36 Hours in Gulu

Top: walking Gulu’s streets.  Middle row from left:  Matt biking home with mortar and pestle to make falafel without power, Kiran welcomes us, Gulu town center.  Bottom row from left: TAKS center, Uchumi, GHSP Uganda.

Sure, Gulu is most famous for atrocity.  The name conjures images of oppression and violence dating back for generations.  Acholi people of northern Uganda were targets under Idi Amin, and suffered unthinkable devastation in the late 1990’s and early 2000’s during the civil war with Joseph Kony’s Lord’s Resistance Army (LRA).  But it’s not all child soldiers and human rights violations.  The economic center of northern Uganda, Gulu is a town of about 150,000 and growing.  Go beyond the dusty streets and countless non-governmental organizations trying to save the world by crochet, and you’ll find food, fashion, and friends await you.

Friday

7 p.m. 

1) JUST IN TIME FOR DARK

Arrive at dusk after nearly 12 hours of dodging buses on eroded roads in a thunderstorm.  The clouds part just in time for nightfall and we are greeted by our good friends Matt and Kiran at their house on the edge of town.  No power.  Tepid showers.  Feisty puppy named Tibs (like the Ethiopian meat) they are dog sitting.  It feels like a real home with an equally homey welcome.

8 p.m.

2) GOOD EATS

Settle into a couch or communal table at Abyssinia Ethiopian Restaurant in Gulu Town.  Not to be confused with the Abyssinia Ethiopian Restaurant in Indianapolis (71 reviews on Yelp, 4.5 stars), but equally renowned with the locals.  Having just been to Ethiopia, we can tell you that this is the real deal.  OK, so there is no teff in Uganda, but the injera makes up for in texture what it lacks in sour fermentation, the tibs and shiro are top notch, and they have an excellent boxed wine selection.

10 p.m.

3) MILK & COOKIES

Return home to finish the night with chocolate brownies made from Ghiradelli chips straight from the US of A.

Saturday

8 a.m.

4) WORKING BREAKFAST

Still no power.  Crepes by Matt on the gas cooker and an automatic drip with Starbucks French Roast used as a big pour-over.  Matt offers choices, and we take an everything crepe with caramelized onions, sun-dried tomatoes, sautéed mushrooms, cheese, and avocado.  We meet in the living room with two Peace Corps coordinators to discuss the coming transition, hand-off to the next group of volunteers, and improvements for pre-service training (that’s orientation for anyone not familiar with the unnecessary world of development lingo).

11 a.m.

5) PRACTICE YOUR BANDHAS & ALIGN YOUR CHAKRAS

Break the meeting for yoga class.  Yes, yoga.  In Gulu.  Brought to town by Mandala House (www.mandalahouse.org, 6,000 Ush per class), an NGO bringing yoga to post-conflict northern Uganda.  There was a Ugandan instructor there when we arrived, but he left and five muzungus remained with our muzungu instructor.  There was incense, Mumford and Sons played on a MacBook Air, inspiring poetry about seizing the moment, lavender on your upper lip, and a Namaste at the end.  It felt awesome.  Ideally would have been followed by an iced latte from the Coffee Hut but there wasn’t time nor was there ice (website doesn’t work, but 499 likes on Facebook).

12:30 p.m.

6) WORKING LUNCH

Pick up candles (still no power) and parsley at the Indian grocer, then swing by Sankofa Café (website also doesn’t work, 590 likes on Facebook and 4 stars on TripAdvisor) for phenomenal thin-crust pizzas with interesting toppings like BBQ mushroom.  Bang out the rest of the work, email deliverables, and change for an afternoon on the town.

4 p.m.

7) LOCAL LIFE

Stroll through an Acholi village outside Gulu town.  Flat earth.  Dust.  Round turkul thatched roof homes.  Expansive bright blue sky with a ceiling of fluffy clouds that look perfectly flat on the bottom, like a collection of all the foam sliced from all the Guinness served at bars everywhere.  Excited children slapping their knees and two-handed waving at the gaggle of muzungu walking by.  These are a resilient people with bright smiles and a dark past.

5 p.m.

8) ART, MUSIC, BEER

Catch the tail end of the fashion show at the TAKS center (Through Art Keep Smiling, online at takscentre.blogspot.com), a restaurant, art gallery, and internet café, whose mission is “to engage the people of Northern Uganda in the creative Arts so that they can reaffirm the richness of their culture, reassert their humanity…”  Watch the tall and dark Acholi men and women strut their stuff in bright outfits that meld tradition and modern.  Take in the fashions of the local youth in hipster getups that would shame any Mission denizen.  Or watch the madras pant-wearing dreadlocked white guys that look more Dolores Park (you know, the 20^th and Dolores side with the slack rope walkers and hoola hoopers) than Gulu as they dance behind the crowd.  They probably got the pants while backpacking through Madras.  After the show, listen to live music in the gardens, then peruse the local handicrafts and take in the graffiti art celebrating black icons from Mandela to Marley, all with a local sorghum beer, Eagle Dark (1,500 Ush), in hand.

7 p.m. 

9) A LITTLE SHOPPING, JUST IN TIME FOR DARK

Walk through the little market (not to be confused with the main market) and purchase local fabrics using your flashlight app in the dark stalls as daylight quickly wanes.  Pick up any last minute needs at Uchumi, the Kenyan chain supermarket that carries such amenities as flavored vodka and salsa from San Francisco.  Arrive home in the dark.

8:30 p.m.

10) Power!

10 p.m.

11) FAMILY DINNER

Sit down to an incredible team cooked Mediterranean meal from scratch, complete with Baklava and lycheetinis for dessert.  Enjoy a single malt Scotch and conversation under a dome of stars around a backyard bonfire until the rains suddenly return.  Consider going to BJ’s bar and nightclub, then realize that it is already after 1 a.m., that it is dark and raining, and that we are no longer in our twenties.

Sunday 

7 a.m.

12) THE LONG RIDE HOME

Breakfast burritos and scones for breakfast, then hit the road for upwards of 10 hours back to Mbarara.  Buy your week’s groceries from roadside markets, and watch for zebras on the way.

Guest Blog Part Three: On Coordination.

Kelly’s brother Joe visited last month and made some observations.  Here is his guest blog:

On many occasions I have joked with my global health friends that I want to start an NGO called something fancy like Global Coordination Partners (GCP for short, of course).  The mission of GCP would be simply to coordinate the activities of do-gooders (NGOs, universities, hospitals, church groups, volunteer organizations, etc.) from around the world in effort to reduce redundancy in their work, minimize the strain to the local health system, emphasize the importance of communication and the sharing of resources, and, ultimately, to improve everyone’s efficiency and the positive impact made on humanity.  Simple idea, right?  I think so.  Boring concept?  Perhaps.  Every time I return from the developing world, however, I am struck by how little organizations coordinate with one another, learn from shared experiences, and plan to work collaboratively (or at least compare notes) to improve their impact.  As I recently traveled through Africa for work and to visit Kelly and Ari, I couldn’t help but think: maybe it’s time for someone to make GCP a reality.

As Kelly and Ari have eloquently pointed out in their blog, the need for improved health services in their region of the world is huge.  In public hospitals in the capitals of Malawi, Zambia, and Rwanda where I travel for work, patients fill the wards to the brim, children sleep two and three to a hospital bed, medication runs out or doesn’t exist at all, people die from curable conditions, and the local human resources for health are stretched thin to say the least.  I knew from Kelly and Ari that the same grim reality existed in their hospital, and I saw it first had while I was there.  While the need is tremendous, what is also tremendous is the desire of people and organizations from around the world to do what they can to improve this situation.

Well-meaning organizations can be found in Sub-Saharan Africa doing their part to support the health system, to research ways to better prevent disease, and to care for the sick.  To be sure, it is heartening that there are so many people who are interested in doing their part to help.  But it is endlessly frustrating to see how few of these individuals put in an effort to coordinate with their peer organizations or local partners to make their work more efficient.  I fundamentally believe that failure to coordinate across organizations and with local partners significantly reduces the amount of good that can be done.  How?  Two unrelated organizations send teams of surgeons to the same hospital during the same week to care for patients.  Since the hospital has one operating room, the teams are forced to switch off using the room and therefore reduce the number of patients they see by half.  Researchers from universities travel to the developing world to conduct important research using high tech medical devices, but they refuse to let local doctors use the devices on the patients who desperately need them.  Two donors decide independently to donate machine X to the hospital.  Now the hospital has 2 machine X’s while what it really needed was machine Y, but no one thought to ask.

Unlike many of the poverty-fueled, system-wide problems that Kelly and Ari see everyday in their hospital such as lack of medication, electricity, and specialists, most of these coordination problems (which they also see everyday in their hospital) could be fixed relatively simply.  Sure, the aid industry can sometimes behave like a business and compete for territory and finite resources, but, really, the market is big enough for everyone.  In Mbarara and throughout much of the world, there is plenty of good yet to be done.

I’d like to imagine a coordinated world.  A world in which do-gooders compete not over the same territory but to find the regions of the world that get the least attention.  A world in which problems are tackled through partnering and activities are coordinated by a central, local organization.  A world in which the need is carefully mapped and do-gooders discuss with each other and with local partners who needs what and who can best help.

An organization dedicated to coordination is hardly a sexy investment.  But, as Kelly, Ari, and I discussed the number of universities and organizations cycling in and out of Mbarara each month doing important but isolated work, I couldn’t help but think that with a bit of coordination and a unified effort, so much more could be done.  So much more care could be provided to Ugandans in need.  So many more local medical personnel could be appropriately trained.  And so much more good could be done in this world.

Christmas in March

Divine Mercy Baby’s Home is an orphanage here in Mbarara that provides a home for over 70 children, newborn to 12 years old. The stories of how these children end up in this home tug at your heartstrings and bring tears to your eyes.  One four-year-old boy was left in a gas station in a plastic bag with the placenta and umbilical cord still attached to his barely breathing body. Another little girl entered the home a sick, HIV positive, emaciated infant after she was abandoned in the hospital because her mother died of AIDS. These children have tragic stories, but they have found a relatively soft place to land at the Baby’s Home.  The 4-year-old boy is now healthy, always full of smiles and laughter.  The little girl is now extremely well nourished (fat even!), with her HIV well controlled on medications.  These are normal kids with unfortunate histories.  They are cared for by a rotating group of caregivers who provide for them the best they can.  But there are so many children (over 70 with the majority of them newborns- four years old) and not enough caregivers to go around. Their basic needs are definitely well attended to—they have enough to eat, they have a place to sleep, they are given medical care when they get sick—but there aren’t enough bodies to hold, hug, snuggle and play with the children as much as they need and deserve.

So, we try to help out a little. Kelly’s family every Christmas donates money to a charity in lieu of gift giving.  This year they chose the Baby’s Home (thank you Kelly family!). Other family friends (thank you Ritchie’s, Seberts, and bird watchers!) also raised money for the Home.  With a portion of this money, we decided to throw the children a Christmas party, giving them a day of pure joy and fun.  Supplies from the States were schlepped over by friends from Boston (thank you Noortje and MGH people!) and a few months after Christmas we had our party.  With baby pools, bath toys, balloons, beach balls, bubbles, music, arts and crafts, it was a party to remember.  Laughter, smiles, and screams of joy permeated the air throughout the day.  The kids pounded on makeshift drums, squirted each other with water, made headbands out of balloons, and finger painted to their heart’s content.  They were free to be kids, and were surrounded by 10 adults who were there just to hug, hold, and play with them.

It doesn’t take much to spread a little joy.  All it takes to bring Christmas to March is few minutes, a few dollars, a few hugs, and a lot of love.

Babel

Yes, this is the title of a movie with Brad Pitt.  Yes, there is a biblical reference to the unlimited potential of people if they were to speak one common language, their tower reaching to the heavens.  More than fifty languages are spoken in this small country the size of Oregon.  Drive 150 kilometers to Kasese (about the distance from San Francisco to Sacramento) and people won’t understand you.  Swahili, the language intended to unite east Africa, was declared a national language of Uganda in 2005, as part of the proposed union with Burundi, Rwanda, Kenya, and Tanzania as the East African Federation.  Despite the talk, few here speak Swahili.  The story goes that Swahili was the language of Idi Amin, and therefore the language of atrocity.  It carries a visceral negativity to this day.  English, the imposed colonial language, is what unites.  But the British in their great imperial wisdom intended English to serve as a language only of the highly educated and top leadership, so the educational system was designed with English starting in secondary school.  One in five Ugandans makes it to secondary school.  Odds are high that your local language will get you around town better than English.  Our University students, who study biochemistry in English, are a very small minority. Despite the supposed unifying force of the official national tongue, Uganda remains partitioned by language barriers.

This makes for some serious challenges.  Move from Gulu to Mbarara for a graduate degree, and your classes may be in English, but your patients and townspeople will speak Runyankore. Many of the Bantu languages are similar, some really just dialects, spoken with different accents and word choices, like an American and a Brit conversing.  Others are like Spanish and Italian—you can understand the gist but may not be able to formulate much of a response.  Then there are languages of completely different origins, crossing arbitrary lines drawn onto the continent by Europeans over a century ago.  Some are tonal. Many have a lengthy oral tradition with only a brief written history, meaning that spelling is variable.  For us, the most obvious effect is on patient care.  Congolese refugees are referred to our hospital from the camp down the road and we all struggle to figure out what exactly is going on.  Aside from the very real and very dangerous implications of language barriers in medicine, it often seems like the babble keeps things superficial.  Greetings and niceties abound, but it can be difficult to articulate gravity and nuance.  How do the people stand as one nation when they can’t communicate?

But it also makes for some entertaining wordplay.  Our Ugandan language instructors taught us “Ugandlish” during Peace Corps orientation.  There are some basics like saying “I will pick you from work” instead of “pick you up.”  Pick is also used for phone calls, as in “I tried calling, but he didn’t pick.”  And if you don’t pick, or you haven’t been seen in a while, then “you are lost.”  Then there is the extra s added to emphasize the plurality of already plural words like food.  For example, “these foods are nice.”  On the subject of food, the word food actually means starch.  When entering a restaurant, you might ask a server what foods they have, and learn that the options are matoke (steamed and mashed unripe banana), posho (a brick of cornmeal), Irish (white potatoes), kalo (a brick of millet meal), rice, chapatti, sweet potato, or cassava.  These are foods.  What tops them—maybe a goat stew—is the sauce.  In our part of Uganda, matoke is food.  You have not had a meal without it.

Word choice always seems to downplay any possible enthusiasm.  A great compliment from a student would be “somehow that was a nice lecture” or “your talk was a bit interesting.”  A bit means a lot, and somehow is added to about half of all sentences. Given the circumstances, qualifying life’s victories with somehow does make some sense.  Ask a Ugandan how they are doing today, and the answer is likely to be “fair,” or “somehow, we are very okay.”  Unlike the Californian response that everything is excellent, people here are hesitant to overstate the positive.  The most challenging and entertaining mix of language comes with directions.  There is not a road sign or map in Mbarara, so you either know the place or you don’t.  But instead of landmarks, most directions go something like, “slope there, shift the other side, and it is somewhere there.”  In Mbarara, you are either this side or the other side.

Spelling and pronunciation are other steady sources of hilarity as an expat.  The spelling is mostly a result of British influence, with all the superfluous vowels like oedema, oesophagus, and aetiology.  Some pronunciation is just more literal, like jueece (juice), and clothe-es (clothes).  Like many people who learn English, Rs and Ls are often switched.  Runyankore is pronounced “Runyankole” and we recently heard a hit song called Dance Froor.

It can all be a bit confusing at times, but we find ways to connect and reach skyward together.

Somehow.

Love from this side to the other,

Kerry and Ali

Photoblog Part Five: Visitors

February was a month of visitors from home–Ari’s dad and step-mom, Ari’s high school friend Lisa and her boyfriend Kevin, and Kelly’s brother Joe.  Here are some highlights:

Bwindi Impenetrable Forest National Park, home to half the world’s endangered mountain gorillas.

Dad brought the serious camera gear.

We were surrounded by our hairy cousins, and very close. This one touched dad just after this picture!

Silverback up close

Our awesome lodge in the rainforest.

We made our way to Lake Bunyonyi from Bwindi. This is the view from our balcony.

Crested Cranes

Bwama Island Primary school

Nine holes of golf in Mbarara.

Our caddy is a high school student at Mbarara High.

Our last night together in Lake Mburo.

Relaxing outside their safari tent.

Zebras!

And back to Lake Bunyonyi with Lisa and Kevin.

Waking up in an open air geodome overlooking the lake.

We lasted about thirty seconds in this dugout canoe before being called back to shore for a motor boat. Those things tip easy.

Bunyonyi from above.

Mbarara Central Market

Our local Rolex (omlette wrapped in chapati) guy.

Baby’s Home

Lisa and Kevin flew out the same day Joe arrived!

Meet Joe brunch at our place.

Ugandan food in Fort Portal.

Hiking the Rwenzori Mountains

Joe met an Ankole cow…

…and conquered the mountain

Guest Blog Part Two: Roads, An African Massage

Our dear friends Lisa and Kevin flew to visit this week.  We spent the weekend at Lake Bunyonyi, then they continued on to Bwindi and Queen Elizabeth before returning for a glimpse of our life in Mbarara.  We talked a lot about infrastructure, and in particular about roads.  On one of the last episodes of West Wing, White House Chief of Staff CJ Cregg is offered a job at a charitable foundation.  The fictitious billionaire founder asks CJ what single problem he should tackle with $10 billion.  She responds, “highways,” and explains, “nine out of ten African aid projects fail because the medicine or the personnel can’t get to the people in need.”  It may be television, but there is some data behind it.  The World Bank released a report in 2006 called Rural Access Index: A Key Development Indicator.  The RAI is the proportion of a population that lives within two kilometers of an “all-season” road.  Briefly, the report shows that over one billion people lack reliable transportation (98% in developing nations), many of them spending an average of up to 50 hours per week on movement.  This isolation has far reaching effects on economic growth, health, and development.

Here is Lisa’s reflection on travel in Uganda:

The toddlers running solo on the side of the road seem unnoticed by our driver who barrels around curves and potholes on a backcountry unpaved short cut.  He calls it our “African massage.” We are driving 5 hours from Entebbe, Uganda’s only international airport, where our landing strip paralleled a dirt road with people riding bicycles, to visit Ari and Kelly in Mbarara.

The road constantly reminds me that I am far from the familiarity of home.  In the states, I am confident behind the wheel, but transportation here is a live wire of potential accidents (and I am sure I would cause many).  My driving would completely disturb the ecosystem of the road, yet Ugandans manage with incredible ease, adhering to a chaotic system of unwritten rules.  After the careening car has passed the fourth group of toddlers at unnerving closeness, I chuckle and realize that everything is as it is and I might as well enjoy my African massage.

The tolerance for chaos is high, or maybe it is just an understanding from birth that if something is bigger than you and rapidly approaching, you move out of the way. Lanes are a suggestion, speed limits determined by how fast you can go, reflectors are missing, and signs are few and far between, only the posts remaining after the metal has been stolen for more practical use like roofing.  Honking maintains the hierarchy, as if to say, “I am behind you, I am bigger than you, and I will pass you, most likely with only an inch or two between us, and I suggest you move over.”  You don’t have to yield, but you do have to get comfortable being really close.

I am excited as we turn onto a paved road. The ride gets smoother and the honk gets longer as a larger car on the other side speeds toward us while we pass a motorcycle loaded with five grown men.  We are the sandwich meat of many high-speed passing fests.  Humans and machines coexist in frightening proximity.  We continuously disturb the steady walking traffic, dodge nearly 500 people gathered for a funeral, and aggressively pass slow moving trucks that I can’t believe are even on these roads.  I take a deep breath and am reminded, this is Africa.

The boda bodas (motorcycles) are heavily laden with people of all ages—even babies—without helmets, some of them drinking a beer.  Cars, taxis, vans and trucks around us are overflowing with travelers, goods, and animals.  Gas is expensive and the desire and need to get places exists here as much as any other place. I feel equally comforted by the space I have in the car I hired to personally drive me and my boyfriend, as well as pressed with discomfort at my economic privilege to have such a luxury.

We arrive safely in Mbarara in record time. Ari and Kelly are astonished at how quickly we made the journey, and I laugh as I recall nearly killing 17 children, a man loading copious bananas on his bicycle, a handful of boda drivers, that woman with a stack of two-by-fours on her head and a baby strapped to her back, and some cows, all in the name of a short cut.

Roads are the pathway to our experience in Uganda. Uganda is merely the size of Oregon, yet it can take several hours to travel roughly 15 miles, depending on the road.  I had no idea I would become so invested in the road portion of my travels.  As we drove from Mbarara to Lake Bunyonyi—called the “lovelist lake in Africa”—Kelly said, “I have never appreciated the quality of a road so much in my life.” I am quickly following in her footsteps.

I am equally shocked and fascinated at the road construction we weave through on our way.  Many roads in Uganda are in progress, but open for business.  People don’t even really pause unless you find yourself within five feet from a giant backhoe digging red earth from the hillside with a Mack truck actually obstructing your path.  Then you wait for the truck to fill, and follow it through the developing road.  At one point, we narrowly squeezed passed a moving steamroller, bumping over loose gravel on what by American standards would be a shut down road. Strong tires are all too important, and I am thankful for our Toyota 4Runner.  Although, as we bob and weave up and down the outlying mountains leading us to Bwindi Impenetrable Forest, shocks could make all the difference.

I wonder what a Ugandan would think of my experience. I assuredly would be laughed at.  But at the same time, what could a completed, paved, dependable road system do for a country like Uganda? How much faster could a sick patient get to the hospital where Ari and Kelly work? How many less head and body injuries would there be from boda boda accidents? Would more tourists come to provide economic growth to the community? How many communities could be unified to work together to strengthen their country? However, roads are in development, and it is truly a miracle in some places that there are roads at all. And I have to admit, there is rawness to the experience that I appreciate all to well; I am thankful for the remoteness, the perspective and the joy of my African massage.

Leila’s Story

Six months ago, we visited a primary school on Bwama Island, in the middle of Lake Bunyonyi.  The lake is a flooded river valley surrounded by the mountains that separate Uganda from the Democratic Republic of Congo and Rwanda.  It is truly a magical place, where morning mist gives way to tropical sun and constantly shifting skies revealing layers of mountain ridges.  Bunyonyi means “place of many little birds” and it is studded with small islands that are home to hundreds of songbirds.  It is also an isolated place.  The closest town big enough to make note on a map is over a mountain ridge on a dirt road.  Kids commute to primary school from the many islands surrounding Bwama on dugout canoes made from eucalyptus trees.  Some even swim across the narrow channel from the mainland.  The island used to be a leper colony started in the 1930s, and the population grew enough to necessitate a school.  It is now a government run school with about 180 students.  The stark contrast between the underfunded school and the lush surroundings made for great photographs, which we posted on our first photoblog.

Leila, our six-year-old niece, was completely taken by these photos. Ari’s sister Megan, Leila’s mom, emailed us the following about her reaction:

“The photos you sent last month made a huge impression on Leila.  In particular, she’s brought up the school several times, and we’ve talked a lot about how kids in Uganda and many other countries do not have as many educational resources as we do here…”

And Leila was right. Education does not come easy to the majority of Ugandan children.  According to UNICEF, only 32% attend through the end of primary school.  Less than two-thirds of those continue to secondary school.  Fewer than 10% of all Ugandans continue beyond high school.  And for those who actually make it to school, their education is often compromised by lack of funding from the government.  Classroom supplies are scarce; chalkboards are eroded and stained; desks are falling apart.  Twice this school year, the teachers at Mbarara public schools went so long without pay that they felt no choice but to strike.  Aaron, the second grade teacher who lives on the island, explained to us that many kids arrive without any food or water, and they struggle to keep them fed and hydrated.  The children show up ready and excited to learn, but due to lack of funding, that simple task is all too often unattainable.

Leila, a first grader, didn’t think this was right. Megan writes:

“At the end of our last talk about this, Leila said it made her sad to think that the students don’t have everything that she has, and she asked if we could send them a box of school supplies.  I said I thought it was a great idea.  And now, Leila’s Daisy troop (Girl Scouts) wants to contribute to the school supplies too.  This means we will have 10 families collecting supplies to send along to a school there.”

And that Daisy troop contributed.  Pens, crayons, pencils, chalk, and art supplies were packed into a heavy suitcase and carried across the world by Bill and Teresa, Ari’s parents.  That suitcase travelled to Amsterdam, Tanzania, and finally Uganda.  We returned to Lake Bunyoni, motored back to Bwama Island, and hand-delivered the suitcase to the primary school headmaster.  Students, in their tattered uniforms, stood in their stark classrooms and sang to us with all the English they know.  They used their brand new writing utensils to draw beautiful pictures that they displayed proudly with huge smiles.  We signed the donation log in Leila’s name.

The barriers to education are still great, but sometimes the solutions to big problems start small.  Sometimes it can be simple.  A student doesn’t have a pen and paper to write their ABCs.  So you give them a pen and a paper and they engage in that lesson and learn the alphabet.  The ABCs lead to reading and writing competency, which enable them to perform well in primary school, and enroll and succeed in secondary school.  At least for now, the child who swims to school will have a dry pad of paper from a little girl in California awaiting her at her bench.  And maybe, just maybe, she believes in herself a little more.  And one day she will demand better for her children, for her people.  Sometimes it really can be a simple act that leads to great big consequences.  Leila, with insight well beyond her years, saw just that.

Ups & Downs

We returned to Uganda after vacationing in Ethiopia, and we found ourselves feeling a bit, well…overwhelmed, frustrated, even despaired.  Just two weeks away and suddenly all the bad stuff, that maybe we hadn’t seen before, or had become used to dealing with, seemed highlighted. The wards emptied out over Christmas, then filled to twice capacity in January.  People may have waited until the New Year to seek medical care, but their illnesses did not.  They came in droves, flooding the ER with the sensory experience of sickness: moans of pain and rattling coughs, smells of incontinence and digested blood in stool, the feel of thready pulses and matted lymph nodes, and the sight of an empty plastic bottle on a rusty IV pole in front of a dingy powder blue curtain, bright in the window-shaped beam of sunlight in an otherwise powerless room.

The enormity of the challenges and the depth of the problems seemed clearer after a break.  No organized primary care infrastructure to prevent the badness, no open ICU beds or money to pay the bill for the ICU even if there are beds, no oxygen, no blood in the blood bank.  One patient coughs tuberculosis on her neighbor, whose immune system has been wiped out by HIV and all we can do is offer a mask.  Inefficiencies and tragedies abound.

The University’s master timetable, which dictates the class schedule of over 500 medical, nursing, and pharmacy students was not published until halfway through the first week of class.  Students wandered aimlessly around campus, looking for the professors that are supposed to be teaching them the courses they have paid for. But the professors haven’t shown up because the timetable is not yet out; or those who have shown up don’t seem to be concerned about the lack of organization.

The power is worse than usual and stays off long enough to let the food spoil, but the electricity prices have gone up again, and people resort to robbery in order to pay their bills.  The interns go on strike because they haven’t been paid in two months and no longer have enough to eat, and we find out about a man who has been stealing crucial medications from our public hospital stores to sell them at a profit in a private clinic in town.  Ari broke a bottle of vodka in the Kenyan owned supermarket.  A simple accident, the cart hitting the bottom shelf, but when a worker was informed his face went sullen, knowing that he would be charged the cost of the bottle.  We paid at the register, reminded of how thin a margin this whole place works on.

We witnessed a horrendous accident on the extremely busy Kampala-Mbarara road.  A 12-year-old girl was struck by a fast-moving car as she tried to cross the street.  We saw her fly 15-feet in the air, landing on the other side of the road.  The worst thing we have witnessed. Ever.  We ran to assess her, and found, shockingly, she still had a pulse and was moving her arms and legs.  We pulled tissue paper from our bags, the only thing we could find, and applied pressure to her bleeding head wound, and helped the family load her into a car.  There was no 911 to call, no paramedics to stabilize her spine and provide emergency care, no police to question the driver.  Not even cell phone service IF those things were actually available.  There was only an extremely sick little girl and a wailing mother on their way to a hospital which likely does not have a CT scanner or a neurosurgeon to actually assess and treat her severe injuries.  We are shocked, saddened, and disheartened as we watch the car speed away from us, left only with the questions and doubts in our heads.  We did what we could, didn’t we? What more could we have done from the dusty side of the road?

With less than six months left it feels like working non-stop would be a drop in the bucket.  And it would.  Problems are easy to identify, but solutions?  That’s another story.  But, slowly slowly, the dust begins to settle on our re-entry and things begin to look different.  Little things, like the power coming on before dark on Saturday, and the plumber fixing the water pressure not only to our old apartment, but our entire building. And not so little things, like our students returning to class with huge smiles on their faces, so excited to be back in school for another semester; or the patient with the chest tube from August returning with his cheekbones less prominent and his temples not so concave.  He is beating tuberculosis, has gained 25 pounds, and feels great.

And we, again, are beginning to see positivity and hope, even amid the despair. Our friend whose kitchen burned down is chipper as always and concerned only about those around him.  We are planning a dinner party where everyone brings a plate and leaves it behind to rebuild his kitchen.  A patient with such profound anemia she is nearly bedridden musters the strength to hold her even sicker neighbor so she can pee in a bucket.  And the nursing student, who ended last semester in tears because her computer was stolen and she didn’t know how she would come up with the money for a new computer or tuition next year, is granted a scholarship, thanks to many hours of help and computer assistance by her classmate.

Today, the added water pressure blew a leak in our water heater, leaving us with a flooded bathroom and no shower.  Then the power went back out.  But after a candle-lit bucket bath, looking out over a dark Mbarara, somehow, the world still looks like a good place.

Photoblog Part Four: Ethiopia

Addis at rush hour

Ethiopia takes coffee very seriously, and the macchiato is the one good thing left behind by the Italian occupation

Layered avocado and fruit juice

The Ethiopian lion atop the steps of Italian occupation. Ethiopia is the only African country not to be colonized.

14th century monastery on Lake Tana

Blue Nile Falls outside Bahir Dar

Teff, the grain used to make injera. It has it’s own yeast and the bread tastes like spongy sourdough

King Fasiladas’ weekend bathhouse outside Gondar

King Fasiladas’ castle in Gondar

The Netela scarf, worn all over Ethiopia to shade the sun, cover your head in church, and keep you warm

Trekking in the Simien Mountains

Gelada baboons.

Our guide, armed scout, driver, chef, and chef’s assistant.

Ethiopia from the road

Ethiopian Christmas in Lalibela, a set of eleven monolithic rock churches carved in the 12th century. Thousands make a pilgrimage dressed in white.

The view from our balcony at our hotel in Lalibela

Nearly thousand year old churches that are still in active use today

One piece of rock.

This is one piece of rock!

Traditional coffee pot, called a jebena

Lalibela cooking school

Making injera

Our final result

Foosball on the streets

Healthy, Wealthy, & Wise

HEALTHY.  Although our US healthcare system is far from perfect, we always have a backup plan. We have laws that state in emergency situations, you cannot be turned away for lack of payment. We have 911. We have cars and buses and trains to get us to clinics. We have constant electricity to power our heart monitors and dialysis machines. We have clean water to wash our hands and sterilize our wounds. This is far from what we have seen in Uganda and Ethiopia. In Uganda, if you don’t have cash, you don’t get antibiotics. Power is out most of the weekend, so there is no option to keep the baby incubator on or the dialysis machine running. Water causes more illness than it cures. While trekking the Simien mountains in Ethiopia, Ari developed altitude sickness. His illness was mild, but it was a reminder of the complexity that access to healthcare presents. There was no cellphone service. The nearest town or city with even a small healthcare facility was 6 hours away, by car. The nearest drivable road was a half a day’s hike. Our only option, should we have needed it, would have been to walk or ride a donkey for a day or two through the wildnerness. Thankfully, Ari was okay; but we gained perspective on the huge undertaking of obtaining healthcare.  It was also a reminder of the fragility of health.  A simple headache can be crippling, yet our patients deal with far worse as part of their daily existence.

WEALTHY.  We have eaten pho on the streets of Vietnam, drunk rum in small smoky cafes in Cartegena, discussed happiness with Buddhist monks in Cambodia, swung with monkeys in the jungles of Costa Rica, walked through coffee plantations in Laos, indulged in burrata with shaved truffles in the hills of Tuscany, and, now, we are exploring Africa. We have seen more of Uganda than the majority of Ugandans we know have and likely ever will see. We came home one day from work to find Scovia, our friend and housekeeper, reading our Uganda travel guide, enthralled by the beauty that her own country offers outside the southwest corner that she knows. She looked at us wide-eyed as we described the places we planned on visiting during our one year in her country.

WISE.  We sit on the balcony of our beautiful hotel in Lalibela, Ethiopia, after spending the day hiking up a mountain to a 12th century monastery, guided by our new friend Mareg, a 23-year-old who moved by himself to Lalibela from the countryside at age 9 seeking an education, as his parents wanted and needed their five children to work the land, not attend school. He shined shoes through primary school and started guiding tourists around the churches when he had the English and connections to do so. His favorite is Biete Gabriel-Rufael, where he used to play in the tunnels that represent heaven and hell. He is now estranged from his parents, working to save enough money to send his 13-year-old sister to school before she is married off, and get himself to university in Addis. How do we explain to our hard working friend that education was a given for us? That we grew up knowing that college, and likely a graduate degree, would be the path we would take, without question? That our families urged us, encouraged us, and supported us to accomplish all that we could, be all that we could be?

We are healthy. We are wealthy. We are wise. But our travels have taught us that although access to education and healthcare and well paid jobs can make your life a lot easier, they don’t necessarily make you happier.

Scovia cleans our house while listening to Ugandan music on her cell phone. She takes extreme pride in her work and our home is always pristine and safely cared for. She meets her sister everyday for lunch at her favorite canteen, where she eats matoke and sauce with gusto. She giggles when we offer her an American treat, like banana bread or a cupcake. She chats about her boyfriend, her mother, her schoolwork, and her future. She cleans houses for expats because it pays better than working at the bank, and she studies for her business degree.  She knows she will one day have a good job, a husband, and children (only two, she says). She is happy.

Mareg bounces about Lalibela with a smile, greeting everyone we meet with a warm Ethiopian handshake and a shoulder bump. He invites us to join him and his friends at the local Tej (honey wine) house for drinks and dancing. He talks about girls, the latest styles, and his favorite musicians.  Our payment for his two days of guiding will pay for his rent and food for the month, and allow him to save for his and his sister’s education. He dances with complete abandon. He is happy.

Six months ago, we landed in a poor landlocked country called Uganda.  Yesterday, we landed for a second time at Entebbe, at home.  After a warm embrace from a Ugandan friend who picked us up, we literally drove off into the sunset, headed west through this fertile land of red earth and green leaves.  Michael Bolton’s gospel re-make of “Lean on Me” played loudly on the radio, and zebras gathered by the road.  Seriously.  You can’t write fiction that poetic.  It was like the entire universe aligned to remind us that life is good, to welcome us home.

So, we enter 2014 feeling extremely lucky, profoundly healthy, wealthy and wise. And we wish the same for you. Happy New Year. May you be wise, whether measured by your level of education and number of degrees or by your knowledge of the land that you cultivate, the food that you cook, and the baskets that you weave. May you be wealthy, whether you count it by dollars, livestock, banana trees, or friends.  And may you be healthy enough to experience the world around you.  May you smell fresh roasted coffee, taste a perfect passion fruit, hear the call of a bird you never appreciated before, feel the beat of a drum, and see the same sun and same moon we do as another day turns.