-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.

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…