April 11, 2007
Easter Sunday
Mmmm… It’s Easter Sunday. The sun is starting to play hide and seek- finding refuge between the horizon and a few lingering clouds. The wind is dropping a few degrees with every new gust- and with every new gust, a new smell- roasting plantains, lake water, smoke from the bonfire–loud beats thumping from the bar across the beach. Since I’m still waiting to hear back from work and the whole country is on a four day holiday, I hopped on a 4 hour ferry to the ever-popular, but crazy strange, Ssese Islands- an archipelago of 84 islands amidst of what is known to be “the greatest vertebrate mass extinction in recorded history” (– A quick tangent, Kampala is on Lake Victoria, the world’s second largest freshwater body… but unfortunately, this lake has been suffering from total environment degradation since the early colonial era. It started with over-fishing, then continued with the introduction of Nile tilapia which threw off the whole ecosystem. This environmental destruction continued with the runoff of agricultural chemicals – resulting in booming levels of algae, therefore decreased levels of oxygen, leaving Lake Victoria as a mass of dead water – no oxygen, no fish, just loads of algae and bilharzia. Anyway, it’s the weirdest feeling being on this island, you end up laying out in the sun on a white sand beach and having to treat the water that’s two feet away from you as if it were a toxic bath). Seriously, I should be shot. I’m clumsily multi-tasking – in one hand, I’m babbling away on the phone with Dan about wind reports at Crissy Field and life as we do, and fumbling with the camera in the other hand as I’m trying to take a picture of the sunset, all without stopping the momentum of the rocking hammock with my right foot. I never thought I‘d ever say this, but I miss my life back at home, miss being stressed, miss the jog up Fort Mason along the bay, miss crisp spinach, miss silly girly chit chats with my favorite paparazzi, miss my space, miss feeling grounded.
But the thought of the day puts a smile back on my face- Easter really was unlike any other. Earlier this morning, I took a boda boda and zipped through fields of tall golden grass on a dirt path, zig-zagging up the Kalangala hill to the village’s small church – a very modest inconspicuous one-story tall building. The bewitching intricate beat of bongo drums intermingled with a few scraggly voices leads us towards the Easter service. I take a seat next to a shriveled little old lady lost in an extravagant elaborate traditional dress. Her eyes are sparkling through piles of wrinkles. She smiles, it’s completely contagious. I look around the room – white washed walls, bars over windows with no glass pane, a simple cross made from two wooden sticks adorn the front wall, benches packed together as tightly as possible, in turn packed with people as tightly as possible, people flooding out of the doors onto blankets under the windows, little munchkins dressed in oversized black tie regalia running through the aisles. Ah, I love this! – oh wait, until I find myself paralyzed under the glare of those sparkling adorable eyes every time I eye the exit door throughout the 3 hour service in Luganda. Ah la la, an Easter to remember.
Ride back
The African orphan ads we chuck in junk mail never felt so real.
Monday morning, it’s time to get off the island and back to the city. But we discover at 7 am that the 8:30 ferry, and only ferry, back to Kampala has already left. The boat was full. Ok, plan B. You always need a plan B in Uganda. The only other option is to take the long way back. So boda boda (motocycle taxi) to Kalangala, matatu (intended 14 person mini-van, which turns out to be 25 –30 once out of Kampala) to the other ferry, ferry to mainland town/fishing village, taxi (Corolla intended for 4 passengers, 8-10 people when out of Kampala) from fishing village to Masaka and then take a bus from Masaka to Kampala, probably 9 hours door to door. It’s going to be a long, rough road, but fine- it’s all an adventure.
We’ve now reached the second stage of the trip back to Kampala, cruising along in a raging matatu easily going over 80 mph on a dirt road. We can barely catch a glimpse the racing countryside, when the driver slows down – Five little silhouettes are trotting alongside the road, one carrying a huge bag atop his head. The tallest carrying the bag looks like he’s about seven, turns out he’s 10. The youngest is barely 3. Two of the toddlers have fuzzy orangey hair – a sign of malnutrition. The conductor hops out and calls out to the boy with the bag over his head – Replying in muffled Luganda, the boy looks down at his feet while the other four stare blankly at the matatu, wide empty and eerily cloudy grey eyes. Silence. They have 10, 000 shillings, which is barely enough to pay for two seats on the ferry to come – how they were supposed to make it from Kalangala to the ferry and from the ferry to Masaka, which is a full day’s trip with wheels? And more importantly, what were these kids doing alone? And on such a trip? The conductor opens the door of the matatu, and five little bodies with torn, dirty shreds of clothes, rocks studding their bare feet, pile in. The car drives off, slowly and silently.
The matatu finally arrives at the pier where the ferry should be (which, of course, is not there, nor is it working today – Ugandan style). Two girls from the matatu and I unload our bags and find a spot in the shade – noticing that the five kids are slinking away, all huddling and finding refuge behind the 10 year old. We call them over and offer them a few snacks, which they shyly, quietly but voraciously devour. Over the course of the next few hours as we wait by the side of the pier, their story unravels.
Their father died of AIDS and their mother sick (the Ssese islands have about 25% AIDS prevalence). She works in Masaka, traveling the 6 hour road once a week back to Kalangala to drop off food supplies for the week. Thus, the oldest (the tiny 10 year old) cares for his four younger brothers and sisters – I used to take care of the most autonomous, independent, brilliant 10 year old back in New York - no comparison - while I’d like to think that children are just children, no, its a world apart. So the eldest, being in charge of the well-being of his family and household, had to pay the school fees and was heading off searching for his mum. However, since there was no one to care for his brothers and sisters (some so young they were barely walking), he had to take them with him.
A small fishing boat putters up towards the pier, offering to take us all across. We all pile in, and I take one of the little girls on my lap. Hot, damp little feet dangle against my legs. I don’t think I’ve ever felt so helpless, so ill-at-ease, so motherly as with this frail delicate sweaty little body on my lap- all I wanted to do was hold them, protect them, relieve them of this undeserving situation, give them everything I had on me, make it all disappear. What do you do in such a situation? The immediate was to feed them, buy them shoes, make sure that they safely arrived where they wanted, making sure they’d be ok for today and leaving them better off than when we had met them. But then what? Making sure they’d be ok for tomorrow, and maybe the day after that? But then what? But putting these adorable and heart-wrenching munchkins aside, a flood of new questions … What would happen if they had traveled all this distance and their mother was not there? 20% of children in Uganda are orphans (mostly due to AIDS) under the age of 18. There’s absolutely no infrastructure for them, nowhere for them to turn; less than a quarter have access to free services and external support. How does a situation like this occur? How can a situation like this be resolved? This is just the tip of the iceberg… triggering a chain reaction of interlinked HIV/AIDS, ABC methods (abstinence, being faithful, condoms), contraception, abortion, sexually based violence, brought forth with the greater questions of poverty that affect most of the world just outside of our comfortable doors … how do you tackle one issue, without tackling them all?
But the saddest part of the story is that this story is all but uncommon.
Monday, April 23, 2007
Thursday, April 19, 2007
Tanzania
Africa can also be a fairy tale. I had just finished reading Kuki Gallman’s book, African Nights- a book with the most beautiful descriptions of lions and elephants and leopards and of the amazing symbiotic relationship that this mizungu woman had fostered between these creatures and herself. A few times, I had to stop reading and put the book down, infuriated by her self-righteous style and overly-romantic vision of Africa. Where were the slums, the overcrowded streets, the lingering cloud of exhaust, the incessant noise of a bustling city that shared the same land that she was describing… grrr, false advertising!
“It is the Africa that, since the beginning of time, has evoked in travelers a deep recognition, an inexplicable yearning to return. The place that still has what most of the world has lost. Space. Roots. Traditions. Stunning beauty. True wilderness. Rare animals. Extraordinary people. The land that will always attract those who can still dream.”
Yes, so maybe this passage is now underlined and covered with angry exclamation marks all over the margins. The Africa she was describing with such mystery, superstition, danger and beauty belonged to an Africa from last century and Dinesen’s Out of Africa! Oh, but I was wrong, there really is such a place… and I would later recognize Gallman’s beloved Kenya in the endless plains of the Serengeti, the wild jungles of Lake Manyara and the surreal crater of Ngorongoro, in an unforgettable trip.
Lake Manyara
The little plane slowly putters its way down, hiccupping its way through heavy clouds. I’m grabbing the sides of the seats, my palms are clammy; I look over to Pierre, who’s completely absorbed with videotaping the pilot, control panel and descent with great concentration. A barely visible airstrip appears, Pierre’s concentrated pout melts into a huge grin, the plane lands.
We jump out in the heavy mist, run to a land rover parked by the side of the airstrip. A tall, handsome man in dressed in khaki greets us ‘ Welcome to Tanzania, my name is Ndoskoi and I’ll be your guide for the week’. Oh, let the adventure begin!
“So how about a safari on the way to the lodge?” Asks Ndoskoi as we drive away from the airstrip. Somehow, I thought of safaris as hours of driving, through plains, up mountains, down valleys, to the moon and back just to catch a far-away glimpse of a few exotic animals. And with Pierre having been to every bit of the world and twice back, this was going to be a treat… A few minutes later, the car arrives at the gates of the Lake Manyara National Park- Our 4x4 slowly enters these densely packed tall trees – lianas, thick vegetation with a balance of tall acacias and bushy bushes. The car creeps around every turn, over every rock, feeling terribly sneaky. “OH MY GOD A BABOON!!! ” Shhtt… a silent pandemonium fills the car – “where’s the camera, you had it! No! so where’s yours? oh take the camera, no! better angle here! Don’t open the window, they’re baboons! Be careful, oh, baboons!” Ndoskoi just sits back and smiles. Three goofy baboons walking as if puppets held by strings stop and look at us from the side of the road with their large owl-like eyes. We stare at them, they stare at us. After spending a good twenty minutes oogling and googling over these three monkeys and exhausting our camera capacities, the landrover lurks on.. Not even a minute later, another group of baboons. “Look look, another baboon!!!” The car stops, the same circus in the car proceeds. But by the time we reach the hotel (which turns out to be a childhood dream come true- each room is actually its own tree house- although tastefully conceived in a mixture of rustic and sophisticated design), baboons have become part of the landscape, and we numbly drive past dozens of groups of baboons, not even slowly down.
The following day, the same happens- first wart hogs, then elephants, then buffalo, flamingos, giraffes, lions, zebras, ostriches. Ah, I would have to write a never-ending book describing all of the animals and landscape in my awkward words, but words wouldn’t do Lake Manyara or the rest of the trip any justice. The only way to do so would be with a diary of pictures…
So in the theme of yearbooks, here are the superlatives minus the pictures:
Most impressive: Elephants. Powerful, dangerous, gigantic, confident, calculated stride, rugged skin, softest and kindest eyes ever. Takes your breathe away.
Sexiest: it’s a tie between zebras and giraffes, although Pierre seemed to have an unusual soft spot for the former. Patterns more refined than you could ever imagine…
Most disappointing: cheetahs – I was expecting them to be dangerously elegant creatures, but cheetahs are slightly small in stature with a little scraggly fur. But beside those initial superficial first impressions, they're amazing. We were in awe as we observed three female cheetahs hunting a baby wildebeest.
Shyest: Black rhino. We spent a good afternoon trying to track him in the Ngorongoro crater, spotted his horn and waited over an hour for him to make a full frontal appearance. Unsuccessfully.
Most standout moment: tie between lunching in the midst of the wildebeest migration, when we were surrounded by thousands of wildebeest and zebras, and watching the sun rise in the middle of the Serengeti plains.
Most obnoxious moment: how commercial we found the Masai Mara to be. Beautiful people, bold colors, but it seemed as if all of their authenticity vaporized for tourist dollars and satisfaction.
Most inappropriate moment: videotaping impalas in the heat of the moment. Oh, and lions too…
Only animals, wilderness, comfort, romanticism, exoticism; was this the real Africa? But safaris can’t only be Disneyland for tourists. How can such polar opposite worlds coexist so closely together? Another layer to the intricacies of this continent…
Africa can also be a fairy tale. I had just finished reading Kuki Gallman’s book, African Nights- a book with the most beautiful descriptions of lions and elephants and leopards and of the amazing symbiotic relationship that this mizungu woman had fostered between these creatures and herself. A few times, I had to stop reading and put the book down, infuriated by her self-righteous style and overly-romantic vision of Africa. Where were the slums, the overcrowded streets, the lingering cloud of exhaust, the incessant noise of a bustling city that shared the same land that she was describing… grrr, false advertising!
“It is the Africa that, since the beginning of time, has evoked in travelers a deep recognition, an inexplicable yearning to return. The place that still has what most of the world has lost. Space. Roots. Traditions. Stunning beauty. True wilderness. Rare animals. Extraordinary people. The land that will always attract those who can still dream.”
Yes, so maybe this passage is now underlined and covered with angry exclamation marks all over the margins. The Africa she was describing with such mystery, superstition, danger and beauty belonged to an Africa from last century and Dinesen’s Out of Africa! Oh, but I was wrong, there really is such a place… and I would later recognize Gallman’s beloved Kenya in the endless plains of the Serengeti, the wild jungles of Lake Manyara and the surreal crater of Ngorongoro, in an unforgettable trip.
Lake Manyara
The little plane slowly putters its way down, hiccupping its way through heavy clouds. I’m grabbing the sides of the seats, my palms are clammy; I look over to Pierre, who’s completely absorbed with videotaping the pilot, control panel and descent with great concentration. A barely visible airstrip appears, Pierre’s concentrated pout melts into a huge grin, the plane lands.
We jump out in the heavy mist, run to a land rover parked by the side of the airstrip. A tall, handsome man in dressed in khaki greets us ‘ Welcome to Tanzania, my name is Ndoskoi and I’ll be your guide for the week’. Oh, let the adventure begin!
“So how about a safari on the way to the lodge?” Asks Ndoskoi as we drive away from the airstrip. Somehow, I thought of safaris as hours of driving, through plains, up mountains, down valleys, to the moon and back just to catch a far-away glimpse of a few exotic animals. And with Pierre having been to every bit of the world and twice back, this was going to be a treat… A few minutes later, the car arrives at the gates of the Lake Manyara National Park- Our 4x4 slowly enters these densely packed tall trees – lianas, thick vegetation with a balance of tall acacias and bushy bushes. The car creeps around every turn, over every rock, feeling terribly sneaky. “OH MY GOD A BABOON!!! ” Shhtt… a silent pandemonium fills the car – “where’s the camera, you had it! No! so where’s yours? oh take the camera, no! better angle here! Don’t open the window, they’re baboons! Be careful, oh, baboons!” Ndoskoi just sits back and smiles. Three goofy baboons walking as if puppets held by strings stop and look at us from the side of the road with their large owl-like eyes. We stare at them, they stare at us. After spending a good twenty minutes oogling and googling over these three monkeys and exhausting our camera capacities, the landrover lurks on.. Not even a minute later, another group of baboons. “Look look, another baboon!!!” The car stops, the same circus in the car proceeds. But by the time we reach the hotel (which turns out to be a childhood dream come true- each room is actually its own tree house- although tastefully conceived in a mixture of rustic and sophisticated design), baboons have become part of the landscape, and we numbly drive past dozens of groups of baboons, not even slowly down.
The following day, the same happens- first wart hogs, then elephants, then buffalo, flamingos, giraffes, lions, zebras, ostriches. Ah, I would have to write a never-ending book describing all of the animals and landscape in my awkward words, but words wouldn’t do Lake Manyara or the rest of the trip any justice. The only way to do so would be with a diary of pictures…
So in the theme of yearbooks, here are the superlatives minus the pictures:
Most impressive: Elephants. Powerful, dangerous, gigantic, confident, calculated stride, rugged skin, softest and kindest eyes ever. Takes your breathe away.
Sexiest: it’s a tie between zebras and giraffes, although Pierre seemed to have an unusual soft spot for the former. Patterns more refined than you could ever imagine…
Most disappointing: cheetahs – I was expecting them to be dangerously elegant creatures, but cheetahs are slightly small in stature with a little scraggly fur. But beside those initial superficial first impressions, they're amazing. We were in awe as we observed three female cheetahs hunting a baby wildebeest.
Shyest: Black rhino. We spent a good afternoon trying to track him in the Ngorongoro crater, spotted his horn and waited over an hour for him to make a full frontal appearance. Unsuccessfully.
Most standout moment: tie between lunching in the midst of the wildebeest migration, when we were surrounded by thousands of wildebeest and zebras, and watching the sun rise in the middle of the Serengeti plains.
Most obnoxious moment: how commercial we found the Masai Mara to be. Beautiful people, bold colors, but it seemed as if all of their authenticity vaporized for tourist dollars and satisfaction.
Most inappropriate moment: videotaping impalas in the heat of the moment. Oh, and lions too…
Only animals, wilderness, comfort, romanticism, exoticism; was this the real Africa? But safaris can’t only be Disneyland for tourists. How can such polar opposite worlds coexist so closely together? Another layer to the intricacies of this continent…
Wednesday, April 4, 2007
Rwanda and the DR Congo
- my computer gave up, has gone on vacation, so fini with iPhoto – the next pictures will have to come up when back in SF -
Kampala
Back to the human jungle and chaos! My mum has always been a proponent of visiting markets when traveling to new country, saying that they show the true colors of its people and culture. Kampala’s main open air market was to be no exception. Owino Market was known as one of the most chaotic spots of the capital, as well as being the accessories and wardrobe closet for ‘The Last King of Scotland’. So I asked Justine, Heidi's housekeeper, if I could tag along and help her with groceries and errands. It was early on a Monday afternoon, Justine had just finished work early and had a few hours before picking her daughter up from school.
We get off the matatu at the City Center (at which point I find out that I had been paying double the standard fare the entire time, bloody mizungu tax!). With the simplicity of a little girl, Justin takes my hand before diving into the downtown chaos. Chatting, giggling, we float our way through rivers of people - under the scorching equatorial sun and amidst the smells of animal, man, food, and dust that come along with the heat. Not even five minutes into our expedition, an army vehicle drives by with six soldiers in camouflage with large black guns in the back of the truck. Suddenly, there's a quick change in the happy jostling atmosphere of the crowd. The flow of the pedestrians has now changed to one general direction, and from a slow pace to a more hurried and worried one. Justine stops in her tracks, eyes dart around alarmed but assertive, grabs my hand and whispers 'tear gas'.
Before I can even mutter a '???', we melt back into the crowd for a few moments, taken in by the momentum of the mass and then branch off on a little side alley- revealing a secret-garden-ish, hidden universe. Stuff. Everywhere. Rows of stuff- horizontal rows of stuff, vertical rows of stuff, like a thick overgrown tropical jungle- as far as the eye could see everywhere. Cloths, underwear, plastic toys, more cloths, posters, electronics, people sleeping in corners, people crouching behind stands, people running through stalls, a thick jungle of people and stuff. With a confident pace, Justine weaves our way through it all, hand in hand, away from disorganized chaos towards this organized chaos, we're at the gate to Owino Market. The crowd has now scattered, pace has returned to normal, as if nothing had happened. Justine later told me that she had been caught in teargas twice before, as teargas and police violence are the government's knee-jerk reaction to quell political and student protests- this time it was targeting Museveni's political opponent who was trying to infiltrate Parliament.
Owino is an experience in itself. I wish I could put a video of it on this thing to convey the feeling- there are these walkways that resemble the retractable bridges above medieval castles moats– as if the entrances of the market were the elevated bridges since the handbag and luggage vendors display their goods on these 20 ft tall panels. You then cross the walkway, under the towering display of bags, into Owino, and into a world of black leather shoes. I never knew so many black leather shoes existed; they're all second hand, but perfectly shined and looking new. We walk across 10, 50, 100 feet of wooden planks (covering the stagnant puddles of trash and rain from the night before) through piles of neatly arranged shiny black leather shoes, until we reach basketball jerseys. Another 10, 20, 50 feet of wooden planks through every basketball jersey conceivable, thousands piled up horizontally and vertically. Another ten feet, and we reach the linen department, and then the women's shirts, then women's pants, at which point the jungle of clothes part and we reach an opening, and here is the 'lingerie' department – a 15 x 15 area where five men are sitting on the floor surrounded by piles of lingerie, organizing, yelling, throwing items around. A ten minute walk later, we arrive at the end of the clothing jungle – grains. Every grain one could possibly imagine- huge bags, piles of peanuts, dried beans, soy. Then the butchers, then vegetables. Just as my eyes are about to pop out of my head, Justine takes my hand again, stops by her favorite passionfruit lady sitting in the 3 rd row, 7 piles down, and checks the first errand off her list.
Beginning of travels
Two months later, I finally feel as if I'm getting the hang of Kampala. Taking Jaime's words to heart- '"Wherever you are, be all there.". I've started to settle into a routine, am comfortable ridding side-saddle on the back of bodas (the motorcycle taxis), have *almost* seen the sun come up after a night of dancing, found my favorite jogging path through Makerere University campus – but work has been stagnating, which has made room for this crappy feeling of purposelessness. The most frustrating bit is that I feel like a spring, all wound up ready to work, completely give myself to a project, make a valid contribution… I'm ready, charged, wanting to put these past 18 years of school to good use, especially when one sees how much can be done here, on all different levels. But coordination, expectations, everything takes time here, so I'm just waiting to hear back… With the malaria project completed, the next one undetermined, I think I'll embrace unemployment and explore.
Rwanda
Rwanda – the country of a thousand hills (aptly named after the hotel starring Hotel Rwanda, 'Hotel des Milles Collines' ) – also known as the 'Switzerland of Africa', and yes, it's quite possibly one of the highlights of adventures so far.
I'm scribbling this over dinner at the New Cactus, a little Belgian restaurant that makes a mean grilled Tilapia, savoring a glass of South African sauvignon blanc, treating myself to a reminder of Westernism. In this lush green garden, Cesaria Evora in the background, romantic candlelight tables overlooking the twinkling lights of Kigali, capital of Rwanda, at the foot of the hill, it's hard to believe that this city was victim to one of the most horrific genocides of our time with more than a million deaths.
1994. I was in sixth grade, the year of Kurt Cobain's overdose, the rise of ska, mid-weekly's dance lessons… and I faintly remember headlines in the media of some 'internal conflict, a civil war' in Rwanda. Maybe it was because we were so far away, or maybe I was just too young (or clueless, as I realize is the case far too often), but I never quite understood the extent or meaning of a genocide within such a small, densely populated country. So yes, maybe the motives of my tourism are gruesome and voyeuristic- genocidal tourism- but it was this gruesome legacy which brought me to this unbelievable country.
At first glance, Rwanda just seems like a beautiful, fertile, lush country – with terraced rolling hills covered with a patchwork of dark chocolatey browns and deep olive greens, and all the hues between the two. Tea is one of their main exports, so the valleys between the hills are filled with the bright greens of the young tea buds, speckled with little dots of color from the bright clothing of tea-pickers. The roads are immaculate; not a pot-hole in site, speed limits properly marked and enforced, trees neatly line the road. This come in such a stark contrast with Uganda, where just a few kilometres north of the border, the roads are littered with trash, people drive like maniacs (love the cab that would still cruise, with no headlights, at normal speeds in Kabale), towns are grubbier. Even the people are different, mannerisms are different. On the drive to the Rwandan border, we were 8 scrunched in this tiny car, the woman beside me wanted to hold my hand and invited us to her home, Caribbean-beat music was happily blasting on the crackly radio, people just seemed to have a happier carefree way about them. But as soon as we crossed the border and hopped in a Rwandan taxi, we were 4, properly buckled in, music was either off or Western (I think I listened to more Celine Dion and Kenny Rogers in Rwanda than in my life combined!).
So Rwanda definitely has a very distinct feel - There's a sophisticated air to this capital, with undertones reminiscent of Geneva, perhaps due to the strong NGO presence mostly based out Switzerland– ranging from MSF, UNICEF, OXFAM, CICR, WHO, USAID, the list of labeled vehicles and imposing properties continues. Inflation is relatively low, the currency is strong, supermarkets have butter and Cote d'Or chocolate. You would never imagine that one million people (one million people, more than the population of San Francisco), Tutsis and moderate Hutus, were slaughtered, the rest of the country terrorized, vacated, destroyed, disseminated only a decade ago… But then you start talking to people and you find a few clues that hit you with such force- as if the Rwandan people were trying so hard to put the past behind and start from scratch: the cab driver, the hotel concierge, Frederick the passenger, Josephine, the woman who accompanied us through the streets of Gisenye, the two scouts I met at the restaurant in Kigali, they’re all orphans. The multitude of dismembered beggars, the disfigured man waiting by the car on my way back to Uganda, subtle traces of this horrible past are everywhere...
My god, the baggage, the stories – At first, I tippy toed around the subject, wanting to hear about the genocide first hand but not knowing how to approach such a personal and painful recent history, but then found that Rwandans are eager to share and tell you about their country. Their stories would come with a strange mixture of deep sorrow and love for their country, desire to make you appreciate Rwanda, with a very grounded, matter-of-fact way of dealing with the past. For example, I mistook this man getting in his Jeep for a cab driver, but he laughed and offered me a ride regardless- and for the entire duration of the car ride, he praised Rwanda as if he were its salesman, insisting on the greatest of its people, how they have learned from the past, are not the same people as 10 years ago and that I should encourage friends and family to visit. He was also an orphan. When I asked him why were people so eager to volunteer something so personal, he replied that it was important to approach the issue head on, as an integral part of moving forward.
Entry into Rwanda
With only a small backpack, passport in hand and a pocketful of Rwandan francs exchanged at the border (there are no known working ATMs in the country) on the black market, Mike (a med student from UCSF I had just met a few days earlier) and I bumbled across the Ugandan/Rwandan border, not exactly knowing where we were heading, except that our final destination was to be Lake Kivu. We had reached Kigali and the sun was beginning to call it a day, but the road to Gisenye (the town on Lake Kivu) seemed quick and easy enough from Kigali – besides, we were two and we were just going to head straight to a hotel upon arrival.
After purchasing a ticket in advance for an on-time departure in French (unheard of in Uganda), we hit the road in a mini-van, Kigali-Gisenye. Half an hour in the trip, this little old man is standing by the side of the road, looks left then right, then hobbles across the road, twenty feet in front of our racing matatu. The car can't stop, everybody gasps, but since we're driving on these narrow roads on such steep hills, we can't swerve. A brutal thump sends the whole matatu in shivers. Silence, people are running towards the car, to the man beside the car. Mike walks out, medical kit in hand- we were driving through what seemed to be a few houses, but people are coming out from everywhere, streaming, 20, 30, 40, to see what has happened. This is the first contact we have had with rural Rwanda- while I had been seduced by countryside, capital and people up to now, I had never seen such hungry poverty-stricken eyes in the past two months. Rather than calling out 'mizungu', kids were tugging at us aggressive calling out (or us?) 'money'.
But the old man is still breathing and is driven to a nearby hospital. There is nothing Mike can do and it seems best to let the crowd deal with this incident. We never knew the fate of the old man. We returned to the car and drove into the night.
The volcano
A couple hours later, the matatu is zipping along in total obscurity. Everything around us is pitch-black and the only thing we can see are the 10 feet in front of the car illuminated by the headlights, definitely creepy. And then we see the Nyiragongo Volcano. This is the most surreal amazing vision- a cartoon fairy tale couldn't have portrayed it any better- There, in the middle of the jet black vast open nothingness, big billows of foaming reddish grey smoke. The Lonely Planet vaguely mentioned a volcano on the Congolese border, but this angry, fuming, active volcano was the last thing we were expecting. Suddenly, the Congo – nicknamed the ‘true heart of darkness' – captured our interest.
The matatu putts along, finally arriving at the bus terminal at Gisenye around 9pm. We stumble out of the car, sleepy and achy, and find ourselves in a completely deserted town - we're in the center of town and one mangy security officer with a gun disproportionally large for his body size is lurking in the shadows. We jump in the back of the cab with Jules, the cab driver, who happens to be a pastor as well (and why not?). After a long day and finally finding vacancy, we collapse at the Hotel Gisenye. The following morning, it took a few moments to remind myself where we were- architecture, tall ceilings, lake views, manicured shrubbery landscape, it's all Switzerland. Even the butter with breakfast!
Gisenye is a strange place – the only non-Rwandan presence appears to be only NGO's, not a single tourist in sight. Apparently, this town was one of the most affected by the genocide. Rwandan officials were known to have their headquarters based out of the nicest hotel in town and had easy access to cross the lake into the Congo in the event of evacuation when the political situation became too hairy. The nearest point of refuge would’ve been Goma, the neighboring town just 5 km away on the Congolese side of the border. Goma also lay at the foot of Nyiragongo, an active volcano straddling the Congolese/Rwandan border – which erupted and swallowed half of this town in 2002. Goma would be our next destination.
Lake Kivu and the DR of Congo
So we quickly gobble down our breakfast; an array of exotic fruits (where we had these bitter but beautiful Asian plums- a hybrid between pomegranate, persimmons, with hues of greens and purples- but they just had to be enjoyed because they were so pretty, regardless of the taste), coffee, fresh bread… and yes, the quintessential flavorful creamy butter that tasted like cow. As we walk out of the hotel’s gate, Mike and I befriend Josephine, a university student who has the day off and she volunteers to guide us around the town for the day... just because. We stroll by the lake shores under tall manicured trees, with a run-down, nostalgic, grandiose air to this place, along a long road which leads to the Kivu Sun Hotel - the hotel that briefly served as the headquarters for the interim government that presided over the genocide… Kids everywhere, staring at us, aggressively. This is by far the most uncomfortable I’ve been so far – they’re pulling at our bags, demanding money, surrounding us. Thank God Josephine is with us. But what feels most disturbing, though, is the obvious divide between very wealthy and very poor, and that we unfortunately and uncomfortably fall in these tracks and follow the stereotype of segregation. There’s no middle ground- and feel as if we have no choice but to find ‘refuge’ in these tourist havens. Soon, we arrive at the gates of the Kivu Sun Hotel, where we part ways with Josephine and wait in the gated community for Jules, the pastor, to visit Goma.
Unchartered, unknown territory. Ouh, the sexiness of exploring a buried town at the foot of an active volcano. We read every bit of information about Goma available, spoke to every traveler we met, double checked the latest security reports with the local hotels – the rebel activity was located only at the rim of the crater, but the town of Goma was known to be safe during the day. Again, the only foreign presence being NGO and humanitarian aid organizations. After clearing the border with our pastor, we drive into a shabby, run-down town, we’ve already arrived. The car drives up a small hill, the road is getting a bit rougher, but the town is not as sexy as I had imagined. But suddenly, Mike knudges me, pointing at a small wall- a fence maybe.. ‘No, it’s the roof of a house covered by the lava’ explains Jules. My jaw drops- a completely new layer of life and town has been built directly above and among the old town. Two towns: one partially covered graveyard, the other resurrected new town- both co-existing in an eery symbiotic way. But as quickly as we had crossed over, we had to cross back into Gisenye. The shadows were getting longer, and our place was not there.
Bolting across the border
After sitting in a taxi for a good hour and a half waiting for the car to fill up with passengers, we finally leave the taxi park realizing that the border closes in two hours and that the road to the border is to take two hours. Why nobody else is tweaking out at the prospect of spending the night at the border, I can't tell you. So the taxi is chugging along, Mike is grumping- livid at the idea of missing his last day in Kampala if we get stuck, tea plantations racing by, kids running after the bus – we're at the border, 4 minutes before the deadline. However, we have to fill out exit forms from Rwanda, cross a large metal gate leaving Rwanda, walk over 100 meters through non-man's land, to cross another large metal gate opening up to Uganda, and fill out entry forms. Ah, I wish I could post a picture of this whole scene! Mike's roommates found themselves in this situation just a few weeks back, arriving at the Rwandan border like us at 6pm, thought they had made it and nonchalantly walked the 100 m only to realize that there was no one on the Ugandan side, so turned back to Rwanda, found that the Rwandan border officials had left, and so they had to sleep in no-man's land under the gaze of both Rwandan and Ugandan border patrols. So in the most ridiculous sprint under the cheer (and yes, I got a high five) of the black-market currency exchangers, with books and flashlights flying out of backpacks in the muddy truck tracks, we made it.
Bus ride back home from Rwanda
(3 days later, 2nd trip in Rwanda, having return to Rwanda for a few days after Mike left)
I'm sitting on the coach bus, embarked on a 9h bus ride back. We've just crossed the border, music starts to resound, the TV is turned on, with movie entitled 'Without Shame'. The text with the title and the cast pops up a-la-Back to the Future. This is Nollywood- the 2 nd largest movie industry after Hollywood is Bollywood, with Nollywood coming in third (Rwanda's budding movie industry goes by Hillywood). Mind you, 95% of the bus is male, but their cool, composed, oozing-with-virility demeanor switches to that of a group of Latin American grandmothers giddy over soap operas. The Nollywood acting and way of filming is very different than what we are used to in the West- one may think almost rudimentary, but not to this crowd. Just as the husband is about to reprimand the wife on her marital duties, the lover hiding in the shower, the crowd goes wild. Yes, even the large old man overflowing into my seat is hooting at the lover. Priceless. Best bus ride I've ever had.
Kampala
Back to the human jungle and chaos! My mum has always been a proponent of visiting markets when traveling to new country, saying that they show the true colors of its people and culture. Kampala’s main open air market was to be no exception. Owino Market was known as one of the most chaotic spots of the capital, as well as being the accessories and wardrobe closet for ‘The Last King of Scotland’. So I asked Justine, Heidi's housekeeper, if I could tag along and help her with groceries and errands. It was early on a Monday afternoon, Justine had just finished work early and had a few hours before picking her daughter up from school.
We get off the matatu at the City Center (at which point I find out that I had been paying double the standard fare the entire time, bloody mizungu tax!). With the simplicity of a little girl, Justin takes my hand before diving into the downtown chaos. Chatting, giggling, we float our way through rivers of people - under the scorching equatorial sun and amidst the smells of animal, man, food, and dust that come along with the heat. Not even five minutes into our expedition, an army vehicle drives by with six soldiers in camouflage with large black guns in the back of the truck. Suddenly, there's a quick change in the happy jostling atmosphere of the crowd. The flow of the pedestrians has now changed to one general direction, and from a slow pace to a more hurried and worried one. Justine stops in her tracks, eyes dart around alarmed but assertive, grabs my hand and whispers 'tear gas'.
Before I can even mutter a '???', we melt back into the crowd for a few moments, taken in by the momentum of the mass and then branch off on a little side alley- revealing a secret-garden-ish, hidden universe. Stuff. Everywhere. Rows of stuff- horizontal rows of stuff, vertical rows of stuff, like a thick overgrown tropical jungle- as far as the eye could see everywhere. Cloths, underwear, plastic toys, more cloths, posters, electronics, people sleeping in corners, people crouching behind stands, people running through stalls, a thick jungle of people and stuff. With a confident pace, Justine weaves our way through it all, hand in hand, away from disorganized chaos towards this organized chaos, we're at the gate to Owino Market. The crowd has now scattered, pace has returned to normal, as if nothing had happened. Justine later told me that she had been caught in teargas twice before, as teargas and police violence are the government's knee-jerk reaction to quell political and student protests- this time it was targeting Museveni's political opponent who was trying to infiltrate Parliament.
Owino is an experience in itself. I wish I could put a video of it on this thing to convey the feeling- there are these walkways that resemble the retractable bridges above medieval castles moats– as if the entrances of the market were the elevated bridges since the handbag and luggage vendors display their goods on these 20 ft tall panels. You then cross the walkway, under the towering display of bags, into Owino, and into a world of black leather shoes. I never knew so many black leather shoes existed; they're all second hand, but perfectly shined and looking new. We walk across 10, 50, 100 feet of wooden planks (covering the stagnant puddles of trash and rain from the night before) through piles of neatly arranged shiny black leather shoes, until we reach basketball jerseys. Another 10, 20, 50 feet of wooden planks through every basketball jersey conceivable, thousands piled up horizontally and vertically. Another ten feet, and we reach the linen department, and then the women's shirts, then women's pants, at which point the jungle of clothes part and we reach an opening, and here is the 'lingerie' department – a 15 x 15 area where five men are sitting on the floor surrounded by piles of lingerie, organizing, yelling, throwing items around. A ten minute walk later, we arrive at the end of the clothing jungle – grains. Every grain one could possibly imagine- huge bags, piles of peanuts, dried beans, soy. Then the butchers, then vegetables. Just as my eyes are about to pop out of my head, Justine takes my hand again, stops by her favorite passionfruit lady sitting in the 3 rd row, 7 piles down, and checks the first errand off her list.
Beginning of travels
Two months later, I finally feel as if I'm getting the hang of Kampala. Taking Jaime's words to heart- '"Wherever you are, be all there.". I've started to settle into a routine, am comfortable ridding side-saddle on the back of bodas (the motorcycle taxis), have *almost* seen the sun come up after a night of dancing, found my favorite jogging path through Makerere University campus – but work has been stagnating, which has made room for this crappy feeling of purposelessness. The most frustrating bit is that I feel like a spring, all wound up ready to work, completely give myself to a project, make a valid contribution… I'm ready, charged, wanting to put these past 18 years of school to good use, especially when one sees how much can be done here, on all different levels. But coordination, expectations, everything takes time here, so I'm just waiting to hear back… With the malaria project completed, the next one undetermined, I think I'll embrace unemployment and explore.
Rwanda
Rwanda – the country of a thousand hills (aptly named after the hotel starring Hotel Rwanda, 'Hotel des Milles Collines' ) – also known as the 'Switzerland of Africa', and yes, it's quite possibly one of the highlights of adventures so far.
I'm scribbling this over dinner at the New Cactus, a little Belgian restaurant that makes a mean grilled Tilapia, savoring a glass of South African sauvignon blanc, treating myself to a reminder of Westernism. In this lush green garden, Cesaria Evora in the background, romantic candlelight tables overlooking the twinkling lights of Kigali, capital of Rwanda, at the foot of the hill, it's hard to believe that this city was victim to one of the most horrific genocides of our time with more than a million deaths.
1994. I was in sixth grade, the year of Kurt Cobain's overdose, the rise of ska, mid-weekly's dance lessons… and I faintly remember headlines in the media of some 'internal conflict, a civil war' in Rwanda. Maybe it was because we were so far away, or maybe I was just too young (or clueless, as I realize is the case far too often), but I never quite understood the extent or meaning of a genocide within such a small, densely populated country. So yes, maybe the motives of my tourism are gruesome and voyeuristic- genocidal tourism- but it was this gruesome legacy which brought me to this unbelievable country.
At first glance, Rwanda just seems like a beautiful, fertile, lush country – with terraced rolling hills covered with a patchwork of dark chocolatey browns and deep olive greens, and all the hues between the two. Tea is one of their main exports, so the valleys between the hills are filled with the bright greens of the young tea buds, speckled with little dots of color from the bright clothing of tea-pickers. The roads are immaculate; not a pot-hole in site, speed limits properly marked and enforced, trees neatly line the road. This come in such a stark contrast with Uganda, where just a few kilometres north of the border, the roads are littered with trash, people drive like maniacs (love the cab that would still cruise, with no headlights, at normal speeds in Kabale), towns are grubbier. Even the people are different, mannerisms are different. On the drive to the Rwandan border, we were 8 scrunched in this tiny car, the woman beside me wanted to hold my hand and invited us to her home, Caribbean-beat music was happily blasting on the crackly radio, people just seemed to have a happier carefree way about them. But as soon as we crossed the border and hopped in a Rwandan taxi, we were 4, properly buckled in, music was either off or Western (I think I listened to more Celine Dion and Kenny Rogers in Rwanda than in my life combined!).
So Rwanda definitely has a very distinct feel - There's a sophisticated air to this capital, with undertones reminiscent of Geneva, perhaps due to the strong NGO presence mostly based out Switzerland– ranging from MSF, UNICEF, OXFAM, CICR, WHO, USAID, the list of labeled vehicles and imposing properties continues. Inflation is relatively low, the currency is strong, supermarkets have butter and Cote d'Or chocolate. You would never imagine that one million people (one million people, more than the population of San Francisco), Tutsis and moderate Hutus, were slaughtered, the rest of the country terrorized, vacated, destroyed, disseminated only a decade ago… But then you start talking to people and you find a few clues that hit you with such force- as if the Rwandan people were trying so hard to put the past behind and start from scratch: the cab driver, the hotel concierge, Frederick the passenger, Josephine, the woman who accompanied us through the streets of Gisenye, the two scouts I met at the restaurant in Kigali, they’re all orphans. The multitude of dismembered beggars, the disfigured man waiting by the car on my way back to Uganda, subtle traces of this horrible past are everywhere...
My god, the baggage, the stories – At first, I tippy toed around the subject, wanting to hear about the genocide first hand but not knowing how to approach such a personal and painful recent history, but then found that Rwandans are eager to share and tell you about their country. Their stories would come with a strange mixture of deep sorrow and love for their country, desire to make you appreciate Rwanda, with a very grounded, matter-of-fact way of dealing with the past. For example, I mistook this man getting in his Jeep for a cab driver, but he laughed and offered me a ride regardless- and for the entire duration of the car ride, he praised Rwanda as if he were its salesman, insisting on the greatest of its people, how they have learned from the past, are not the same people as 10 years ago and that I should encourage friends and family to visit. He was also an orphan. When I asked him why were people so eager to volunteer something so personal, he replied that it was important to approach the issue head on, as an integral part of moving forward.
Entry into Rwanda
With only a small backpack, passport in hand and a pocketful of Rwandan francs exchanged at the border (there are no known working ATMs in the country) on the black market, Mike (a med student from UCSF I had just met a few days earlier) and I bumbled across the Ugandan/Rwandan border, not exactly knowing where we were heading, except that our final destination was to be Lake Kivu. We had reached Kigali and the sun was beginning to call it a day, but the road to Gisenye (the town on Lake Kivu) seemed quick and easy enough from Kigali – besides, we were two and we were just going to head straight to a hotel upon arrival.
After purchasing a ticket in advance for an on-time departure in French (unheard of in Uganda), we hit the road in a mini-van, Kigali-Gisenye. Half an hour in the trip, this little old man is standing by the side of the road, looks left then right, then hobbles across the road, twenty feet in front of our racing matatu. The car can't stop, everybody gasps, but since we're driving on these narrow roads on such steep hills, we can't swerve. A brutal thump sends the whole matatu in shivers. Silence, people are running towards the car, to the man beside the car. Mike walks out, medical kit in hand- we were driving through what seemed to be a few houses, but people are coming out from everywhere, streaming, 20, 30, 40, to see what has happened. This is the first contact we have had with rural Rwanda- while I had been seduced by countryside, capital and people up to now, I had never seen such hungry poverty-stricken eyes in the past two months. Rather than calling out 'mizungu', kids were tugging at us aggressive calling out (or us?) 'money'.
But the old man is still breathing and is driven to a nearby hospital. There is nothing Mike can do and it seems best to let the crowd deal with this incident. We never knew the fate of the old man. We returned to the car and drove into the night.
The volcano
A couple hours later, the matatu is zipping along in total obscurity. Everything around us is pitch-black and the only thing we can see are the 10 feet in front of the car illuminated by the headlights, definitely creepy. And then we see the Nyiragongo Volcano. This is the most surreal amazing vision- a cartoon fairy tale couldn't have portrayed it any better- There, in the middle of the jet black vast open nothingness, big billows of foaming reddish grey smoke. The Lonely Planet vaguely mentioned a volcano on the Congolese border, but this angry, fuming, active volcano was the last thing we were expecting. Suddenly, the Congo – nicknamed the ‘true heart of darkness' – captured our interest.
The matatu putts along, finally arriving at the bus terminal at Gisenye around 9pm. We stumble out of the car, sleepy and achy, and find ourselves in a completely deserted town - we're in the center of town and one mangy security officer with a gun disproportionally large for his body size is lurking in the shadows. We jump in the back of the cab with Jules, the cab driver, who happens to be a pastor as well (and why not?). After a long day and finally finding vacancy, we collapse at the Hotel Gisenye. The following morning, it took a few moments to remind myself where we were- architecture, tall ceilings, lake views, manicured shrubbery landscape, it's all Switzerland. Even the butter with breakfast!
Gisenye is a strange place – the only non-Rwandan presence appears to be only NGO's, not a single tourist in sight. Apparently, this town was one of the most affected by the genocide. Rwandan officials were known to have their headquarters based out of the nicest hotel in town and had easy access to cross the lake into the Congo in the event of evacuation when the political situation became too hairy. The nearest point of refuge would’ve been Goma, the neighboring town just 5 km away on the Congolese side of the border. Goma also lay at the foot of Nyiragongo, an active volcano straddling the Congolese/Rwandan border – which erupted and swallowed half of this town in 2002. Goma would be our next destination.
Lake Kivu and the DR of Congo
So we quickly gobble down our breakfast; an array of exotic fruits (where we had these bitter but beautiful Asian plums- a hybrid between pomegranate, persimmons, with hues of greens and purples- but they just had to be enjoyed because they were so pretty, regardless of the taste), coffee, fresh bread… and yes, the quintessential flavorful creamy butter that tasted like cow. As we walk out of the hotel’s gate, Mike and I befriend Josephine, a university student who has the day off and she volunteers to guide us around the town for the day... just because. We stroll by the lake shores under tall manicured trees, with a run-down, nostalgic, grandiose air to this place, along a long road which leads to the Kivu Sun Hotel - the hotel that briefly served as the headquarters for the interim government that presided over the genocide… Kids everywhere, staring at us, aggressively. This is by far the most uncomfortable I’ve been so far – they’re pulling at our bags, demanding money, surrounding us. Thank God Josephine is with us. But what feels most disturbing, though, is the obvious divide between very wealthy and very poor, and that we unfortunately and uncomfortably fall in these tracks and follow the stereotype of segregation. There’s no middle ground- and feel as if we have no choice but to find ‘refuge’ in these tourist havens. Soon, we arrive at the gates of the Kivu Sun Hotel, where we part ways with Josephine and wait in the gated community for Jules, the pastor, to visit Goma.
Unchartered, unknown territory. Ouh, the sexiness of exploring a buried town at the foot of an active volcano. We read every bit of information about Goma available, spoke to every traveler we met, double checked the latest security reports with the local hotels – the rebel activity was located only at the rim of the crater, but the town of Goma was known to be safe during the day. Again, the only foreign presence being NGO and humanitarian aid organizations. After clearing the border with our pastor, we drive into a shabby, run-down town, we’ve already arrived. The car drives up a small hill, the road is getting a bit rougher, but the town is not as sexy as I had imagined. But suddenly, Mike knudges me, pointing at a small wall- a fence maybe.. ‘No, it’s the roof of a house covered by the lava’ explains Jules. My jaw drops- a completely new layer of life and town has been built directly above and among the old town. Two towns: one partially covered graveyard, the other resurrected new town- both co-existing in an eery symbiotic way. But as quickly as we had crossed over, we had to cross back into Gisenye. The shadows were getting longer, and our place was not there.
Bolting across the border
After sitting in a taxi for a good hour and a half waiting for the car to fill up with passengers, we finally leave the taxi park realizing that the border closes in two hours and that the road to the border is to take two hours. Why nobody else is tweaking out at the prospect of spending the night at the border, I can't tell you. So the taxi is chugging along, Mike is grumping- livid at the idea of missing his last day in Kampala if we get stuck, tea plantations racing by, kids running after the bus – we're at the border, 4 minutes before the deadline. However, we have to fill out exit forms from Rwanda, cross a large metal gate leaving Rwanda, walk over 100 meters through non-man's land, to cross another large metal gate opening up to Uganda, and fill out entry forms. Ah, I wish I could post a picture of this whole scene! Mike's roommates found themselves in this situation just a few weeks back, arriving at the Rwandan border like us at 6pm, thought they had made it and nonchalantly walked the 100 m only to realize that there was no one on the Ugandan side, so turned back to Rwanda, found that the Rwandan border officials had left, and so they had to sleep in no-man's land under the gaze of both Rwandan and Ugandan border patrols. So in the most ridiculous sprint under the cheer (and yes, I got a high five) of the black-market currency exchangers, with books and flashlights flying out of backpacks in the muddy truck tracks, we made it.
Bus ride back home from Rwanda
(3 days later, 2nd trip in Rwanda, having return to Rwanda for a few days after Mike left)
I'm sitting on the coach bus, embarked on a 9h bus ride back. We've just crossed the border, music starts to resound, the TV is turned on, with movie entitled 'Without Shame'. The text with the title and the cast pops up a-la-Back to the Future. This is Nollywood- the 2 nd largest movie industry after Hollywood is Bollywood, with Nollywood coming in third (Rwanda's budding movie industry goes by Hillywood). Mind you, 95% of the bus is male, but their cool, composed, oozing-with-virility demeanor switches to that of a group of Latin American grandmothers giddy over soap operas. The Nollywood acting and way of filming is very different than what we are used to in the West- one may think almost rudimentary, but not to this crowd. Just as the husband is about to reprimand the wife on her marital duties, the lover hiding in the shower, the crowd goes wild. Yes, even the large old man overflowing into my seat is hooting at the lover. Priceless. Best bus ride I've ever had.
Sunday, March 4, 2007
-will upload more pictures later today or tomorrow-
Goddamnit. Once again, time after time, without fail, I have to spray the entire content of my passionfruit around the room, walls- on ever bit of clean clothing I have, yes – even the white ironed button down shirt that I lay on my bed for the Malaria Consortium Conference tomorrow. I don’t know how I do this every time, but I’m really good at this. A nice, little orange blob, with the slight crunch of the seed in the middle, that had the potential of being so scrumptious. Good job Angle, nice work.
Picture of passion fruit on my white shirt:
*** malaria and the meeting ***
So today is the first day of the first meeting ever on the implementation of RDT’s for the diagnosis of malaria in Uganda; the pinnacle of Heidi’s research and organized by the Uganda Malaria Surveillance Project and the Ministry of Health (aka a 3 day retreat away from Nagon to hang out with some very cool people to listen to some very cool things in).
If you’ve been able to read as far as this, maybe I owe you an explanation behind this whole endeavor. Malaria, while completely preventable, treatable and curable, still stands as the leading cause of mortality in tropical diseases. Now this is a crazy massive burden of disease - it costs Uganda about 120,000 lives annually and drains the economy by US $600m (a value more than all exports put together). However, there is a strong new influx of funds with a new global interest in malaria - coming anywhere from the Global Fund, the Gates Foundation, WHO. Now the health-economic interest is in how to approach this question… with drug resistance on the rise, the first line of treatment and most effective drug (artemisin based treatment- ACT - an example being Coartem) is an expensive drug, standing at about US $8 per treatment. And people in highly endemic areas, Nagongera being one of them, seem to catch malaria more than the common flu- Vicki was telling me that she’s had a good year- only had it 4 times since September! And for a country with such a small budget, with such a limited health care system, whose annual per capita income is less than US $300- you can’t start dispensing anti-malarial left and right… But this is just the top layer. Ugandan physicians are taught to treat every fever case as if it were malaria unless proven otherwise, since the consequences of letting malaria go undiagnosed can prove to be fatal very quickly. So the common way of diagnosing is to make a blood slide and analyze it under microscopy- but this is terrible and rarely works for many many reasons. This means that malarials are dispensed far more than they should, to far more people than those actually needing them, many times at the wrong dose, leading to drug resistance and ending up being far more expensive than it should be. Anyway- it goes on and on, very interesting stuff, but the point that I’m trying to make, and the purpose behind this research project and this RDT implementation conference- is that a method to diagnose malaria at US $1 per case; through an RDT, a pregnancy test looking thing that works by placing a drop of blood in the case, which might also be much more accurate, easily interpreted, transportable, etc... So is it more cost-effective to have RDT’s to diagnosis malaria, and then the obvious why, when, how, by whom, bla bla bla? Fantastic stuff.
The invitation said 8:30 at the bling bling Hotel Africana. Expecting to get lost, I show up at 8 am in this huge room overlooking a rather sad looking pool, expecting a massive crowd of people for this ground-breaking meeting – not a soul, a few people are setting up chairs. 8:30, no one, 9:00 – yes, Ugandan time. Anyway, the room eventually fills up and the scene is definitely an interesting one. A few misungus- the world specialists on RDT’s and malaria, practically all women, and then the majority of the room are Ugandan male doctors, rather young, then there are the two presiding doctors, the elders, who taught all of the other doctors in the room, including the State Minister Otaala – health minister for primary health care – who marches in, only after everyone else has sat, with his whole entourage, with all the charm in the world. The meeting proceeds, all are so enthusiastic about the international interest and the potential of this new tool, and all of this with a very interesting dynamic in the room… the two elders give their closing honorary speeches- unbelievably – on their dangers of RDT’s and modernization, which completely goes against everything everyone in the room is advocating, but their presence is very respected because they are the elders. At the end of the second day, the first draft for the implementation of the use of RDT for malaria diagnosis in Uganda was written.
*** leaving Kampala ***
The 3-day retreat in the city turns out to be exhausting- the big bustling cities, with constant grit and people, and honking and black exhaust, and having to follow schedules and be social – seems to drain all motivation and energy. But as the bus inches its way out of Kampala, picking up speed through the greenest fields of tea, significantly accelerating across the Jinja dam (which marks the head of the Nile), I’m feeling more and more alive. Baboons clutter the sides of the road. The countryside constantly seems lusher, greener, more beautiful. Someone’s music is happily resonating with Caribbean-like beats throughout the bus. Flipping through my guidebook, reading about prospects of climbing Kili or diving in Zanzibar. Work is finally on track. Thinking about recent emails from good friends from Shenzhen to Bangalore to New York to San Francisco. Ah, I’m happy. The road has turned from 80 % cement 20% dirt + potholes to 20 % cement 80% dirt + potholes. Apparently, a few years ago, the government had commissioned this road through the Mabira Forest- overcome with corruption and the embezzlement of funds, the project was abandoned in the midst of everything, literally. From one day to the other, shovels, piles of rocks, foundation, cement, everything was just left in the open. Only now, the dense tropical Mabira forest is quickly being replaced by sugar plantations.
The bus finally arrives in Tororo. The shadows are getting longer, and with the Equator only a few miles away, the sun will be down in the blink of an eye. I don’t know if I’m just paranoid, if I just have a knack for attracting people who enjoy freaking lone women travelers out, but the conversation I’ve just had with a Jehovah’s Witness on the bus is fresh in my mind. Apparently, just last week, a group of Japanese resea\rchers were working in Tororo. The one responsible for the group’s finances ha9ol.\d an armed guard – the armed guard killed him. Lovely.
So I just wanted to make a quick stop by my passionfruit lady and find a green/fruitful dinner before spending the night in my beloved weekend-get-away-hotel… oh, a squeeze of lemon/lime drizzled over avocado, chopped up tomato, a dash of salt sprinkled over – maybe a little chili powder, a little onion? And if only they had cilantro- bam, there they’d have it! And if they could cut the chiapatta in little strips and either bake or fry them as they do so many things – or then maybe make plantains chips – Ouh, plantain chips, themselves drizzled with lime juice and a hint of chili salt, coupled with our newly created guacamole… so why, oh why, rice and beans?
But the sun is already down and the walk to my beloved hotel is far, so I opt for a seedy hotel just at the entrance of the market, right by the taxi stand for Nagongero, which I find out is seedy and full of sketchbag truck drivers only too late, and confronted with its seediness as someone was trying to get in my room at 2 am– not helping with the whole paranoia situation… But not before long, the morning sun is coming up, music can be heard from the street, and a new day full of exciting unknown is dawning.
*** little detail at the clinic ***
The cutest thing happened today – this woman comes, sits to get her blood drawn. The medical record (or her blue book) in my hands says her age is 40 +. Our study sheets require exact numbers, so what is it? And with laughter in her eyes and the shrug of a shoulder, she says she doesn’t know. She forgot how old she is. She’s right- what’s the need?
*** weekend in Tororo ***
Sunday morning, in the main hotel in Tororo, savoring my CNN and scrambled eggs over white toast and coffee made with coffee grinds in it- Uganda is one of the top coffee producers and yet, they can’t make a cup of coffee to save their life. When asking for coffee, you’ll be served with a thermos of hot water and with a bowl of either instant coffee or coffee grounds. So stir in three spoons of grounds, let sit, and spoon out. I just don’t get it.
The Oscars gossip comes on the news. Jaffar Amin, the son of Idi Amin, is interviewed about his reaction to “The Last King of Scotland” and naturally criticizes it as having a “euro-centric point of view” as well as creating ‘a fictitious portrayal of his father’. The movie has been overwhelmingly well received and supported by Ugandans, including the government. Theatres have been sold out.
*** Afternoon in Nagongs ***
A spontaneous, furious and powerful equatorial rainstorm is passing through. Huddled in our room, Joanne and I are howling with laughter and shouting above the storm’s rumblings like two teenage girls, as rain spills in through our only light source. Joan finds refuge under her covers and I finish threading a frangipani/plumeria and red hibiscus wreath by the bars of the open cell window; intoxicating and delightful aromas creeping in the dark corners of the TB cell.
*** scratching, the anti-malarial ***
The wife of the doctor at the surveillance site prior to Nagongera just died of a practice known as ‘scratching’. Now this brings in question western versus traditional medicine. Not that that one is right and one is wrong, but sometime you just wonder. I remember writing a paper in college justifying the virtues of traditional healing. And now I find thinking otherwise.
Scratching is the local traditional healing treatment of malaria. It is believed that the fever associated with malaria is due to witchcraft. The patient is to scratch himself until he bleed profusely- freeing the body of witchcraft. And so too often, the patient dies of severe infection. How can malaria, proven and solved by modern science, still be put in the hands of traditional medicine Now one would think that seeing victims of this parasite, embracing traditional medicine, and still dying time after time, would associate scratching with ineffectiveness. I guess not…
*** white ants ***
The day is coming to an end. A few patients are still lingering on the veranda, waiting for their blue books – the hustle and bustle that belongs to the halls has finally subsided- and this strange surge of howling can be discerned at a distance. It’s a very strange, war-like cry – constantly howling. The girls in the lab barely raise their heads; “Oh, someone must have died. It’s a common practice to howl when mourning”. Alright. We carry on the days work, close the door, lock the lab. This is now an hour later – the howling is still in full force. What in the world is going on? So right outside of the health clinic’s gate, with the chiapatti man on my right and the bore-hole on my left, is a crowd of little munchkins- a few of them crouched on the floor, howling at plastic bags buried under ground. Apparently, they’re yelling at white ants- termites- a local delicacy. Since the rains have not been frequent enough to incite the white ants to come out, kids put plastic bags over a few white ants, kneel and hover above these bags, howl their brains away, and white ants apparently come out…. Absolutely wonderful
***
Fish eyeballs. I just had fish eyeballs for dinner- a delicacy here – with a silky oyster-like consistency, and a crunch at the end. And the worst part about it- it wasn’t that bad.
*** work ethics ***
Now while I am just a ‘newbie’, have been here for such a short period of time, and have no idea what I’m talking about most of the time, here’s an attempt to a illustrate why Africa seems to fall victim to a certain stereotype. Purely observational.
So it’s now 10:00 AM at Nagongs. Electricity is out and has been since yesterday. No one is in the lab. The clinic opens at 9. The lab techs aren’t here to make or analyze the blood slides because power is out, and so the doctors aren’t here because the lab techs aren’t here – since protocol has it that treatment is carried out based on microscopy readings. Bref, this cycle continues.
The only consistent thing is the stream of patients.
The dishes for morning coffee are still sitting where they were sitting Saturday morning, which also means no coffee, only adding to my caffeine-craving grumpiness, but no one does their job here without being supervised.
So maybe I fall in their stereotype of the crazy anal misungu. This morning I woke up to be here early – was by the car waiting, and waiting – about a dozen men standing around the car, chit chatting, while four women wait completely squooshed in the back seat. I start becoming frantic, seeing the minutes go by – minutes that were now going to be minutes late. I get out of the car to show frustration, that I’m soon to learn is a game to be played. The men standing around, you say “when are we leaving”, they will say “we’re leaving right now”, then you go back in the car, and so on and so forth. 45 minutes later, we leave. It’s all a game they play because bottom line is that we leave when they want. Finally, the car starts moving- laughing and shouting and the guy who I’m sitting on with his fish imbued fingers resting on my warm-showered and soaped shoulder- smells mixed in with the soothing aroma of just-passed rainfall, raw mud, fresh grass and humus- And everyone’s laughing, and it’s a great time.
The car zigzags, somehow 10 people managed to fit in the car today – weaving through potholes as if trying to sow the road together – specks of kids dot the road- there must be at least a dozen schools along this road, if not 15, 20. Each school has a uniform, so as we happily bump along, we pass patches of bright purple, blue, crisp whites with khaki shorts- in sharp contrast with their soot-black shaved head – kids on bikes, four huddles on a motorcycle – all scurrying, and skipping along with their little blue books.
So it’s now 10:30 and the halls are packed with patients, there must be more than a hundred. Still no a member of the medical staff here. Unbelievable. It feels like 3rd grade – or forcing children to go to Catechism – How is it possible that you have to go and knock on people’s homes to coerce them to show up to work. But the funniest part is that you’ll knock, knowing the person is in there, and (with the reaction of an ostrich when it puts its head underground and whatever has been the issue, disappears) they just don’t answer the knock or calls. Not a peep. And this is a regular day at the health clinic - no power, no work.
***
Onward and forward- so it’s now Saturday night. I’m about to have another sleepover with Vicki. I’d rather stay here- I somehow feel part of the compound of women, inside the walls and can finally enjoy Nagons – a shower by jerry can – an outdoor shower, that is such a novelty and treat anywhere from Napa to Court’s place on the Vineyard, with my Kiels body wash, Redken shampoo for blonde highlights, loofa, face goo… and who would’ve known that all you need is 4 cement walls in one’s backyard.
And there’s so much to look forward tomorrow! After a fairly short day at work, I realized I needed to get some water to do laundry – at this point I had three little visitors sitting on my bed, legs dangling and kicking, nibbling on cookies and bananas that I had brought back from Tororo, so we all headed to the bore hole… (the middle one had malaria, oh, and she was impossibly adorable.
She’s the daughter of one of the lab techs who lives here alone– and what I’m about to say is terrible, but she had a wet cough, that made it sound like she was purring when she breathed which just added to her charm)
One of my favorite things is the kids. Children absolutely everywhere. Granted, the average age here is 15, yes, 15- everywhere you look, munchkins. You can also sense their gaze over you, the whisper of ‘misungu’, whatever it is- but when you establish eye contact, oh, they smile, giggle, with the most incredible warmth. The contrast of their white white teeth and dark skin – their smile just lightens up their face – happens to be contagious too.
***
On the road back to Kampala, savoring the surroundings with the biggest smile, warm wind streaming the window, uplifting crackling beats on the radio, petrol trucks ahead. The highway is basically a one-lane pavement road. Nuhu overtakes the truck ahead by swerving to the right onto dirt, only to realize there’s another petrol truck using the dirt shoulder as his side of the highway. Nuhu then swerves even more to the right, right in the bush. I gasp, plunge back in my book. Total ostrich reaction, but it works. If you can’t see it, it’s not happening or at least is not as bad as it would look. I’m getting hot flashes – the roads are notoriously bad. And Nuhu, Joanne, and Kambale all laugh “hee hee, welcome to Uganda!” and the radio goes up.
***
After looking back at what I’ve just written, I realize that this all may seem very negative- but no, not at all… yes, maybe the work ethic is a bit strange, appearing inefficient, but it’s so foreign, so different that what we’re used to in the west. And this feeling of insecurity is a learning experience to being more cautious, of being aware of your sense of preservation, of your reactions, of your independence, of your dependence. To quote Tamara after tonight’s dinner – it’s important to know how 90% of the world feels like and lives by. As the Lonely Planet describes and enumerates in the ‘psychological well being” section of culture shock; there’s the initial awe, delight, natural high of new things (the honey moon stage)- then there’s the disillusionment, disorientation, and then there’s now. I’m finding myself questioning what makes people here act and be the way they are. How do people think this way, how do people emerge from such a serious and dark past, and have this pervading lightheartedness and day-to-day sense of mortality? How can people be so individualistic, so careless of pollution? What makes a nurse watch a child convulse because he’s not being administered his medicine, simply because she’s on her lunch break? What is it that makes a matatu crash turn into a public spectacle and have a crowd of 20, 30 people run towards the crash, with the sole intent of robbing and observing those stuck inside? So I think that it can be only now, staying in Uganda for a longer period of time, that I can try to make some sense to these questions, under the spell of these people, their stories and their country.
Goddamnit. Once again, time after time, without fail, I have to spray the entire content of my passionfruit around the room, walls- on ever bit of clean clothing I have, yes – even the white ironed button down shirt that I lay on my bed for the Malaria Consortium Conference tomorrow. I don’t know how I do this every time, but I’m really good at this. A nice, little orange blob, with the slight crunch of the seed in the middle, that had the potential of being so scrumptious. Good job Angle, nice work.
Picture of passion fruit on my white shirt:
*** malaria and the meeting ***
So today is the first day of the first meeting ever on the implementation of RDT’s for the diagnosis of malaria in Uganda; the pinnacle of Heidi’s research and organized by the Uganda Malaria Surveillance Project and the Ministry of Health (aka a 3 day retreat away from Nagon to hang out with some very cool people to listen to some very cool things in).
If you’ve been able to read as far as this, maybe I owe you an explanation behind this whole endeavor. Malaria, while completely preventable, treatable and curable, still stands as the leading cause of mortality in tropical diseases. Now this is a crazy massive burden of disease - it costs Uganda about 120,000 lives annually and drains the economy by US $600m (a value more than all exports put together). However, there is a strong new influx of funds with a new global interest in malaria - coming anywhere from the Global Fund, the Gates Foundation, WHO. Now the health-economic interest is in how to approach this question… with drug resistance on the rise, the first line of treatment and most effective drug (artemisin based treatment- ACT - an example being Coartem) is an expensive drug, standing at about US $8 per treatment. And people in highly endemic areas, Nagongera being one of them, seem to catch malaria more than the common flu- Vicki was telling me that she’s had a good year- only had it 4 times since September! And for a country with such a small budget, with such a limited health care system, whose annual per capita income is less than US $300- you can’t start dispensing anti-malarial left and right… But this is just the top layer. Ugandan physicians are taught to treat every fever case as if it were malaria unless proven otherwise, since the consequences of letting malaria go undiagnosed can prove to be fatal very quickly. So the common way of diagnosing is to make a blood slide and analyze it under microscopy- but this is terrible and rarely works for many many reasons. This means that malarials are dispensed far more than they should, to far more people than those actually needing them, many times at the wrong dose, leading to drug resistance and ending up being far more expensive than it should be. Anyway- it goes on and on, very interesting stuff, but the point that I’m trying to make, and the purpose behind this research project and this RDT implementation conference- is that a method to diagnose malaria at US $1 per case; through an RDT, a pregnancy test looking thing that works by placing a drop of blood in the case, which might also be much more accurate, easily interpreted, transportable, etc... So is it more cost-effective to have RDT’s to diagnosis malaria, and then the obvious why, when, how, by whom, bla bla bla? Fantastic stuff.
The invitation said 8:30 at the bling bling Hotel Africana. Expecting to get lost, I show up at 8 am in this huge room overlooking a rather sad looking pool, expecting a massive crowd of people for this ground-breaking meeting – not a soul, a few people are setting up chairs. 8:30, no one, 9:00 – yes, Ugandan time. Anyway, the room eventually fills up and the scene is definitely an interesting one. A few misungus- the world specialists on RDT’s and malaria, practically all women, and then the majority of the room are Ugandan male doctors, rather young, then there are the two presiding doctors, the elders, who taught all of the other doctors in the room, including the State Minister Otaala – health minister for primary health care – who marches in, only after everyone else has sat, with his whole entourage, with all the charm in the world. The meeting proceeds, all are so enthusiastic about the international interest and the potential of this new tool, and all of this with a very interesting dynamic in the room… the two elders give their closing honorary speeches- unbelievably – on their dangers of RDT’s and modernization, which completely goes against everything everyone in the room is advocating, but their presence is very respected because they are the elders. At the end of the second day, the first draft for the implementation of the use of RDT for malaria diagnosis in Uganda was written.
*** leaving Kampala ***
The 3-day retreat in the city turns out to be exhausting- the big bustling cities, with constant grit and people, and honking and black exhaust, and having to follow schedules and be social – seems to drain all motivation and energy. But as the bus inches its way out of Kampala, picking up speed through the greenest fields of tea, significantly accelerating across the Jinja dam (which marks the head of the Nile), I’m feeling more and more alive. Baboons clutter the sides of the road. The countryside constantly seems lusher, greener, more beautiful. Someone’s music is happily resonating with Caribbean-like beats throughout the bus. Flipping through my guidebook, reading about prospects of climbing Kili or diving in Zanzibar. Work is finally on track. Thinking about recent emails from good friends from Shenzhen to Bangalore to New York to San Francisco. Ah, I’m happy. The road has turned from 80 % cement 20% dirt + potholes to 20 % cement 80% dirt + potholes. Apparently, a few years ago, the government had commissioned this road through the Mabira Forest- overcome with corruption and the embezzlement of funds, the project was abandoned in the midst of everything, literally. From one day to the other, shovels, piles of rocks, foundation, cement, everything was just left in the open. Only now, the dense tropical Mabira forest is quickly being replaced by sugar plantations.
The bus finally arrives in Tororo. The shadows are getting longer, and with the Equator only a few miles away, the sun will be down in the blink of an eye. I don’t know if I’m just paranoid, if I just have a knack for attracting people who enjoy freaking lone women travelers out, but the conversation I’ve just had with a Jehovah’s Witness on the bus is fresh in my mind. Apparently, just last week, a group of Japanese resea\rchers were working in Tororo. The one responsible for the group’s finances ha9ol.\d an armed guard – the armed guard killed him. Lovely.
So I just wanted to make a quick stop by my passionfruit lady and find a green/fruitful dinner before spending the night in my beloved weekend-get-away-hotel… oh, a squeeze of lemon/lime drizzled over avocado, chopped up tomato, a dash of salt sprinkled over – maybe a little chili powder, a little onion? And if only they had cilantro- bam, there they’d have it! And if they could cut the chiapatta in little strips and either bake or fry them as they do so many things – or then maybe make plantains chips – Ouh, plantain chips, themselves drizzled with lime juice and a hint of chili salt, coupled with our newly created guacamole… so why, oh why, rice and beans?
But the sun is already down and the walk to my beloved hotel is far, so I opt for a seedy hotel just at the entrance of the market, right by the taxi stand for Nagongero, which I find out is seedy and full of sketchbag truck drivers only too late, and confronted with its seediness as someone was trying to get in my room at 2 am– not helping with the whole paranoia situation… But not before long, the morning sun is coming up, music can be heard from the street, and a new day full of exciting unknown is dawning.
*** little detail at the clinic ***
The cutest thing happened today – this woman comes, sits to get her blood drawn. The medical record (or her blue book) in my hands says her age is 40 +. Our study sheets require exact numbers, so what is it? And with laughter in her eyes and the shrug of a shoulder, she says she doesn’t know. She forgot how old she is. She’s right- what’s the need?
*** weekend in Tororo ***
Sunday morning, in the main hotel in Tororo, savoring my CNN and scrambled eggs over white toast and coffee made with coffee grinds in it- Uganda is one of the top coffee producers and yet, they can’t make a cup of coffee to save their life. When asking for coffee, you’ll be served with a thermos of hot water and with a bowl of either instant coffee or coffee grounds. So stir in three spoons of grounds, let sit, and spoon out. I just don’t get it.
The Oscars gossip comes on the news. Jaffar Amin, the son of Idi Amin, is interviewed about his reaction to “The Last King of Scotland” and naturally criticizes it as having a “euro-centric point of view” as well as creating ‘a fictitious portrayal of his father’. The movie has been overwhelmingly well received and supported by Ugandans, including the government. Theatres have been sold out.
*** Afternoon in Nagongs ***
A spontaneous, furious and powerful equatorial rainstorm is passing through. Huddled in our room, Joanne and I are howling with laughter and shouting above the storm’s rumblings like two teenage girls, as rain spills in through our only light source. Joan finds refuge under her covers and I finish threading a frangipani/plumeria and red hibiscus wreath by the bars of the open cell window; intoxicating and delightful aromas creeping in the dark corners of the TB cell.
*** scratching, the anti-malarial ***
The wife of the doctor at the surveillance site prior to Nagongera just died of a practice known as ‘scratching’. Now this brings in question western versus traditional medicine. Not that that one is right and one is wrong, but sometime you just wonder. I remember writing a paper in college justifying the virtues of traditional healing. And now I find thinking otherwise.
Scratching is the local traditional healing treatment of malaria. It is believed that the fever associated with malaria is due to witchcraft. The patient is to scratch himself until he bleed profusely- freeing the body of witchcraft. And so too often, the patient dies of severe infection. How can malaria, proven and solved by modern science, still be put in the hands of traditional medicine Now one would think that seeing victims of this parasite, embracing traditional medicine, and still dying time after time, would associate scratching with ineffectiveness. I guess not…
*** white ants ***
The day is coming to an end. A few patients are still lingering on the veranda, waiting for their blue books – the hustle and bustle that belongs to the halls has finally subsided- and this strange surge of howling can be discerned at a distance. It’s a very strange, war-like cry – constantly howling. The girls in the lab barely raise their heads; “Oh, someone must have died. It’s a common practice to howl when mourning”. Alright. We carry on the days work, close the door, lock the lab. This is now an hour later – the howling is still in full force. What in the world is going on? So right outside of the health clinic’s gate, with the chiapatti man on my right and the bore-hole on my left, is a crowd of little munchkins- a few of them crouched on the floor, howling at plastic bags buried under ground. Apparently, they’re yelling at white ants- termites- a local delicacy. Since the rains have not been frequent enough to incite the white ants to come out, kids put plastic bags over a few white ants, kneel and hover above these bags, howl their brains away, and white ants apparently come out…. Absolutely wonderful
***
Fish eyeballs. I just had fish eyeballs for dinner- a delicacy here – with a silky oyster-like consistency, and a crunch at the end. And the worst part about it- it wasn’t that bad.
*** work ethics ***
Now while I am just a ‘newbie’, have been here for such a short period of time, and have no idea what I’m talking about most of the time, here’s an attempt to a illustrate why Africa seems to fall victim to a certain stereotype. Purely observational.
So it’s now 10:00 AM at Nagongs. Electricity is out and has been since yesterday. No one is in the lab. The clinic opens at 9. The lab techs aren’t here to make or analyze the blood slides because power is out, and so the doctors aren’t here because the lab techs aren’t here – since protocol has it that treatment is carried out based on microscopy readings. Bref, this cycle continues.
The only consistent thing is the stream of patients.
The dishes for morning coffee are still sitting where they were sitting Saturday morning, which also means no coffee, only adding to my caffeine-craving grumpiness, but no one does their job here without being supervised.
So maybe I fall in their stereotype of the crazy anal misungu. This morning I woke up to be here early – was by the car waiting, and waiting – about a dozen men standing around the car, chit chatting, while four women wait completely squooshed in the back seat. I start becoming frantic, seeing the minutes go by – minutes that were now going to be minutes late. I get out of the car to show frustration, that I’m soon to learn is a game to be played. The men standing around, you say “when are we leaving”, they will say “we’re leaving right now”, then you go back in the car, and so on and so forth. 45 minutes later, we leave. It’s all a game they play because bottom line is that we leave when they want. Finally, the car starts moving- laughing and shouting and the guy who I’m sitting on with his fish imbued fingers resting on my warm-showered and soaped shoulder- smells mixed in with the soothing aroma of just-passed rainfall, raw mud, fresh grass and humus- And everyone’s laughing, and it’s a great time.
The car zigzags, somehow 10 people managed to fit in the car today – weaving through potholes as if trying to sow the road together – specks of kids dot the road- there must be at least a dozen schools along this road, if not 15, 20. Each school has a uniform, so as we happily bump along, we pass patches of bright purple, blue, crisp whites with khaki shorts- in sharp contrast with their soot-black shaved head – kids on bikes, four huddles on a motorcycle – all scurrying, and skipping along with their little blue books.
So it’s now 10:30 and the halls are packed with patients, there must be more than a hundred. Still no a member of the medical staff here. Unbelievable. It feels like 3rd grade – or forcing children to go to Catechism – How is it possible that you have to go and knock on people’s homes to coerce them to show up to work. But the funniest part is that you’ll knock, knowing the person is in there, and (with the reaction of an ostrich when it puts its head underground and whatever has been the issue, disappears) they just don’t answer the knock or calls. Not a peep. And this is a regular day at the health clinic - no power, no work.
***
Onward and forward- so it’s now Saturday night. I’m about to have another sleepover with Vicki. I’d rather stay here- I somehow feel part of the compound of women, inside the walls and can finally enjoy Nagons – a shower by jerry can – an outdoor shower, that is such a novelty and treat anywhere from Napa to Court’s place on the Vineyard, with my Kiels body wash, Redken shampoo for blonde highlights, loofa, face goo… and who would’ve known that all you need is 4 cement walls in one’s backyard.
And there’s so much to look forward tomorrow! After a fairly short day at work, I realized I needed to get some water to do laundry – at this point I had three little visitors sitting on my bed, legs dangling and kicking, nibbling on cookies and bananas that I had brought back from Tororo, so we all headed to the bore hole… (the middle one had malaria, oh, and she was impossibly adorable.
She’s the daughter of one of the lab techs who lives here alone– and what I’m about to say is terrible, but she had a wet cough, that made it sound like she was purring when she breathed which just added to her charm)
One of my favorite things is the kids. Children absolutely everywhere. Granted, the average age here is 15, yes, 15- everywhere you look, munchkins. You can also sense their gaze over you, the whisper of ‘misungu’, whatever it is- but when you establish eye contact, oh, they smile, giggle, with the most incredible warmth. The contrast of their white white teeth and dark skin – their smile just lightens up their face – happens to be contagious too.
***
On the road back to Kampala, savoring the surroundings with the biggest smile, warm wind streaming the window, uplifting crackling beats on the radio, petrol trucks ahead. The highway is basically a one-lane pavement road. Nuhu overtakes the truck ahead by swerving to the right onto dirt, only to realize there’s another petrol truck using the dirt shoulder as his side of the highway. Nuhu then swerves even more to the right, right in the bush. I gasp, plunge back in my book. Total ostrich reaction, but it works. If you can’t see it, it’s not happening or at least is not as bad as it would look. I’m getting hot flashes – the roads are notoriously bad. And Nuhu, Joanne, and Kambale all laugh “hee hee, welcome to Uganda!” and the radio goes up.
***
After looking back at what I’ve just written, I realize that this all may seem very negative- but no, not at all… yes, maybe the work ethic is a bit strange, appearing inefficient, but it’s so foreign, so different that what we’re used to in the west. And this feeling of insecurity is a learning experience to being more cautious, of being aware of your sense of preservation, of your reactions, of your independence, of your dependence. To quote Tamara after tonight’s dinner – it’s important to know how 90% of the world feels like and lives by. As the Lonely Planet describes and enumerates in the ‘psychological well being” section of culture shock; there’s the initial awe, delight, natural high of new things (the honey moon stage)- then there’s the disillusionment, disorientation, and then there’s now. I’m finding myself questioning what makes people here act and be the way they are. How do people think this way, how do people emerge from such a serious and dark past, and have this pervading lightheartedness and day-to-day sense of mortality? How can people be so individualistic, so careless of pollution? What makes a nurse watch a child convulse because he’s not being administered his medicine, simply because she’s on her lunch break? What is it that makes a matatu crash turn into a public spectacle and have a crowd of 20, 30 people run towards the crash, with the sole intent of robbing and observing those stuck inside? So I think that it can be only now, staying in Uganda for a longer period of time, that I can try to make some sense to these questions, under the spell of these people, their stories and their country.
Sunday, February 18, 2007
So…. I’ve been cautioned and warned by everyone I’ve met from the UMSP-UCSF (Ugandan Malaria Surveillance Project- joint effort/study w/UCSF) of the experience of total seclusion that I am to anticipate here in Nagongera, with so much free time and with so little company, that apparently you end up going absolutely mad, craving any bit of human interaction or communication with the outside world, bringing anal organization and test-tube labeling to a whole new level, overanalyzing past friendships, reliving heartbreaks, and so yes, driving yourself crazy… so I brought my laptop and figured I’d entertain myself by attempting to recount the whirlwind of the past few weeks here. Both related and unrelated, here is a picture of a goat standing outside of the door as I’m writing this exact sentence.
First of all, I have to say that Uganda is amazing- I had no idea what to expect, since it didn’t hit me that I was actually moving to Africa until a week after I had landed, but this is everything I had hoped for and it’s so much more, and on another level, not at all.
FIRST DAY
New smells, new colors, new climate, new everything- I felt like an absolute twit with my perma-smile and eyes just about popping out of my head ever since the minute the plane descended below the clouds. My god- Africa. Consuming the view with the hungriest eyes through those miserable little plane windows where you can’t really see anything- the massive, impressive and beautiful vast Lake Victoria extended itself as far as the eye can see. Everything was green- a really dark lush overgrown greenish brown grey, hiding a bright, dark, reddish brown soil – but there was this surreal film of fog covering/surrounding it all- kind of like in Beijing. You don’t really know if it’s pollution, but it has that beautiful ethereal feeling to it, blending all the colors in. The second you step off the plane though, you realize it’s a mix of burning garbage, humidity and … yes… pollution (they don’t have a waste disposal system- they burn everything in their back yard- wood, charcoal, food, plastic, tires, dirty syringes). Apparently, a rain shower has just passed through an hour earlier. Happens a few times a day…A few palm trees, a few organized orchards (smaller than our kitchen) in people’s back yards, a couple circular dirt houses with straw thatched roofs- all right by the airport.
Before even stepping foot on the continent, you get a strange and interesting impression from just your immediate surroundings… the overly talkative guy sitting beside me is a Mormon missionary – works with the Makere University. The woman I met in the bathroom who kindly invited me to dinner and offered a couple hours of much-welcomed advice was a born-again Christian. The couple in front of me is working for an HIV/AIDS non-profit. A few Ugandans speckled around the cabin – all missionaries, mercenaries, or medics- hmmm.
Anyway, so I walk off the airplane ramp, through immigration. Posters of the current president Museveni everywhere (who has been in democratic power for the past 20 years?!?). The people here are so black- but you can immediately recognize very different features between people working there- some have much rounded features and a little ploum ploum, whereas others are very tall, proud composure, very dignified and striking features.
I meet Nuhu, UCSF’s driver, and we drive from the Entebbe airport on an hour drive to Kampala, the capital of Uganda. Perma-smile in full force, I just can’t take things in fast enough, and I probably didn’t shut up for the full drive, hitting the 3 year old stage – ‘why why what why why?’. We drive past UN helicopter (these huge hardcore looking things)- deployed for missions in the Democratic Republic of Congo. A lazy, peaceful chaos on the road. English cars, driving on the left side of the road, bikes and people sitting on the back of them going in the opposite direction to our left, people doing U’ees, intersections with non-functioning lights (it’s been about a month since the major intersection had been fixed), massive potholes (I’m talking 1 ft deep potholes!!). This is so exciting. The smells are overwhelming, the people and the vegetation have this sort of romantic overgrowth to it- the pollution giving it the romantic era. People’s houses are so poor- everything is dirt, everything is rusty brown- but the women are ‘drop dead’ (yes, Charlie’s tongue would be trailing along the road- bodacious, elegant, poised, and just beautiful), very well put-together, but walking on dirt sidewalks. And the babies and the kids, cutest things in the world.
Starting to call it CBS, Cute Baby Syndrome.. it’s everywhere- We pass many markets, fruit vendors (lots of matoke-plantain), and tile makers – arranged in funny formations (like tombstones, slanted at a 45 degree angle – planted in the front area of a house or a store. They’re displaying them to sell… )
Nuhu stops by the Malaria Consortium to pick up the keys from Heidi. Every big rep for malaria in Kampala is there – members of the WHO, UCSF, Makere University, Dr. Quick (the dr. from the Ministry of Health with whom I will work with in a few weeks)… Heidi invites me to come and assist the meeting of about 15 people- one hour, two hours later, fascinating lectures, but then my eyes collapse – the 36 hour trip just caught up with me – arg, I’m mortified, but Heidi walks me down to the office and I sleep until Nuhu comes to pick me up to go to Heidi’s apt- Pictures to follow – ouh la la, quite a little contrast with SF. Woke up around 7 pm, went out to this wonderful little Indian restaurant by means of the crazy white taxis with the expat girls – Heidi, Tamara (working in public health and has been living here for over 7 yrs) and Lisa (Columbia U. Med student who’s about to head back to finish her 4th year)… bed.
SECOND DAY
Second day in Kampala… Unbelievable – Only 15 seconds after I open my eyes do I realize I’m actually here, in Africa. So giddy, brimming with excitement at the idea of discovering what the day has to bring… I walk out, meet Heidi in the kitchen- pineapple and banana fruit salad, coffee. She’s talking on the phone with the plumber, water’s dead- we’re going to have to wait until he arrives. She asks me if I want milk with coffee- why not, so she directs me to go to the ‘cantina’ – a small little market in the middle of the apartment complexes (pics to follow). So I waddle on down- walking past four or five marabou storks, which are these huge, strange, carnivorous looking things, go to this little bodega, open air store, and ask for milk. Ugandans have a funny manner – no rush, no tone in speaking- the softer one’s voice, the more polite one is. I ask her if she has milk, the woman looks away, a few silent seconds go by and then she nods no. But this is just part of Ugandan mannerisms… she then proceeds to tell me that I don’t want milk, so I ask ‘why not, it’s to put in my coffee’, she laughs and says ‘no no, you don’t want this milk (cold plastic bag with fresh milk)’ and points to a carton of stabilized UHT milk in the back of the room. 1000 shillings. So I hand her a 10 000 shilling bill. She doesn’t move. Do you have change? I ask. No. is my answer. How is that possible, the man before me just paid 5000, and 10 000 shillings is only about 5 USD. (it turns out that everyone in Uganda ‘doesn’t have change’). So I ask, ‘what do we do?’ – ‘it is not possible.’ Silence again. And then wait. And then that’s all that happens – pace of Uganda. There’s no way to get a solution.
The plumber comes for the broken pipes. Milk story rerun … ‘it is not possible’. So Heidi problem solves for the plumber, and we end up waiting for 2 hours in the house. Total Ugandan style. Heidi tells me that this is even what happens in hospitals – a kid is acutely ill, needs to be attended at 1 pm, nurses are out for lunch, kid dies, nobody blinks twice – same frame of mind – life goes on.
Plumber’s back, we can finally start the day. We walk to the nearest taxi stand (matatus). There are only men- Heidi approaches them and 4 of them focus their attention to her. She breaks out in perfect Luganda, hands gestures from both parties, and the four men all decide Heidi and I should get into this one matatu. Crazy mini-van drive to the Mulago hospital. This is a level 5 hospital – on a scale of 1-5 - the best because it is the national hospital. UCSF is based out of what used to be the animal building. All of the data entry, analysis, etc.. is based out of this building… Heidi is absolutely great – showing me the facilities (fairly limited – very basic equipment to US standards- air conditioning in just one long room for the computers. I’ll include pics later). The hospital is spread out in little independent houses- people lounging around everywhere – very slow slow slow pace around. We run into two other ‘misungus’ – Heidi’s friends working for Cass University on another project working out of this hospital. Heidi and these two among other misungus get together on Wednesday nights to watch Queer Eye – a strong expat alliance that I’m soon going to find out is very strong/important and omnipresent in this country. We then walk back to the animal house, put in an order for lunch – which is going to be among the 7 only foods in Uganda “greens (shredded bitter greens – scrunched like confetti), matoke (boiled or fried plain plantain), cassava (root), rice, beans, g-nut sauce (a purple ground peanut sauce – absolutely nauseating)”. No salt, no spice, just lots of oil with that starch. I’ll be living off of rice and beans for the next 5 months. And yes mom, BMI is sure to double by the time of return. Lisa, Heidi and I talk about plans for the weekend and the site out in Tororo- deciding that Lisa and I could spend the weekend at Sipi Falls and hike, heading straight to ‘up-country’ for a month (Narangera, two hours north of Tororo) on Sunday. We’ll leave tomorrow.
Lunch is over, Heidi needs to get to work after taking the morning off – so Lisa and I head over to Lugogo- a part of town in the outskirts that are not accessible by public transportation (matatus)- only private taxis (special hires. They’re ordinary cars- no taxi sign, no meter, just a Toyota Corolla, with a guy willing to drive you, so you really have to trust he’s not some psycho. So a special hire is technically just someone with a car, picking up hitch-hikers and naming a price). So we hop in a special hire, grubby grubby streets and trees, and tropics- and then pow, pristine shopping center. We part ways, Lisa heads to Barclay’s atm, and I to open an account- Ugandan style … slow, nothing is possible… anyway, they then tell me something’ll work out by next week. I then stop to get what is possibly the best coffee I’ve ever had- smooth, not too strong- time to pull out my Map and guide of Uganda- yes, being that obnoxious tourist just to have an idea where in the world I am, and how in the world am I going to find the French embassy, and how I’m going to get back to Heidi’s place in this sea of mayhem, and no street signs and no official public transportation and no obvious taxis and no address to Heidi’s apt… (there is none).
So I leave, ask the security/police/guard to the phone store (owned by the gvt, as most things around are) for a special hire. Long story short- I get a car to the French embassy- blab la – register – take a boda boda (hop on the back of a moped, same principle as a special hire) to the nearest shopping district to buy converter and internet café, matatu it back to Heidi’s just in time before the sun goes down.
FIRST WEEKEND
So this may just be a coincidence, or the fact that Heidi is a great match-maker, or that people connect much more easily and quickly when far away from their home country- but so far, Heidi has organized two short vacations with two people who don’t know each other and having it work out beautifully. And traveling is such a personal experience.. but I guess that’s what happens in a country with so few tourists and so many ridiculous cool things around – Kenya is 30 minutes away from here, Serengeti on the border of Tanzania, gorilla tracking just a few hours west of the capital, and diving in Zanzibar just next door!
Anyway, I digress. Friday morning, Lisa and I take off in the dark- towards the Matatu park in downtown Kampala (this one you can Google-Earth it. Just type kampala, and I believe you may need to move east, and you see millions of little white dots/larva looking things – the matatu park). Hop onto a commercial bus, the safest because of the law of the biggest. Two cars on the road, bus always wins. Along ensue five hours driving through fields of coffee, tea, papyrus, bananas, babbling away, making connections of places in SF and people in NY, only to be occasionally interrupted by the medical salesperson standing in an overly crowded bus aisle as he pulls out a new miracle drug out of his pocket ever ½ hour, and impressively delivers a non-stop multi-lingual sermon of emphatic crazy-talk about the pill that will cure digestion, impotence and laziness, all in one. The med-student besides me is going crazy. Five hours later, we arrive in Mbale- total chaos of transportation… Oh la la… public transportation, a story in itself! It’s great, it’s energetic, it’s disgusting, it breaks all personal boundaries, it’s spontaneous, it’s disorganized, it’s logical, it’s economical, and it works-
In a nutshell- we get off our big bling bus, and walk around this matatu park. There must be about 30 different white mini-vans parked in total disarray in a big dirt space, each door open with a few passengers sitting in each, and the driver and about 5 of his buddies screaming the direction of where that specific matatu is heading. The standard matatu would carry in comfortable US standards about 8 people – with 3 to 4 benches and the drivers seat – just to give you an idea. The matatu does not leave until it’s full – that is, 16 minimum – here’s a video with 25 people and a chicken from a later trip:
So please let me digress on public transportation- Before choosing the matatu, you might ask them when they’re leaving. The answer will ALWAYS be ‘right now, right now’. The driver might jump behind the wheel and rev his engine- chances are, you’ll be waiting in the matatu for another 30 minutes waiting for it to fill up… We opt for a smaller car headed for Sipi Falls… wait a little while, personal bubble bursts, Lisa’s in my lap, I’m in some sweaty strange man’s lap, and this continues on- until someone decides to bring the windshield window (the front window of a car) – IN the matatu (wtf?!)… ok- so we’re now all ontop of each other, wait in the parking lot for a while, but the car is still not full enough, so we drive to the gas station, try to find people, no one, so we park for 10 minutes, no one, so we drive back, one person, then we wait for another 10 minutes, no one, so we head back to the gas station, fill up with gas, wait another 10 minutes for the driver to get in an elaborate conversation with his driver-buddy of his, and then finally take off… here’s a video of this trip.
Anyway, we leave, arrive successfully at Sipi Falls- (ah, an another interesting thing is crossing USAID SUV’s, UN security troops and other foreign aid vehicles along the roads, and other services catered to by foreign aid, (peace corps)).
Beautiful beautiful local – Located at around 1,775 m high. We arrive and have swarms of little munchkins following us wherever we go- ‘misungu, misungu, how are you?’ . While Lisa and I really don’t know each other at all, we find our new home to be this adorable little cabana with the view that is in the picture on the upper right … The weekend is looking great – we go on a 4 hour hike, visit bat caves (that had been used to hide cattle from the Karamojong until recently- source of a lot of conflict and violence) , the three waterfalls – only to be caught offguard by the most powerful rainstorm ever at the top of the mountains. We giggle and run down the mountain, run into the 5 star hotel to confirm the evening’s dinner reservation (candle-lit dinner, bottle of South African chardonnay – yes, we definitely got to know each other!), soaked from head to toe, white tshirts and dark red mud all over. And loving it.
*** Mt Elgon ***
Heidi orchestrates another successful weekend getaway with two people who don’t know each other. She wants to work at Nagon for a few days so sets me off with her friend Melinda to go hike Mt. Elgon for a day- At this point, I was starting to go crazy at Nagon, realizing that I was actually in Africa, in what seemed the most depressing place in the world (at first…). So we took off – only to realize that Mt. Elgon is a crazy hard mountain to climb- 1700 m elevation in 5 hours- uphill and fast the whole time… Mt. Elgon is the 8th tallest mountain, straddling the Kenyan border- it’s an extinct volcano, and so you get a complete change of vegetation- farmland at the foot, low-canopy tropical forest, then you climb this really steep wall, to enter the crater of the volcano and you get this unreal bamboo forest and this is the beginning of the national forests. It really was a surreal experience- there was this thick fog, and you could only hear this unbelievably loud symphony of birds and baboons. Along with the surprisingly expensive park fees, you need to hire a porter and an armed guide – bring all your food, camping gear, cooking equipment, warm clothing. Of course, we had nothing, but had great conversation and a bit of a what-in-the-world-am-i-doing-out-here mutual feeling.
*** First day at work ***
Ah, work… this sounds so silly and maybe this is just a western obsession or I really am my father’s daughter, but I’ve been craving the feeling of putting in a hard day’s work. Granted this is just tedious, repetitious lab work- coordinating the prescriptions the patients hand us with these rapid diagnostic tests (RDT’s), drawing blood for blood smear testing for malaria, which will be diagnosed by microscope, RDT and later down the road, PCR in Kampala or UCSF labs back in the states. We then collect information as to how much time has been spent on transportation, how much time has been spent caring for the patient, how much has the treatment cost – all to be able to determine the costs associated with the disease and the impact of a small investment in these RDTs. Oh, but it’s so great, so exciting- Heidi’s paper, perspective, potential so fascinating! God, this is worth every rotten, grumpy, miserable table I waited on over the past few months…
Anyway, I wake up with the sound of mosques in the town- 5 am… so I stay in bed (romantic setting in the TB cell under the mosquito net) with my eyes closed, birds start making noise, then chickens wake up, ruffling and shuffling in the TB compounds beside us- 7:00 am, everyone’s awake.
This is such a natural high! A quick breakfast, a lesson on washing out of a jerrican in a showering ‘pit’ (oh, and this shower/bath with less than 2 L of water is so disturbing- you have a prickly feeling from head to toe for the rest of the day… making you think you’ve caught bilharzia. Quick creepy and fun tangent – bilharzia is extremely common in Uganda- affecting most people in contact with water from Lake Victoria, the Nile, etc… in the words of the Lonely Planet, Health in Africa “ you may get itching all over, known as ‘swimmer’s itch, and perhaps a rash as the worms penetrate your skin” mmm, a delightfully gross concept) -and the most heart-warming, welcomed, comforting thing ever– a phone call from dad- ah, now reenergized, we head over to the health center.
I can’t even tell you how exciting this is. Sort of like the picture I had always had in my head of this early 20th century, English colony in the heart of darkness- veranda overlooking a long dirt path – a few mothers lingering with their babies tied to their backs with just one piece of cloth. Don’t know how they make it look so comfortable, so natural, so practical, with just a little head popping out of a cocooned bundle, snuggled against his mum. As we walk up the stairs of the health clinic, I’m just struck by the amount of people waiting for the health clinic to open… Four men sitting on the stairs, a dozen women and either their babies or children on each side of the patio. Through the front door, there are six benches lining the hall packed with patients, with a couple blankets on the floor with toddlers curled in a ball, sleeping.
There’s a certain bestial feeling to it – a general noise of wailing, whining, crying, lamenting – a sort of sad orchestra of dying battle field… it definitely smells of bodies –a mixture of sweat, urine, wet chicken (always raining these days – February is supposed to be the draught season in Uganda, but the screwy weather is blamed on ‘global warming’ – and yes, there are chicken and pigs and goats running on the health center grounds), wet soil and plumeria from the tree by the doctor’s house. It’s a crazy feeling – time, culture warp, whatever, it really does feel like what medicine should be all about, but sadly the basic necessities are not even here to satisfy the need (take a look at the pharmacy! Just a handful of drugs available, dispensed out of the window, see pic on the left).
We walk into the lab – dingy, grubby, very basic. A couple dirty cups for urine tests on the counter, iodine and slide stains staining the counter and sink, piles of slides in the sink, soaking for some unknown reason and a bunch of random boxes and story… not quite the lab at Gladstone or the Doerrer group lab. We open the door connecting this lab room to the main one by a very squeaky door- a room overlooking the patio we had just crossed with an open window, with bars.
Patients line up- hand in their blue books by the window, the day begins.
*** The Killer Ants ***
Our homeOh, this is a good one – So Wednesday night, Heidi and her friend Melinda (a friend of hers from Columbia med, now a shrink at Yale, visiting Uganda for 10 days) arrive at Nagongera- bla bla bla, night arrives, dinner, bla, bed. Heidi sleeps in the trading center, Melinda in the TB cell with Joanne and myself. So the three of us are sleeping away, when Melinda starts slapping herself. “Smack! Smack!”… funny, I’m starting to feel small little pricks, then realize they actually hurt… “ OW!” I start slapping myself too – Joanne wakes up – “ what’s going on?”. Melinda turns on her light- “OH MY GOD!!!” I jump to mine- fumbling around to find my glasses somewhere tangled in the sheets, realizing there are small little black things all over the bottom of the bed. I jump up on my feet, lean in to the light switch, only to realize that the entire floor is moving- Swarms of ants are infiltrating the door, spilling out of my suitcase, blocking the door… at this point, you have two grown women in their 30’s, jumping on their beds, in absolute panic... but now here’s the unsettling part. We open the window and scream for help, I’m whistling with my fingers, all of us making as much noise as possible for at least five minutes since we can’t leave the room, and nobody responds. This is very strange, since the TB wards are right next to each other, with 15 families living side by side. Joanne jumps to the door, with an ‘ow, ow, ow!’, and flies out- and starts banging on these neighbors’ doors, calling them by name, no answer. Finally, Joanne reaches the doctor’s house, who comes out with his brother back to our place with petrol, spraying everything. Ants vacate and move to the next TB ward. Lights go on, people run out –
Now while I look back at the Killer Ant Night and can’t stop laughing, I can’t help but think how disturbing the behavior of what seems to be such a tight-knit community is. What if we had been in serious danger or trouble; had one of us had a heart attack, had someone broken in, had raped us, anything- the small compound of 15 families would have kept their doors locked and not answered to a call of help. And while I definitely feel as if Misungu are not sincerely welcome, Joanne is Ugandan, so how could they show such a cold shoulder to one of their own? Maybe this is the reflection of the post-Idi Amin brutality… I don’t know. But this definitely adds a darker layer to an apparent, voire even superficial smiling front.
*** Day 10 at Nagon ***
Mmm- so the glowing aura of the retreat at Nagon has somewhat faded as quickly as it arose… The past week was just getting better and better- after a stern conversation with myself realizing that the project we are working on has been everything I had hoped for in San Francisco and that the best way to embrace this experience was just to dive in the work… However, Heidi left for London this morning, and it is only Joanne, Kambale and myself representing UCSF-UMSP here at Nagon. Knowing that I’m a naturally neurotic person, I try to take this in account when I start questioning things, myself, whatever… But I’m starting to worry. I was flipping through some of the medical files of some of the patients, and did a double take when I realized that file after file for young women had accounts of assault and rape. Let aside the frightful stats of HIV/AIDS…
So I’m flipping through the files of the Okello’s, Othieno’s, Obene’s … all stopping by our lab for their diagnosis of malaria. I fill out the lab work for the next patient from her ‘medical chart’ – that is, a blue book for primary school that the patient must carry around with a few scribblings by prior medical visits…. 19 year old female, wait, no- 6 month old boy – they’re both using the same blue book. Hmm- looking closer at the book.. In late 2005, this young woman was diagnosed with an STI… more messy med scribble… assault …. Rape. Oh… my stomach turns… and yes, we are going to get a blood smear for a six-month old boy.
Joanne was just telling me of her skepticism towards the people of this village. “I don’t trust these people. They would kill over a chicken- these are poor poor people”. Apparently, less than 5 years ago, the archbishop of Ghana was buried on the road between Tororo and Nagangero (the bumpiest hour ride that we all must take to get here from anywhere). It was a procession of about 20 cars, quite a big ordeal. Now maybe this is where I’m freaking out unnecessarily, or the bit of being isolated may be taking its toll, but yes, I’m a little concerned… Coupled with the reaction post-killers ants…
As far as I know, I’m the only misungu (white person) in the district – haven’t crossed paths with another white person since the top of Mt. Elgon (specially geared towards tourists – a site about 4 hours away). Now this isn’t a problem – actually, I think I should be loving it… not needing to worry about the mess I usually am and being completely engulfed in a new culture and world. And you almost forget you’re white, getting used to only seeing rich dark chocolate skin to a bluish-black-coffee-bean-post-french-press color- and then look down and are almost disappointed/turned off by the pale, greenish complexion of your arm… anyway, digressing again… all this to say there’s just no way for a white person to remain inconspicuous. Walking down the street, everyone turns around – people come out of their houses and shops to look at you- kids screaming ‘Misungu’ 300 yards away - you turn around and you have a little entourage of half a dozen kids following you. This weekend, in Tororo, a relatively large town, a private car (every vehicle is basically a crappy Toyota used as a taxi/public transport) did a U-turn on the street and pulled up next to me. There was a man and woman, and about 5 kids in the back seat – the guys rolled down his window and said that his kids wanted to shake my hand. Cute, novel, momentarily flattering (ouh, they all want to meet me) .. but not when you’re alone and sometimes, I wish I could just walk anonymously down 42nd street again... But it is this very candid way of discrimination- with not a bad feeling (or at least my naïve self would like to believe that) associated with it – that seems to create such an insurmountable divide between the two colors. Ugandans are very unwelcoming to strangers. Apparently, no matter how much you try to incorporate yourself, you will always be an outsider.
As I was just telling a wonderful friend of mine, everyone talks about how these experiences change you, but I’m starting to worry that it may not be for the best… and I’m not talking about the not-showering, shaving, bit. The misungu expats community seems to be so barred, hardened, walled up – keeping to themselves, doubting everyone, being ‘too independent’, ending up lonely – in an attempt to keep it together. And I’m definitely not ruling out the possibility of coming back like a scruffy, hippy, missionary-looking, dirty hooligan.
*** Day 12 ***
Today is Valentine’s Day – Surprisingly, it’s a huge deal here… and not even Hallmark sponsored! Everybody dresses up- red, black… and the lab girls have been talking about it since 9 A.M. They tell me that in the big city, Kampala, Valentine’s day is the occasion where women try to outdo each other- it’s all about the biggest bouquet of flowers delivered at work, the biggest show – total Christmas light phenomenon. Women apparently save up for months to secretly buy themselves beautiful dresses, only to boast them as gifts from boyfriends or suitors… Newspapers are full of personal ads -
Nostalgia settles in… a slow night at the TB ward brings me back to last year on this very night… life goes on. Oh, and tomorrow is Morgan’s birthday. Last week was Emerson’s and Shirwin’s – before that, Dave graduated from college, hopefully down a snow covered hill.
*** End of the week ***
Perspective on being here has changed… again. Somehow, if I wasn’t so obsessed about these stupid ants eating us alive in our sleep and nobody doing anything about it, I think I’d absolutely love it here..
There’s something deeply soothing about being here – a retreat from crazy modern life if you will. I try to wake up by 6:45 with the sun because the chicken coop is right by the window, and I love seeing the woman opening it up exactly at 6:45, and brushing the chickens out of their nighttime shack with a broom- about 20 chickens including chicks, that awkward chick-to-chicken stage chickens (not cute, not bodacious or filled out, just growth-spurted and awkward), and regular old chickens.
The post-jerrican itch has now subsided. I haven’t seen a mirror in since I got here. Mornings are slow- everyone is slow. And it gets so hot that you just have to let it go – it’s great. Chiding people for showing up 45 minutes late to work seems to get nowhere and do nothing, so I now just prefer to enjoy my coffee and book, and watch the man make his chiapatti (fried dough) on his iron slab, patients arriving and sitting under the plumeria tree, and the day slowly wake up.
The patients roll in, most of them with CBS, gurgling and smiling until they get their fingers pricked for the blood smear, at which point they let out a howl, shriek, silent cry, hysterical scream. Patients after patients roll in, apparently because word is getting out that the ‘misungus’ are doing a study- enrollment numbers have almost tripled since we’ve arrived.
The day takes its on its slow pace- Rachel the cook comes and knocks on our door by 2:30 – bellies are grumbling, but if you tell her that lunch is supposed to be at 12:30-1 pm and that you’re dying, she just giggles, and you realize there’s absolutely nothing you can do and you have to giggle too. Ah, and yes- lunch with indubitably be rice, beans and oily cooked cabbage- with a few onions and tomatoes for taste – with pineapple for dessert… and dinner will be rice, beans and cabbage, just as it was yesterday’s dinner, and yesterday’s lunch, and the same for the past two weeks. In a country with such lush vegetation and fertile grounds, how do they come up with this?!? But they’re the best rice and beans ever, and your belly is still grumbling, and you woof it all down. I’m fantasizing about spinach and grilled asparagus.
The day wraps itself up- second reading of slides and blood work- Hopefully we’re out by 6.. a few hours left to read, type nonsense on my laptop and emails to be sent if internet ever comes back to my life .. I very much enjoy this solitude, not having to talk persistently with only a bit of casual conversation with the lab techs (all women) – Vicki, on of the girls working there, is sleeping in Joanne’s bed Friday night since Joanne (the other doctor running this study) left for the week to be with her family – and yes, I have no shame is saying that I don’t want to sleep alone in that place in case the ants come back. I’m leaving for Tororo the next day
*** Big day to Tororo ***
So now Tororo! Ah, the last patients are leaving, Rachel has just set lunch… yes, 2:30, yes rice, beans and cabbage and pineapple…
Treating myself to a weekend getaway in the town of Tororo .. a 2 hr car ride away in a fantastically crappy Toyota Corolla with no shocks on a dirt and potholed ridden road with 8 people in the car (normally 4 in the US, and in Ugandan terms, that means normally 8 people), hot, sweaty, dusty .. intimate… oh, but it really is fun- total chaos… it was really fun when a bee landed on me on the ride over, and I freaked out, lunged on top of the mother and baby on my right, threw my legs on the grandfather on my left, and car wouldn’t stop. Anyway, tangents. So here, on my hotel bed in Tororo- deliriously happy over a dinner of jackfruit, mango, raw carrots, bananas, oranges and watermelon. And kit kats. Oh god, the kit kat.
A few interesting tidbits – abortions are illegal here. The only way to get one is to present yourself to a board of 10 physicians as suicidal. You have to be examined by 5 doctors and 5 psychiatrists and have a 100% approval from all of them… Homosexuality is illegal – punishable by prison. Dowry’s all alive and kicking – Jane (another lab tech) was worth 12 goats. Kambale (the lab guy working for Heidi representing UCSF) was adopted 28 years ago – and the Amin years are from 1971-78.
Other amazing things –the huge families… hard to believe pop growth is 3.5% a year- that means that the population would double in the next two years. Is was in the car with this grandfather (and in Ugandan terms, I spend two hours on his lap) who proudly told me that he had 40 children. 40 children! Family planning, anyone? But what’s interesting is that it’s such a predominantly Christian country, the rest Muslim – and yet, having multiple wives doesn’t seem to be a problem…
First of all, I have to say that Uganda is amazing- I had no idea what to expect, since it didn’t hit me that I was actually moving to Africa until a week after I had landed, but this is everything I had hoped for and it’s so much more, and on another level, not at all.
FIRST DAY
New smells, new colors, new climate, new everything- I felt like an absolute twit with my perma-smile and eyes just about popping out of my head ever since the minute the plane descended below the clouds. My god- Africa. Consuming the view with the hungriest eyes through those miserable little plane windows where you can’t really see anything- the massive, impressive and beautiful vast Lake Victoria extended itself as far as the eye can see. Everything was green- a really dark lush overgrown greenish brown grey, hiding a bright, dark, reddish brown soil – but there was this surreal film of fog covering/surrounding it all- kind of like in Beijing. You don’t really know if it’s pollution, but it has that beautiful ethereal feeling to it, blending all the colors in. The second you step off the plane though, you realize it’s a mix of burning garbage, humidity and … yes… pollution (they don’t have a waste disposal system- they burn everything in their back yard- wood, charcoal, food, plastic, tires, dirty syringes). Apparently, a rain shower has just passed through an hour earlier. Happens a few times a day…A few palm trees, a few organized orchards (smaller than our kitchen) in people’s back yards, a couple circular dirt houses with straw thatched roofs- all right by the airport.
Before even stepping foot on the continent, you get a strange and interesting impression from just your immediate surroundings… the overly talkative guy sitting beside me is a Mormon missionary – works with the Makere University. The woman I met in the bathroom who kindly invited me to dinner and offered a couple hours of much-welcomed advice was a born-again Christian. The couple in front of me is working for an HIV/AIDS non-profit. A few Ugandans speckled around the cabin – all missionaries, mercenaries, or medics- hmmm.
Anyway, so I walk off the airplane ramp, through immigration. Posters of the current president Museveni everywhere (who has been in democratic power for the past 20 years?!?). The people here are so black- but you can immediately recognize very different features between people working there- some have much rounded features and a little ploum ploum, whereas others are very tall, proud composure, very dignified and striking features.
I meet Nuhu, UCSF’s driver, and we drive from the Entebbe airport on an hour drive to Kampala, the capital of Uganda. Perma-smile in full force, I just can’t take things in fast enough, and I probably didn’t shut up for the full drive, hitting the 3 year old stage – ‘why why what why why?’. We drive past UN helicopter (these huge hardcore looking things)- deployed for missions in the Democratic Republic of Congo. A lazy, peaceful chaos on the road. English cars, driving on the left side of the road, bikes and people sitting on the back of them going in the opposite direction to our left, people doing U’ees, intersections with non-functioning lights (it’s been about a month since the major intersection had been fixed), massive potholes (I’m talking 1 ft deep potholes!!). This is so exciting. The smells are overwhelming, the people and the vegetation have this sort of romantic overgrowth to it- the pollution giving it the romantic era. People’s houses are so poor- everything is dirt, everything is rusty brown- but the women are ‘drop dead’ (yes, Charlie’s tongue would be trailing along the road- bodacious, elegant, poised, and just beautiful), very well put-together, but walking on dirt sidewalks. And the babies and the kids, cutest things in the world.
Starting to call it CBS, Cute Baby Syndrome.. it’s everywhere- We pass many markets, fruit vendors (lots of matoke-plantain), and tile makers – arranged in funny formations (like tombstones, slanted at a 45 degree angle – planted in the front area of a house or a store. They’re displaying them to sell… )
Nuhu stops by the Malaria Consortium to pick up the keys from Heidi. Every big rep for malaria in Kampala is there – members of the WHO, UCSF, Makere University, Dr. Quick (the dr. from the Ministry of Health with whom I will work with in a few weeks)… Heidi invites me to come and assist the meeting of about 15 people- one hour, two hours later, fascinating lectures, but then my eyes collapse – the 36 hour trip just caught up with me – arg, I’m mortified, but Heidi walks me down to the office and I sleep until Nuhu comes to pick me up to go to Heidi’s apt- Pictures to follow – ouh la la, quite a little contrast with SF. Woke up around 7 pm, went out to this wonderful little Indian restaurant by means of the crazy white taxis with the expat girls – Heidi, Tamara (working in public health and has been living here for over 7 yrs) and Lisa (Columbia U. Med student who’s about to head back to finish her 4th year)… bed.
SECOND DAY
Second day in Kampala… Unbelievable – Only 15 seconds after I open my eyes do I realize I’m actually here, in Africa. So giddy, brimming with excitement at the idea of discovering what the day has to bring… I walk out, meet Heidi in the kitchen- pineapple and banana fruit salad, coffee. She’s talking on the phone with the plumber, water’s dead- we’re going to have to wait until he arrives. She asks me if I want milk with coffee- why not, so she directs me to go to the ‘cantina’ – a small little market in the middle of the apartment complexes (pics to follow). So I waddle on down- walking past four or five marabou storks, which are these huge, strange, carnivorous looking things, go to this little bodega, open air store, and ask for milk. Ugandans have a funny manner – no rush, no tone in speaking- the softer one’s voice, the more polite one is. I ask her if she has milk, the woman looks away, a few silent seconds go by and then she nods no. But this is just part of Ugandan mannerisms… she then proceeds to tell me that I don’t want milk, so I ask ‘why not, it’s to put in my coffee’, she laughs and says ‘no no, you don’t want this milk (cold plastic bag with fresh milk)’ and points to a carton of stabilized UHT milk in the back of the room. 1000 shillings. So I hand her a 10 000 shilling bill. She doesn’t move. Do you have change? I ask. No. is my answer. How is that possible, the man before me just paid 5000, and 10 000 shillings is only about 5 USD. (it turns out that everyone in Uganda ‘doesn’t have change’). So I ask, ‘what do we do?’ – ‘it is not possible.’ Silence again. And then wait. And then that’s all that happens – pace of Uganda. There’s no way to get a solution.
The plumber comes for the broken pipes. Milk story rerun … ‘it is not possible’. So Heidi problem solves for the plumber, and we end up waiting for 2 hours in the house. Total Ugandan style. Heidi tells me that this is even what happens in hospitals – a kid is acutely ill, needs to be attended at 1 pm, nurses are out for lunch, kid dies, nobody blinks twice – same frame of mind – life goes on.
Plumber’s back, we can finally start the day. We walk to the nearest taxi stand (matatus). There are only men- Heidi approaches them and 4 of them focus their attention to her. She breaks out in perfect Luganda, hands gestures from both parties, and the four men all decide Heidi and I should get into this one matatu. Crazy mini-van drive to the Mulago hospital. This is a level 5 hospital – on a scale of 1-5 - the best because it is the national hospital. UCSF is based out of what used to be the animal building. All of the data entry, analysis, etc.. is based out of this building… Heidi is absolutely great – showing me the facilities (fairly limited – very basic equipment to US standards- air conditioning in just one long room for the computers. I’ll include pics later). The hospital is spread out in little independent houses- people lounging around everywhere – very slow slow slow pace around. We run into two other ‘misungus’ – Heidi’s friends working for Cass University on another project working out of this hospital. Heidi and these two among other misungus get together on Wednesday nights to watch Queer Eye – a strong expat alliance that I’m soon going to find out is very strong/important and omnipresent in this country. We then walk back to the animal house, put in an order for lunch – which is going to be among the 7 only foods in Uganda “greens (shredded bitter greens – scrunched like confetti), matoke (boiled or fried plain plantain), cassava (root), rice, beans, g-nut sauce (a purple ground peanut sauce – absolutely nauseating)”. No salt, no spice, just lots of oil with that starch. I’ll be living off of rice and beans for the next 5 months. And yes mom, BMI is sure to double by the time of return. Lisa, Heidi and I talk about plans for the weekend and the site out in Tororo- deciding that Lisa and I could spend the weekend at Sipi Falls and hike, heading straight to ‘up-country’ for a month (Narangera, two hours north of Tororo) on Sunday. We’ll leave tomorrow.
Lunch is over, Heidi needs to get to work after taking the morning off – so Lisa and I head over to Lugogo- a part of town in the outskirts that are not accessible by public transportation (matatus)- only private taxis (special hires. They’re ordinary cars- no taxi sign, no meter, just a Toyota Corolla, with a guy willing to drive you, so you really have to trust he’s not some psycho. So a special hire is technically just someone with a car, picking up hitch-hikers and naming a price). So we hop in a special hire, grubby grubby streets and trees, and tropics- and then pow, pristine shopping center. We part ways, Lisa heads to Barclay’s atm, and I to open an account- Ugandan style … slow, nothing is possible… anyway, they then tell me something’ll work out by next week. I then stop to get what is possibly the best coffee I’ve ever had- smooth, not too strong- time to pull out my Map and guide of Uganda- yes, being that obnoxious tourist just to have an idea where in the world I am, and how in the world am I going to find the French embassy, and how I’m going to get back to Heidi’s place in this sea of mayhem, and no street signs and no official public transportation and no obvious taxis and no address to Heidi’s apt… (there is none).
So I leave, ask the security/police/guard to the phone store (owned by the gvt, as most things around are) for a special hire. Long story short- I get a car to the French embassy- blab la – register – take a boda boda (hop on the back of a moped, same principle as a special hire) to the nearest shopping district to buy converter and internet café, matatu it back to Heidi’s just in time before the sun goes down.
FIRST WEEKEND
So this may just be a coincidence, or the fact that Heidi is a great match-maker, or that people connect much more easily and quickly when far away from their home country- but so far, Heidi has organized two short vacations with two people who don’t know each other and having it work out beautifully. And traveling is such a personal experience.. but I guess that’s what happens in a country with so few tourists and so many ridiculous cool things around – Kenya is 30 minutes away from here, Serengeti on the border of Tanzania, gorilla tracking just a few hours west of the capital, and diving in Zanzibar just next door!
Anyway, I digress. Friday morning, Lisa and I take off in the dark- towards the Matatu park in downtown Kampala (this one you can Google-Earth it. Just type kampala, and I believe you may need to move east, and you see millions of little white dots/larva looking things – the matatu park). Hop onto a commercial bus, the safest because of the law of the biggest. Two cars on the road, bus always wins. Along ensue five hours driving through fields of coffee, tea, papyrus, bananas, babbling away, making connections of places in SF and people in NY, only to be occasionally interrupted by the medical salesperson standing in an overly crowded bus aisle as he pulls out a new miracle drug out of his pocket ever ½ hour, and impressively delivers a non-stop multi-lingual sermon of emphatic crazy-talk about the pill that will cure digestion, impotence and laziness, all in one. The med-student besides me is going crazy. Five hours later, we arrive in Mbale- total chaos of transportation… Oh la la… public transportation, a story in itself! It’s great, it’s energetic, it’s disgusting, it breaks all personal boundaries, it’s spontaneous, it’s disorganized, it’s logical, it’s economical, and it works-
In a nutshell- we get off our big bling bus, and walk around this matatu park. There must be about 30 different white mini-vans parked in total disarray in a big dirt space, each door open with a few passengers sitting in each, and the driver and about 5 of his buddies screaming the direction of where that specific matatu is heading. The standard matatu would carry in comfortable US standards about 8 people – with 3 to 4 benches and the drivers seat – just to give you an idea. The matatu does not leave until it’s full – that is, 16 minimum – here’s a video with 25 people and a chicken from a later trip:
So please let me digress on public transportation- Before choosing the matatu, you might ask them when they’re leaving. The answer will ALWAYS be ‘right now, right now’. The driver might jump behind the wheel and rev his engine- chances are, you’ll be waiting in the matatu for another 30 minutes waiting for it to fill up… We opt for a smaller car headed for Sipi Falls… wait a little while, personal bubble bursts, Lisa’s in my lap, I’m in some sweaty strange man’s lap, and this continues on- until someone decides to bring the windshield window (the front window of a car) – IN the matatu (wtf?!)… ok- so we’re now all ontop of each other, wait in the parking lot for a while, but the car is still not full enough, so we drive to the gas station, try to find people, no one, so we park for 10 minutes, no one, so we drive back, one person, then we wait for another 10 minutes, no one, so we head back to the gas station, fill up with gas, wait another 10 minutes for the driver to get in an elaborate conversation with his driver-buddy of his, and then finally take off… here’s a video of this trip.
Anyway, we leave, arrive successfully at Sipi Falls- (ah, an another interesting thing is crossing USAID SUV’s, UN security troops and other foreign aid vehicles along the roads, and other services catered to by foreign aid, (peace corps)).
Beautiful beautiful local – Located at around 1,775 m high. We arrive and have swarms of little munchkins following us wherever we go- ‘misungu, misungu, how are you?’ . While Lisa and I really don’t know each other at all, we find our new home to be this adorable little cabana with the view that is in the picture on the upper right … The weekend is looking great – we go on a 4 hour hike, visit bat caves (that had been used to hide cattle from the Karamojong until recently- source of a lot of conflict and violence) , the three waterfalls – only to be caught offguard by the most powerful rainstorm ever at the top of the mountains. We giggle and run down the mountain, run into the 5 star hotel to confirm the evening’s dinner reservation (candle-lit dinner, bottle of South African chardonnay – yes, we definitely got to know each other!), soaked from head to toe, white tshirts and dark red mud all over. And loving it.
*** Mt Elgon ***
Heidi orchestrates another successful weekend getaway with two people who don’t know each other. She wants to work at Nagon for a few days so sets me off with her friend Melinda to go hike Mt. Elgon for a day- At this point, I was starting to go crazy at Nagon, realizing that I was actually in Africa, in what seemed the most depressing place in the world (at first…). So we took off – only to realize that Mt. Elgon is a crazy hard mountain to climb- 1700 m elevation in 5 hours- uphill and fast the whole time… Mt. Elgon is the 8th tallest mountain, straddling the Kenyan border- it’s an extinct volcano, and so you get a complete change of vegetation- farmland at the foot, low-canopy tropical forest, then you climb this really steep wall, to enter the crater of the volcano and you get this unreal bamboo forest and this is the beginning of the national forests. It really was a surreal experience- there was this thick fog, and you could only hear this unbelievably loud symphony of birds and baboons. Along with the surprisingly expensive park fees, you need to hire a porter and an armed guide – bring all your food, camping gear, cooking equipment, warm clothing. Of course, we had nothing, but had great conversation and a bit of a what-in-the-world-am-i-doing-out-here mutual feeling.
*** First day at work ***
Ah, work… this sounds so silly and maybe this is just a western obsession or I really am my father’s daughter, but I’ve been craving the feeling of putting in a hard day’s work. Granted this is just tedious, repetitious lab work- coordinating the prescriptions the patients hand us with these rapid diagnostic tests (RDT’s), drawing blood for blood smear testing for malaria, which will be diagnosed by microscope, RDT and later down the road, PCR in Kampala or UCSF labs back in the states. We then collect information as to how much time has been spent on transportation, how much time has been spent caring for the patient, how much has the treatment cost – all to be able to determine the costs associated with the disease and the impact of a small investment in these RDTs. Oh, but it’s so great, so exciting- Heidi’s paper, perspective, potential so fascinating! God, this is worth every rotten, grumpy, miserable table I waited on over the past few months…
Anyway, I wake up with the sound of mosques in the town- 5 am… so I stay in bed (romantic setting in the TB cell under the mosquito net) with my eyes closed, birds start making noise, then chickens wake up, ruffling and shuffling in the TB compounds beside us- 7:00 am, everyone’s awake.
This is such a natural high! A quick breakfast, a lesson on washing out of a jerrican in a showering ‘pit’ (oh, and this shower/bath with less than 2 L of water is so disturbing- you have a prickly feeling from head to toe for the rest of the day… making you think you’ve caught bilharzia. Quick creepy and fun tangent – bilharzia is extremely common in Uganda- affecting most people in contact with water from Lake Victoria, the Nile, etc… in the words of the Lonely Planet, Health in Africa “ you may get itching all over, known as ‘swimmer’s itch, and perhaps a rash as the worms penetrate your skin” mmm, a delightfully gross concept) -and the most heart-warming, welcomed, comforting thing ever– a phone call from dad- ah, now reenergized, we head over to the health center.
I can’t even tell you how exciting this is. Sort of like the picture I had always had in my head of this early 20th century, English colony in the heart of darkness- veranda overlooking a long dirt path – a few mothers lingering with their babies tied to their backs with just one piece of cloth. Don’t know how they make it look so comfortable, so natural, so practical, with just a little head popping out of a cocooned bundle, snuggled against his mum. As we walk up the stairs of the health clinic, I’m just struck by the amount of people waiting for the health clinic to open… Four men sitting on the stairs, a dozen women and either their babies or children on each side of the patio. Through the front door, there are six benches lining the hall packed with patients, with a couple blankets on the floor with toddlers curled in a ball, sleeping.
There’s a certain bestial feeling to it – a general noise of wailing, whining, crying, lamenting – a sort of sad orchestra of dying battle field… it definitely smells of bodies –a mixture of sweat, urine, wet chicken (always raining these days – February is supposed to be the draught season in Uganda, but the screwy weather is blamed on ‘global warming’ – and yes, there are chicken and pigs and goats running on the health center grounds), wet soil and plumeria from the tree by the doctor’s house. It’s a crazy feeling – time, culture warp, whatever, it really does feel like what medicine should be all about, but sadly the basic necessities are not even here to satisfy the need (take a look at the pharmacy! Just a handful of drugs available, dispensed out of the window, see pic on the left).
We walk into the lab – dingy, grubby, very basic. A couple dirty cups for urine tests on the counter, iodine and slide stains staining the counter and sink, piles of slides in the sink, soaking for some unknown reason and a bunch of random boxes and story… not quite the lab at Gladstone or the Doerrer group lab. We open the door connecting this lab room to the main one by a very squeaky door- a room overlooking the patio we had just crossed with an open window, with bars.
Patients line up- hand in their blue books by the window, the day begins.
*** The Killer Ants ***
Our homeOh, this is a good one – So Wednesday night, Heidi and her friend Melinda (a friend of hers from Columbia med, now a shrink at Yale, visiting Uganda for 10 days) arrive at Nagongera- bla bla bla, night arrives, dinner, bla, bed. Heidi sleeps in the trading center, Melinda in the TB cell with Joanne and myself. So the three of us are sleeping away, when Melinda starts slapping herself. “Smack! Smack!”… funny, I’m starting to feel small little pricks, then realize they actually hurt… “ OW!” I start slapping myself too – Joanne wakes up – “ what’s going on?”. Melinda turns on her light- “OH MY GOD!!!” I jump to mine- fumbling around to find my glasses somewhere tangled in the sheets, realizing there are small little black things all over the bottom of the bed. I jump up on my feet, lean in to the light switch, only to realize that the entire floor is moving- Swarms of ants are infiltrating the door, spilling out of my suitcase, blocking the door… at this point, you have two grown women in their 30’s, jumping on their beds, in absolute panic... but now here’s the unsettling part. We open the window and scream for help, I’m whistling with my fingers, all of us making as much noise as possible for at least five minutes since we can’t leave the room, and nobody responds. This is very strange, since the TB wards are right next to each other, with 15 families living side by side. Joanne jumps to the door, with an ‘ow, ow, ow!’, and flies out- and starts banging on these neighbors’ doors, calling them by name, no answer. Finally, Joanne reaches the doctor’s house, who comes out with his brother back to our place with petrol, spraying everything. Ants vacate and move to the next TB ward. Lights go on, people run out –
Now while I look back at the Killer Ant Night and can’t stop laughing, I can’t help but think how disturbing the behavior of what seems to be such a tight-knit community is. What if we had been in serious danger or trouble; had one of us had a heart attack, had someone broken in, had raped us, anything- the small compound of 15 families would have kept their doors locked and not answered to a call of help. And while I definitely feel as if Misungu are not sincerely welcome, Joanne is Ugandan, so how could they show such a cold shoulder to one of their own? Maybe this is the reflection of the post-Idi Amin brutality… I don’t know. But this definitely adds a darker layer to an apparent, voire even superficial smiling front.
*** Day 10 at Nagon ***
Mmm- so the glowing aura of the retreat at Nagon has somewhat faded as quickly as it arose… The past week was just getting better and better- after a stern conversation with myself realizing that the project we are working on has been everything I had hoped for in San Francisco and that the best way to embrace this experience was just to dive in the work… However, Heidi left for London this morning, and it is only Joanne, Kambale and myself representing UCSF-UMSP here at Nagon. Knowing that I’m a naturally neurotic person, I try to take this in account when I start questioning things, myself, whatever… But I’m starting to worry. I was flipping through some of the medical files of some of the patients, and did a double take when I realized that file after file for young women had accounts of assault and rape. Let aside the frightful stats of HIV/AIDS…
So I’m flipping through the files of the Okello’s, Othieno’s, Obene’s … all stopping by our lab for their diagnosis of malaria. I fill out the lab work for the next patient from her ‘medical chart’ – that is, a blue book for primary school that the patient must carry around with a few scribblings by prior medical visits…. 19 year old female, wait, no- 6 month old boy – they’re both using the same blue book. Hmm- looking closer at the book.. In late 2005, this young woman was diagnosed with an STI… more messy med scribble… assault …. Rape. Oh… my stomach turns… and yes, we are going to get a blood smear for a six-month old boy.
Joanne was just telling me of her skepticism towards the people of this village. “I don’t trust these people. They would kill over a chicken- these are poor poor people”. Apparently, less than 5 years ago, the archbishop of Ghana was buried on the road between Tororo and Nagangero (the bumpiest hour ride that we all must take to get here from anywhere). It was a procession of about 20 cars, quite a big ordeal. Now maybe this is where I’m freaking out unnecessarily, or the bit of being isolated may be taking its toll, but yes, I’m a little concerned… Coupled with the reaction post-killers ants…
As far as I know, I’m the only misungu (white person) in the district – haven’t crossed paths with another white person since the top of Mt. Elgon (specially geared towards tourists – a site about 4 hours away). Now this isn’t a problem – actually, I think I should be loving it… not needing to worry about the mess I usually am and being completely engulfed in a new culture and world. And you almost forget you’re white, getting used to only seeing rich dark chocolate skin to a bluish-black-coffee-bean-post-french-press color- and then look down and are almost disappointed/turned off by the pale, greenish complexion of your arm… anyway, digressing again… all this to say there’s just no way for a white person to remain inconspicuous. Walking down the street, everyone turns around – people come out of their houses and shops to look at you- kids screaming ‘Misungu’ 300 yards away - you turn around and you have a little entourage of half a dozen kids following you. This weekend, in Tororo, a relatively large town, a private car (every vehicle is basically a crappy Toyota used as a taxi/public transport) did a U-turn on the street and pulled up next to me. There was a man and woman, and about 5 kids in the back seat – the guys rolled down his window and said that his kids wanted to shake my hand. Cute, novel, momentarily flattering (ouh, they all want to meet me) .. but not when you’re alone and sometimes, I wish I could just walk anonymously down 42nd street again... But it is this very candid way of discrimination- with not a bad feeling (or at least my naïve self would like to believe that) associated with it – that seems to create such an insurmountable divide between the two colors. Ugandans are very unwelcoming to strangers. Apparently, no matter how much you try to incorporate yourself, you will always be an outsider.
As I was just telling a wonderful friend of mine, everyone talks about how these experiences change you, but I’m starting to worry that it may not be for the best… and I’m not talking about the not-showering, shaving, bit. The misungu expats community seems to be so barred, hardened, walled up – keeping to themselves, doubting everyone, being ‘too independent’, ending up lonely – in an attempt to keep it together. And I’m definitely not ruling out the possibility of coming back like a scruffy, hippy, missionary-looking, dirty hooligan.
*** Day 12 ***
Today is Valentine’s Day – Surprisingly, it’s a huge deal here… and not even Hallmark sponsored! Everybody dresses up- red, black… and the lab girls have been talking about it since 9 A.M. They tell me that in the big city, Kampala, Valentine’s day is the occasion where women try to outdo each other- it’s all about the biggest bouquet of flowers delivered at work, the biggest show – total Christmas light phenomenon. Women apparently save up for months to secretly buy themselves beautiful dresses, only to boast them as gifts from boyfriends or suitors… Newspapers are full of personal ads -
Nostalgia settles in… a slow night at the TB ward brings me back to last year on this very night… life goes on. Oh, and tomorrow is Morgan’s birthday. Last week was Emerson’s and Shirwin’s – before that, Dave graduated from college, hopefully down a snow covered hill.
*** End of the week ***
Perspective on being here has changed… again. Somehow, if I wasn’t so obsessed about these stupid ants eating us alive in our sleep and nobody doing anything about it, I think I’d absolutely love it here..
There’s something deeply soothing about being here – a retreat from crazy modern life if you will. I try to wake up by 6:45 with the sun because the chicken coop is right by the window, and I love seeing the woman opening it up exactly at 6:45, and brushing the chickens out of their nighttime shack with a broom- about 20 chickens including chicks, that awkward chick-to-chicken stage chickens (not cute, not bodacious or filled out, just growth-spurted and awkward), and regular old chickens.
The post-jerrican itch has now subsided. I haven’t seen a mirror in since I got here. Mornings are slow- everyone is slow. And it gets so hot that you just have to let it go – it’s great. Chiding people for showing up 45 minutes late to work seems to get nowhere and do nothing, so I now just prefer to enjoy my coffee and book, and watch the man make his chiapatti (fried dough) on his iron slab, patients arriving and sitting under the plumeria tree, and the day slowly wake up.
The patients roll in, most of them with CBS, gurgling and smiling until they get their fingers pricked for the blood smear, at which point they let out a howl, shriek, silent cry, hysterical scream. Patients after patients roll in, apparently because word is getting out that the ‘misungus’ are doing a study- enrollment numbers have almost tripled since we’ve arrived.
The day takes its on its slow pace- Rachel the cook comes and knocks on our door by 2:30 – bellies are grumbling, but if you tell her that lunch is supposed to be at 12:30-1 pm and that you’re dying, she just giggles, and you realize there’s absolutely nothing you can do and you have to giggle too. Ah, and yes- lunch with indubitably be rice, beans and oily cooked cabbage- with a few onions and tomatoes for taste – with pineapple for dessert… and dinner will be rice, beans and cabbage, just as it was yesterday’s dinner, and yesterday’s lunch, and the same for the past two weeks. In a country with such lush vegetation and fertile grounds, how do they come up with this?!? But they’re the best rice and beans ever, and your belly is still grumbling, and you woof it all down. I’m fantasizing about spinach and grilled asparagus.
The day wraps itself up- second reading of slides and blood work- Hopefully we’re out by 6.. a few hours left to read, type nonsense on my laptop and emails to be sent if internet ever comes back to my life .. I very much enjoy this solitude, not having to talk persistently with only a bit of casual conversation with the lab techs (all women) – Vicki, on of the girls working there, is sleeping in Joanne’s bed Friday night since Joanne (the other doctor running this study) left for the week to be with her family – and yes, I have no shame is saying that I don’t want to sleep alone in that place in case the ants come back. I’m leaving for Tororo the next day
*** Big day to Tororo ***
So now Tororo! Ah, the last patients are leaving, Rachel has just set lunch… yes, 2:30, yes rice, beans and cabbage and pineapple…
Treating myself to a weekend getaway in the town of Tororo .. a 2 hr car ride away in a fantastically crappy Toyota Corolla with no shocks on a dirt and potholed ridden road with 8 people in the car (normally 4 in the US, and in Ugandan terms, that means normally 8 people), hot, sweaty, dusty .. intimate… oh, but it really is fun- total chaos… it was really fun when a bee landed on me on the ride over, and I freaked out, lunged on top of the mother and baby on my right, threw my legs on the grandfather on my left, and car wouldn’t stop. Anyway, tangents. So here, on my hotel bed in Tororo- deliriously happy over a dinner of jackfruit, mango, raw carrots, bananas, oranges and watermelon. And kit kats. Oh god, the kit kat.
A few interesting tidbits – abortions are illegal here. The only way to get one is to present yourself to a board of 10 physicians as suicidal. You have to be examined by 5 doctors and 5 psychiatrists and have a 100% approval from all of them… Homosexuality is illegal – punishable by prison. Dowry’s all alive and kicking – Jane (another lab tech) was worth 12 goats. Kambale (the lab guy working for Heidi representing UCSF) was adopted 28 years ago – and the Amin years are from 1971-78.
Other amazing things –the huge families… hard to believe pop growth is 3.5% a year- that means that the population would double in the next two years. Is was in the car with this grandfather (and in Ugandan terms, I spend two hours on his lap) who proudly told me that he had 40 children. 40 children! Family planning, anyone? But what’s interesting is that it’s such a predominantly Christian country, the rest Muslim – and yet, having multiple wives doesn’t seem to be a problem…
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