brief update

Sorry the blog seems to be languishing at the moment.
Don't be dismayed, there is plenty more cynical and injurious reflection left in me.
But Nancy and I have been having a great time exploring all the bits of uganda I haven't had a chance to see yet. And today we are off to Tanzania to see if we can check in on the migrating Wildebeest!
Cheers!

for more pics of our latest roadtrip!

Nancy goes on Safari!

The rare Murchison Falls rock climbing hippo!

our first leopard spotting...

Nancy wasted no time at demonstrating superior safari karma, as she managed to spot a leopard (so to speak) on her first morning out. Above she has a visit with Bella and her baby Augusto at the Ziwa rhino sanctuary. And below, one of the 3 male lions we saw fighting for the affections of the lioness three pics below.

do these spots make by butt look big?


Nancy at the top of Murchison Falls.

For more pictures of the trip, click here!

signing off for a while...

Nancy flew into Entebbe last night, after a brief stopover to visit Anabelle in Paris, and a quick plane change in Amsterdam. We treated her to the burning piles of trash tour of the Entebbe Road at night.

At the moment she’s back at the ranch taking a nap, but when she wakes up we’ll start checking out Kampala, and then greater Uganda. All this to say that the free time I would usually spend reflecting on the condition and meaning of life as manifested in rambling blog posts of questionable coherency will now be spent entertaining Nancy and making it up to her for leaving her alone in San Francisco for much of the past year. As such, this is likely to be the last posting for a while.

We are bound for the wine garage tonight and Murchison Falls for the weekend—hoping for some good safari karma, some rain-free mornings, and a kilometer or two of pothole free road.

On the housing front, we are still squatting at the old house. I did get an email from VSO last Thursday saying: “Hello Rob. Hope you are well, am writing to inform you that your house where you will be moving to is ready as per today i.e. its located in kironde in the same compound with the Cowans, hope you are ready to move please try to pass by office to receive the keys…” Needless to say, this piqued my interest, so I did pass by office to receive keys, and dropped by my new digs just to check things out. And, as you might expect, the place wasn’t quite ready for occupancy: the power was off, the water was off, there was no furniture other than a single bed, a small plastic table and four plastic chairs (this is a 2 bedroom house that I am going to share with another VSO couple, Richard and Pat, who apparently didn’t learn their lessons during their first placement and so are being forced to repeat them….), and there was not a single lightbulb to be found in the house. And, oh yeah, the place was a filthy mess.

So, as you might expect, I didn’t move in. Instead I wrote a polite email back pointing out the problems with the space that would need to be corrected to make it habitable. But I did cc the email to Richard. And apparently this struck a nerve because in September of ’08 they had been dumped into the exact same sort of situation at 5pm on a Friday night and were left to fend for themselves. So Richard shot off a rather scathing reply and cc’d to Kevin (IMG’s CEO) and Benon (director of VSO Uganda) saying something about turning right around and getting back on the plane… And apparently this got some people yelled at and rousted from their Easter Monday holiday, and this has made me immensely unpopular around the VSO and the IHK HR offices. Without even really trying.

I ran into Richard and Pat in the hall today (they are off on a drive to Lira tonight and back tomorrow, with Kevin, a punishment in its own right) and they suggested that the house might be ready to move into by the weekend…

And, in another interesting development, it appears that my little blog has come under scrutiny by the senior management of the hospital. The head of HR e-vited me into her office to “discuss your work in IHK, its value to both parties and agree on way froward/ specific achievable goals…” Appealing premise to address in the waning days of my placement, to say the least. It came out that although she herself had not read Random Uganda, others who had were afraid that my ‘cynical’ point of view might be ‘injurious’ to the Hospital. I explained to her that yes, I am a cynic by nature, but that I tried to find humor and amusement where I could find it. And I am not trying to be injurious to anyone, merely reflective on my own position here.

But it does beg the question. If the truth is injurious to an organization, what should that organization’s response be?

I will think about that. I will let you think about that. I am off to spend some time with the most beautiful, loving and understanding woman in the world.

Plight of the Bodas (part 2, up close and personal)

The boda boda crackdown (see previous post, plight of the bodas) has eased up. Unlicensed, unhelmeted bodas have returned as the majority. Still, even without the police harassment, the life of a boda driver, despite the cachet of riding a motorbike for a living, is a hard one. Fuel prices in Kampala have shot up six or seven hundred shillings a liter in the last few weeks, eating into narrow profit margins. (most of the drivers rent their Indian made Bajaj Boxer 5 bikes for about 40000 shillings a day, making it twenty 2000 shilling trips just to pay the owner of the bike) And one slight misjudgment at one of the many universally disregarded traffic lights can land them on one of the cushionless blood stained gurneys in Mulago’s casualty ward.

One of my fellow VSO volunteers has fallen for her boda driver. Michael is an affable young man with a tight leather jacket and a winning smile. It is good to see them together. I’m jealous, among other things, that, after only a few months, she’s conversant in Lugandan, while I’m still stuck in the basic phrases and counting to 9 that I sort of learned my first few days in Uganda.

Last Saturday night we had an eviction party. (Dorothy had told us we’d be kicked out last Friday, but, as of this writing, the sheriff has yet to come beating on the door, and alternative housing has yet to fully materialize, so I guess, at the moment, we are squatting) A good number of my fellow volunteers got stranded by a rainstorm at the Wine Garage on their way to the party (fortunately, they did not suffer overly much), but a small and enthusiastic crowd made it and kept the loud music going for the neighbors until the wee hours.

And shortly after getting to bed, my phone rang. Michael had been found in a ditch by one of his fellow boda drivers, unconscious and bleeding from facial wounds. His friend Issac was called and took him to Mulago where they were unable to locate a doctor or a nurse. From Mulago they traveled to a clinic on the other end of town in Kireka where some unusually crude suturing (even by Ugandan standards) was perpetrated on his face.

I had to apologize that my alcohol level was probably not within a level you’d want your doctor’s to be. But I put her in contact with the IHK ambulance driver and, a bit later, caught a boda over to meet them at the hospital just as the sun was peeking up over the Kampala hills. Michael reclined on one of the gurneys. His head enlarged to half again its usual size. His left eye was swollen shut. Moses, our night doctor had already seen him and ordered a CT scan and neck x-rays as well as requesting consultations from a plastic surgeon and a neurosurgeon. Fearing the worst, I leaned in and called Michael’s name.

Slowly his good eye opened and focused with a hint of recognition.

He was going to be okay. But given that I wasn’t his doctor, and I was operating on a sliver of sleep and an incipient hangover, I figured it best that he go through with the CT scan. Which, not surprisingly, meant that he had to get back into the ambulance and go to a hospital with a functional CT scanner. The radiologist’s report from Kampala Hospital pointed out the obvious extracranial soft tissue swelling and some ‘mild cerebral edema,’ a finding that might be concerning in a setting other than Kampala where nearly every CT comes back with a reading of cerebral edema. To my eyes, the brain looked normal, but I have to admit that I’m out of practice reading the CT scan in multiple little 3 inch squares of film, since CT scans on film (now we read them on a monitor) disappeared from my practice 15 years ago…

So, given that Michael’s injuries were proving mostly cosmetic, the plastic surgeon swooped in for the kill. He wanted to take Michael to the operating theatre to reopen his facial wound and close it nicely. Estimated cost: another million shillings ($500, on top of the million and a half for the hospitalization and ambulance and CT). A bargain by American standards, but when you consider that VSO only gives us 500,000 shillings a month as a living allowance (and some volunteers aren’t fortunate enough to have a loving wife back home to support them in their folly, and so actually have to live within their allowance), it seems a daunting amount. And, of course, completely and utterly out of the question for a boda driver or your average Ugandan.

So stop and think about it for a couple of minutes. What would you do? Your loved one has a facial wound. There’s going to be a scar. The plastic surgeon seems very concerned (concerned enough to charge for 3, count’em 3, consultations for a 1 inch wound) and wants to make the wound look better. But it’s going to cost you another 2 months salary, on top of the 3 months you already owe. Think about it. Then pray that you never ever have to make this call.

We tried to get Michael onto the Hope Ward (IHK’s charity ward), but it was getting late in the day and Jemimah, the ward’s gatekeeper doesn’t like to work with this particular plastic surgeon due to his excessive billing issues.

At the end of the day, she took him home with the Frankensteinian sutures still in place.

I saw them on Wednesday. Michael was on his feet and looked one hundred percent better. His left eye was open and his smile was back. I wish I knew exactly how the scar is going to look a year from now. I can only hope it won’t be too bad.

Further Impressions of Mulago, Part 1

A small boy walks tentatively into Casualty. In his left hand he clutches a fiber-plastic sack of clothes, in his right, a sheaf of rain and mud speckled papers. It’s about 5pm and all four stretchers are occupied by young men either coming to grips with their newly crippled status or completely oblivious of the fact due to the severity of their head injuries. Since you seem to be only one in the crowded room who will meet the occasional upward flicker of his sunken eyes, the boy shuffles over within reach. His scalp is a flaking field of scabs. He is dirty, dehydrated, and underfed. When he raises his right hand to offer you his paperwork, the minimal weight of his hand and its contents causes his forearm to droop like Harry Potter’s after Gilderoy Lockhart accidentally removed the bones.

The papers suggest that he is twelve years old, but to your eyes he’s an eight year old boy with eighty year old eyes. He has been abused by his father and step-mother. The police intervened and he was removed from the home and placed with, well, placed in the care of the state. In a country where the state has a lot more to worry about than the well-being and whereabouts of a lone 12 year old boy.

You examine his injured right arm. Both of the bones—the radius and the ulna—have been snapped in half. Then you notice that the arm holding the bag sways unnaturally as well. Both of his arms have been broken and untreated, from the dates on the papers, for at least 10 days.

You walk the boy over to the cast room and introduce him to the orthopedic house officer. Best as you can tell from the conversation, the house officer bawls the boy out for not coming sooner—now he’ll need surgery to fix the arms.

Later you find the boy on the crowded surgical holding ward. The boy now has plaster casts on both arms to above his elbows. His look of desperation grabs you by the trachea. You go to the canteen and buy a Fanta orange and a plate of chicken and chips and bring it back to the ward, feeling guilty as you walk by nine or ten other equally hungry patients. The boy looks at the food, and then to his hands—neither of which can now even begin to approach his mouth.

To the best of your ability, you feed the boy the greasy chicken and fries. You wipe the chicken fat and dirt from the boy’s mouth with a waxy napkin. You’ve heard, but never witnessed, that you can offer the nurses a little something to get them to actually pay attention to a patient, so, even though you have sworn to yourself that you would never do this, you go looking for a nurse. But 8pm is rapidly approaching and the nurses are making an exodus. At 8pm the ward will be down to night staffing: one nurse, one intern, 30 or 40 patients.

The night nurse and intern are nowhere to be found. You understand that the intern is probably in the process of barricading himself inside his call room. Much as you wish to help the boy, you have experienced what it is like to be the lone person in a white coat on a ward full of injured and dying patients (and their families) where you don’t speak the languages and you have nothing to offer more than another bottle of normal saline (if the IV fluids have been restocked today) and a helpless facial expression. You slink out the door behind the nurses.

The next afternoon you try to track the boy to the orthopedic ward and can find no evidence that he was ever in the hospital.