise, I had to look out the window for a small aircraft) and then smash into my window. And then you’d hear this smack like a crumpled beer can going into an empty trash can as they fell back to the walk. In the morning, I found 3 of these mini dinosaurs lying on their backs on the gravel. They can fly, but they can’t roll over. There’s a lesson in that somewhere.

From Mrarara we headed west to Bushenyi and then turned north into the great rift valley and Queen Elizabeth Park. Named, surprisingly enough, for the Queen, when she visited in 1952, QENP covers over 2000 km2 of the rift valley and protects the kazenga channel as it weaves between lake Edward and lake albert. For our first day we went on a nature walk with a ranger carrying a ak47 in the maramugambo forest. We saw vervet monkeys and baboons.

That afternoon we went on the channel cruise out of mweya and were entertained by hundreds of hippos, thousands of buffalo, a multitude of water birds, 3 small crocodiles and 2 elephants.

We had dinner at the tembo canteen overlooking the channel and, as if to be expected waited 2 hours for our food to be delivered until it was good and dark. Walking back up the road (300-400 yds at most), Alison’s eldest, Amy starts pestering us ‘what if there’s a lion out here, shouldn’t we have an armed ranger with us?’ We’re telling her that there would never be lions this close to the hostel with all these people around… Then one of the tour guides screeches to a stop in his land rover and basically demands we get into the car… ‘what are you doing in the dark, with children on the road, don’t you know there’s lions here?

We get into the vehicle. Amy says she told us so. I’m still thinking, yeah, right, lions and tigers and bears, oh my…

Until about 3am when I wake from my dream about hippos to what sounds suspiciously like a roar. Still, I’m thinking, right, I roll back over. I wake up about 15” later to more of a muttering and purring. So I pull up the mossie net and creep to the window. At the hedge, maybe 30ft away, some animal is moving… hmmm…. Can’t quite make it out. Lion? Nah. Back to sleep. Then there really is an MGM lion sort of roar. I sneak back to the window and the king of the jungle has a female lion pinned to the ground about 15ft from my window. Oops, sorry leo, did not mean to be snoopy….

The 2 lions came back one more time and I managed a rather dark looking pic, (didn’t feel like keeping my arm out the window too long futzing with the camera…)
I didn’t tell amy about it in the a.m. because I knew it would make here insufferable, but she heard about it from the other guests on my side of the building.

Alison and I went to visit the clinic in Kasese at the colbalt mine there…

Sep 30th

…continuing on. Caught the bus back from fort portal on Saturday. the post bus wasn’t an option as we didn’t get into town until mid afternoon. Sat next to a very nice, but very large woman in a red suit carrying a brief case, a knock off channel handbag, and two live chickens…

didn’t drive back with al and Alison ‘cuz (aside from the fact that if I heard one more rousing chorus of ‘my bonnie lies over the ocean’ I was going to have to choke some body) I’d promised to visit (vso volunteer) Chris and Maggie in Masindi, and even though Masindi is closer to fort portal than kampala, you can’t really get there from there, so I needed to catch the Sunday am bus to masindi so I could make rounds with chris (a gp from uk) on Monday…

alison said, ‘well, what time is the bus scheduled to leave? We’ll drop you then.’ I had to chuckle. Aside from the post bus, buses in Uganda leave when they are full, not according to any known timetable. So you crawl aboard a hot stinky bus and wait for your fellow passengers. Maybe an hour, maybe two. And then, after every square centimeter of seating space is crowded with flesh, then the bus pulls out of the bus park… and drives to the petrol station to fill up with diesel… (that is called tight cash flow)

for the ride up to masindi I got to sit next to the raving drunk man in his best Sunday go-to-church suit. Apparently he goes to the service where they serve waragi afterwards instead of donuts.

Chris is working at masindi district hospital. Districts would be the equivalent of US states in Uganda. The masindi district is home to about a half a million people. So the district hospital would be the main referral hospital for that district. I wanted to get a feel for hospitals out of kampala…

Masindi district hospital is a grim place. Built by the brits in the 50s. 3 long low-slung buildings each containing 2 open wards with 20-30 beds each. An operating ‘theatre’ from the 50s where they still use ether as an anesthetic. An xray machine from the 50s that doesn’t get used much, not because its probably a radiation hazard, but because they don’t have any film for it. Only one of the wards has running water, except that it wasn’t running that week. There are no flush toilets. Its not that much different looking than the mission hospital I visited in kiwoko a few months back except at kiwoko there was a slight sense of hope and at masindi there is nothing but despair.

I did rounds with Chris on Monday. About half of the patients in the hospital have hiv and TB.

One thing you have to learn about practicing medicine in Uganda is to listen. The patient whispers to the clinical officer who translates and whispers to Chris who whispers to me—this in a long concrete barracks with 30 other patients each with at least one or two family members who are laughing, crying or shrieking as the case may be. I suppose the whispering is the only form of confidentiality available to them.

Most of the patients who were on antibiotics were on Gentamicin (an older antibiotic that we don’t use too much of in the states anymore because it can be toxic if you don’t keep a close watch on the blood levels). To my inquiry, Chris replied that’s what the ministry (of health) sent us this month. Some months they don’t get any antibiotics… Typically the doctor will write the name of the antibiotics that he thinks the patient ought to be on on a scrap of paper and the family will go across the street to the private pharmacy and purchase it along with an IV set and bring it back… that is, if they have the money for it. If they don’t have the money for it, or if they don’t have a family member, then they get gentamicin. If the hospital has gentamicin.

And, no, the lab at masindi hospital isn’t able to check blood levels of gentamicin.

We visited the pharmacy at the hospital. They had just gotten a pallet of co-artem (one of the newer, combined, treatments for malaria). They hadn’t had any drugs for malaria for a few weeks. Malaria is a big problem in masindi. The pharmacist was in the process of telling one of the subdistrict health centers that he didn’t have enough co-artem to send them. All of the boxes of co-artem are marked ‘this medicine donated by X drug company, NOT FOR SALE’ Not too surprisingly, most of the medications for sale at the pharmacy across the road, which is owned by the hospital superintendent and run by the same pharmacist, bear the same markings on the box… hmmm….

Chris is burned out. I sit with him in his clinic for an afternoon, telling patient after patient that he has nothing to offer them. He has a stare like a concrete wall. We are driving out to visit with the community volunteers and a 2 women come in on the back of a bota. The one riding side saddle practically falls off the back into the dust of the parking lot and delivers a baby. Chris glances over, tells the driver to keep going.
Part of me wishes I was in masindi fighting the good fight with Chris… but part of me sees the price that he’s paid and is glad that I’m in kampala where things aren’t so grim. And where I can get a decent pizza and my choice of antibiotics.
Somewhere a couple of months ago I wrote about Chris and Pam’s community volunteer project in the miirya subdistrict of masindi. We drove out and met with the volunteers and talked about malaria and mosquito nets. It was the first time I saw Chris smile all day.