August 1st
Cannot believe it’s august already.
Went out to fuego’s for a beer to celebrate. Have switched to Club beer as opposed to the better tasting and slightly more alcoholic Nile specials. Have found that the clubs (in a reasonable amount) don’t give the hangover of the niles—the niles must have a secret ingredient not on the label (sterno or ethylene glycol or something)
Fuego’s has a lovely garden to sit in with an open fire pit and a 70s music soundtrack. How can you argue with that?
After that wandered down to kabalagala for Chinese food at 7th heaven (or something like that). You have to wonder about a place that has a 103 item menu and the kitchen the size of a portopotty. But, my fellow vsos said this was the Chinese place to beat on the south side of town… I think we ordered six different entrees and, surprisingly enough, they all came out looking like sweet and sour pork. None of us, mind you, ordered sweet and sour anything… but, I will say, it was pretty tasty sweet and sour pork…
August 2nd
Washed my underwear today. Mukwaye doesn’t do underwear. It is good to know that even in this land of cheap labor, money can’t buy you everything. But just the simple act of hand washing a few pairs of underwear makes you realize how much work it is to stay clean in this land of dust and dirt (and no running water, at least at my house at the moment). So doubly more impressed when I do my Sunday morning run down through the slums and see the women walking with their 5 or 6 children to church each dressed in a perfectly white and clean and pressed shirt.
Went down to movie night at Al and Alison’s. Richard’s wife Pat was supposed to give a lecture on Friday (but was canceled at the very last minute because the director decided she needed to address the group instead) so she took the ngo’s computer projector home. Watched a pirated copy of ‘state of play’ replete with soundtrack footage of someone in the audience talking back to russel crowe and slurping on their soda.
Alison had cute story. Standing on the corner with her 3 daughters (amy7, zoe5, bella almost 3). One of the Bota drivers stops and asks what country they’re from. Alison says England. The driver gives her a look and asks: ‘don’t they teach family planning in your country?’
August 3rd
Still no running water. Getting a little stinky around my house. Use the shower in my office after the hash tonight. The pipes haven’t been used in a while, so the water came out rusty and choked with debris. Sigh.
The hash was good. Out at the dateline guest house in luzira (southwestern suburb on the way to port bell—where the shipping traffic across lk Victoria comes in, also where the ganda kabaka, king of Uganda, use to keep his fleet of getaway canoes). Nice night for it. Good course they put up. Some of the nicest trash heaps I’ve run across in my day, some good hills, a nice sunset, out to the swamp canals and wound up sprinting through this village to the finish with all the children laughing at pointing at us (me… couldn’t tell if they were laughing at me for breathing like a freight train or laughing at the young black men for not being able to drop the mazungu). But couldn’t drink beer at the end as was coming in to work, so had to lay low during the drinking song part of the event. But they did have a nice stewed goat meat for dinner.
Speaking of the kabaka, the crown prince of Buganda (the traditional kingdom which involved most of southern Uganda when the Brits showed up and misnamed it Uganda because they were using Swahili translators and in Kiswahili, the Bu or Lu is just U) was at the hash tonight, getting warm beer poured on him by his royal subjects who would otherwise have to approach him crawling on their hands and knees with their eyes averted…
August 4th
Gave a lecture on trauma in the trauma room to the nurses today. Actually packed the room. Was a little surprised. Managed to get a little audience participation, but really had to work for it. Mostly just 20-25 pairs of eyes staring at me.
Went to great length to try to extol the benefits of keeping the trauma room prepared for the trauma patient at all times… will see how that takes. Justine, the head nurse (or, senior sister, as they like to say), didn’t make it.
But managed to draw them into an imaginary patient scenario (by physically dragging 5 of them out and around the trauma table and assigning them a letter in the abcd’s of trauma assessment) which seemed to go well and, at least the nurses whom I didn’t pick on, everyone seemed to get interested and show a little enthusiasm.
We will see how this translates into trauma care the next time….
August 13th
Let’s see… where was I?
Spent 5 days and 4 nights in Rwanda (except for a day trip across the border to the DRC)
Didn’t take the computer (can’t write without the macbook). Went to visit a few of the folks from the Liverpool course. Sat around and ate Indian food and drinking expensive beer (the cost of living is high in Kigali—beer is almost 2$ a bottle—and it only comes in small bottles, what kind of a country is this, anyway?) and bitched about our respective placements…
But otherwise Kigali is a beautiful city, aside from the high price of beer, smaller, cleaner, greener and more organized than kampala. Kigali cabdrivers actually stop at traffic signals and the botabota drivers (in Kigali they’re called motos) all wear helmets and have to carry a helmet for their passenger.
Stayed at the Hotel Mille Colline in the city center. Mostly ‘cause when I got to the Kigali airport (I chose the one hour flight over the 12 hour bus ride) I didn’t have any money (okay, a little disorganized ‘cause I worked the night before I caught the plane and I figured that, being neighbor countries I could exchange Ugandan shillings for Rwandan francs at the airport, but no, the Rwandans want nothing to do with the Ugandan currency) so I needed to stay at a place that took Visa and had a hotel airport shuttle. Unfortunately, the Mille Colline is in the process of a major renovation and there is early morning jackhammer work and the pool area is fenced off. Fortunately they did give me a good rate and the coffee at breakfast (not to mention a hot shower with real running water) made it all worthwhile. The Mille Colline is the hotel that was the basis for the move hotel Rwanda (but not the hotel filmed in the movie).
On Friday I wandered through the Nyabugogo market and then caught an impromptu hip hop concert in the taxi park.
Saturday I did the genocide tour… walked up to gisozo where the national genocide memorial sits overlooking the city. Pleasant grounds with a nice garden, but you kind of, initially, wonder why there are so many huge concrete slabs in the garden, until you come to the understanding that all the slabs are mass graves and that roughly a quarter of a million bodies are under there. Long black wall runs the length of it, with only about a tenth of it covered in names. If they knew the names of everyone buried there, the wall would be completely full of names…
Then caught a matatu out to Nyamata. The matatus in Rwanda go 4 to a row, as opposed to Uganda where its only 3. I think the Ugandans must have bigger butts. But you don’t want to be the last one on, ‘cause you wind up sitting on the little bar in between the real seat and the jump seat.
In Nyamata there is a Catholic church that has been left empty since the genocide. Several thousand people sought sanctuary in the church and were killed there. Blood stained piles of slashed clothing line the benches. The altar and the baptism fount have blood stains as well. Downstairs there are skulls and the coffin of a young woman who was raped and killed and thrown down the latrine. Legend has it that when she was pulled out of the latrine she was clean and dry (but apparently still dead).
Sunday I caught the bus to Gisenyi. Gisenyi is in the far NW corner of the country on Lake Kivu on the border with the DRC. Pav, one of the Liverpool gang, works in the DRC in Mweso.
The bus ride was very beautiful and painful at the same time. The Rwandan countryside is beautiful. Winding road through the foothills of the Virungas (volcanic mountain chain separating Rwanda and Uganda). Lovely terraced hillsides, nice little roadside villages and markets. Small children seemingly daring the bus to crush them…
Painful in that one of the previous passengers in the bus had thrown up. Someone had pointed it out to the driver, whose response was to take a mildewed rag and dip it in a bucket which must have contained urine and spread the vomit around a little bit. Unfortunately, as we went up into the mountains, the passengers all closed their windows (because everyone knows that cool air is going to give you a cold or the flu… not the nice man with the tubercular cough next to you), so the last half of the bus ride was a pretty trying olfactory challenge of vomitus, urine and mildew….
Gisenyi is a tired old colonial town on the banks of lake kivu… aside from the methane gas platform about a mile off shore, it could be a tropical town from the turn of the century anywhere…
Winding palm tree lined shore path with neglected houses, closed and dying hotels and banda bars… Bar Bikini tam tam, next to the fish market, seems to be the place in Gisenyi to watch the sun go down while you drink your Mutzig or Primus and gnaw on a tough but flavorful chunk of barbequed chicken.
The beach is nice enough, and the lake warm. Wasn’t able to get a straight story about the presence of schistosomiasis (so may have to pop some praziquantel), but was told that there would be no crocodiles or hippos…
Being the travel geek that I am, I did feel the necessity to walk across the border to the DRC to the city of Goma. Goma has a distinctly different feel. Dirtier, dustier, with almost no living vegetation. The people seem beat down and suspicious. I was the only muzungu walking on the streets. The UN is mounting their response to the conflict in the DRC (Dem. Republic of Congo, formerly Zaire) from Goma, so there were big cargo planes flying in/out and many armoured vehicles moving in convoys through the streets carrying Indian and indonesian troops.
In Rwanda the people speak a patois of French and English in addition to Rwandan, whereas in the DRC, only French and pidgin French. So I got to use what little French I could remember… Je ne comprende pas. Et Je n’ai pas d’argent….
Flew back to Kampala Tuesday night. (was fortunate enough to get a clean smelling and not totally packed bus) Joseph, my preferred cabbie, was only about an hour late in picking me up (and still had to stop in Kabalagala on his way into town to pick up dinner from ‘I feel like Chicken tonight.’)
Wednesday I gave part one of an ACLS type lecture to the medical officers and then that afternoon we headed out to the Ridar hotel in Seeta (east of Kampala on the jinja road) for the annual planning session for the health programme of the VSO… more on that later.
August 15th
The VSO Uganda PAP (programme area plan) Health session was interesting. Most of the health volunteers from around the country came in and gave reports on their placements. I did not need to give a report because my placement is so new and I am so obviously clueless. So the part where I got to hear from all of my fellow health volunteers was good for me. Even some of the ones in the kampala area, I guess I hadn’t really figured out what it was exactly they were doing. There is some interesting stuff going on out there.
Enjoyed the presentation by the volunteers in Masindi (NW of here, on the way to Murchison Falls Park) on their work putting together village health teams. But even there, working in the sub-district of Miireya, they ran out of money for their mosquito net program (they had committed to getting nets out to 5000 households) and there was no money from the VSO or the health district they were working in and so Pam (one of the volunteers) had to fly back to the UK and raise 15000 pounds from her family and friends in order to finish the project (I can just see you all changing your phone #s right now). From their follow up, the numbers suggest that they have decreased childhood malaria in the sub-district (in africa, aside from muzungus, almost all severe malaria happens in children—adults who live in malarious areas develop partial/temporary immunity to malaria) by 40%. So the project was a great success. And the MOH (ministry of health) officials have basically demanded that VSO ‘roll-out’ the project to the entire Masindi district…
But of course the MOH wasn’t going to commit any funds to the project, nor was VSO Uganda, so apparently Pam was supposed to go home and now raise 150k more…
Unfortunately, after the project reports, then came the small group sessions to work out the VSO Health PAP for the coming few years. And decide on the aims and objectives. (I always thoughts that aims were objectives, but, apparently, I am mistaken). Sigh.
I really really don’t want to sound too cynical here. Okay. But. The reality is that VSO is placing about 20-30 health related volunteers into Uganda in the coming years. None of these volunteers will be placed in the ministry of health or in any policy making position. Most will be placed in positions of minimal influence and with minimal if any control of finances or resources. So, maybe our aims and objectives should be kept in line with our influence—for instance: keep our volunteers healthy and well-fed, try to teach the health care providers we come in contact with the best way to practice medicine given the limited resources at hand, and try to show by example the value of health care workers and how compassionate care is possible even under less than ideal medical circumstances…
But, no. VSO Uganda’s health care aim is a little more grandiose: improve the health and quality of life of the disadvantaged people of Uganda. And the objectives: 1)increase the access to and quality of health care delivery in Uganda; 2) increase the recruitment and retention and quality of training of health care professionals in Uganda; and 3)improve the advocacy for health rights for the disadvantages, especially women and children.
All very admirable. Don’t get me wrong. But achievable? On the level we’re working at?
August 19th
Re: the above. I suppose what is important here is that I determine what my aims and objectives are here as I amble into my third month in Uganda. Hmmm.. will have to give that some thought. Maybe over a cold nile at the palm café.
And, even though, their aims may be a little beyond their means, they did take me to a nice hotel with a pool for a few days… I know, as donors, what you’re thinking… couldn’t those hotel and conference and banquet fees be better put to use buying mossie nets in masindi? Enquiring minds want to know. Well, just feel thankful I haven’t send this email list to the vso fundraising staff.
So I have moved into the ‘posh house’ as some of the other volunteers call it. The house actually belongs to Ian’s adopted daughter Rose (see prior) or the hospital, I’m not sure. But it’s a nice 4bdr 2.5ba house with thick walls and a cool interior. The house is off of kironde road and about 10-15” closer to the hospital than my last place. The walk is also nicer, mostly backroads with less traffic. Although, mostly dirt, so we’ll see how nasty they get in the rainy season. The house also has hot water and a refrigerator. It used to have an oven, but one of the previous volunteers set a fire in it… or something like that. Also included in the package is daily housekeeping from Grace and an askari (gatekeeper) named Wilberforce. I think I will be more comfortable here, and, since I now have roommates, I will be less able to continue my antisocial ways. Also, strangely enough, the hospital buys food for the house as well (nobody ever offered to buy me food at Sanyu’s place…). Now if I could just get them to stock the fridg with niles…
Went to Entebbe over the weekend. Aside from being the country’s only international airport and an international incident from the 70s to boot (do you remember what happened at Entebbe? There will be a quiz later), Entebbe is a sleepy little town on lake Victoria. Nicola, one of the English vso volunteers, had her birthday at the sailing club. Plans were to spend the afternoon sitting on the beach, but the rain came all day so we spent the afternoon huddled in the bar… and the extra water trashed some of the roadways, so our trip back took twice as long.
Apparently the much talked about fall rainy season that everyone feared wasn’t going to come due to global warning is here.
Okay. Pop quiz time. What day did the Entebbe raid take place?
Mulago hospital played a small role in the Entebbe incident. One of the hostages, a 75yo woman named Dora Bloch, was taken to Mulago with a presumed heart attack before the raid occurred. After the raid, Idi Amin’s soldiers came to the hospital and killed her and the doctors and nurses who tried to protect her.
Answer to pop quiz: July 4th, 1976.
August 25th
Don’t really know where august went….
This past weekend I played in a netball game on Saturday. One of the volunteers coaches a netball team and they have been getting their drawers blown off in all their games, so Becky thought that it would be a confidence builder for them to play a bunch of overweight old muzungus, many of whom had never played the game before…
Netball, in case you’re wondering, is a UK game played mostly by school girls which is probably most similar to being a cross between basketball and ultimate Frisbee…
It’s played on a basketball sized court, but the hoops at the ends have no nets and no backboards… you also cannot dribble the ball. And once you catch a pass, you can only pivot on the foot you landed first on… Additionally you have to stay a step away from your opponent when they are shooting. And, when you are shooting, your feet need to stay on the floor.
Weird. But we did accomplish our goal and get beaten badly by the team of schoolgirls. I was particularly embarrassed on numerous occasions by anna the 5 foot nothing barefoot girl guarding me…
Also, over the weekend. One of our volunteers had a syncopal episode and fell off the toilet and split his eyebrow open. He went to the IHK and was evaluated by one of my young doctors, had his eyebrow shaved (usually we don’t recommend doing this because in a fair number of people eyebrows don’t grow back), had some rather large gauge stitches put in in a random and haphazard fashion, had a blood count done of which his white count was slightly elevated as would be compatible with falling off a toilet in the middle of the night, so he was immediately diagnosed with bacteremia, but never once was the question asked why he passed out and struck his head… sigh… guess I have to put together a lecture on wound management and syncope…
Saturday night we went on a road trip out to wakeso where joanne and liam live. Joanne is the fund raiser I think I mentioned… her ngo still hasn’t paid their rent or their power bill… but anyway.
We were in wakeso because Dr. Jose Chameleon was playing at the wakeso recreation center. Dr. Jose, just in case you are one of the uninitiated, is Uganda’s premier pop star. You may have caught with worldwide smash ‘angelina’ which, surprisingly enough, is not available on iTunes…
First off, I should note that Uganda is a highly musical country. Little girls and boys sing in school. Young people are often singing as they carry their jerry cans of water home. Even Dr. Rose sings religious songs to herself as she plays solitaire on her computer… But. In the clubs of Uganda, instead of singing, or even karaoke, the favorite is lip-syncing or miming to other people’s music with a fake microphone…
So we filtered onto the recreation center grounds along with about a thousand other Ugandans and drank the new official drink of VSOUganda: waragi gin and fanta orange…
And we were expecting to have a few warm up acts before the great chameleon appeared, but instead we were treated to lip syncing kids prancing around on stage and a Ugandan comedy quartet complete with dwarf. Unfortunately they did their schtick mostly in lugandan, so much of the humor was lost on us, but, suffice it to say, I suspect very little of it would have been considered politically correct…
Finally, after midnight, Dr. Jose made an appearance on stage for exactly an hour. His voice sounded like it had been trashed by too much singing and cigarettes, and, although he was surrounded on stage by his entourage of folks dancing and waving a german flag (?) and road flares, his singing was accompanied by a drum machine and taped backup vocals…
Very camp. Probably would have been very annoying were it not for the waragi.
August 26th
Went for my first real ambulance ride in nearly 20 years. Lights and sirens, the whole works.
There was an industrial accident at one of the factories IAA (international air ambulance—the insurance arm of IHK, even though we really really don’t have an air ambulance—even if we had a pilot for the helicopter, its not really rigged out for patient transport) insures. In Jinja, about 75km down a busy 2 lane road from kampala. But, a first for me, before we could get on the road, we had to stop at the petrol station to put 12 liters of fuel in the ambulance. Yes, even the ambulances are kept with their fuel gauges on empty and only enough gas for the trip is put in… So we go screaming out of the ambulance bay with lights and sirens, up the hill in the middle of the road, rip around the corner to kibuli road and screech to a halt… in the petrol station.
Our ambulances at IHK are basically souped up matatus with the rear seats ripped out and a siren on top. Moses, my driver, was pretty stressed about the whole thing. Apparently they had asked for the helicopter and he had had to tell them the pilot wasn’t available, then they had demanded a plane (which would have been pretty silly given that the airstrip is half way to jinja and then they would have need another ambulance on the jinja end…) and he had had to tell them no on that one, too.
Anyway. It was a pretty wild ride. A real E ticket. (e-ticket Disneyland from the 70s, not e-ticket on an airline) Driving impossibly fast for the conditions down the middle of the road with botas, bicycles, matatus, and pedestrians diving into the ditch on both sides. On several occasions, with a truck on our left and another bearing down on us from the other lane, I looked for the lever to make the ambulance thinner (like on the night bus in harry potter), only to find that it hadn’t been installed first.
I probably would have enjoyed the ride a little bit more (aside from the very real threat of death and dismemberment) if I hadn’t picked up a bit of a stomach bug, and if the ambulance didn’t leak exhaust fumes into the passenger compartment…
As it was, I had to keep fairly focused on the road to keep from vomiting.
Jinja, in case you were wondering is where the headwaters of the Victoria Nile is, and looks like a nice little town, from what little of it I got to see… They run rafting trips down the Nile out of jinja, I’ve been meaning to get over and do a trip, but haven’t had a free weekend yet.
The patient had been caught in some sort of turbine apparatus and partially transected. I was never able to get a clear idea from the factory management exactly what happened. They pulled him out of the machine and brought him by truck to the MOH (ministry of health) hospital in jinja where he was pronounced dead on arrival. We arrived about 15 minutes later. In my rough assessment of his injuries, he wasn’t going to survive even under the best of conditions.
August 29th
Came down with my first gastro bug of my time in africa. Little bugger was probably a few weeks overdue. But nothing like hourly trips to the loo to remind you that maybe you’ve gotten a little lax in your eating and drinking habits… (I guess I may have to rethink the unidentified meat on a stick in kabalagala) can’t really moan too loud. At least I don’t have to haul the water to flush my toilet. At least I have a toilet.
By near the end of day on Thursday, I was pretty weak and feverish. So I visited the lab and got tested (negative) for malaria (maybe just a wee bit on the paranoid side—charles, the lab tech looks at me… ‘do you not sleep under a net?’... and looks at my slide… ‘you do not have malaria, but you do have neutrophilia… go home, take some antibiotics…and some painkillers… you’ll feel better’ ). So I took my lab techs advice.
Saturday, December 5, 2009
July 2009
My commute:
I walk to work. It takes about 30” at a brisk walk (and, if its hot out, which it usually is, arriving soaked in sweat) or 35-40” at an African saunter…
I start by walking up the back to tank hill (there are big water tanks on top) on tank hill (or muyenga, people call it either) road which is a fairly wide and paved road with a generous shoulder for the motorbikes to scream by inches from the pedestrians who fight for the last few millimeters of macadam.
In the morning I am joined by a large number of commuters as well as a few obese middle aged African men in jogging shoes (‘development’ has brought chronic diseases such as diabetes and hypertension to Africa), so I am glad to see that my ugandan colleagues are prescribing exercise to their patients… (I think prescribed, ‘cuz I don’t see much in the way of enjoyment in the eyes of the joggers)
Sensing a possible tired muzungu, the bota bota boys that don’t have a fare slow the down on the hill and offer me a ride into town: ‘hey, good morning, hello, we go to town?’ but, not having the courage to ride the back of the boda boda just yet, I just smile and wish them a good morning. The matatus zing by, already loaded with the 14 passenger limit that is upheld in Kampala as opposed to other African capitols.
Cresting tank hill I have some great views of kampala, as well as of the muyenga club and the hotel international. There is a smaller road that continues up to the tanks and some very large posh houses (one of them is Dr. Ians) as well as a few shacks that have ‘this is not for sale’ signs on them.
Also in the morning I get to witness the trucks picking up loads of private security guards. It would appear (to me) that the second largest industry in kampala (the first being the collection and disbursement of international development money by the various NGOs) is private security to protect the compounds of the NGOs from the people they are here to help. Every evening truck loads of thin young men (and a few women) in the paramilitary colors of their respective companies are unloaded at gates around the city. Some of them are handled rifles. A few are even handed a bullet for the ancient weapons. Every morning the trucks swing by to retrieve their charges. Some of the trucks have trailers full of snarling dogs. This evening as I walked home I passed a large pack of the falcon security boys in their midnight blue being led in kung fu exercises by a small asian man.
July 2
The rest of my commute…
Once I crest the road’s path over the shoulder of tank hill I pass the athletic club (?name) on the right and look down toward reste corner where, I’m told, there used to be reste corner hotel. But reste corner is home to VSO headquarters as well as the ever important Italian supermarket and gelateria where you can get really bad Italian wines for only 20000/= ($10), authentic prosciutto, and mango gelato that hits the spot after a hot dust walk up the hill.
You can also buy toilet paper, deodorant dishes and small appliances…
Rest corner turns to the left down into Kabalagala which, besides being fun to say, is a tight packed strip of bars, restaurants, internet cafes, and street food vendors—unknown meat on stick, yummy, and, my fav, Rolexes (greasy fresh cooked chapatti bread wrapped around an omelette for 600/=).
If you take a right off reste corner onto St. Barnabas road you wind steeply off the hill on a narrow potholed piece of asphalt fought viciously over by trucks, cars, motorcycles, bikes and the large number of pedestrians (myself included) silly enough to risk life and limb in the melee. Unfortunately, this is the road down to the hospital…
First Bota Bota ride today!
We were supposed to be at a meeting at 0730 at the KPC clinic across town… we were told there would be no way to take a car across town at that time in the morning because of what, in Kampala, they affectionately call the jam… so we were advised that we would need to take botas ‘cuz they can weave in and out of the ‘jam’. So we dutifully picked up the helmets VSO mandates and made phone contact with a couple of hand picked bota boys recommended by Irene who met us at neighbors pub in namuwongo near Alison’s house (having to get up at 0600 and skip breakfast to make the rendezvous).
Joseph and Jamal were waiting there for us. Allison rode side saddle in the manner of the kampala women whereas I chose to straddle the bike and hang on for dear life (but apparently it’s poor form to wrap your arms around the driver and scream like a little girl…)
Will have to say it’s actually kind of fun. And didn’t have to yell mpola (slow down) once… but did feel the proximity of my exposed shins to the other vehicles as we wove our way as we wove through traffic on bukasa, mukwono, and jinja roads…
Of course we got there late at 0740. And of course, we were nearly the first ones there. The rest of the people we were meeting with came in over the next hour, noting how bad the jam was.
Personally I find it refreshing how unapologetic they are about showing up late.
But, note to self, stop setting alarm clock.
July 4, 2009
Happy independence day. Had the unpleasant opportunity to visit the US embassy the other day… wanted to register with the embassy and try to get on the email list for the American expats… and maybe score an invite to the 4th of July party and fireworks at the embassy…
Since the bombings of the Kenya and Tanzania embassies, however, American missions abroad have become less like putting a friendly face on the USA abroad and more like fortified bunkers. They moved the embassy from downtown Kampala to a hill outside of town surrounded by multiple layers of barricades and armed guards. To even approach the embassy you have to get patted down by the Ugandan military police and then go through an airport like screening to get into the building and even then (as someone carrying a US passport, mind you—I’m sure if you’re not, you are subject to even further humiliation) the embassy staff addresses you through a window of bullet proof thickness via a speaker.
And she’ll tell you that you could’ve registered with the embassy on line (which is only half true—travel.state.gov is a piece of crap and when I tried to register online it never sent me an email confirmation).
And, as far as an invite to the fireworks. Yeah, forget it.
July 8th
Ian is proving an interesting boss.
He calls me periodically.
“Robert. I’m talking to some people who need a doctor to fly to Gabon and help medevac a patient to south Africa… “ “Robert, there’s a couple of guys from the British Army in my office… they’re planning a live-fire exercise in X jungle… they want to know what our trauma capabilities…” “ Robert, what do you know about swine flu… I want to you to organize our response…”
and as immediately as one crisis arises, his attention to the previous one evaporates, so when you present him with the swine flu protocol or talk about flying to Gabon a few hours later he looks at you with a blank face.
Am finally finishing up a two week orientation for the hospital… had a rescheduled appointment with the Navision guy from IT (Navision is the electronic medical record system that is soo bad they couldn’t even manage to sell it in the US…) at 0830, for which he never showed up (and didn’t return any phone calls, and nobody in IT knows where he is or how else to reach him… apparently being the only person in the system who understands this antiquated piece of shoddy software that they have pawned off on the third world puts him in a position of power…) But did manage to attend the multiple sessions on mission statement and customer service…hmmm.
The A and E (accident and emergency) ward seems like it will be a fun place to work, but am still in the process of deciding on and developing what that work will be. My thought was that I was going to help the doctors assigned to A and E develop their emergency medicine skills, but whenever I come down there to see patients they have a tendency to disappear… this may take some time.
Went bota-ing downtown last night to get some rather disappointing palak paneer at an Indian restaurant all the expats rave about and to meet some of the vso volunteers who are down from bwindi (sw Uganda, where the gorillas are). Went to the National theater, to see the percussion discussion Africa—kind of like a mix between a jazz quintet and 6 person traditional African drum band. Not too bad. Didn’t buy the cd. Didn’t feel the need to get up and dance and demonstrate my complete lack of rhythm.
July 9th
Went back downtown to the vso ‘cluster’ meeting… chaired by Marcel, a dutch volunteer who works improving the lives of the people imprisoned in Ugandan jails.
The cluster is supposed to represent volunteers located in the same general vicinity. Apparently the word cluster doesn’t carry some of the same military induced connotation that it enjoys in the US, at least in ER circles. Most of the volunteers in Uganda are located in Kampala (because, as I think I mentioned, the main industry in kampala is the generation and distribution of foreign aid, and this is what the majority of the volunteers are involved in), so we have a really big cluster—in more ways than one…
So 15-20 volunteers wander into the masala chaat house and order 15-20 pints of nile special… and the whinging begins. I guess I feel pretty lucky that my expectations are pretty low and so are those of my employer, so I don’t feel as if I was set up for failure, as a number of my colleagues seem to feel…
Joanne and Liam (English) were sent out to wakesa, which, I’m told, is a northwestern suburb of kampala (but apparently in the suburbs they have to haul their own water in jerry cans…). She is a fundraiser for a british medical charity at home and she volunteered to work here as a fundraiser to raise money for an ngo that works for people with disabilities. At least on paper. Joanne showed up at her posting to find an empty office… no phone, no computer, no internet, nothing. But they are very anxious for her raise some funds, so that they can buy some office equipment. The first order of business was her new boss asking her for a loan…
TimTim, from the phillipines was also quite distressed. Pretty much every third sentence out of his mouth was ‘they will cheat you.’ (the other two sentences, in case you were wondering, would have been asking for another beer and ‘the vso in Uganda does not care about us.’ Hmmm
Met a lovely irish couple. Jo (short for Josephine), a nurse who basically walked away from her assignment with a private orthopedic clinic to start working with the nurses at Kibuli (Ki is pronounced Chi here) Hospital which is the muslim funded mission hospital where things are apparently desperate. She’s asked me to come hang out in their OPD and teach their doctors manners… hmmm…
Her husband Larry, works in management for another NGO that works with hiv patients. He just scored them a 2.5M USAID grant which means that the NGO will be able to pay the salaries of its employees for another 2 years. Which I thought was a pretty big score. And should make him a hero where he works… but he has described it as a double edged sword. Now that their income is secure for another 2 years, he feels his coworkers are doing even less than before… and he’s a little miffed that he had to pay 30000/= (which isn’t that much money, but looks more impressive in ug. Shillings than pounds) in back fees on the ngo’s postoffice box, so that he could get his mail, because his boss (who reportedly drives a bmw) said that they didn’t have the money to pay the fees…
Jo and Larry were robbed at knifepoint in their apartment the other night. They swear that they feel this was a totally random event and have chosen to remain in their apartment.
July 11th
Today was Rose’s walk. Rose is Ian Clarke’s adopted daughter (he has a large number of ‘adopted’ African children—4-5 of them were here today). 20 years ago, an orphaned Rose walked away from the village of Bamunanika and walked 52km to the village of Kiwoko where the Ugandan church has a mission hospital and where the Clarkes were working in 1989. Rose has since gone on to nursing training in Uganda and in the states (she worked as a neurotrauma nurse at Baylor) and now she’s in a PhD of nursing program at Yale.
So today we walked the 52 kilometers (I think it was probably in the mid-forties, but in high sun and heavy dust, it was plenty) to raise money for the IHK nursing scholarship fund and to raise awareness about the ongoing practice of child sacrifice (apparently witch doctoring is still happening in Uganda and if you need really powerful magic then you’ll want something with some child parts in it).
Hannah from HR said she’d pick me up at 0450. I told her I’d walk to the hospital to meet the buses, but I think she thought I’d flake. So something completely startling happened… she came early. I would have been ready to go at 0450, really I would have. (but then, naturally, we got there before 5am and the buses that were supposed to take off at 0530 so we could get out there walking before it got hot, didn’t leave til almost 0630 once again, stop with the alarm clock stuff)
So it was my first trip out of kampala, and I was pretty excited (even if I slept through most of the drive up to Bamunanika).
We walked from Bamunanika to Wobulenzi, wobulenzi to Luwerro, and Luwerro to Kiwoko. The way from Wobulenzi to Luwerro is on one of the main N-S highways (the Gulu road), so it was hot, choked with diesel fumes and not a lot of scenery except the occasional roadkill. I jogged the middle section with an irish lady named Irene who, even half winded, was able to keep up both ends of the conversation. Her husband sean, hungover from a party at the irish embassy the night before (their embassy invites them to parties, Hilary, just to let you know), so he took it out on us by telling us we had 5 miles to go when really it was less than 2km.
The other 2 segments were packed red dust roads through little villages of mud huts and brick houses with children that would run out to the curb to wave “Bye” (because, apparently that is easier to get off than ‘good day, how are you?’), and buses and matatus and determined looking men and boys pushing bicycles loaded with impossibly big bags or charcoal or bundles of sticks and boys herding cows with horns 2-3’ across and motorcycles whipping by with entire families of 5 or 6 balanced on the limited seating and nonseating areas.
All in all, a nice walk. Wound up at the Kiwoko hospital where the nursing students sang and danced for us and we sat in the grass and had tea and chapati and cold stony ginger beer (it is, after all, a church compound). And I got a tee-shirt that says ‘End Child Sacrifice’. Won’t see too many of those in Noe Valley…
July 12th
Oh. Forgot to mention that some friends of Hannah gave me a ride home from kiwoko. Not exactly sure where they fit into the whole IHK/IMG/extended family of Ian bit, but they are apparently doing okay ‘cuz they’re driving a newish Toyota landcruiser and they live in Muyenga. So on the drive back home they stop (literally) to do a little shopping. They pull over at the luweero markets, which are all roadside and open air and roll down the window and yell and point at the vendors. I am told that there is no word for please in Lugandan. Its basically ssento meko (how much?) and mpa (pronounced oompah, which is give me) that.
Edith and Charles complained bitterly that ever since they got the new car the vendors in the market want to cheat them and charge them the mazungu price. So they have to haggle twice as hard and this slows down the roadside shopping experience. Edith did buy me a big bag of mangos for only 2000/=, however, for which, given my poor market skills, I probably would have come home with only two mangos.
Ugandan mangos, by the way, are pretty amazing. They pick them ripe from the trees and the kids will eat them peel and all. I could pretty much eat them until I’m sticky all over and have a pile of mango pits bigger than my head (and I have to spend the rest of the day in the potty).
Today Sanyu, my landlady, made matooke in the backyard, okay, actually Mukwaye, one of the servants, peeled the green bananas, wrapped them in banana leaves and steamed them over a charcoal brazier. Sanyu added salt and spices and mashed it up to its usual off yellow mush consistency. Maybe because it was fresh, but this was the best matooke I’ve ever had (the matooke they serve us at the hospital has started to cool and takes on the consistency of rubber cement left with the lid open).
July 13th
Caught a Bota after work across town to Ntinda for a run with the Kampala Hash House Harriers. Hashing is sort of a group run where the course is poorly marked with bizarre symbols and only really known to one or two of the crowd (the hash masters) and the goal seems to be trying to get people irreparably lost in an unknown part of town (not hard for me) and then gathering at the end to sing drinking songs and chug lukewarm club beer (actual warning label on club—‘don’t drink and walk home, you might fall into the road and block traffic’). Needless to say, I have found my people.
Hashing apparently is a worldwide phenomenon hitherto unknown to me. I’m told, by Jo and Larry (irish vsoers, see above) that typically hash clubs are made up of expats, but what makes the Kampala group special is that the bulk of the hashers (including the has master) are Ugandan.
Regardless of whether I was participating in a worldwide phenomenon, it was fun to get out and see another neighborhood of kampala and follow a papertrail (literally piles of shredded paper were used to mark the route) over hill, through swamp, through the back yards in the slums, across fields occupied by cows and strung with barb wire, across the grounds of a catholic school and winding up at the headquarters of the ASFU (acid survivors foundation of Uganda—now, coming from san Francisco, I was pretty sure this had something to do with Tim Leary and lsd, but actually here it is a form of domestic violence…) So I was running (and drinking) for a good cause, and have added another teeshirt to my collection: ‘Hashing to support victims of Acid violence’
July 14th
Walked to the corner store for a nile special (singular, as I don’t have a frig, I don’t have the luxury of purchasing 6-paks). I know you think all I write about is beer, but I feel pretty righteous about walking a half a mile for a cold beer. And I remembered to bring an empty with me. Some places won’t even sell you a beer without an empty and some will charge you 1000/= for a deposit on a beer that costs 1500/=… but it is one thing they do right here. Reuse, not recycle. Now if they could just figure out what to do with all the plastic water bottles—personally I think they need to start selling bottled water to the mazungus in glass bottles with the same deposit. I could probably walk 10 miles across kampala and put my foot on a flattened plastic water bottle for every step…
Reason for beer (okay, do you really need a reason?): I am supposedly here to help the IHK develop a trauma system which might, eventually, translate to better trauma care for greater kamplala and Uganda. I have been asking myself just how bad could trauma care be? Today I found out. It is bad. Really really really bad.
I stood in a trauma room choked with nurses and watched a man die. Granted, he had been hit by a speeding minivan packed with people, and his chances of survival were poor from the get-go. But he could have at least died with a functioning IV in place, or some oxygen, or connected to a heart monitor, or an airway tube, or a chest tube or two, or, how about this, some pain medicine to ease his suffering… but none of this happened. The larygoscope (the metal thingy you use to place an airway tube) was not in the crash cart (it turns out the dentist borrowed it), the monitor leads in the crash cart are for a different brand of monitor, the oxygen tank had been moved out of the room, and the nurses were more interested in restraining the patient (‘cause he and I were the only people in the room who knew he was dying) than putting in an intravenous.
I suppose that I should be glad that there is plenty of room for improvement, but when I tried to engage the medical officers and the nurses later about what had happened and what we could learn from it, I got nothing. Nothing but blank stares and what I perceived to be just a bit of attitude: You’re the great mazungu trauma doctor and you couldn’t save him—what do you expect us to do? And I guess that is the question. Sigh. I’ll have to figure out an answer for that.
Note to self. Don’t get injured here. IHK reportedly is Uganda’s best hospital.
July 18 and 19
This past weekend the kampala cluster did a public service project… obviously something planned well in advance of my arrival, but, according to rumor, apparently a bunch of vsoers were sitting around at a bar and someone said, ‘hey, all we ever do when we get together is drink beer and bitch about out placements, so why don’t we get together and do something constructive for a change?’
So Marcel and Nicola put together a project to paint the wards at the Mwanamugimu nutrition center at Mulago hospital (Mulago is Uganda’s state referral hospital and teaching hospital and mwanamugimu wards are where the malnourished kids are treated). They hired a local artist to sketch cartoons on the wall that we would paint, along with the walls, etc…
So 12-15 of us descended on the ward this weekend. They moved all the kids from ward 2 to ward 3 and we scraped and sanded and aerosolized all sorts of nastiness, not to mention uncovering several hordes of mice and roaches (the roaches are bigger than the mice) and then started to paint.
Kind of amusing watching 12-15 doctors, nurses, speech therapists, accountants, project managers, fundraisers, etc—none of who could paint a straight line on a wall to save there lives (and this is in a country whose greatest resource is cheap labor, where nurses work for $150/month—on the months where the government actually pays them and you can hire a ‘gate-boy’ for 24hours/day 6.5 days a week for roughly $25, so my guess is there are lots of guys/gals in kampala who can paint and would be happy to work for a pittance) while Stevie Wonder plays on the ipod doc, high on paint fumes, accompanied by the relentless crying of 20-30 starving children down the hall.
Fortunately I was able to keep my hyperactive sense of irony to myself.
I will say that I have done my fair share of painting (with various results) over the years of our home improvement fiascos—but I like using masking tape, and I prefer water based products… but the plan came with painting big swatches of color around the room with oil-based paint done over two days so that there wasn’t enough for the paints to dry so that masking tape could be applied without ripping off the fresh paint… and the project manager ‘thinned’ the paints with a bit too much terpentine… (also we were using donated paints… like pepto bismol pink, camo green, traffic stripe yellow and other soothing pediatric colors), so despite out best efforts there were drips and splashes everywhere (even the toilet seat came away with a swatch of cornflower flue—don’t ask me…)
When we got too high from fumes, we went and visited the ward and held the babies whose mothers were too sick (mostly hiv) to do so. The babies looked like little old men with wrinkled foreheads and huge, nonblinking, relentless eyes (and matchstick limbs). Then the nurses hit us up for money… We were told that the World Food program feeding supplements (soy products for the kids that can’t absorb milk) had run out and they weren’t due another shipment for a month)… I don’t know what to think of this… the administrator we talked to (he came through and told us not to use the blue paint next to the purple (duh)) said that that was not the truth, that there was plenty of food supplement… (but why do the kids look so sick? Why don’t they have feeding tubes? How can this be the country’s referral center for malnourished kids?)
Ch3
July 23
Have been working nights this week 8p-8a… just to change things up a little bit. And to see if the A&E is any more happening at night.
The jury is still out on that. What does happen in A&E at night is the mosquitoes come up from the namuwongo swamp and roam the hallways. And not just your average buzzy little black things. You swat one of the mossies here at IHK and invariably its full of partially digested blood. And you wonder, hmm… has this little anopheline been feeding on the malaria babies on the paediatric ward, or has she (boy mosquitoes don’t suck blood) been feeding off the HIV/TB patients on the Hope ward. (Or was it the one that bit me on the scalp last night while I was trying to catch a little zzzz time?) Either way, makes you think twice about swatting the little buggers. Tonight though, I’ve brought my secondary mosquito net just in case I want my nap to be undisturbed by some pathogenic insect.
Gave a lecture to DFID (the british development aid agency) and the staff of the British high commission. Managed to put together a 30 slide powerpoint prez in the middle of the night last night while fighting off mosquitoes and a really pushy Indian patient with an entourage of no less than 13 people (3 of them claimed advanced medical training… the patient had been on no less that 6 different antibiotics (2 of the intravenous) in the past 10days, none of them for more than 2 days… and, lo and behold, he was not getting any better, naturally when I tried to explain how antibiotic resistance develops and tried to get them to choose one antibiotic and stick with it they looked at me like I was the one on drugs)
Anyway, the topic was swine flu, a topic on which I have little of no expertise, but, in keeping with the general idea of powerpoint, that fact matters very little—I kept with my basic strategy of downloading lots of funny images from google image and putting in as few word slides as possible. It appears to have been well received, but not so well received as to encourage more lectures.
Tonights little fiasco was a women who’d been in the hospital for 10 days earlier in the month and had been given several conflicting but equally devastating neurosurgical diagnoses by the medical officers, but hadn’t seen the neurosurgeon…
Tonight she came in with a severe headache, proceeded to have a fit, and stopped breathing…. The nurse said, we’d better take her to the trauma room (given my previous experiences with the trauma room, you can imagine I was a bit reluctant to go back) Fortunately the dentist had been kind enough to return the laryngoscope, so I was able to intubate the patient. But the O2 tank was missing. The nurse went out to get the tank… And never came back…. After bagging the patient for what seemed like eternity, and pretty much exhausting my extensive collection of curse words, another nurse comes in. Not to help me with the only critical patient all night, mind you, but to remind me that my guy in room 3 with the sore hip is waiting for me to come and read his x-rays…
Manage to get the neurosurgeon Dr. Kirubwere (sp) on the phone. Says to get a CT scan and he’ll be right in (this is a miracle by the way, in the states if you call the neurosurgeon before the CT has been done all you’re gonna get is a chunk taken out of your butt). Unfortunately, they cannot find the key to the CT scanner room. I am not making this up. Dr. kirubwere, who unlike his western brainsurgeon colleagues has the patience of a saint, shows up about the same time that security finds the unlabeled key, out of a box of 300, that opens the door… So we put her on the CT table and my nurses disappear, again, and I find myself bagging this poor woman for another hour while the tech futzes with the scanner… and gets no images… so we go to the ICU, where, blessedly, Dr. Kirubwere takes over managing the patient, and, will miracles never cease, there is a ventilator and I can stop bagging…
Best thing about the whole experience—documentation—my note summarizing the entire encounter on a 4 x 6 notecard…. With a little space left over.
July 25th
Update on the unfortunate 37 yo woman above.
The reason that the tech was unable to get the CT scanner up and running the other night—the memory was full… The printer (the machine that puts the images onto film like they used to do at home before digital x-ray became the norm about 10 years ago) for the CT scanner doesn’t work and they haven’t bought the software package that would allow them to store the images on a CD, so they don’t dump any of the images…
Anyway, Dr. Kirubwere was finally able to get his CT 20 hours later: huge bleed. 24 hours later he took her to the OR to decompress… prognosis: poor. Had she gotten out of the country (she’s Chinese) 2 weeks ago, her chances would have been better.
So I finished a string of 4 -12 hour night shifts, Friday morning. So, after a little nap, I had Friday off to wander into town…
Caught a matatu (15 passenger minibus) into the downtown taxi park. Had to go into town to pick up a plane ticket. (some of my Liverpool trop med buddies are in Rwanda and the congo and are converging in Kigali in a couple of weekends, so thought I’d pop over). Rwandair Express is the only airline on the entebbe-kigali route—so I go to their website and book a flight, just like you’d do on alaskaair.com, etc, until you get to the part where you click on the purchase ticket button and it takes you to a screen that says—‘go to rwandair express office. Rwenzori courts, lumumbu avenue, kampala, pay for the ticket in US dollars.’ ..
So I wandered downtown and stopped at the Standard Chartered Bank (where, I’m told, I have an account, even though VSO has yet to deposit any of the living allowance promised me…) I thought I could cash some traveler’s checks to get the US dollars needed. I thought this because of the big sign that says “we accept American express travelers checks” above the teller booth. But, the teller tells me, no we don’t cash traveler’s checks. So I ask if I can deposit some of the checks into my account… No, I can’t deposit into the account because the account isn’t active yet. And the reason the account isn’t active yet? Because no one has deposited any money into it yet. I start to get a headache. The manager comes over to explain things to the silly mazungu who looks like he’s about to stroke out at the teller booth and is holding up the long line of nice people who actually know what they want. She kindly explains that my account is at the Lugogo branch (wherever the heck that is…) and that I will need to take at least 100000/= over there to fund the account….
Go to ATM, take 400000/= out of US acct. Go to forex bureau, change money back to USD, go to Rwandair and purchase ticket, and wander back down hill to old taxi park.
2 taxi parks in Kampala. Picture an area smaller than a safeway parking lot seething with a thousand minibuses moving as if by Brownian motion. Generally, if you want to go to the southwest of town you make your way to the SW corner of the old (south) park. The buses are all running, filling the space with diesel and gas exhaust fumes as they jockey for position. A conductor for each van is trying to load his van with the maximum number of passengers… by screaming out his route and hustling people into the van. I find one yelling kabalagala (which is the closest I can find to my place) which already has 10 or so people in it (score, it will be leaving soon) and crawl to the far back corner (people get in, grab the best seat available, then future passengers have to scramble over them..)
Our matatu takes off out of town, through the roundabouts and up the hill on nsambia road. Still full, the driver pulls over near one of the alleyways… the passengers look at each other as the conductor hops out and runs down the alley. (None of the passengers are getting off, so they start grumbling to the driver) The conductor comes running back carrying 2 plastic bags—the local gin (waragi) is sold in little 60cc bags called tot packs (or, given that the Ugandans like 2 syllables, totter packs). The conductor hands one to the driver who bites into it and starts sucking on it. I crawl over the people again and get out of the van. The conductor wants my full 500 shillings for the ride. I tell him that I don’t mind if he drinks gin on the job, but I won’t ride if the driver drinks with him… we settle on 200/=.
26 July
Had dinner last night with Conrad and his wife Katherine (sp). Conrad was in my trop med course in Liverpool. Conrad works for The Surgery, which is IHKs main competition (although they don’t pretend to be a hospital, they do have 6 overnight beds and 24 hr medical coverage). The surgery is where most of Kampala’s expats go for their first round of medical treatment before they get the hell out. It sounds like they are working poor Conrad pretty hard: 10-12 hours a day, 6-7 days week. He does say that they pay him by the hour, though, so I think he may be taking some extra hours to earn a few extra shillings.
He says that he’s been using the DTMH (tropical med diploma) stuff quite a bit. He says that in medical school in Kampala they tend to rush through the infectious diseases (which is mostly what trop med is)… just like in the states.
Katherine is also a physician. She works at an HIV/aids clinic out toward Entebbe. They have 2 kids, Matthew (18mos) and Joshua (3mos). They have a ‘house-girl’ who watches the kids during the day (and cooks and cleans). At night Katherine works on her MPH from Makerere university. The goal is to get hired by an NGO as a project manager—pays a lot better and better hours than doing clinical work…
Conrad and I reminisced about our trip to Snowdonia. A couple of the Norwegians took us hiking up ‘Bristly Ridge’ into a freezing rain storm. The Norwegians were decked out in full goretex ad hiking boots while Conrad and Simon and Rocky (from the tropics) were wearing varying degrees of unsuitable clothes… I remember looking back at Conrad, soaked to the skin, his non waterproof hood tight around his face with this look of amused disbelief on his face. I caught up with Hege and Hilde on a big rock which offered no shelter from the wind or the rain and offered the opportunity to fall to one’s death in 3 directions. I tactfully suggested it might be time to turn around.
Conrad fondly remembers the weekend as the time we took him into the mountains and tried to kill him. (we got back to the chalet and he shivered for a good 2 hours, then fell asleep, and woke briefly for dinner, but otherwise slept the rest of the night). He also remembered a berry crisp I made for dinner that night… We talked about if it would work with pineapple, mango, and jackfruit.
Conrad says that Mulago sent one of friends from med school to Italy to study emergency medicine. His friend came back with the task of organizing the emergency department… His friend worked at Mulago for a few weeks when he got back… then left the country for a better paying job in Botswana…
Conrad is going to get me a few contacts at Mulago.
July 28th
Monday night, hash night, was going to bota over, but Ian said he’d give me a lift, so hung out at the hospital until 5:40p (hashing starts at 6) waiting with Charlotte (another vso) and patricia (manager of ian’s construction co) who he also promised rides to. Ian screams up in his bmw x5. He had just driven cross town in traffic from a meeting with parliament about providing health insurance to parliament members and staff (the big new item this week in Uganda—aside from the famine in NE Uganda due to crop failure—is that the government purchased new 100,000,000/= ($50k) SUVs for the MPs… not too bad. Better for running the muzungus off tank hill road with…)
Ian drives like the Ugandans, except with a bigger, faster vehicle. Was kind of a fun ride, as things go, except the part where you’re begging whatever higher power you beg to that the little kids stay out from under his wheels.
But despite his best efforts we were 20 minutes late for the start. Couldn’t catch the running masses. Jogged up to the top of the hill with the radio towers and watched a great sunset. Jogged down and had a beer. In consolation Ian invited us to Rose’s birthday dinner at one of the nicer Italian restaurants in town. Ian, however, had a change of clothes… Rose and all of her friends are there dressed to the nines and I’m wearing a tee shirt and running shorts… I can just tell from the looks: ‘@#$%ing mazungus, you cannot take them anywhere.’
But it was a nice dinner. Had my first wine in a while and a very nice piece of tilapia completely buried in mushroom and cream sauce…
Ian had a couple of beers and became a little more voluble, went into a long tirade about all the medical aid etc that goes to mulago and doesn’t do anything ‘cuz the place isn’t organized well enough to accept it. Tactfully hinted he could probably get some of that aid if IHK was willing to provide more charity care. But then he counters with, “I’ve never asked for any of their help.” Okay then.
July 29th
Would swear I walked by a young man on tank hill road today who was wearing Justin’s boy scout uniform shirt from the early 70s, with the eagle scout badge sewn on. Troop 129. Similar bad haircut and black framed glasses as well, but of course this young man was black. Wanted to give him the secret boy scout handshake, but, of course, I’d forgotten it. Saluted him instead. Probably thought I was an idjit.
July 30th
Sanyu (my landlady)’s dad died this past week. He’s been sick since I moved in. First at a public hospital, then a private hospital, then in a private hospital in Nairobi. Sounds like diabetes, hypertension, and then stage 4 colon cancer to top it off…. Not good. Sounds like he had surgery for the colon ca and then never made it out of the ICU in Nairobi. One of the hardest things to learn about intensive care medicine is when to say goodbye. And I’m afraid, from my limited exposure, that they haven’t learned this in Africa. If the intensive care medicine works, then they are too happy to keep it going to think about turning it off… sanyu’s dad had been on dialysis and a ventilator for something like 3 weeks, she kept telling me she didn’t understand why he wasn’t getting better because he was ‘getting the best of care’. This is kind of the thing in africa, I’m afraid. Because they’ve had crap for health care for so long, they assume that all they have to do is get better care, and then they’ll live forever…
Anyway, as someone stressing about a sick relative and , now, in mourning, she hasn’t paid her water bill… so I am now without running water. Fortunately, mukwaye is kind enough to bring me a jerry can of water every couple of days, so that I can sort of bathe and wash dishes and flush the toilet… Not really sure exactly where sanyu is, or what her # is, but don’t think it would be too appropriate, at the moment, to call her up and say sanyu where’s the flippin’ water, so have been suffering in righteous silence.
I walk to work. It takes about 30” at a brisk walk (and, if its hot out, which it usually is, arriving soaked in sweat) or 35-40” at an African saunter…
I start by walking up the back to tank hill (there are big water tanks on top) on tank hill (or muyenga, people call it either) road which is a fairly wide and paved road with a generous shoulder for the motorbikes to scream by inches from the pedestrians who fight for the last few millimeters of macadam.
In the morning I am joined by a large number of commuters as well as a few obese middle aged African men in jogging shoes (‘development’ has brought chronic diseases such as diabetes and hypertension to Africa), so I am glad to see that my ugandan colleagues are prescribing exercise to their patients… (I think prescribed, ‘cuz I don’t see much in the way of enjoyment in the eyes of the joggers)
Sensing a possible tired muzungu, the bota bota boys that don’t have a fare slow the down on the hill and offer me a ride into town: ‘hey, good morning, hello, we go to town?’ but, not having the courage to ride the back of the boda boda just yet, I just smile and wish them a good morning. The matatus zing by, already loaded with the 14 passenger limit that is upheld in Kampala as opposed to other African capitols.
Cresting tank hill I have some great views of kampala, as well as of the muyenga club and the hotel international. There is a smaller road that continues up to the tanks and some very large posh houses (one of them is Dr. Ians) as well as a few shacks that have ‘this is not for sale’ signs on them.
Also in the morning I get to witness the trucks picking up loads of private security guards. It would appear (to me) that the second largest industry in kampala (the first being the collection and disbursement of international development money by the various NGOs) is private security to protect the compounds of the NGOs from the people they are here to help. Every evening truck loads of thin young men (and a few women) in the paramilitary colors of their respective companies are unloaded at gates around the city. Some of them are handled rifles. A few are even handed a bullet for the ancient weapons. Every morning the trucks swing by to retrieve their charges. Some of the trucks have trailers full of snarling dogs. This evening as I walked home I passed a large pack of the falcon security boys in their midnight blue being led in kung fu exercises by a small asian man.
July 2
The rest of my commute…
Once I crest the road’s path over the shoulder of tank hill I pass the athletic club (?name) on the right and look down toward reste corner where, I’m told, there used to be reste corner hotel. But reste corner is home to VSO headquarters as well as the ever important Italian supermarket and gelateria where you can get really bad Italian wines for only 20000/= ($10), authentic prosciutto, and mango gelato that hits the spot after a hot dust walk up the hill.
You can also buy toilet paper, deodorant dishes and small appliances…
Rest corner turns to the left down into Kabalagala which, besides being fun to say, is a tight packed strip of bars, restaurants, internet cafes, and street food vendors—unknown meat on stick, yummy, and, my fav, Rolexes (greasy fresh cooked chapatti bread wrapped around an omelette for 600/=).
If you take a right off reste corner onto St. Barnabas road you wind steeply off the hill on a narrow potholed piece of asphalt fought viciously over by trucks, cars, motorcycles, bikes and the large number of pedestrians (myself included) silly enough to risk life and limb in the melee. Unfortunately, this is the road down to the hospital…
First Bota Bota ride today!
We were supposed to be at a meeting at 0730 at the KPC clinic across town… we were told there would be no way to take a car across town at that time in the morning because of what, in Kampala, they affectionately call the jam… so we were advised that we would need to take botas ‘cuz they can weave in and out of the ‘jam’. So we dutifully picked up the helmets VSO mandates and made phone contact with a couple of hand picked bota boys recommended by Irene who met us at neighbors pub in namuwongo near Alison’s house (having to get up at 0600 and skip breakfast to make the rendezvous).
Joseph and Jamal were waiting there for us. Allison rode side saddle in the manner of the kampala women whereas I chose to straddle the bike and hang on for dear life (but apparently it’s poor form to wrap your arms around the driver and scream like a little girl…)
Will have to say it’s actually kind of fun. And didn’t have to yell mpola (slow down) once… but did feel the proximity of my exposed shins to the other vehicles as we wove our way as we wove through traffic on bukasa, mukwono, and jinja roads…
Of course we got there late at 0740. And of course, we were nearly the first ones there. The rest of the people we were meeting with came in over the next hour, noting how bad the jam was.
Personally I find it refreshing how unapologetic they are about showing up late.
But, note to self, stop setting alarm clock.
July 4, 2009
Happy independence day. Had the unpleasant opportunity to visit the US embassy the other day… wanted to register with the embassy and try to get on the email list for the American expats… and maybe score an invite to the 4th of July party and fireworks at the embassy…
Since the bombings of the Kenya and Tanzania embassies, however, American missions abroad have become less like putting a friendly face on the USA abroad and more like fortified bunkers. They moved the embassy from downtown Kampala to a hill outside of town surrounded by multiple layers of barricades and armed guards. To even approach the embassy you have to get patted down by the Ugandan military police and then go through an airport like screening to get into the building and even then (as someone carrying a US passport, mind you—I’m sure if you’re not, you are subject to even further humiliation) the embassy staff addresses you through a window of bullet proof thickness via a speaker.
And she’ll tell you that you could’ve registered with the embassy on line (which is only half true—travel.state.gov is a piece of crap and when I tried to register online it never sent me an email confirmation).
And, as far as an invite to the fireworks. Yeah, forget it.
July 8th
Ian is proving an interesting boss.
He calls me periodically.
“Robert. I’m talking to some people who need a doctor to fly to Gabon and help medevac a patient to south Africa… “ “Robert, there’s a couple of guys from the British Army in my office… they’re planning a live-fire exercise in X jungle… they want to know what our trauma capabilities…” “ Robert, what do you know about swine flu… I want to you to organize our response…”
and as immediately as one crisis arises, his attention to the previous one evaporates, so when you present him with the swine flu protocol or talk about flying to Gabon a few hours later he looks at you with a blank face.
Am finally finishing up a two week orientation for the hospital… had a rescheduled appointment with the Navision guy from IT (Navision is the electronic medical record system that is soo bad they couldn’t even manage to sell it in the US…) at 0830, for which he never showed up (and didn’t return any phone calls, and nobody in IT knows where he is or how else to reach him… apparently being the only person in the system who understands this antiquated piece of shoddy software that they have pawned off on the third world puts him in a position of power…) But did manage to attend the multiple sessions on mission statement and customer service…hmmm.
The A and E (accident and emergency) ward seems like it will be a fun place to work, but am still in the process of deciding on and developing what that work will be. My thought was that I was going to help the doctors assigned to A and E develop their emergency medicine skills, but whenever I come down there to see patients they have a tendency to disappear… this may take some time.
Went bota-ing downtown last night to get some rather disappointing palak paneer at an Indian restaurant all the expats rave about and to meet some of the vso volunteers who are down from bwindi (sw Uganda, where the gorillas are). Went to the National theater, to see the percussion discussion Africa—kind of like a mix between a jazz quintet and 6 person traditional African drum band. Not too bad. Didn’t buy the cd. Didn’t feel the need to get up and dance and demonstrate my complete lack of rhythm.
July 9th
Went back downtown to the vso ‘cluster’ meeting… chaired by Marcel, a dutch volunteer who works improving the lives of the people imprisoned in Ugandan jails.
The cluster is supposed to represent volunteers located in the same general vicinity. Apparently the word cluster doesn’t carry some of the same military induced connotation that it enjoys in the US, at least in ER circles. Most of the volunteers in Uganda are located in Kampala (because, as I think I mentioned, the main industry in kampala is the generation and distribution of foreign aid, and this is what the majority of the volunteers are involved in), so we have a really big cluster—in more ways than one…
So 15-20 volunteers wander into the masala chaat house and order 15-20 pints of nile special… and the whinging begins. I guess I feel pretty lucky that my expectations are pretty low and so are those of my employer, so I don’t feel as if I was set up for failure, as a number of my colleagues seem to feel…
Joanne and Liam (English) were sent out to wakesa, which, I’m told, is a northwestern suburb of kampala (but apparently in the suburbs they have to haul their own water in jerry cans…). She is a fundraiser for a british medical charity at home and she volunteered to work here as a fundraiser to raise money for an ngo that works for people with disabilities. At least on paper. Joanne showed up at her posting to find an empty office… no phone, no computer, no internet, nothing. But they are very anxious for her raise some funds, so that they can buy some office equipment. The first order of business was her new boss asking her for a loan…
TimTim, from the phillipines was also quite distressed. Pretty much every third sentence out of his mouth was ‘they will cheat you.’ (the other two sentences, in case you were wondering, would have been asking for another beer and ‘the vso in Uganda does not care about us.’ Hmmm
Met a lovely irish couple. Jo (short for Josephine), a nurse who basically walked away from her assignment with a private orthopedic clinic to start working with the nurses at Kibuli (Ki is pronounced Chi here) Hospital which is the muslim funded mission hospital where things are apparently desperate. She’s asked me to come hang out in their OPD and teach their doctors manners… hmmm…
Her husband Larry, works in management for another NGO that works with hiv patients. He just scored them a 2.5M USAID grant which means that the NGO will be able to pay the salaries of its employees for another 2 years. Which I thought was a pretty big score. And should make him a hero where he works… but he has described it as a double edged sword. Now that their income is secure for another 2 years, he feels his coworkers are doing even less than before… and he’s a little miffed that he had to pay 30000/= (which isn’t that much money, but looks more impressive in ug. Shillings than pounds) in back fees on the ngo’s postoffice box, so that he could get his mail, because his boss (who reportedly drives a bmw) said that they didn’t have the money to pay the fees…
Jo and Larry were robbed at knifepoint in their apartment the other night. They swear that they feel this was a totally random event and have chosen to remain in their apartment.
July 11th
Today was Rose’s walk. Rose is Ian Clarke’s adopted daughter (he has a large number of ‘adopted’ African children—4-5 of them were here today). 20 years ago, an orphaned Rose walked away from the village of Bamunanika and walked 52km to the village of Kiwoko where the Ugandan church has a mission hospital and where the Clarkes were working in 1989. Rose has since gone on to nursing training in Uganda and in the states (she worked as a neurotrauma nurse at Baylor) and now she’s in a PhD of nursing program at Yale.
So today we walked the 52 kilometers (I think it was probably in the mid-forties, but in high sun and heavy dust, it was plenty) to raise money for the IHK nursing scholarship fund and to raise awareness about the ongoing practice of child sacrifice (apparently witch doctoring is still happening in Uganda and if you need really powerful magic then you’ll want something with some child parts in it).
Hannah from HR said she’d pick me up at 0450. I told her I’d walk to the hospital to meet the buses, but I think she thought I’d flake. So something completely startling happened… she came early. I would have been ready to go at 0450, really I would have. (but then, naturally, we got there before 5am and the buses that were supposed to take off at 0530 so we could get out there walking before it got hot, didn’t leave til almost 0630 once again, stop with the alarm clock stuff)
So it was my first trip out of kampala, and I was pretty excited (even if I slept through most of the drive up to Bamunanika).
We walked from Bamunanika to Wobulenzi, wobulenzi to Luwerro, and Luwerro to Kiwoko. The way from Wobulenzi to Luwerro is on one of the main N-S highways (the Gulu road), so it was hot, choked with diesel fumes and not a lot of scenery except the occasional roadkill. I jogged the middle section with an irish lady named Irene who, even half winded, was able to keep up both ends of the conversation. Her husband sean, hungover from a party at the irish embassy the night before (their embassy invites them to parties, Hilary, just to let you know), so he took it out on us by telling us we had 5 miles to go when really it was less than 2km.
The other 2 segments were packed red dust roads through little villages of mud huts and brick houses with children that would run out to the curb to wave “Bye” (because, apparently that is easier to get off than ‘good day, how are you?’), and buses and matatus and determined looking men and boys pushing bicycles loaded with impossibly big bags or charcoal or bundles of sticks and boys herding cows with horns 2-3’ across and motorcycles whipping by with entire families of 5 or 6 balanced on the limited seating and nonseating areas.
All in all, a nice walk. Wound up at the Kiwoko hospital where the nursing students sang and danced for us and we sat in the grass and had tea and chapati and cold stony ginger beer (it is, after all, a church compound). And I got a tee-shirt that says ‘End Child Sacrifice’. Won’t see too many of those in Noe Valley…
July 12th
Oh. Forgot to mention that some friends of Hannah gave me a ride home from kiwoko. Not exactly sure where they fit into the whole IHK/IMG/extended family of Ian bit, but they are apparently doing okay ‘cuz they’re driving a newish Toyota landcruiser and they live in Muyenga. So on the drive back home they stop (literally) to do a little shopping. They pull over at the luweero markets, which are all roadside and open air and roll down the window and yell and point at the vendors. I am told that there is no word for please in Lugandan. Its basically ssento meko (how much?) and mpa (pronounced oompah, which is give me) that.
Edith and Charles complained bitterly that ever since they got the new car the vendors in the market want to cheat them and charge them the mazungu price. So they have to haggle twice as hard and this slows down the roadside shopping experience. Edith did buy me a big bag of mangos for only 2000/=, however, for which, given my poor market skills, I probably would have come home with only two mangos.
Ugandan mangos, by the way, are pretty amazing. They pick them ripe from the trees and the kids will eat them peel and all. I could pretty much eat them until I’m sticky all over and have a pile of mango pits bigger than my head (and I have to spend the rest of the day in the potty).
Today Sanyu, my landlady, made matooke in the backyard, okay, actually Mukwaye, one of the servants, peeled the green bananas, wrapped them in banana leaves and steamed them over a charcoal brazier. Sanyu added salt and spices and mashed it up to its usual off yellow mush consistency. Maybe because it was fresh, but this was the best matooke I’ve ever had (the matooke they serve us at the hospital has started to cool and takes on the consistency of rubber cement left with the lid open).
July 13th
Caught a Bota after work across town to Ntinda for a run with the Kampala Hash House Harriers. Hashing is sort of a group run where the course is poorly marked with bizarre symbols and only really known to one or two of the crowd (the hash masters) and the goal seems to be trying to get people irreparably lost in an unknown part of town (not hard for me) and then gathering at the end to sing drinking songs and chug lukewarm club beer (actual warning label on club—‘don’t drink and walk home, you might fall into the road and block traffic’). Needless to say, I have found my people.
Hashing apparently is a worldwide phenomenon hitherto unknown to me. I’m told, by Jo and Larry (irish vsoers, see above) that typically hash clubs are made up of expats, but what makes the Kampala group special is that the bulk of the hashers (including the has master) are Ugandan.
Regardless of whether I was participating in a worldwide phenomenon, it was fun to get out and see another neighborhood of kampala and follow a papertrail (literally piles of shredded paper were used to mark the route) over hill, through swamp, through the back yards in the slums, across fields occupied by cows and strung with barb wire, across the grounds of a catholic school and winding up at the headquarters of the ASFU (acid survivors foundation of Uganda—now, coming from san Francisco, I was pretty sure this had something to do with Tim Leary and lsd, but actually here it is a form of domestic violence…) So I was running (and drinking) for a good cause, and have added another teeshirt to my collection: ‘Hashing to support victims of Acid violence’
July 14th
Walked to the corner store for a nile special (singular, as I don’t have a frig, I don’t have the luxury of purchasing 6-paks). I know you think all I write about is beer, but I feel pretty righteous about walking a half a mile for a cold beer. And I remembered to bring an empty with me. Some places won’t even sell you a beer without an empty and some will charge you 1000/= for a deposit on a beer that costs 1500/=… but it is one thing they do right here. Reuse, not recycle. Now if they could just figure out what to do with all the plastic water bottles—personally I think they need to start selling bottled water to the mazungus in glass bottles with the same deposit. I could probably walk 10 miles across kampala and put my foot on a flattened plastic water bottle for every step…
Reason for beer (okay, do you really need a reason?): I am supposedly here to help the IHK develop a trauma system which might, eventually, translate to better trauma care for greater kamplala and Uganda. I have been asking myself just how bad could trauma care be? Today I found out. It is bad. Really really really bad.
I stood in a trauma room choked with nurses and watched a man die. Granted, he had been hit by a speeding minivan packed with people, and his chances of survival were poor from the get-go. But he could have at least died with a functioning IV in place, or some oxygen, or connected to a heart monitor, or an airway tube, or a chest tube or two, or, how about this, some pain medicine to ease his suffering… but none of this happened. The larygoscope (the metal thingy you use to place an airway tube) was not in the crash cart (it turns out the dentist borrowed it), the monitor leads in the crash cart are for a different brand of monitor, the oxygen tank had been moved out of the room, and the nurses were more interested in restraining the patient (‘cause he and I were the only people in the room who knew he was dying) than putting in an intravenous.
I suppose that I should be glad that there is plenty of room for improvement, but when I tried to engage the medical officers and the nurses later about what had happened and what we could learn from it, I got nothing. Nothing but blank stares and what I perceived to be just a bit of attitude: You’re the great mazungu trauma doctor and you couldn’t save him—what do you expect us to do? And I guess that is the question. Sigh. I’ll have to figure out an answer for that.
Note to self. Don’t get injured here. IHK reportedly is Uganda’s best hospital.
July 18 and 19
This past weekend the kampala cluster did a public service project… obviously something planned well in advance of my arrival, but, according to rumor, apparently a bunch of vsoers were sitting around at a bar and someone said, ‘hey, all we ever do when we get together is drink beer and bitch about out placements, so why don’t we get together and do something constructive for a change?’
So Marcel and Nicola put together a project to paint the wards at the Mwanamugimu nutrition center at Mulago hospital (Mulago is Uganda’s state referral hospital and teaching hospital and mwanamugimu wards are where the malnourished kids are treated). They hired a local artist to sketch cartoons on the wall that we would paint, along with the walls, etc…
So 12-15 of us descended on the ward this weekend. They moved all the kids from ward 2 to ward 3 and we scraped and sanded and aerosolized all sorts of nastiness, not to mention uncovering several hordes of mice and roaches (the roaches are bigger than the mice) and then started to paint.
Kind of amusing watching 12-15 doctors, nurses, speech therapists, accountants, project managers, fundraisers, etc—none of who could paint a straight line on a wall to save there lives (and this is in a country whose greatest resource is cheap labor, where nurses work for $150/month—on the months where the government actually pays them and you can hire a ‘gate-boy’ for 24hours/day 6.5 days a week for roughly $25, so my guess is there are lots of guys/gals in kampala who can paint and would be happy to work for a pittance) while Stevie Wonder plays on the ipod doc, high on paint fumes, accompanied by the relentless crying of 20-30 starving children down the hall.
Fortunately I was able to keep my hyperactive sense of irony to myself.
I will say that I have done my fair share of painting (with various results) over the years of our home improvement fiascos—but I like using masking tape, and I prefer water based products… but the plan came with painting big swatches of color around the room with oil-based paint done over two days so that there wasn’t enough for the paints to dry so that masking tape could be applied without ripping off the fresh paint… and the project manager ‘thinned’ the paints with a bit too much terpentine… (also we were using donated paints… like pepto bismol pink, camo green, traffic stripe yellow and other soothing pediatric colors), so despite out best efforts there were drips and splashes everywhere (even the toilet seat came away with a swatch of cornflower flue—don’t ask me…)
When we got too high from fumes, we went and visited the ward and held the babies whose mothers were too sick (mostly hiv) to do so. The babies looked like little old men with wrinkled foreheads and huge, nonblinking, relentless eyes (and matchstick limbs). Then the nurses hit us up for money… We were told that the World Food program feeding supplements (soy products for the kids that can’t absorb milk) had run out and they weren’t due another shipment for a month)… I don’t know what to think of this… the administrator we talked to (he came through and told us not to use the blue paint next to the purple (duh)) said that that was not the truth, that there was plenty of food supplement… (but why do the kids look so sick? Why don’t they have feeding tubes? How can this be the country’s referral center for malnourished kids?)
Ch3
July 23
Have been working nights this week 8p-8a… just to change things up a little bit. And to see if the A&E is any more happening at night.
The jury is still out on that. What does happen in A&E at night is the mosquitoes come up from the namuwongo swamp and roam the hallways. And not just your average buzzy little black things. You swat one of the mossies here at IHK and invariably its full of partially digested blood. And you wonder, hmm… has this little anopheline been feeding on the malaria babies on the paediatric ward, or has she (boy mosquitoes don’t suck blood) been feeding off the HIV/TB patients on the Hope ward. (Or was it the one that bit me on the scalp last night while I was trying to catch a little zzzz time?) Either way, makes you think twice about swatting the little buggers. Tonight though, I’ve brought my secondary mosquito net just in case I want my nap to be undisturbed by some pathogenic insect.
Gave a lecture to DFID (the british development aid agency) and the staff of the British high commission. Managed to put together a 30 slide powerpoint prez in the middle of the night last night while fighting off mosquitoes and a really pushy Indian patient with an entourage of no less than 13 people (3 of them claimed advanced medical training… the patient had been on no less that 6 different antibiotics (2 of the intravenous) in the past 10days, none of them for more than 2 days… and, lo and behold, he was not getting any better, naturally when I tried to explain how antibiotic resistance develops and tried to get them to choose one antibiotic and stick with it they looked at me like I was the one on drugs)
Anyway, the topic was swine flu, a topic on which I have little of no expertise, but, in keeping with the general idea of powerpoint, that fact matters very little—I kept with my basic strategy of downloading lots of funny images from google image and putting in as few word slides as possible. It appears to have been well received, but not so well received as to encourage more lectures.
Tonights little fiasco was a women who’d been in the hospital for 10 days earlier in the month and had been given several conflicting but equally devastating neurosurgical diagnoses by the medical officers, but hadn’t seen the neurosurgeon…
Tonight she came in with a severe headache, proceeded to have a fit, and stopped breathing…. The nurse said, we’d better take her to the trauma room (given my previous experiences with the trauma room, you can imagine I was a bit reluctant to go back) Fortunately the dentist had been kind enough to return the laryngoscope, so I was able to intubate the patient. But the O2 tank was missing. The nurse went out to get the tank… And never came back…. After bagging the patient for what seemed like eternity, and pretty much exhausting my extensive collection of curse words, another nurse comes in. Not to help me with the only critical patient all night, mind you, but to remind me that my guy in room 3 with the sore hip is waiting for me to come and read his x-rays…
Manage to get the neurosurgeon Dr. Kirubwere (sp) on the phone. Says to get a CT scan and he’ll be right in (this is a miracle by the way, in the states if you call the neurosurgeon before the CT has been done all you’re gonna get is a chunk taken out of your butt). Unfortunately, they cannot find the key to the CT scanner room. I am not making this up. Dr. kirubwere, who unlike his western brainsurgeon colleagues has the patience of a saint, shows up about the same time that security finds the unlabeled key, out of a box of 300, that opens the door… So we put her on the CT table and my nurses disappear, again, and I find myself bagging this poor woman for another hour while the tech futzes with the scanner… and gets no images… so we go to the ICU, where, blessedly, Dr. Kirubwere takes over managing the patient, and, will miracles never cease, there is a ventilator and I can stop bagging…
Best thing about the whole experience—documentation—my note summarizing the entire encounter on a 4 x 6 notecard…. With a little space left over.
July 25th
Update on the unfortunate 37 yo woman above.
The reason that the tech was unable to get the CT scanner up and running the other night—the memory was full… The printer (the machine that puts the images onto film like they used to do at home before digital x-ray became the norm about 10 years ago) for the CT scanner doesn’t work and they haven’t bought the software package that would allow them to store the images on a CD, so they don’t dump any of the images…
Anyway, Dr. Kirubwere was finally able to get his CT 20 hours later: huge bleed. 24 hours later he took her to the OR to decompress… prognosis: poor. Had she gotten out of the country (she’s Chinese) 2 weeks ago, her chances would have been better.
So I finished a string of 4 -12 hour night shifts, Friday morning. So, after a little nap, I had Friday off to wander into town…
Caught a matatu (15 passenger minibus) into the downtown taxi park. Had to go into town to pick up a plane ticket. (some of my Liverpool trop med buddies are in Rwanda and the congo and are converging in Kigali in a couple of weekends, so thought I’d pop over). Rwandair Express is the only airline on the entebbe-kigali route—so I go to their website and book a flight, just like you’d do on alaskaair.com, etc, until you get to the part where you click on the purchase ticket button and it takes you to a screen that says—‘go to rwandair express office. Rwenzori courts, lumumbu avenue, kampala, pay for the ticket in US dollars.’ ..
So I wandered downtown and stopped at the Standard Chartered Bank (where, I’m told, I have an account, even though VSO has yet to deposit any of the living allowance promised me…) I thought I could cash some traveler’s checks to get the US dollars needed. I thought this because of the big sign that says “we accept American express travelers checks” above the teller booth. But, the teller tells me, no we don’t cash traveler’s checks. So I ask if I can deposit some of the checks into my account… No, I can’t deposit into the account because the account isn’t active yet. And the reason the account isn’t active yet? Because no one has deposited any money into it yet. I start to get a headache. The manager comes over to explain things to the silly mazungu who looks like he’s about to stroke out at the teller booth and is holding up the long line of nice people who actually know what they want. She kindly explains that my account is at the Lugogo branch (wherever the heck that is…) and that I will need to take at least 100000/= over there to fund the account….
Go to ATM, take 400000/= out of US acct. Go to forex bureau, change money back to USD, go to Rwandair and purchase ticket, and wander back down hill to old taxi park.
2 taxi parks in Kampala. Picture an area smaller than a safeway parking lot seething with a thousand minibuses moving as if by Brownian motion. Generally, if you want to go to the southwest of town you make your way to the SW corner of the old (south) park. The buses are all running, filling the space with diesel and gas exhaust fumes as they jockey for position. A conductor for each van is trying to load his van with the maximum number of passengers… by screaming out his route and hustling people into the van. I find one yelling kabalagala (which is the closest I can find to my place) which already has 10 or so people in it (score, it will be leaving soon) and crawl to the far back corner (people get in, grab the best seat available, then future passengers have to scramble over them..)
Our matatu takes off out of town, through the roundabouts and up the hill on nsambia road. Still full, the driver pulls over near one of the alleyways… the passengers look at each other as the conductor hops out and runs down the alley. (None of the passengers are getting off, so they start grumbling to the driver) The conductor comes running back carrying 2 plastic bags—the local gin (waragi) is sold in little 60cc bags called tot packs (or, given that the Ugandans like 2 syllables, totter packs). The conductor hands one to the driver who bites into it and starts sucking on it. I crawl over the people again and get out of the van. The conductor wants my full 500 shillings for the ride. I tell him that I don’t mind if he drinks gin on the job, but I won’t ride if the driver drinks with him… we settle on 200/=.
26 July
Had dinner last night with Conrad and his wife Katherine (sp). Conrad was in my trop med course in Liverpool. Conrad works for The Surgery, which is IHKs main competition (although they don’t pretend to be a hospital, they do have 6 overnight beds and 24 hr medical coverage). The surgery is where most of Kampala’s expats go for their first round of medical treatment before they get the hell out. It sounds like they are working poor Conrad pretty hard: 10-12 hours a day, 6-7 days week. He does say that they pay him by the hour, though, so I think he may be taking some extra hours to earn a few extra shillings.
He says that he’s been using the DTMH (tropical med diploma) stuff quite a bit. He says that in medical school in Kampala they tend to rush through the infectious diseases (which is mostly what trop med is)… just like in the states.
Katherine is also a physician. She works at an HIV/aids clinic out toward Entebbe. They have 2 kids, Matthew (18mos) and Joshua (3mos). They have a ‘house-girl’ who watches the kids during the day (and cooks and cleans). At night Katherine works on her MPH from Makerere university. The goal is to get hired by an NGO as a project manager—pays a lot better and better hours than doing clinical work…
Conrad and I reminisced about our trip to Snowdonia. A couple of the Norwegians took us hiking up ‘Bristly Ridge’ into a freezing rain storm. The Norwegians were decked out in full goretex ad hiking boots while Conrad and Simon and Rocky (from the tropics) were wearing varying degrees of unsuitable clothes… I remember looking back at Conrad, soaked to the skin, his non waterproof hood tight around his face with this look of amused disbelief on his face. I caught up with Hege and Hilde on a big rock which offered no shelter from the wind or the rain and offered the opportunity to fall to one’s death in 3 directions. I tactfully suggested it might be time to turn around.
Conrad fondly remembers the weekend as the time we took him into the mountains and tried to kill him. (we got back to the chalet and he shivered for a good 2 hours, then fell asleep, and woke briefly for dinner, but otherwise slept the rest of the night). He also remembered a berry crisp I made for dinner that night… We talked about if it would work with pineapple, mango, and jackfruit.
Conrad says that Mulago sent one of friends from med school to Italy to study emergency medicine. His friend came back with the task of organizing the emergency department… His friend worked at Mulago for a few weeks when he got back… then left the country for a better paying job in Botswana…
Conrad is going to get me a few contacts at Mulago.
July 28th
Monday night, hash night, was going to bota over, but Ian said he’d give me a lift, so hung out at the hospital until 5:40p (hashing starts at 6) waiting with Charlotte (another vso) and patricia (manager of ian’s construction co) who he also promised rides to. Ian screams up in his bmw x5. He had just driven cross town in traffic from a meeting with parliament about providing health insurance to parliament members and staff (the big new item this week in Uganda—aside from the famine in NE Uganda due to crop failure—is that the government purchased new 100,000,000/= ($50k) SUVs for the MPs… not too bad. Better for running the muzungus off tank hill road with…)
Ian drives like the Ugandans, except with a bigger, faster vehicle. Was kind of a fun ride, as things go, except the part where you’re begging whatever higher power you beg to that the little kids stay out from under his wheels.
But despite his best efforts we were 20 minutes late for the start. Couldn’t catch the running masses. Jogged up to the top of the hill with the radio towers and watched a great sunset. Jogged down and had a beer. In consolation Ian invited us to Rose’s birthday dinner at one of the nicer Italian restaurants in town. Ian, however, had a change of clothes… Rose and all of her friends are there dressed to the nines and I’m wearing a tee shirt and running shorts… I can just tell from the looks: ‘@#$%ing mazungus, you cannot take them anywhere.’
But it was a nice dinner. Had my first wine in a while and a very nice piece of tilapia completely buried in mushroom and cream sauce…
Ian had a couple of beers and became a little more voluble, went into a long tirade about all the medical aid etc that goes to mulago and doesn’t do anything ‘cuz the place isn’t organized well enough to accept it. Tactfully hinted he could probably get some of that aid if IHK was willing to provide more charity care. But then he counters with, “I’ve never asked for any of their help.” Okay then.
July 29th
Would swear I walked by a young man on tank hill road today who was wearing Justin’s boy scout uniform shirt from the early 70s, with the eagle scout badge sewn on. Troop 129. Similar bad haircut and black framed glasses as well, but of course this young man was black. Wanted to give him the secret boy scout handshake, but, of course, I’d forgotten it. Saluted him instead. Probably thought I was an idjit.
July 30th
Sanyu (my landlady)’s dad died this past week. He’s been sick since I moved in. First at a public hospital, then a private hospital, then in a private hospital in Nairobi. Sounds like diabetes, hypertension, and then stage 4 colon cancer to top it off…. Not good. Sounds like he had surgery for the colon ca and then never made it out of the ICU in Nairobi. One of the hardest things to learn about intensive care medicine is when to say goodbye. And I’m afraid, from my limited exposure, that they haven’t learned this in Africa. If the intensive care medicine works, then they are too happy to keep it going to think about turning it off… sanyu’s dad had been on dialysis and a ventilator for something like 3 weeks, she kept telling me she didn’t understand why he wasn’t getting better because he was ‘getting the best of care’. This is kind of the thing in africa, I’m afraid. Because they’ve had crap for health care for so long, they assume that all they have to do is get better care, and then they’ll live forever…
Anyway, as someone stressing about a sick relative and , now, in mourning, she hasn’t paid her water bill… so I am now without running water. Fortunately, mukwaye is kind enough to bring me a jerry can of water every couple of days, so that I can sort of bathe and wash dishes and flush the toilet… Not really sure exactly where sanyu is, or what her # is, but don’t think it would be too appropriate, at the moment, to call her up and say sanyu where’s the flippin’ water, so have been suffering in righteous silence.
June 2009
Some first impressions of Uganda… 27 June
… the ICT1 (first week of in country training, of which I missed the first half because CUSO-VSO Canada insisted I take their skills in working in development (acronym SKWID…) before they’d fly me over here) is winding down and everyone is excited about getting started with there placements… also everyone is excited about moving out of the Lwewa training and conference center and into their new housing situation… but I have been informed that my housing isn’t ready yet, so I will be going to ‘temporary housing’, but as all the fresh new volunteers are hugging goodbye and heading off to various parts of Uganda, Rose (VSO program admin) pulls me aside and tells me that even my temporary housing isn’t ready yet. It’s being cleaned. I’ll be spending the night at the shalom guest house and ‘someone’ will be picking me up in the morning to take me to my temporary housing…
so I hang out all morning. But I don’t have an idea of who is supposed to be picking me up… and I couldn’t call them if I did, because I haven’t got my phone sorted yet. Finally at 2pm a beat up looking SUV rumbles up the drive and a kid who might be 15 gets out and starts loading my bags into back. He doesn’t speak much English, and my Lugandan stops at what’s your name (ggwe ani?, literally, who you?), but he doesn’t seem to recognize that as a question, or even a manifestation of his language…
we pull out of the shalom and head up the hill toward… oh, I don’t have a freakin clue, ‘cuz noone’s given me an indication as to where this temporary housing is going to be, somewhere away from town and from the hospital, but otherwise into uncharted territory as far as I’m concerned. About half way up the moderately steep hill, the SUV dies. Traffic backs up as the bota-botas swarm around both sides and the trucks behind start honking… the kid puts on the e-brake, gets out of the car, and runs off down the hill.
so I’m sitting in the passenger seat of a car stuck at the front of an ever growing line of pissed off drivers… some of them are putting their heads in the open window and screaming at me, others, more entrepreneurial, are trying get me to move my boatload of crap into their trucks and come with them, which is tempting, except that I have no idea where I’m going… meantime, I’m getting shouted at and not having much luck with my limited lugandan—wasuze otye ssebo (how did you sleep last night sir?) and the ever important oosela ssebo (I believe you are overcharging me, sir)…
about 30 minutes (I was keeping an eye on my watch, figuring I’d give the kid 30 minutes before I really started to freak out) later the kid comes back on the back of a boda-boda (motor cycle taxi and kampala’s leading cause of head trauma) holding 2 liter water bottles full of petrol. He empties the bottles into the tank (carefully discarding the plastic in to ditch) and, surprisingly enough, the car starts and we proceed up the hill…
28June
I’m staying in Muyenga, one of kampala’s many posh suburbs that dot the hilltops (Kampala, like rome and seattle was built on seven hills, but has expanded since then) while the slums fill the swampy valleys below. I’m staying in the guest house of a Ugandan family, or maybe the servants quarters (hope they don’t mind sleeping in the shed while I’m here). It’s a cute little place—one large room that doubles as bedroom and living room, a small bathroom with toilet and shower (but no sink, and no hot water), and a small kitchen with a two burner gas stove. I’d love to say there were cold beers in the fridg, but there isn’t one. All in all, pretty livable. Compared to some of the volunteers in the villages who have to haul their water from the communal pipe in jerry cans and have no electricity, it’s pretty posh. When I ask where the help is sleeping, my land lady Sanyu says, ‘you know, its africa, what can you do?’
Muyenga has many large white stuccoed houses with terra cotta roof tiles built to take in the views of the hills and Lake Victoria. Most of them have high walls strung with concertina wire or set with broken glass. My house, I think because Ugandans live there, doesn’t have any concertina wire, but the wall is still there. Many of these large white mansions behind high walls have tastefully small signs denoting one of the numerous NGOs that work in Uganda: Holland War Child, Danish Refugee Association, Save the Children… Makes you think about what Paul Collier said in the ‘Bottom Billion’ about aid not getting to the poorest of the poor because aid workers don’t want to go there. And wonder about your donations to X charity when they say that X% of your donations goes to work in the field—does that mean building a fortified mansion somewhere in the third world?
Went for a run this morning (Sunday) that, through my generally poor sense of direction, took me off the hill and down into the namuwongo slum. Don’t really know if this is advisable or not, but figured better on Sunday morning when they are putting on their best clothes and heading to church than on Saturday night. Didn’t really feel particularly threatening, everyone smiled at me and gave me the ‘stupid mazungu’ look. (mazungu is lugandan for single white man, bazungu would be plural, just like mantu would be man and bantu would be people) Maybe it was ‘cuz I was wearing a Liverpool FC shirt and they are all Arsenal fans. Figured I didn’t really have much on me worth chasing me down and mugging me for, but I suppose in a dollar a day economy, even a beat up pair of asics have some resale value.
29June
speaking of resale value… Dr. Hamsa (sp), one of the ‘young doctors’ (we would call them interns or 2nd year residents) that I met the other day is in the ICU this morning on a ventilator. Apparently he was mugged outside his house in Makerere, for his cell phone. Frontal epidural hematoma. At least he was able to get a CT scan and a burr hole. But doesn’t really look too good from my cursory glance. Makerere is across town from here, over near the university and the Mulago hospital(the large state run hospital in kampala). Apparently not as nice a neighborhood as Muyenga. The Ugandans assure me that violent robbery seldom happens in Kampala, and certainly never in my part of town, BUT, as they say with a shrug, ‘this is africa, sometimes things happen…’
cell/mobile phones are everywhere here, so you wouldn’t think that they’d be worth braining someone for (or maybe that is precisely why?). The other day in the market where a man in fairly beat up, dirty attire (which is unusual—most people here in kampala are dressed better than I am) was shoveling the bones and waste left by the fish sellers onto a rudimentary handmade wheelbarrow when a jazzy ringtone went off. The fishseller checked his phone then looked at me, while the fishgut shoveller wipes off his hands on his shirt and pulls a little nokia out of his pocket… my in-Uganda calls on MTN cost about 400 /- (Ugandan shillings) a minute, or about 20 cents… A third of Uganda survives on less than a dollar a day… So if you were living on a dollar a day (or even $8/day which is what my stipend works out to, and is what, I’m told, a doctor at mulago gets paid), would you be willing to spend 1/5 of your income on a minute of airtime?
Met Ian Clarke today (or Dr. Ian, as almost everyone in Kampala knows him). The man with the vision and energy behind the IHK (internatl hospital of kampala), as well as 13 Internatl Medical Clinics, the Internatl Medical foundation (the charitable arm, providing free care), the IAA (internatl air ambulance) which is actually kind of an hmo selling ‘subscriptions’ to employers, and a construction company (for building these things). Talking with a couple of our language teachers… they think Dr. Ian has gone over to the dark side (‘he used to be one of us, now all he thinks of is’) also the Ugandans are already leery of the hmo thing ‘if you are on the subscription, they give you the cheaper drugs…’
Dr. Ian assures us that the hospital and its various subsidiaries are broke…(and to judge from his shabby dress and beat up Seiko watch, he may be telling the truth) he’s just returned from trip to china where he’s been looking at Chinese icu monitors and trying to find donors.
We’ll see.
… the ICT1 (first week of in country training, of which I missed the first half because CUSO-VSO Canada insisted I take their skills in working in development (acronym SKWID…) before they’d fly me over here) is winding down and everyone is excited about getting started with there placements… also everyone is excited about moving out of the Lwewa training and conference center and into their new housing situation… but I have been informed that my housing isn’t ready yet, so I will be going to ‘temporary housing’, but as all the fresh new volunteers are hugging goodbye and heading off to various parts of Uganda, Rose (VSO program admin) pulls me aside and tells me that even my temporary housing isn’t ready yet. It’s being cleaned. I’ll be spending the night at the shalom guest house and ‘someone’ will be picking me up in the morning to take me to my temporary housing…
so I hang out all morning. But I don’t have an idea of who is supposed to be picking me up… and I couldn’t call them if I did, because I haven’t got my phone sorted yet. Finally at 2pm a beat up looking SUV rumbles up the drive and a kid who might be 15 gets out and starts loading my bags into back. He doesn’t speak much English, and my Lugandan stops at what’s your name (ggwe ani?, literally, who you?), but he doesn’t seem to recognize that as a question, or even a manifestation of his language…
we pull out of the shalom and head up the hill toward… oh, I don’t have a freakin clue, ‘cuz noone’s given me an indication as to where this temporary housing is going to be, somewhere away from town and from the hospital, but otherwise into uncharted territory as far as I’m concerned. About half way up the moderately steep hill, the SUV dies. Traffic backs up as the bota-botas swarm around both sides and the trucks behind start honking… the kid puts on the e-brake, gets out of the car, and runs off down the hill.
so I’m sitting in the passenger seat of a car stuck at the front of an ever growing line of pissed off drivers… some of them are putting their heads in the open window and screaming at me, others, more entrepreneurial, are trying get me to move my boatload of crap into their trucks and come with them, which is tempting, except that I have no idea where I’m going… meantime, I’m getting shouted at and not having much luck with my limited lugandan—wasuze otye ssebo (how did you sleep last night sir?) and the ever important oosela ssebo (I believe you are overcharging me, sir)…
about 30 minutes (I was keeping an eye on my watch, figuring I’d give the kid 30 minutes before I really started to freak out) later the kid comes back on the back of a boda-boda (motor cycle taxi and kampala’s leading cause of head trauma) holding 2 liter water bottles full of petrol. He empties the bottles into the tank (carefully discarding the plastic in to ditch) and, surprisingly enough, the car starts and we proceed up the hill…
28June
I’m staying in Muyenga, one of kampala’s many posh suburbs that dot the hilltops (Kampala, like rome and seattle was built on seven hills, but has expanded since then) while the slums fill the swampy valleys below. I’m staying in the guest house of a Ugandan family, or maybe the servants quarters (hope they don’t mind sleeping in the shed while I’m here). It’s a cute little place—one large room that doubles as bedroom and living room, a small bathroom with toilet and shower (but no sink, and no hot water), and a small kitchen with a two burner gas stove. I’d love to say there were cold beers in the fridg, but there isn’t one. All in all, pretty livable. Compared to some of the volunteers in the villages who have to haul their water from the communal pipe in jerry cans and have no electricity, it’s pretty posh. When I ask where the help is sleeping, my land lady Sanyu says, ‘you know, its africa, what can you do?’
Muyenga has many large white stuccoed houses with terra cotta roof tiles built to take in the views of the hills and Lake Victoria. Most of them have high walls strung with concertina wire or set with broken glass. My house, I think because Ugandans live there, doesn’t have any concertina wire, but the wall is still there. Many of these large white mansions behind high walls have tastefully small signs denoting one of the numerous NGOs that work in Uganda: Holland War Child, Danish Refugee Association, Save the Children… Makes you think about what Paul Collier said in the ‘Bottom Billion’ about aid not getting to the poorest of the poor because aid workers don’t want to go there. And wonder about your donations to X charity when they say that X% of your donations goes to work in the field—does that mean building a fortified mansion somewhere in the third world?
Went for a run this morning (Sunday) that, through my generally poor sense of direction, took me off the hill and down into the namuwongo slum. Don’t really know if this is advisable or not, but figured better on Sunday morning when they are putting on their best clothes and heading to church than on Saturday night. Didn’t really feel particularly threatening, everyone smiled at me and gave me the ‘stupid mazungu’ look. (mazungu is lugandan for single white man, bazungu would be plural, just like mantu would be man and bantu would be people) Maybe it was ‘cuz I was wearing a Liverpool FC shirt and they are all Arsenal fans. Figured I didn’t really have much on me worth chasing me down and mugging me for, but I suppose in a dollar a day economy, even a beat up pair of asics have some resale value.
29June
speaking of resale value… Dr. Hamsa (sp), one of the ‘young doctors’ (we would call them interns or 2nd year residents) that I met the other day is in the ICU this morning on a ventilator. Apparently he was mugged outside his house in Makerere, for his cell phone. Frontal epidural hematoma. At least he was able to get a CT scan and a burr hole. But doesn’t really look too good from my cursory glance. Makerere is across town from here, over near the university and the Mulago hospital(the large state run hospital in kampala). Apparently not as nice a neighborhood as Muyenga. The Ugandans assure me that violent robbery seldom happens in Kampala, and certainly never in my part of town, BUT, as they say with a shrug, ‘this is africa, sometimes things happen…’
cell/mobile phones are everywhere here, so you wouldn’t think that they’d be worth braining someone for (or maybe that is precisely why?). The other day in the market where a man in fairly beat up, dirty attire (which is unusual—most people here in kampala are dressed better than I am) was shoveling the bones and waste left by the fish sellers onto a rudimentary handmade wheelbarrow when a jazzy ringtone went off. The fishseller checked his phone then looked at me, while the fishgut shoveller wipes off his hands on his shirt and pulls a little nokia out of his pocket… my in-Uganda calls on MTN cost about 400 /- (Ugandan shillings) a minute, or about 20 cents… A third of Uganda survives on less than a dollar a day… So if you were living on a dollar a day (or even $8/day which is what my stipend works out to, and is what, I’m told, a doctor at mulago gets paid), would you be willing to spend 1/5 of your income on a minute of airtime?
Met Ian Clarke today (or Dr. Ian, as almost everyone in Kampala knows him). The man with the vision and energy behind the IHK (internatl hospital of kampala), as well as 13 Internatl Medical Clinics, the Internatl Medical foundation (the charitable arm, providing free care), the IAA (internatl air ambulance) which is actually kind of an hmo selling ‘subscriptions’ to employers, and a construction company (for building these things). Talking with a couple of our language teachers… they think Dr. Ian has gone over to the dark side (‘he used to be one of us, now all he thinks of is
Dr. Ian assures us that the hospital and its various subsidiaries are broke…(and to judge from his shabby dress and beat up Seiko watch, he may be telling the truth) he’s just returned from trip to china where he’s been looking at Chinese icu monitors and trying to find donors.
We’ll see.
another wakiso weekend
November 29th
Wakiso for the weekend.
Jo and Liam are finishing up their placement and getting ready to launch on the travel portion of their year off. The Kavumba recreation center, the venue for the ill-fated Peace corps-VSO soccer game in October and the infamous Dr. Jose Chameleon concert in August, was hosting the grand gala opening of their swimming center (even though we have been swimming there for 4 months), and it seemed a good excuse to see Jo and Liam before they disappear.
On Friday, I had arranged a ride out to Wakiso with Alan and Alison, but on Saturday morning I got a text from Alison saying that Zoe was ‘squitty.’ I guess I wasn’t curious enough as to what squitty means in the UK medical vernacular to spend 50 shillings on a return text. I’ll leave it to your imagination. I took matatus out to Wakiso.
The head of the Ugandan National Swimming certification body was on hand to cut the ribbon and, as a treat, some members of the Ugandan National Team in Swimming were on hand for some exhibition races. Godfrey, the ribbon cutter, wanted to have his swimmers race our ‘team’ in a 200m medley relay. We joked that we’d be disqualified for using performance altering substances (the even was scheduled to kickoff at noon, but didn’t get underway until close to 4p, at which time we had already cracked a nile special or two). Then we realized he was serious. We politely begged off. But, I will say after watching them swim, it would not have been as big blow out as you might think (not, of course, because of my aqua-skills which focus primarily on staying alive in the water, but Jo and Liam actually can swim).
As an additional draw to the swim gala, Moses, the center’s director, offered dinner and a show. Dinner was a sharp stick with 3 or 4 large hunks of meat on it to roast on one of the several large fires out behind the pool. The show was Uganda’s own BeBe (pronounced baby) le Cool, who is either the most famous or second most famous pop singer in Uganda. I know, it sounds like you’ve heard this before.
The secret to searing your meat over an open flame (and making sure all the encysted tapeworms are fully sizzled), as we were shown the our highly amused hosts, is to get a good charred crust going and then remove it from the flames and nibble away the crust. And then return the meat to the fire and repeat the process.
The concert was much the same process. Stick with the crusty layer on top. At least now we understood the format: 4-5 hours of ‘warm up’ acts followed by a few songs by the headliner. And then end of show. No encores. As opposed to the Dr. Jose show where everybody mimed, however, last night, most of the opening acts actually sang into the microphone. Some of them shouldn’t have, but at least they tried. And the comedy act actually seemed funny (maybe my lugandan vocabulary is getting a little better—having picked up some gems like cabina kalungi, big fat ass (in a complimentary way), and banangay, which, I think, loosely translates as WTF?) even if they didn’t have dwarf.
So with a little help from the new official VSO Wakiso cocktail (mountain dew and waragi) we generally enjoyed the show. I particularly enjoyed the gluteal muscle control of the girl groups (I swear, this one woman could have done calligraphy with the pen clenched behind her back), but the crowd seemed to go more for the guys in askew yankee caps and large sunglasses doing tired hip hop renditions. Who is to explain taste? Certainly it was in short supply all around.
Bebe le cool made a brief appearance after the rain, much to the crowd’s delight. His anthem (be cool. Bebe cool is cool… blah blah. ) was a particular crowd favorite. I did not feel cheated when he cut his performance short.
I spent the night at the guest house on the recreation center property and was lulled off into waragi-aided slumber by the thudding bass of the all-night disco, also on the property. In the morning I wandered through the detritus and out to the gate. There were no botas to be had for the 2 miles of dirt road separating Kavumba from Wakiso, so I walked in a strangely Seattle-like mist falling from a cement colored sky.
I walked by traditional mud and stick huts with thatch roofs and brick houses with tin roofs. I walked by towers of mud bricks stacked into and fired as on-site kilns, ready for new construction. I walked by shells of huts overgrown with Spanish yellow oleander, the words ‘not for sale’ slowly disappearing with the disintegration of the bricks. I walked by children playing in yards—a baby being pushed over uneven ground in a wash basin, a boy pulling a toy car fashioned entirely from bits of trash, an urchin throwing rocks and twigs at the chickens and goats eating the vegetation in drainage ditch (invariably, the children see me a wave and shout, ‘Hi Mzungu, or Bye Mzungu.’) I walk by families on their way to church—the mothers with a baby or two in one arm and the other hand bunching the brightly printed floral fabric of her skirt to keep it out of the mud, the fathers similarly grasp a wad of dark cloth at their crotch in an attempt to keep their cuffs clean. (Do you ever wonder where that suit went? A little too shiny? The lapels too big? Maybe Ralph or Pierre decided that the ventless back was passé? Well. Some guy in Africa has your suit. It doesn’t fit him very well either. Remind me to go off on a tangent at some point and talk about how clothes donated to goodwill in America wind up for sale in Africa and have resulted in the demise of the African clothing industry…)
I walk by the Real Life church—a few walls, no roof, but a congregation already filling the floor. I walk past the True Life Church. ‘Worship God. Do not worship money.’ (just leave a little in the collection plate, please)
At the Wakiso taxi park I pick up a matatu back to Kampala. The minivan is nearly full, so we are underway in a few minutes. The windows have all been shut against the mist, so within a few minutes it is stifling within the vehicle. I dig deep for my travel zen as I watch the baby in the next seat regurgitate breast milk onto the church frock of the unsuspecting woman in front of me. Ugandan matatus are licensed for up to 14 passengers (its 18 in Rwanda with the same seat configuration), and the passengers tend to self-enforce the rules if the conductor tries to pick up a 15th, but children ride for free on their mother’s lap, so it is not unusual to see 3-4 infants in a matatu or even 16 year old boys sitting on their mother’s lap. Giles Foden, in The Last King of Scotland, describes a ride from Kampala to Mbarara in a matatu with ‘goats, chickens and what must have been nearly thirty human bodies—in a space meant for ten…’ Most matatu rides feel like this. (Foden unfortunately muddied the picture when 3 soldiers ‘climbed in’ to the matatu and ‘walked down the aisle’—matatus don’t have aisles… no one walks on a matatu, certainly not a fully packed one, you slide on your butt or crawl, and only with the assistance of several of your neighbors, and no one climbs in to a fully loaded matatu.)
The matatu from Wakiso eventually arrives and deposits me at the new taxi park. The persistent rains and the continual Brownian motion of the hundreds of minvans jockeying for position have churned the park to a muddy milk chocolate froth. Walking ankle deep in diarrheal soup, I try not to lose my shoes or my toes as I negotiate the tiny gaps between vehicles heading to the southeast end of the park (there is an unsignposted rule that vans parked to the southeast will be heading to the southeast part of town). ‘Ogende wa?’ I ask the conductors. ‘tugende mengo… tugende nsambya… tugende ggaba.’ Close enough, I can walk up the hill from kabalagala. I pick a seat in a nearly full bus. As we wait, we can take advantage of the commerce going on in the taxi park’s interstitial spaces—I could have my shoes resoled (or buy new ones), buy a new watch or one of several Obama tee shirts, or purchase meat on a stick or a rolex or a bag of groundnuts or a chunk of jack-fruit. A man approaches who appears to have slept in the taxi park (kind of like sleeping on the benches in the bus station, except for the part where there aren’t any benches). The right side of this body is covered in clotted mud. Naturally he’s headed in my direction. Either I can hold my seat (as is considered proper matatu etiquette) and let him crawl over me, or I can slide over so he can rest his muddy side against me. I brace for the worst. At the last moment, the conductor says something that I don’t quite catch that must have been the lugandan equivalent of show me the money. The mud man digs in his trousers but fails to find even a 100 shilling coin for the shortest ride possible. I feel relief. Then shame at my relief. For a second I think about handing him a 500 coin. But a woman in orange and brown print and a large shopping bag quickly grabs the seat and the conductor slams the door and we’re off. Tugende.
Wakiso for the weekend.
Jo and Liam are finishing up their placement and getting ready to launch on the travel portion of their year off. The Kavumba recreation center, the venue for the ill-fated Peace corps-VSO soccer game in October and the infamous Dr. Jose Chameleon concert in August, was hosting the grand gala opening of their swimming center (even though we have been swimming there for 4 months), and it seemed a good excuse to see Jo and Liam before they disappear.
On Friday, I had arranged a ride out to Wakiso with Alan and Alison, but on Saturday morning I got a text from Alison saying that Zoe was ‘squitty.’ I guess I wasn’t curious enough as to what squitty means in the UK medical vernacular to spend 50 shillings on a return text. I’ll leave it to your imagination. I took matatus out to Wakiso.
The head of the Ugandan National Swimming certification body was on hand to cut the ribbon and, as a treat, some members of the Ugandan National Team in Swimming were on hand for some exhibition races. Godfrey, the ribbon cutter, wanted to have his swimmers race our ‘team’ in a 200m medley relay. We joked that we’d be disqualified for using performance altering substances (the even was scheduled to kickoff at noon, but didn’t get underway until close to 4p, at which time we had already cracked a nile special or two). Then we realized he was serious. We politely begged off. But, I will say after watching them swim, it would not have been as big blow out as you might think (not, of course, because of my aqua-skills which focus primarily on staying alive in the water, but Jo and Liam actually can swim).
As an additional draw to the swim gala, Moses, the center’s director, offered dinner and a show. Dinner was a sharp stick with 3 or 4 large hunks of meat on it to roast on one of the several large fires out behind the pool. The show was Uganda’s own BeBe (pronounced baby) le Cool, who is either the most famous or second most famous pop singer in Uganda. I know, it sounds like you’ve heard this before.
The secret to searing your meat over an open flame (and making sure all the encysted tapeworms are fully sizzled), as we were shown the our highly amused hosts, is to get a good charred crust going and then remove it from the flames and nibble away the crust. And then return the meat to the fire and repeat the process.
The concert was much the same process. Stick with the crusty layer on top. At least now we understood the format: 4-5 hours of ‘warm up’ acts followed by a few songs by the headliner. And then end of show. No encores. As opposed to the Dr. Jose show where everybody mimed, however, last night, most of the opening acts actually sang into the microphone. Some of them shouldn’t have, but at least they tried. And the comedy act actually seemed funny (maybe my lugandan vocabulary is getting a little better—having picked up some gems like cabina kalungi, big fat ass (in a complimentary way), and banangay, which, I think, loosely translates as WTF?) even if they didn’t have dwarf.
So with a little help from the new official VSO Wakiso cocktail (mountain dew and waragi) we generally enjoyed the show. I particularly enjoyed the gluteal muscle control of the girl groups (I swear, this one woman could have done calligraphy with the pen clenched behind her back), but the crowd seemed to go more for the guys in askew yankee caps and large sunglasses doing tired hip hop renditions. Who is to explain taste? Certainly it was in short supply all around.
Bebe le cool made a brief appearance after the rain, much to the crowd’s delight. His anthem (be cool. Bebe cool is cool… blah blah. ) was a particular crowd favorite. I did not feel cheated when he cut his performance short.
I spent the night at the guest house on the recreation center property and was lulled off into waragi-aided slumber by the thudding bass of the all-night disco, also on the property. In the morning I wandered through the detritus and out to the gate. There were no botas to be had for the 2 miles of dirt road separating Kavumba from Wakiso, so I walked in a strangely Seattle-like mist falling from a cement colored sky.
I walked by traditional mud and stick huts with thatch roofs and brick houses with tin roofs. I walked by towers of mud bricks stacked into and fired as on-site kilns, ready for new construction. I walked by shells of huts overgrown with Spanish yellow oleander, the words ‘not for sale’ slowly disappearing with the disintegration of the bricks. I walked by children playing in yards—a baby being pushed over uneven ground in a wash basin, a boy pulling a toy car fashioned entirely from bits of trash, an urchin throwing rocks and twigs at the chickens and goats eating the vegetation in drainage ditch (invariably, the children see me a wave and shout, ‘Hi Mzungu, or Bye Mzungu.’) I walk by families on their way to church—the mothers with a baby or two in one arm and the other hand bunching the brightly printed floral fabric of her skirt to keep it out of the mud, the fathers similarly grasp a wad of dark cloth at their crotch in an attempt to keep their cuffs clean. (Do you ever wonder where that suit went? A little too shiny? The lapels too big? Maybe Ralph or Pierre decided that the ventless back was passé? Well. Some guy in Africa has your suit. It doesn’t fit him very well either. Remind me to go off on a tangent at some point and talk about how clothes donated to goodwill in America wind up for sale in Africa and have resulted in the demise of the African clothing industry…)
I walk by the Real Life church—a few walls, no roof, but a congregation already filling the floor. I walk past the True Life Church. ‘Worship God. Do not worship money.’ (just leave a little in the collection plate, please)
At the Wakiso taxi park I pick up a matatu back to Kampala. The minivan is nearly full, so we are underway in a few minutes. The windows have all been shut against the mist, so within a few minutes it is stifling within the vehicle. I dig deep for my travel zen as I watch the baby in the next seat regurgitate breast milk onto the church frock of the unsuspecting woman in front of me. Ugandan matatus are licensed for up to 14 passengers (its 18 in Rwanda with the same seat configuration), and the passengers tend to self-enforce the rules if the conductor tries to pick up a 15th, but children ride for free on their mother’s lap, so it is not unusual to see 3-4 infants in a matatu or even 16 year old boys sitting on their mother’s lap. Giles Foden, in The Last King of Scotland, describes a ride from Kampala to Mbarara in a matatu with ‘goats, chickens and what must have been nearly thirty human bodies—in a space meant for ten…’ Most matatu rides feel like this. (Foden unfortunately muddied the picture when 3 soldiers ‘climbed in’ to the matatu and ‘walked down the aisle’—matatus don’t have aisles… no one walks on a matatu, certainly not a fully packed one, you slide on your butt or crawl, and only with the assistance of several of your neighbors, and no one climbs in to a fully loaded matatu.)
The matatu from Wakiso eventually arrives and deposits me at the new taxi park. The persistent rains and the continual Brownian motion of the hundreds of minvans jockeying for position have churned the park to a muddy milk chocolate froth. Walking ankle deep in diarrheal soup, I try not to lose my shoes or my toes as I negotiate the tiny gaps between vehicles heading to the southeast end of the park (there is an unsignposted rule that vans parked to the southeast will be heading to the southeast part of town). ‘Ogende wa?’ I ask the conductors. ‘tugende mengo… tugende nsambya… tugende ggaba.’ Close enough, I can walk up the hill from kabalagala. I pick a seat in a nearly full bus. As we wait, we can take advantage of the commerce going on in the taxi park’s interstitial spaces—I could have my shoes resoled (or buy new ones), buy a new watch or one of several Obama tee shirts, or purchase meat on a stick or a rolex or a bag of groundnuts or a chunk of jack-fruit. A man approaches who appears to have slept in the taxi park (kind of like sleeping on the benches in the bus station, except for the part where there aren’t any benches). The right side of this body is covered in clotted mud. Naturally he’s headed in my direction. Either I can hold my seat (as is considered proper matatu etiquette) and let him crawl over me, or I can slide over so he can rest his muddy side against me. I brace for the worst. At the last moment, the conductor says something that I don’t quite catch that must have been the lugandan equivalent of show me the money. The mud man digs in his trousers but fails to find even a 100 shilling coin for the shortest ride possible. I feel relief. Then shame at my relief. For a second I think about handing him a 500 coin. But a woman in orange and brown print and a large shopping bag quickly grabs the seat and the conductor slams the door and we’re off. Tugende.
Monday, November 30, 2009
disclaimer and warnings
Here in Kampala it is now the first of December. My computer still thinks it's monday night in san francisco, and I haven't the energy or technical skills to disabuse it of this notion.
I have been working as a vso medical volunteer here in Kampala for slightly more than 5 months of a year-long placement. Over these months I have been sending out long rambling hyperdramatic emails to loved ones, family and friends. A few of whom ( a very few) have chastised me for being too lazy to write a blog such that I finally went to blogspot and discovered that even someone with my limited motivation and understanding of computers can have a blog in a matter of minutes.
So here it is. A blog. Those of you who asked for it, you know who you are, the rest of you probably clicked on a link for male enhancement.
First of all, the opinions expressed herein are the product of a deeply disturbed imagination coupled with a cynical nature and should not be thought to reflect the facts, the truth, reality or the official views of CUSO-VSO or any other person or organization described in the rambling passages that will fill this blog.
I am working as a medical volunteer. Some of the posts here may be on the unsettling side. I suggest at least a glass of red wine before proceeding. Most of the what I will write about, however, will not be of a medical nature. In general I will try to describe random moments of the life of a mzungu in Uganda--things that strike me as funny, ironic, or maybe even educational.
In the next few weeks, I will try to get some pictures up and post some of my previous meanderings through the countryside. But now I have to make a roadtrip to Soroti, and the macbook is not invited.
I have been working as a vso medical volunteer here in Kampala for slightly more than 5 months of a year-long placement. Over these months I have been sending out long rambling hyperdramatic emails to loved ones, family and friends. A few of whom ( a very few) have chastised me for being too lazy to write a blog such that I finally went to blogspot and discovered that even someone with my limited motivation and understanding of computers can have a blog in a matter of minutes.
So here it is. A blog. Those of you who asked for it, you know who you are, the rest of you probably clicked on a link for male enhancement.
First of all, the opinions expressed herein are the product of a deeply disturbed imagination coupled with a cynical nature and should not be thought to reflect the facts, the truth, reality or the official views of CUSO-VSO or any other person or organization described in the rambling passages that will fill this blog.
I am working as a medical volunteer. Some of the posts here may be on the unsettling side. I suggest at least a glass of red wine before proceeding. Most of the what I will write about, however, will not be of a medical nature. In general I will try to describe random moments of the life of a mzungu in Uganda--things that strike me as funny, ironic, or maybe even educational.
In the next few weeks, I will try to get some pictures up and post some of my previous meanderings through the countryside. But now I have to make a roadtrip to Soroti, and the macbook is not invited.
eid
November 27th
Today is Eid (Eid al-Adha), a Muslim holy day celebrating the willingness of the prophet Ibrahim (Abraham?) to sacrifice his son… If you are one of the faithful, you are probably eating goat tonight. My understanding is that today you are supposed to sacrifice a chicken, or a goat, or, if you are wealthy, a cow or two. You are to share the meat with the poor. About 10% of Ugandans are Muslim. But Eid is still a recognized bank and government holiday. At the Kibuli Muslim hospital, where Jean a VSO midwife works, there was a skeleton staff of infidels working.
Eid is not, however, a recognized IHK holiday, but the place is surprisingly vacant of staff all the same. Even our OPD and emergency areas are frighteningly empty (as I think I mentioned before… our clientele don’t like to waste their time off going to the doctor. Something to be said for that. I was thinking about scoring a 3 day weekend myself, but we had a training team meeting for the clinics this morning and Dr. Andrew, knowing I was already in for the meeting, asked me to cover for him.
Andrew is not Muslim. But it is his wedding anniversary, so I said sure. Andrew is one of the three medical directors here. The first two function so ineffectively at their jobs, they had to appoint Andrew medical director as well…(I don’t have a degree in medical management or anything—as it turns out, neither does Ian, or his buddy Kevin, our new ‘CEO’—but something seems wrong with this management strategy) Part of Andrew’s job is to put out customer care fires as they blaze up around the hospital…
Today’s customer care dilemma was an angry patient in pharmacy: A man suffering from diabetes who had just been told that his health insurance wasn’t going to pay for the insulin his doctor prescribed him. Hmmm. Probably my remark—that I’d be pretty pissed off, too, if I found out that my health plan didn’t cover the medicine that I needed to ward off premature heart disease, renal failure and blindness—did not help things much. And of course, his health coverage is us.
With IAA, and our newly acquired Microcare (finally, an insurance company that tells you right up front exactly how much they care) insurance line, the International Medical group at IHK now has the biggest share of the health insurance market in Uganda. And unfortunately, the folks who sell our policies have taken a page out of the American Insurance industry playbook: Advertise the world, sell the moon, and then given them the 27 page booklet of fine-print exclusions. Things like insulin.
Lorna, the customer care rep for the day, wanted to pin the problem on one of my doctors. ‘She (the doctor) shouldn’t have prescribed insulin. She knows we don’t pay for insulin.’ I tried to explain the concepts of the physician as patient advocate and do no harm. But she wanted me to reprimand Dr. Emma and have her apologize to the patient. Let me think… No. I think Lorna will be happy when Dr. Andrew gets back on Monday.
Today is Eid (Eid al-Adha), a Muslim holy day celebrating the willingness of the prophet Ibrahim (Abraham?) to sacrifice his son… If you are one of the faithful, you are probably eating goat tonight. My understanding is that today you are supposed to sacrifice a chicken, or a goat, or, if you are wealthy, a cow or two. You are to share the meat with the poor. About 10% of Ugandans are Muslim. But Eid is still a recognized bank and government holiday. At the Kibuli Muslim hospital, where Jean a VSO midwife works, there was a skeleton staff of infidels working.
Eid is not, however, a recognized IHK holiday, but the place is surprisingly vacant of staff all the same. Even our OPD and emergency areas are frighteningly empty (as I think I mentioned before… our clientele don’t like to waste their time off going to the doctor. Something to be said for that. I was thinking about scoring a 3 day weekend myself, but we had a training team meeting for the clinics this morning and Dr. Andrew, knowing I was already in for the meeting, asked me to cover for him.
Andrew is not Muslim. But it is his wedding anniversary, so I said sure. Andrew is one of the three medical directors here. The first two function so ineffectively at their jobs, they had to appoint Andrew medical director as well…(I don’t have a degree in medical management or anything—as it turns out, neither does Ian, or his buddy Kevin, our new ‘CEO’—but something seems wrong with this management strategy) Part of Andrew’s job is to put out customer care fires as they blaze up around the hospital…
Today’s customer care dilemma was an angry patient in pharmacy: A man suffering from diabetes who had just been told that his health insurance wasn’t going to pay for the insulin his doctor prescribed him. Hmmm. Probably my remark—that I’d be pretty pissed off, too, if I found out that my health plan didn’t cover the medicine that I needed to ward off premature heart disease, renal failure and blindness—did not help things much. And of course, his health coverage is us.
With IAA, and our newly acquired Microcare (finally, an insurance company that tells you right up front exactly how much they care) insurance line, the International Medical group at IHK now has the biggest share of the health insurance market in Uganda. And unfortunately, the folks who sell our policies have taken a page out of the American Insurance industry playbook: Advertise the world, sell the moon, and then given them the 27 page booklet of fine-print exclusions. Things like insulin.
Lorna, the customer care rep for the day, wanted to pin the problem on one of my doctors. ‘She (the doctor) shouldn’t have prescribed insulin. She knows we don’t pay for insulin.’ I tried to explain the concepts of the physician as patient advocate and do no harm. But she wanted me to reprimand Dr. Emma and have her apologize to the patient. Let me think… No. I think Lorna will be happy when Dr. Andrew gets back on Monday.
a kampala thanksgiving
November 26th
Thanksgiving in Uganda.
The rainy season continues. As I’ve said, I prefer the mud to the dust (‘cuz the dust doesn’t get into your lungs), but the 4am thunder storms that have ruined my sleep for the past week are getting a little old. And the back roads that I walk to work on are getting slowly washed downhill. Some less slowly than others. Occasionally a truck will pull up at the bottom of the washout (on Bukasa road, where the mud hits the pavement) and a group of young men will get out and shovel the silt into the bed where it will get mixed with yard clippings, household waste and the odd brick. The truck will then drive up one of the dirt roads and find a particularly nasty hole or rut to shovel their road fill mixture into. They will gently pat the unstable mass with their instruments or their flip flops and move on to the next highway repair job… two storms later, the disposable diaper that was the lone structural element of the road patch will be back down on Bukasa road.
This morning, on my walk to work, as I made my usual corner-cut up through the housing development (2 ragged lines of rust roofed shacks surrounding a mud courtyard and a row of pit latrines) on the corner of Bukasa and St. Barnabas roads, a large turkey with its tail feathers fully arrayed walked around one of the latrines and blocked my path. (I know it sounds like I’m probably invading the privacy of the 20 or 30 people who live on this sloping scrap of earth roughly the size of your living room, but I have been assured that the path that winds by the latrines is a public right of way). Usually I see chickens and goats and half naked children on this section of my commute, but, in the 3-4 months that I have crossed this yard, I have never seen a turkey. I stood there looking at the turkey. He looked at me. The tail feathers grew ever so slightly more erect. Was it a sign? Was I really supposed to be at home peeling sweet potatoes instead of going to work? Was someone trying to tell me that my excuse (our oven only works on broil, our refrigerator just died, and, for some reason, our hot water taps have run dry) for skipping the traditional American exercise in excess is a lame one?
A small bareassed and barefooted toddler runs over, kicks the turkey in its tail feathers, and runs off squealing before the turkey can mount a defense.
No matter where you are, it sucks to be a turkey on thanksgiving.
So instead of stuffing a turkey, I went off to give a lecture on oxygenation, ventilation and airway management.
For dinner we went to the New York kitchen restaurant. Conveniently located in the parking garage of the Garden City shopping center—with outdoor seating in parking stalls B1-6. I figured that since, surprisingly enough, I hadn’t been invited to thanksgiving at the American embassy (and I don’t belong to the American Recreation Assoc.), it would be my best chance of getting some turkey with stuffing and overly-thickened brown gravy. No such luck. I had a chicken chef’s salad instead. The volunteer sitting next to me, a Norwegian who writes news stories for Mama FM radio (an NGO nonprofit thingy that gets disadvantaged women on the air), kept looking at my dinner. Finally she said, ‘you’re eating a salad?’ Yes, I had to admit, I was. I guess I’ve gotten slightly away from the peel it, boil it or throw it away doctrine.
After dinner we went bowling.
Thanksgiving in Uganda.
The rainy season continues. As I’ve said, I prefer the mud to the dust (‘cuz the dust doesn’t get into your lungs), but the 4am thunder storms that have ruined my sleep for the past week are getting a little old. And the back roads that I walk to work on are getting slowly washed downhill. Some less slowly than others. Occasionally a truck will pull up at the bottom of the washout (on Bukasa road, where the mud hits the pavement) and a group of young men will get out and shovel the silt into the bed where it will get mixed with yard clippings, household waste and the odd brick. The truck will then drive up one of the dirt roads and find a particularly nasty hole or rut to shovel their road fill mixture into. They will gently pat the unstable mass with their instruments or their flip flops and move on to the next highway repair job… two storms later, the disposable diaper that was the lone structural element of the road patch will be back down on Bukasa road.
This morning, on my walk to work, as I made my usual corner-cut up through the housing development (2 ragged lines of rust roofed shacks surrounding a mud courtyard and a row of pit latrines) on the corner of Bukasa and St. Barnabas roads, a large turkey with its tail feathers fully arrayed walked around one of the latrines and blocked my path. (I know it sounds like I’m probably invading the privacy of the 20 or 30 people who live on this sloping scrap of earth roughly the size of your living room, but I have been assured that the path that winds by the latrines is a public right of way). Usually I see chickens and goats and half naked children on this section of my commute, but, in the 3-4 months that I have crossed this yard, I have never seen a turkey. I stood there looking at the turkey. He looked at me. The tail feathers grew ever so slightly more erect. Was it a sign? Was I really supposed to be at home peeling sweet potatoes instead of going to work? Was someone trying to tell me that my excuse (our oven only works on broil, our refrigerator just died, and, for some reason, our hot water taps have run dry) for skipping the traditional American exercise in excess is a lame one?
A small bareassed and barefooted toddler runs over, kicks the turkey in its tail feathers, and runs off squealing before the turkey can mount a defense.
No matter where you are, it sucks to be a turkey on thanksgiving.
So instead of stuffing a turkey, I went off to give a lecture on oxygenation, ventilation and airway management.
For dinner we went to the New York kitchen restaurant. Conveniently located in the parking garage of the Garden City shopping center—with outdoor seating in parking stalls B1-6. I figured that since, surprisingly enough, I hadn’t been invited to thanksgiving at the American embassy (and I don’t belong to the American Recreation Assoc.), it would be my best chance of getting some turkey with stuffing and overly-thickened brown gravy. No such luck. I had a chicken chef’s salad instead. The volunteer sitting next to me, a Norwegian who writes news stories for Mama FM radio (an NGO nonprofit thingy that gets disadvantaged women on the air), kept looking at my dinner. Finally she said, ‘you’re eating a salad?’ Yes, I had to admit, I was. I guess I’ve gotten slightly away from the peel it, boil it or throw it away doctrine.
After dinner we went bowling.
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