Archive for September, 2008

Twenty-one people, two chickens, and The Hairy Lemon

September 30, 2008
Two weekends ago I went to a land of peacefulness that took an adventure to get to and from. Willem, Michiel, Tomas (a Norwegian medical student), and I met in the Wandegeya neighborhood to get there.
The guys on the short of the island

The guys on a shore of the island

We took boda bodas from our apartment and then the torrential downpour started. All said and done, it took the 4 of us 1 hour to get to the taxi park that usually takes 20 minutes to get to because of the downpour and streets. But we made it thoroughly soaked. After disembarking from the first matatu near Jinja, we boarded the adventure mobile matatu to Nazigo. Oh yes. Matatus normally seat 14 people. Our conductor managed to cram 21 people into 14 spots. And, then there were the two chickens in a lady’s purse. What’s an overcrowded matatu without speeding fast while I ponder the Russian roulette being played with our lives?

Well we made it Nazigo and argued a bit when the conductor tried to charge us slightly more than double the price. After getting through the normal verbal football of negotiating transportation prices, the four of us went by boda bodas (2 grown men behind each motorcycle driver = CRAMMED part two) for about 15 minutes to the Victoria Nile River. A canoe came and picked us up and rowed us to The Hairy Lemon island in the middle of the Nile River (http://www.hairylemonuganda.com/). What a peaceful, wonderful place, and including transportation a weekend trip cost about only $40 USD.

Owned by Irish expats Erin and Rob, it’s a very cozy, no frills camping/banda island with wonderful food and common areas to read, relax, and socialize.
Michiel reading in the dining area

Michiel reading in the dining area

Everyone speaks quietly there and best of all the Nile here is safe to swim in, which is uncommon in other water sources here for risk of the etiological agent of schistosomiasis, a brutish disease. The rapids were quite peaceful, ebbing and flowing around the small island. We all swam, soaked up some sun, and read, read, read. We stayed in a 10 bunkbed dormitory at night and met other expats relaxing from the big city or elsewhere. Saturday night I taught the 3 guys how to play euchre — they learned quickly making it all the more fun to play.

Nile diversion

Nile diversion

Falling asleep to the gentle roar of the Nile rapids provided an idyllic background for drifting to sleep.

Some Victoria Nile rapids

Some Victoria Nile rapids

We read in the morning and swam before leaving.
Tomas leisurely reading

Tomas leisurely reading

The trip back was about as crazy (sans chickens), but the 24 hours on the island were well worth it. I hope to go back next month with at least Chris and Sarah. The desire to relieve the tensions from being in the hectic city comes quickly here, all the more reason to go whenever I can.

Sunrise on a Nile diversion

Sunrise on a Nile diversion

Alex’s Father

September 28, 2008

Last Friday, September 19, Alex came back, but this time with his father. Dad had a CD4+ T-cell lymphocyte count of 28 on August 9. To say that 28 is low is an understatement. A normal CD4+ count in a healthy individual ranges between 500-1500. We addressed his medications, but father looked quite ill. This boy has really captivated the nurses and physicians. I think embedded in our concern for Alex, lies not only the human draw to preserving childhood innocence, but also some elements of hope and fear surrounding the outcome. Alex’s father’s death would leave him an orphan. But from what I can tell and in light of my previous posts, he will not be stranded.

Portents of filth: Maribou storks

September 24, 2008
Enjoying trash

Enjoying trash

I have written about the Maribou stork previously, but they make me laugh, feel pity, and groan at the same time. Hugely awkward-looking birds flying around the big city and looking out of place, when you see a Maribou stork you know that there is garbage nearby. Everytime. They are portents of filth. They wait for it, swoop down, make a strange noise that should scare any little child (which incidentally the storks are bigger than), and finally perch upon a building or a tree or in the picture below said dumpster. Waiting…

Care to join me?

Care to join me?

Accompanying the home health visitors (HHV)

September 23, 2008

Last Tuesday, I had the chance to go to with the home health visitor (HHV) team to one of the community zones where our team is surveying chronic coughers. Kampala is divided into 5 divisions, 128 parishes, and many, many more zones. The main research project on which I work is surveying individuals in the Rubaga division. One this particular day, I accompanied the team – Hassard, Joyce, Kezron, Sheila, Joanna, Mustafa, Joseline, Esther, and Stella – to the field. We went into Wakaligga B zone in Rubaga division, Rubaga parish.

Let me tell you how the process for going to a new zone goes. Two weeks before starting in a new zone, someone from the project meets with a community leader (not quite mayor) for a particular zone to get permission to survey in that zone. (At the division and parish levels, permission has already been granted.) Community guides are then selected to accompany the research team. The first day in a new zone is an orientation day. The Ugandan HHV team goes out subsequently to interview the pre-calculated proportion of zone residents using a geographic sampling strategy to cover the zone.

Not knowing Luganda other than for a few phrases, my presence was more spectator than anything else. I had a great time spectating, though. First of all, a mzungu (me) knowing any Luganda usually shocks people, especially kids. So when kids asked me “how are you doing?” as we passed a school, and I responded with “I’m fine. Oli otya (how are you)?”, a roaring chatter and laugh ensued.

As I’ve written in mass emails from other trips, I then experienced being the Pied Piper of Hamelin. Kids followed me, daring each other to get to as close to me as possible and then running away or holding my hand while walking. The attention given warmed me up quickly given I probably was understandably met with some suspicion. Meanwhile, the HHVs were doing the hard work getting informed consent, explaining the survey, collecting sputum and performing rapid HIV tests on the spot.

One child humored me greatly. Probably near 2 years old, she kept chasing a chicken and hitting it until her mother kept reprimanding her. The chicken was not thrilled as the child still continued to harass it. I couldn’t stop laughing – the child was just so curious at the chicken’s response to her hitting it.

The whole HHV experience gave me insight into the data monitoring I do every morning on the template forms that the HHVs fill out the previous day. One woman, during the informed consent process, was hung up on the use of “East Africa” in the address of the project. Of all the potential issues needing explaining in the informed consent document, she was most concerned about whether or not she was going to be calling “East Africa” if there was a problem. The health literacy of those I saw surveyed varied, and the HHVs do a fantastic job explaining the trial and basic health information to the participants.

Sometimes people are shy about volunteering to be surveyed. Some mistrustful. Others wait until the HHVs have been here for awhile and then volunteer but usually after the cap has been met. Men are particularly difficult to interview because some are working during the day (ideal in the ultimate sense but not for research purposes), some may be lying about their incomes so that their wives/girlfriends do not find out, and some are shy about the process.

Wakaligga B does not see many mzungus I came to find out. It was moderately crowded for a place with lower socioeconomic status (as opposed to the “very crowded” distinction used in the project). Hassard said he wished I could have been at a previous site that was more “slummy.” I will in time, and I told him that I bought some furniture from some carpenters in one of the squatter community Katanga, near the hospital. I cannot say that I am morbidly curious to go to such an area after time spent in the Kibera, Mathare, Mukuru, and Kawangware squatter settlements in Nairobi. But, I was glad for the people we saw and interviewed that they had better living conditions than a left-behind squatter settlement. Make no mistake, the poverty still overpowers.

A few of the participants knew English a bit, so I talked with them when possible. One mother explained how her daughter had chicken pox. Happiest baby I have ever seen with the chicken pox as I took note of her skin lesions. The language of the body provided most of the conversation today. Smiles, laughter, a few phrases and the joy of children. I left to have a late lunch at a local joint with the HHV team after we all ate tangerines bought from a man riding a bike driving around a gigantic bag of them.

The HHV team took good care of me and included me whenever they could. I look forward to going to the field once each zone!

HIV/AIDS, tuberculosis, and KS Part 2 – her health story

September 18, 2008

This week has been my first “normal” week since I have been here in the sense that my weekly schedule is starting to solidify. Shortly, I will post what I now do through the program. Among those activities, I will have clinical time three times a week at this point.

 

On Wednesdays, I will be seeing patients with Dr. Henry Luzze, one of the researcher co-investigators and physicians here at Mulago. He staffs the tuberculosis clinic at Mulago hospital in Wards 5 and 6, which are pictured elsewhere on my blog already. We had one woman in particular whose condition particularly struck me this past Wednesday, as do many.

 

She came in for her “check-up.” A tough woman in her 40s (but looking as in her 60s), she was taking second-line anti-retroviral therapy (medication for HIV/AIDS), presumably because of a resistant strain. She had miliary tuberculosis (more advanced form of the disease), cervical cancer (status unknown by this staff but status post two radiation therapy courses I was told), and disseminated KS (Kaposi’s sarcoma) lesions. I wrote about KS lesions in an earlier post. This lady had the distinctive KS lesions on her arms, legs, and in her mouth scattered around her oral palate. Relatively emaciated – relative, that is, to other patients seen here – she was still strong and kept going.

 

We knew a little less about her because she is enrolled in a clinical research trial through the IDI (Infectious Disease Institute: http://www.idi.ac.ug/) at Mulago, a well-funded research institute here on campus. Dr. Luzze commented on her grave condition. One Ugandan resident physician here who has rotated in the US talked about how different aggressive therapy approaches are in the US compared to here. He said in her case, “why would we continue when she is in the condition she is in?” looming on death’s doorstep. Part of his answer may have been cultural, but part of it has embedded in it in the resource constraints here, even despite decent medications available through the IDI research study. I listened but wanted to say that her life is worth it, and she keeps going; this is why she should continue therapy.

 

Physician Paul Farmer writes of tuberculosis as an imposition, a punishment in many ways. I will write more on his views and how I see them manifest after I have experienced more here. Suffice it to say, the illness-poverty link is unmistakably glaring and visible. I have studied and written about this link in the context of the USA through an opportunity as editor of an issue on the topic in Virtual Mentor: American Medical Association’s Journal of Ethics (http://virtualmentor.ama-assn.org/2006/11/toc-0611.html). And while there are similarities, there are many differences structurally between access (or restrictions) to care in the US and here. More rumination on that topic throughout the year to come…

Entebbe Gardens (second time) and Wildlife Education Centre

September 18, 2008
 

The weekend was relaxing. I am getting more comfortable taking the matatus around town, mostly because I know the prices generally so I hopefully do not get ripped off. After morning errands and reading at Rwenzori café over coffee and a sandwich, I later had Chinese food with Chris. He told me about his African bus trip to and from Nairobi, which rivaled my bus trip to Kigali in terms of discomfort and unexpected events.

 

 

  

Sarah has been having some logistical issues upon arrival which made mine seem like child’s play. She needed to get out of town as she put it. Chris, Sarah, and I went to Entebbe by matutu yesterday for a fun day of the Botanical Gardens and Wildlife Centre (essentially a zoo). For some reason at the Gardens, one of the men told me to be the guide since I had been there before. I think a big bus required all of their efforts. Plus, more people equal more tips. I took them on a tour and recalled as much as I could from my trip there three weekends ago. We saw/did the highlights including vervet monkeys, Tarzan vine swinging, the sacred coffee bush, and the aromatic bark of the cinnamon tree. We tried to seek out a restaurant run by expats from Laos, but we could not find it and settled for another meal.

 

The Wildlife Education Centre is more an animal orphanage than a zoo, though by appearance one would think only zoo. It is essentially a sanctuary for animals that were harmed by predators, poachers, or were injured. Chris pet one of the vervet monkeys. We saw river otters, warthogs, water buffalo, snakes, zebras, a lion, rhinos, crocodiles, chimpanzees (fascinating mammals), a python, and yes, a donkey. Enjoy some pictures below. The best part was watching Ugandan families have so much fun there. Kids and parents were saying “Pumba!” “Simba!” “Mufasaaa.” They even had an Elder Tree on the site – home of Rafiki.

Chimps at WEC

Chimps at WECLion at WEC

 

 

River otter - WEC

River otter - WEC

 

 

Vervet monkey up close and personal - WEC

Vervet monkey up close and personal - WEC

Shoebill stork

Shoebill stork

Crested crane - WEC

Crested crane - WEC

Rethinking laundry and chores

September 16, 2008

In only a month, I have had an evolution about how I approach chores and laundry around my apartment. At first, the frugal individual in me wanted to do everything. I thought that paying someone to clean the house, sweep the floor, do my laundry, take out my trash was lazy, costly, and perhaps demeaning. A series of events has led me to question those preconceptions:

 

1. A woman approached me a few weeks ago one night with one of her two young kids in hand and asked if I had any work for her to do at my place. She was looking for extra work and currently was the “house woman” for one my neighbors and lived in the “help quarters” there. She offered to do the laundry, dishes, house cleaning, and trash clean up. She was looking for extra income. Anyone, Ugandan or expat, who can afford what are called “house boys” or “house girls” hires them, even people who have lower-middle class economic status. The way she approached me summed up why I should let up on my “can do it all mentality” because I can afford to help one of them out by offering work, work that costs me no more than $7 or $8 equivalent per week.

 

2. So on that note, I decided to hire one of Matt’s Ugandan friends. His name is Nelson, and he works for a Christian organization Matt supports locally. Nelson is a guard there and lives with his girlfriend/partner Jasper (soon to be married) and child. Nelson’s story is interesting. He trained at one point to be a mercenary in Iraq. Apparently, some East Africans were being recruited to be employed as mercenaries there. (I do not know for which faction though.) He ended up not going; however, he has some friends who are there and some who died as mercenaries. Now he is trying to earn enough money so he and Jasper can get married. Marriage is extremely expensive here and rarely do poorer people elope or get married. Even to get a simple legal marriage from a judge is difficult and expensive by itself. I got back my first load of laundry that he and Jasper cleaned for me – they cleaned out stains that were in the clothing when I brought it to Uganda. I still clean a few items myself and hang them on a line on my balcony, but I plan on employing them for laundry while I am here.

 

3. I still do not feel comfortable giving a key to someone to come in and dust. It is SO dusty here and floors, countertops, basically anything not in a closet gets dirty here quickly. I can see why the tenants above and below me employ a cleaning woman and man, respectively. I think Willem, Michiel, and me will do it ourselves for the time being. I probably could trust someone, if I pick someone connected to people here that can vouch for them, such as Nelson. Time will tell if I change my mind, but there is something nice about cleaning yourself and since I’ve furnished the place I like taking ownership in cleaning so far.

 

4. Garbage. I left it out one Wednesday morning to be taken by a presumed garbage service that comes to my wealthier neighbors. I do not think it was taken by the garbage trucks, though. Someone disposed of it somehow. The cleaning guy downstairs told me to put it out on Saturdays by his room that is attached to first floor tenant, but I am not sure if I would pay him or if it is included with my rent. Any way, I hired the house woman upstairs, Rose. Rose has two children, Micah and Catherine, who live with the 30-something brother and sister who rent above me. My garbage will probably get dumped or burned, but the landlord decided not to offer a pickup service because the other tenants in the complex area thought it too costly. It is a short term solution that will hopefully help Rose, but my “green” side shirks from the disposal method.

 

This is an entirely too long and detailed post but the point of it follows. At least in my current context, doing the work myself, although perhaps rewarding and certainly cost-saving, essentially equals less work for others in a society that lacks enough jobs for the employable population and where people make low wage even at relative standards. While the work is menial, it is work available in a place lacking enough employment. At home I would feel lazy paying someone else, but here I could see myself eventually feeling stingy and guilty in not hiring people for some of the jobs.

King Muloki, RIP

September 16, 2008

Did you have Monday, September 8, 2008 off? We did at the last minute. The king of Busoga, King Muloki, died the previous Thursday. This kingdom’s boundaries starts past the town of Jinja at the Victoria Nile River, which you will see mentioned in future posts. According to my guidebook, Busoga kingdom was created in the 20th century as essentially a conglomerate of smaller chiefdoms. Sarah and I ventured into the Nakasero fruit, vegetable and spice market since we had the day free. We found foods ranging from watermelon and eggplant to cloves and vanilla sticks. I bought some ingredients to make a salsa that turned out quite nice. Michiel took a liking I think when he dumped a heap of it on pasta one evening. But he also dumped a can of tomato paste on his pasta, too.

I’m not only a research trainee…

September 16, 2008

…but also an electrician trainee.

Plug conversions

Plug conversions

 
 

 

Since the twists and turns of my place’s wiring and plumbing, I have started to acquire a broader skill set. Two Saturdays ago, my big accomplishment was converting electrical plugs on appliances. Both my electric tea kettle and iron had South African style plugs apparently, and I had converter plugs to switch them. So I cut off the plugs, stripped the wires, matched the 3 naked wires to the corresponding spots in the new plugs and prayed I would not blow a fuse and shut down the electricity at place. Success!

Matt’s last meal

September 15, 2008

We gathered a posse together for Matt’s send off meal on September 4, before he returned to Vancouver after his month here. Here’s a picture of us at Mamba Point Pizzeria.

Mamba Point Pizzeria

Mamba Point Pizzeria

 

Matt is on the far left followed by Chris who is here until early June on a Rotary Club International fellowship. You know the next guy going clockwise, and next to me is Michiel who is here until mid-November. Willem next to him and then Sarah. Michiel and Willem, both Dutch medical students doing rotations here until November, moved into my 2 other bedrooms. It would have been more complicated to have the picture retaken, but yes, that is the server’s thumb in the picture.