Summer In Uganda


Thursday, July 15, 2010

Week 7

Becky, Dustin’s wife arrived today. We headed to the ferry landing in Entebbe to get to Kalangala, which is one of the Islands in the chain of Ssesse Islands within Lake Victoria. You have to see it to understand, but the lake is immense. Communication continues to be a problem. Dustin was told by the Taxi driver that the ferry left at 2pm so we had planned to be there about an hour early. This morning we were told that the ferry leaves at 11am so we scrambled to get there before it left. We arrived at the landing and of course the ferry was not there. It leaves the island at 8am and arrives there at 11am and then departs at 2pm, so we were there about three hours before it was. Getting on was very frustrating because the searched our bags thoroughly, much more so than they have ever been searched at an airport. The ferry was about 100ft landing craft and the ride was about 3 hours and fairly smooth except for about 15 or 20 minutes of rocking when we were in some of the more open parts of the lake and the wind kicked up the waves. When we arrived there was a small wooden boat waiting to take us to our hotel which we could see in the distance along the shore. We pulled up on the beach which was quite clean and not what you would expect of a beach in a fresh water lake. It had white sand and the water was fairly clear. We managed to get from the boat to the beach without getting our stuff and our selves wet, since a few of the staff pulled the boat up o shore enough for us to hop of the bow. They had tea and popcorn for us. Afterwards we got settled in to our rooms which were nice except they felt humid and the furniture and linens felt wet. There was not mold though. Dinner was different and good based on that alone. It was fried chicken that didn’t taste like fish. They light a bonfire at night by the shore and we sat out by it for a little while before heading to bed.
When we came to breakfast we were surprised to see monkeys just across the lawn. We had breakfast and watched the monkeys, before heading up the mountain to the town. We walked and it was evident then that I needed to start exercising again, because I nearly died on the hike up the hill. As we were leaving the hotel a very friendly and health looking German Sheppard adopted us, probably because few locals show dogs affection and he has come to learn that foreigners like dogs. He walked with us the whole way and back. The town was a very basic trading center with just a few small stores and a bank. It didn’t have ATM, so we hung out outside with Stegosaurus Rex, the name that Chris gave the dog, while Dustin tried to negotiate the red tape in the bank in order to withdraw money. We got back to the hotel and took a nap, until dinner was ready. They made the most amazing fresh fish and so far the best meal we have had in Uganda. We relaxed by the fire for a little while again before heading to bed. It rained a little while later after they had shut off the generator and it was very relaxing to fall asleep with the noise of the rain on the tin roof.

We had to be ready early to catch the ferry back early, so we had breakfast and anxiously awaited the van to take us back to the landing, which got us there just in time to have our bags rummaged through and to get on board. We weren’t anxious to leave really, but if we missed the ferry we would have to wait until tomorrow to catch the next and we had reservations. We headed back to Kampala to a back packer’s hostel called Red Chili to stay the free night that we were entitled to, because we had booked a tour of Queen Elizabeth National park with them. We were skeptical of a hostel, but we hoped it would not be much worse than Hotel City Square. We were wrong the mattresses were repulsive and the bathroom was disgusting, but we reluctantly stayed because our tour left early.
Our guide was on time and we received our briefing before we left. We were told that we would be going a certain route because the roads were better, but it seemed like most of the 8 hour drive was on the worst roads in Uganda. They were under construction and much of the roads were dirt and full of pot holes. We stopped about half way to eat lunch and then continued a short distance to waterfalls nearby. After a short visit at the waterfall we continued and arrived at Simba Safari Camp near the park about 6pm. We had dinner took a shower and went to bed
The first part of the tour was taking a community walk and visiting with a group of women who make crafts. We heard many similar cultural explanations as we do in our research. When we arrived to visit the women’s group the tour guide had them sing for us, which made us a little uncomfortable because it didn’t seem like it was part of the program and they were not expecting to. Also, the second song which was in their native language was explained by the tour guide as being about how colonizers had devastated them and asking us to help them. We went through a question and answer session for a few minutes. Our group asked pretty superficial questions about their crafts and how they came together to make them. They on the other hand had some pretty hard hitting questions, one of which was if in the US women had the problem of their men getting drunk often and coming home and beating them. After that we headed to a boat ride on the channel between lake George and lake Edward for a wildlife tour. Along the shores there were elephants and hippos in mass. We also saw one crocodile and a few warthogs and waterbucks. There is also a fishing village along the shore of the native people, who were allowed to remain within the park when it was formed. We took a lot of good pictures. After that we drove through crater tour. It’s an off road path along the ridges of the calderas in the area and there were some very scenic views. We stopped at Queens Pavilion for a short rest before we continued to our camp. The next day was the safari drive and you have to be up early in order to see the animals that are more active in the morning before it gets too hot, so we got back and went to bed.
We headed to the park about 6. The Toyota van that we were in has a pop up camper roof without the canvas so you can stand up and see all around the vehicle, so see the animals and taking pictures was pretty comfortable and pleasant. We were concerned that we would not be able to see lions because cattle ranchers had recently poisoned several lions and there were only about 7 left. Our driver received a call after driving for about 30 minutes that a lion had been spotted and we headed in that direction. We arrived to see a female lioness walking about fifty feet, parallel to the road we were driving on. Not too far ahead of her was a herd of waterbuck, which seemed to be cautiously aware that she was there, but not necessarily concerned. We followed her for some distance and eventually she laid opposite to a tree off the side of the road, so we were not able to see her anymore. There was another call about hyenas being spotted and after a few minutes of debate between our guide and driver, they decided to circle around the tree to take a closer look at the lioness. She just watched us as we drove just about ten or fifteen feet from her. We stopped and she sat up for just a second, which made everyone very nervous, because we could see now just how big she really was and we got the feeling that she could easily get to us. She settled back down a second later and was calm as we took a few more pictures before driving off. We drove a few more hours and saw plenty of warthogs, antelope, waterbuck, and buffalo. We also stopped by the fishing village that we saw yesterday and were standing on the shore with the Hippos just a few feet away in the water. I got a little nervous, since Hippos kill more people than any other animal I Africa each year. We headed back to camp to take a nap. The final part of the trip was to learn how to make paper-bead crafts and grass baskets with some local women, which we did after dinner. It was very interesting and it gave us an appreciation for how much time goes into making the crafts we see in the markets.
Today was all about driving back to Kampala, again on the worst roads known to man. We arrived about 5. We had hoped to make it earlier so that we could settle into hotel city square and make it to the 4th of July celebrations at the Embassy earlier. No such luck, but we made it just in time to get some of the last burgers and hot dogs. We watched a African dance troupe perform and then they had fireworks. They were better than expected and they went on for about 10 to 15 minutes. After that we went out in town with a group of young girls that we met on the trip. The nightlife was rather dead, so we called it a night early, and we headed home about 2am.

Week 6

Today I felt completely defeated and hopeless. I felt as if nothing that we could do here, or anyone else for that matter could make a difference in the health and quality of life in the communities here. We were dragged to the president’s rally today in Kbale, about 4km away, where he was campaigning for the elections next year. The day started out bad. We knew better than to be ready at 0800hrs when David said he would pick us up, but we were anyway, since he had shown up early when he picked us up in Kampala a few weeks ago. He showed up at almost 1000hrs and decided he would eat breakfast, which would need to be prepared. We left about 1100hrs. I brought my camera under the naïve assumption that we would be able to take pictures and document what would be a social event and it would be a good exercise in understanding how politics affects communities. When we arrived, the first thing I noticed was a portable metal detector by the edge of the road and that the venue was the open area behind it. I thought how ridiculous it that. As we approached it, the officers asked if we had cameras and thinking nothing of it I said yes. I thought they wanted to just ensure that the metal detector would not go off, but instead they said no cameras are allowed at the event. I felt insulted. I can go anywhere, well almost anywhere, and take pictures in the US. Who were they to tell me I couldn’t take pictures. David reinforced that I could not bring it and I should leave it in the car. I thought about going back to the hotel with Charles when he went to pick up some others that were waiting for transport, but in the interest of staying with the team I reluctantly gave Charles the camera to hold for me and stayed. Needless to say, by that point, I was pissed.
The president has been in power for 26yrs, and I saw exactly why today. Chris referred to him as a democratically elected dictator. They do hold elections here and they are probably accurate in counting votes, so it is fair enough to say that he is elected into office, but the underlying conditions holds the details and the devil. He is called his Excellency by the people and at first I thought well maybe it’s just a difference in culture and they don’t mean to give him what I would consider a description for a hierarchical figure. While waiting for him to arrive there were several local schools that performed songs in his honor in the local language. Not just one school, all of them. I know this not because I have learned enough of the language to understand, but because each verse of the song mentioned his name and the accompanying choreography seemed to give him praise as well. A few things struck my while watching these kids. They had nice clean clothes, uniforms and decent shoes! Strangely enough many other school kids in the area are barefoot and their clothes are usually in poor condition. This went on for the nearly the three hours that we waited under the blistering sun for the president to arrive, with brief interludes by the master of ceremonies reviewing the program how things would happen when the president arrived. Particularly that no one should hand the president any documents that had not been properly submitted thought the appropriate protocols, announcing the arrival of local government officials, and having people move from areas that were considered restricted.
He arrived like a rock star. His new luxury SUV rolled through the opening in the crowd as he stood in the sun roof waving with his cowboy hat on. At the same time I noticed a pickup truck came around the back of the field, whose sole purpose was to serve as his podium, and a new, large, armored, tactical command truck that parked behind the tent he would be sitting in. The people cheered and whistled for a few minutes until he settled into his throne like chair under his tent. We had been sitting in a tent for the fairly common visitors, but unfortunately David had arranged for us to sit in the tent where his supporters sat, apparently. It’s good politics for David to be seen with the muzungos that he brought to help the community. I was concerned that Kbale is one of the areas we wanted to study and now the entire community had seen us smoozing with the elite and presidential cronies. The dog and pony show continued with the local government officials speaking about how much they appreciated what the president had done for their communities and more performances from local groups and school kids praising him. One of the officials talked about an electrical grid project that the president had promised in 2006 and how appreciative he was that it was coming to fruition. He went on to say that he knew of the plans being started and that he hoped that the project would be implemented soon. Four years and there was nothing concrete and they were thanking him for it. After all the sucking up by local officials, he began his speech to the public. He perched himself on top off his “podium” pickup truck and gave his speech. We still haven’t gotten anyone to tell us exactly what he said. He was very dry though in his delivery and enthusiasm and charisma were not present at the microphone with him. His speaking seemed matter of fact with little reaction from the crowd. At one point he called one of the local officials forward to list the funding that was provided to the sub-county over the last several years, as what I can best describe as tooting his own horn. We all nodded off throughout the speech, probably because we couldn’t understand and likely because of his monotonous tone. I’m sure if we understood, many more criticisms would have arisen. After his speech there were more songs by a local school and upon their completion he walked over, ever so slowly to allow his media team to capture his generosity, to the school leader and handed him an envelope and said when he came back to his seat that he would renovate the school. Of course the crowd cheered. After that an official introduced a group of about 50 men that were part of the opposition group that were there to convert over to his party. I don’t know what to make of that except it seems like they lost hope of anything changing and said if you can’t beat them, join them. As we talked afterwards I learned from Dustin that there are squads of plain clothes police officers that show up at opposition rallies to beat the opposition party participants as if they were public citizens and the police monitoring the rallies do nothing about it. I would probably give up too. I certainly felt like it, but I was glad to have Veronica to talk to. The analogy that she gave me was that you can move a mountain one spoonful at a time. It’s corny but it helped me feel better.

Thoughts for research question;
• Is poverty a disease?
• What are the symptoms?
• Can education change the course of an impoverished adult’s life?
• What are the ways social construct, socioeconomic status, and political climate influence stagnation in poverty over multiple generations?

Today we visited an NGO called Pacodet (non-governmental organization) that is near the town of Kibaale about 12km away. Liz, the Peace Corps volunteer that we met a few days earlier accompanied us there, since she had been there before. It was a little out of the way down a very narrow path that few cars travel. We learned that it was started about 20 yrs ago in as a community funded and directed organization with the help of university students. It was very inspiring to hear how the community came together to help solve their health problems, which was at the time the high rate of infant and maternal mortality. The director also expressed a very positive attitude of progressive change, reassessment of needs on a regular basis, and he has produced literature on needs assessment for his community. They also train community nurses to handle low level health problems at the village level. Initially the training was free in the early days of the program, but now there is a fee for the training, which helps support the education and clinic. I left there feeling positive and looking forward to sharing Pacodet’s successes with Agule clinic.
Later in the evening we went back to Liz’s house where she prepared pasta and garlic bread. We were all very appreciative, me especially. I needed to eat something different then the rice, plantains, and meat that taste the same regardless of the type.

Thoughts for research question;
• Can health be relative within the context of African associational life?

Today we headed back out the area in Agule near the lake, with Dustin this time. We stopped by the Agule clinic to drop off about 10 mosquito nets, since ironically their patients who are admitted for malaria treatment currently sleep in beds that have no nets. When we arrived we headed directly to the home of an informant from our previous visit, which is near the church we parked at in hopes of finding him there so that he could help us with translation as we visited others in the community. Throughout the course of our previous interview he indicated that he made his money by selling his crops, so we expected to find him there. Interestingly his wife told us that he was at school teaching. That raised the question in my mind as well as the rest of the team, as I later found out in our evening debriefing, if we were getting good data or if people were making themselves appear to be in worst situations in order to elicit aid.
A local teenager showed us the way to the school where he worked. We drove because he said it was far. The path, not road, to get there was extremely precarious at times and the SUV was leaning at angles that made everyone anxious. Luckily we arrived without having to find a way to roll the vehicle back on it wheels. He greeted us and, as we usually are, we were the spectacle. He took us to say “hi” to the school kids who clapped as we entered and were very happy to see us. I have mixed emotions about this, because on one hand you can see genuine curiosity of the kids in meeting someone new who is, in their perspective, so different from themselves. On the other I feel like we are contributing to the conditioning of the kids to place other cultures, most of who they see as whites, as being providers to be celebrated.
He was able to have the other staff tend to his students and he joined us as we visited other homes in the area. We walked about 1km to where we conducted the first focus group and then about 3km more to the second. At both we heard the same themes as before except we heard about a child who was thought to have epilepsy, a woman who had a history of miscarriage, and dehydration for the first time. The first interview was conducted by Chris and the second by Veronica. Chris had facilitated once on the other occasion that we were in the area and I had facilitated twice, so they were given the opportunity to practice.
My role as was Dustin’s was to observe and take notes. I realized as we reviewed our day at debriefing that I had a lot to learn in observation. I have to change my perspective of observation to one that is an active pursuit in which I am constantly generating questions during my observation rather than a passive one of just looking.
Thoughts for research question;
• Poor health is cited in literature on Uganda as a source of poverty. Is the idiom “if you give a man a fish you feed him for a day, but if you teach a man to fish you feed him for a lifetime” applicable to health as it is too food?
• Can health and health sufficiency be advocated in the context of a system that fosters chronic poverty and lack of confidence?

We had planned on conducting more focus groups today, but with the team building/retreat week coming up soon we needed to catch up on our writing, transcriptions, and reading. Dustin also needed to plan the upcoming week’s events and accommodations, so we stayed at the hotel preparing and catching up. Dustin had sent the team several articles about aid organizations to African countries and the impacts. It made for some very interesting reading and it helps put the attitude of dependency that we frequently encounter into perspective.

We packed smaller bags for this one week retreat and put the rest of our stuff in one room to store it while we are gone. We left Pallisa about 1pm and stopped for gas and food in Jinja, which is on the Nile, at about 3pm. We ran into traffic as we approached Kampala, the capital, so we didn’t make it to the hotel until about 1830hrs. Everyone wanted to take the opportunity to eat something different while we are in Kampala, so Dustin took us to an Italian restaurant. The food was excellent and the pizza had real cheese which is hard to find. After that we went to watch Soccer at a sports bar and then to dance clubs. The first club was unusual in that there seemed to be at least one foreigner (muzungos) for every Ugandan. There also seemed to be a lot of Ugandan women being very forward with foreign men. We were there for a while and then went to another club and hung out there for the rest of the night until about 5am. I didn’t drink anything after the wine I had with dinner, because I was feeling a little under the weather, so I was able to observe people. Social research if you will. I thought of how bad the HIV rate here is reported to be and wondered how many of the people that were there that evening had been exposed to education.
We stayed at the hotel most of the day working on papers and doing lit review. At night we went to eat dinner and watch soccer. It’s the thing to do right know. We hung out again at some local clubs after that.
Today we got our stuff ready, we were picked up about 2 and we headed to Entebbe. We were spending the night there because, Becky, Dustin’s wife arrives early and then we head to the Ssesse Islands, Kalangala to be exact. It is a chain of islands within Lake Victoria. When arrived about 1 hour later and Veronica and I continued working on our papers and Dustin and Chris went into town to watch the game.

Week 5

We had to get some admin things accomplished today. The hotel manager had not yet written up the price agreement for our accommodations and meals and a week had passed. There wasn’t enough clear planning on the cost so initially the charge was per person then per room, then per person and per room. Well finally we agreed on 35000 UGX per room and 10000UGX per meal per person if we had dinner buffet. We’re still not sure about the cost for lunch. We printed the contract and a letter that we drafted for the clinic and we went into town to get some money out of the only atm in town. It was out of money and has been for about a week. We went to the grocery store to confirm that there was no other atm and the owner offered to help us. He asked for just Justin to come along and they went to see the bank manager. I’m not sure how things went or if because we were Americans the manager said there would be money in the atm by midday and someone would call to let us know when it was available.
The hotel had requested that we pay a deposit of 500k UGX per person, about $250, because the president is due to visit and there is a lot of prep work going into making the hotel look better for his visit. We could only come up with 500k UGX total, so we paid that and planned on trying the atm later in the day. I had mentioned it before but David, the person who picked us up in Kampala and whose car we are driving, wanted to sit down with us and coach us on what to say to the president about our work and the affiliation to his clinic. Interestingly, David is running for parliament. So far we have avoided it and we all feel like we are being used as political pawns in his interest and we don’t want any part of it. We have been told that we are on the VIP list though. Maybe we’ll be out in the field that day doing research instead.
The vehicle we drive is also an issue with conducting good research. Everyone knows David’s car and his affiliation with the clinic and that he is running for office. So we discussed it and we agreed that we should park the vehicle and walk into and around towns to reduce our status and to try to speak to people in as much of a normal setting as possible.
So we went to the clinic to shadow the staff and observe. The goal at the clinic is to make general recommendations on how to improve care, resource allocation, and efficiency. The staff was receptive and seemed to be going about things naturally without any concern for our being there. The doctor is only at the clinic Friday through Sunday, so the medical officer (equivalent to a P.A. in the US) sees patients on the other days. I was shadowing John the PA for the day. They had seen about 18 patients before we arrived about 12pm and there were about 6-8 more waiting. He said there was a mix of illnesses seen in the clinic that morning. There were patients with malaria, PID, PUD, TB, Poisoning, and an injury. I asked if they triaged and they don’t. It’s first come, first serve for the most part. The first patient observed was a young boy about 10yrs old and his father. John asked about complaints and symptoms. The father said he had a headache and he also complained of an injury on his foot. John felt the boys head and said he thought it was malaria, so he would have him tested. It was so hard to not say anything, but I was there to observe at this point. The cut on the boy’s foot was badly infected and he didn’t have any other symptom of malaria. It’s probably a good practice here to test all patients for malaria, but that was not what was happening here. He was assuming that the boys fever was from malaria. Well it turned out later that he did not have it, so he just had the nurse squeeze out the pus and clean the wound. I think the boys fever was a result of how bad the infection was. More troubling was that he did not prescribe antibiotics, which they have in stock, to treat the infection.
After that an older woman came in complaining of lower back pain, but the doctor was interrupted by the nurse bringing in a young woman who he thought was in respiratory distress. Someone had found her on the side of the road and brought her there. She seemed to me to be having a very severe case of hiccups. She did not look cyanotic, was walking, but could not speak. He took her to the next room and he said he needed to give her a bronchodilator to open up her bronchioles. I assumed he thought she was having an asthma attack. The nurse got her IV access set. He said he was giving her aminophenol, but I’m not sure I caught his pronunciation correctly. He pushed 2 syringes over about 10 minutes and there was no improvement in her hiccups. After he pushed the meds, he remembered that previous visitors had brought inhalers and he used two different types. One was a bronchodilator and the other a corticosteroid. One thing that concerned me at that point was that he had not auscultated her lungs, so I decided to borrow a stethoscope that was hanging on the wall to listen for myself. I asked for alcohol to clean the ear pieces, because I had heard staff members talk of alcohol and I the nursing assistant just referenced a bottle that was next to her as alcohol. It was actually a bottle of normal saline. I cleaned them as best I could with cotton and normal saline. Her lungs sounds were clear with no wheezing. There was no change in her hiccups after the treatment with both inhalers. He had her wait a while and receive some normal saline to see if she felt better. She did not, so he referred her to Pallisa Hospital about 8km away.
The older woman came in after that and complained of pain in her leg and back. He thought it was probably just her age. I was glad to see that he did check her blood pressure. It was 140/90. She said she did not suffer from hypertension before. He said he was having her tested for malaria, because he thought her pain might by psychological and having her confirm that she did not have malaria would make her feel better. The next patient was also an older woman who complained of a head ache, but the doctor said he knew her and checked her blood pressure right away. It was 160/96. He asked her and she said she had been out of medication for a week. While following the doctor around, he went to the lab to speak to the lab tech. I watched while the tech took a blood sample from a toddler by finger stick. He used an insulin syringe to pinch the child’s finger. I thought; it would be more cost effective to use the small plastic finger pricks, than to use syringes. It would also likely be less pain full for the patient. Chris later confirmed for me that what the lab tech referred to as alcohol was also normal saline.
The doctor took a break and went to check on if lunch was being prepared, so I poked into the treatment room in the mean time. The nursing assistant was administering a medication from a glass vial. She used a regular needle to draw up the medication and then using the same needle she went into the side of a bottle of normal saline to dilute the medication and then used that needle to administer the medication intravenously to the patient.
Lunch was ready about an hour later. We ate lunch and headed back to the hotel to debrief. I feel like I’m being critical of these people who are trying to help others, but at the same time I feel like some of these things are easily addressed and care could be much better as well as more cost effective.
We went to Gogonio village today and met with Asakad Sam, who was someone that we identified as having potential for being a good translator the on our last visit to Gogonio. We parked at the clinic, as to attract the least amount of attention to ourselves and we had already decided that we would be walking wherever we went the rest of the day. I called Sam and told him we would meet him at the subcounty offices which was a few hundred meters from the clinic. We walked there and he directed us to a building near buy to have a seat. The building belongs to a seed and livestock exchange program that works with the community to encourage and facilitate self sufficiency.
Sam introduced us to 3 other staff members there and we all sat down to talk and introduce ourselves. My gut feeling was that Sam would not be a good translator at this point because he belonged to an organization that served the same community, but I felt better as the conversation went along. It seemed that he would be able to stay objective and provide accurate translation. We asked Sam for his guidance in pointing us to homes where he felt people would be receptive and who could provide information on health needs.
We walked about 2km through some crop fields and came across a small village of a few mud huts. They received us warmly and we all sat in to talk. The theme that came to the surface immediately was malaria as we have encountered with others I the area. There were a few other issues, but the one notable thing was the reaction to HIV. When one of the members of the village said he was positive the others laughed at him. We have talked about this since and it is definitely something we need to continue to explore.
The next village that we walked to about another 2km away was also very welcoming. Again we sat in a clearing in between the homes to talk. This was more of a compound and while we hadn’t built enough rapport with them to inquire, it seemed like it was an older man with several wives. There was one younger male in the village, but he indicated that he worked in farming there. The older man was very outspoken about the need for money, which is what he says, facilitates the access to health care and primarily medicine. He referenced the conditions of his cows and that his crops did not earn him enough money. It seems though that that the first concern for everyone that we speak to is money, even the ones that clearly have more resources, in terms of livestock or crops. This also ties in with the immediate request for biomedical interventions as the solution to every health need. At each village we left mosquito nets for each home. It was our first focus group attempt and we were feeling good about the information we received.
Today the weather looked bad in the morning and we were all tired emotionally and physically. I didn’t think this type of interaction would take so much out of you, but the concentrating on the observation and the walking really take a toll. After breakfast we decided to take a walk in town and see if we could find some different foods to eat. The hotel serves the same thing every day, and it’s getting old fast. I realize how spoiled I have become. When I was younger and in the Army, we would go much longer than this eating MREs and it wouldn’t bother me. I would just make the best of it. Here the food is getting to me. The chicken taste fishy sometimes and gamey others. The goat is tolerable, but they figured out we don’t like the chicken so we are served goat often. It is a blessing when we get beef, but only if it is fried because if they stew it, it tastes fishy. The rest of the day we spent working on journals and typing up our field notes. UGGHHH!!Goat for dinner AGAIN!!
We had made arrangements to have the ambulance from Agule clinic take us to Mbale, to pick up anti-malarial medication for the “outreach” debacle we had been coerced into for Friday. While we waited for the ambulance to arrive we went to the market again, determined to but something different. We walked around for a while and finally found the fresh fruit area. We bought some pineapple, avocado, passion fruit, and what we thought was limes. The tangerines here look like limes and the oranges are green like limes as well.
The ambulance showed up about 12 and we headed out for what was supposed to be a 1 hour drive to Mbale. 2 hours later we arrived in Mbale. Tom the lab tech knew right where to go and we were able to get full dosage malaria treatments for adults for 3200UBX (less than $2). We had lunch there as well at an Indian restaurant. I ordered a cheeseburger knowing good and well that it would not be what I expected, but it was a cheese burger either way. It was on white toast and a bit undercooked but I ate it anyway, since I have come to accept that I will have parasites by the time I leave here. Meat here is butchered in the open and hangs exposed for at least one day. At least I like to think it’s not more than one day. We made the long drive back and we were all exhausted. We had dinner and it was pleasant. We had bought beans earlier in the morning as well, which we had not had here before, and the hotel cook prepared it for us.
Today was incredibly tense. We were supposed to go to Gogonio to participate in the “outreach”, but we heard from the staff that people had travelled all the way from Gogonio to our hotel to seek treatment. The hotel staff had managed to turn most of them away, but as we were finishing breakfast and older woman sat down at a nearby table and one of the staff members translated for her that she has several symptoms resembling syphilis. Dustin replied as best he could that we were not doctors and directed her to the clinic.
This was obviously a huge problem for our acceptance into the community and for obtaining good objective data. The message that we would be speaking with the community and providing some treatment for malaria had snowballed into people thinking that we were coming to provide treatment for everyone and for everything. So we decided to let the clinic staff to go ahead with the event and we would not go. We have actually decided that we will not go back to Gogonio for several weeks and the “thank you” nets will be given to the clinic to distribute so that we try to get the best data possible. The culture of dependency here is such that we feel it is the only way to attempt to remain objective.
The rest of the day we walked around Pallisa Towne as two separate teams, Dustin and Veronica as one team and Chris and I as another team. I don’t know if the tension from the morning was still there, but I was feeling pretty edgy. The day before I had gotten pretty upset about a blatant and rude advances by one of the local men towards Veronica; I was able to walk away from the situation and nothing came of it and I came to terms with the differences in culture. I thought I came to terms with it. Those feelings came back today as we were deciding how to split the groups, so we decided that it would be best if Veronica and I did not work together, at least while trying to gather information in town. I think the dynamic is different in the villages and the more personal interactions are less likely to lead to that type of incident. Either way I need to find a way to remain objective.
While in town we talked to a few people here and there. It is obvious that people are not used to Muzungos walking around town. We received several perplexed looks as well as some serious faces. We tried to wave and are friendly and it worked in most cases. The theme we keep encountering is malaria is the prevalent illness and medication is the solution for it. I have not heard anything about prevention as of yet.
The World Cup has been going on for about a week now and I had not gotten into it so far, even when the US played England. Today’s game was different. The US played Slovinja and I found myself excited and cheering on the US. It was a great game until the end and it was a draw. I’m looking forward to watching again.
We had planned on eating dinner in town and watching the game, but I fell asleep, and the Dustin, Chris, and a few Peace Corps people we met here left into town. They sent a text later asking if Veronica and I wanted to go to a club. I was reluctant since we had to walk through town at night and we didn’t know how to get there. We got lost, of course, and walked around most of the town. It’s not very big at all, but it was intimidating since we were getting funny looks. People here are not accustomed to seeing muzungos walk around during the day, never mind at night. Most foreigners drive around in cars and go to and from directly where they are working/staying. By the way muzungo is equivalent to white people regardless of your ethnicity and race.
So we found Dustin, who gave us directions over the phone, and walked to the club a few meters away. As we entered there we a few locals crowded around the door asking for us to pay for them to get in. Of course we got more puzzled looks, but people got used to us after a little while and we started mingling and dancing. At about 1am, Charles showed up looking for us. He said he was concerned that we were there and that we were not safe. He might have been right. We had to walk back to the hotel across town. Luckily the RDC (the president’s representative to the people) was there and he gave us a ride back in his car.
Today the plan was to meet Sam, our translator at the hotel and head to Agule sub district near the lake shore. Sam showed up about 11am, but Dustin said he was trying to resolve some issues between Julia and David and would not be going with us. David insists that he understood that we were coming here to treat patients, even though the agreement with CBU clearly states otherwise. So Chris, Veronica, Sam, and I went on our own.
I was happy to be driving. It had been over a month and I think I needed to feel in control of something.
We interviewed three families at three different villages. They went fairly well, although I recognized where I needed to make some improvements in the way I asked questions and in keeping contact with the participants and not Sam, the translator. The themes are pretty consistent; malaria, no money for treatment, and treatment not always available. A few interesting things came from the older gentleman we were speaking with at the second village. He mentioned that mosquito populations increased after 1987, when a tribe from northern Uganda raided the area and stole their cattle. He mentioned that the mosquitoes used to feed on the cattle, but now feed on people. It’s more likely that once livestock was gone, people began to farm more as a means of income and survival, rice farming in particular. The stagnant water of rice fields is a perfect breeding ground for mosquitoes. He also mentioned a plant that was used before for treating malaria that is no longer in the area. He says development has caused it to disappear, although he thinks it can still be found further away in less developed areas.
At the last interview of the day we heard about a tree that the government recommended for treating malaria, but they said did not work. What is interesting about that is that it goes along with other observations we have made of the way the government and media conveys misinformation. There was a local news report a few days on a new trial of malaria treatments, consisting of avocado seed and some other herbs. The problem was that they closed out the segment saying that this was going to be the biggest breakthrough in malaria treatment and that people could hope to see it available soon as if the trial was conclusive and it was known to be effective. As we discussed this at our debriefing in the evening, Dustin brought up another good example of miscommunication. Not too long ago the President made a statement during a press conference that circumcision prevented males from getting HIV, when in fact his advisors had told him that circumcision reduced the rate of HIV transmission.
Sunday is our one day off, so we use it to get caught up on our journals, read, and any other work we need some quiet time to complete. I think we are the only quest at the hotel, so it has been very quiet all day. Tomorrow I suspect will be different, since the president is coming to Pallisa for a visit and he will be meeting here with other government officials here at the hotel.

Week 4

I miss good sleep! It was cool enough last night, but the traffic outside our windows begins promptly at 4am. Every driver also has an obsession with the horn and taxis beep every 3 yards to gauge pedestrian’s interest in their services as if they would not simply raise their hand or wave. There is also a night club on the next block and the music is blaring all night long. I will be glad to get out of the city and into a more rural area.
Today, we met with David. David is one of the founders of the clinic that we will be working with in Pallisa. Interestingly, he is also a politician who is running for parliament. He had a lot of good information for us about the basic operation and population served. The clinic is funded by the Ugandan government and through some charitable work through other sources. According to David, the clinic serves 12 sub-counties and about 50k people overall. He mentioned malaria, HIV, and cholera among the top health issues. He also said that the staff also organizes education within the community and especially in the youth. He also introduced us to Simon, who is the founder of Young Uganda. His organization is Christian faith based and they work on education of youth. We still have a lot of questions that we all agreed would be better answered by the medical staff at the clinic. We agreed that we will travel to Pallisa on Wednesday. We plan on visiting his home in Kampala tomorrow to meet and have dinner with him and his family.
After our meeting, we walked to a nearby tourist market that we have visited before. We were there for a few hours browsing and then chatting with some new friends that Julisa made, Faith and Suzan. We then crossed the street and hung out at 1000 cups, which is a coffee shop that is makes Ugandan grow coffee and also provides tours of their farm. Visitors get to grind their own coffee and take it with them. It seems like a neat experience. We then decided to head to a Bahai Temple that is on the outskirts of Kampala. Bahai, from what I understand is a very broad religion that incorporates the beliefs of many religions as being similar. I only know what Julisa explained, but I am interested to read up on it. After a long taxi drive through some very poor areas and bad roads we arrived and it was closed. We headed back to meet with Dustin. Dustin was finally able to coordinate internet access. We spent some time setting up our computers and then went to have dinner. At dinner our group all expressed that we have some concerns about the expectations of the clinic, medical staff, and the population. Dustin’s contact who has worked in the area said that it will be difficult to convey that our role is to do assessment and not provide care and medications. She said that the population has become accustomed to receiving aid and particularly western medicine. She feels as though they have abandoned good traditional practices that work for the western medicine that is pushed by the religious medical groups that have provided aid in the area before. The plan for tomorrow is to get some last minute supplies that we expect will not be available in Pallisa and to have dinner with David.
We went out into town again to try to find some other things that we think will not be available. It is still a little unsettling that we do not know much about Pallisa, where we are going. We got back to the hotel in the afternoon and then later went out for to a few other local night life places. We went to a place called Kicking It, which is a sports bar and restaurants. Getting there was a little scary. We took bodas, the motorcycle taxis, three to each including the driver. We had ridden these once before, but it was very late when there was no traffic and we were buzzed. This time it was still rush hour and we were sober. I had a really hard time trying not to control which way we leaned as we squeezed in between cars and I thought for sure we were not going to make it there without at least getting into a fender bender. None of the drivers knew the place by name so Dustin was leading the group. The two groups that were following Veronica and I on one and Chris and Ciara on the other were separated from the leading boda which Dustin and Janessa were on. We ended up going to far and then Dustin reached Chris by cell and guided them and or driver followed. We met a few friends of friends of Dustin’s contacts. While we were there Carol the site leader for Embarara, where Janessa and Ciara will be going, arrived. She had just arrived a few hours earlier, dropped her bags at the hotel and came out to meet us. After we ate there we headed to another place, Cayazze, another restaurant/bar/club that is part of a hotel. It was a nicer place and it was clean and the music was pretty good. I was feeling pretty miserable though. I had taken my Lariam and I was feeling the adverse affects. I was nauseas, anxious and just feeling generally lousy. I didn’t feel much like dancing and I just watched everyone as the group did. I felt bad about not participating, but I really wanted to be in bed. After a while, I threw up and I felt a little better. I danced a little bit after that and then we headed back to the hotel with Jude, Dustin’s friend who had his car. David came with us back to the hotel and there he headed to find a boda to take him home.
Today we are leaving to Pallisa and I woke up a little nervous. We didn’t pack last night, we had about 2 hours to get ready and eat, but I was hopeful that David (from Pallisa) would be on Uganda time. No such luck though, he arrived at 930hrs, thirty minutes early. Simon also planned on traveling with us, but he did not fit, so he said he would meet us later in Pallisa. Simon is the founder of Young Life Uganda. He works with David in coordinating efforts to find resources for assisting the clinic and also an NGO for the education of children. We were ready a few minutes later, but Dustin and Chris had not started to pack. At least it wasn’t Veronica and I he was waiting for. We packed our entire luggage to the ceiling of the Land Rover and we were on our way to Pallisa about 1030hrs for what David said would be a 2 ½ hour drive, except we had to stop at the cell phone store to try and fix our internet modem. I guess the anxiety was getting to me because even though I knew that it was not going to be quick, I couldn’t help getting inpatient as they tried to fix the problem. About 2 hrs later we were back on the road. The back windows would not go down and it was miserably hot with three of us sitting in the back. I think we all fell asleep for a while. About 2 hrs later we reached Jinji, a major town on the way to Pallisa, and stopped for lunch and a break. It was already nice to be out of the big city. The air was cleaner. David received a call from the clinic requesting IV fluids, so he said we needed to eat quickly so that he could stop along the way and get some. We ate in about 30 minutes got back in the car. The rest of the drive was trough some farming areas with a few small towns/villages sprinkled in between. We reached Pallisa town in about another 2 hrs and stopped at a Pharmacy as we entered the town. David picked up what he needed and we were on our way again. I thought it would only be a few more minutes down the road because the roads had been good so far and we were already in Pallisa, but that was not the case. We turned off the main road onto a dirt road, which seemed to get worst and worst. The boxes of IV fluids started shifting and soon Chris and I were struggling to keep them from falling forward on top of us as we bounced around. We made it to the Country Inn, home for the next two months, about 30 minutes later. Simon was already there. It turned out to be a very nice place by Ugandan standards for Rural accommodations and I certainly felt better here already then I ever did in Kampala. It was cleaner and better maintained. We headed out to Agule clinic to meet everyone there and introduce ourselves. It was about another 15 to 20 minute drive down a very rough dirt road to get to the clinic. We arrived and were introduced to everyone. We talked a little about what we would be doing and briefly on some of the expectations. We explained that our role is research and that our work would serve to access the needs of the community so that resources could be allocated and, potentially, funding could be sought. Although they acknowledged this idea, the conversation seemed to always come back around to what we could do hands on, or so it seemed. We went back to the hotel had dinner and went to bed. Everyone was exhausted.
Interesting quotes by Simon;
It is better to be like the snail, travel a short distance, but leave a mark.
Blessed are the flexible, for they will not break
The plan was to introduce ourselves and research to the local authorities. We started fairly late under the guidance of Simon, because he said that it is rare for a government official to be in the office before 10am. He also mentioned that they take 2-3 hour lunches. We met with too many officials to remember all the names, but basically we met the representative to the president on behalf of the people, the head of the ministry of education, the head of security (does not mean what it sounds like, but I don’t have a clear understanding of their duty), the sheriff, and the head of the ministry of health. Simon basically introduced the group and some background on our research and we had brief meetings with each area and requested support from them in our efforts. I gathered though that their support would be vicarious as really what we were there for was just to inform them that we are here and that if anyone called to inquire about us that they had knowledge of us and our project. We were done with the meetings and a walk around town to get oriented about midday. We walked back to the hotel for lunch and Simon and Charles, our driver and camera person went off to take care of some errands. They said they would be back at 3pm to take us to the clinic to try and iron out some plans with the doctor and staff for the “outreach” events. We had lunch, which has been consisting of rice, matooke, chicken, some kind of meat, and a drink. Before we left our team sat down to sort out how the meetings should go, because we were all feeling like there had been some miscommunication and there was some misunderstanding between what our roles would be and what the Agule administration and Simon expected. We headed back to Agule at about 3 to discuss our plans further with the clinic administration, with the understanding that we needed to continue to affirm that our roles were to conduct research and not provide treatment. The meeting revolved around the number of “outreaches” and what we were going to provide to the community. The meeting was a little tense and we agreed that before we could make any concrete plans we needed to get cost of supplies/medications. They were focused on how much money was budgeted and Simon on several occasions had already inquired as well. We were not on the same page. The intent of the program was to provide some consumable goods to the community, but the focus is the qualitative research. We debriefed at dinner and we all agreed that we needed to continue to emphasis this. The plan for tomorrow is to visit Gogonio Village to inform the village government that we plan on conducting some activities in the village on Friday.
We headed out to Gogonio with the four of us, Simon, and Charles (our driver). Gogonio is a peninsula into the area’s largest lake and the area identified by the clinic staff as the area most affected by mosquitoes. We drove about 5-6 kilometers and arrived in Gogonio about 30 minutes. The meeting with the govt officials started out well and then Simon suggested that Veronica and I speak with the group that was sitting outside. I was irritated by this because Simon had overstepped his role and was starting to direct the work, research, that we were doing. We reluctantly went out and started to superficially explain what we would be doing and asked some broad open ended questions about health. It could have gone worst, but it did not go well. Simon communicated to them that we would have testing and anti-malarials, but we have no information on cost or if it’s even going to be possible. He is putting us in a very bad place with the community. I was looking forward to leaving after that but we had to visit the Health Center. We met there again with who had been introduced in Pallisa as the area statistician. He actually runs the clinic in Gogonio, which makes it easier to understand why there is no updated statistic information for the past ten years. After a brief meeting, since he knew what we were doing already, Simon insisted that we go see how bad the mosquitoes were further towards the lake. As we were leaving the clinic, the nurse asked if we would take a mother of twins in the direction we were going. She had come to the clinic to get treatment for the babies, who were thought to have malaria. She had gone to the clinic in Opeta, but they did not have any malaria medication. She paid for a boda boda (motorcycle) to bring her the 3km to Gogonio, but there was no medication there either. She had riden there with two newborn twins and her other child, who looked about 10yrs old, on one motorcycle! We squeezed a few people in the back of the SUV and took her and her children as well as the area security representative with us. We made it to where we could see the water and then we drove parallel along the shore until we reached an area where there were a few mud huts. Charles drove right up into the village and parks in between them. This was not a good thing and we got some not so happy looks. Simon immediately started to communicate to the group and even though I don’t speak the lanquage, I could tell that he was going the schpeal that he had gone through the in Gogonio. We were feeling very uncomfortable. We rolled into these peoples home, uninvited in this big SUV, and we were telling them what we were going to do. We told Simon that we wanted to go, but Charles had disappeared. When showed back up, he told us that the people a little further down wanted to say hi. Actually he was apparently going over the same stuff that Simon was. This was disastrous. It is going to be very difficult to reenter this community in a non-intrusive way and to talk to people, and get objective opinions. We went to say hi to the people further in so that we would not go against what our hosts wanted. We left there feeling miserable about what just happened. Not only did we damage our possibilities for good research, we entered their community like elitist dictating what was going to happen. We wanted to get back to the hotel as soon as possible, but Charles had made plans with a finger piano group to perform for us. We found out that this group had traveled to Gogonio just for this and had been there since the morning, waiting for us. Again we were put in a very uncomfortable situation. The group performed just for us four and the group leader made it obvious that he was looking for sponsorship. On the positive side the music was good and they put on a good show. It just would have been nice if it was not so contrived. We felt so bad about them spending all day there waiting for us that we all gave them more than just tips for their performance. When we got back to the hotel everyone was mentally exhausted and we all agreed that we need to take a nap and then meet later to discuss what had happened. When we debriefed, we all expressed the same frustrations. I was sure Dustin already knew, but he asked my opinion, so I told him he needed to talk to Simon about this even though it would be difficult and a sensitive topic. We all also acknowledge d that the way we entered the community was not the way to continue and not the way to get real feedback from the community. The next day was to be devoted to getting familiar with the operation of the clinic and to divulge how much is available for the “outreaches” and to try to finalize the plans.

On the way to the clinic we received a call from Simon asking us to turn around and pick up a student from his school, who was feeling ill. So we made it to the clinic about 1030 am. We didn’t miss much since the doctor had not arrived. We spent most of the morning getting familiar with the clinic, shadowing staff, and playing with the kids. The kids were pretty dirty, they run around bare foot, their clothes are in tatters, but most appear generally well nourished and happy. There a few concerning practices at the clinic that I encountered. When talking to the midwives I inquired about prenatal vitamin distribution, because I had seen a stock in the pharmacy. It turns out the standard protocol s to give pregnant mothers one prenatal vitamin during pregnancy. Also, for pregnant HIV positive mothers who should not breastfeed, they are told to feed their infants cow or goats milk as an alternate. There is no formula. The doctor called me into his office to palpate a patients liver. I found out later that the woman was 55years old. I would have guessed that she was in her seventies by her appearance. He called me in, since he said I would probably never see a liver so enlarged in western medicine. He was probably right the patient’s liver extended about 3inches below the costal margin, bulged out slightly, and was hard. He thought it was a late stage cancer. She had not been to the doctor before now.
Deborah, the administrative person at the clinic made lunch for us and we sat and ate with the doctor. After lunch we had a meeting with our group, the doctor, and the clinic chairperson under a tree on the property. So it started out again with how much money was available. Dustin let them know that there was only $800 as the memorandum of understanding stated, which was known to them prior to the start of the project. So after so back and forth trying to figure out what was possible with the funds available, we settled on a plan. We agreed that we would not us the doctor or the clinic staff, since there would not be any medication distributed. Instead of doing “outreaches” we would go door to door and use the funds to purchase only mosquito nets. The nets would then be distributed after we had completed our conversations with individuals as a token of appreciation, if they fit the population of vulnerability to malaria. We all felt relieved after the meeting that we were all on the same page now. So from now on we will be on our own for the most part, without Simon and Charles. Simon will also be busy with another group that is coming in through his NGO, so he should be out of our hair. Dustin heard from Julia that the leader of that group is a rougue ex-MHIRT student that never returned from his site and stayed here and has been coordinating aid and preaching. They say he’s very overzealous, so we are concerned about his activities and we want to stay clear of him and not be associate with his efforts in the eyes of the community.
Dustin was driving the car now. They left us with the vehicle to use. On the way back to the hotel we came across a chicken in the road that at first looked like it was sitting there, but as we got closer it was apparent that it had been injured somehow. Dustin tried to avoid it but it didn’t move out of the way quickly enough and we think the back tire ran over it. We talked about stopping and going back, but we didn’t. We talked about maybe stopping and finding out about whose it was and buying them another. I’m not sure it’s funny, but it’s the ongoing joke now.
Today was just a day to get caught up on our journals and work. We walked to the supermarket to get a few things and came right back and have not gone anywhere else. We did meet to peace corp workers that live here and teach at a school a few kilometers away. One of them, Joe, may join us when we do our getaway in the beginning of July. We have plans for later tonight to go watch one of the World Cup games at a local restaurant.

Week 3

We were not able to change our train tickets to get back to Amsterdam, so we had to buy a new fare. We were told we had to go back to Germany to exchange the tickets that we did not use and I tried to call but so far no luck in getting them exchanged. We’ll have to try to get them refunded on our return trip through Frankfurt in August. We made it back to Amsterdam and to our hotel by the airport fairly easily, although we had to use a combination of train and busses to get there. We dropped of our bags at the hotel and went back into town on a bus. When we got off the bus, and we were trying to get oriented, we were approached by a very helpful man that offered to walk with us in the direction we were going since he lived that way. Veronica was convinced that he was hitting on me. Anyway, he gave us some insight on life in Amsterdam. He is American and has been living in Amsterdam for about 20 years. He says he loves it there as do most foreigners. He did say the wages are low and the taxes are high, but he feels that this is offset by the level of healthcare provided at no cost and the retirement and social security benefits. He pointed us in the right direction and wished us a good trip. Later we visited the red light district. My first impression as we walked towards the first of the brothels with women in the display was that they were mannequins, but no, they were real women in bathing suits or lingerie. The brothels were sprinkled between restaurants and bars and it seemed like anywhere else in the city, except here it was perfectly acceptable to purchase sex, or view it live. We walked through and continued back towards our bus stop, since it was late, and had a drink at a pub near the stop while we waited for our bus.
We were able to chat a while with Julia, from CBU, who is coordinating our participation in the Uganda MHIRT program. Maybe I’m still feeling a little desensitized. Despite all of Julia’s grim descriptions and warnings about how bad it will be in Uganda, it’s difficult to imagine right now as I sit in a hotel room, with all the luxuries one could ask for what it is going to be like in Uganda. I can say I don’t feel like I’m going to be surprised, although I’m cautious because sometimes emotions can catch you by surprise. I feel as I have seen suffering and dealt with death before. Days before I left for Thailand I was sitting in my living room getting things ready for my trip when I received a call from one of my cousins. He and I are like brothers. He called and asked if I could do him a favor and go to his mother’s house, my maternal aunt, so that I could be there when he called her to break the news to her that his brother, my cousin, had been shot in the head and was in critical condition. I took my sons, who I was spending some time with before I left, back to their mother and went to her house right away. After the initial shock, my aunt composed herself and I drove her to see her son in West Palm. I wanted her to at least see him, alive, one last time. I was with her through it until I had to leave to Thailand. He was 32 years old with a newborn, a 1 ½ year old, and a wife who doesn’t have full use of one arm. He died over an argument about less than $100. Death and suffering needs no valid, rational reasons.
The trip to Africa wasn’t too bad, but the long layover in Dubai was uncomfortable until recliner chairs became available in the middle of the night. The flights were smooth and the Emirates planes had personal entertainment screens to watch movies. We arrived in Entebbe a few hours before the others we were going to be meeting. We exchanged some Euros, ate, and got online briefly in an internet café while we waited. The exchange rate here is about 2300 Shillings to the US dollar. It seems like the US dollar goes a long way. A soda or water is about 1000 to 1500 Shillings. Dustin, Chris, Julisa, and Sierra arrived about 8pm and we recognized them easily since Julia had sent us pictures of them by email. Dustin recently completed his Master’s in Anthropology and is our site leader. Chris and Julisa are undergrads who are considering Anthropology. Sierra is also an undergrad studying Biology with plans for med school.
The drive from the airport to Kampala, the capital, where we are staying was about one hour. Our van driver recruited a few other drivers once we were loaded up to push start the van, since it seems that the starter was not working. The driving here is definitely different than in the US. Cars have the right of way, or so it seems, not pedestrians. We had, what I would consider, near misses on running over pedestrians about 3 times. The weather was a lot milder than I had expected and there was a nice breeze in the evening and it seemed to get cooler as we moved up in elevation towards Kampala.
I was a little concerned about where we are staying. The hotel is above a restaurant on the second floor and it’s in pretty bad disrepair. We have mosquito nets over the beds, since there are no screens in the windows. Overall, I feel a little icky about the bathroom and beds, but this is it for now until we leave for Pallisa in a few days. We walked a few blocks after we dropped our bags to get something to eat. There is a variety of foods served in the restaurants from burgers to traditional African foods. Yesterday Dustin, who has been here in Kampala before, took us all for a walk around town. We stopped in a little market not too far from the hotel and picked up some neat souvenirs, then continued to a café. After that we walked further to the mall, which is similar to malls in the US in terms of the products they sell. Last night Dustin took us to a central park area (Fendi’s) that incorporates a spa, restaurant, and club for some refreshments. On the way there is where we first encountered the street children that Julia had told us about. She told us to be very cautious about giving them any money or food because the other children could harm them to get it away from the one you gave it to. At first we came across a very small child, he looked no more than 1 year old, sitting in the middle of the sidewalk alone holding out his hand. After looking around we could see that there was a group of older kids in the dark on the median looking our way. It was very heart wrenching to see that, and you want to do something to help, but Dustin reinforced that it’s better not to. Later, when we came back through that area, they all came up to us begging also. After a few drinks at Fendi’s we took motorcycle taxis back to the hotel, which was interesting because we rode two, plus the driver per bike! Luckily it was late and there weren’t too many cars or people out and we made it back safe to the hotel in a few minutes.
We have to wait here in Kampala for the other site leader to arrive on June 8th, then Dustin, Chris, Veronica, and I will be leaving by car to Jinja and then Pallisa. Julisa and Sierra will be going with the other site leader to a different area. Our project in Pallisa is to do needs assessment of the area. There has not been one done before and there is little if any information about the demographics and needs of the community. There is an established clinic in the area where we plan to start, as they may have some valuable insight.
Today we just hung out at the hotel, tried to catch up on some reading and journals, and organized some of our luggage better. We ate at the restaurant below the hotel and then came right back up.

I made it up in time to have breakfast at the hotel, which is included in the price of the room. It was pretty good and consisted of eggs, toast, fruit, coffee, and tea. We had plans to meet with Paul, Dustin’s contact from his previous study in Kampala, at 12pm. His family had offered to make food for us. Time is a little slower here and Paul arrived about 2pm. We would soon experience why. We walked a few minutes to the central “taxi” area, where you catch little Toyota vans that carry about 15 passengers to just about anywhere in and around Kampala. The vans are crowded in an open area in between buildings in such a way that it is difficult to make your way through them by foot. My first thought as we made our way deeper into the area was if we find the right one to where we are going, how will the driver get out? We found the right one after working our way to about the center of the area, took a seat in the van, and waited about 20 minutes while enough people filled the van. The driver then started to move up slowly and somehow we eventually made it out to a main street. There is no schedule. The van goes when, if, it fills up. We made it to Paul’s Family’s home a little past 3pm. His immediate and extended family had all come to welcome us and to eat with us. There were nearly 20 people besides our group. Paul’s grandmother, brothers, aunts, cousins, and some of the neighbors that are like family were all there. The family had prepared a feast for us that consisted of goat, chicken (cooked a few different ways), fish, matooke, rice, pumpkin, beans, peas, carrots, sweet potatoes, yams, bitter tomatoes, g-nut sauce, and some millet dough preparation which I didn’t catch the name of yet. It was all very delicious and fresh. Well, most of the food. The millet dough, which we’re told is a staple where we are going, was quite bland and the texture was gritty. There is no western style kitchen in the house. The food is all cooked on open flame in the yard and some in banana leaves. Communication was limited, but we learned a little about Paul’s family and everyone was very happy to have us. After dinner, we walked as a group with Paul and few of his brothers and friends to the top of the hill above his home which has a clear view towards Kampala. On the way up they pointed out land which belongs to the family on which they plant. There were different kinds of fruit, corn and cassava from what I could tell. We encountered a lot of children out playing in the roads. Most without shoes and playing in the dirt with whatever they had found to entertain themselves. We took some pictures at the top and then walked back down to Paul’s house to say goodbye. Paul walked us down, about a 15 minute walk, the hill to catch a van back into town. On the way down we walked through what you might say were other people’s yards, but from what Dustin was saying, it’s quite common and neighborly to do so. The children were quite to see us and some of them tagged along for the walk.
We got together later in the evening with Janessa and Ciara, to have dinner. Dustin and Chris were still sleeping. We walked towards a coffee shop that we remembered, but it was closed when we arrived, so we ate at an Indian restaurant across the street. It was all vegetarian and I was initially reluctant, but I thought I would give it a try. I ordered a salted lime soda which I thought would be like soda. It turned out to be very salty and it looked like it had pepper and spices in it as well. I couldn’t drink it. I found out later from the others, that when I ordered it the waitress raised her eyebrows and open her eyes widely when I ordered it. No one told me. The rest of the meal was very delicious. I ordered chat puri, which are bite sized crispy bead shells filled with beans and a sweet and spicy sauce, topped with cheese.
As we finished dinner, we received a message from Dustin. He asked if we wanted to get a drink. We all came back to the hotel. Ciara was a little tired, so she stayed, but everyone else got ready and we went to a bar about 20 minutes away by foot. It was a little slow when we arrived, but Dustin explained, that the night life starts very late and sometimes extends to 7 to 8 am here. Dustin explained a little bit about the social interaction between men and women, which was pretty confusing. Men and women dance only with their own gender and there is little direct interaction. There are “progressive” Ugandans that interact more directly as westerner do, but that is fairly recent. We left there by taxi and headed to a place called Fat Boys, which was pretty much like a western night club. They played a mix of English and Ugandan pop music and they had a full bar. Here too we saw some of the cultural nuances and same gender groups dancing together, but there were more couples dancing together. We met up with another of Dustin’s friends there and his group of friends. I had already had 4 beers when we arrived and the beer here comes in large bottles and I found out that the brand I was drinking has a high alcohol percentage. We were having a good time dancing and as good host they continued to bring beers and drinks, sometimes before we had finished the previous drink. At one point two of the group we were with pulled one guy aside and others in the group said they saw them hit him. We found out later that he had tried to pickpocket Dustin. We have seen this type of mob justice on a few other occasions, while walking around town. It happens sometimes that when police catch up with criminals, they may just slap them on the wrist, since they have already been beaten through mob justice. I was not as lucky to notice someone picking my pocket, and I lost a phone that I had been holding for Veronica. We left there and I had too much to drink and I was felt sick as soon as we sat in the car. I was sick, out of the window before we pulled out of the parking lot, but I was conscious enough to remember that the driver wanted to demonstrate the sex trade and on the way back to the hotel, he stopped to talk to some prostitutes that were on a corner, not too far from where our hotel is. They seemed to know that we were not customers and didn’t pay him much mind. We made it back to the hotel and I slept in.
The next day, I slept until about midday and then we went to eat lunch. I came back to the hotel and slept some more. Later in the evening we went out for dinner and then we went to a concert that Janessa wanted to attend, since it was her 21st birthday. The closer we walked towards the stadium, the more dangerous our surroundings felt. As we approached the gates, what seemed like scalpers huddled around us offering different prices for admission. We squeezed through the crowd and into the outer gates to an open area and there was another gate further ahead, with a very dark entry through an opening in the concrete wall. We finally paid for admission, once we were inside and then, we seemed to be safer, but still, I think that we were probably the only mzungos (term for foreigner) among at least fifty thousand Ugandans. We worked our way over to the beer stands where we met some new friends that were happy to show us some new dances and explain a little about the performers and music. The music was all in Ugandan, but sounded much like pop, rap, and R&B. The rest of the evening was pretty uneventful. We walked back the way we came and the area seemed a little less intimidating, either because there were less people, or we had been that way before.

Week 2

Since we were waiting on an assignment, it was a good opportunity to explore Europe. We arrived in Frankfurt, Germany from Thailand in with enough time to go out and see a little bit of the city before dark. Our flight was pretty uneventful, but I wasn’t sure if we would survive the Taxi ride to the hotel. I think the driver was in a hurry to get to another fare, because he drove like a mad man.
Once we figured out how to get on the tram with the help of a couple at the stop, getting around was easy. Everyone we met spoken English, so communication was not a problem. We visited the city center, walked down to see the Main River and visited St. Bartholomaus Cathedral. The city center was very beautiful and picturesque. Monday was a holiday in Germany, so just about everything was closed, and we didn’t see much else in Frankfurt.
We decide to head to Amsterdam, then Paris, and we planned to head back to Frankfurt because we thought that would likely where we would fly to our next site, Uganda. It turned out that we’re flying from Amsterdam so we’re headed back there on 5/31 to catch our flight, which departs on 6/1. Getting to Amsterdam was easy enough on the high speed trains. The agent that helped us at the train station was incredibly patient and found us the best and least expensive options for our trip. The tourist office was very helpful there also and oriented me to the tram system and provided us with a map of the city. We had a little trouble finding the right tram stop for our hotel and I dragged about 100lbs of baggage, one with broken wheels, around what felt like miles around Amsterdam’s cobble stone roads trying to get to the hotel.
Amsterdam just feels like a cool place. It’s hard to describe, but I felt at home and at ease there. It was a little chilly, but nice since we were walking. People are nice, friendly and willing to help, especially if you look lost. There are a lot of people on bicycles and it seems like the preferred way to get around town, even though the trams are very convenient. There are all types of restaurants, but I didn’t see anything that could be considered local cuisine, and one person we met confirmed that there wasn’t anywhere that was really Dutch as far as food. He said “you might as well have Mexican food”. We did eat at two Middle Eastern influenced restaurants which were both excellent. We did get to experience healthcare first hand since we needed to get immunizations and anti-malarial medications for our trip to Uganda. The hotel desk informed us of where the clinic was, which was within walking distance. Most everything is it seems. The immunization clinic ran smoothly and had a very efficient way of getting everyone through the different stages up through when you received your immunizations and prescription. We saw a nurse to review what we needed, choose what medications we wanted, and to receive our prescriptions. Unfortunately we lost the majority of the day between the clinic and getting our meds, but we did get to visit the Van Gogh Museum while we were there.
We missed our scheduled train to Paris, which was a little frustrating, since we were still dealing with luggage without wheels and we tried to rush to catch it. Luckily we there was a train one hour later with the same destination. We knew which metro line to take when we arrived in Paris and we purchased a ticket on the train before we arrived, so getting to the hotel in Paris went well. We arrived in Paris later than we anticipated, but we did make it to see the Arc de Triomphe. We also visited the Eiffel Tower, The Louvre, and of course ate French pastries and bread. Walking around Paris gave me the feeling of having gone back in time. Unlike Amsterdam which has older buildings and architecture mixed with the new, in Paris it feels like you could be 100 years in the past when the traffic dies down and there are few cars.
Next week will be all about getting back to Amsterdam and catching our flight to Africa!

Week 1 Journal

You'll notice I am now in Uganda Africa. I will be updating this blog with my journal entries as I am able to and as the internet allows here in Uganda. This post begins from the coclusion of my week in Thailand after arriving in Germany;

I am actually writing from Frankfurt Germany, where I arrived yesterday, and not Thailand. The administration at FIU decided that it was not safe for students to stay in Thailand and they got us all tickets out of the country ASAP. However, There was no immediate danger and everything in the North East part of the country (Isaan) was calm. There were however, serious issues in Bangkok, where several people lost their lives. This was incredibly disheartening and very stressful initially, because in the short week that we were there, everyone from our mentors to our translators, to the regional hospital staff was very warm, kind, friendly and knowledgeable. We were able to settle in to our apartments, get orientation to Khon Kaen University, and visit the village of Lumhin for 1 and a half days.
After the very exhausting trip from Miami and sleeping very uncomfortably on the planes and seats in the airports we arrived in Khon Kaen in the afternoon where Dr Darunee, Erico, and Mei welcomed us and brought us to our new apartments. Dr Darunee is a professor in the school of Nursing and owns the apartments where we had been staying. Erico is the husband of another faculty member and works in computers and English language editing. Mei is Dr. Siriporns secretary. After we unpacked Erico and Mei came back to show us around the area. Not to far from our apartments was an area where there were several restaurants, food and fruit carts, and ofcourse a 7-11 Store. After our orientations in the mornings our translators took us around the campus, which is much like a city in size and complexity, and the Khon Kaen area. They took us to eat Thai food and began to show us how to communicate. The days were long, usually getting back our apartments after 8pm, but everyone was excited to get to know our new friends and community.
The research project that Veronica and I were assigned to was an ethnographic study of the villiage of Lumhin about 30 mins by car from Khon Kaen. Lumhin means place with holes. It has been established for about 50 years and was initially the site of surface mining for materials used for making concrete. The name comes from the very large and deep holes created around the village by this mining. People settled here to work in this industry and have stayed, although there is no longer work due to the use of machines that currently continue mining in the area. The village is very poor compared to others in the area and is mostly composed of grandparents who care for their grandkids, while their mothers and less commonly their fathers are away working in either Khon Kaen or Bangkok. We were told by our mentors that there is a very large gap in classes in Thailand. It’s clearly evident in some neighborhoods where you see very elaborate homes next to homes that are very basic. In Lumhin the majority of the village is extremely poor and the entire village is marginalized. This village has been blamed for all sorts of crimes and problems by surrounding villages . We were only able to begin to update the physical mapping with Pinan, a nurse assigned to this community, before we had to pack up and go. An interesting aspect of nursing in Thailand is that nurses are required to participate in community health nursing at leat 2 days per week. Pinan works three days in the ER and 2 days in the community.
Before we left we felt it was important to go back to the village and say good bye, thank them, and get some closure. We were able to visit the Khon Kaen Sancturary before arriving at the village to say good bye. It was very impressive and ornate. Interestingly had some fun aspects as well, like a rotating Monk sculpture with pots that opened and closed for throwing donations into. There were also stands with representations of the Chinese calendar animals that played a recording of a Monks prayers according to your animal sign.
Dr Siriporn and our translators accompanied us to the airport when we departed and were all very sad to see us go. I think that all of us would return to Thailand without hesitation.
We're now waiting to find out from other sites if they will be able to take us on another