This morning one of my colleagues insisted I take a matasu (size of an old VW Van but with 15 seats crowded in) with 4 other volunteers downtown to get a latte and a scone. Up to this point, I had only taken private hire cars with drivers recommended by HVO or walked to my destinations when possible. By sharing rides, it was quite inexpensive – equivalent to $4 to $8 for a 15 minute to 30 minute drive. However, the matasu was the equivalent of 50 cents each for a longer ride. The downside is being squeezed into a crowded and hot van. At any rate, I relented but refused to take a bota bota ride back from the coffee house.
As we entered the intersection and waited for an opening to dodge across the street to catch a matasu, a full size bus came up the street at a good speed at the very moment an older Ugandan woman stepped off the curb, oblivious to the oncoming bus. Helplessly, we stood on the curb to see the inevitable. The bus hit her full force, throwing her to the ground. The only thing that saved her was the driver reacted quickly and slammed on the brakes. We and several Ugandan men ran to help her. We were able to get her to the center divider and a taxi stopped to take her to Mulago Hospital which was right up the street. One of my colleagues took the license plate number of the bus and gave it to the taxi driver. The bus took off as soon as we cleared the woman out of the way. The driver never got out of the bus.
Later, I spoke with a doctor who is Nigerian but lives in New Jersey and spends a lot of time in Uganda and S. Africa. He said it is not uncommon for a driver who has hit someone to back up and drive over them a second time to make certain death was immediate. That way, the victim can not testify against him. When they go to court, the magistrate is paid off. Life is cheap and corruption thrives.
We did manage to get downtown and enjoy our lattes and scones. Anita, a doctor friend from Boston, and I returned to the guest house while the others decided to shop at the craft market. I needed to get back to pack and be ready for an early pick up at 5pm for the 10:45 pm flight. I was at the airport at 6pm and couldn’t check in until 8pm. As luck would have it, a lovely Rwandan graduate student on her way back to London for school, sat down next to me. We chatted for a few minutes before she opened her computer and invited me to join her in watching a movie she had downloaded. About half way through, my flight was called for check in, so we said our goodbyes, and I checked in and made for the business and first class lounge as fast as my legs could carry me. Thank heaven for frequent flyer miles and Joe’s calling regularly to see if an upgrade opened up!
It is now 9:20 pm, so I have an hour + before departure. ……
Sunday, September 27, 2009
Friday, September 25, 2009
Visit to Acid Survivor
Yesterday I met Jude, the Psychosocial Counselor, and Samson, the Legal Counselor, at Mulago Hospital’s Burn Unit. We were there to see a middle aged Muslim man who had acid thrown on him a week before. Three of his subordinates at the hospital where he worked were jealous of his position and tried to slander him to his boss. Consequently, all three were fired, as the boss knew he was a good employee. Seeking revenge, one of the three fired men got his brother and another man to throw acid on him on his way to pray at the mosque. Luckily, he had seen a sign in his village (thanks to the Acid Survivors Foundation) that clean cold water should be thoroughly doused on acid burns. He ran to a neighbor who helped him and then took him to a local hospital. He was then transported to Mulago Hospital to get the treatment he needed.
When I met him, he was awake and able to talk. He is a handsome man with a beautiful smile. Only part of the left side of his face was burned but the worst damage was to his throat and upper chest. Skin had been grafted from his thigh in order to close the gaping wound in his neck and on his chest. Apparently, it will take a week or so to see if the graft was successful. He will remain in the Hospital for several weeks, and has a caretaker and his family who come and sit with him.
A note about hospital care in Uganda ... Patients must bring their own bedding, pajamas, food, etc. It is up to the family or a friend to change their sheets, feed them, and basically do everything an LVN or nurse would do in the States. In the nursery, the expectant parents must bring a blanket to dry the new born and another to swaddle him in. They must provide all bedding and change the sheets every time the baby soils them. There are no diapers! Parents, patients’ families and caretakers bring their own mattresses and sleep in the corridors on the floor when they are not by the bedside.
Back to the burn victim ... He told me he found solace in his religion and said his family and children were very supportive. The AS Foundation gives the victim’s family a little money to help them get by while the breadwinner is indisposed. The legal counselor told him that he was working with the police to find the perpetrators, one of whom left a shoe behind in his haste to get away. This will be used as evidence if the 2 are caught. We thanked him for his time, and he thanked us for our interest in him. From there we went to the plastic surgery unit to visit a young woman who had just come from the operation theater where the surgeon was attempting to rebuild her nose. This would be one of several surgeries to try to restore her face. Since she was just out of surgery, we did not get to speak with her. The staff from the ASF will return on Monday for a visit.
I forgot to mention that a peer counselor also visits the survivors. This is an acid survivor who volunteers his or her time to reassure the victim that he/she is not alone and that there is life after physical healing. To me, survivors helping survivors is the best treatment there is.
This begins the countdown to departure tomorrow night…
When I met him, he was awake and able to talk. He is a handsome man with a beautiful smile. Only part of the left side of his face was burned but the worst damage was to his throat and upper chest. Skin had been grafted from his thigh in order to close the gaping wound in his neck and on his chest. Apparently, it will take a week or so to see if the graft was successful. He will remain in the Hospital for several weeks, and has a caretaker and his family who come and sit with him.
A note about hospital care in Uganda ... Patients must bring their own bedding, pajamas, food, etc. It is up to the family or a friend to change their sheets, feed them, and basically do everything an LVN or nurse would do in the States. In the nursery, the expectant parents must bring a blanket to dry the new born and another to swaddle him in. They must provide all bedding and change the sheets every time the baby soils them. There are no diapers! Parents, patients’ families and caretakers bring their own mattresses and sleep in the corridors on the floor when they are not by the bedside.
Back to the burn victim ... He told me he found solace in his religion and said his family and children were very supportive. The AS Foundation gives the victim’s family a little money to help them get by while the breadwinner is indisposed. The legal counselor told him that he was working with the police to find the perpetrators, one of whom left a shoe behind in his haste to get away. This will be used as evidence if the 2 are caught. We thanked him for his time, and he thanked us for our interest in him. From there we went to the plastic surgery unit to visit a young woman who had just come from the operation theater where the surgeon was attempting to rebuild her nose. This would be one of several surgeries to try to restore her face. Since she was just out of surgery, we did not get to speak with her. The staff from the ASF will return on Monday for a visit.
I forgot to mention that a peer counselor also visits the survivors. This is an acid survivor who volunteers his or her time to reassure the victim that he/she is not alone and that there is life after physical healing. To me, survivors helping survivors is the best treatment there is.
This begins the countdown to departure tomorrow night…
Thursday, September 24, 2009
Acid Survivors Foundation
As you know, we received another threat notice from the State Dept. I rather think that this one is more like New York’s maintaining an orange alert – at least I hope so. However, we have been told that things can erupt very quickly here. My colleagues and I are all departing on different days and flights this weekend, so we’re praying for calm until we’re safely home again.
Regarding my work, I visited the Acid Survivors Foundation on Tuesday and will meet with some staff members again today and Friday. The Foundation was started in 2003 to help acid survivors cope with their trauma and disfigurement and to raise public awareness to help integrate these people back into their communities, to put what would be equivalent to a “neighborhood watch” program into place for the purpose of monitoring the sale of battery acid, and to provide legal aid in an attempt to prosecute the perpetrators (13 have been tried since 2003, receiving anywhere from 25 yrs. to one month in prison.)
The Foundation helped 37 Survivors last year through counseling programs, occupational training, and meeting with village elders around Uganda to develop local support for these people. Because the survivors are so disfigured, they are often ostracized and are ashamed to be seen even in their own village. There are several motivations for this sort of crime: a husband or boyfriend suspects his wife/girlfriend of infidelity, a woman is jealous that her boyfriend is dating another woman, or disputes related to property and business matters. Acid crimes generally take place when it is dark and families are gather around their dinner table. The perp then sneaks in under cover of darkness and throws the acid in the face of the victim. Even more tragic is the fact that mothers are often holding their babies, so they are also burned. The Foundation is trying to educate victims and their families that dousing the face with cold water immediately can sometimes prevent the acid from eating through to the bone.
Those who are able to make the journey to a Mulago Hospital are treated over a period of 2-3 months and then return for plastic surgery, which can help cover exposed bone but little else. Those who have sustained eye injuries receive the surgery they need to save at least partial vision if possible. The cost of medical care was assumed by the government but that is changing. Only those who can pay will receive treatment, which means most won’t.
The Foundation employs 7 survivors: 4 full time and 3 part time. I met the full time survivors who were busy sewing shoulder bags, pot holders, and towels and making greeting cards. They sell through the various craft markets to generate a little cash flow.
The Director of the Foundation was very enthusiastic about any help I could provide. Consequently, I will accompany a staff member to the hospital this afternoon the see how he assesses two patients: one in the burn unit and one in plastic surgery. No one has formal training, so they are eager to learn. I was asked to return to the Foundation tomorrow to discuss group therapy techniques with them. They also need metrics to demonstrate that their work is helping the survivors cope with their disfigurement and be assimilated back into their villages. This is important in terms of receiving financial support. I hope to leave them with some tools which will help measure a survivor’s progress.
Regarding my work, I visited the Acid Survivors Foundation on Tuesday and will meet with some staff members again today and Friday. The Foundation was started in 2003 to help acid survivors cope with their trauma and disfigurement and to raise public awareness to help integrate these people back into their communities, to put what would be equivalent to a “neighborhood watch” program into place for the purpose of monitoring the sale of battery acid, and to provide legal aid in an attempt to prosecute the perpetrators (13 have been tried since 2003, receiving anywhere from 25 yrs. to one month in prison.)
The Foundation helped 37 Survivors last year through counseling programs, occupational training, and meeting with village elders around Uganda to develop local support for these people. Because the survivors are so disfigured, they are often ostracized and are ashamed to be seen even in their own village. There are several motivations for this sort of crime: a husband or boyfriend suspects his wife/girlfriend of infidelity, a woman is jealous that her boyfriend is dating another woman, or disputes related to property and business matters. Acid crimes generally take place when it is dark and families are gather around their dinner table. The perp then sneaks in under cover of darkness and throws the acid in the face of the victim. Even more tragic is the fact that mothers are often holding their babies, so they are also burned. The Foundation is trying to educate victims and their families that dousing the face with cold water immediately can sometimes prevent the acid from eating through to the bone.
Those who are able to make the journey to a Mulago Hospital are treated over a period of 2-3 months and then return for plastic surgery, which can help cover exposed bone but little else. Those who have sustained eye injuries receive the surgery they need to save at least partial vision if possible. The cost of medical care was assumed by the government but that is changing. Only those who can pay will receive treatment, which means most won’t.
The Foundation employs 7 survivors: 4 full time and 3 part time. I met the full time survivors who were busy sewing shoulder bags, pot holders, and towels and making greeting cards. They sell through the various craft markets to generate a little cash flow.
The Director of the Foundation was very enthusiastic about any help I could provide. Consequently, I will accompany a staff member to the hospital this afternoon the see how he assesses two patients: one in the burn unit and one in plastic surgery. No one has formal training, so they are eager to learn. I was asked to return to the Foundation tomorrow to discuss group therapy techniques with them. They also need metrics to demonstrate that their work is helping the survivors cope with their disfigurement and be assimilated back into their villages. This is important in terms of receiving financial support. I hope to leave them with some tools which will help measure a survivor’s progress.
Wednesday, September 23, 2009
New Threat Warning
We received a new warning and are concerned about being able to get out of the country for our return home...
Warden Message - Security Reminder
Kampala, Uganda
September 22, 2009
In response to the recent terrorist attacks in Somalia and U.S. military action resulting in the death of Saleh ali Saleh Nabhan, a leader of Al Qaeda’s East Africa operations, and the recent attack attributed to Al Shabaab against African Union Mission in Somalia (AMISOM), which included the death and injury of Ugandan soldiers, the U.S. Mission to Uganda would like to remind American citizens of the threat of terrorism against U.S. facilities, personnel, and interests in East Africa. U.S. citizens in Uganda are also reminded of the warning for East Africa that is part of the Worldwide Caution warning of the continuing threat of terrorism in the region.
Although the U.S. Mission is not aware of specific threat information related to Uganda or U.S. interests in Uganda, U.S. citizens are reminded that a number of Al Qaeda and Al Shabaab operatives and other extremists are believed to be operating in and around East Africa. U.S. citizens residing or traveling in the region should carefully review their travel plans, remain vigilant with regard to personal security, and exercise caution. Terrorist actions may include suicide operations, bombings, kidnappings, and/or targeting maritime vessels. Terrorists do not distinguish between official and civilian targets. Increased security at official U.S. facilities has led terrorists to seek “softer” targets such as hotels, beach resorts, landmarks, and other prominent public places (i.e., shopping venues). U.S. citizens in remote areas or border regions where military or police presence is limited or non-existent could also become targets.
U.S. citizens with questions or concerns may telephone the Consular Section of the U.S. Mission to Uganda at (256) (0) (414) 306 001 or (256) (0) (414) 259 791. In case of an emergency outside business hours, or during any suspension of public services, U.S. citizens may reach the U.S. Mission duty officer at the same numbers.
U.S. citizens are advised to register and update their contact information with the U.S. Mission to Uganda. The U.S. Mission is located at Plot 1577 Ggaba Road. The phone number is (256) (0) (414) 306 001 or (256) (0) (414) 259 791, fax (256) (0) (414) 258 451, email: KampalaUSCitizen@state.gov, and travel registration website: https://travelregistration.state.gov/ibrs/.
For the latest security information, U.S. citizens living or traveling abroad should regularly monitor the Department’s Bureau of Consular Affairs internet website at: http://travel.state.gov/, where the current Worldwide Caution, Travel Alerts, Travel Warnings, and Country Specific Information can be found. Up-to-date information on security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or, for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8 a.m. to 8 p.m. Eastern Time, Monday through Friday (except U.S. Federal Holidays).
Sincerely,
Consular Section
U.S. Embassy Kampala
Warden Message - Security Reminder
Kampala, Uganda
September 22, 2009
In response to the recent terrorist attacks in Somalia and U.S. military action resulting in the death of Saleh ali Saleh Nabhan, a leader of Al Qaeda’s East Africa operations, and the recent attack attributed to Al Shabaab against African Union Mission in Somalia (AMISOM), which included the death and injury of Ugandan soldiers, the U.S. Mission to Uganda would like to remind American citizens of the threat of terrorism against U.S. facilities, personnel, and interests in East Africa. U.S. citizens in Uganda are also reminded of the warning for East Africa that is part of the Worldwide Caution warning of the continuing threat of terrorism in the region.
Although the U.S. Mission is not aware of specific threat information related to Uganda or U.S. interests in Uganda, U.S. citizens are reminded that a number of Al Qaeda and Al Shabaab operatives and other extremists are believed to be operating in and around East Africa. U.S. citizens residing or traveling in the region should carefully review their travel plans, remain vigilant with regard to personal security, and exercise caution. Terrorist actions may include suicide operations, bombings, kidnappings, and/or targeting maritime vessels. Terrorists do not distinguish between official and civilian targets. Increased security at official U.S. facilities has led terrorists to seek “softer” targets such as hotels, beach resorts, landmarks, and other prominent public places (i.e., shopping venues). U.S. citizens in remote areas or border regions where military or police presence is limited or non-existent could also become targets.
U.S. citizens with questions or concerns may telephone the Consular Section of the U.S. Mission to Uganda at (256) (0) (414) 306 001 or (256) (0) (414) 259 791. In case of an emergency outside business hours, or during any suspension of public services, U.S. citizens may reach the U.S. Mission duty officer at the same numbers.
U.S. citizens are advised to register and update their contact information with the U.S. Mission to Uganda. The U.S. Mission is located at Plot 1577 Ggaba Road. The phone number is (256) (0) (414) 306 001 or (256) (0) (414) 259 791, fax (256) (0) (414) 258 451, email: KampalaUSCitizen@state.gov, and travel registration website: https://travelregistration.state.gov/ibrs/.
For the latest security information, U.S. citizens living or traveling abroad should regularly monitor the Department’s Bureau of Consular Affairs internet website at: http://travel.state.gov/, where the current Worldwide Caution, Travel Alerts, Travel Warnings, and Country Specific Information can be found. Up-to-date information on security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or, for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8 a.m. to 8 p.m. Eastern Time, Monday through Friday (except U.S. Federal Holidays).
Sincerely,
Consular Section
U.S. Embassy Kampala
Sunday, September 20, 2009
Return from Bwindi
The next morning we were on the road by 7AM. We had decided to take a different route home in order to drive through a game reserve and pass some crater lakes – both of which proved disappointing. Instead of heading NE to Kampala, we drove north, adding an extra couple of hours to our trip. The scenery as we left Bwindi was again breathtakingly beautiful – at least what we could see of it. For several miles, we were on a dirt mountain road which was under construction, making visibility almost zero due to the thick red dust kicked up by the construction equipment and other cars and trucks ahead of us. (Unlike in the U.S., there is no watering down the dirt when building roads.) Finally, the mountains and verdant hillsides appeared, as we left the road work behind us. After several hours, we passed a lovely little lake behind a wire fence. We stopped for a photo and continued on our way. I did not realize until later, that this was one of the crater lakes – in fact, the only one we saw!
We proceeded toward the game reserve, passing cyclists balancing enormous bunches of bananas behind their seats and women carrying their produce and wares on their heads. Needless to say, this results in very erect posture. However, I would think that their cervical spine would compress over time. I did learn from the orthopedic doc traveling with us, that the incidence of osteoporosis is extremely high in Uganda due to lack of calcium in their diets. They just cannot afford dairy products, but their life style certainly lends itself to weight bearing exercise. Many suffer fractures in their late 40’s. The average lifespan is early 50’s due to malnutrition, HIV/AIDS, and lack of access to healthcare.
We arrived at the game reserve in the heat of the day – high 90’s with high humidity. Our driver drove us around the reserve in search of animals. We did get to see warthogs, kobs and waterbucks (the latter two being members of the antelope family). We were disappointed with so little animal sightings, but the driver explained most were probably hanging about watering holes at this time of day. We left the park and proceeded to Fort Portal for what we thought would be a quick lunch. We ordered and then waited an hour for our food to arrive. One comes to learn that African time is quite different than our concept of time. Hoping to get back to Kampala before 9PM, we gobbled down our passable lunches and headed southeast.
Around 8PM we knew we were entering the capital, as the traffic was horrific – as always. Bota botas (motor bikes), bicycles, matatus (small van-like buses), and cars vie for the little space available on the roads. There are no street lamps or traffic lights and many vehicles have no headlights and reflectors on bikes are almost unheard of. Basically, it’s a free-for-all and extremely dangerous. Mulago Hospital gets about 1000 bota bota accidents a month – mainly open fractures and head injuries. Open fractures are particularly dangerous here due to the probability of tetanus, and most can’t afford to pay for treatment.
At 9 PM, we were back at our guest house and happy to sleep in our comfortable beds, after enjoying hot showers.
Next entry…my visit to the Acid Victims Foundation
We proceeded toward the game reserve, passing cyclists balancing enormous bunches of bananas behind their seats and women carrying their produce and wares on their heads. Needless to say, this results in very erect posture. However, I would think that their cervical spine would compress over time. I did learn from the orthopedic doc traveling with us, that the incidence of osteoporosis is extremely high in Uganda due to lack of calcium in their diets. They just cannot afford dairy products, but their life style certainly lends itself to weight bearing exercise. Many suffer fractures in their late 40’s. The average lifespan is early 50’s due to malnutrition, HIV/AIDS, and lack of access to healthcare.
We arrived at the game reserve in the heat of the day – high 90’s with high humidity. Our driver drove us around the reserve in search of animals. We did get to see warthogs, kobs and waterbucks (the latter two being members of the antelope family). We were disappointed with so little animal sightings, but the driver explained most were probably hanging about watering holes at this time of day. We left the park and proceeded to Fort Portal for what we thought would be a quick lunch. We ordered and then waited an hour for our food to arrive. One comes to learn that African time is quite different than our concept of time. Hoping to get back to Kampala before 9PM, we gobbled down our passable lunches and headed southeast.
Around 8PM we knew we were entering the capital, as the traffic was horrific – as always. Bota botas (motor bikes), bicycles, matatus (small van-like buses), and cars vie for the little space available on the roads. There are no street lamps or traffic lights and many vehicles have no headlights and reflectors on bikes are almost unheard of. Basically, it’s a free-for-all and extremely dangerous. Mulago Hospital gets about 1000 bota bota accidents a month – mainly open fractures and head injuries. Open fractures are particularly dangerous here due to the probability of tetanus, and most can’t afford to pay for treatment.
At 9 PM, we were back at our guest house and happy to sleep in our comfortable beds, after enjoying hot showers.
Next entry…my visit to the Acid Victims Foundation
Friday, September 18, 2009
Gorillas
The morning of our trek, the four of us arose bleary-eyed and exhausted. The motel was not at all conducive to sleeping (not worth going into the details). However, we were all energized by the prospect of tracking the gorillas in the rain forest. After a very rough one hour ride over unfinished mountain roads, we arrived at our destination. A young woman working in the British Embassy in Sudan joined our group. We were introduced to our guide who laid the ground rules for our trek:
• Stay close together.
• Put your pant legs into your socks to avoid being bitten by stinging red ants.
• Watch for nettles (prickery plants) while bushwhacking through the forest.
• Take plenty of water.
• When the trackers find the gorillas, do not move if they become aggressive.
• Do not look the gorillas in the eye.
• If the trek becomes too strenuous for anyone, a guide will be radioed to take the person back to base camp.
• No flash photos.
• Anyone with a cold, cough, or any potentially contagious disease must stay behind.
We were on our way by 8:30 AM and were pleased to see the sun peeking through the clouds. We hired a porter to carry our water, clothes as we shed them with the rising temps and our lunches. The guide was in front with the porters (2) pulling up the rear. Walking about 25 feet in front of the guide was another park official carrying a rifle. The semblance of an initial trail quickly disappeared, giving way to dense overgrown jungle with rope-like vines along the ground ready to snag and trip any non-vigilant trekker (We all succumbed to the vines at one point or another). The terrain became very steep and slippery from the moisture, forcing us to grab at any branch or outgrowth to help us with the ascent, deeper and deeper into the forest. We had to forge 3 streams, which ended up soaking everyone’s feet and lower pant legs.
As we continued, our guide kept in radio contact with the trackers who had left earlier in the morning in search of a gorilla troop. After 2 ½ hours of some of the most difficult hiking and climbing I have ever done, we met the trackers who informed us there was a troop of 20 gorillas ahead. We were told to leave our walking sticks and everything behind except our cameras, to keep our voices down and to follow the trackers and our guide. The trackers were armed with a machete and scythe to clear the way to the gorillas.
We came upon two silver backs (mature males), several teenagers, females and frolicking babies. The alpha sliver back was not to be seen. The teenage males became quite aggressive at times, making threatening noises while moving toward us. The trackers and guide held their ground and responded in kind, imitating the gorilla sounds. Thank heaven the standoff worked, as I had already turned and was ready to run for my life in spite of instructions to the contrary! Adult gorillas can weigh up to 420 lbs and the teenagers 200 plus.
The entire troop busied themselves munching on leaves with some of the larger apes devouring every leaf in site from a comfortable seated position on the ground. Some of the mothers and their babies sought higher places from which to feed. However, the branches eventually snapped under their weight, forcing them to swing to other branches until those too succumbed to the strain of supporting their diners. Eventually, we realized that the troop had encircled us, so we were able to view them from all sides. It was amazing to see their dexterity in plucking a single leaf or grabbing an entire handful. When some of the older ones were sated, they decided to take a snooze, allowing us to move a bit closer. They assumed very human like positions, lying on their sides and cradling their heads in their arms.
One silver back took umbrage at our invasion of their privacy and rose to full height, making frightening sounds and pounding on his chest. Our guide stood tall and pounded his chest in response. This caused the enormous male to retreat to another spot – thank heavens! I’m so glad the ape had eaten before this interaction!
I can’t imagine anyone disputing evolution when confronted by these creatures who so resemble us, or is it the other way around? To be so up close and personal was a truly amazing experience and one I hope others will be able to enjoy for many years to come. There are fewer than 400 wild gorillas in Uganda with slightly fewer in neighboring Rwanda and the Congo. They are an endangered species but are enjoying a slight increase in numbers over the past few years. The rather stiff fee one must pay to see them helps pay for their protection. In addition, denying access to anyone who appears to be sick, protects the apes from catching human viruses which could potentially wipe out an entire troop and more.
Trekkers are allotted one hour to remain with the troop, before heading back to base camp. Most of us got some good photos which we plan to share with each other. One person in our party had a very good telescopic lens, so I am eager to get some of her shots and eventually share them with you.
Our trip back was equally as treacherous as our hike in, as we got caught in an afternoon thunderstorm storm, which made our footing even more precarious. By the time we made it to base camp, we were drenched through and through – not to mention exhausted.
We had a small “graduation” ceremony for having successfully made the trek and seen the gorillas. We each received “diplomas” to a round of applause, and then headed back to our motel, eager for a nice hot shower. Unfortunately, the generator hadn’t been turned on, so we had to forgo showers and sponge off the mud and grit as best we could and wait until after dinner to shower and fall into bed. Needless to say, we all slept well that night!
Next entry…the ride back to Kampala and more…
Wednesday, September 16, 2009
Kampala to Bwindi
After a beautiful 8 hour drive to the southwestern corner of Uganda, we arrived in Kabale where we were to spend the night before our early morning trek. On the way to Kabale, we crossed the equator where we stopped for a photo op – each of us straddling both the north and south.
We decided to treat ourselves to café lattes in the little restaurant and gift shop, before proceeding to our destination. The lattes were delicious but scalding hot, so I decided to spill some of mine out rather than risk burning myself while riding over the rough terrain. Well, the best laid plans… As I entered the van after my 3 traveling companions, one inadvertently put out her arm, splashing the latte into my face and over my clothes. The lower portion of my face was burned but luckily not to the point of permanent damage but enough to bring tears to my eyes. Had we been in the States at a McDonalds, a lawsuit would have been in order, assuming I had a litiginous nature!
Our drive to Kabale and ultimately to the Bwindi Rain Forest involved a climb from 4000 ft above sea level to 6,232 ft. The country is very hilly with variegated shades of green against clay colored soil, making for a stunning landscape. Banana trees and tea are planted everywhere and little black, brown, white and multi-colored goats, and cows graze along the roadside, sharing the space with locals of all ages walking to their various destinations. Colorful crudely constructed small stores and homes interrupt the bucolic scene, indicating a small village. As we climb, the pastoral scenes become more breathtaking with terraced hills and homes perched high above mist covered valleys. The narrow roads require our driver to honk throughout our journey, as a warning to bicyclists, pedestrians, and animals to move aside. Unlike in the States where many take a honking horn as a personal affront and respond with a descriptive gesture which is less than polite, the Ugandas simply comply, knowing the driver is motivated by their safety. Children along the roads are always excited to see Mzungos (white people) passing by and greet us with waves and smiles. Mountains arise in the distance (the Ruwenzoris), which mark the boundary between Uganda and the Congo and Uganda and Rwanda. ( I hope to have some photos to share at some point.)
We were all happy to arrive at our hotel and have the chance to stretch are legs and meander around the small village before turning in for the night. We were in bed by 10PM, so as to make a 6 AM pickup for our drive to the start of our trek into the dense Bwindi National Park in search of gorillas.
Next entry… our trek.
Monday, September 14, 2009
The Program
I had a very good meeting on Monday with the committee in charge of implementing a MS in Psychiatric Healthcare. They were very impressed with the curriculum I wrote for them. I did most of it before traveling to Uganda, as I knew I would not have access to reference material here. They had a few more questions regarding credits per course, clinical hours required, and staff qualifications. Of course, they don’t have the degreed instructors i.e. MDs, PhDs, and NPs that we do in the U.S. but will use locals with lots of clinical experience. The challenge will be for them to get funding for the psychiatric program. This will not be easy, as many sources within the US have dried up. Sweden provides quite a bit of support, sending doctors, financial aid and medicine. However, there are so many programs which are competing for financing, making the situation more difficult – not to mention the worldwide recession.
Aside from delivering the curriculum, I took a tour of the outpatient psychiatric clinic and the inpatient facility. Locals were lined up waiting for evaluations or follow-up visits. In patients are all in one dorm-style room with men and women separated. Most were being treated with Haldol, an antipsychiotic, to calm them down. The other drug used is a mood stabilizer, carbamazepine. Needless to say, they do not have the financial capability of providing SSRIs or many of the Atypicals we use in the U.S. In fact, there are only about 100 medications available in Uganda to treat all diseases, as opposed to thousands we have. This is consistent with the medical coverage. There are 7 psychiatrists in Mulago and 9 in Batabika Hospital (see below). A total of 28 in the entire country.
Most of the psychiatric patients are suffering from PTSD and depression. These patients do not have to pay for their drugs, unlike those with non-psychiatric conditions i.e. HIV, hypertension, strokes, cancer, etc. Patients arrive at the hospital due to an emergency situation, are evaluated based on whatever tests they can afford (if any)and prescribed medication, which most can’t afford to buy. They are then discharged to live as long as they can without treatment. So sad! The system here makes ours look like the gold standard!
I also visited another National Mental Hospital , Batatika, about 40 minutes east of Kampala. It is a beautiful facility in the country and seems to be very well run. The patients have access to the expansive grounds which are secured by high fences and guards placed strategically around the hospital. They all wear bright green shirts which protects any patient who is able to find a way out of the hospital. The police know not to arrest anyone attired in the green shirt but to return them to the Hospital. The average stay is 4 weeks, as most are compliant in taking their medications.
I was given a tour of the ward which houses the most acute male psychiatric cases and received 2 marriage proposals in short order. In fact, one of the men led me to his bed, hoping to consummate the anticipated union on the spot!!
Next entry: Time off to trek in Bwindi to see the gorillas.
Aside from delivering the curriculum, I took a tour of the outpatient psychiatric clinic and the inpatient facility. Locals were lined up waiting for evaluations or follow-up visits. In patients are all in one dorm-style room with men and women separated. Most were being treated with Haldol, an antipsychiotic, to calm them down. The other drug used is a mood stabilizer, carbamazepine. Needless to say, they do not have the financial capability of providing SSRIs or many of the Atypicals we use in the U.S. In fact, there are only about 100 medications available in Uganda to treat all diseases, as opposed to thousands we have. This is consistent with the medical coverage. There are 7 psychiatrists in Mulago and 9 in Batabika Hospital (see below). A total of 28 in the entire country.
Most of the psychiatric patients are suffering from PTSD and depression. These patients do not have to pay for their drugs, unlike those with non-psychiatric conditions i.e. HIV, hypertension, strokes, cancer, etc. Patients arrive at the hospital due to an emergency situation, are evaluated based on whatever tests they can afford (if any)and prescribed medication, which most can’t afford to buy. They are then discharged to live as long as they can without treatment. So sad! The system here makes ours look like the gold standard!
I also visited another National Mental Hospital , Batatika, about 40 minutes east of Kampala. It is a beautiful facility in the country and seems to be very well run. The patients have access to the expansive grounds which are secured by high fences and guards placed strategically around the hospital. They all wear bright green shirts which protects any patient who is able to find a way out of the hospital. The police know not to arrest anyone attired in the green shirt but to return them to the Hospital. The average stay is 4 weeks, as most are compliant in taking their medications.
I was given a tour of the ward which houses the most acute male psychiatric cases and received 2 marriage proposals in short order. In fact, one of the men led me to his bed, hoping to consummate the anticipated union on the spot!!
Next entry: Time off to trek in Bwindi to see the gorillas.
Saturday, September 12, 2009
Just received another warning from the State Dept that more riots could break out anytime over the weekend. The airport in Entebbe is closed. I was invited to meet a volunteer (PhD in Public Health from Johns Hopkins) this afternoon in another part of town, and I’m desperate for some exercise and need to get out. I’ll be walking away from the center of the violence so feel quite comfortable. Since President Museveni’s response to the rioters was so swift and harsh, he may have deterred any future protests. We’ll see…
Moving from politics to happier topics….Uganda is very green with beautiful flowering trees and bushes and monkeys swinging overhead or frolicking on the grounds of our quarters. The topography is hilly with Lake Victoria and Lake Albert bordering the western and eastern boundaries of the country, respectively. The Albert Nile flows from the north east and turns west above Lake Albert and becomes Victoria Nile. Other lakes dot the middle of the country, making for a truly beautiful place.
The capital, Kampala, is very crowded. The British never bothered to develop a city plan , concentrating their efforts more in Kenya. Consequently, development has been random and less than appealing. There are wealthy sections in the hills overlooking the capital and east of downtown. There may be more, but I haven’t discovered them yet. In contrast, there are shanties with corrugated roofs, which look like a good wind could easily level them, right down the road form the hospital. Mud and garbage surround these roadside “businesses” and homes which encroach onto the sidewalks. Shoes, food stuffs, and even wooden coffins are sold there. With the extremely high accident rate, I can see where the coffins could be a hot commodity.
I happened into this area accidently when walking back from a shopping mall several days ago. The farther I walked, I realized I was going in the wrong direction. Happily, a woman was kind enough to guide me back to where I wanted to be. Rich or poor, everyone seems willing to help.
Moving from politics to happier topics….Uganda is very green with beautiful flowering trees and bushes and monkeys swinging overhead or frolicking on the grounds of our quarters. The topography is hilly with Lake Victoria and Lake Albert bordering the western and eastern boundaries of the country, respectively. The Albert Nile flows from the north east and turns west above Lake Albert and becomes Victoria Nile. Other lakes dot the middle of the country, making for a truly beautiful place.
The capital, Kampala, is very crowded. The British never bothered to develop a city plan , concentrating their efforts more in Kenya. Consequently, development has been random and less than appealing. There are wealthy sections in the hills overlooking the capital and east of downtown. There may be more, but I haven’t discovered them yet. In contrast, there are shanties with corrugated roofs, which look like a good wind could easily level them, right down the road form the hospital. Mud and garbage surround these roadside “businesses” and homes which encroach onto the sidewalks. Shoes, food stuffs, and even wooden coffins are sold there. With the extremely high accident rate, I can see where the coffins could be a hot commodity.
I happened into this area accidently when walking back from a shopping mall several days ago. The farther I walked, I realized I was going in the wrong direction. Happily, a woman was kind enough to guide me back to where I wanted to be. Rich or poor, everyone seems willing to help.
Friday, September 11, 2009
War Zone
Just received this warning from the American Embassy here. The riots are continuing, and we are in earshot of the gunfire. We have been told to remain in the guest house or the hospital. The military carry AK 47s and were shooting at pretty close range.
A very nice couple, Danielle and Jay, who are both dentists and an orthopedic surgeon from Sweden, Bjorn, were called into the hospital last night after we returned from dinner. They worked until 3 AM to save as many of the wounded as possible.
I went with Bjorn, Jay and Danielle to the hospital this morning. The place looks like a war zone. Families are camped on every available bit of floor space, waiting to see their loved ones. The operating theaters were going all night and more wounded were arriving this morning.
I went to look in on a 13 year old boy who had climbed a tall tree to escape the rioters yesterday, but fell. A neurologist was called this morning, because the boy had bleeding from his ears and came in unconscious. (The neurologist didn’t want to work last night, so he went home.) Thank heaven for the volunteer docs who managed to keep him alive.
He has a major fracture of his femur, a broken wrist and shoulder, and a fractured jaw. The doctors were only able to set the leg and try to stabilized him by manually ventilating him all night. His condition is too precarious right now, so surgery will have to wait. A dentist friend who lives here, Mathew, was able to wire his jaw back together last night, but it didn’t hold. He is on morphine which is reducing some of the pain but definitely not all, as he is writhing around in an attempt to release the restraints holding his arms and legs. Jay was hoping to give him a jaw block this morning to alleviate his suffering.
Both Jay and Danielle brought 3 suitcases full of medical supplies from the States which has been a godsend for those in need. Bjorn is going non-stop, treating as many fractures from gunshot wounds as he can. Most are through and through, although one man wanted to know how to dig a bullet out of his friend where it lodged in a bone.
Everywhere one looks, there are acute cases waiting for treatment – many are lying on the floors, as there aren’t enough gurneys or beds. The Head ER doc told the staff to ignore the rule of not getting x-rays or treating unless the patient could pay. We were so glad to hear this, as the doctor sitting in one of the temporary ICUs told us we couldn’t get an X-ray or scan on the young boy unless his family had the money to cover the procedures!
Being in a place like this really makes one appreciate the U.S. Our problems pale by comparison to these poor third world countries.
A very nice couple, Danielle and Jay, who are both dentists and an orthopedic surgeon from Sweden, Bjorn, were called into the hospital last night after we returned from dinner. They worked until 3 AM to save as many of the wounded as possible.
I went with Bjorn, Jay and Danielle to the hospital this morning. The place looks like a war zone. Families are camped on every available bit of floor space, waiting to see their loved ones. The operating theaters were going all night and more wounded were arriving this morning.
I went to look in on a 13 year old boy who had climbed a tall tree to escape the rioters yesterday, but fell. A neurologist was called this morning, because the boy had bleeding from his ears and came in unconscious. (The neurologist didn’t want to work last night, so he went home.) Thank heaven for the volunteer docs who managed to keep him alive.
He has a major fracture of his femur, a broken wrist and shoulder, and a fractured jaw. The doctors were only able to set the leg and try to stabilized him by manually ventilating him all night. His condition is too precarious right now, so surgery will have to wait. A dentist friend who lives here, Mathew, was able to wire his jaw back together last night, but it didn’t hold. He is on morphine which is reducing some of the pain but definitely not all, as he is writhing around in an attempt to release the restraints holding his arms and legs. Jay was hoping to give him a jaw block this morning to alleviate his suffering.
Both Jay and Danielle brought 3 suitcases full of medical supplies from the States which has been a godsend for those in need. Bjorn is going non-stop, treating as many fractures from gunshot wounds as he can. Most are through and through, although one man wanted to know how to dig a bullet out of his friend where it lodged in a bone.
Everywhere one looks, there are acute cases waiting for treatment – many are lying on the floors, as there aren’t enough gurneys or beds. The Head ER doc told the staff to ignore the rule of not getting x-rays or treating unless the patient could pay. We were so glad to hear this, as the doctor sitting in one of the temporary ICUs told us we couldn’t get an X-ray or scan on the young boy unless his family had the money to cover the procedures!
Being in a place like this really makes one appreciate the U.S. Our problems pale by comparison to these poor third world countries.
Thursday, September 10, 2009
Violent Demonstrations in Downtown Kampala
Violent Demonstrations in Downtown Kampala and Surrounding Areas.Warden Message
Kampala, Uganda
September 10, 2009
The U.S. Embassy in Kampala wishes to advise U.S. citizens that this weekend the leader of the Kingdom of Buganda is planning his annual visit to Kayunga District against the wishes of the central government. The disagreement has resulted in a stand-off which appears to be fueling long-standing grievances between the Kingdom of Buganda and the central government, and between different political factions within the kingdom.
As of the afternoon of September 10th, 2009, violent protests are occurring in downtown Kampala as a result of this situation in Buganda. This message is an advisory to all U.S. citizens to avoid the central and western downtown areas of Kampala including, but not limited to Kampala Road, the Hotel Ecuador, Clock Tower and Kabuye Circle. U.S. citizens should avoid large crowds of people anywhere in the city as protests can materialize quickly and become violent.
The U.S. Peace Corps has withdrawn its volunteers from Kayunga District and U.S. Mission employees have been advised not to travel to the Kayunga District until further notice.
U.S. citizens with questions or concerns may telephone the Consular Section of the U.S. Mission in Kampala at (256) (0) (414) 306 001 or (256) (0) (414) 259 791. In the case of an emergency outside business hours, or during any suspension of public services, U.S. citizens may reach the U.S. Mission duty officer at the same numbers.
U.S. citizens are advised to register and update their contact information with the U.S. Mission in Kampala. The U.S. Embassy is located at Plot 1577 Ggaba Road. The phone number is (256) (0) (414) 306 001 or (256) (0) (414) 259 791, fax (256) (0) (414) 258 451, email: KampalaUSCitizen@state.gov, and U.S. Embassy Kampala website: http://kampala.usembassy.gov .
For the latest security information, citizens living or traveling abroad should regularly monitor the Department’s Bureau of Consular Affairs internet website at: http://travel.state.gov/, where the current Worldwide Caution, Travel Alerts, Travel Warnings, and Country Specific Information can be found. Up-to-date information on security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or, for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8 a.m. to 8 p.m. Eastern Time, Monday through Friday (except U.S. Federal Holidays).
Kampala, Uganda
September 10, 2009
The U.S. Embassy in Kampala wishes to advise U.S. citizens that this weekend the leader of the Kingdom of Buganda is planning his annual visit to Kayunga District against the wishes of the central government. The disagreement has resulted in a stand-off which appears to be fueling long-standing grievances between the Kingdom of Buganda and the central government, and between different political factions within the kingdom.
As of the afternoon of September 10th, 2009, violent protests are occurring in downtown Kampala as a result of this situation in Buganda. This message is an advisory to all U.S. citizens to avoid the central and western downtown areas of Kampala including, but not limited to Kampala Road, the Hotel Ecuador, Clock Tower and Kabuye Circle. U.S. citizens should avoid large crowds of people anywhere in the city as protests can materialize quickly and become violent.
The U.S. Peace Corps has withdrawn its volunteers from Kayunga District and U.S. Mission employees have been advised not to travel to the Kayunga District until further notice.
U.S. citizens with questions or concerns may telephone the Consular Section of the U.S. Mission in Kampala at (256) (0) (414) 306 001 or (256) (0) (414) 259 791. In the case of an emergency outside business hours, or during any suspension of public services, U.S. citizens may reach the U.S. Mission duty officer at the same numbers.
U.S. citizens are advised to register and update their contact information with the U.S. Mission in Kampala. The U.S. Embassy is located at Plot 1577 Ggaba Road. The phone number is (256) (0) (414) 306 001 or (256) (0) (414) 259 791, fax (256) (0) (414) 258 451, email: KampalaUSCitizen@state.gov, and U.S. Embassy Kampala website: http://kampala.usembassy.gov .
For the latest security information, citizens living or traveling abroad should regularly monitor the Department’s Bureau of Consular Affairs internet website at: http://travel.state.gov/, where the current Worldwide Caution, Travel Alerts, Travel Warnings, and Country Specific Information can be found. Up-to-date information on security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or, for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444. These numbers are available from 8 a.m. to 8 p.m. Eastern Time, Monday through Friday (except U.S. Federal Holidays).
Food
An observation….Food: everything that is sold except for fresh produce seems to have partially hydrogenated oils or even fully hydrogenated oils in it! I bought some peanut butter and crackers just to try not to lose any more weight and read the label. For 2 days I ate this but my stomach rebelled - I know that Dr Andrew Weill would be horrified! Prepared food at the guest house and in restaurants is very highly salted, so I’ve learned to request no salt. Have only had vegetables once since I arrived, so I decided to trek to the store today and buy some fresh produce and cook for myself. Thank heaven I bought my vitamins with me! Indian food is very common in Uganda, as there was a large influx of Indians during the British colonial period. Many left during Idi Amin’s rise to power but the cuisine has remained dominant here. Although Uganda is a major exporter of very good coffee, one is usually served Nescafe – OH that these ersatz foods and drinks should cross my lips!! I actually have 2 cups every morning – may the culinary gods forgive my transgressions! An interesting but sad side note is that the coffee production could end in the next 40 years, because of the extremely high rate of carbon emissions and global warming. The locals claim that the weather patterns have already changed.
Wednesday, September 9, 2009
Rounds at Mulago Hospital
Just back from doing rounds in the cardiac/pulmonary unit at the Mulago Hospital with an internist who is here from Boston. I had the time, as I am waiting to hear later today from the faculty reviewing the Psychiatric Healthcare Masters Program I have developed for them.
About the Hospital – wards are simply large rooms with as many beds crowded in as possible. Patients have no privacy – not even a curtain is pulled when doctors and residents round. They do at least separate the men from the women in terms of wards. However, men are in the women’s ward, as family members caring for their relatives. There are a few nurses around, but they don’t seem to do anything. Basically, family and doctors tend to the patients. The doctors even take the vital signs.
The patients are critically ill and would be in an ICU in the States, but that doesn’t exist here. Patients and their families have to buy any medication the doctor prescribes and pay for any lab tests or x-rays, etc. Most can’t afford this, so they die. This explains the average lifespan of early 50’s. For the few who can afford to pay, the medications are nowhere near the gold standard in the US. They use ones that have been around many years and are cheap. Lab tests are not very accurate, nor are procedures. However, they do the best they can with what they’ve got.
There is no hand washing or use of Purcell or an equivalent when moving from one patient to the next. Anesthesia is often ether in the outlying areas or some other outdated one by our standards. There are something like 11 Anesthesiologists in the entire country, so RNs often give it during a procedure.
The man whose jaw was crushed, his lower lip severed and his hard palate split in two as a result of an elephant attack, finally had a six hours surgery yesterday after waiting a week. He had to wait because he could not afford the operation. An NGO outside the capital where this happened, got wind of this and wrote an article in the paper pointing out the government’s neglect in treating someone in such desperate shape. Embarrassed by the negative publicity, the man got his operation. I may have photos for Ralph and Marie when I return, as it’s not for the faint hearted. One of the dental volunteers here photographed the entire operation. Apparently, any of us could have stood around the operating table and observed the entire procedure.
The patients I saw this morning had uncontrolled hypertension, HIV, chronic heart failures, arrhythmias, pneumonia, diabetes and strokes. Most have 5 out of the 7 mentioned. Co-morbidities are commonplace. It was truly a heartbreaking experience, so I left before rounds ended.
I interviewed a nurse who was from Lira in the North where the Lord’s Resistance rebels were. She did a research project last year, interviewing survivors of torture. The detention camps are gone, but she was able to go into peoples’ homes since she was from the area. She spoke with many young women who were kidnapped and raped by the rebels when they were in their early teens. They were held captive by the soldiers and mutilated if they did not respond to questions posed by their captors. If they were accused of not listening, their ears were cutoff. If they gave a wrong answer or no answer at all, their lips were either severed or clamped shut. In spite of reconstructive surgery, they are still very disfigured and consequently isolated. They have no chance to ever marry or lead a somewhat normal life.
The child soldiers either fled into the bush after the head of the rebels was driven out of Uganda into a neighboring country (most likely Sudan or the Congo) or sought help in an effort to reconcile to themselves what they had done with the help of counseling. Most were kidnapped by the rebels when they were 8 to 10 yrs. old and brainwashed and drugged regularly until they were ready to be given a rifle and join the raiding parties. Their initiation usually involved murdering their parents and eating human flesh. Consequently, you can imagine how difficult, if not impossible, it is for these young men to return to “normal.”
Since the detention camps have been closed and the victims dispersed, I won’t be able to interview any of them. However, I am still hoping to go to the Acid Burn Foundation run by another NGO to visit the women there. A few do come into the Mulago Hospital, so I may also have an opportunity to see them here. Since my time is so short, I probably won’t be able to do any kind of therapy. I was hoping to do Narrative Exposure Therapy which is short term, but I would still need several weeks. Not really sure how effective NET would be, since these women are not only scarred on the inside but are disfigured for life. I think group therapy with other burned women would be the most helpful.
Well ,enough for today. This gives you an idea of conditions here. Please keep in mind that Uganda’s medical facilities are considered some of the best in all of Africa.
About the Hospital – wards are simply large rooms with as many beds crowded in as possible. Patients have no privacy – not even a curtain is pulled when doctors and residents round. They do at least separate the men from the women in terms of wards. However, men are in the women’s ward, as family members caring for their relatives. There are a few nurses around, but they don’t seem to do anything. Basically, family and doctors tend to the patients. The doctors even take the vital signs.
The patients are critically ill and would be in an ICU in the States, but that doesn’t exist here. Patients and their families have to buy any medication the doctor prescribes and pay for any lab tests or x-rays, etc. Most can’t afford this, so they die. This explains the average lifespan of early 50’s. For the few who can afford to pay, the medications are nowhere near the gold standard in the US. They use ones that have been around many years and are cheap. Lab tests are not very accurate, nor are procedures. However, they do the best they can with what they’ve got.
There is no hand washing or use of Purcell or an equivalent when moving from one patient to the next. Anesthesia is often ether in the outlying areas or some other outdated one by our standards. There are something like 11 Anesthesiologists in the entire country, so RNs often give it during a procedure.
The man whose jaw was crushed, his lower lip severed and his hard palate split in two as a result of an elephant attack, finally had a six hours surgery yesterday after waiting a week. He had to wait because he could not afford the operation. An NGO outside the capital where this happened, got wind of this and wrote an article in the paper pointing out the government’s neglect in treating someone in such desperate shape. Embarrassed by the negative publicity, the man got his operation. I may have photos for Ralph and Marie when I return, as it’s not for the faint hearted. One of the dental volunteers here photographed the entire operation. Apparently, any of us could have stood around the operating table and observed the entire procedure.
The patients I saw this morning had uncontrolled hypertension, HIV, chronic heart failures, arrhythmias, pneumonia, diabetes and strokes. Most have 5 out of the 7 mentioned. Co-morbidities are commonplace. It was truly a heartbreaking experience, so I left before rounds ended.
I interviewed a nurse who was from Lira in the North where the Lord’s Resistance rebels were. She did a research project last year, interviewing survivors of torture. The detention camps are gone, but she was able to go into peoples’ homes since she was from the area. She spoke with many young women who were kidnapped and raped by the rebels when they were in their early teens. They were held captive by the soldiers and mutilated if they did not respond to questions posed by their captors. If they were accused of not listening, their ears were cutoff. If they gave a wrong answer or no answer at all, their lips were either severed or clamped shut. In spite of reconstructive surgery, they are still very disfigured and consequently isolated. They have no chance to ever marry or lead a somewhat normal life.
The child soldiers either fled into the bush after the head of the rebels was driven out of Uganda into a neighboring country (most likely Sudan or the Congo) or sought help in an effort to reconcile to themselves what they had done with the help of counseling. Most were kidnapped by the rebels when they were 8 to 10 yrs. old and brainwashed and drugged regularly until they were ready to be given a rifle and join the raiding parties. Their initiation usually involved murdering their parents and eating human flesh. Consequently, you can imagine how difficult, if not impossible, it is for these young men to return to “normal.”
Since the detention camps have been closed and the victims dispersed, I won’t be able to interview any of them. However, I am still hoping to go to the Acid Burn Foundation run by another NGO to visit the women there. A few do come into the Mulago Hospital, so I may also have an opportunity to see them here. Since my time is so short, I probably won’t be able to do any kind of therapy. I was hoping to do Narrative Exposure Therapy which is short term, but I would still need several weeks. Not really sure how effective NET would be, since these women are not only scarred on the inside but are disfigured for life. I think group therapy with other burned women would be the most helpful.
Well ,enough for today. This gives you an idea of conditions here. Please keep in mind that Uganda’s medical facilities are considered some of the best in all of Africa.
Monday, September 7, 2009
very little internet access!
Just a quick entry as I'm using the computer in someone's office at the medical school. I was supposed to start working today, but my contact person is no longer here. Consequently, I am waiting to meet the new director and the others with whom I shall be working. All the volunteers are finding a need to make themselves useful without much if any direction. Hospital conditions are very primitive and access to healthcare scant at best. On the bright side, people are very friendly and polite.
I am hoping to meet someone who did a research project up north on the trauma victims of the Lord's Resistance Rebels (child sholdiers and kidnapped young girls. If I can, I shall try to find a way to travel north and interview some survivors. Will keep you posted...
I will cut and paste an entry I wrote on word some other time, when I have access to my own computer and the internet. It describes the 2 day journey to get here and first impressions.
I am hoping to meet someone who did a research project up north on the trauma victims of the Lord's Resistance Rebels (child sholdiers and kidnapped young girls. If I can, I shall try to find a way to travel north and interview some survivors. Will keep you posted...
I will cut and paste an entry I wrote on word some other time, when I have access to my own computer and the internet. It describes the 2 day journey to get here and first impressions.
Saturday, September 5, 2009
Hello From Uganda
Hello from Uganda! After surviving my numerous flights to get here, I arrived on Friday. The 12 seat adjustments one is able to make when flying business class (thank heaven for miles) on American almost did me in! I never knew I could contort my body into too so many different positions on a plane – from knees pressed against my chest to being flatten and propelled under the seat in front of me.
The trick I learned after my “workout” was not to push the buttons too fast! Unfortunately, I learned this after my seat mate tried to pass in front of me to get out. He got one leg over me when I decided to make things easier for him by completely lowering my leg and foot rest. The next thing I know I am raising him off the floor as my legs shoot up! Luckily, he was of slight build, leaving the seat and the two of us intact, as I lowered him enough so he could extricate himself from straddling my legs. Oh my, that sounds all wrong!
On to the reason for this blog: my experience in Uganda…. We flew in over an incredibly verdant hilly landscape partially shrouded in a low hanging mist. Truly beautiful! I was met at the airport by a driver sent by Health Volunteers Overseas. Thank goodness Jared was an excellent driver, as I’ve never seen such horrific and chaotic driving in my life! The trip to Mulago Hospital and my accommodations took about an hour. For the most part, the roads are just two lanes with drivers crossing over into oncoming traffic more often than not. Autos spewing out clouds of pollutions, motorbikes (botas)
weaving in and out, bicycles vying for a place on the road and pedestrians risking their lives walking along the sides does not adequately describe the situation. The accident rate is very high with 3 deaths in the 2 days I’ve been here. Pedestrians do not have the right of way and law enforcement seems completely ineffectual in maintaining any semblance of order. Hit and runs are commonplace and pedestrians have no recourse if they are injured nor do their families if there is a death. Of course, helmets are unheard of here. I’m sure I’ll hear a lot more stories involving accidents when the orthopedic surgeon who is here for 2 weeks returns from a camping trip to Lake Victoria.
Aside from the traffic, Kampala is a very safe city. There is little theft, so I feel perfectly safe walking about with a small shoulder bag –no need to wear a money belt under my clothes. The locals are very friendly and polite and most seem to understand and speak at least a little English. Swahili used to be the second language, with English being the first for the educated, but now it is Luganda. Most residents of the capital are quite soft spoken and have a hint of a lovely British accent.
The help at the Mulago Guest where I am staying couldn’t be nicer and more accommodating. Meals are provided for a small fee or one can eat out or bring groceries in. We have to buy our own water which means frequent rides to the market. I bought a large thermos, so I could boil water and keep it in my room for washing utensils I purchased or to drink in a pinch. All the volunteers have brought a supply of cipro in the event of stomach upset from eating anything which has been contaminated by the local water or any other source……
9/5/09
The trick I learned after my “workout” was not to push the buttons too fast! Unfortunately, I learned this after my seat mate tried to pass in front of me to get out. He got one leg over me when I decided to make things easier for him by completely lowering my leg and foot rest. The next thing I know I am raising him off the floor as my legs shoot up! Luckily, he was of slight build, leaving the seat and the two of us intact, as I lowered him enough so he could extricate himself from straddling my legs. Oh my, that sounds all wrong!
On to the reason for this blog: my experience in Uganda…. We flew in over an incredibly verdant hilly landscape partially shrouded in a low hanging mist. Truly beautiful! I was met at the airport by a driver sent by Health Volunteers Overseas. Thank goodness Jared was an excellent driver, as I’ve never seen such horrific and chaotic driving in my life! The trip to Mulago Hospital and my accommodations took about an hour. For the most part, the roads are just two lanes with drivers crossing over into oncoming traffic more often than not. Autos spewing out clouds of pollutions, motorbikes (botas)
weaving in and out, bicycles vying for a place on the road and pedestrians risking their lives walking along the sides does not adequately describe the situation. The accident rate is very high with 3 deaths in the 2 days I’ve been here. Pedestrians do not have the right of way and law enforcement seems completely ineffectual in maintaining any semblance of order. Hit and runs are commonplace and pedestrians have no recourse if they are injured nor do their families if there is a death. Of course, helmets are unheard of here. I’m sure I’ll hear a lot more stories involving accidents when the orthopedic surgeon who is here for 2 weeks returns from a camping trip to Lake Victoria.
Aside from the traffic, Kampala is a very safe city. There is little theft, so I feel perfectly safe walking about with a small shoulder bag –no need to wear a money belt under my clothes. The locals are very friendly and polite and most seem to understand and speak at least a little English. Swahili used to be the second language, with English being the first for the educated, but now it is Luganda. Most residents of the capital are quite soft spoken and have a hint of a lovely British accent.
The help at the Mulago Guest where I am staying couldn’t be nicer and more accommodating. Meals are provided for a small fee or one can eat out or bring groceries in. We have to buy our own water which means frequent rides to the market. I bought a large thermos, so I could boil water and keep it in my room for washing utensils I purchased or to drink in a pinch. All the volunteers have brought a supply of cipro in the event of stomach upset from eating anything which has been contaminated by the local water or any other source……
9/5/09
Tuesday, September 1, 2009
count down to departure
This time tomorrow, I shall be at SFO ready to board my flight to NY and then on to London and Entebbe. In the meantime, soooooooooo many last minute details to wrap up!
Just wanted to touch base to make sure I knew how to use this blog and promise that future entries will be more interesting than this! Next one for Kampala...Nancy
Just wanted to touch base to make sure I knew how to use this blog and promise that future entries will be more interesting than this! Next one for Kampala...Nancy
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