heatha like the weatha

Fast forward

2009-10-27T01:53:00.004+03:00

So here we are towards the end of October. I'm a bonafide med student, 10.5 weeks in, white-coated, stethoscoped, 3 exams survived (and passed!), 3 more exams looming a couple of weeks away, oodles of enzyme names floating in my brain...what happened to my promise to keep up the blog during medical, you ask? It's actually not that I've been too busy. (Busy? Yes. But too busy to spend a few minutes a week doing some reflective typing? No.)

The thing is, we got this talk the first day of school. The technology and digital footprint talk. It went something like this: you're medical students now, entering the medical profession--we have high professional standards of conduct, so don't let some online meandering thoughts reflect poorly on you. You have to get into residency a few years from now. They will scrounge up all the dirt they can find in your digital footprint...everything from the drunken parties captured in facebook photos to the disgruntled blog entry where you slammed a professor out of the need to vent. Oh, and then there's that thing called HIPAA, and we wouldn't want anyone intentionally or unintentionally violating HIPAA, revealing private patient information in an online forum. And, oh wait, what would you do if a patient requested your friendship on facebook? (See the required reading they gave us, from the New England Journal of Medicine on Practicing Medicine in the Age of Facebook

Take-home messages: Sweep away your digital dirt. Adjust your privacy settings on facebook. Untag yourself from irresponsible-looking pictures. And, think twice about blogging about medical school.

Hmmmmm...so I guess that's what I've been doing. Thinking twice about blogging about medical school. And I still haven't made up my mind. I do know that I miss blogging for that reflective pause it gives me. Time to reflect on what's happening, and assemble those thoughts and observations (in a hopefully semi-interesting way) in a blog entry. Go back two years later and see how you've changed, grown, stayed the same. But...are those all things I can accomplish in a private journal? Do I want future patients, residency admission committees, and classmates to scrutinize my journey, read about my weaknesses, joys, frustrations, strengths? But then, on the flip side, I think about some really fine medical school blogs I read in those intolerably exciting months leading up to medical school. They gave me an insider's view, and answered questions about what to expect, what it's actually like going through med school, the highs, the lows, the challenges, the joys, the milestones. I learned from them, laughed from them, sympathized with the authors, and they forced me to contemplate on the journey I was about to embark on. So, maybe these positives outweigh the negatives? One thing that concerns me, as I continue to mull over this, is that I realize that dozens of those golden first impressions are going unblogged, unjournaled, un-anythinged (aside from of course, discussions and correspondence with family and friends).

Yeah, so I'm still thinking. One thing I'm thinking about is creating a blog that's either less open to the general public (I have to invite you to read my blog), or a blog in which my true identity (Heatha like the Weatha) is concealed. Thoughts?

Life's about to change!

2009-08-05T11:09:00.002+03:00

My goodness how time has flown. Our departure date is staring us in the face--a mere 36 hours away. We are moving to a new home in a different continent. Med school starts in 12 days. Wow, life's gonna change quickly and dramatically. No time for long blog entry now...I'll probably update again once I'm on the other side of the Atlantic.

Obama does Africa!

2009-07-12T10:40:00.004+03:00

I've written on here before how exciting it has been to witness Obama making history from an African perspective. I watched the election night results come in in the wee morning hours at a restaurant/bar in Kampala, I felt my first pangs of pride for being an American, I marveled as Ugandans embraced him as one of their own, I watched the inauguration from a tiny, overcrowded restaurant up-country in Mubende.

Yesterday was no exception. Obama made his first visit to sub-Saharan Africa, making a highly anticipated speech in Accra, Ghana. All of Africa was watching.

Many Ugandans feel that Obama is a Ugandan (at heart, by blood, by tribe). Obama's father was from the Luo tribe, which actually extends across the Kenyan border into Uganda. Therefore, Obama is Ugandan. But I think across sub-Saharan Africa, many Africans feel this raw connection to him and are overwhelmed by the hope, joy, and pride that that connection stirs.

The whole speech had me buzzing with excitement, and I know that this continent was buzzing with the same excitement. I don't know how important/followed/anticipated this speech was in America, but in Africa it was huge! I think one of the things that excited me was that this man has the power to re-cast Africa in the world's eye not as a dark, diseased continent, but the way I see it: a land of abundant opportunity, a land where hope prevails, a land set for exciting growth and change, a beautiful land with rich and diverse cultures, a land that does matter to the rest of the world, and a land that of course still has challenges--but challenges we can overcome.

Obama's speech yesterday (Kris and I caught it on BBC radio) was, I thought, very poignant. He essentially re-branded Africa as a land of hope and opportunity, while emphasizing shared responsibilities. He said that Africa's future is up to Africans, and focused on four key areas for the continent: democracy & good governance, creating opportunities, strengthening public health, and peaceful resolution of conflicts. He called upon young people in Africa to bring about change, with the words of encouragement: Yes, you can!

As a public health professional, I was thrilled to hear health--with a focus on systems strengthing, primary health care, and prevention--featured so centrally in his speech. I was glad he highlighted the US's comprehensive global health $63Billion commitment. I also liked the way he addressed good governance and corruption. I had to wonder if Ugandan president Museveni wriggled in his chair when he heard Obama say, "Now, make no mistake: History is on the side of these brave Africans, not with those who use coups or change constitutions to stay in power. Africa doesn't need strongmen, it needs strong institutions."

Oh, Obama, we love you. But of course, some Africans (including Ugandans) are winding down their Obama honeymoons. This has been evident in the local press. For example, I read an opinion article expressing the first pangs of discontent with Obama from more conservative and religious Kenyans who were disappointed with his reversal of the Mexico City Policy. I was a little disappointed with the sensationalistic coverage in the Ugandan Daily Monitor, where today's headline (post-Accra speech) exclaimed, "Obama attacks tribal politics; there is no cause for alarm - Kampala."

I'm going to miss experiencing Obama from Africa, but I'm also excited to live in the US under his presidency.

We had a malaria party...

2009-07-10T10:54:00.005+03:00

Haha, I found this cartoon while poking around online to read up about malaria. A very accurate way of capturing this past week--Kris and I both had malaria (and trust me, it was not very much fun!). (Not sure who to credit with penning this cartoon...)

Well, it’s Day 6 of symptoms and the worst of malaria episode number 2 is behind me. I am feeling much, much better, but still left with a residual spinning headache and drained of energy. It’s hard to fathom that I could still be tired after all the sleeping I’ve done the past six days, but my poor body is still drained of energy.

Despite how much it sucks, the silver lining of getting malaria is that it’s a learning opportunity. I think I mentioned on my blog during my first (and far worse) battle with the ole’ malaria buggers, that if I had to pinpoint something good out of the whole experience, it was the perspective I gained as a patient regarding the lived experience of the disease. It really doesn’t compare to the type of textbook-learning I’ll be doing in medical school!

Anyways, I’ve been trying to supplement the experiential learning with some online reading, and wanted to share some insight on the life cycle of malaria parasites and what it does to your body. Let me preface this by saying that malaria and reading don’t jive together very well (hard to read or concentrate when your head is whirling)…but here’s what I gleaned...

The type of malaria that predominates in Uganda is from the parasite plasmodium falciparum. All it takes is one bite from an infected female anopheles mosquito. During the bite, it injects about 15-20 sporozoites into your blood, which make their way down to your liver. In the liver, the sporozoites divide quickly over the next few days, until the liver cells burst, releasing upwards of 600,000 merozoites into your blood.

The merozoites find their way to your red blood cells, thus becoming trophozoites. The trophozoites hang out silently over the next two days as they continue growing. Up until this point (7 days after the bite), the malaria sufferer will have felt no symptoms, and gone about their normal life. After the two days of growth, each trophozoite divides into 32 new baby merozoites, causing the red blood cells to burst as the next generation of merozoites is released into the blood. The 2nd generation merozoites find additional red blood cells to hang out in, become trophozoites and start over again.

Symptoms start when the red blood cells start bursting as this releases toxins into the blood. These toxins are what cause headache, fever, projectile vomiting, achy joints, and other classic symptoms of malaria. Often there's not enough parasites in your blood by Day 7 to feel any severe symptoms, but you may just feel fatigued. But by Day 9, (after the 2nd generation trophozoites have time to grow and burst the next set of red cells), that’s when most people start feeling stronger symptoms (headache, fatigue, stiff neck). By Day 11 (after the 3rd wave of red blood cells burst), you’ll feel pretty awful (fever, vomiting, headache). The generational bursting of red blood cells explains why malaria symptoms tend to come in waves, with peaks every two days. This also explains why it is absolutely crucial to get treatment early—every two days the parasite level increases tenfold or more, with symptoms escalating too. If you’ve failed to get treatment by Day 19 (post-bite), you risk multi-organ failure and cerebral malaria.

Based on this research, I’m pretty sure I got my malaria test and started treatment on Day 11, when the real ugly symptoms started to show their head, which means the culprit mosquito bite would have occurred the night of June 24th. Guess who happened to be visiting me in Ssembabule that night? That’s right, Kris. So we both must have been bitten by the same mosquito that night in our hotel room in Ssembabule.

Of course malaria can play out slightly differently in different individuals. Case in point, Kris and I had alternating waves of severe symptoms. On the day that I was sick as a dog, Kris thought he was getting better; the next day he took a turn for the worse, while I felt slightly improved; and on and on like that. If our red cell bursting had been in sync, we wouldn’t have been able to take care of each other as well! (We also had Kris’ bro Julius here with us all week, taking care of us, keeping us hydrated and fed.)

The process I described above is how malaria plays out in someone with little to no immunity to the disease. Apparently it takes 6 bouts of malaria within 12 months to build up any sort of immunity, so that rules out both Kris and myself as immune! In someone with immunity, their immune system puts up various lines of defense to destroy cells with parasites in them and clear away toxins from burst red cells. Someone with immunity built up may not even notice that he has malaria.

The interesting thing is, it’s the people with immunity to malaria who perpetuate the spread of the disease. When parasites encounter a tough defense from the immune system, instead of developing more trophozoites, they develop into male and female gametocytes. When the mosquito bites a malaria-naïve person (like me or Kris), she sucks up some trophozoites, which simply get digested. However, when she bites a semi-immune person, she sucks up the gametocytes, which hatch in the mosquito’s stomach, mate, and produce sporozoites. The mosquito then injects those sporozoites into its next victim.

Malaria life cycle--from WHO

There you go--some malaria enlightenment!

Malaria strikes again

2009-07-07T19:06:00.003+03:00

Currently suffering from my second bout of malaria. Woke up feeling fatigued/funny/naseous/headachey on Sunday; the feeling got worse as the day progressed, and I swung by the neighborhood clinic for a "B/S" (bloodsmear for malaria). The lab tech pricked my finger, did his thing, then came out with a slip of paper bearing my results. "Did you find malaria?" I asked, anxious to get the results. To which he replied "[raise eyebrows]". (In UG, raising your eyebrows means yes.) Had a brief consultation with the doctor, picked up my treatment, and swung by the supermarket to stock up on juice and sprite (staying uber-hydrated is a must for malaria sufferers).

Okay, the next sentence is going to get a little bit nasty, so reader discretion advised. About an hour and twenty minutes after swallowing my tabs (artemether), I could no longer fight the urge to vomit. And I started projectile-vomiting, including through my nose (which was, by the way, an extremely unpleasant experience). Repeat two times, and Kris decides to take me (armed with a kaveera (polythene bag) and taking the potholes and speed humps very slowly) to the AAR hospital downtown. The doctor there said an hour and twenty minutes was sufficient time for the first dose of malaria meds to start doing their job, so he just prescribed an anti-vomitting medication. Meanwhile, Kris had a headache that had worsened throughout the day, so he decided to get a B/S too. Ten minutes later, his results came back--he also had malaria.

We got back home at midnight Sunday night, and now it's 7:15pm Tuesday evening. Monday and Tuesday have been a complete blur of dizziness, achey-ness, nausea, drowsiness, and general rotten-ness and unpleasant-ness. Malaria just takes time get through; you have to give your body over for a good 2-4 days. I've been sleeping 20 out of 24 hours a day, and in a horizontal position for all but 15 minutes of the remaining four hours. Kris doesn't seem to have it quite as bad as me--probably a combination of having caught it very early and his residual immunity. My guess is we both must have gotten bit by the culprit mosquito while he came to visit me up-country in Ssembabule about a week and a half ago. The mosquitoes there were terrible.

The good thing is that I caught this relatively early (within 10 hours of symptom onset), and I should theoretically have some immunity built up from my first bout with malaria circa March 2009, so I'm hoping I'll turn a corner real soon.

Until then, ugggggghhhhh.

Where did June go?

2009-07-02T08:28:00.001+03:00

I predicted that June would fly by, and, indeed, it did. Most of June was consumed with the KPC (Knowledge, Practice and Coverage) survey that served as the mid-term evaluation of our community-based family planning project. It was a monster of an undertaking (at least compared with the level of activity and logistics we are set up to handle), and I was the one doing all the orchestrating. I had a lot of help from our Ssembabule and Mubende staff and the international volunteers placed here, but I still ended up working myself to the bone. For three weeks straight, I worked 16-18 hour days, including weekends. I was at the office every morning by 7am and didn’t leave until 10 or 11pm, only to go back to my hotel room and continue working for another hour or so. (The bright side of this? Hopefully med school will seem easy and relaxing after this job! I calculated and realized that for three weeks straight, I worked more hours than US medical residents are allowed to work per week!)

So, all this work, what did it involve? Week 1 was the planning week. Planning is generally not a forte for many Ugandans, including many of my staff. Something that could be planned relatively easily and straight-forwardly in the US becomes unimaginably complicated here. So just gearing up for all of the logistics for the following two weeks took a lot of time, energy, and careful spelling-out of tasks. Logistics we had to consider included vehicle and driver hire for the survey pilot and survey implementation, lunches and teabreaks for the training, packed lunches for the survey implementation week, fuel calculations, hiring chairs, how to make the photocopies, finalizing recruitment of interviewers/supervisors, preparing to pay allowances to staff and interviewers/supervisors. In addition to this, we had to adapt an existing KPC training for interviewers/supervisors, and decide upon and establish rules for survey protocols (e.g. household selection, respondent selection, etc.) Another time-consuming task was translating and back-translating the entire 30-page survey to Luganda.

Part of the training prep included coaching our American MPH-student volunteers how to speak slowly. When I’m in Uganda, I tend to slow down my rate of speech by 50% in general (mainly in Kampala), and by 200% when in the field. I watched them visibly struggle to slow down their pace of speech, only to receive feedback from our Ugandan staff that they still couldn’t understand a word they were saying. No matter how much the volunteers felt like they were slowing down their speech, it still wasn’t slow enough. The best advice I heard from one of our Ugandan staff was a stern request to “speak word per word!”

Week 2 was a five-day training of survey interviewers and supervisors, as well as a half-day sensitization meeting for District officials (DHO, CDO, LC3s from each sub-county). The selection of villages was done with the District officials present, so the random process we used was fully transparent. We divided sessions amongst the facilitation team, and each led different sessions. The fourth day of the training was a pilot, where we went out in teams to see how data collection went. We encountered a major hiccup when two of our interviewers dropped out the morning of the pilot, but luckily we were able to train two new ones over the weekend between Weeks 2 and 3.

Week 3 was the actual survey implementation. We had 6 teams, each consisting of a supervisor and two interviewers; when possible, teams were supervised by one of the training facilitators as well. Each team was responsible to conduct 10 surveys with women of reproductive age each of the five days of survey implementation. Supervisors made sure proper protocol was followed, especially in terms of random selection of the first household (using a household list prepared by the LC1 and a random number table), selection of subsequent households (visit every other house), and selection of the respondent within the household. Supervisors also did a field-level check of each survey to ensure no questions had been accidentally skipped, skip patterns were followed, and there were no inconsistencies within a survey. Each survey took between 30-75 minutes to complete (partly depending on skip patterns followed within the survey). Six teams times 10 interviewers a day times five days yielded 300 surveys at the end of the week, all of which needed to undergo a final pre-data entry check, then be double-entered onto two computers with EpiInfo.

Whew! My head is just spinning thinking about everything that this KPC survey entailed! I’m glad the bulk of the work is over, although we’re still finishing up the data entry and need to do some data cleaning as well.

I spent three days plus the pilot actually in the field supervising survey teams and have some interesting stories and photos to share…in a future blog entry.

I can’t believe it’s July 1st! July is also going to fly by. Kris and I have a vacation planned for the week of July 13th (he’s keeping the details secret in an effort to wow and surprise me!). I finish work towards the end of the month, then have just over a week in Uganda at the beginning of August before flying back to Wisconsin (with a two-day sightseeing stopover in Dubai along the way). Then life’s going to change dramatically and rapidly on August 17th (first day of med school)!

MJ is dead

2009-06-28T15:16:00.002+03:00

Back in Kampala after a loooong three weeks in the field for an amazingly hectic but interesting KPC Survey to assess knowledge, practice and coverage of FP in Ssembabule District. I have some blog entry ideas whirling around in my head related to the KPC and my past few weeks in the field, and also lots of great pictures to share. My internet connection was so poor in Ssembabule that I was unable to post any blog entries.

The other inconvenience of poor internet connection was no source of news. It's hard to even find a newspaper in Ssembabule; any news on the radio is broadcast in Luganda (and I don't have a radio there anyways). The way I found out about Michael Jackson's death? I got a text message at 5:45AM from a former Makerere classmate from Tanzania saying simply: "Michael Jackson is dead!" This friend was a huge MJ fan and was devastated by the news. I wouldn't have known if it weren't for that text.

Got back to Kampala on Friday night and on Saturday Michael Jackson was on the cover of every single newspaper here, with a good 10 pages of each newspaper devoted to the late star. He was huge here. Huge everywhere, I guess.

Kampala always feels overwhelming after spending several consecutive weeks in the bush! The people, the buildings, the traffic, the commotion! All so very different than my base of Ssembabule, and the extraordinarily rural areas of the district I visited for the KPC.

Freshness and flexibility

2009-06-12T19:54:00.002+03:00

Oh, the joys of spending time with people who are **fresh** in Uganda. And I don’t say that sarcastically—there really are joys. It’s been so, so long when I was fresh here that I forget what it’s like, what’s strange, what’s exciting, what’s frustrating, what’s interesting. Everything just seems normal to me at this point. While there is always more to be learned, I very infrequently shocked by anything. My trip to West Nile gave me a taste of freshness. I felt like I had landed in a different country, where I didn’t know the language, the culture, the norms, the lay of the land.

But I’ve also been able to taste freshness through interactions with people who are fresh. May-August is tourist/volunteer/academic exchange “high season,” and I frequently meet with a friend of a friend, or a friend of a friend of a friend for coffee or drinks or a meal. I’ve had several of these meetings lately, in addition to a host of interns placed in my organization, and students and faculty from a number of universities that I’ve met in the past few weeks/months.

I genuinely enjoy hearing people’s first impressions of Uganda, and still laugh at their re-telling of the things that seem old and boring to me (e.g. “Have you noticed that a lot of Ugandans have really long handshakes, where they keep changing grips?”) I never tire of hearing of their enchantment with the beautiful, joyous, curious, friendly children they meet, or even listening to them describe what it’s like to eat matooke. It’s always interesting to hear what it’s been like to witness absolute poverty and severe inequities, and even more interesting when they share their impressions of people’s resiliency in the midst of all that.

Then I also watch them get frustrated (some more than others) when things don’t go as planned. (Essential ingredient for enjoying any experience in Uganda? Flexibility). I patiently explain that flexibility is a way of life here; nothing ever goes as planned. Some people really can’t wrap their brains around what that means; they’re the ones who often end up doing less well.

Interacting with those fresh to Uganda also reminds me of how far I’ve come, and how enriched my life has become in the journey between when I was fresh in Uganda and now. For instance, I’ve realized what a blessing it is to have learned to be totally, irrevocably flexible. This is a skill I’ve acquired in Uganda and something that will serve me throughout my life, in nearly any situation. Throw anything at me, and I can adapt, I can take it in stride, I can enjoy the challenge. What a joy to take life as it unfolds.

June is going to fly by!

2009-06-11T00:02:00.006+03:00

Google Maps confirms just how far on opposite sides of the greater Kampala area Munyonyo and Mpererwe are. (Sorry it's kind of blurry. Munyonyo is the one at the very bottom; Mpererwe up towards the top). I put red markers on the approximate locations. Can't believe I connected the dots!

I had another major breakthrough on my driving last weekend: I drove all the way from yoga class in Munyonyo to Kris' parents' house in Mpererwe. Not only is this a good 45-minute drive ALL the way across town, the route also passes through so many different "obstacles" and types of road. The extremely pothole-ridden sections (which requires adept swerving around potholes), the pothole-free sections (which means everyone's driving at a much faster speed). Several roundabouts and traffic lights. Very uneven, narrow, dirt/marram roads, and also four-lane, smooth, fast roads. Cows. Matatu taxis. Crazy boda boda drivers. And also through the extreme congestion of Kalerwe market. The best part was it all felt...so normal! I was really wondering to myself what the difficulty has been this whole time. It was easy, felt natural, I was cool, confident, and in control. Kris was in the car but reading his book for much of the way (I did have him talk me through a couple of congested roundabouts, and help me navigate my way across where Acacia Road meets Kira Road).

This really was a breakthrough. I realized I could do it, no sweat. It would have been unfortunate to leave UG this time still not knowing how to drive--I would have felt defeated and may not have ever tried driving here again! But now I know I can do it, I keep driving, and then in the future when I come back, I'll already know that I can drive. Yay!

I'm up-country for most of June. Was in West Nile last week, now three weeks in Ssembabule (and a bit of Mubende) to lead a big random-cluster KPC survey on family planning. Should be an interesting experience and looking forward to gaining some good evaluation experience, but it's also going to be really intense (i.e. 14-18 hour days for three weeks straight, including weekends!). To add to the complication, we have a lot of brand new staff, plus brand new international and national volunteers who will all need various levels of "hand-holding."

Overall I think these three weeks will be good, and it's going to make June fly by! Then I just have a couple more weeks of work in July, followed by a highly anticipated vacation (location TBD). Before I know it, Kris and I will be flying back to the US (with a 3-day layover in Dubai), start settling into life in Wisconsin. Then, exactly one week after arrival--BAM!--medical school starts. Wow, lots happening in a very short period of time!

"Malaria is worse than Kony"

2009-06-08T17:19:00.009+03:00

Last week, I was in Arua mainly to co-facilitate a capacity-building training for our West Nile CSO partners, but expressed a desire to the West Nile Program Manager (my counterpart in Arua) to get out to the field. He made it happen, allowing me to accompany him to a Malaria Awareness Day (MAD) in Koboko District.

Koboko is a relatively new district, carved out of Arua District in 2005, and nestled between the Sudan and Congo in the far northwestern region of Uganda. The event we attended was in Ludara sub-county, about 2 hours' drive from Arua town. Along the way I got to observe the countryside (beautiful and green; different vegetation), note the road conditions (all the roads were so much better than in Central!), and observe other differences. One difference I originally noted from the air was the homestead set-up. The typical West Nile homestead in a rural area consists of one large house, surrounded by several smaller houses, all constructed from mud and grass-thatched. (By the way, it seemed oh-so-stereotypically African--I feel like a lot of people back in the US imagine me living in a grass-thatched mud hut). From the vantage point of the Ludara health center, we could see both neighboring nations.

A girl going off to dig; typical West Nile homestead in the background.

Ludara sub-county, our final destination.

As we waited for the community to gather for the MAD event, the health center in-charge gave us a tour of the health facilities. They were not unlike the health facilities I've seen in Central Uganda: overflowing, understaffed, equipment lacking, structures crumbling, but trying to do as much as possible with meager resources. The facility housed a fancy solar-powered refrigeration system (a many thousands-dollar donation from someone)--that wasn't working. So tragic. The in-charge explained that there are only two health facilities in Ludara sub-county, and that their farthest clients have to walk up to 26 kilometers (over 16 miles) to seek medical care. He also said that the health unit was severely under-staffed. It is supposed to be staffed by a team of 20, but currently has only 4 staff, who are over-worked and burnt out. All five of the women admitted in the women's ward at the time were there following spontaneous abortions caused by malaria in pregnancy.

The MAD day started at about midday. Surprisingly, most of the event took place in English, with only a few speeches and the songs and drama conducted in local language. Ludara sub-county sits between two distinct cultural-linguistic groups, so English was the common language. (A similar event in Central would never take place in English!) CSO partners are expected to be creative in planning their MAD events; they are intended to be fun events that pass on information and raise awareness about malaria in creative ways. This MAD included singing of original songs, drama skits, poems, personal testimonies about malaria, long-lasting insecticide treated net (LLIN) demonstrations, and speeches.

One of the local politicians took a strong stance against malaria. "Malaria is worse than Kony [LRA rebel leader]," he said, "Kony is now far away, but malaria is in our homes."

I was most touched by the opening song performed by a women's group. The lyrics for the chorus (translated into English) were something like, "We ask our husbands if we can take the child for treatment, and the husband says, mmmm-mm-mm." (Mmmm-mm-mm, in a certain intonation, in Uganda connotes a disinterested but resolute NO). Later in the day, I heard little children humming and singing this song as they played.

Women's group members sing about malaria during the Malaria Awareness Day in Koboko, Uganda

Husbands as barriers to treatment were a reocurring theme throughout the day. The storyline of the drama went like this: a woman receives a free LLIN from the health center; she takes it home so her child can sleep under it, but the husband takes the net away and sells it to feed his drinking habit; a few weeks later, the child falls very sick but the husband says it is not serious; the next day, the child's convulsions spur the woman to go drag her husband home drunk from bar to deal with the sick child; he finally agrees to take the child to a witch doctor; the witch doctor cuts the child's chest to release the sickness, but the child ends up getting sicker and weaker; finally, the woman persuades the husband that they must take the child to the clinic and he eventually obliges; the child narrowly escapes death. Personal testimonies given by mothers also told of precious time lost taking children first to a witch doctor/traditional healer instead of taking them promptly for treatment at a clinic; several of their children died because of such delays. A local counselor told of several occasions when he was leaving a remote corner of the District and a desparate mother who had been hiding in the bushes leapt out in front of his vehicle, almost getting knocked by the car. They all had the same story: their child was gravely ill, but their husband refused to give transport money to reach a clinic or insisted on using a witch doctor. The mothers insisted the counselor talk to the husband and insist that he take the child to the health facility, making the counselor swear not to tell the husband that the wife alerted him to this child's condition.

A community drama about malaria.

What really struck me about these stories--told through song, dance, and personal story-telling--was that even though the public health issue (malaria) was different from the public health issue I mainly work on (family planning/reproductive health), the underlying causes are the same. Men typcially hold decision-making power and control family cash flow--often serving as a barrier to women who want to seek care for themselves or their children. Domestic violence and absentee fathers add to the plight. These gender norms, combined with myths and misconceptions (e.g. cutting a child's chest will release malaria, serving meat to family elders will cure a child, or family planning causes birth deformities) can become a lethal mix. (Of course not all Ugandan men are like this! Including the one I married!)

What was so touching about the day's stories were that they were unfiltered. Straight from the hearts of some courageous women. The "Mmmm-mm-mm" song almost brought me to tears.

A few facts about malaria in Uganda:
Malaria in Uganda accounts for:

25%-40% of outpatient attendance
20% of all health facilities admissions
15% of in-patient deaths (PMI, 2006)

Arua to K'la

2009-06-07T16:44:00.007+03:00

This is the GaaGaa coach I took from Arua to Kampala, being swarmed by food vendors at a brief stop-over in Pakwach.

Last week, I flew up to Arua by Eagle Air, then bused down by GaaGaa bus. I appreciated both perspectives, although the bus ride down was a bit more…shall we say colorful?

GaaGaa buses have set a new standard of service for buses through Uganda and East Africa. The man behind the company is a West Nile man, who named the bus line after the sound that a crow makes (in English, we’d say Caw, Caw, but here crows say Gaa, Gaa!). The business has a customer-is-king approach, always leaves punctually, has better than average safety track (still not great); it has been highly profitable and the bus routes are quickly expanding from Uganda to Kenya, Tanzania, Rwanda, Sudan, and even Burundi.

I woke up at 4:00am to catch the 5:00am GaaGaa bus. It was pitch black and I was stuck inside the hotel compound—the askari (guard) was nowhere to be found to unlock the gate for me. At 4:45am, after a fruitless search, I decided I’d have to break my way out of a construction gate at the back. I boarded the bus at 4:55am, just as the conductor was passing around buveera (polythene bags) for “emergencies.” He led the passengers in a prayer, then at 5:00am on the dot, the bus launched into the pitch black.

The road from Arua is quite good; probably one of the best in the country. Wide, pothole-less, reflective markers on the sides and lines painted down the middle. Still, I was scared. I took the itty-bitty plane up the day after the Air France plane crash and was admittedly an itty bit nervous, but I was far more scared for my life on the bus. Even though GaaGaa has an **okay** safety track record, I know that travel by road in Uganda is very dangerous, especially on any form of public transport.

The seating was quite crowded and uncomfortable. Even me at 5’4” felt the lack of leg room, and had to cozy up quite close to the stranger sitting in the next seat. Just as the sun was coming up, we arrived in Pakwach, where we crossed the Nile for the first time. In the early morning hours we also saw some wildlife (a family of giraffes, some Ugandan kob) standing by the roadside. We also passed through several IDP camps along the way. We crossed the Nile a second time at Karuma; this time the bridge went directly over some very fierce rapids.Sunrise over the Nile as viewed from Pakwach. This bridge (only about 1/5 of its length is visible in the picture) links West Nile with the rest of Uganda.

The bus made several 30-second stops at designated towns to drop off/pick up passengers, and two five-minute stops where people scurried off to the bushes for short calls (to take a piss) and to buy meat on a stick, roasted corn, chapatis and other typical “bus food.”

At some point along the way for some strange reason there were—no exaggeration—around 100 speed “humps” (they’re humps, not bumps in UG) in close succession (i.e. every 10 meters). For about 30 minutes the bus driver took alternating diagonal approaches over these huge humps, so that the bus swerved and bumped in successive S’s—a challenge to even the toughest of stomachs. It wasn’t long before people to the left, right, in front of, and behind me started vomiting. Some throwing up because of motion sickness, others throwing up more from the smell and sight of the person next to them throwing up. I’d say at least a dozen passengers used their “emergency” buveera.

Seven hours after leaving Arua, we finally rolled into the Arua bus park in Kampala. I was grateful to see a familiar face—my bro-in-law Julius—waiting for me in the crowd.

The route:

This is the approximate route we took (the red dotted line). I got to see a lot of the country that I'd never seen before, and beautiful scenery along the way. The farthest North I'd been before this trip was Masindi, which is half-way to Kampala! Also, I added Koboko (the area I visited for a Malaria Awareness Day) onto this map; it's in the far Northwest corner.

West Nile - first impressions

2009-06-04T21:17:00.003+03:00

I've now spent three full days in West Nile, Uganda--enough to give me a flavor of the region, note some differences between the southern 2/3 of the country and this beautiful region, and plant a desire to come back and spend more time here in the future. Of course 3 days is not enough to claim to "know" the region or the many cultures that co-exist up here, and I apologize in advance for any generalizations I may make in this blog entry.

I spent the first two days in Arua town, co-facilitating a capacity-building training for CSOs on malaria and PDME (program design, monitoring and evaluation). Today, I went to the far northwestern corner of the country, to Lubara district in Koboko district to observe a Malaria Awareness Day (MAD). (More on that in a future blog entry...)

One of the first things I noticed here was that people, really, don't stare. Not like they stare in Central Uganda. At first I thought it was just because there are quite a few expats in Arua, so people were just used to seeing them around, no big deal. But today we went out to a very rural area, about 2 hours' drive from the Arua municipality, and still, no staring. I went on a walk through the village with an American volunteer. In Central Uganda, two white people going on a walk like that would cause people to stop in their tracks and stare and would likely attract a handful of children running behind, with more children on the sides of the path chanting, "how are you, muzungu? how are you, muzungu?" But here? People were more or less disinterested. We walked past a primary school and I was sure all the kids would run up and call out to us, but no, a couple were semi-interested, but most were far more interested and intrigued by a large truck that was backing up. It was refreshing.

The word "muzungu" also isn't really used here. (I heard it maybe once over three days.) There is another word that's used around here, but it's used sparingly. When people address me on the street they simply call me "madam" or "sister." Again, refreshing.

Ugandans are notoriously friendly and the people of West Nile fit this stereotype. However, they seemed to be friendly in a different way. I can't quite place my finger on it...maybe a gentler version of friendliness? In Central, people express friendliness towards foreigners, for example, by calling out, "Yes, muzungu! You are welcome, muzungu!" Here, people are less in-your-face. They give a gentle "Good morning, sister." Or "You are welcome, my friend."

Another thing that's strikingly different is the frequency with which English is used. There are so many different cultures and languages up here that the only common language is English. Thus community events, trainings, workshops, and IEC materials are all in English, rather than local language (in Mubende and Ssembabule, English is rarely used; everything at the community-level or even the District-level is conducted in Luganda or sometimes Runyankole). And here in West Nile, your average person speaks and underestands English better than the average person in Central.

Another difference I noted is that people here talk over meals. In Kiganda culture, you do not talk while eating. In Mubende/Ssembabule, if we were to have a lunch during a training/workshop at the District level, everyone just shovels food into their mouths, no talking. It is considered rude and inappropriate to talk while eating a meal. But people here have so much conversation over a meal. I liked this because it felt more like the way I like to have meals. There's something nice about sharing a meal with someone and connecting with them through conversation while being nourished.

Oh, one more thing: the women here are strong! They ride bicycles (which is a no-no in Buganda, but is common in Busoga), and they also carry BIG loads on top of their heads (more than I've seen women in Central carrying). Today my jaw almost dropped when I saw a group of about 40 young women jogging in shorts in through Koboko town. You would never see a woman jog in Central, especially not showing her legs! Oh, and definitely no basutis or gomesis up here (the traditional dress of Central region). The women here where a mixture of "modern" clothes (t-shirts, skirts) and kitenge (African-print fabric). They tend to wear very bright, bold colors.

Arua municipality itself is also a lot bigger than I expected. The municipality has a population of 499,000. It is a bustling, booming city. Bicycles everywhere! It has 6 or 7 banks (including Barclays, Diamond Trust, Stanbic), several Indian restaurants, an actual Bata shoe store, and even has a golf course! In comparison, Mubende district has a population of about 500,000 in the entire district, Ssembabule has 200,000. Ssembabule has zero banks (you have to travel one hour to reach the bank in Masaka). And there are certainly no Indian restaurants in either place (Mubende now has 2 resident Indians, up from the one whom Shara and I had dinner with in a quest to find Indian food--read about it here). There is this bustling feeling in town, but there are also quieter neighborhoods with lots of green, popular with expats. It's kind of reminding me of a smaller version of Kisumu.

Anyways, these are just first impressions. Nothing too deep. But overall, I really love it here. I could see myself living here and loving it. The landscape is beautiful, the cultures are diverse and rich, the people are beautiful and friendly. I'm sorry that I'm already leaving tomorrow morning. I take the 5:00am GaaGaa bus out of Arua, so I better get to bed.

In Arua!

2009-06-02T21:18:00.003+03:00

I am now in Arua! I took the 8:00AM Eagle Air flight, a simple one-hour hop from Entebbe to Arua. It was one of the smallest commercial planes I’ve ever been on (though I’ve certainly been on much smaller (2-seater) private planes with my late uncle John). It was a prop plane with seats for 12-15 passengers; the captain and co-pilot were in full view (no barrier separating passengers from pilots). The co-pilot also put on his flight attendant hat, welcoming us to the plane, showing us the emergency exit (the same door we used to board), and explaining that refreshments were “self-service” (a mini-cooler on wheels stocked with waters and juice, from which passengers grabbed a drink, then slid the cooler up to the row ahead of them).

An hour later, we arrived and I soon jumped into my role as co-facilitator in a training for civil society organization (CSO) partners on community-based malaria projects. Today I led a five-hour session on behavior change communication.

It’s fascinating to finally be here in West Nile. My Uganda experience to date has been very skewed towards Central, Eastern, and a bit of Western regions, with zero experience in West Nile or Northern Uganda. (The farthest this way I’d ever been was a safari in Murchison Falls in 2003). There are subtle differences I’m already noticing, but I’ll have more time to reflect on them as I spend the rest of the week here.

The people of Central, Eastern, and Western Uganda are (for the most part) Bantu people, whereas people in this part of the country are Nilotic. Yes, within each of these regions there are dozens of tribes and languages, but the Bantu and Nilotes are actually different ethnicities with languages that are totally unrelated. Different peoples.

In my very Bantu-centered Uganda experience, I’ve learned exactly how to speak (slowly, with particular word choice and enunciations) to be understood in Central Uganda. I’ve even Bantu-fied my name (Heather becomes Heatha or Hezza). I’m often called upon to “translate” from American English (of tourists and volunteers who draw blank stares and confusion from anything they try to communicate) to Ugandan English.

But I realized today that I wasn’t quite sure how to…speak to this audience of CSO partners from 7 districts of the West Nile region. They tend to speak a lot faster (very fast, actually), but enunciate things totally differently, employ different word choices, etc. I stuck with my tried-and-tested Bantu-friendly manner of speech and it seemed to go over well enough. (During the day’s review session, I asked some participants if they were picking my accent, and they said I was “very clear” and appreciated that I had “African-ized” speech.) However, I’ll probably speak a bit faster in tomorrow’s session because they’re used to very rapid speech.

It’s also nice to be talking and thinking about a public health issue other than family planning or HIV/AIDS, which is what I spend most of my time doing in my job duties in Central Uganda. I’m learning a lot from our CSO partners about malaria, some of the common myths and misconceptions, and the challenges of implementing a community-based malaria program.

I’m hoping that I can actually duck out of some of my facilitation duties on Thursday so that I can go out to the field for a Malaria Awareness Day. It would be a shame to come to Arua and spend most of my time in a conference hall, without ever leaving Arua town (which, by the way is big, busy and bustling, has many expats, restaurants offering non-Ugandan cuisine). It would be nice to get out to the field, so I’m going to try to make that happen.

The inside-outside view

2009-06-01T21:33:00.002+03:00

Perspective. In my opinion, that is one of the greatest allures of travel. The perspective one gains by uprooting themselves from their home, land, and culture, and inserting themselves in an unfamiliar place. Perspective not only on the new culture, but also a newfound perspective on one’s own culture.

I’ve realized that there are two types of people in Uganda with whom I tend to form fast and strong connections. The first is Ugandans who have lived “outside.” In Uganda, the word “outside” is used to connote any country outside of Uganda. Ugandans who have lived outside tend to have broader perspectives, more context in which to place their own culture and country, and tons of here-vs-there stories that I find really amusing. The second category of people is non-Ugandans currently living in Uganda, who have integrated into the host society to a certain extent. The ones who can rightfully claim to have lived “inside”—not just within the country’s borders, and not just inside some embassy bubble, but actually, truly inside. Why? The perspective they have! The new lens with which they view their home culture and Ugandan culture, the insights, the observations! Of course I also form connections with the tourists who come trotting through (especially at this time of year, tourist high-season), and also with the expats who are living-here-but-not-living-here in the sense that they’ve made little effort to immerse themselves in Uganda culture, and they also offer perspective of a different sort (sometimes fresher, sometimes edgier, sometimes shallower).

I thoroughly enjoy the perspectives and insights that both these categories of people have to offer. I like swapping here-vs-there observations with these people and being able to think, wow, I’ve been thinking the same exact thing but I haven’t been able to place my finger on it. I can also relate to these types of people through our common struggle of being not quite…anything (neither insider nor outsider) and having a foot in two worlds. Swapping these types of stories helps us make sense of our lives that are lived in two worlds. I’m so glad that Kris and I have both lived “inside” and “outside”—we understand one another so much better as well as one another’s cultures.

There are oh-so-many here-vs-there stories and observations I could share (and I’d have a grand time relating all of them), but I’ll limit myself now to just two topics: showers and grasshoppers. Both of these observations are colored by stories that a Ugandan woman who’s lived both inside and outside shared with me.

Showers: It may seem surprising (given the perception of Africa as a land of severe water shortage, and the hard work required to shower out of a bucket), but Ugandans shower twice per day. Morning and night, morning and night, morning and night. Many even shower three times a day: after waking up, after getting home from work, before sleeping. Shower only once per day and you risk being seen as a social outcast, someone totally careless of personal hygiene. For years, I’ve had to defend myself for tending to shower (gasp!) only once per day. I didn’t grow up in a culture where showering twice a day was the norm, I say in defense. In my country, it is not so hot and it is not so dusty, so there’s no need to shower multiple times per day, I add. I’ve overheard Ugandans complaining about bazungu (especially bazungu of the tourist variety) who have been known to space their showers by a week or more; I’ve been asked on numerous occasions why muzungus hate to shower. Ugandans are so used to showering multiple times daily that they continue to do so even after they’ve left the dust and the heat far behind them. The Ugandan woman I mentioned above had a great story to drive this difference home. She was staying with a host family in the US during the winter, and naturally, showered both morning and evening. After a few weeks, her American host parents sat her down for a talk. “Pam,” they said, “You are driving up our electricity bill with all of this showering you are doing. Why must you shower twice every day?” They insisted that she limit herself to only one shower per day.

Grasshoppers: Last year sometime, CNN had one of those “offbeat news” stories that irked some of my Ugandan friends living in the US at the time. The “news” was that Ugandans eat (gasp!) insects. They showed footage of Ugandans capturing grasshoppers, then serving them up to eat. The newscaster threw in some “Golly-can-you-imagine?” line to increase the shock factor. The facts were true: Ugandans do eat bugs (including ants and grasshoppers); in fact, in Luganda one of the months is called the grasshopper month because that’s when they’re in season. I’ve never eaten them myself (I play the vegetarian card), but have many friends who love them. Pam, the same Ugandan woman who got scolded for taking too many showers, also had a good story about bugs. A friend of hers came from Uganda to visit her at her American host family’s home. The friend had carried some fried grasshoppers in her luggage, which Pam then kept in the freezer and ate slowly, savoring a taste of home, over the next few weeks. One day, her nine-year-old host sister exclaimed, “Ewww! I can’t believe you’re eating bugs! That’s gross.” Pam patiently explained that in her country, they are a very special food. A lightbulb went off in the little girl’s head. “Oh yeah,” she said, excitedly, “I guess that’s like when we took you out for a celebration dinner at the mussels restaurant and you thought the mussels were gross.” “Yes,” Pam said, “I knew the mussels were a very special food for your family, but to me they were gross.” Pretty good observation for a nine-year-old, if you ask me. And, by the way, a lot of Ugandans do tend to get grossed out by mussels (I’ve watched them gag and groan during that scene in Mr. Bean), but expats seek them out and shell out lots of money to eat mussels at that Le Petit Village restaurant near the American Embassy in Kampala.

These types of stories and observations make you question what’s weird, what’s normal. Are mussels gross, or are grasshoppers gross? Is it normal to shower once a day or two or three times a day? Of course the observations about insects and showers are two of hundreds of such stories I’ve discussed with friends of mine.

Sunday morning victory

2009-05-31T17:40:00.000+03:00

I had a small personal victory today: I drove myself to yoga class! Of course, I’ve been trying to learn how to drive here for several months, and I’ve been driving more and more (mostly on Sundays—so I didn’t break out of that today). But I did drive myself for the first time! I’ve always been driving with Kris in the car, or with other people who know how to drive in the car. They were my security blanket, my second pair of eyes to see if I was driving a bit too far to the left, my ego-massagers. But today, I decided I was ready, and I did it alone! It felt so…liberating! And the best part was I was cool as a cucumber, totally confident, and in control. Watch out Kampala—here I come, on wheels!

I’m looking forward to this week. Tomorrow I’m getting four MPH-level volunteers from various American universities settled into their summer internship sites, then I’m spending the rest of the week in Arua! I’m pumped to get up there because (I’m embarrassed to say), out of all the time I’ve spent in UG, I’ve never made it to that part of the country. I’m going to be providing some technical assistance to our programming in West Nile and facilitating a capacity-building training for community-based organization partners in the region.

Tough questions, and a march!

2009-05-27T20:23:00.006+03:00

Schoolchildren, only some of them shoe-d, lined up and ready to march.

In reflecting on my work, I've realized one of the aspects I really enjoy about my job is working closely and collaboratively with the District health systems. Last week, I invited district health officials from each district (including the District HIV/AIDS Focal People and District Chairpersons for People Living with HIV/AIDS) to sit on a district hiring committee panel for the final round of interviews for all the open positions on our new HIV program.

We jointly developed questions to assess candidates' readiness to work in the respective districts (both rural, underserved), sensitivity to HIV/AIDS issues, ethics and morals, and linguistic/cultural fit with the districts. The district stakeholders provided valuable feedback on the candidates in ways that I wouldn't have been able to. They also asked some tough ethical questions. For example, one of the questions they posed was: "As an effect of HIV, some houses are headed by children who really need support. However, some local leaders are taking advantage of this by asking for sex from 14-year-old girls in return material support. Assuming you are faced with such a scenario, how would you handle it?" Another asked whether people living with HIV/AIDS who do not disclose their HIV status to sexual partners should be criminalized and punished.

While there is certainly a perception in Uganda that some district officials are corrupt and take long weekends (Thursday evening-Tuesday morning) in Kampala, I generally have tremendous respect for the highly educated people (including doctors) who take posts in rural, underserved districts. I recently learned that Mubende district (population over 500,000) has only three doctors! (And then I realized I know all three of them.) Also, the Mubende district health system is currently staffed at only 42%. We talk a lot about brain drain from developing countries to developed countries, but there is also a rural to urban brain drain which leaves districts like Mubende severely understaffed. I don't know the statistics for Ssembabule district, but I assume it is even more dismal, since it's farther from Kampala and even more rural than Mubende.

Anyways, I really enjoyed working with these District people and appreciated being able to spend an entire day with them to get to know them a bit better. The District HIV/AIDS Focal Person for Ssembabule invited me to attend a candlelight memorial walk for HIV/AIDS in Ssembabule. I was honored to be present at that event earlier this week. Here are some pictures from the memorial walk.

A surprisingly chipper policman led the march past the district headquarters and through Ssembabule trading center...

With an energetic marching band next in line...

Followed by schoolchildren from several primary schools. I loved how into it these kids were. They were actually marching, knees up high, arms swinging proudly!

Several hundred people joined the march, including people living with HIV/AIDS and representatives from NGOs.

Post-march, schoolchildren performed songs about "silimu" (AIDS in Luganda), and we listened to speeches.

And finally, we lit candles in memory of those who have died from the disease.

Nothing like a good concert in Kampala

2009-05-26T11:39:00.007+03:00

For the past few years, I've heard about the Shaggy concert-of-a-lifetime that took place New Years 2004 or 2005, that everyone and their mother seems to have gone to and is still talking about. Everyone except me. Shaggy "over"-loves Uganda; he's probably been here about 5 or 6 times to perform, but somehow I always seem to narrowly miss his performances. Well, Saturday night I finally had my opportunity to join the I-saw-Shaggy-in-Uganda club. I went with a small group of friends to the Orange Karnival concert, put on by the newest telecom company in UG.

I enjoyed the start-up acts almost as much as Shaggy himself. The evening started off with some acrobat-dancers who like to play with fire, then there were performances by lots of great East African artists (Radio & Weasel, Navio, Nameless, GNL). I'm such a East African music junkie--I know all the words even though I don't know all the words, if that makes any sense (language barrier). I finally got to see Nameless perform Sinzia in person (big E African hit circa 2007 "I wish I could be your saliva, so that I could taste your lips wheneva'...I wish I could be your shoe, I would have such a beautiful view..."). Radio & Weasel are huge crowd pleasers lately, especially with Bread and Butter, Nakudata, and all the new Good Lyfe hits. GNL told his rags to riches (or rather, ensenene-and-rolex to bling-bling) story, and drove the crowd wild with his Luga-flow flava' hits and Ay-ay-ay-ay-ay's.

After the opening acts, Orange put on a splashy fireworks spectacle--actually the best fireworks I've seen in Uganda yet. (An aside about fireworks: whenever someone wants to do fireworks in Kla, you have to put up public notices in advance (posters, ads in the newspaper) so no one thinks a civil war is breaking out. I have to admit one time I was having dinner with Kris' parents, and we started hearing the bang-bang-she-bang of fireworks, but couldn't see them. People were ducking under their tables, fearing the worst. It DID kinda sound like gunshots!) Ugandans looooove fireworks to the extent that it puts American fourth-of-July-goers to shame. Watching fireworks here is infintely more exciting than in the US, mainly because of how excited and into it the crowd gets. No quiet rumblings of ooh's and aah's, but shrieks and squeals of excitement, and jumping up and down. Someone once told me they watched fireworks in UG and noticed several people in the crowd weeping because the fireworks were so beautiful and moving. So infectious was the excitement, that I jumped on the bandwagon, took out my mobile phone and also started taking crappy pictures of fireworks! Everyone's main comment was that MTN (Orange's biggest competition for the telecom market) must be scared!

Crappy fireworks picture I took knowing it wouldn't turn out - Hey, everyone else was doin' it!

Finally it was time for the big man himself to come on stage. The crowd was completely worked up and the anticipation hot and heavy. I had to stop and wonder if Shaggy would have gotten such an electric crowd in the US. Anyways he's a good performer: he works the stage, sings his heart out, teases and pleases the crowd. On Saturday he performed for almost 90 minutes straight, including the big hits like It Wasn't Me, Repent, Hey Sexy Lady, etc. A higher than expected percentage of the crowd sang along with every word of every song (I was lucky if I could recall the chorus of a few popular songs). Ugandans just can't get enough of Shaggy!

Shaggy himself!

I think one of my favorite things about concerts in UG is how excited the crowds get. (I guess you could say the same thing about concerts anywhere...) They dance, sing along at the top of their lungs, scream, laugh, and just have a blast. I'm not sure that I would have gone to a Shaggy concert in the US (okay, maybe...), but in UG? Anyday!

Mosquitoes and mangoes and mud - oh my!

2009-05-22T18:05:00.000+03:00

It’s that time of year again. The time of year where the rain falls hard for a few hours, most days out of the week. A lot of people here now say there are no longer definable seasons (usually attributed to global warming). They point out that while you used to be able to say these months are the rainy seasons and these months are the dry seasons, now it just rains anytime. However, I think even if the seasons aren’t as cut and dry as they used to be, there are still times of year when it tends to rain more than other times of the year. This is one of those times of year.

Along with the rain comes other seasonal phenomena, some enjoyable, others not so enjoyable. On the enjoyable side of the spectrum are mangoes! Admittedly, Ugandan mangoes don’t have anything on Pakistani mangoes, but they’re still mangoes! I always try to eat my fill of mangoes to last me until the next mango season.

Less enjoyable are the mosquitoes. Mosquitoes are always pretty bad in the evenings in Uganda, but come rainy season, they multiply at least tenfold. Last night I had the unfortune of having a mosquito trapped under my mosquito net. It feasted on me all night, until I finally woke up at 4:00 AM as it buzzed dangerously close to my ear. I spent the next one hour waving a flashlight around and clapping my hands hoping to catch the little bugger between them. All in vain. It kept escaping and hiding and outsmarting me. Frustrated and hoping to squeeze in a little more sleep before morning, I finally gave up and went back to sleep with my blanket carefully placed so it covered me from head to toe. If I come down with malaria in the next 7-10 days, I’ll know who the culprit was! More mosquitoes means more malaria. My colleagues tend to get sick with malaria once every 8 weeks in the dry season and once every 3-4 weeks in the rainy season. My Mubende housemate Lilian is down with malaria, as I type this. I just mixed her up a homemade ORS (salt, sugar, drinking water, orange juice).

Another unenjoyable aspect of the rainy season are the snakes! Mubende is infamous for its snake population: it has both a wide variety and large number of the slinky reptiles, many of them poisonous. The other night, we heard a commotion outside the house and then the guard started shouting in Luganda that a snake was entering the house. The current occupants of my house in Mubende are myself and two other young women, so you can imagine the squealing this unleashed. We all immediately jumped up on chairs and tables, as the guard came in, pulled the black beast out of the kitchen, and killed it in the backyard. (Thank God for our observant guard! Apparently the snake slipped in through the crack below the back kitchen door.)

Oh, and then, the obvious unpleasant side-effect of rain is mud. I’ve written before how driving on mud is a lot like driving on ice. The other week, the 45-minute journey from Ssembabule to Masaka ended up taking 2.5 hours because of the mud. There was actually a traffic jam due to the mud. A stretch of the road was essentially impassable. We saw 5 or 6 cars that had slid off the road into ditches, and two sets of cars that had collided with one another (at slow speeds) after slipping and sliding on the mud. Several times, I felt our car losing control and starting to careen towards the ditch, but thankfully my driver was skilled and always brought it back under control.

I’m trying to decide if the mangoes outweigh the mosquitoes, malaria, snakes, and mud. The mangoes are tasty, but now that I know first-hand the misery of malaria, I think I’d forego the mangoes to avoid malaria.

Interviewed out!

2009-05-16T17:39:00.002+03:00

In a marathon three days, four other field-level staff and I conducted 40 interviews for 7 vacant positions in the organization I work. It was completely exhausting and, in retrospect, probably not a great idea to be doing 15 interviews a day. (You know you’re overextending yourself when, for three days in a row, you don’t even have time to walk the 20 feet from your office to your house to grab a quick snack for lunch!) We had some really excellent candidates and some really mediocre candidates, and several shades of grey in between. After watching about a dozen applicants squirm nervously in their chairs in front of the 5-member interview panel, I added in a line during my welcome/introduction to help people feel very comfortable. I looked them right in the eye, gave them a smile myself, and said "Please feel very free with us." It was so much fun watching these smiles form (everything from a timid half-smile, to a full-toothed grin), and it became my goal to get every candidate to smile before starting the interview. (I like smiling.)

After a while, we felt like we were listening to a CD on repeat, with people giving the same old answers to certain questions. Especially true for the “tell me about your career goals” question we asked of candidates applying for all positions. I don’t know how many people told us how much they’d love to get an MPH in the next 2-3 years. Or how many people aspire to start their own consultancy firm within the next 5-10 years. And after about the fifth or sixth time, we got sick of the ha-ha-funny response to our closing question, “Do you have any questions you’d like to ask us?” To which a few too many people replied, “Well, I’d like to ask you for the job!” I had never heard that joke before. Maybe I just haven’t sat on enough interview panels in the US, maybe it’s a Ugandan joke, or maybe I just interviewed far too many people in far too short a time!

In the US employers can get sued for asking job applicants about their age, marital status, number of kids, etc. But here, most job applicants broadcast all that information openly on their CVs and during interviews. Often when you open an interview by asking someone, “tell me about yourself,” their reply starts out “I’m 36 years old, married, mother of five children (two of them twins), I was born in Masaka District…” All this information is featured prominently on the typical CV, where people proclaim at the top of the page:
NAME:
DATE OF BIRTH:
MARITAL STATUS:
NUMBER OF CHILDREN:
PLACE OF BIRTH:

Frequently, they also include:
TRIBE:
RELIGION:

In a surprising twist, I actually received one CV with the following information included in the CV heading:
UNIQUE FEATURE: Lame (RIGHT LEG)
(Yes, “RIGHT LEG” was actually in all caps and bold)

Of course not all Ugandans put all this silly information at the tops of their CVs, and I consider it kind of progressive for them not to put it. There’s no law in place here that would protect these candidates from disclosing this information if asked, but at least they can make a statement by not highlighting it on their resumes: judge me by my qualifications and background, not my age and marital status.

All cover letters for these positions were addressed to me as the Program Manager. I saw some novel variations on my name. Even though the newspaper posting clearly stated my name with the correct spelling, I got cover letters addressed to Hither, Helter, Healthier, and Mr. Heater. (I guess I can add these to the growing list of names I get called in Uganda, including Hilda, Helen, Esther, Eva, Kevin, Arthur, and Other (you can read my entire blog post about this issue here).

The Heatha Cake

2009-05-10T16:22:00.003+03:00

Thursday was Kris’ birthday, and as a treat, we him a birthday cake from the highly popular The Cake Lady, the same business that did our wedding cake. Thursday was the long-awaited day when the cake, ordered several months in advance, was ready for pick-up. The Cake Lady is famous for its innovative cake designs and delicious, moist, dense fruit cakes; the cakes are so popular you have to book months in advance, sometimes even a year in advance for weddings.

I absolutely loved our wedding cake. It wasn’t anything like an American wedding cake. Cake is really a different concept altogether in Uganda than in the U.S. But The Cake Lady makes arguably the best cakes in Uganda, and our wedding cake was both delicious and beautiful. The main cake was five layers tall, with an additional six single-tiered cakes arranged around the main cake. It was sculpted like a huge white rose, with big icing petals.

The cake from our December 2007 wedding

On Thursday, I walked into the Cake Lady office to pick up Kris’ cake. Immediately, the woman working there asked, “Are you Heatha?” I was taken aback that she had remembered me, especially since I hadn’t set foot in that office in over 18 months, and we’d sent someone else to place the birthday cake order (and thus she didn’t know the birthday cake for Christopher had anything to do with me). “Yes,” I replied, surprised. “We have named a cake after you!” she exclaimed.

She eagerly motioned me over to the bookshelf, where they keep albums full of the decadent, creative, sometimes elegant, sometimes quirky, sometimes gorgeous cakes. She showed me the large picture of our wedding cake, then showed me pictures of about five other cakes that had been made since our wedding, emulating our wedding cake. She explained that lots of brides-to-be fell in love with my cake design, and they’ve kept on making variations of my cake. Since I was the one who came up with the original design, they decided to name it after me: the Heather cake. Wow, I still can’t get over the fact that I have a cake named after me!

(If you’re interested in reading more about the tradition of wedding cakes in Uganda, you can look back at this old blog entry of mine)

I left The Cake Lady office with Kris’ much smaller but equally delicious birthday cake in my arms. It was elegant and sophisticated. We had intended to share it with a large group of friends at Kris’ birthday party last evening, but, um, these cakes just have too much sentimental value for us. We decided to keep the Cake Lady birthday cake all to our greedy selves (of course we’ll share if you come visit), and buy a different cake for the birthday party. (Don’t worry, the replacement cake was still fab—a decadent Red Velvet Cake from New York Kitchen!)

Pre-med bookshelf: How Doctors Think

2009-05-09T17:02:00.003+03:00

In the months leading up to the start of medical school, I’m trying to read a variety of books that address medicine, health care, medical education, and doctoring from different angles. My pre-med bookshelf consists of non-fiction, novels, memoirs, collections of short stories. The latest book I read was How Doctors Think by Jerome Groopman, M.D. It was a well-written, interesting book peppered with stories of actual patients that delved into the common cognitive errors that doctors frequently make. It was written in a manner such that it would be accessible and interesting to health professionals as well as patients, and included suggestions of what patients could say to their doctors to guide them away from the common cognitive errors that can lead to misdiagnoses or sub-optimal treatment courses.

The major cognitive errors Groopman identified were anchoring, availability, and attribution (the three A’s). Anchoring occurs when a physician fixates on a certain symptom and makes a “snap judgment” of a diagnosis based on that symptom. This is related to the error of “search satisfaction,” or the tendency to stop searching for a diagnosis once you find something. Availability refers to the cognitive error that doctors can make when they diagnose a patient with a condition that is most “available” in their mind (i.e. the doctor has recently seen other patients with similar symptoms who were deemed to have that condition or this is something they recently read about in the literature) and thus close their minds off to other, less common conditions. Doctors in training are often told to think horses, not zebras, when they hear hoofbeats, but sometimes doctors do need to think about the less common diseases. Groopman talked about the “zebra retreat” to describe doctors’ shying away from rare diagnoses (partly because such rare diagnoses are not the most available in the doctor’s mind). Attribution errors usually happen when stereotypes come into play (e.g. the doctor attributes a sixty-year-old woman’s dementia to early onset Alzehimer’s rather than destruction of the pituitary gland). Groopman also writes about diagnosis momentum; once a diagnosis is made, doctors are less likely to go back and revise the initial diagnosis, especially if the doctor to make the initial diagnosis was eminent in his field. He also identifies confirmation bias, which happens when doctors expect to find something and thus selectively accept or ignore information to confirm that hunch. He also writes about doctors’ egos, the urge to “do something” and patients’ demands for diagnoses in the face of uncertainty. Groopman also includes in his analysis the ways the managed care and increasing pressure on doctors’ time increase the frequency of these types of cognitive errors. The issue of medical uncertainty lay at the core of the book, as well as epistemological questions about medicine (questions about how how we know what we know).

Groopman does not put the onus of avoiding cognitive errors entirely on physicians, who because of increased demands on their time, often don’t have time to “think about their thinking.” He suggests patients can also play a role. They can ask the following series of questions to work with their doctors to prevent falling into cognitive traps: “What else could it be?” encourages a doctor to pause and re-examine his diagnosis, re-directing his thought to avoid anchoring, availability, and attribution errors. “Is it possible I have more than one problem?” helps safeguard against search satisfaction. “Is there anything in my history or physical examination or lab tests that seems to be at odds with the working diagnosis?” helps steer doctors away from confirmation bias.

Overall, I thought this was an interesting read, and I’ll be interested to see the extent to which these types of cognitive errors and thinking patterns are addressed in my medical education. Next up, I’m reading the highly satirical, tongue-in-cheek The House of God by Samuel Shem.

For several years, I’ve been an avid follower of health and medicine stories in the news, something I think all public health, pre-med, and medical students should do. Here’s a synopsis of a few recent articles.

This BBC article talks about the development of a male contraceptive injection.

This NYT article talks about the shortage of doctors to take care of the aging population and what Obama might do about it!

A few weeks ago, I wrote a blog entry about text messaging for public health, and some text messaging efforts in Uganda. My mom sent me this link for a NYT story describing a service similar to the Straight Talk Foundation service in Uganda, targeting teens with sex questions in North Carolina.

Yoga-nda!

2009-05-04T18:38:00.003+03:00

I discovered the most fabulous yoga class a couple of weeks ago, and my only complaint is that I didn't discover it much sooner! I was at a party and met a girl who was subbing for one of the regular yoga teachers at Kevin & Gavin's place in Munyonyo. I had heard about Kevin and Gavin before, but didn't know when the yoga classes took place, exactly where their home was, and if it was open to anyone. The girl from the party insisted I go the next morning. I obliged and I loved it. Then went again last week on Thursday, and would have gone on Sunday if it wasn't for this horrible cold/flu I'm still recovering from.

Kevin and Gavin have a lovely open-air, grass-thatched banda in a garden on their Munyonyo property, where they hold yoga classes Tuesday and Thursday evenings, plus Sunday mornings. They have mats, masai blankets, bamboo blocks, and bolsters and eye pillows made from local materials. The fee is sliding-scale: pay what you can.

The class on Sunday was a good, tough get-back-into-yoga class that challenged every muscle in my body but reminded me why I need yoga! On Thursday, I brought Kris with me and we both sweated through the 90-minute class. The evening classes start at 6PM, which means you have to leave work at exactly 5PM to make it across town by 6PM. Despite this challenge, the timing is perfect; it begins while it is still light outside but starting to cool off. The sun starts to set and paint the sky orange and pink as the class goes on. By the time you come out of relaxation pose at the end of class, it is dark, and the teacher has lit candles and tiki torches all around the perimeter of the banda. Magical! Not only was it a great yoga class, but it was in the most phenomenal setting I've ever done yoga!

Afterwards, they serve tea and bread in their beautiful home. Almost everyone who took part in the yoga class (usually around 6-12 participants, men and women, expats and one or two Ugandans) gathers in the kitchen to share tea and conversation. It feels warm and home-y. Kevin and Gavin are so generous and welcoming. Kris and I were proud when the Thursday evening's instructor (Gavin) told us he could tell both of us had done yoga before.

Why, why, why didn't I discover this months ago? The great thing is it's right near our home in Bunga--no more than a 5 minute drive, or even joggable! I can guarentee you I will be going to this yoga class every Tuesday, Thursday, and Sunday when I'm in Kampala.

Nakumatt grand opening (grand headache?)

2009-05-02T13:41:00.005+03:00

The view of the newly constructed Nakumatt Oasis shopping mall from the rooftop of Garden City (taken on my camera phone)

Hooray, hoorah, the Nakumatt (Kenyan-based walmart-esque store) finally opened in Kampala. After several months of anticipation, it opened last week on Monday. Kris and I managed to keep ourselves away until Tuesday evening, when curiosity got the better of us and we decided we had to go check it out.

We were not the only curious ones. We managed to get into the parking lot just before a huge traffic jam built up of people trying to get in. Once inside, we were amongst hundreds of other people (Ugandans, expats, couples, hot twenty-somethings straight from their office jobs, families, grandparents, children, etc) who had decided to get their first taste.

Nakumatt occupies one side of the brand new, expansive, three-story mall called the Nakumatt Oasis. There is space for dozens of shops, most of which are not yet opened, save a Bata shoe store (nothing new and exciting there), a perfume store, and a Mr. Price. The crowd outside the actual Nakumatt store was intimidating, so Kris and I first ventured over to Mr. Price. Mr. Price is perhaps similar to the clothing sections of a Target store: reasonably priced (compared to Woolworths, at least—still exorbitantly expensive for the average Ugandan), stylish, trendy clothes for women, men, teens, and children, along with accessories like shoes, purses, jewelry, hats. It wasn’t as big as the Mr. Price I’ve been to in Dar Es Salaam, but it was nonetheless amazing. Mr. Price is really the FIRST such store in Kampala (aside from Woolworths, but Woolworths is lame and obscenely priced). I buy most of my clothes here second-hand, partly for the fun of tearing through Owino market, partly to steer clear of the way over-priced stores that sell a hodge-podge of new clothes. This is the first time that I’ve been to a store that had racks of stylish, affordable clothes, available in different sizes and colors. Not just one of each style of clothes. But each clothing item had its own rack, and if you leaf through the rack, you’ll see all the different sizes and colors available in that style. Never before had I experienced such a thing in Kampala. I realize that this may seem like nothing-to-blog-about, but it was so fresh and exciting! The types of people wandering through Mr. Price one day post-opening included the see-and-be-seen crowd of Kampala, the bu-stylish campus chicks, the wealthier twenty- and thirty-somethings with corporate jobs. A rather up-scale target market. Kris and I both bumped into a few of our friends, who were also wandering through Mr. Price with wide eyes. There were a few things that I was eyeing and hoping to buy, but the lines at the registers were far too long, so I decided to hold off.

Next stop: Nakumatt. We made an agreement that we were there only to look, not to buy. Anyone who knows me knows that I enjoy taking stock of what’s available in Kampala. I regularly scour various supermarkets to see what new products have entered the Kampala market, to answer questions such as, if I wanted to make a salad with juicy tomatoes, fresh mozzarella cheese, olive oil, and freshly cracked black peppercorns, would it be possible? Supposing I wanted to have falafels, with pita bread, a scoop of plain yogurt, a couple spoons of hummus, and a homemade tabboleh salad, would that be possible?

In this spirit, I walked up and down each aisle of Nakumatt. It has an impressive selection of groceries; however, my conclusion was that there was nothing in the Nakumatt that you couldn’t find somewhere else in Kampala (although it may take some searching). Granted, you may have to go to two or three stores to get all the ingredients of the mozzarella-tomato salad I listed above, but it would still be possible to get those ingredients outside of Nakumatt. Nakumatt brings it all together, in one place. In addition to the vast selection of groceries (which includes a wonderful produce section with sweet corn on the cob, strawberries, apples, kiwis, and pre-chopped, pre-washed veggies; the fresh bakery section that had some multi-grain bread that looked pretty tempting; and the dairy section that had dozens of cheeses, tofu, and skim milk), there are several other sections to the store. The bath/body products section includes a Nivea make-up counter (like a clinique counter in a Macy’s), where a Nivea lady comes and assesses your skin and recommends products. There is an amazing selection of fairly-priced products: lotions, shampoos, perfumes, face washes, deodorants, make-up, mouthwash, etc. Some of this stuff used to be hard to find in Kampala; now there are several specialty shops specializing in this kind of thing, but the selection at Nakumatt was impressive. Then there was the book section upstairs, which had tons of books (mostly best-sellers, books about current events, and self-help books) being sold at a cheaper price than Aristoc. There was a really lame clothing section (maybe it just seemed lame after Mr. Price—I definitely wouldn’t buy clothes at Nakumatt). Then there were sections devoted to furniture, household items, electronics, appliances, camping, sports, and children’s toys. Lots of stuff in there! Really, quite similar to a Walmart, although Nakumatt attracts mid-upper class shoppers (versus Walmart’s lower-middle class shoppers).

I was enjoying just watching all the people—hundreds of people—streaming through the mall. The looks on their faces! Some of them walked up and down aisles, wide-eyed, with huge grins slapped on their faces. Others wandered aimlessly, looking a bit overwhelmed. Others walked briskly, with a frantic but determined look on their faces—determined to buy it all now. Others just seemed to be there because it was the place to be; they were more concerned about bumping into their friends and colleagues than scouring the aisles. Some patrons were fixated on the escalators (usually called “moving stairs” in Uganda), riding up and down and up and down just for the thrill of it!

I think most of Kampala decided to check out Nakumatt yesterday, which was a public holiday here. I went past Nakumatt on the way to meet my girl friends at NYK. The traffic jam was incredible, and there was a mob of people formed outside, fighting its way in! I have to confess that I took a boda to Garden City; it was raining, and getting there by car from the Mukwano roundabout would have easily taken more than an hour. Five-minutes later, after maneuvering our way between trucks and cars and up and down curbs, with my heart pumping at three times the rate as when I boarded the boda, I was conveniently dropped off at Garden City. (I know, this was bad, bad, bad! But I had to meet my gals!)

Yusuf Lule Road from Garden City up to Jinja Road was already a traffic nightmare due to Garden City traffic. From the day I learned about the Nakumatt being built, my biggest concern was that it would not have proper entrances/exits and would add to the congestion on that road. Currently, Nakumatt’s only entrance and only exit both connect to the roundabout just down from Garden City. What terrible planning! It looks like Nakumatt may be building a second exit that would exit straight onto Jinja road (near the taxi stage), and this might alleviate some of the traffic, but overall, I think this place is going to cause a headache! I’m waiting until the buzz dies down to venture back there.

You can call me Sheila

2009-04-28T13:43:00.002+03:00

By this point, I think everyone knows the story of why I started introducing myself as Heatha like the Weatha, and how this blog got its name. Admittedly, my name is hard to pronounce. When I lived in France/Switzerland, whenever I introduced myself, people looked at me like I had the strangest name imaginable. The closest they could come up with was Esther. When I lived in Montreal, same problem, not just with the Quebecois, but also my Spanish teacher from Spain. In Pakistan, I've become accustomed to being called Hyder, a common man's name.

But nowhere in the world have I encountered so much difficulty in getting people to conceptualize my name than in Uganda. You’d think that stopping to carefully explain, my name is Heatha, Heatha like the Weatha, boils it down to something pretty easy. Everyone can pronounce the word “weather”—just swap the w for and h and you’ve got Heatha. But, no. Even the bishop who married us called me HEEther during the wedding ceremony (despite the fact that Kris went to great lengths to coach him on the pronunciation of Heatha (like the Weatha)). I’m always perplexed, when I hear people introducing me to others, using my handy little catch phrase but still messing it up: “She’s called Heether,” they often say, “Heether like the weatha.” Honestly? HEEther like the weatha? Don’t they get it?

For those who don’t speak English and actually cannot pronounce the word “weather,” I give them a Lugandanized version of my name, which my Luganda teacher helped me come up with a few years ago. Heather becomes Hezza. And usually they get that. All the sounds that go into Hezza are phonetically familiar to a Luganda speaker. But, I can’t go around introducing myself as Hezza to…everyone! Hezza is reserved for people who live deep in the villages and speak approximately 0-5 words of English.

In addition to being called Heether, I am also frequently called Hilda, Helen, Esther, Eva, Kevin, and occasionally even Arthur. I can recount meeting men named Arthur on several occasions, who say, “Hello, my name is Arthur.” I respond, “Hi my name, is Heather.” Amazed, Arthur replies, “Wow, you are also called Arthur?” Then there’s the certain special hire taxi driver who, for years, has thought my name is Other. (But he also thinks my brother Raza’s name is Lazarus, so I really shouldn’t complain.)

So conditioned are my ears to responding to HEEtha, that often my ears perk up when I hear someone call out “Sheila.” Unfortunately for me, the house help of the lady who lives in the flat below us is called Sheila. The lady of the flat often calls out—loudly—for her at all hours of the night. “Sheila!” she yells at 3:00AM, “Sheeeila!” And poor little Heether in the bed one floor up, thinks her own name is being called and thus wakes up every time. Her husband, whose name has no resemblance whatsoever to the name Sheila, sleeps right through it.

Text messaging for public health?

2009-04-24T13:56:00.001+03:00

Yesterday, in the middle of a meeting, my phone beeped and vibrated, indicating I’d received a text message. After the meeting, I checked my phone and saw the following message:

MINISTRY OF HEALTH ALERT! POLIO IS BACK IN UGANDA. ENSURE CHILDREN UNDER 5 YEARS COMPLETE ALL 4 DOSES OF POLIO PREVENTION VACCINATION. FREE AT HEALTH CENTRES.

The message had been sent on behalf of the Ministry of Health by MTN, one of the big telecommunication companies in Uganda, in some act of corporate social responsibility.

I remember hearing about the idea of using text messaging to send out health messages when I was at Hopkins. And I remember thinking right away, how much information can you convey in 160 characters? What good could a text message do? What can a text message convey or prompt that a billboard, poster, newspaper ad, TV ad, radio ad, or interpersonal communication couldn’t do more effectively?

I subscribe to all these public health, health communication, HIV/AIDS, and FP/RH listservs. A few months ago, I got an email through one of these listervs requesting me to fill out a 5-minute survey on how I get my health information. On one of those mornings where the urge to procrastinate outweighs the urge to tackle an actual to-do list, I clicked on the link to fill out the survey. It asked all kinds of questions about how, as a public health professional, I obtain my health information. A few of the questions centered around text messaging: Have I ever received health information through a text message? How effective, on a scale of 1 to 5, do I think text messages are in passing on health information, etc. I have to admit, I gave it pretty low rankings.

In one of my recent blog posts, I wrote about a project spearheaded by Straight Talk Foundation to answer young people’s health-related text messages sent in to a hotline. This was the first time my ears perked up when I heard about text messaging for public health. Hmmm, okay, sounds interesting. Makes sense. Let’s see how it goes.

Yesterday, when I got the text message about polio, I had to stop and think. Polio is indeed back in Uganda (I blogged about it a couple of weeks ago), and the public does need to be informed of the risk. But is this effective? I certainly don’t think sending the text messages out hurt anyone or anything, but how many people did it prompt into action? Mobile phone use and ownership is relatively widespread in Uganda; you can now buy a brand-new, ready-to-go phone for $15, then load airtime as infrequently as you desire in increments of 25 cents. Amongst mobile phone owners, text messaging is a preferred mode of communication (I picked up my text messaging habit in Uganda, back when no one was texting in the US), and receiving an SMS is free. But did this SMS make it to the people who were most in need of its information? Or were the people who most needed to read it the ones who don’t own phones? The ones who live in communities where the MTN network has no coverage (like many of the communities I work in)? The ones who don’t read English?

Personally, I just couldn’t imagine myself hauling my (hypothetical) children down to the nearest health unit just because of that text message. Maybe if I were already contemplating taking them, the text message would have given me the extra nudge (can anyone say Prochaska and DiClemente’s stages of change model?).

Maybe the allure of text messaging for public health rests in its simultaneous speed and strength in numbers. With the typing of a few characters and the push of the send button, you can get information out to thousands or even millions of people, relatively inexpensively, in seconds.

I’m not saying that this text message was a bad idea. I guess what I’m trying to say is that I, personally, still need to be convinced of the relevance and effectiveness of text messaging in public health.

Touching lives

2009-04-23T18:44:00.000+03:00

Today, I broke the news to my staff at the Mubende field office that I will be returning to the US in early August to begin medical school. I explained that I was originally only hired in this position for 11 months (at that point we did not have the HIV grant, so there would not have been funding for my position beyond September of this year), and that I could not pass up this opportunity to further my education and pursue my dreams. I tried to frame it positively, and I emphasized the months that we still have together and told them I was confident that we would find an excellent replacement for my position.

The room fell silent, and everyone looked down at their feet. They were taking the news hard. In an effort to fill the silence, I kept talking about my decision and how hard it was to make, the process we’ll use to find my replacement, and how medical education in the US compares to that in Uganda. Still silence. And more silence.

Finally, one of the guards started talking very quickly in Luganda. I understood the gist of what he was saying, but it was not until his words were translated that I understood the full mean. He said that he was “in agony” because of this news. This is a staff member whom I helped relocate to a field office closer to his homeland, obtain a raise, and always check with him to understand his concerns. Other staff chimed in, maintaining that this was bad news. “We’ll never find another Program Manager like you,” they insisted.

After the meeting, my co-worker/housemate Lilian came to me asking if she could talk to me about something personal. I invited her to sit down. Immediately, her eyes welled up with tears. “But why are you leaving?” were her first words. I explained again, gently, telling her that it had been a hard decision, and that I would especially miss her, as we have grown quite close. I am working with her over the next few months to mentor her on her career path (she wants to pursue further studies in public health), and to help her research academic programs (diplomas vs. certificates vs. degrees) at various universities in Uganda.

I’ve now had the first bit of quiet time after a very long and hectic day, and I’ve spent some time reflecting. I guess I hadn’t realized the impact that I’ve had during the past 7 or 8 months and the fact that I’ve actually touched lives. Often I get overwhelmed with the little things required of a Program Manager--the reporting obligations, the setting up of monitoring and evaluation systems, the attending meetings, the financial reporting, etc, etc, etc--and lose sight of the bigger picture. Spending time in the field, deep in the communities reminds me of the larger impact that my efforts have on communities (think the Hopkins slogan: “Saving lives, millions at a time”…but on a smaller scale, maybe hundreds at a time?). Moments like today with my staff remind me of the deeper imprints I’ve left on a few people (in the spirit of the Hopkins slogan, shall we say “Touching lives, a few people at a time”…?). But I cannot stop to say that I have touched lives, full stop. My life has been touched too.

Lessons from the community: giving

2009-04-20T11:09:00.007+03:00

A young man bearing a basket of cassava.

I spent last week visiting both of our field sites. One of the activities funded under our new HIV/AIDS grant involves supporting the districts to reconvene their respective District HIV/AIDS Committees (DHACs, pronounced “Docs”). The DHAC meetings are intended to be a quarterly meeting in which district officials and other stakeholders come together to harmonize efforts to address HIV/AIDS in the district. However, due to lack of funding, both of the districts I work in have not been able to call the DHAC for years. Thus, you can imagine the excitement of one of the ditrict’s HIV/AIDS Focal Person, when I told him that the organization I work for had
a budget to support the DHACs. On Friday morning, I went into his office to talk numbers. I shared with him that we were able to provide 100,000 Uganda Shillings (around $50) per quarterly meeting over the next two and half years. Plenty of money to buy flip charts and notepads for all the participants, along with bottles of water. While I knew this would by no means fund extravagant meetings, I was not expecting just how short this budget would fall in terms of expectations from the district. He told me that it would cost 1.2 million Ugandan Shillings (roughly $600) for allowances alone, not to mention the cost to provide lunch, stationary, and other costs.

Let me pause to explain the concept of an “allowance” in Uganda. Here, the meeting culture includes paying a fee to all meeting attendees. This “fee” has a whole range of names, including “facilitation allowance,” “transport refund” (even when the fee is clearly not intended to actually refund transportation costs), or sometimes just “logistics.” Payment of these fees has become the norm, such that many people will not attend a meeting unless they are promised to be paid this fee. Never mind that the meeting they’ve been invited to attend happens during the working hours for which they receive a salary; never mind that attending these types of meetings is part of their job duties. Meetings don’t happen without “logistics.” The organization I work for does not believe in these allowances. Under certain circumstances, we pay allowances on the order of $3, actually intended to reimburse transportation costs. Other organizations pay allowances on the order of $30-$50 per participant, with some organizations paying double that figure. The allowance tradition is not something inherent to Ugandan culture. Quite the opposite, actually. It was a practice brought in by external NGOs and perpetuated by USAID and other funding bodies that continue to fund hefty allowances without deeply contemplating the consequences. Start doing the math and it’s no wonder these districts haven’t held DHAC meetings in ages.

A trip out to the communities to supervise our family planning community health workers (FPCHWs) tempered the frustration I was experiencing with the DHAC meetings. We did a house-to-house supervision of those FPCHWs who have been trained to give Depo Provera injections (injectable contraception). A Family Planning Community Health Worker proudly displays the type of syringe she uses to inject community members with Depo Provera.

These FPCHWs live deep in the communities, some of their homes not even reachable by vehicle. Their homes were modest but well kept, and these FPCHWs who are not paid a shilling for their work, graciously welcomed us to their homes and shared their experiences with us. They told us about challenges they had encountered and the joy with which they carry out their volunteer work, as we gleaned information on client visits and referrals from their register books. Here were people who have been given little, but are doing so much. Not for material gain, but from the goodness of their hearts.A family planning community health worker displays his Depo Provera community distribution kit.

And my heart almost melted when almost every FPCHW we visited gave us a gift as we were leaving their homes. A basketful of garden-fresh cassava from one; a round of sodas from another; a few sticks of juicy sugar cane from yet another; a bunch of freshly-picked chili peppers from the next; a large bag full of dried beans from the last. This tells you something about Ugandan hospitality and what it means to truly welcome someone into your home. It also contrasts sharply with the “big” people with big salaries who don’t like to attend a meeting unless it involves personal material gain. I wish that everybody could learn from the community members who have so little, but give so much.

Proud father and community health worker

A child happily chomps on his share of sugarcane, after his mother gave my team a few stalks to carry home.

The radiant and joyful daughters of one of our family planning community health workers.

Calling all behavior change communication enthusiasts!

2009-04-18T11:31:00.002+03:00

The other week I attended a round-table discussion for strategic health communication experts and implementers of behavior change communication (BCC) programming in Uganda. I’ve mentioned before that one thing I love about my job is the opportunity it provides me to engage in such national-level discussions but also to interact with local communities through regular field exposure.

A great number of NGOs attended this “think-tank” meeting, with the goal of sharing successes and challenges in implementing BCC interventions and exploring possible avenues for collaboration. (I liked what our USAID Senior Technical Advisor said about the three C’s: collaboration, coordination, and complimentarity between partners.)

Listening to all the various organizations share their experiences affirmed my thinking that there is some really fascinating work going on in the BCC world in Uganda! One example, which I’ve mentioned on my blog before, is PSI’s GoRed campaign, which encourages faithfulness, love and respect in marriage and mainly targets younger couples in urban areas. The PSI team presented data that Ugandan men are 5x more likely to be unfaithful than Ugandan women. They also presented data showing that 83% of married Ugandan couples are faithful (I find that figure a little bit hard to believe), but their point was that even though people perceive unfaithfulness to be the norm, there is a substantial percentage of married couples who are faithful. The PSI team explained how they are effectively trying to “steal” the color red, so that anytime you see someone putting on red, you can use that as a launchpad for discussion about faithfulness. I think they want “red” to become a catchphrase too, so that anytime a married person gets propositioned for an extra-marital affair, they can say, “I’m red.” (Red stands for Reliable, Exceptional, and Dependable.) Kampala is plastered with GoRed billboards, and the ads play in popular places like the Cineplex and on the TV screens at Nando’s. I always find campaigns that encompass changing norms to be extremely interesting, but challenging work. I think this is a very important issues in Uganda, where marriage is a risk factor for HIV acquisition.

Another neat example is some new work done by the Straight Talk Foundation, an organization that publishes free newspapers for youth (and now also for parents and teachers) on health, sexual and reproductive health, and other development issues. It tries to address these issues mainly through sharing true life stories of young people in the country. Straight Talk has enjoyed enormous success from its modest beginnings, and keeps growing and expanding. Its latest initiative, to be unveiled soon, is an SMS project in partnership with Grameen and MTN. Here’s how it works: a kid with a health concern sends a text message to a toll-free MTN hotline, and within a short time frame, they receive a text message from Straight Talk addressing their concern and also providing them with a list of clinics in their area that can assist them with that particular problem. The project has already been piloted at Kyambogo University, and will go country-wide soon.

Several organizations talked frankly about health communication strategies or materials that didn’t work so well. One organization pointed out that the currently nationally favored slogan for FP, “Plan a small, manageable family for a better life” sometimes implies that family planning is for the poor and that people who perceive themselves be well-off don’t need family planning.

The meeting was hosted by the organization where I did my master’s internship, the Health Communication Partnership. Although there has been quite a bit of turnover of staff since my internship days, there are a lot of familiar faces and people I fondly remember working with. It always catches me off guard when people I wouldn’t expect to necessarily remember me (me, the measly intern who toiled there for eight months over a year ago!), but everyone from the driver to the groundskeeper to the guy who started a week before my internship ended greet me by name and a smile.

In keeping with my pledge to make this blog more visually appealing with more pictures, here’s a photo someone emailed to me after the meeting.

I'm from here now

2009-04-14T13:03:00.001+03:00

I’m now back at work after a much-appreciated four-day weekend full of mingling, catching up with friends, spending time with family, hanging out, and R&R. One night (okay, actually two nights) this weekend, Kris and I went to hang out at Zone 7 in Bugolobi. On Thursday evening it was just the two of us, and when a couple asked if they could join us at our table we said definitely. They sat down and we exchanged niceties. The guy sitting across the table introduced himself to me, but I had I already known who he was. He is a rather well-known expat doctor (who will remain unnamed on this blog) who has made Uganda his home. An almost mandatory conversation point for any muzungu involves asking where they’re from. He asked me first. “The States,” I said, “How about you?” His response? “I’m from here now.” I loved it.

"I’m from here now" is a simple but powerful response. When people ask me the predictable small-talk questions that encompass “How are you finding Uganda?” “For how long have you spent in Uganda?” I never know quite what to answer. Sometimes, when I don’t feel like going into a long-winded answer, I keep my answers vague. “I’ve been here a long time,” is a response I typically use (but almost always this invites further questioning: how long? When did you first come?). Rarely, I give the person the low-down: “I first came here in 1986, and in the 23 years that have ensued since, I have spent a total of about four years here, on and off. In fact, I’ve spent more time here in the past six years than I have in my home state. Oh, and did I mention my husband is a Ugandan? Yes, this place is like a second home. Or maybe it’s just home.” You can imagine how tiring it gets to shell out that explanation every time you meet a new person who, by virtue of your muzungu-ness, feels obligated to ask how long you’ve been here. Thus the allure of, “I’m from here now.”

I’ve also been thinking lately about expats in Uganda and I’ve come to my own conclusion that there are essentially two types of expats in Uganda: the likers and the lovers (or lifers). Of course there are other categories of expats who come here, the tourists (including the gorilla-trekkers, the rafters, and the safari-goers), and the haters (the people who would be stretching it to claim they liked the place), but the majority of expats who spend a minimum of three months here fall into one of the above mentioned categories.

The Likers: There are many people who come here who genuinely like Uganda. They enjoy being here and make the most out of their experiences. They see the sights, hang out at lots of cool places, make good friends (mostly fellow Likers), and learn a few phrases of Luganda. But there is not necessarily anything about Uganda in particular that makes sparks fly. They could be equally happy, form the same types of friendships, see similarly exciting sights in Tanzania, Senegal, Haiti, or Thailand. Some of them are in Uganda for a year or two or three to get that living-in-a-third-world-country experience under their belt (a gem of perspective that will undoubtedly shape the rest of their lives and careers!); others find themselves in Uganda for a stint between other stints in other exotic locations (three years in Haiti, two years in Uganda, next they’re shipping their family off to Vietnam).

The Lovers (a.k.a. the Lifers): Then there are those expats who come to Uganda and fall in love with Uganda. Not the tourist attractions or the expat bubble, but actually fall madly, deeply in love with Uganda. The kind of love that could not easily be duplicated in Kenya or Indonesia or Guatemala or Cambodia. They form genuine, meaningful, lasting relationships with Ugandans and these relationships deepen their love affair with the country. They learn more than a few phrases of Luganda, and more importantly they come to understand and appreciate the many cultures of Uganda. Of course they’ve hit up all the tourist attractions too, but that is not why they are here. They’ve hung out in the expat spots (Bubbles, KLC, Igauna, etc.), but they often end up having more fun when they hang out in the non-expat spots. They believe that a love for Uganda must surely be infectious, and do their part to cultivate a love for Uganda in first-time visitors and the friends they have who may be Likers. They’ve probably already been in Uganda for at least a year or two; if not, they are the type that keeps coming back to Uganda (not to Africa, but to Uganda) four, five, six times. Uganda becomes a part of the fabric of their lives. They are the type of expat who you know will form a life-long love affair with Uganda, coming here for the rest of their lives, if not settling here permanently (hence the name Lifers). They may leave Uganda for stretches of time, but often as part of an effort to equip themselves with knowledge and skills (and sometimes savings) to better serve Uganda. They are the types who, as their relationship with Uganda grows and matures, can genuinely and proudly proclaim, “I’m from here now.”

Disclaimer: Whenever I write a blog entry that somehow categorizes expats, I feel a need to write a disclaimer (even though most expat bloggers (myself, at times, included) write blog entries that contain sweeping generalizations about Ugandans). I’m not saying that being a lover is inherently better than being a liker; there’s something for everyone and obviously not everyone who comes here is going to fall in love with the country and end up making it a part of the rest of their lives. Likers can have great, powerful, meaningful experiences here too, and in taking those experiences back home with them or to other countries, they have a unique ability to better the world from the perspectives and insights gained, and to broaden other people’s worlds by sharing their experiences with them.

Sadly, polio makes a comeback too

2009-04-07T20:49:00.003+03:00

In my last post, I wrote about the fantastic news that family planning is making a comeback in the international development and public health scene. But family planning isn’t the only thing that’s shown signs of revival over the past few weeks. Polio, which was eradicated from Uganda in 1996, is creeping its way back into Uganda via Sudan.

So far 7 cases have been reported in Uganda. The disease, which is transmitted by drinking water or eating food contaminated with the virus, is an import from Sudan. Poor sanitation around the Kampala-Juba highway, and increased cross-border traffic have contributed to its spread.

A polio-infected child presents with acute fever accompanied by weakness in the limbs, and can eventually lead to crippling and paralysis. The good news is the disease is preventable with a simple immunization, and key public health players in Uganda have already rolled out a campaign to increase polio vaccinations, especially in high risks districts. It would be tragic if this disease is not successfully contained and it instead spreads like wildfire throughout the country. Let us hope that Uganda’s efforts to eradicate polio in the 1990s are not undermined by the current situation.

Back to the FP comeback, there was a fabulous op-ed in the New York Times today that has been circulating on many-a-FP/RH-listservs. The piece, by Nicholas Kristof, frames family planning as a pre-requisite to poverty alleviation, maintaining we will lose the global fight against poverty if we do not step up efforts to increase family planning around the world. Echoing my previous post, the author talks about how FP efforts have lost momentum in the past years, and some of the reasons for its demise, namely the bad rep gained from coercive FP campaigns in China and India, the politics of abortion, and the difficulty of changing a behavior that is intimately entangled in social norms, cultural norms, gender norms, and contraceptive logistics systems. He goes on to talk about evidence that an opportunity is coalescing to regain lost momentum in global FP efforts.

It's comeback time!

2009-04-02T18:07:00.005+03:00

What did our FP/RH Senior Technical Advisor at USAID mean when she exclaimed, “FP is making a COMEBACK!” in a recent email? Well, in the international public health scene, topics and diseases fall in and out of fashion. Just like UGG boots. Or sideswept bangs. Certain topics (can anyone say HIV/AIDS?) hog all of the spotlight, leaving less sexy topics (e.g. sleeping sickness, and to a certain extent malaria) in the shadows. Sexy topics get huge bucks for programming and research, attract hoards of public health and medical professionals to fancy conferences, and often (even) have a celebrity face publicizing the issue.

Over the past couple of years, family planning (FP) has lost some of its sex appeal. It hasn’t become totally neglected, but there has been less funding available and has had less attention devoted to it.

But lately, FP has been on its way back up, and this makes those of us working in FP/RH very excited! We are seeing evidence of the upswing from Kampala. For one thing, the Bill and Melinda Gates Foundation and the Johns Hopkins Bloomberg School of Public Health (my alma mater) are organizing an international conference on FP right here in Kampala. It’s going to be a big deal, with lots of big wigs at it, and lots of interesting experiences shared. Sadly, it’s going to take place after I head back to the States to start med school, but I’m still working on preparing some abstracts to submit for conference presentations/posters.

Family planning was also the cover story of this month’s glossy African Woman magazine. I dutifully picked up a copy. While I was happy to see FP featured so prominently in this magazine--which targets mid-upper class, modern African women across East Africa--I found the articles to be a bit blasé. Oh well.

Perhaps Obama has ushered in some of this FP attention during the first months of his presidency. He revoked of the Mexico City Policy (which banned USG funding for international FP groups that provide abortion) and pledged to “initiate a fresh conversation on family planning, working to find areas of common ground to best meet the needs of women and families at home and around the world.”

Speaking of America, I recently read an article that said as the economic downturn has sunken in, vasectomy rates in the US have increased. Now, if only we could spread this pattern of thinking, so that people viewed family planning as making financial sense. “Plan a small, manageable family for a better future” is the current FP-speak in Uganda. This campaign was spearheaded by HCP during my internship days, and is still ongoing, with billboards and posters all over the country trying to make this case. “Fred” and “Bernard,” the poster boys of this campaign, model two different sets of family planning behaviors. The take-home message? Bernard is an FP user, and he has the extra spending money, healthful meals, and fancy wheels to prove it!
(What I love, is that I actually here people making Fred and Bernard references in towns across Uganda. When someone’s too broke to accept a let’s-grab-lunch invitation, they might say, “You go for Bernard’s lunch. But me, I’m having Fred’s lunch today.”)

Kampala tidbits

2009-04-01T10:10:00.002+03:00

I’m still smiling from my boda ride up Mbuya hill to the Kampala office this morning. I haven’t been to the Kampala office in nearly a month (spent a lot of time in the field, was down with malaria for a week and a half, and spent several days working from my home in Bunga). There’s something, for lack of a better word, empowering about my journey from town (post- Garden City workout) to Mbuya. Partly because this journey is in no way reliant on Kris and also because of all the familiar faces I see along the way. While I have been driving some, realistically I only drive in certain areas of town, usually on Sundays, certainly not in rush hour traffic, and not in the dark. That is pretty restrictive, and makes me fairly reliant on Kris to get around (of course, I could take matatu taxi buses everywhere, but it’s hard to psyche yourself up for it once you’ve been spoiled by a personal car, and I could zip around on boda bodas, but I value my life far too much). So that leaves me with Kris driving me around 80% of the time when I’m in Kampala. Except for my morning journeys to the Mbuya office.

After finishing up an hour long workout at the Garden City gym, I walk down to the Jinja Road taxi stage in front of Centennary Park (a 5-10 min walk). I know exactly where the taxis going to Bugolobi pull in, know the hand signal they use so I can spot them from a distance, and my ears tune into the particular call of a Bugolobi-bound taxi (sounds like “Zla, Zla, Zla, Bugolob, Zla,” actually it’s “Luzira, Luzira, Luzira, Bugolobi, Luzira!”). (By the way, by some strange coincidence everywhere I’ve worked in Uganda has been in the Bugolobi area, so I got this route down pat!) I hop in and enjoy moving in the opposite direction of traffic (everyone else is trying to come IN to town from the suburbs). I call “stage” at the appropriate place, slip the conductor a 500 Shilling coin, and start walking to my boda boda boys. Usually, I don’t even need to walk. They come to me. And not the way bodas in town swarm muzungus hoping to make a buck. These ones, they come to me because they know me, and they know where I’m going. Some of them even know my name (Heatha); others can’t seem to remember my name, but they call me nnyabo (Luganda for ma’am). Whenever I get called nnyabo, I do a little victory dance in my mind, for the simple fact that I am not being called muzungu. This pleases me immensely, especially when combined with some Luganda banter (“Gyebaleko, nnyabo.” “Kale ssebo, naawe gyebale.” “Ngo buze!” “Uuuh uh!” “Ogamba otya?”….) These boda guys, they know that I speak some Luganda, that I’m married to a Ugandan, that I work for an NGO, that I am up-country in Mubende and Ssembabule much of the time. I just sit on the back and they take me, no directions required, stopping right in front of my workplace’s gate on top of Mbuya hill.

Upon further reflection, I think the main reason I love this commute is because--for a few minutes of the day--I cease to be a muzungu (foreigner) but become, even to relative strangers, a woman, and a woman who is capable, adapted, and fits right in.

In other Kampala news, Nakumatt (Kenyan-based chain of stores a-la-walmart), which was rumored to be opening in February still has not opened (I blogged about this in December). But every week you can see major progress on the structure, the landscaping, and paint jobs, so I think it will be opening soon (hopefully before I leave in August?). The prospect of a walmart-esque store in Kampala both excites and appalls me. The convenience, variety, and bargains are appealing, but the thoughts of an over-commercialized society and the demise of mom-and-pop (maama-ne-taata?) shops are scary. (Oh, and the traffic jams it is bound to cause, unless by some miracle some stellar traffic planning has gone into the place). It does somehow symbolize, to me at least, that Uganda is “up there” on the development scale (I don’t know when I started to measure development by number of large shopping centers), that we’re on par with the Kenyas and the Tanzanias. I’m not sure how long it’s been up, but today I noticed for the first time a billboard for Nakumatt right in the roundabout up to Garden City “Experience Uganda’s first 24-hour shopping experience. Opening soon.” Hopefully by “soon,” they mean before I head back to the States for med school because I want to check it out!

In further Kampala news, a few weeks ago I wrote about how sad I was that Owino market burnt down. I went on and on about the tragedy and bemoaned the prospect that it may take months, if not a year, for Owino to rebuild and to replenish its stock of secondhand clothes, shoes, and just about anything you could ever think of. Boy was I wrong! A week and a half ago, Kris and I ventured into Owino in search of a 70s outfit for Kris to wear to his office theme-party. The place is already re-built, and built nicer than before (wider walkways, pointed roofs covered in tin (rather than makeshift tarp coverings). But the part I wasn't expecting was that it is completely re-stocked as well. Where do all those clothes come from??? We're talking tons (not just lots, but metric tons) of clothing amongst other items galore. I was beyond impressed. We chatted with some of the vendors about the fire and thanked them for their work in re-building the place. They shared their stories of that fiery morning. One woman credited the police for saving her life. If the police had not been there to physically stop her, she said she would have run in to retrieve her goods, and probably would have met her death in the process. We left Owino with a great tie-dyed button up shirt with a big collar, and some super flared polyester pants for Kris!

Of PEPFAR and BBC

2009-03-31T20:42:00.002+03:00

Our new HIV grant was awarded by PEPFAR (the President's Emergency Plan For AIDS Relief), which, incidentally, used to be referred to as the "Bush monies" (after former president Bush) in Uganda, although thankfully that colloquialism died several years ago). So today I spent the day at a PEPFAR partners meeting at Hotel Africana. I think I've mentioned this before, but one of the things I **love** about my job is that it allows me to play on the national public health field, rubbing elbows with major (and minor) players in public health in Uganda, being involved in policy, and feeling like I have a voice in all of it.

Several years ago, I did my undergraduate honors thesis research on Uganda's efforts to scale up access to antiretroviral therapy (ART). I was passionate and excited about the topic. It set off all these blinking lights and fireworks like no research topic ever had before. The experiences I had in Uganda those years (2004-2005) undoubtedly shaped my interest in both public health and medicine.

Anyways, PEPFAR was an enormous contributing factor in Uganda's efforts to scale up access to ART. Over the last few years, my public health interests and work in Uganda has moved away from treatment (to broader areas of sexual and reproductive health, family planning, and other areas of HIV/AIDS), but being at this PEPFAR meeting today had me reminiscing about the emotions the access to treatment movement elicited in me, and the educational and professional path it set me down.

The HIV program I am currently managing for the NGO I work for does not include treatment; it is focused on home-based, palliative care and nutritional support to people living with HIV/AIDS, support to orphans and vulnerable children (OVC), and youth prevention. I am grateful to gain some experience in these domains, but still keep an eye on Uganda's efforts to scale up access to treatment.

Today I learned that in 2004 (when my interest in ART provision was sparked), PEPFAR supported 26,415 people in Uganda living with HIV/AIDS with ART; in 2008, that number had risen to 130,837 (surpassing the national target for the year by over 13,000). Of course there is still a long way to go to ensure that everyone who needs ART has access to it, but this is pretty impressive growth. Outside of PEPFAR, there are other funders providing AIDS treatment in Uganda, but in 2008 PEPFAR provided funding for the vast majority of individuals on ART (PEPFAR accounted for 130,837 out of the total 143,542 people receiving AIDS treatment last year). If I had to choose something that former president George W. Bush did that I am proud of, it would definitely be PEPFAR.

Sadly, the global economic downturn and other factors, leave the future funding levels of PEPFAR somewhat uncertain. Today Mike Strong (the PEPFAR Coordinator for Uganda) cautioned PEPFAR partners that we are entering a new era that requires us to be even more cost-effective and to set targets that are realistic in the face of future budgets. He said that we cannot anticipate further dramatic increases in PEPFAR funding over the next few years.

In other news, Kris and I, the complete dorks we are, are still buzzing from Kris' 60-seconds of fame when he got put on air for the BBC's "World Have Your Say" program over the weekend. He called in to give his two cents about the Brazilian president's comments that the credit crunch has been caused by "light-skinned, blue-eyed" people and whether such a comment was racist. He's tried calling in to BBC programs in the past but this is the first time he's gotten through and put on the air--very exciting! We are total BBC-addicts.

Right now we're eating leftover homemade baked pasta (with decent cheese and textured vegetable protein, both purchased in Uganda(!!) and both surprisingly yummy!) and sipping a new drink concoction: freshly squeezed passion juice concentrate over diet 7-Up and ice! Oh, and there's a pineapple upside-down cake in the oven (guaranteed to be delicious if made with a fresh UG pineapple). Kitchen activity always spikes on the days when we beat the traffic jam and get home by 5:30 or 6pm!

Basking in free time

2009-03-29T16:16:00.003+03:00

One of the things that scares me about medical school looming in my near future is that I am going to have to live a life completely devoid of free, leisure time. In fact, soon after hearing about my acceptance in the freak-out and am-I-really-cut-out-for-this-? stage, I started mourning the loss of my free time. I went to the extreme, spending entire Saturdays vegging out watching pirated television series (Lost, Boston Legal, Desperate Housewives, Ugly Betty) for no good reason other than that I knew I wouldn’t have that luxury in medical school (…but is that extent of sloth a luxury?? Usually I love being busy, actually!).

Anyways, I know that in medical school I will have some free time, and in order to be successful in med school while staying sane, I will have to find a way to balance studying and school responsibilities with fun, stress-relieving activities and time with family and friends.

Now that I’ve progressed into this can’t-contain-my-excitement stage as med school approaches, I’ve been really trying to enjoy my free time, and do more meaningful things than just watching TV series.

One thing that I’m really enjoying is reading! I’ve ordered a bunch of books and novels off of amazon, which some UWSMPH 4th year med students en route to Uganda agreed to carry for me, so I can do some inspired reading about medicine, medical school, doctors, etc. before school starts. I’ll share some reflections on those titles once I get my hands on them and have some time to read them. In the meantime, I’ve been reading lots of non-medical books and novels. I’m still reading Love in the Time of Cholera by Gabriel Garcia Marquez and really like the book, and especially the case it makes for doctors to be trained in public health! But it was a little slow, so I took a break and, in the span of 48 hours read Anna Quindlen’s Black and Blue, a novel that chronicles the life of a woman in an abusive relationship. It was an excellent book and helped me understand more about “battered women” and why they stay in abusive relationships and the courage it takes to leave them. Now, I’m reading Monica Prahdan’s Hindi-Bindi Club, a fun, lovely novel about some first- and second-generation Indian Americans. The book is really resonating with the quarter of me that is Pakistani, and I am flying through the book!

I've continued reading through other blogs written by current and former med students to psyche myself up. One that I really like is The Island Med Student, written by a current 3rd year med student, documenting her first two years of med school on the island of Dominica and her last two years of med school in New York.

I’ve also been trying to spend more time with friends and doing fun things. I’ve been being more social in Mubende and making some great friends there. I’ve been trying to re-connect and spend time with friends in Kampala whom I haven’t been able to spend quality time with in months for various reasons. And I’ve been doing fun stuff with Kris. Last night we went out to the movies and saw The International (which, although violent, was very exciting and thought-provoking), then we went out to Kampala’s newest night-club, T1, and drank Kampala’s newest drink, Alvaro. T1 was nice, not too much different than Silk or Ange and located near them in the industrial area, but it was smaller and--the part I loved--the majority of it is smoke-free (smokers, are relegated to a small, lower level room). I always used to love the fact that you could go out in Kampala and not come home reeking of cigarettes. This is no longer the case. Tragically, smoking is on the rise (and there is limited focus on this in the public health arena), and bars, clubs and restaurants are filled with smoke. Thus, the smoke-free nature of T1 was refreshing. Alvaro is a non-alcoholic, carbonated beverage served in a sexy beer-like bottle, marketed with the lines “make a statement” and “be unique.” Last night, not in the mood for drinking, I tried Alvaro for the first time. It was delicious! Not as sweet as soda, and flavored with pear! Yummy!

Other things I’ve doing in my free time? Cooking and baking, doing yoga, working out, and planning a couple of vacation get-aways before we head back to the US. I was also excited when I figured out how to upload the little map thing on my blog, so I--and you--can see where my readers are!

I’m also hoping to gain some more clinical exposure during my free time. In particular, I would like to spend a few days, over the course of the next 4 months, shadowing some doctors in Uganda. I plan on asking my father-in-law to hook me up with some practicing doctors who don’t mind being shadowed for a day by an incoming med student.

I'm starting to like this whole Mubende thing...

2009-03-29T14:28:00.005+03:00

I’ve had quite the productive, fun, and interesting week in Mubende. I’ve been productive, after missing a solid week of work from my bout of malaria. I got a lot accomplished this week, including submitting a revised version of our workplan for the HIV/AIDS grant based on feedback from USAID Washington, the USAID Mision in Uganda, and District partners. I feel like I’m getting back on track.

This has also been one of the most fun weeks I’ve had in Mubende. Monday was my co-worker/housemate Lilian’s birthday, so we took her out to Mubende esteemed International Pork Centre (a glorified name for your typical pork joint). Although I had to carry in chips and a omelette from a neighboring take-away restaurant since I’m a vegetarian, the atmosphere inside was very fun and there was a group of about 15 of us. From there we moved on to one of the bars in town for a few rounds of drinks and the guys gave us a push back up to the house/office compound, which has affectionately taken on the name of “California.” (Why not call it California, instead of Minnesota??)

Tuesday one of our intern’s cousins was in town and it happened to be her birthday, which gave us an excuse to throw a big party at the house. This was the first party I had hear. We cooked up a feast (matooke, rice, cassava, spaghetti, peas, beans, meat, eggplants, greens, cabbages), provided a few drinks (wine, amarula, waragi), listened to music and talked and laughed for much of the night. I learned a new game, called “juke box.” A box filled with slips of numbered paper gets passed around, and whoever is stuck with it when the music stops has to reach in and grab a paper. The number on the paper corresponds to a question on the MC’s questions list, ranging from trivia to riddles to tell-me-about-your-most-embarrassing-moment-type questions. If the person got the question wrong or refused to answer it, they had to get up and dance in front of the whole group. It turned out to be loads of fun!

It was the same gang of people Monday night and Tuesday night, so I feel like I really solidified some friendships. Guys, girls, work colleagues, non-colleagues, all educated, fun-loving people who have graciously let me inside their little clique. What a privilege to be able to make so many fun Ugandan friends!

The week has also been very interesting. In revising this workplan, I had to meet with some district officials to get their input into program design and program planning and to see where their priorities laid. I had some really interesting conversations and learned a lot. Today, I went to a very remote sub-county of Mubende called Butoloogo to supervise the ongoing quarterly supervisions of our Family Planning Community Health Workers. Some of the Family Planning Community Health Workers that came for the Quarterly Supervision in Butoloogo.

Beautiful Butoloogo sub-county. (By the way, can you see why community members often don't buy the argument that we need family planning to avoid running out of land?--look at all that free, open, green space!)

To get to Butoloogo, you pass through Madudu, which I just learned is the sub-county with the highest concentration and greatest number of poisonous snakes of all the sub-counties in Uganda. (Okay, nice to know.) In all of Butoloogo sub-county, there is only one house with an iron roof, and people talk about its owner like you would talk about royalty, marveling over his clothes and his two boda bodas. Most of the houses are made of mud, with thatched roofs—even the police post and prison were mud, thatched roofed structures! Those mud huts in the above photo? Three of them are prison blocks and the fourth is the Butoloogo sub-county police post!

After the quarterly supervision and training on how to lead a radio discussion, we went with a little boy to his home to buy ghee (turned out, there was none but an interesting adventure nonetheless), then stopped at the health center for a tour. They had the neatest handwashing contraption, where you step on this stick with your foot, and a jerry can of water automatically pours. (Took me back to the good ole’ days of the JHSPH water and sanitation class!)

Washing my hands with the neat little contraption.

p.s. I've realized that my blog has been looking a little dry lately due to lack of pictures--partly because I do a lot of posting via blackberry and I haven't figured out if it's possible to upload pictures when using the the BlackBerry blog entry uploader-thingy. So I've included several snaps (as they're called in UG) on this entry, and have also gone back and added some to recent entries. Enjoy!

p.p.s. When I typed in heathaliketheweatha.blogspot.com this morning, I got taken to some sort of Bible College religious page??? I don't know if I kept typing it in with a typo, or if some religious fanatics are trying to take over my url! If anyone else has this problem, let me know!

To diarrhoate?

2009-03-24T16:49:00.002+03:00

A behind-the-scenes shot of Mubende program staff maneuvering our puppets! This was just done in my house/office compound as a practice, but it still attracted quite a large crowd of on-lookers, who peered over the wall from a higher vantage point on the hill. (What does this tell you about puppets? They are instant crowd-pleasers and puppet shows require little mobilization--crowds just form!)

Anyone who's spent considerable time in Uganda—especially those of us who work in the public health arena—has most likely picked up on a uniquely Ugandan English verb: to diarrhoate (as in, to have diarrhea).

No, my inspiration for this blog entry was not prompted by a bad spell of diarrhea that came with my malaria (thankfully, diarrhea was not among the symptoms I experienced last week). Rather, this was inspired by a training we held a few weeks ago on how to use drama and puppetry for community health education. As a practical exercise, I tasked my staff with developing some short skits related to water and sanitation, and let's just say the verb to diarrhoate featured prominently. Phrases from the skits included "Wash your hands, or else you will diarrhoate!" and "Last week I diarrhoated and diarrhoated!"

First of all, I've chosen to spell this verb with an "o" because the British spelling of diarrhea has an "o" in it: diarrhoea. I always say if I weren't a public health specialist/aspiring doctor, I would be a linguist. The linguist in me led to a little investigation into the etymology of this oh-so-Ugandan verb.

In Luganda, the noun for diarrhea is "ekidukano"; the verb to have diarrhea is taken directly from this noun and is "okudukana". Luganda speakers, then, follow the same pattern in English. They take the noun "diarrhoea" and verb-ify it so it becomes "to diarrhoate"!

In discussing the fascinating etymology behind this verb with my husband, we got slightly off topic. In the past, I had shared with him that in my tween years just the mention of the word "turd" would send me and my cousing Josh into a fit of giggles. Well, Kris said that in his childhood just the utterance of the Luganda word for poop—"bbi"—would elicit the same level of giggling. For some reason, I found this very, very funny. Bbi!!!

S e n t f r o m m y B l a c k B e r r y ® s m a r t p h o n e

Malaria Diary: Days 6-8

2009-03-20T12:00:00.006+03:00

(Written on Day 8, at the very, very, very beginning stages of feeling "back to normal")

The last few days have been so horrible, I don't even know where to start. Maybe I'll start with quoting a blog entry I wrote on Day 5, Tuesday, and then didn't have a chance to publish because I took a second, more dramatic turn for the worse. On Tuesday I wrote, "I have a confession: It wasn’t as bad as I feared it would be. The thought of getting malaria for the first time in twenty-something years scared me...While by far my subjectively worst sickness experience in Uganda (or maybe in my life) was the food poisoning episode in 2004, this malaria was pretty bad and I was pretty miserable for several days. However, personally, I’d rather be lying around with chills and a splitting headache (my malaria experience) than puking my guts out (my food poisoning experience)."

Oh, how I wish I could take those words back. On Wednesday morning I woke up feeling exactly the same as I did on Friday morning: glued to my bed, achey body, swirling head, cramped up stomach. I tried to talk myself out of it, telling myself, "you're fine! you're just imagining these symptoms!" I even went into the office for a few hours and then nearly collapsed from exhaustion and dizziness. By the time I internalized how bad I had gotten, I didn't know if I would make it on foot to the Mubende AAR clinic. Somehow, with Lilian holding my arm, I made it there. The doctor commented that I looked very weak and much worse than I did the first time. I did another blood test. My malaria parasite level had actually increased from the first time my blood was checked. (Every single red blood cell in my body was, at this point, proliferated with 2-3 malaria parasites!) Obviously, the first line of treatment had failed. He offered me an injection of artemethur in my buttocks, then I got a ride back to my Mubende home and crashed. By that time (6:00pm), it was bordering too late to travel back to Kampala (organization policy states no travel on major highways after dark), so I decided I would travel back to Kampala and straight to the main AAR hospital first thing in the morning.

That night was, by far, the worst night of my entire life. Knowing I would probably have trouble sleeping because of my fever and discomfort, I popped a benadryl (along with 3 panadols) at 7:30pm and got in bed at 8:00pm. Usually, benadryl works like magic for me: 45 minutes after taking it, I fall into a deep sleep and wake up about 9-10 hours later. Well, not that night. I spent the next 11 hours grimacing and moaning through waves of spiking fevers, shaking chills, intense abdominal cramping, severe headache, and so much dizziness I actually thought the room was spinning. Every little noise anywhere in the house (a door squeaking, my housemate coughing, frogs outside making frog noises), elevated the pain in my head. Every few minutes, I re-dipped a washcloth into cool water and placed it on my forehead; I was so hot the washcloth heated up instantly. I kept looking at my clock every 10 minutes, wondering how it had only been 10 minutes since the last time I looked at the clock. I kept catching myself actually grimacing and clamping my teeth together in pain. My mantra for the night: "Heather, you just have to make it to morning; try to relaaaax." At some point in the middle of the night, I have vague memories of my housemate coming into my room and making me drink another glass of juice. Sometime around 5:30am, I finally managed to drift to sleep, for about an hour. I woke up at 6:30am, ecstatic that my departure for Kampala was only an hour away. I looked in the mirror and almost didn't recognize myself: sweat had plastered my hair to my head, my skin was pale, my eyes had this lifeless look in them, and there were what looked like saucer-sized, dark bruises around each eye from lack of sleep/fatigue.

I got into the car and lay across the backseat. Two hours later, I was at the AAR main hospital in Kampala. Kris was there to meet me. AAR Kampala is lightyears ahead of AAR Mubende. The former reminiscent of a nice, small hospital/clinic in the US; the latter, a dark and dingy bat-infested place (but I wasn't complaining at the time, for I knew this was the best medical care available in Mubende). I really liked the doctor in Kampala who saw me, and even if he hadn't done anything to make me feel physically better, he comforted me through the way he interacted with me, his knowledge, his concern (and also the fact that he knows my father-in-law). I handed over the records from my two visits to the Mubende clinic and he took a history and asked about the progression of the disease and how I was currently feeling. Given that I have been taking mefloquin as malaria prophylaxis, the Kampala doctor felt that the Mubende doctor had made a very poor choice of first-line treatment, and had also given me an inappropriate dosage. This was why the first treatment had failed.

The shmorgusboard of (inneffective) treatments I received in Mubende. I got sent home with four vials of an artemesin-derivite along with needles, that I was supposed to find someone to jab into my butt every day. By the way, the doctor in Kampala informed me that the Mubende clinic sent me home with a child's doses and pediatric needles!)

[By the way, here's how my first encounter with the Mubende doctor played out...
Dr: "How are you feeling? You have fever?"
Heatha: "Yes, and--"
Dr: "Any vomiting?"
Heatha: "No, but--"
Dr: "Let's take you to the lab and get you tested for malaria."
Heatha goes to the lab, gets her finger prick, and comes back 10 minutes later with results.
Dr: "You have malaria. I'm going to give you treatment. You prefer tabs or injection? Or I could even put you on drip."
Heatha: "Well, um, I don't know. What type of injection?"
Dr: "Oh, you fear injections? Then I'll give you the tabs."
Heatha: "No I don't fear injections. But, if you think the tabs are best, then--You know, this is my first time to get malaria, so I am very worried. I've been taking malaria prophylaxis."
Dr: "You can't be serious?! First time?! Ha! Let us give you these tabs and you'll be fine. If not, come back and I put you on drip."
Not exactly the gold-standard of doctor-patient communication. And, in retrospect, I realize he chose the treatment very arbitrarily, mainly concerned with what form it came in (tabs vs. injection), and unexperienced to judge what a first-time malaria sufferer who's been on prophylaxis might need. This helps explain why the first treatment failed but instead allowed the malaria parasites to come back even stronger in their second cycle.]

Back at AAR Kampala, the doctor decided to admit me and put me on a "drip" (IV fluids) to help restore my strength. I think this was the first time in my life I've been on IV fluids. He gave me a second, stronger dose of the antimalarial injections that had been started in Mubende, and tabs to take for the next few days. The great news was that by the end of the day, blood tests revealed no more malaria parasites in my blood!

I am now at home, working on regaining my strength. Although the malaria is gone, I still have this headache and feel weak and utterly exhausted. Likely a combination of the side-effects of the anti-malarials (I still have to finish the treatment, even though parasites are gone), and my poor body just being so worn out after this loooong week.

Conclusion? I wholeheartedly retract the statement I quoted above from the never-published blog entry: this malaria experience was far worse than I expected and hands down the worse sickness experience of my life. Forty-eight hours of puking my brains out (the infamous 2004 food poisoning episode) sounds quite attractive now!

Malaria Diary: Days 3-5

2009-03-17T08:59:00.001+03:00

(Written in bits and pieces Sunday-Tuesday)

Well, I took a turn for the worse soon after I wrote my previous blog entry. The symptom that by far has made me the most miserable and that's been the most relentless has been this severe headache compounded by severe dizziness. It's hard to disentangle what exactly is caused by the malaria and what are side effects of the malaria treatment, but all I can say is it's been pretty awful. The last few days are a blur, all blending into one another.

There's three ways I can think of to describe the state of my head for the past few days.

1) Have you ever been on that carnival ride called the "Gravitron" (or something to that effect)? It's this circular UFO-looking contraption that you get inside of and stand up against a padded wall. They turn on the machine and the thing starts spinning so fast that the so-called centrifugal force (I know that's not really a force, but give me a break, my brain's not working) makes you stick to the wall like a strip of Velcro. Sometime in my youth, I took the regrettable opportunity to ride on the Gravitron, and let's just say it was a horrible experience for me that ended in vomit. Well, for the past 2-3 days, I've been on a Gravitron ride that just won't end. Somebody stop the spinning--I want off the ride! My head is spinning like it's never spun before; I am dizzy, so much so that I actually feel like I have motion sickness.

2) Have you ever been seasick? I haven't but this is what I imagine being seasick feels like. A constant rocking motion that throws off your balance, your clarity of mind, your sanity and makes you feel slightly nauseous. And maybe, for good measure, let's say that I am not just any seasick ship passenger, but that I am also terribly hungover.

3) I feel like there's an elephant sitting on my head. That's how heavy my head feels.

Actually, maybe we should combine all three of those descriptions to accurately capture what I've felt like the past few days: a hungover carnival-goer on the Gravitron, spinning on a boat as it crosses the ocean, with an elephant sitting on my head. I just want the spinning to stop! So terrible were these sensations that when my husband (who wanted to surprise me by driving down from Kampala to Mubende to take care of me) walked into the room when I least expected it, I thought I must be hallucinating!

Okay, so maybe I got a little carried away with these analogies and added embellishments here and there. Bottom line is, I've felt pretty icky. Luckily I haven't been overly nauseous since the first couple days, so I've been able to eat and drink and keep it all down; if I hadn't been able to, the doctor in Mubende offered to come to my house and put me "on drip" (IV fluids) in my own bedroom. Although I was touched by the offer, I was glad to be able to avoid the drip.

S e n t f r o m m y B l a c k B e r r y ® s m a r t p h o n e

Malaria Diary: Days 1-2

2009-03-16T10:15:00.001+03:00

(Written on Saturday (Day 2) in a rare moment of lucidness…)

I knew it was only a matter of time before this happened. I'm living in a country where more than 90% of the population live in malaria-endemic areas, and my job involves travel to areas where malaria is highly endemic. Furthermore, I've watched my staff, friends, colleagues, and husband all experience the effects of malaria; at least once a month, I have a staff member who is "down with malaria" and misses up to a week of work as a result.

The onset: Thursday night (in Mubende) I was unusually sleepy at an early hour (8:00pm), and with a headache setting in, I decided to turn in early. My alarm went off at 7:00am Friday and I could not get myself out of bed. Even though I'd had an astounding 11 hours of sleep, my body would hardly move. I felt nauseous and spent the next few hours fighting the urge to vomit, willing myself not to vomit (luckily, I never did). I lay in bed for several more hours, overcome by achey muscles and that pin-pricky feeling you get when a fever is setting in. Since my home is in the same compound as the Mubende office, I gathered up the strength to pull myself at of bed at around 11:00am and put in a few hours of work. I had to excuse myself from the office when I realized that I was lightheaded, dizzy, not thinking clearly, and had a throbbing headache. After a two-hour nap, little workaholic me, convinced this was just some sort of "strange African bug" that would pass, I went back to the office and put in a few more hours of work. The nausea had subsided but I still had no appetite. I finished up what I was working on a 6:00pm and almost collapsed into my bed.

"Come on," my Ugandan housemate and co-worker, Lilian said, "let's slope down to the clinic to see the doctor." My reply? "No, I think I'll be fine. I just need to rest. I'm sure I'll feel better by morning." But she wouldn't take no for answer. "The doctor travels back to Kampala later tonight; if you don't see him now, you won't get a chance the whole weekend. Come on, we're going." I caved. Got dressed, put on a jacket, grabbed my AAR health insurance card, and we slowly made our way to the AAR clinic in Mubende (a private clinic, by far the nicest clinic in town). I was surprised by how quickly and easily I got winded and how slowly we had to walk.

To be honest, I had agreed to pay the doctor a visit more out of the interest of checking out the clinic to see what is was like in case in the future I was actually sick and needed to go there. I was still convinced that this was nothing, that I was wasting Lilian's time by making her accompany me to the clinic. Afterall, this was Lilian's third trip to the clinic in two days; she had spent the last two nights sleeping at the clinic with a friend who had such a bad case of malaria she had to be admitted on a "drip" (IV fluids). I described my symptoms to the doctor: nausea, fatigue, achey muscles, fever, chill, headache. He took my blood pressure and pulse, then sent me off to the lab. The lab technician asked me if I "feared needles" and when I said no, pricked the tip of my ring finger with a needle, squeezed my finger, and smeared a few drops of blood on a glass slide. A few minutes later, she handed me a slip of paper with some sort of lab jargon scribbled on it and sent me back to the doctor.

"You have malaria," he told me. "Uh oh," I said. "I've never had malaria before." (Which was actually a lie because I did have malaria when I was two years old and my family was living in Uganda in the 1980s, but I didn't want to go into all those details. The point was, I hadn't had malaria in twenty-something years, and thus have no immunity built up to it, like people living here do because they're constantly exposed to it.) Anyways, I think the doctor thought I was joking when I told him I'd never had malaria before; that was just unfathomable. When I asked him whether this was going to be really bad because I'd never had it before, he didn't quite no how to respond. A lot of questions were unanswered.

He prescribed me Artequin, a new artemesin-based combination therapy, along with panadol (Tylenol) and multi-vitamins and sent me home. (I didn't have to pay a shilling, thanks to my health insurance coverage.) I thanked Lilian profusely for having insisted I visit the clinic; had I delayed getting treatment, the outcome could have been a lot worse. Lilian insisted I drink an entire pitcher of freshly squeezed passion juice with my first set of tabs before going to bed, saying I needed the hydration and the energy. I obliged and then slept, waking up every hour or so from the burning muscles.

This morning the nausea has somewhat subsided, although my stomach is still cramped up. I mostly just feel completely devoid of energy, have a splitting headache, am still sweating and chilling from a fever, and all the muscles in my body ache so badly I want to scream. I keep cat-napping, and every hour or so Lilian is bringing in another glass of juice and another plate of food for me to at least try to eat even though I have no appetite. It's too bad I don't have appetite because it's lots of yummy Ugandan things: katogo (chopped and boiled green bananas cooked with tomatoes and beans), millet porridge with milk and sugar, pineapple and bananas.

Anyways, that was probably way more detail than anyone cares to know about the first bout of malaria that I have memory of. I do feel like this was a long-time coming, and now at least as a public health person and a future doctor, I have lived experience of what malaria actually feels like. I'll update again tomorrow or the next day. For now, I'm going back to sleep.

S e n t f r o m m y B l a c k B e r r y ® s m a r t p h o n e

Electricity woes the cause of Uganda's population crisis?

2009-03-13T08:09:00.001+03:00

The other day, I cam across an article in the New Vision that reported some politician had pointed his finger at the country's electricity problems as the cause of the high population growth rate. This politician's logic? When people don't have power, they go to bed early; when people go to bed early, they, um, procreate.

One of my FP staff members was riding in the vehicle with me and I had to share my amusement with her. "You'll never believe this," I started as I read her the article, expecting her to find it equally laughable. Her reply? "It's true. These people have nothing else to do when there is no power. They eat dinner and they're in bed by 7:30PM." I thought she was finished, but she continued. "It's even worse in the dry season. At least in the rainy season people are busy farming all day an0d come to bed tired, but in the dry season they go to bed with too much energy. In fact, that's when most babies are conceived."

Okay, so why are we spending so much time working to involve men in FP, change gender norms, and get religious leaders on board to support FP? We should focus our efforts on electricity supply!

S e n t f r o m m y B l a c k B e r r y ® s m a r t p h o n e

What does grief sound like?

2009-03-11T21:13:00.001+03:00

Monday morning brought sad news to my organization: Mukasa our Ssembabule driver for nearly 15 years had died, after battling esophageal cancer. The burial was to be the next day at 2:00pm. I was to be there to represent my organization.

Mukasa was a wonderful man. Gentle in character, a joy to talk with, and with an extremely strong work ethic (he insisted on reporting to work daily, even months after his cancer had robbed him of strength and appetite, chiseled kilograms off his already slim frame). Although you may not have guessed it from his profession--driver--he was an educated, eloquent man. He used to constantly surprise me with knowledge and astute observations, all delivered in perfect English. In his early 40s, he was a caring man, the type of person who looked out for his fellow staff members and dug into his own pockets when others were in need. He was a devoted father of 8 children: 7 boys, and 1 girl.

Several months ago, after he was no longer able to report to work, he invited me to his home to talk about his medical condition and future work prospects. It was a simple home, set in a lovely area about 20 minutes drive outside of Ssembabule town, adjacent to a primary school teeming with schoolchildren. Although they didn't have much, his wife offered me a cob of freshly roasted corn to munch on as we sat and talked under a tree.

Yesterday, I found myself sitting under that same tree, staring at a casket with a framed photo of Mukasa in more healthful times. It was my first burial in Uganda that took place outside of Kampala, and it was different than all of the funerals and burials I've attended in and around Kampala and revealed some of the more traditional burial rites that have been passed over, shortened, or modified in the capital-city setting. I had expected that, since the burial was taking place outside of a tiny town in an off-the-beaten-path District, and since Mukasa was a driver who perhaps did not have too many friends, that it would be a small gathering. I was wrong. There were probably close to 1,000 people in attendance, which blew me away. This is what community means, I thought.

As I was sitting under that tree, surrounded by hundreds of others who had come to pay their respects, I started focusing on the sounds. This made me wonder, what does grief sound like? And I quickly came to the conclusion that grief sounds different in different cultures.

Sounds. The sound that struck me the most sounded almost like a kissing sound. But it's not a kiss, but rather what is referred to in Uganda as a jeer. Sucking air in through your teeth and lips, used to convey desperation, dismay, grief, disgust, something incomprehensible. I opened my ears and, as various people were telling stories about Mukasa, I realized that these noises were coming from all around me. It was most pronounced when Mukasa's father spoke. His message (in Luganda, of course) was simple: my son resembled me in every way--appearance, manners, habits. He was an extension of me. Now he is gone. The touching, simple message elicited hundreds of jeers from every direction.

The sound of wailing. Not just crying, not sobbing, but wailing. The haunting, heart-wrenching wails of a widow who will never see her husband again, who has no idea how she will provide for her seven boys and one girl.

Sounds. The reading of letters and text messages. After those present shared their stories about Mukasa, a man with a stack of letters from various people whose lives Mukasa had touched were read out over a megaphone. The letter from his primary school principal. The letter from his best friend in secondary school. The letter from his colleague at a former job. The letter from a relative who could not travel from Kampala. The letter from the hospital that treated him in Masaka. The letter from the Local Councilor (local-level politician). The letter from his neighbor growing up. When the man got to the bottom of the stack of letters, he started reading all the text messages that had poured in expressing grief and condolences from various parties.

It was an emotional day, even more so because this burial took place exactly one day before the fourth anniversary of my own father's death. How differently we grieve, how differently we go through burial rites of our loved ones, how differently we talk about death in different countries and different cultures. I have been somewhat fixated on cross-cultural differences in grieving and thinking about death and dying since losing my dad four years ago when I was living in Uganda. There are practices I perceive as problematic in American society (e.g. not talking about death), as well as problematic practices in Ugandan society (e.g. this push to "move on" which often deprives people of the opportunity to fully grieve). Having had the opportunity to observe the grieving process and to grieve in both cultures has made me realize there is no perfect way to grieve. It's always hard, but there are usually mechanisms available to shoulder the burden.

S e n t f r o m m y B l a c k B e r r y ® s m a r t p h o n e

Anxiety turns to excitement, with medical school on the horizon

2009-03-09T13:12:00.004+03:00

It’s official: I’m returning to the U.S. in August to begin medical school at the University of Wisconsin School of Medicine and Public Health (UWSMPH). I got my acceptance letter in November, but Kris and I just decided more recently that we want to go back this August, rather than deferring for a year.

To be honest, when I first got my acceptance letter (via blackberry!), as soon as my initial excitement wore off and my heart rate slowed down, a wave of panic swept over me. Gulp, am I really cut out for this?, I thought. This anxiety stayed with me for a while, but it eventually subsided and has been replaced by sheer excitement. I find myself getting so excited I can’t concentrate on work. My brain keeps fast-forwarding to August (although I’m sure by September, my brain will keep rewinding to March, wondering why it can’t have the carefree life of a Program Manager based in Uganda!). Of course the excitement has always been there; it was just momentarily clouded over by the wave of anxiety that came when it dawned on me what exactly I was getting myself into. I think that some of this excitement was once again coaxed out when I received news that my school has selected me to receive a very hefty scholarship for all four years of school. This news helped chip away at the anxiety, as I started to think, Okay, if they think I'm deserving of this amazing scholarship, maybe that says something about me really, indeed, being cut out for medical school...I can do it, and I'm suddenly uncontrollably excited about the challenge!

I’m sure that I’ll be riding a roller-coaster of anxiety and excitement all the way through to the first weeks of school. But I know that this is normal, so I’m just sort of riding out the emotions, and enjoying this time before I start.

I’ve actually been reading through several blogs written by medical students, documenting the medical school process, the process of becoming a doctor. I’ve already had somewhat of an “insider’s view” into medical school, since my mom is a professor at UWSMPH and I’ve interacted with many of her students and residents over the years. I also took a fascinating class at McGill called The History of Objectivity of Medicine, which among other things, documented the socialization of medical students in medical school. (I’m sure future blog posts will probably refer back to this class, as it was one of the coolest classes ever, and the class where I learned the concept of epistemology and really stopped to think about medical knowledge!)

Anyways these blogs have provided me with the day-to-day happenings and given me some further clue about what to expect. Two recommended blogs are Over My Med Body! (written by a Stanford medical student who finished his medical education in 2008) and Panda Bear, MD (written by an M3 med student). In addition to forcing me to think about my personal/professional transformation that lies ahead, these blogs have also made me think about the importance of blogging and the power that blogging has to document the journey of becoming a doctor. One of the things I do know about med school is that you go in thinking one way and come out not just equipped with knowledge, but a whole new way of thinking. You go into medicine with certain reasons and a healthy level of idealism, and many students come out having lost touch with those original intentions. Thus, I would like to take this opportunity to publicly declare, that I fully intend to keep heathaliketheweatha going through med school. Over the next few months, I want to document some expectations, fears, excitements, and other pre-med school ruminations, so I will always know how I went into med school.

Reshaping manhood

2009-03-08T09:33:00.001+03:00

A few years ago, when I was here for my Master’s internship, I provided technical assistance to a Ugandan NGO working to redefine manhood or masculinity under the “Be a Man” campaign, which is still ongoing. I thought it was extremely important and challenging work, for changing social norms is in my opinion one of the most difficult tasks in public health. This campaign set to a realign what it means to be a real man. Among other things, it re-cast real men as those who love and respect their wives, play active roles in their children’s lives, support their wives to use family planning, and drink responsibly. Now those notions go against some very deeply rooted social norms: that masculinity is defined by the number of children you have; that it is perfectly acceptable for men to cheat on their wives (but not for wives to cheat on their husbands, of course); that drinking excessively is a display of manhood; that domestic violence and gender-based violence is acceptable; and that men don’t need to play a nurturing, supportive role in family life.

Anyways, this Be a Man campaign has continued and is well known in Uganda, and it has certainly crept into subsequent work I’ve carried out in Uganda, including my current work in family planning. When we try to champion men’s involvement in family planning, we are going against some very strong social and gender norms. And quite honestly, until those norms can be shifted, it will be difficult to make any substantial or sustained progress in changing the associated behaviors. PSI Uganda just launched a big campaign called RED (Reliable, forget what the rest stands for), but it is basically trying to promote fidelity by showing the rewards of fidelity and casting faithful men as the type of men you should look up to, respect, and emulate. I think it is a great campaign and it draws to mind a lot of the participatory research I did for my Master’s thesis on multiple sexual partners among young men in Uganda.

But one thing I’m really happy about is that I am married to a very different sort of man, one who embodies everything (and more!) that these public health/social norms campaigns are trying to achieve. I feel lucky and proud that Kris is a role model to so many Ugandan men, and that a lot of other men and couples look up to us. Sometimes the things Kris does draw stares or jokes from the guys (he doesn’t drink; he always talks about his wife, he keeps a framed wedding picture on his office desk; he makes a deliberate effort to balance family time with other demands; he takes his wife out on the weekends; he speaks out against domestic violence), but that doesn’t stir Kris. On a few occasions, I’ve had to ask Kris to back off from some joking that perpetuates a certain type of manhood. For example, recently Kris jokingly teased his brother for being present at the birth of his first child. Very few Ugandan men support their wives through childbirth, and Kris cracked this joke about not believing his brother could go watch the birth (even though Kris will definitely be there for the birth of our children!). Anyways, everyone knew Kris was joking, but I encouraged Kris to apologize because we, as role models and educated people who know better, have the power to help reshape social and gender norms by simply not participating in the activities that perpetuate them.

There’s a certain waiter at Nando’s (fast food restaurant, right in the city center), who has admired Kris and I as a couple for a long time. When he finally had the courage to come and talk to Kris, we found out that he had been watching us and put two and two together and realized we were a married couple, and a really loving/supportive one at that. He basically confessed to Kris that he thinks we are a great couple, that he looks up to us, that watching us interact together has made him think about the way he interacts with his wife. Kris keeps several wallet-sized wedding photos in his wallet, and one day while paying for a pizza, this waiter caught a glimpse of the mini-album in Kris’ wallet. With Kris’ permission, he flipped through the wallet photos, taking it all in. Last night we were at Nando’s again, and the waiter came and said a friendly hello like he always does. Then he asked if he could show us his wallet. He took it out and he had put together a wallet-sized album of his wedding pictures. “I got this idea from you,” he told Kris. “I want everyone to see that I too am happy with my wife.”

Amazing. I’ve carried out all this work and maintained such a strong interest in these big public health campaigns to shift norms, but now here was one man demonstrating real, tangible, inspired change. Everyone knows the power of role models. But what an amazing thing to stop and realize that you are somebody’s role model.

(P.S. I just realized this is an excellent day to post a blog entry on gender norms--it's International Women’s Day!)

Gripe time: Call it what you like

2009-03-05T22:28:00.001+03:00

My life in Uganda is cyclical. While I generally love Uganda and think it's fabulous (aside from the traffic jams), every now and then I go through phases where Uganda just frustrates me. One of the frustrations that comes and goes in cycles is the annoyance of always standing out, of being a muzungu in Africa, of constantly being stared at, and being assumed to be a "visitor."

I've been coming to Uganda for a good portion of my life and have lived in the country for several years, so I am certainly long past the shock of sticking out like a sore thumb and being called muzungu by passer-bys both young and old. You quickly learn to not mind it and with time learn to ignore the stares and you eventually develop this armor that makes you feel like you can do anything without caring what anybody thinks (cultivated by the feeling that, if everyone's going to stare at me no matter what I do, there's no point trying to fit in, and I can do whatever I want!). Sometimes I indulge the children who chant "how are you muzungu" with a wave, or call out "by-eeee!" to the children who say bye to me. I sit there obligingly--no fit involved--when I'm traveling by matatu taxi and then feel the fingertips of children and adults, gently stroking my hair. My hair is quite different, what harm is one little stroke to satisfy their curiosity? Sometimes I give the staring men a stern "ki ki?" or "olina kizubu ki?" or "otunula ki?" if I feel like displaying some attitude, before proceeding with my normal life. Sometimes I chuckle to myself, now that I understand so much Luganda, when I listen to the comments random people on the street have to say about me (e.g. "akazungu kalungi nnyo!"). Usually, all of this is amusing, and it's all taken light-heartedly with no stress.

But when I hit the 5-6 month-mark of being in Uganda without a break, I start to grow extremely tired and frustrated by the whole sensation. I've never know quite what to call it, but recently I've heard two phrases that resonated. First is that this is the "fishbowl effect." As a muzungu in Africa, you sometimes feel like a fish swimming around in a little glass bowl, being observed and picked apart by anyone and everyone, constantly scrutinized, with every move watched. You want desperately to be out of the fish bowl, to just be another fish in the ocean where you wouldn't be such a big deal! Another person recently described the sensation as the "celebrity-ness of being white in Africa." While some whities who come to Uganda naively comment, that now they know what discrimination feels like (for them, discrimination must boil down to being stared at), I always maintain that what we experience in Uganda is in many dimensions the opposite of discrimination. We are put on a silver platter, treated like celebrities for no good reason. People will bend over backwards to attend to you, they assume you are ultra-important, and are extremely high-maintenance. And yes, they stare. Sometimes they stop, stare, continue walking, then turn back for a double-take. But no, they don't stop there, they then turn back and stare a third time, sometimes even squeezing in a quadruple take. I get it, we look different and there is something intriguing about that--but all the staring, all the bending over backwards gets to you.

When my frustration with Kampala peaks, the so-called fishbowl effect becomes draining. The way I describe it to Kris is that a very simple activity (say, walking to the matatu stage, flagging down a taxi, crawling into the taxi, calling out "sitegi," paying the conductor, and making your way out of the taxi) becomes an energy-sucking activity, when you have people staring at your every micro-move, calling things out to you, talking about you in Luganda when they're sitting right next to you, and taxi conductors relentlessly trying to overcharge when you know the price because you take that taxi every day. Don't get me wrong, these activities aren't always energy-draining; the burden is only cyclical.

Recently some Ugandan children who live in the same apartment building were overcome by a case of muzungu-fascination. While I used to be a friendly neighbor with a name, suddenly these young children have resorted to calling me muzungu, and when they see me coming home, they whisper to one another, "Come, let us go and watch the muzungu." My husband gave them a stern lecture the other day. Come on, people. I'm your neighbor! Not some specimen to be studied. And I have a name, which you know!, so don't call me muzungu!

Another pet peeve is when people constantly "welcome" me to Uganda, assuming I'm some tourist who's come to trek gorillas and then will be flying back to my own country. But I live here, and I've spent a lot of time here over the years. I do not need any further welcoming to Uganda. Often when Kris introduces me as his wife, the first question people ask is, "Oh, how are you finding Uganda?" and the second question is "is this your first time here?" My new reply involves the phrase, "well, actually I fell in love with Uganda before I fell in love with Kris."

The really frustrating thing for me (during these frustration-peak periods), is that no matter how hard I try to fit in (learning local languages, speaking in a Ugandan English accent, learning all the Ugandan slang, slowing down my pace of speech, slowing down my walking speed, etc, etc), I will always stick out like a sore thumb. People will always stare.

S e n t f r o m m y B l a c k B e r r y ® s m a r t p h o n e

A tribute to Owino

2009-03-04T09:07:00.001+03:00

What I consider to be one of Kampala’s must-see places (at least for a true Kampala experience), Owino market, burnt to the ground last week. I have so many memories there and have bought so many secondhand clothes and shoes there over the years.

Driving into work last Wednesday around 6AM, Kris and I noticed billows of smoke rising from somewhere in the part of town I frequently refer to as the under-belly of Kampala. (Don’t know why I use that term, I just do!) With wide eyes, we wondered what was possibly on fire. Then I got sucked into the workday, and was up on top of Mbuya hill in our very much insulated-from-Kampala country office and didn’t think twice about the smoke. When Kris picked me up, he gave me the news: Owino was no more. Eh eh?!, I exclaimed.

For those who don’t know, Owino market, popularly known simply as “D.T.” (in reference to its downtown location) is--or rather was--a maze of stalls squashed together selling everything from secondhand clothes to herbal medicines to pots and pans to used bras to gently-worn shoes and belts, bedsheets, camping gear, household items, and pretty much anything else you can think of. There is stall after stall of miscellaneous goods (mainly used) and all built willy-nilly out of a combination of wood, used tarps, and sticks. The place has always screamed “fire hazard” and whenever I’m in the narrow, crowded, muddy passageways being elbowed by people trying to work their way through the maze, escapability has always been a chief concern. If everyone had to get out of that place--fast--there would most certainly be deaths involved. Anyways, it’s all part of the charm of Owino and the price you must pay to find cheap, nice, unique secondhand clothing! This is also why I consider Owino market to be an essential “initiation” experience for visitors and new folks in town. Some newbies love the place, find it exhilarating and interesting and entertaining; others get mild panic attacks, feel suffocated, and are fearful. Whenever you emerge from Owino--several tens-of-thousands of shillings poorer, with a bag full of precious finds--you are absolutely drained of energy. The place just sucks it out of you.

My first trip to Owino was in early 2005, when Doreen took me there to buy some jeans and going-out tops. I’ve been back at least 2 dozen times, with Doreen, Maude, Teddy, and other visitors and friends over the years. I had formed relationships with particular vendors, whom I could call in advance, let them know what I wanted, and knowing my size, they’d scout things out ahead of time. And I have oh-so-many memories in that place! That is where Maude and I coined the acronym “YMS,” which stands for “Yes, my size!” which is what men call out to you when they like the way you look. We would keep track of how many times we got “YMS’ed” with every trip into Owino. In addition to have men grabbing my arm after every few steps, YMS’ing me or asking me to marry them, I also once had a woman reach up my shirt and rub my stomach! (I guess she just wanted to see what a muzungu stomach felt like.) Maude and I kept a running Owino Wish List, where we would jot down items we hoped to score in Owino in the future. Although I’ve never been there with Kris, a good percentage of the market vendors recognize me and know that I am married to a Ugandan man, that a can stumble my way through a conversation in Luganda, and that they cannot get away with overcharging me!

The miraculous thing was that nobody was killed in this fire. Had it happened at any other time of day, there could have been a death toll in the hundreds. The ridiculous thing is that there is a fire station within eyesight of the market, but because of a lack of water and lack of access routes to the congested market area, they watched the whole thing burn to the ground. 20,000 vendors’ livelihoods were wiped out with that fire. While there have been pledges of money from the government to help rebuild, most worry that the money will never make to the vendors because of corruption. While truckloads of donated construction supplies have been dropped off to rebuild the market, rebuilding commenced without any planning and with no efforts to decrease congestion and improve access routes. While the rebuilding is already well underway, it will probably take months or even years for vendors to re-stock their stands. Sadly, I don’t think Owino will ever be the same.

Boot camp for USG-funded programs...at the Sheraton

2009-02-19T22:30:00.001+03:00

As part of the new grant my organization has been awarded, I went through a rather intense launch conference last week in which I learned the nitty-gritty of how to manage US Government funded programs. My organization was one of 19 organizations (out of 800 applications) to be awarded PEPFAR (President’s Emergency Plan for AIDS Relief) money earmarked for smaller organizations with less experience managing USAID-funded programs.

To be honest, the content was semi-dry, with all-you-ever-wanted-to-know (-and-more!) about compliance, US Government rules and regulations, audits, procurement, cost-share, PEPFAR reporting requirements, and filling out the SF-269 and SF-270 forms. While rather tedious, it was all actually extremely pertinent information—stuff that usually organizations just have to figure out on their own, and now here we were getting detailed instruction on it. There were also some very interesting sessions on managing human resources, monitoring and evaluation, organizational development, experiences from previous grantees, etc. So overall, it was worthwhile, but intense and at certain points grueling. Which is I why I have taken to referring to it as USG-funds boot camp!

All useful information, but also overwhelming. At one point towards the end of the conference, one of the facilitators did a mood check-in, asking people to describe their current emotional state. Overwhelmed. Anxious. Scared. Panicked. Excited. Like a computer with memory full. If nothing else, we were flooded with the reality of what is to come over the next three years of the grant and all of the work and attention to details involved in that journey. Amidst all the angst, one of the facilitators told us a little story. A story about a family in rural Uganda that she formed a personal connection with through previous work, a story that embodied why she works in public health, a story that put perspective on all the details, a story that made her want to work harder, delve deeper. I think this is important. Sometimes we get caught up in all the details, reporting, deadlines, meetings and we forget why we went into this line of work in the first place.

It was exciting to be at this conference with other smaller- to mid-sized NGOs from all over the world based in North America, Africa, Europe, and doing work across Africa, Latin America and the Caribbean and beyond! The networking opportunities were fabulous and the socializing lots of fun as well (enhanced by the obscenely high USAID per diem, which I sadly did not get since I happen to be based in Uganda). Oh, and did I mention the whole thing took place at the Kampala Sheraton, and Kris and I got to sleep there for a week? (This made me realize how much I miss living in town. Traffic in Kampala is nightmare-ish! Forget my previously blog-documented dream to own a home on a hill with a view somewhere in an outlying neighborhood of Kampala. Maybe I actually aspire to a house in Kololo.)

Please avoid storytelling in here

2009-02-07T12:09:00.000+03:00

One of important preliminary step in launching a new community health program involves lots of meetings with various stakeholders at the District level as well as other nonprofits engaged in similar work. This past week, I made courtesy calls on many interesting and important people in the two districts where we are preparing to launch a three-year program to address HIV/AIDS. The importance of these meetings cannot be understated. They build community approval and ownership of the program, lay groundwork for future collaboration, guide us in shaping our program to match local priorities, and help ensure harmonization rather than duplication of efforts to address HIV/AIDS.

In Mubende, after meeting with several district officials, my colleagues and I eventually wound up in the waiting room to see the Chief Adminstrative Officer, or CAO (pronounced “cow”), who is sort of like the governor of the district. There was a long line of people there to see him and another group of people engaged in a lengthy discussion with the CAO behind a closed door. A notice had been posted on the door:

NEW POLICIES:
1. ONE DELEGATION/PERSON AT A TIME. THIS QUICKENS CONSULTATIONS AND AVOIDS DISRUPTIONS.

2. PLEASE AVOID STORYTELLING IN HERE.

This posted notice greatly amused me, especially the point about no storytelling, and the fact that they would post that as an official notice. This was up there with my other all-time favorite posted notice in Uganda, which was a notice posted on the outside of a bathroom door on a clinic, reading:

ABSOLUTELY NO LONG CALLS.
- MANAGEMENT

This is only funny if you know what a “long call” is in Uganda. Let’s just say taking a short call is like doing “Number 1” on the toilet, and taking a long call is doing “Number 2.” It was highly amusing to see this posted as an official policy. They must have had some pretty nasty or pretty clogged toilets to prompt them to hang that sign!

Anyways, back to the CAO. We waited patiently and it was finally our turn to go in and see him. My delegation entered, shook hands, signed the visitors book, introduced ourselves and our organization, and had an interesting discussion about building public-private partnerships and the need for making an integrated plan to streamline efforts to address HIV/AIDS in Mubende.

But then, here’s the funny part: he started telling stories! When our discussion turned to the focus of our other program in Mubende—family planning—he went on and on talking about how culture is such a funny thing and telling stories of men who refused to support family planning. “Look at the birds,” they always say, “they just lay their eggs any time, and over the course of a bird’s life, it lays so many eggs. You see, it is natural to have large families. Family planning is unnatural.” The CAO had an interesting response to this fairly common argument that points you to the birds: “Yes, some birds may lay many eggs, but what about the most beautiful bird of all, the dove? The dove produces only two eggs in its lifetime. If these birds can plan, what about you?”

On the way to school...

2009-02-06T16:00:00.001+03:00

School is back in session, a fact that certainly has not escaped our notice, with the hundreds of energetic primary school children making noise again at a school near our home in Bbunga, and the unbearable traffic jams that bracket the school day.

I’ve often watched the various ways children get to school in Uganda and thought about the levels of safety, comfort, and trust in the community involved in each way.

Parents who have the means (own a car, know how to drive, have time in their day to fight traffic, have money to fuel the car) often drive their kids to school. But this is not so common.

More commonly, children are sent off (often in pairs, with an older child holding the hand of a younger sibling) in matatu taxis. I’ve often been impressed with the care and kindness many taxi conductors display in assisting unchaperoned young children on what seems like a daunting journey to school. These kids have to flag down the right taxi and squeeze their way in, pay the conductor, tell the conductor where exactly where to stop, and then proceed on foot to school. Parents are confident enough in their childrens’ ability to negotiate all this and arrive safely in school; they trust that taxi conductors and other kind souls will watch out for their children when they are miles away.

Frequently, I see parents load up their children on a boda boda, entrusting their children’s lives in the hands of boda boda drivers who often (in my opinion) do not drive as if they are carrying the most precious cargo. Sometimes, when I see mothers send their young children off on boda bodas, I think “how could they?” until I think about the circumstances that lead to such decisions.

And then there are the children who walk to school. In Kampala, this involves crossing terrifyingly busy streets and avoiding all kinds of obstacles along the way. I smile as I watch children holding hands as they walk, looking out for one another. I also smile when I see strangers take the hand of a child and help her cross the street. What parent in America would trust society enough to send their child walking across a big city? I cringe when I see overly confident youth march right in front of oncoming traffic, with their hand held out to stop the traffic. Usually the cars are able to stop in time, but can these wee ones accurately gauge risk in these situations? In rural areas, walking to school often entails walking miles (I don’t know about up-hill both ways, Ugandan certainly has its share of imposing hills) barefoot through all the elemements. Sometimes this happens on little dirt roads or foot paths where cars never pass; other times, it happens on the edge of a highway, where vehicles overspeed and taxis pull on and off the shoulders without always seeing the school children. With frightening frequency, I read about school children who were killed by speeding, careless matatu taxis.

When I see (rich?) expat parents in posh suburban neighborhoods (Mbuya, Munyonyo, Kololo) send their children off to the International School of Uganda in fancy, air-conditioned buses rumored to have bullet-proof windows and leather-upholstered seats, I also raise an eyebrow, as I think, “would I really want that for my kid?” To travel around in an insulated, climate-controlled bubble, with a high degree of oblivion about the Africa that goes on all around them? Of course I’d want them to be safe, but, at what cost? What other safe alternatives exist that aren’t prohibitively expensive?

The vastly different modes of going to school speak volumes of the inequality in Uganda. I wish that all students had safe means of getting to school. And often think about how my future children (if they should have the privilege of spending at least a sliver of their childhood in Uganda) would get to school. (And also, of course, the question of where I would send them to school!)

Friends don't let friends...ride bodas.

2009-02-01T19:43:00.003+03:00

Friday night, I'm stranded in town and there's a big jam on Ggaba Road. I have a dinner date with my two best friends in Kampala. I call them to tell them my situation and that I'll be late. "Just hop on a boda! You'll be here in 5 minutes," Maude suggested. My reply: "I'm not going to risk my life to get there a few minutes earlier. I'm coming and I'll get there eventually." Three hours later, I would be immensely grateful that I stuck my ground, adhered to my principles, and refused to get on a boda.

Fast forward 3 hours later, after a lovely dinner for three at Le Petit Bistro (amaaazing salads--hard to find in Kampala). Kris picks me up and we drive home, get changed to go out. 10:30 PM and we get back in the car and drive the short distance (maybe 1/2 mile) from my house to Maude's, along a not-too-busy stretch of Ggaba Road. We see the crowd gathered first, the telltale sign of an accident in Uganda (everyone wants a glimpse or a long stare). As we get closer we see pools (and I don't mean drops, I mean pools) of blood on the road. I look to the right and see the lifeless, blood-soaked body of a boda boda driver (or possibly a passenger?) He was wearing a helmet but that wasn't enough. The helmet was cracked in two. His face was mush, there were guts outside his body. We drove on, our tires leaving bloody tracks beyond the scene. My mood to go out was deflated. I couldn't get the accident off my mind. If I had followed my friend's suggestion, that could have been me. That could have been me dead on the side of Ggaba Road at 10:30 on a Friday night.

1:30 AM, on our way back from the bar, the crowd, the body, the police were all gone. But the blood was not. Even in the black of night, we could see the large stains of blood on the pavement and little shards of glass. That night it rained hard and long. The next morning when we drove past the accident scene, there was not a trace of blood or glass. The rain had cleared it all away. Just like boda-boda frequenters must clear away such images in time to carefreely, confidently hop on the back of another boda-boda.

This weekend's fruitless search for baking powder

2009-01-26T21:52:00.000+03:00

Kris came down to stay with me in Mubende this weekend, which was sandwiched between two consecutive weeks of fieldwork for me. It was his first trip to Mubende, and my first opportunity to introduce him to my staff (who frequently and enthusiastically mention that "this is Omukyala Lukolyo and she is married to a Ugandan" when they introduce me to anyone from workshop attendees to community members and community partners), show off what I do, and host him in the lovely, hillside home I occupy when in Mubende. He came down on a Friday afternoon and left today (Monday) mid-day, since it's a public holiday. His friend Henry, equally eager to escape from Kampala for the weekend, came along for the fun.

On Friday I took the boys to the finest restaurant in town (with a view to write home about), the Town View Hotel. We had dinner and drinks there. We had grand plans to hike up to the Nakayima tree, eat at the second-finest restaurant in town (at the Nakayima hotel), hang out at the club (called The Club), and more. But alas, those adventures shall be saved for Kris' next trip to Mubende because our weekend was, for the most part, marked by gloriously utter laziness, illuminated by round-the-clock electricity thanks to the inverter that was installed for the house and office on Thursday. We watched movies on my lapotop, played several matches of Scrabble, read novels, cooked lots of good food, and ate all that good food. (One thing I'm excited about is that Lilian, my house-mate co-worker, taught me how to cook on a charcoal stove. We prepared pumpkin, yams, and sweet potatoes wrapped in banana leaves (to lock in moisture and add a subtle but delicious flavor) over a small ceramic stove, heated by charcoal. It was fun and yummy!

Our weekend wasn't total laziness. I abided by my recently instated rule to leave the house/office compound at least once per day when I am in Mubende (otherwise, I could just stay inside this walled compound and never go out! I live here, I work here, I have basically everything I need here and whatever I don't I can just send someone for). On Saturday Lilian took us to the Mubende market day, which sets up every Saturday near the army barracks. I hadn't had the privilege of going to the Mubende market day yet, but have eyed its skeletal remains--consisting of crudely-constructed-out-of-sticks stand after stand on the side of an otherwise bare and muddy hill--that sit abandoned every Sunday-Friday. Kris wasn't too keen on going (What are we even going to buy?) but I insisted in the spirit of adventure and in an effort to break him out of his Kampala bubble. (Kampala doesn't really have market days, per se, like these other smaller towns and communities in Uganda. Every day is a market day in Kampala!). We waited out rain for half the day and went as soon as the sun started shining, which made for an extremely muddy experience. I've been to market days in other, smaller communities around the district and the Mubende market day was about the same (perhaps slightly bigger). I even saw a calendar stand selling Obama calendars (among other themes) set up adjacent to a stand selling monkey tails, turtle shells, strange stones, and herbs--I saw the same two stalls neighboring each other at the market day in Kasambya a few months ago. It made me wonder if it's the same vendors and same merchandise that just travels from little town to little town over the course of each week--like a traveling circus. We ended up just buying yams, sweet potatoes, eucalyptus leaves (boil it in tea for a wonderful flavor), and mangoes. It was more for the experience.

With high hopes of fulfilling a lazy-Sunday tradition, Sunday morning we set out in search of baking powder (or even baking soda) so that I could make banana pancakes. FYI, should you require baking powder or baking soda in Mubende, bring it from Kampala. After visiting the three best stocked "super"markets (I don't know if they should actually be called super) in town, I concluded that there is no baking powder in Mubende (or if there is, it's really hard to find). We did, surprisingly find several (dusty) cans of sugar-free red bull and diet pepsi--items that are rare enough in Kampala that you have to know where to go to find them--although I imagine they ended up in Mubende by some fluke and nobody here particularly wants to buy them or know what they are. (I happily bought them--and dusted them off at home.) Lesson learnt: for the next lazy weekend in Mubende, pack some baking powder.

S e n t f r o m m y B l a c k B e r r y ® s m a r t p h o n e

Awesome. President Obama.

2009-01-20T22:29:00.001+03:00

It is a good day.

And I will always remember where I was at this moment that will define a generation. I watched President Obama take his oath and deliver his inaugural speech from a small but popular—and packed beyond capacity this evening—restaurant in Mubende, Uganda. I write this entry as the emotions are still sizzling, my head still whirling as I try to grasp that this is reality.

Lilian (my coworker and housemate) and I strolled down the hill from the house to the restaurant, which had DSTV and CNN, at about 7:30pm Uganda time (11:30am Eastern Time in the US). The two-roomed, two-TVed restaurant was already packed. No one was there for the food. Lilian and I took the last two remaining chairs and set them up in the front row.

As 8:00pm approached, dozens more people squeezed in so that their eyes could also witness a moment in history. Excitement, genuine interest, pride, and anticipation filled the room. Somehow my presence there, as an American, validated the experience for the Ugandan viewers. Now they were not just witnessesing a moment in history, but were witnessing a muzungu witnessing her moment in history.

Just like I did on election night (which turned out to be a very early election morning, Uganda time), I felt blessed to be able to view this moment through a different lens. Through an African lens, an East African lens, a Ugandan lens, a global citizen lens. Yes, it would have been amazing to have been in DC to watch the thing unfold before my eyes, but watching it on a TV screen hooked up to a generator in some dingy restaurant in a small town in Uganda will certainly be memorable.

When the instrumental piece was performed ahead of the President's oath, the crowd died with giggles and shrieks of joy when Obama gave that little wink to an unknown person. (He just radiates coolness, doesn't he??). When he turned somewhat awkwardly to watch the musicians above and behind him, viewers shouted in Luganda "Banange, turn the man's chair around so he can see properly!" When one of the speakers mentioned that Obama is the son of an African immigrant, the room erupted in cheers. (The thought, 'he is one of us and anything is possible!' seemed to float through the air.)When President Obama made a slight slip-up during his oath, my fellow viewers did not notice. They were far too mesmerized.

As the President began his speech, a whispering of the gravity of the moment started to trickle in. I need to re-watch, re-read, and re-live that speech in order to fully appreciate it and identify the lines that rang most truly in my heart. Being in Uganda amongst Ugandans, we felt as if Obama were speaking directly to us as he said "To all other peoples and governments who are watching today, from the grandest capitals to the small village where my father was born; know that America is a friend of each nation and every man, woman and child who seeks a future of peace and dignity, and that we are ready to lead once more."

And in this way, the American dream becomes more than an American dream, and more than Americans share in that American dream. Soon after President Obama's speech concluded, my phone started getting flooded with text messages from friends congratulating me on my new president. One friend's message: "Smooth seas never make skillful sailors. And because it's so, Obama will be a great president. Congratulations and God bless America, but at one time let him also remember Uganda."

S e n t f r o m m y B l a c k B e r r y ® s m a r t p h o n e

Like Driving on Ice

2009-01-19T22:18:00.000+03:00

Today I traveled from Kampala to Ssembabule, a trip I've taken many times before, but never with so much slipping and sliding. The dry season is coming to an end so we are starting to get big rains again. This morning it rained and rained and rained, especially this side of Ssembabule. By the time we reached the marram (dirt) road that leads from Masaka to Ssembabule (90 minutes' drive on a good day), the road was in horrible shape. Thick, slick mud on upward slopes and downward slopes of hill as well as flat parts of the road. We watched a big pick up truck slip and slide its way off the road and into a ditch right in front of us. We watched a sedan (sans four-wheel drive) do a 360 spin through a muddy patch. Even with our four wheel drive on, I felt our vehicle losing traction as skidding through inches of mud. Richard, my driver—just like I learned in high school driver's ed in case of skidding on ice—skillfully steered the vehicle into the skid and managed to bring it to a stop with only a 120 degree spin. At one point there was a traffic jam (which is weird because this is in the middle of nowhere). We were behind about 5 other vehicles waiting patiently for their turn to inch slowly down a muddy slope. About ¾ of the way down the hill, there was a car that had lost control and gone into the ditch. We couldn't start making our way down until the 3-4 cars partially up the hill made it all the way up—which required the assistance of several gum-booted villager by-standers who lent a hand in pushing these vehicles up the treacherous slope, all-in-all a grueling 45 minute task. Finally it was our turn to engage the four-wheel drive and ever-so-carefully make our way down.

We made it to Ssembabule 2 hours behind schedule with probably an inch-thick coat of mud covering most of the vehicle! At least we were safe. Tomorrow we venture onto equally muddy marram roads for the 3-hour drive (on a good day) from Ssembabule to Mubende.

I came to two conclusions during today's drive:

1. Driving on muddy marram roads is a lot like driving through a slushy-snowy-icy mix in Wisconsin!

2. I think I hate mud much, much more than I hate dust.
S e n t f r o m m y B l a c k B e r r y ® s m a r t p h o n e

It's one of those weeks....

2009-01-14T17:19:00.000+03:00

I’m having a typically packed Kampala week. Oh, how many of these weeks I have had. Leaving home before the sun is up (i.e. 6:00 a.m.), coming home long after the sun has set (i.e. 10:00 p.m. or later) every day of the week. (And don’t forget this is the equator, so leaving before the sun rises and coming home after it sets means a much longer time period than all you Northern-hemisphere winter folks!) Between work, social activities, and family stuff, the week gets filled up quickly!

A snapshot of this week:

Monday:
6:30am-8am--gym
8:30am-7pm--work
7pm-9pm--retirement party for my DJ friend who wants his weekends back
9pm-11pm—anniversary party for a relative
Home at 11:30pm

Tuesday:
6:30am-8am--gym
8:30am-7pm--work
7pm-11:30pm--farewell dinner for brother-in-law going back to the States
Sleep overnight at Kris’ parents house

Wednesday:
5:30am-6am--on the road early from in-laws’ house to avoid the horrific traffic jam
6am-7:30am--gym
8am-5:30pm--work
6pm-7pm--work-related conference call from US
7pm-9pm--meet and greet UW students visiting Uganda
Home at 10pm.

Thursday:
6:30am-8am--gym
8:30am-7pm--work
Evening is free! A debate between getting some stress-relieving laughter at comedy nite or getting some stress-relieving sleep in my bed!

Friday:
6:30am-8am--gym
8:30am-6pm--work
7pm-9pm--dinner plans with friends
10pm-3am--girls' night out!

It’s a nice balance of work and play but it for some reason always tires me just not being home. This week is a little crazy at work (I’m working from the Kampala office), as I have both an annual report and annual workplan (for 2 separate programs) due Monday next week. Each of these are 20-50 page documents. Fun.

Uganda Diaspora Descends on Kampala

2009-01-06T11:36:00.005+03:00

It’s that time of year. The time of year when Ugandans who are working, studying, or settled in other countries come home to Uganda for 2-6 weeks of mingling, partying, networking, reminiscing and doing everything in their power to alleviate homesickness. Every December, around the Christmas holidays, hundreds of Ugandans fly home for a few weeks of the good ole’ times. This holiday season, we’ve had family and friends come in from the United States (including our Minnesota crew!), Canada, the UK, Australia, Norway, Kenya, and South Africa.

From the moment they land at Entebbe, these people **happen** (to use a Ugandan English slang word). Some go straight from the airport to the club, where they reunite with various ghosts from their pasts. Partying becomes a full-time (night-shift) job. Showing off their new wardrobes and gadgets (and sometimes toned bod’s), they hit up every hot nighttime hangout, including the classics (Ange, Silk, Fat Boyz, Mateos) and the newer happening spots (Kampala Latino Club, Iguana, Sway). They also make sure they take time to chill during the day (at the beach, at the pool, at a friend’s place with a bunch of cold beers). They attend, with certainty, at least one wedding (December is, after all, the most popular wedding month of the year in Uganda) and probably a baptism of the bouncing baby of an “O.B.” or “O.G.” (old classmate) as well. They carve out some time to hang with the ‘zees (parents), and somehow even find time to go to Villa (their village). Also in order is a trip to the craft market to find little treasures to decorate their homes abroad with, and plenty of consumption of comfort food (matooke, sweet potatoes…supposedly even the chips (French fries) taste better in Uganda!) The amount of activities packed into their weeks in Uganda is dizzying! Example? My brother-in-law, visiting from Minnesota, has seen more people, hit up more places, and hung out more nights in 4 weeks than Kris and I did our first 3 months back in UG.

All this action is an attempt, I think, to pack as much in, soak as much up, to last them through no-telling-how-many-more-winters until their next trip home. I think a lot of Ugandans in Diaspora are genuinely homesick. They crave this place; they live for it; they ache for it. But most cannot break the chains that form after a few years abroad: as the bills, mortgages, limited vacation days, pressure to chase the American dream add up, it becomes more and more difficult to come home for more than a few weeks every couple of years. I know that Kris and I have been an inspiration to some Ugandans in Diaspora. We did it. We broke the chains. We moved back to Uganda. It wasn’t simple, we aren’t making as much money, but my God we are happy!

By the end of January 95% of these visitors will have gone back to their homes in whatever (usually cold) country they are currently living in. We will miss them and the way that they bring us together. And of course we'll miss all of the fun and **proggie** that they bring with them too.

Together at last! The UGA-MNs inspired this impromptu party at our house. Here are the boys.

And the ladies of the party. When will we all be together again?

Speaking of Ugandans in Diaspora, I just read in the Daily Monitor that in 2007, Ugandans in Diaspora sent back a whopping 1.9 trillion Uganda Shillings ($1 billion USD!) in remittances, up from 14.3 billion Shillings in 2006. While the figure is likely to decline in 2008 due to the global financial crisis, you can't ignore the magnitude of these contributions. In 2008, remittances from abroad surpassed revenue earned from Uganda's lead export (coffee)!

Same sh*t, different day

2009-01-03T14:14:00.003+03:00

Those words are straight from the lips of one of my Ugandan-Canadian friends who is back and forth between those two countries. He's a very laid back, hip hop artist, who is working to use hip hop to bring about change in Uganda and beyond. "Same sh*t, different day" was his evaluation of life in Canada/North America. Basically his way of saying that life in North America is mundane, the same every day, every place; but in UG there are surprises around every corner and every day seems to hold something very new and very exciting.

Capping off the first year...in Dar Es Salaam

2009-01-03T12:58:00.002+03:00

Kris and I celebrated our one year anniversary last week. Wow, how time flies! It certainly doesn't seem like one year ago that Kris dipped in to give me that illicit kiss much to the chagrin of the Bishop who had just married us! It's been a good year that has seen the back and forth movements across two continents, two masters diplomas doled out, a series of jobs, and lots of adventures.

To celebrate this first milestone, Kris planned a secret getaway. I didn't have a clue where we were going. All I knew was that I was to pack my passport, swimsuit, and enough clothes for 6 days! It wasn't until we got to the airport that I found out our destination: Dar Es Salaam, along the East African coast of the Indian Ocean.

So alluring was the prospect of lounging on the beach and at the pool, that we hardly explored Dar Es Salaam town. We mostly just stayed at our resort and did some serious relaxing! We did venture into town a couple of times, however. It's always nice to explore other big cities in East Africa so I can start to tease out in my brain what is "Ugandan" what is "Tanzanian" and what might be an overarching "East African," "Former British Colony" or even "African" phenomenon. (Example: spelling salon like saloon seems to be an East African/former British colony thing--not unique to Uganda!)

Sappy Christmas to all

2008-12-25T13:03:00.004+03:00

One Chirstmas tradition in Uganda is the sending of overly sappy text messages with Christmas wishes.

Example? This morning my inbox contained the following messages (amongst many more):

"Like d fresh dew drops of a new day, may GOD's Loving hands be upon you today to freshen your Soul. Merry x mas n a Blessed 2009."

"The 1st sunlight 2 grace yo face in the morning is my whispered prayer 2 God 2 take care of u & 2 remind u of how special u r. merry xmas to u n yo family!"

When in Rome, do like the Romans do, right? So Kris and I penned our own text message to send widely to people in our address books. Ours, a little toned down and none of those obnoxious text message shorthands. "Wishing you and your family much happiness, prosperity and peace in the coming year. Merry Christmas!"

We are now at Kris' parents house for our Christmas lunch. We were told the day's festivities would begin at 11:00 a.m., so we showed up at 11:45. Alas, it is 1:15 p.m. and we are the only guests here.

Christmastime in Kla, Nakumatt is coming to town

2008-12-23T10:03:00.003+03:00

It's Christmas week in Kampala. This will be my second Christmas in Kampala. My first Christmas was last year, but Christmas '07 being T-minus 4 days until my wedding, I was too wrapped up in wedding fever to care too much about Christmas. I have also had no less than 3 Christmas near-misses in Kampala (meaning I left Kampala and/or arrived in Kampala a week before/after Christmas).

Christmas certainly has a different feel here than it does in the Midwestern U.S., with the lack of snow being the biggest non-Christmas-y thing. (The lack of seasons here relates to something I frequently talk about: how the very passage of time seems different here without the seasonal markers. Who knew it was already December 23rd??? It's still sunny and 85 degrees F outside!).

The other major difference is the lack of materialism associated with Christmas, and I must say this is quite refreshing. I have not bought a single Christmas present this year (aside one small one for Kris) and I do not plan on doing any Christmas shopping. Christmas isn't about gift-giving here, as it is in the U.S. It is about going to church, spending the day with family, and eating a big Christmas meal. No--or extremely few--gifts exchanged. I remember how completely overwhelmed Kris was for his first Christmas in the U.S., particularly by the mountain of Christmas gifts piled under the Christmas tree and how much of the day was focused on unwrapping those gifts.

Here in Uganda, the Christmas meal is a major highlight of the day. Kris and I are famously quoted for our observation that "food is food" in Uganda, rather than a social experience, an awakening of the pallette, or a mood enhancer. For the most part, consumption of food in Uganda is just that--consumption of food. Intake of calories. Not much more. But I think it's safe to say that Christmas day is one day when food is more than food--it's what makes Christmas day special for countless families. Most families save up to prepare a Christmas feast, featuring several types of meat, if possible. (Meat is expensive and is reserved for special occassions in most families.) This past week, I was in the field, and my staff would often request our vehicle to pull over so they could buy various things for their Christmas meal ("Irish" potatoes, live chickens, charcoal, etc.). On the way back from Ssembabule, we got stuck behind a pick-up truck with a crude cage built in the back. This cage contained two pigs, a goat, three chickens, and two large bags of charcoal. "That one is going for Christmas," my driver Richard exclaimed, "Christ-MAS!" When I opened my eyes I realized that everyone was busy transporting their Christmas feast items to their homes: a live pig tied to the back of a bicycle, vendors with their best fruits and vegetables set up attractively along the road side, a matatu taxi with probably 20 live chickens tied to the roof.

One negative observation I have about Christmas is that our commercialism/materialism is starting to be imported by countries like Uganda, in a somewhat distorted and disturbing form. The mid-upper classes in Uganda have embraced gift-giving and now there are toys on sale everywhere to try to get all parents swept into this craze. Shopping malls, supermarkets, banks, and restaurants are decorated with holiday decorations, often gone horribly wrong (extremely chintzy, tacky, sparkly, over-the-top). Kampala has in the past couple of years seen the importation of pathetically sparse plastic Christmas trees, now available on street corners and small shops around the city. Middle class Ugandans, in an effort to boast their footing in the middle class, are often the most caught up in the gaudiness of Christmas in Kampala, buying ugly inflatable Santas, strands of Christmas lights that belt out heinously tinny Christmas tunes, and the above mentioned pathetically sparse plastic Christmas trees.

I did, for the first time ever, spot Santa Claus in Uganda yesterday. He was a bespectacled Ugandan man dressed in a Santa suit (complete with a detachable beard), carrying a bag of gifts that said "Bata" (name of a shoe company here). He was walking through the Garden City mall, spreading holiday cheer.

I predict that Santa will become more of a "thing" in Uganda over the next decade. Kris and his brothers did not grow up believing in Santa--the majority of Ugandan children have never heard of Santa, or at least don't believe in him. Santa is not the iconic Christmas character, like he is in the U.S. Kris and I have discussed whether we would tell our future kids about Santa Claus. It kind of depends on which continent we are living during those formative years (I can imagine angry parents of our child's kindergarten classmates upbraiding us for spreading kindergarten rumors about the non-existence of Santa), and the extent to which Santa does catch on in Uganda over the next few years. To be honest, Kris was mildly appalled when he found out that it is the norm for American parents to lie to their own children about the existence of a fictional character. However, since then, he has also used that Santa is a convenient ploy to get children to behave throughout the year, so he has warmed up to the idea!

Speaking of increasing commercialism in Kampala/Uganda, while Santa Claus is not entirely coming to town, Nakumatt is coming to town! Nakumatt is basically the Kenyan version of Wal-Mart. It is a massive shopping complex with just about anything you can think of contained within (food, lawnchairs, toys, diapers, cosmetics, sunscreen, household items, cleaning supplies, etc., etc., etc.). Kenya has several of these Nakumatts and I've been holding my breath waiting for the arrival of a Nakumatt in UG. Well, the time has finally come: Kampala's first Nakumatt is set to open in February '09, just next to Garden City. Too bad it is just missing the holiday season--oh the commercialism Nakumatt could have injected into Christmastime in Kampala.

I heart Ssembabule

2008-12-20T09:11:00.002+03:00

An entire blog entry to gush about why I love Ssembabule, one of the two Districts where I am managing our Family Planning and HIV programs!

Although (as far as I can tell) two hours’ drive to the nearest paved road, Ssembabule exudes a lot of charm. This small town (two hours away from Masaka) in Central Uganda has won my heart over.

My organization has occupied its current premises in Ssembabule for something like 15-20 years. We have a house (two bedrooms, an office, a shower room, and a training/conference room), and a separate office buildings, with pit latrines in the back. This is the house I stay in when I visit Ssembabule and I can tell that it is full of history and artifacts from past volunteers (framed photographs of past volunteers, a map of the great state of Minnesota, what looks like a (now dysfunctional) pizza oven, paintings of the moon and stars in the pit latrine to brighten things up, a support staff that knows how to cook typically un-Ugandan things—spaghetti, lots of vegetable dishes, omelettes).

At the current office, we have neither electricity nor water, but the office is set up to run this way (whereas the Mubende office is NOT set up for power outages), so it works. The lack of power is actually refreshing, although I can’t say the same about the whirl of the generator when it is switched on for short times to facilitate computer work.

Most of the staff here have worked here for 10+ years and have a lot of ‘Minnesota’ pride. While each staff member has a very distinct personality, they share their tremendous sense of welcoming. My day instantly brightens whenever we roll into Ssembabule and I am profusely greeted and welcomed by each member of the staff.

The staff put lots of love and care into their work and prioritize my comfort. The gaurds (3 of whom speak some English but are insistent on speaking to me only in Luganda because they know I understand—and I love this, by the way!) cook me lovely vegetarian meals three times a day. Most of the food is straight out of the garden, which has been cultivated for over a decade. Mzee Baale, the old guard, is one of the sweetest, kindest people. He doesn’t speak a word of English, but we’re able to have basic conversations in Luganda. He is immensely proud of his garden and I took a photo of him in his garden today. They also prepare me tea twice a day, and thoughtfully add ginger into the boiled water to give the tea that scrumptious-comforting flavor.

Mzee Baale, my favorite guard in Ssembabule.

At nighttime, it is quiet here. Very quiet. All I really hear are noises of nature (crickets, frogs, birds). No traffic. Rarely do I hear loudspeakers blaring music or advertisements. And because there is so little electricity in Ssembabule, there is little light pollution here so the stars are amazing! Every night when I’m outside to use the latrines or brush my teeth, I often get caught up in star-gazing. It was particularly special the night I was here when a crescent moon was nestled closely to two bright planets, resembling a cute, droopy smiley face. (I hear it was in the newspaper the next day, but I didn’t know because I never even get newspapers while I’m out here!)

That disconnect is actually in a way refreshing as well. There is no internet café in Ssembabule town; although newspapers are certainly available in town, they are certainly not a part of my daily routine. (Example: I didn’t find out Hillary Clinton was appointed to Secretary of State until 4 days after the fact!) Granted, this isolation is somewhat cheapened by my BlackBerry, which can access the internet, email, online news sources, the blog you are reading now, etc. But I keep the BlackBerry a safe distance when I want to bask in the disconnect from all the happenings of the world.

Yes, this is the Ssembabule that I love. We will be shifting our offices next month and losing this site that holds a tremendous amount of sentimental value within my organization. We will be moving from our current location (about 1 km from the little town center) to a new location right in the middle of the (1 block x 2 block) town, and we will even have—gasp—electricity and running water! (Can anyone say mazzi mawanvu??) Even with all these changes and amenities I think Ssembabule will most certainly maintain its appeal, perhaps to a slightly diminished extent.

Tomorrow I leave this quiet respite for the hustle and bustle, commotion, pollution, noise, and traffic jams of Kampala.

Some of the Family Planning Community Health Workers we supervised this past week in Mubende and Ssembabule Districts.

A week in the field

2008-12-18T12:55:00.000+03:00

I’ve been in Mubende this week experiencing the unpleasant and unexpected challenge of trying to execute all of my job duties without any electricity. I don’t mind living without electricity (reading by candlelight has a certain appeal), but much of my work is computer-based, so I’ve fallen way behind on all of that.

This week we’ve been doing our quarterly supervisions of our family planning community health workers. Once per quarter, we call all of our community health workers to health centers near there areas for additional training, information-sharing, and data collection (they give us all the data on the number of clients they’ve seen over the past quarter, the number of contraceptives dispersed, and the number of health talks given). It’s been interesting to meet all of these people and quite amazing to realize the reach of our community health workers. Some of the sites we visit are way off the beaten path, but when we arrive, there are our committed community health workers, excited to greet us and spend the day with us.

Yesterday, we combined our quarterly supervision in Kasambya with what we call a family planning outreach. The purpose of outreaches is to bring family planning services that are not otherwise available to remote areas, including long-acting family planning methods such as implants. There is one nurse in all of Mubende District (population around 500,000) who can insert implants and IUDs, and yet there is an increasing demand for long-acting and discreet family planning methods among women. This means that women outside of Mubende Town would have to make a journey (sometimes dozens of kilometers) to the hospital in Mubende to access these services.

One of our community health workers had mobilized 12 women who wanted to get implants (Norplant is what is currently used in Uganda, soon to be replaced by Jadelle) and another woman who wanted a Depo injection. We brought the Mubende Town hospital nurse, Esther, along with us. She carried a metallic container full of sterilized equipment. I got to spend the day observing.

First, the women went through a group counseling session on family planning methods, including the implant. Then Esther encouraged all of them to get an HIV test before proceeding with the implants. She conducted another group counseling session and all 13 women accepted to be tested for HIV. I watched these women, one by one, come and bravely don their arm for blood to be drawn. I watched the Esther and her assisting nurse, Specioza, carefully put a drop of each blood sample on 13 rapid HIV test strips. (By the way, there were no gloves used for any of this because they didn’t have any!). I watched the blood + buffer solution slowly move its way down the strip: if one line appears, it means the sample is negative, two lines means it’s a suspected positive. The 20-minutes stretched out as I studied the faces of these women who were awaiting their test results: some looked nervous, others calm. I watched one strip turn positive before my very eyes and tried to fathom what these test results would mean to this woman. We did a confirmatory test of the suspected positive test, which confirmed the original test results. I realized that a positive test result for 1 out of these 13 women was just slightly above the national HIV prevalence rate, which is hovering around 7%.

Next, the nurses did another group counseling session with the women to prepare them to receive their test results. One by one, the women were called into the “labor suit” which doubled as an operating theater. Specioza revealed the women’s HIV status to them; those who were negative were advised on ways to stay negative; the one who was positive was given advice on how to stay healthy, suggestions on how she may approach her husband, and—importantly—hope for the future. After each woman had asked all the questions she had relating to her test results, she lay down across the examination table to have the procedure done.

I watched as Esther skillfully gave each woman an injection to numb the upper arm where the Norplant is inserted, made an incision, and then inserted the six flexible tubes (each a little thicker but half the length of a toothpick). In this case, gloves were worn and great care was taken to make the best of a less-than-fully-equipped operating room to ensure privacy, sterility, and comfort.

What struck me the most as I was standing there watching these procedures? It wasn’t the shoddy condition of the examination table, the lack of equipment, or the handwashing station that was running out of water. It was the smell. It occurred to me as I was standing there, that if this procedure were taking place in the US, I would be enveloped by that disinfectant smell typical of all clinics and hospitals. In this little room in the health center of Kasambya, I was confronted with a very different smell: a mix of urine, body odor, bat droppings, and mildew.

I am by no means attempting to be disparaging by this observation. It is simply an observation—the starkest one I had the whole day. I commend these women for braving the HIV test and implant insertion and the health workers who do so much with so little.

To know and be known

2008-12-10T10:33:00.000+03:00

Yesterday Maude and I went on a mini shopping excursion in Wandegeya, the neighborhood surrounding Makerere University main campus, and the backdrop of the beginning of the H&M in Uganda epic tale. In 2005, I lived in the “yellow flats” on campus with my mom, who was there on Fulbright, and younger brother Isaac. That year, Maude (a friend of mine from McGill) came down for her infamous 5-week visit to Uganda, which turned into a much longer stay. She decided to stay on and study at Makerere with me for my second semester there, and we moved into the Wandegeya flats (reminiscent of the “projects”) for the rest of 2005 (June - December) after my mom and Isaac moved back to the States.

So Wandegeya was our stomping ground. We knew all the nooks and crannies, places for eats, best vegetable stands in the market, etc. Yesterday Maude and I revisted this neighborhood, where I rarely go these days as I live and work on the opposite side of town. I have visited Wandegeya (“Wandegz” for short) many times since 2005, but usually without Maude. Every trip through the market or to our favorite convenience store was met with, “But where is your sister?” or “And how is the other one?” both of which, of course, referred to Maude (who else??).

Well yesterday we were there together, which was very pleasing to all these familiar faces, whom we hadn’t seen (at least not together) since 2005. Our first stop, our old tailor, Josephine. (I recounted an interesting story about Josephine in a blog entry in 2007). Josephine was ecstatic to see the two of us, but scolded me for not inviting her to my wedding! I promised to bring pictures to show her next time I’m in Wandegz. She promised to bring me a picture of the baby she had in 2007, who she said is now walking! She made a repair on Maude’s purse as we waited.

Next, we ventured on to some second-hand clothes shops opposite the special hire stage. The people working in those shops change frequently, so no familiar faces there, although we did find some very cute, cheap, second-hand clothes! As we walked back from these bu-shops, Maude started getting “beeped” on her phone (when someone calls and then hangs up right away, implying they want you to call them back). She didn’t recognize the number, so we continued on. Finally the guy actually called her instead of beeping her. “Hello, I’ve seen you!” the voice explained. “I am the tailor in Wandegeya. Bring the material! I want to see you!” It turns out this was a certain male tailor to whom Maude regrettably gave her phone number in 2005 when she had left a backpack there for repair. He became slightly stalker-ish in 2005, calling her frequently to check up on her. Well, after all these years, he had still saved her number, and upon seeing us walk by, called her up. Needless to say, we did not go back to chat with him!

Our next stop was our supermarket of choice, Kookee’s, where we became friendly with a cashier named Benedict. We walked in and Benedict recognized us immediately and her face lit up with a huge smile. After picking up a few items, we went to her register. She greeted me by name (which I always consider an amazing feat because my name is so strange and foreign by Ugandan standards)!

I think one reason I love Uganda/Kampala is because it is small and because it’s hard to stay anonymous here, like you can in the States. Everyone knows everyone here, and once you’ve lived here for a while, everyone knows you—and remembers you for years and years. It gives me a warm, tingling feeling: to know and be known. To be part of the fabric of a community, rather than just a random face amongst a sea of random faces.

An example? The other week, I went to Nakasero market, where I was hoping to find my faithful vegetable man, Amos, whose vegetable selection services I’ve been using since 2004. I go to his usual spot in the market and he’s not around. An unfamiliar face informs me, “Amos has gone to the village to visit his grandmother, but are you Heather?” I hadn’t been to Nakasero market in over a year and I had never met this guy before, but he knew me! And he graciously helped me with my vegetable selection. (By the way, the next week I randomly bumped into Amos in Owino market (a second-hand clothes market downtown) and he informed me he was moving to South Africa to open his own clothing store.)

A final example? On Monday, Kris and I went to the pool at Speke Munyonyo resort, where I’ve only been swimming once before, and that was probably close to 3 months ago. We forgot to bring towels (just like we did three months ago) and found a pool attendant to ask him for towels. “You people, you never bring your towels,” he scolded us. “Even the other time, when you were seated over there,” he pointed to some lawn chairs on the opposite side of the Olympic sized swimming pool, “you forgot to bring your towels.” There was no escaping it. He remembered us and remembered us well (even though there are hundreds of people who come to this pool in a given week, probably more than a thousands over a couple of months). And this is another great aspect of knowing and being known: no one can get away with anything because everyone knows everyone!

T.G.I.P.H.

2008-12-08T12:45:00.002+03:00

Thank God it's a Public Holiday (TGIPH)!

Eid mubarak to everyone celebrating Eid. For me, this provides a much needed day off work, although I'm still (of course) doing some work from home. Whenever I spend time in the field, my work days are usually 10-12 hours long, in part because of the power situation but also just because I try to get as much out of my site visits as possible.

This past week in the field was very interesting as I am helping my staff through lots of changes going on in the organization. I led to Family Planning Implementation Team (FPIT) meetings in Ssembabule and Mubende last week. The FPIT meetings allow for continuous formative evaluation and community input into our family planning program. There was just a brief written about our FPIT meetings--read it here.

We got great news last week that we have received a 3-year grant to address HIV/AIDS in Ssembabule and Mubende Districts. I am very excited to delve back into HIV/AIDS work in Uganda (that's what most of my past public health experience in Uganda has centered around) and this is also good news because it guarentees that our organization will maintain a presence in these districts even after the end of the family planning program. For this grant, we will be partnering with small community-based organizations (CBOs) to build their capacity. We will be focusing on increasing HIV Counseling & Testing, providing support to Orphans and Vulnerable Children (OVCs), and providing nutritional support to people living with HIV/AIDS (PLWHAs). It should be extremely interesting and will have the potential to impact communities in a very meaningful way. The only thing that is a bit intimidating is that this basically doubles my workload as a program manager and I've already been averaging 50-70 hours a week with my current job duties. The next few weeks I'll be working with the CD to plan for this grant, think about how we want to get it off the ground and running, what new staff is to be hired, etc.

For now, I'm just enjoying the public holiday and Kris and I are thinking about whether we want to go anywhere for Christmas/our anniversary/New Years, as we both have some time off work and need some R&R.

To the field

2008-12-01T09:58:00.003+03:00

In a few hours, I'm off to Ssembabule District for a few days. From there, I'll travel to Mubende District for a few more days before returning back to Kampala on December 9th. I'll compose some blog entries on my computer, but no promises as to when I may next post.

The non-bribe incident

2008-12-01T09:50:00.001+03:00

This weekend we took my mom and Shara to the airport to travel back to America. Their bags were loaded with paper beads (which Shara will sell to fundraise for a scholarship fund Kris and I are setting up) various African crafts, superb Ugandan coffee, delectable honey, and noteworthy finds from Owino market. It’s been a fun two weeks. We packed so much into two weeks that it actually feels like they’ve been here for at least a month!

When we went to pick them up from the airport about two weeks ago, we had a little incident with the Ugandan Police, which I would like to document on this blog. Driving into the airport, we drove up to the parking lot that we usually park in and a police officer standing there motioned that it was full and that we should make a U-turn and park on the lot on the other side of the road. Kris did exactly that, and we quickly found a spot in the 2nd lot. As we were walking into the airport, however, a police officer stopped Kris to notify him that he had made an allegedly illegal U-turn. “But it was your colleague, the policeman over there, that directed me to make U-turn. And there were no signs posted indicating that I could not make a U-turn. It was an honest mistake,” Kris pleaded. The police officer demanded to see Kris’ driver’s license, so Kris handed over (which, later we realized was our fatal mistake—never hand a cop your real driver’s license!). The policeman slipped the license into his breast pocket and explained that Kris would have to pay a fee for his traffic violation. They continued back and forth, I chimed in with what I thought was a solid argument, but Kris told me to keep quiet and let him work this out. He asked how much this “fee” would be. The policeman replied, “There is no set fee. That is for you to decide. You decide what you think is an appropriate amount for the violation you have made.” (This is police-talk for “Give me a bribe and I’ll hand your license back.”) Kris argued for a little while, flattering the police officer, making the policeman feel big and powerful while Kris emphasized his own shortcomings. They agreed that they would resolve the issue after we had collected my mom and aunt from the airport, on our way out.

About an hour later, mom and aunt in tow, we drove back to the policeman’s little station. (Welcome to Uganda, now we have to go bribe this cop.) Kris got out of the car and he and the policeman talked for about 10 minutes, after which he came back with his license. “Did you have to bribe him?” I asked. Then Kris explained that he did not bribe him and here is the elaborate scenario he used to appeal to the policeman’s senses to let him off the hook:

“Officer, you know I was not the one who was supposed to pick these ladies from the airport. You see, I rushed out of the house at the last minute, and you can see that I am even wearing slippers and sweatpants.” Kris pointed to his very casual attire. “I left in such a hurry that I did not even carry my wallet, and honestly, I don’t have any money. I would ask these guests to loan me some money, but Officer, that is my mother-in-law. Please, Officer, man-to-man, you cannot expect me to ask my mother-in-law for money. Would you be able to ask your mother-in-law for money in such a situation? Look, I know it’s cold out here [around 65 degrees F] and you must be hungry and honestly if I had anything I would love to give you some “tea” [a.k.a. bribe money] to help you stay warm. But I have not carried anything and I cannot bring myself to ask my mother-in-law.”

“I understand,” the policeman said. And that was that. The appeal worked. Man-to-man. The officer handed over the license and we drove away, no bribe paid.

Adventures with my maama and young maama

2008-11-27T12:07:00.002+03:00

After a brief blogging hiatus, I am back with a long entry. You can thank the lack of power in Mubende, the glorious three-day escape to Jinja (no BlackBerry!), and the running around with my mom and aunt for that. My mom was in town for a conference on Family Medicine in Uganda all of last week, during which time I took Shara with me to Mubende to volunteer. This week, we spent the first portion in Jinja and now I’m back in Kampala, trying to squeeze in time for work with everything else that’s going on. In Luganda, there is no word for maternal aunt. You call your maternal aunt your “young mother” (maama wange omuto). So here’s a few words about what I’ve been up to with my maama and young maama.

Training in Mubende
Last week, I went with my aunt Shara to Mubende. My organization is leading a two-week training for lay community health workers to learn how to give Depo-Provera (injectable contraceptives) at the community level. Depo is the family planning method of choice for most women in Uganda, in large part due to the discretion with which a woman can receive the injection. While a large part of our strategy involves mobilizing men to support family planning, presently many men remain a barrier to FP uptake. Many women want to use Depo because they can do so without their husbands’ knowledge. Previously, women would have to travel to a health center (on foot, or spending precious resources on transportation) and wait in line all day to receive the injection from an already overworked nurse. Training community health workers to give the injections allows women to receive Depo within their own communities, with someone they know and trust, who has more time to spend counseling them and answering their questions on family planning.

Shara, a Registered Nurse from Kentucky, got to help out with this training. The CHWs practiced giving injections to tomatoes before graduating to human beings. They also of course learned how to screen clients for pregnancy and contraindications to Depo; counsel on all FP methods; refer clients for other services (permanent FP methods, HIV testing, etc); and safety precautions and infection control. The 20 CHWs we trained to give Depo were a subset of the 250 CHWs that the organization has trained and worked with for around two years. Previously, they were able to give FP health talks, counsel clients on FP methods, refer clients, distribute condoms, and give refills of oral contraceptives. The 20 selected for the Community-Based Distribution (CBD) of Depo training are some of the most motivated, highest performing CHWs. It was amazing to watch their transformation over the first week of training. These are individuals who typically have a seventh-grade education but they are passionate about bringing FP information and services to women and couples in their communities. By the end of the first week, they had mastered the art of injections and were ready to proceed to the second week of training, where they administered injections to human beings under close supervsion.

Food in Mubende
While in Mubende, Shara and I took a survey of what the finest restaurants in town were. She was surprised (I was disappointed but not surprised) to find out that all of these “fine restaurants” serve the same exact dishes. And if you’re a vegetarian, that basically means that you’re eating matooke/rice/potatoes/chapatis plus either g.nut sauce or beans 2 meals a day, 7 days a week. By Wednesday neither of us could fathom eating another plate of the stuff (it’s good and I enjoy it, but I need variety).

With the kitchen at my house lacking a fridge and stove (they were delivered at the END of the week), we set out on a mission to find an Indian to cook for us. Well, it turns out that there is exactly one Indian in all of Mubende town. He runs a quite-well stocked supermarket (well stocked by Mubende standards: wine!!, basmati rice, brown bread, spices). We visited the shop in the early evening, both starving and with a un-curable craving for spicy Indian food. Shara marched up to him and asked him if he knew how to cook and if he would be willing to cook for us. She explained our food predicament and that her father was from India and we both love Indian food. After a long discussion, he agreed that he would close his shop early and go home and cook us an Indian dinner at no charge to us (for friendship and cultural exchange, he said).

A couple of hours later, we got a phone call that the food was ready. We got the guy who lives in the Boys Quarters behind my house to drive us to the Sunrise Guest House, where we planned to simply pick up the food, chat for a minute or two, and leave. Well our Indian friend had prepared a feast of several dishes and had laid out a mat and dishes on the floor in a lovely Indian dinner fashion. We couldn’t take the food and run. We would have to sit and eat with him. The first bite awakened my palate, which had been dormant from the (sorry, my Ugandan friends) bland Ugandan cuisine. Spices! Flavor! Garlic! Ginger! Vishal joked that the only spice used in African food is salt. He then poured me a big glass of salty-lassi, which I detest. To be polite, I pretended to take a sip every time he pointed at my glass, reminding me that I shouldn’t forget to drink up. Shara thought she was missing out on something delectable, and took a big sip from my glass. Her face immediately contorted and all she managed was an unconvincing “Mmmm, interesting.” We wound up our conversation and made our way out of the guest house. On the way out, it occurred to Shara that the guy who dropped us off at the guest house and was now waiting for us in his car may possibly have thought that we were prostitutes!

Escape to Jinja
My mom, Shara, Kris and I spent Sunday through Tuesday in beautiful Jinja (the source of the River Nile). One night at Jinja Nile Resort and one night at the Haven. Kris’ parents, and our family friends Vince and Mary Kay joined us for the first night. It was relaxing and we didn’t actually do too much. Good conversation, great food, spectacular views. Kris and I have been contemplating buying land in Uganda (probably a plot in the Kampala area to build a future home and also a plot upcountry somewhere in a beautiful spot). Kris started networking while we were at the Haven and we got the boat captain to take us to view a wonderful 19-acre plot of land about a kilometer from the Haven. It was gorgeous and had an amazing view of the Nile. The Haven sits just upriver,at the top of a wonderfully gushing rapid, and this property sat right at the bottom of that rapid.

Standing there on that property, walking through dense brush to get to the best viewing point of the river, listening to the roar of the mighty Nile, I realized how amazing it is that I was there actually contemplating buying that chunk of earth. What series of unlikely events has led me up to that moment? I could have never imagined it, that’s for sure!

Africa gripped by Obamania

2008-11-14T09:20:00.003+03:00

Obamania. That’s what everyone here calls it—not sure if it’s called the same in America.

Last night Kris and I went to Comedy Nite at the National Theater and my oh my was the extent of “Obamania” evident. The opening act: “Is everybody finally getting over Obamania?” “No!” the audience of several hundred people shouted back excitedly. In fact, last night nearly every act (a series of silly skits, stand-up comedy, and political satire) at least had a mention of Obama. One of my favorites was a skit set on an airplane that was hijacked by terrorists. They are flying the plane towards an unnamed US skyscraper a-la-9-11. The terrorists turn on the radio to the news of: “This just in, in America, Obama has won the election for president of the United States of America.” The terrorists and passenger-hostages all broke into celebration as the terrorist in the pilot’s seat pulled a sharp U-turn away from the skyscraper. Obama’s president? Maybe we shouldn’t commit an act of terrorism on the US after all.

Kenneth, a popular stand-up comedian who is a friend of mine, pulled this line out during his act: “Do you know Barack Obama in full? Barack: Born African, Raised American, Complete Kenyan! Obama: Original Black African Managing America!” I’m not sure if he concocted that himself or if this is something that’s floating around East Africa. Either way, it was hilarious and the audience erupted with laughter.

I've been wearing my three various Obama t-shirts very proudly as often as possible. I've had everyone from the lady selling vegetables at the supermarket, to a guy filling up our car with gas offer to buy the shirt off my back! This weekend, I'm hoping to buy a locally produced Obama t-shirt that proudly proclaims, "Obama: Made in Africa".

This morning on BBC I was listening to an interview with some African Studies professor at Northwestern University who is creating an archive to document Africa’s response to Obama. The archives consist of t-shirts, tickets to “Obama: The Musical” (a production in Nairobi), posters, newspaper clippings, greeting cards, etc. I think it’s great that someone in academia is capturing this phenomenon of Obamania in Africa because it is like nothing else I have ever witnessed. I may not be an African Studies professor, but I will continue to document Uganda’s response to Obama on this blog.

A total lack of power

2008-11-13T14:41:00.000+03:00

I started out sick this week (a weird combination of cold, fever, achy body, chills, but no nausea) and thus my trip to Mubende got cut short by a day. I left Kampala on Tuesday morning at 6:30AM and arrived in Mubende at 8:30AM: a nice and easy two hour journey.

Upon arrival at the Mubende offices the reality of the power outages that I had been hearing about from my staff over the last few weeks dawned on me. Currently (and probably for the next few months), there is no power in all of Mubende from approximately 6:00AM until 7:00PM or 8:00PM. Some nights power doesn’t come back on at all. This all sounds fine and dandy (electricity is so overrated anyways, right?…) until you start thinking about the implications for running an office or a business. My organization still needs to maintain an office during regular business hours, thus staff are in the office from 8:30AM. But there’s not much progress that can actually happen during the entire workday—no computers (except my old laptop with a 2 hour battery life), no printers, no internet (thank God for my BlackBerry!). So yesterday I kept my laptop switched off as I held meetings with my staff and turned it on for short periods of time when I frantically typed away, fighting against the diminishing % Battery Remaining indicator on my laptop. We were preparing for a two-day workshop with religious leaders to train them as family planning advocates. The training manual that I needed to finalize? It was saved on the Mubende office’s desktop computer and thus there was no way to access it without power. The dozens of handouts and registration forms and course evaluation forms we had to print? Good luck—not even the internet cafes in town had power to print.

So we worked the whole day making very frantic use of my little battery and then…waited. I went back to my hotel. At around 7:00PM power came back on. I spent the next three and a half hours going through all the files on my laptop and finalizing them for upcoming workshop. During the day due to lack of computer I worked with my staff to hand-write (how tedious!) a bunch of documents, which I then had to type up once power was back. By 10:30 I was exhausted (remember, I left K’la at 6:30 in the morning and had been working ever since). I called one of my workmates to come and pick up all the documents on his flash drive. He took them to an internet café to print and photocopy them. The problem was everyone in Mubende had been without power for the whole day, so everyone in Mubende who had anything to print or photocopy was at the few internet cafes in town. The next morning (bright and early at 6:30 because we still had to assemble all the paperwork for the day), my colleague informed me he had been at the internet café until after midnight trying to get everything printed (bambi, sorry!).

The lack of power is extremely frustrating because it creates such a difficult and inefficient working environment and it also makes such a long, drawn out and stressful workday. It also casts an unprofessional image because while some **big** NGOs and companies in town have generators, we currently do not have a generator. I’m going to have to think about solutions to this because I don’t think I could operate for extended periods of time like this—at least not happily!

Meanwhile, I visited my soon-to-be-home in Mubende and my goodness it is amazing. I’m embarrassed to say it’s probably one of the nicest houses in all of Mubende. It is a brand-new three bedroom house complete with a flush toilet, a bathtub, a nice kitchen, a huge pantry, a garage, spacious closets that lock, lots of windows (with really nice curtain rods already installed). It is enclosed in a wall, with a very ornate black and gold gate. The “Boys’ Quarters” on the property will be converted into office space for my organization on January 1st. The office also has its own flushing toilet (and shower!). In addition to the house and the boys’ quarters, there are also two outdoor kitchens (where one would cook on a charcoal stove, if one cooked such a way) and a small house for a guard. The house is about one-third of the way up one Mubende’s many beautiful, rolling hills, but still walking distance to town. I couldn’t have imagined a better set-up in Mubende! It is really a mini-paradise. It will be so much more relaxing than the hectic life of Kampala. I have a feeling Kris will want to spend more weekends in Mubende than we originally thought! So, power outages aside, I am very excited about being based largely out of Mubende!

For the first time in my life...

2008-11-06T11:38:00.001+03:00

Wow. What an exciting week this has been. Recap of Tuesday and Wednesday.

Tuesday evening Kris and I went to bed at 8:00 p.m., planning to wake up in the middle of the night to attend an election results viewing party. I slept fitfully, waking up almost every hour with a mix of emotions (excitement, anxiety, nerves, fear, hope). Finally at 3:00 a.m. I was done sleeping. We got up turned on BBC radio to the news of Pennsylvania going to Obama. This was good news and got us energized to wake up fully, get dressed in our Obama gear, and get on the road to drive into town.

We arrived at La Fontaine restaurant/bar in Kamwokya by 4:20 a.m. There was a crowd gathered there, mostly Americans, a sprinkling of Europeans, and several excited Ugandans and Kenyans. Some had stayed there watching the CNN coverage since the previous night and now were zombies fixated on TV screens. We settled in, got some coffee (I never drink coffee, so the caffeine really got my system buzzing!). Soon, Wisconsin and Minnesota (my home states) were called for Obama. Indiana and Florida were both too close to call. The tension was palpable. Everyone was excited but not yet ready to celebrate. When Virginia was called for Obama, and then seconds later the election was called for Obama, we erupted in cheers. We jumped up out of our seats and celebrated. Guards, boda boda drivers, newspaper salesmen on the streets started popping their heads in to share in the excitement.

I felt like I was dreaming. Was this real, or did I fail to wake up and I was still sleeping in my bed? This was the moment I was waiting for, but it wasn’t sinking in. I cried but even the tears didn’t feel real. All these emotions buzzing through me (along with the caffeine). I spent 600 shillings (30 cents) on a phone call to my mom. I guess to make sure that this was really happening, that the news we saw here on the screen was the same news filtering into TV screens around the world. Seeing McCain speak was still a dream. Is this really happening? But when Obama finally came on and spoke, I don’t think there was a single individual in the room with dry eyes. We all cried.

What do these election results mean to me, personally? I’m afraid to even write about this because I won’t do justice to the feelings that this has unleashed. What I can say is that for the first time in my life, I am proud to be an American. Call me unpatriotic, but my entire life I’ve been somewhat embarrassed to be an American, happy to be mistaken for a Canadian (especially when sporting my McGill backbpack, complete with a Canadain flag, overseas). But on Wednesday, I felt the pride rushing into me. I was so proud of my country!

I wore my Obama shirt all day. As I walked around town Ugandans called out “Obama oyee!” (to which the response is a resounding, “Oyeeeee!”). People gave me the thumbs up, waved, clapped, cheered. I saw Ugandans running around Kampala draped in American flags. They were proud of America. My friends, who know I am a big Obama supporter, kept calling me throughout the day to congratulate me. “Congs [Ugandan English for congratulations] on Obama!” I was bursting with pride. Strangers struck up conversation with me on the street: “You must be so happy about Obama! We are also happy!” What the average American may not realize is that Obama’s election will do wonders for America’s image abroad and for foreign relations. The whole world was watching; now the whole world has renewed respect for our country, hope for the planet’s future. (My only worry is that the whole world now has what are perhaps unrealistically high expectations for Obama.)

“This is your victory,” Obama said on election night. Most Americans probably interpret this to mean that this is every American’s victory. But Ugandans definitely feel that they share in this victory. As do Kenyans, who declared Thursday a public holiday to allow the country to celebrate the achievement of their “Kenyan son.” Africans are already talking about the shining example of democracy that this, are already using Obama’s victory as a call for African leaders to step down when their terms are over and let democracy run its course. Being in Uganda to witness this moment was so special because it made this shared sense of victory so tangible. This is a victory for people worldwide, for humankind.

On a more personal level, this victory is so sweet because in so many ways I feel that my family story is Obama’s family story. Not a mirror image, but the same broad brush strokes. And of course it is extra special that Obama shares the same heritage that my own children will have: half-American, half-East African. This will be a day we tell our children, our grandchildren about. We bought today’s edition of the Monitor, the New Vision, and Bukedde (Ugandan’s three daily newspapers) which we plan on saving, perhaps framing or laminating to preserve this slice of history and the Ugandan perspective from which we witnessed it.

Nakayima, the sacred tree

2008-10-31T09:21:00.013+03:00

The last time I was in Mubende (a few weeks ago), I took a hike up to the Nakayima Tree, a 700-year-old sacred tree that sits atop a tall hill overlooking Mubende town. They've turned the tree into a tourist site, although it is definitely one of Uganda's lesser known, infrequently visited tourist attractions (but maybe that's exactly what makes it so special!). There is a guy named Martin who stays on top of the hill who is responsible for giving tours of the area and explaining the cultural and historical significance of the tree.

The tree looks old and wise, large and gnarly, with a very distinctive look to it. There are people gathered to pay their respects and make offerings to sacred spirits who live in the tree. Children are clustered around the tree playing.

The Nakayima Tree

We learn that each section of the tree is associated with a different spirit. There are spirits for different aspects of life, and depending on which one you need to call upon, you leave a small offering at that section of the tree.

Offerings left for the spirits

An offer for anyone who comes to visit me in Mubende--I will take you up to visit this tree and enjoy the beautiful view of rolling, green hills of the surrounding area!

Children gather for a picture under the tree. I got to practice my Luganda with them.

Another view of the tree. The protrusion to the left is said to be that of a cow. The two knots to the right and front of the tree are said to be its breasts.

That is Mubende town at the base of the hill. Looks so quaint from up above.

The ants we saw along the trail on the hike up.

Another view from the hilltop.

Tobama, Obama!

2008-10-29T16:27:00.001+03:00

With less than one week to go until election day, I finished reading Obama's book last night. I absolutely loved it because in some strange way it reminded me of my own family story, with the generations and exact locations somewhat jumbled up, but the overall themes the same. Love conquers anything but can result in confused identities. A yearning and then a search to learn about an absent relative, his life, his country, his culture, his extended family. People are people the world around, and face similar hardships and problems.

I especially enjoyed part three of the book, which centered on Obama's first trip to Kenya as a twenty-something in search of roots, family, identity. This reminded me of our trip to Pakistan in 2006. While I had lived there as a child, it was my aunt Shara's first trip to her father's country. The trip was about putting the pieces together, meeting relatives, learning who this man, my grandfather, was. I realized then that it is possible to miss someone you never knew. And realized also the importance of family, blood. Our family journey paralleled Obama's first trip to Kenya to unmask his dead father, whom he never really knew, to understand what it meant to be half-Kenyan and have a Kenyan family.

I also enjoyed witnessing Obama's eyes opening and his cultural adjustment to those peculiarly East African things. I laughed when I read Obama's account of learning the meaning behind the expression 'you are lost!' This expression is also common in Uganda, and I had to learn its meaning myself. And it was interesting to see how he grappled with confronting poverty, distant family members with various needs, numerous intelligent but unemployed family members, etc.

He painted the picture of growing up half-Kenyan, half-muzungu in America as extremely confusing, at times tumultuous. I wonder the extent my own 'half-cast' (as they call mixed people here) children will feel this confused identity crisis. But I think Obama's confusion was accelerated by his father's absence then death. He never knew that whole side of his heritage.

People here in Uganda (and even more so in Kenya!) are so, so excited for the upcoming election. They are eager to see a black man - an African - in power! Everywhere you go people are talking about Obama, Obama, Obama! Although not being able to watch the debates was a drag, being in East Africa on election day will give us a unique perspective of this historic election. Oh, and by the way, I mailed my absentee ballot in weeks ago!

I recently learned that 'okubama' is a verb in Luganda. 'Tobama' means something like 'don't panic' or 'watch your step' in Luganda. So in this last nerve-wrecking week, I think that that is good advice. We won't panic, but we'll also watch our step and make an effort to get out the vote!

Culture shock!

2008-10-28T15:08:00.001+03:00

For the first time in a long time, I am feeling culture shock as a result of being in Uganda. What is this new culture to which I’m having to adjust? It’s not Ugandan culture—that feels warm and familiar and comforting. It is expatriate culture.

I’ve been working in Kampala the last few weeks, and this has involved long (10-12 hour) work days during which time I am collaborating with the expat staff of my organization. They are all wonderful people and I’ve enjoyed getting to know them, but it takes some adjustment! I’ve never spent this much time with expats in my life! They have a certain attitude, a way of doing things, a way of talking about Uganda and Ugandans, particular likes and dislikes, distinct mannerisms, and varying degrees of naïvete about Uganda. I come home from work every night needing to offload all this cultural baggage to Kris. Spending so much intense time with a few expats over the past few weeks has made me realize how fundamentally different my Uganda experience has been from the typical expat.

Last weekend I even went to—gasp!—two predominately expat parties! This is all new to me. Very foreign. I’m not saying it’s bad, it’s just different. So completely different than my other “world” that the thought of reconciling my two worlds seems next to impossible. Kris and I have decided it wouldn’t be a bad thing to have more expat friends and more mixed couple friends (zungu-Ugandan couples) to diversify our experiences, network, and to have some friends that we perhaps relate to differently. (And, oh yeah, did I mention it would be nice to go out every *once in a while* and not have to “house” everyone and their mother??)

Yes, so my head is spinning as I try to grapple with this strange new culture that I have encountered in my work life and social life. The types of questions I’ve been asked include:

“Does your husband speak English?” (Better than I do. Sometimes we speak in Luganda too just for fun!)
“What does he eat for breakfast?” (Umm, we usually do cereal, oatmeal, toast, lately we’ve been on a smoothie kick.)
“How do you make Ugandan friends?” (No secrets here. How do you fail to make Ugandan friends after staying here for years?)
“What do you talk about with your husband and other Ugandan friends?” (We talk about slaughtering cows, and planting gardens, and religion, 24/7. Just kidding, we talk about the regular stuff!)
“What kinds of places do you go to hang out?” (Mateo’s, Fat Boyz, Rouge, Silk, Ange, Steak Out, Cheese, Cafe Pap, Kabalaga, depends on which places are currently hot. All that’s needed to ensure a good time is nice music and good company)
“Well, your husband lived outside of Uganda for a looong time, right???” (Actually just 2 years for grad school, but so what?)

Sheesh! I simply cannot believe the ignorance! Mind you, the people asking these questions—it’s not like they’ve never set foot in Africa—they’ve all been living here for varying lengths of time.

Currently, I basically have zero expat friends here. Zero. The few expat buddies I have had here have been people I knew from outside of Uganda, who came to visit me, latched on to me, and somehow got sucked into my very un-expat way of life. I am blessed to have some extremely amazing Ugandan friends here, whom I credit for shaping my somewhat unique experience in Uganda. Some of my best friends in the world are Ugandans and in these amazing people here understand me just as much as – if not better than – friends I have elsewhere in the world.

I’ve realized during my interactions with expats here that a lot of them secretly want to have a Ugandan friend (I’ve had a couple of expats actually explicitly state this desire to me), but they seriously don’t know where to begin. I guess for me this was always a non-issue. How do you not know where to begin? We are all humans! (However, I may actually be interested in giving this issue some serious thought--how did I end up with so many amazing Ugandan friends?--and writing a future blog entry on the topic.)

(Disclaimer: the statements above included wide generalizations and crude characterizations. However, I felt justified in doing so because so often we—as expats—do the same to our Ugandan colleagues. Just trying to turn the cultural lens around.)

Yafudde.

2008-10-24T08:59:00.001+03:00

In a taxi on the way to Bugolobi this morning and I could tell something had happened. Whenever anything happens – a tragic scene or a humiliating scene, really any scene –a crowd of people gather, craning their necks to see. I saw the crowd first. As we approached, I then saw the car, its front end smashed in, its front windshield cracked. Nobody was in the car; they must have made it out safe. And then, the boda boda came in to view: mangled, broken, with a crumpled, lifeless, bloody body trapped underneath. The accident had happened minutes ago. Police had just arrived on the scene. Already a swarm of boda boda men had gathered with their boda bodas to pay respect to their colleague.

A haunting image. A chilling reminder of the state of road traffic safety here. Every day in the papers, you read about people dying in road accidents. All the more reason to stay firm: I will not ride boda bodas through congested areas of town, I will not ride matatu taxis between Mubende and Kampala because they go far too fast on highways.

Gearing up for queuing up

2008-10-20T15:56:00.002+03:00

Since I’ll be around Kampala for a few more weeks, I offered to try to get the process started on my work permit because everyone else at the office is so busy. I’ve had my share of bureaucratic nightmares in Uganda before (the—not exaggerating—10 months it took my to get my student ID card at Makerere; the mean lady at immigration that seemed she wanted to do everything in her power to prevent me from getting my Dependent’s Pass after getting married to Kris). And now I am anticipating a new chapter: the work permit.

Here’s everything that I need to get in order for the work permit. And all of this needs to be in triplicate, hole punched, and clipped into three separate file folders.

Work Permit Form
Special Pass Form
Educational certificates from McGill and Hopkins (I didn’t carry this to UG, not sure what I’m going to do)
A police report from the US (got this days before I left MN)
My appointment letter
A letter from my employer requesting that immigration give me a work permit
My job description
My CV
6 copies of passport photos
My current passport
My old passport, which has my old last name and Dependant’s Pass
My Dependant’s Pass
NGO Certificate

Oh boy, I can already tell this is going to be fun! Apparently this process takes months to complete and dozens of trips to Immigration (where the lines are never short). Luckily, I’ll be busy with work in the field in a few weeks’ time, so I won’t have to follow this through all the way to the end!

p.s. This has got me thinking, maybe I should do some blast-from-the-past blog entries to document some of my preciously Ugandan moments in Uganda (the Makerere ID saga, the Mr. Baguma is not in story, the mean lady at immigration story, and the European philosophy professor).

Munene munene- I have a BlackBerry!

2008-10-19T11:23:00.000+03:00

I never thought this day would come, but here I am posting via my BlackBerry! I decided to subscribe to BlackBerry service here in Uganda-at roughly the same monthly price I was paying for the service in Minnesota-mostly so I can have instant internet access anywhere I am in the field. My job will involve a lot of travel upcountry and to remote areas without internet cafes. But now I can be in touch, online, anywhere there is MTN phone coverage-which is virtually the entire country.

Munange, I am feeling so mazzi mawanvu! (to use a Luganda expression... Go find a Muganda to find out what it means.)

Religion and men: two of the biggest barriers to FP in Uganda

2008-10-16T16:11:00.000+03:00

“Mzee [old man],” I asked the 41-year-old man who had just volunteered his age, “did you know that the year you were born Uganda’s population was around 3 million? In your lifetime, it has increased 10 times, and is now more than 30 million.” This was followed by a series of shrieks of disbelief: “Eh!,” the room full of religious leaders exclaimed. I continue, “Our population is set to double again in the next 20 years, and by 2050, this country will have 130 million people if current fertility rates continue.”

I scanned the room as the crowd of about 30 religious leaders from five religions (Anglican, Catholic, Seventh Day Adventists, Muslim, and Pentecostal/Born Again) representing rural communities of Mubende discussed the information I had just shared with them. (“Where will these people live? How will we provide education? Where will they get charcoal?”) This was part of a ½ day sensitization training we had with religious leaders to try to get them on board to support family planning. The goals of the training were to share information with religious leaders on the need for and benefits of family planning (FP), address myths and misconceptions related to FP, provide an overview of FP methods, and discuss how religious leaders can promote FP in their communities—within the bounds of their religion. We framed FP as an issue that everybody—including religious leaders—should care about if they care about the development of their country, the well-being of families in their communities, and health of mothers and children.

For those who don’t know, Uganda has one of the highest total fertility rates (TFR) in the world, hovering around 7. This means that the average Ugandan woman has 7 children during her lifetime. High TFRs have negative implications on mothers’ and children’s health, on the well-being of families, and the development of the entire country. The high population growth rate (3.4%) and forecasted population boom are not good news for a country roughly the size of Wisconsin that is already struggling to meet health, education, social service, and housing needs.

The good news is that there is evidence that Ugandan women want to limit the sizes of their families and that more and more women want to use FP. The ideal family size has decreased from 6.5 in 1989 to 4.8 to 2001. This indicates that women want to have fewer than the 7 children they are having on average. Currently only 23% of married women use FP methods of any type, with 18% using “modern” methods (condoms, oral contraceptives, Depo-Provera, Norplant, etc.) and 5% using “traditional” methods (withdrawal, fertility awareness methods, etc.). However, the Uganda Demographic and Health Surveys 2006 identified a 41% unmet need for FP (up from 35% in 2001). The fact that the demand for FP services is increasing is a good sign; however, there are numerous, complex reasons why providers are not able to keep up with the demand for FP services.

Challenges in FP provision in Uganda include limited political support for FP, stock-outs of FP products, persistent myths related to FP methods, limited number of trained providers, a lack of services in rural areas, and social and cultural norms that define wealth and manhood in terms of family size and grant men decision-making power.

Recently, I was having a conversation with someone else working in FP in Uganda, and she commented that religion and men are two of the biggest barriers to FP in Uganda. While there are some religious leaders (my newly ordained Reverend-Doctor father-in-law included) who actively encourage families to use FP, there are many who many speak out actively against family planning. Some faiths are more anti-FP than others, with Pentecostals and Catholics often pointed out as the two main barriers.

This is why my part of my work involves training religious leaders on FP. There is a new product being marketed called MoonBeads, which is a natural FP method based on the fertility awareness method. It is 95% effective if used correctly and religions that oppose other FP methods have started to embrace these. We talk about this method, but also encourage those who are willing to promote all other FP methods in their communities as well. By the end of the training, the religious leaders in attendance are visibly shaken by their visions of what is to happen to Uganda if the population continues to grow at current rates. Each has made a pledge to take action in their own community. I am impressed by the palpable shift in attitudes in the room, and equally impressed by how well the leaders of different religions worked together throughout the day.

Religious leaders yield tremendous influence in their local communities. They can be major barriers to FP use but can also be a major facilitator of FP use. We are also counting on religious leaders to take messages about the importance of FP to men. In a society where both manhood and wealth are defined by the number of children one has, we need influential people such as religious leaders to speak up and help shift this norm. The FP advocates in Uganda have recognized that we must get religious leaders on board if we are to advance FP.

I think you are not coming from deep in America!

2008-10-13T21:54:00.004+03:00

After a very frustrating two and a half hour journey to work today, I splurged (only 20k) on a special hire taxi home from Bugos after having dinner there with friends. (Yes, I retract my earlier statement that taxis are easy and convenient. The commute this a.m. was horrible! I could have come all the way from Mubende in less time! I can’t wait til Kris is back…or when I can drive myself around!)

Anyways, this evening, I had an extremely talkative special driver, who happened to work as a driver for an organization called Right To Play (which also has a field office in Mubende and which I am planning to visit soon to network). He absolutely loved that I am learning “Kiganda” (which, the way I interpret it means learning not only how to speak Luganda, but actually the entire culture here). Basically the whole ride home, we were talking about how Ugandan I sound and hard it is to understand the accent of Americans.

“But I think you are not coming from very deep in America,” he said. “At least your accent is very clear.” [I slow my rate of speech down about 200% in Uganda and also have (not necessarily on purpose) taken up a lot of Ugandan English mannerisms and accent.] He then related stories about the countless expats he’s driven around for Right To Life and how he sometimes only understands 1 out of every 100 words that they say! He started criticizing how Americans speak “from the nose” and proceeded to start imitating a very nasal-y (but somehow accurate) American accent. “Here we do not speak so fast! We speak slowly but surely. We in Uganda do not say “I’m-from-Amerka” so quickly, we say “I am fa-lum Ame-li-ka!”

Teddy and I were in the back seat absolutely cracking up. It was so hilarious. I especially found the “deep in America” comment funny because it is so Ugandan! Here, people talk about people who are from “deep in the village.” Deep in America just doesn’t translate the same way. Hilarious!

More serious entry soon. Just wanted to jot this down before I forgot.

Two (or so) weeks in Kampala

2008-10-13T21:54:00.002+03:00

So I’m in Kampala for (at least) the next two weeks as I get settled into some of the duties of my job. Right now it’s a bit overwhelming and my head is spinning as I try to figure out everything that’s going on, whom I’m responsible for, what I should prioritize, etc. This time in Kampala will give me a chance to work closely with the CD who is now back in the country and the interim CD whose term ends at the end of this month.

This week, I’ll spend Monday through Wednesday trying to write our program’s quarterly report, which is difficult since it is reporting on a quarter in which I was not here. However, this is allowing me to understand exactly (or maybe approximately) what’s been happening on the ground these last three months as well as to familiarize myself with our M&E tools and various protocols. On Wednesday, I’ll be attending a conference in Kampala. Next week, we have some planning meetings scheduled during which we will sit down to plan our activities for the quarter and the year. I will fill in the other gaps with setting up appointments to network with (both old and new) contacts involved in family planning work in Uganda. This includes folks at HCP, AFFORD, FHI, DELIVER, YEAH, PSI, etc.

Kris left for Kenya in the middle of the night last night. He’ll be back on Friday. In the meantime, I’m going to have sleepovers with Teddy and D. I’ve realized that in at least this regard, I’ve become very Ugandan. When I was here alone in 2005, Doreen and Olivia simply insisted that they stay with me because it is preposterous to even think of staying alone. Anyways, now three and a half years later, I actually do think it seems strange to stay by myself and thus I’ve recruited two friends to keep my company during the week.

While my driving skills are too under par to drive myself to work, I've been getting to work using the typical Kampala means. I've been dreading for days the walking-taxi-boda commute I'd have to make all the way from Bunga to K'la, K'la to Bugos for days. But it turned out to be not so bad. I made the entire trip in under 40 minutes, and my oh my, did I feel like quite the expert Kampal-ite (I never decided if that would be Kampalan, Kampalian, Kampalite, or something else). I made the 5 minute walk to Ggaba Road, crossed it to catch a taxi into town, which dumped me by Nakasero Market, walked up to Kampala Road, caught a taxi going to Bugos ("Zla, zla, zla, bugolobi, zla!"), jumped out at Mbuya hill, and hopped on a boda to ride up the hill. (Don't worry mom, if you're reading this. I never take bodas through town. I just take it up Mbuya hill, where there is almost zero traffic).

I am still intending to write a blog entry (that includes pictures!!) about my trip to the field last week. So you can look forward to reading about the family planning sensitization workshop for religious leaders we held last week, planning for efforts to scale-up community-based distribution of Depo-Provera (injectable contraception), and my visit to the sacred Nakayima tree on top of the tallest hill around Mubende town. Each of those could probably be its own blog entry—we’ll see how much time I have!

Driving Queen!

2008-10-12T19:45:00.002+03:00

I went driving again today with Kris, and have made great strides. First of all, with confidence and comfort built with our first drive last week, this time I started out strong. I felt the car. I didn't feel blinded like the last time, where I had no idea where my car ended on the left. I naturally and easily stayed centered in the lane. So after driving around Munyonyo side again, I decided that I was ready for some real roads. Albeit it was a Sunday (i.e. less traffic than any other day of the week), but I ventured out onto the main road (Gaba Road in this case), and ended up driving all the way to Henry's house, where Kris had to borrow a waistcoat for his tuxedo for the fancy-shmancy conference he's attending in Kenya this week.

This time driving, I felt comfortable. There were no freak-outs. I was relaxed, in control, alert, anticipating various obstacles (cows, boda bodas overflowing with shoes for sale, bicycles carrying entire beds, crazy matatu drivers pulling on and off the shoulders after letting passengers out, children running across the road, etc). By time we reached Henry's--a good 30-minute drive away, down main roads and dirt roads and in-between roads full of potholes--I felt great. Unfortunately I think I am just a few weeks shy of being confident and competent enough to drive myself anywhere across this crazy city, so I will have to use taxis this next week when Kris is out of town. But I now know with certainty that I will learn to drive very well here!

I'm sitting here with the radio on, and suddenly I heard the voice of one of my friends, whom I haven't called up since my return. I realized then that "Rockpoint 256" was on! It was great to hear all of my old colleagues/friends voices. While I have participated in the creative development of Rockpoint 256 in the past, I had never actually heard it on the radio! Rockpoint 256 is a fabulous radio serial put out by YEAH (Young Empowered And Healthy), an organization to which I provided technical assistance during my internship with HCP. The show is like a soap opera, with plenty of suspense and juicy plot lines that drag out for weeks and weeks, but it models specific behavioral goals. The show deals with serious topics such as HIV/AIDS, responsible drinking, what it means to be a man, domestic violence, sex, and friendship. Hearing it just now on the radio made me extremely proud of the show and made me realize there are a lot of people I still need to call up!

The next two weeks I'll be in Kampala, so I can work with the Country Director who is back in the country, attend a conference, and work on some reporting. This will also give me field staff a chance to finalize my house in Mubende. We looked at a few potential houses in Mubende: all lovely and any of which I would be fine with. I have asked them to follow up to see when I could move in, what work needs to be done, and how much rent would be. Hopefully this can all get sorted out over the next 2 or 3 weeks so I can start working on making home #2 feel like a real home!

How do you spot a drunk driver in Uganda?

2008-10-09T14:02:00.003+03:00

There was a joke my dad picked up in Uganda in 1986, that he continued re-telling for years: How do you spot a drunk driver in Uganda? They drive straight down the road! You need to know a little bit about the roads here to get that joke. Because of all the pot holes and other obstacles (cows, bicycles, boda bodas), a good driver learns to swerve around these obstacles as they drive, and to follow the contour of roads succumbing to erosion.

I've been thinking a lot about driving lately and gave it a good try on Sunday of last week. I had a realization a few weeks ago that, while nothing has changed in terms of my capabilities and abilities to live life normally in Uganda, I was suddenly feeling for the first time ever like coming to Uganda has meant a loss of independence. With some careful thought, I realized that as an individual, nothing has changed, I'm just as comfortable here as ever, free to do as I please. However, as half of a couple, I have lost independence in comparison to Kris. Juxtaposed to our life in Minnesota, where we both drove, and both spoke English and thus could do just about anything, suddenly now compared to Kris I feel very incompetent here. Yes, I have survived here for many years on my own and as was the case before, I know the matatu taxi routes, I know how to bargain, how to get from Point A to Point B, how to plan for power outages (load shedding)--everything you need to be able to do to live comfortably here and feel at home. But, in comparison to Kris two of my limitations in particular have suddenly felt repressive: my inability to drive here, and my inability to speak fluent Luganda. We went from a setting where we were both equally capable, to one where I am less capable of certain things. Kris and I discussed this, and he understood exactly what I meant, and we decided we would have to find a solution.

As soon as I realized this, I resolved that I will learn to drive here, and I will learn Luganda. Full stop. I've made up my mind, and in the week that has ensued, I've already made good progress on both of those. Last Sunday, I went out driving with Kris in the passenger seat. I've tried driving here only once before, and that experience ending with a very gentle knock of a matatu (but still enough to make me feel like I could never master driving). With new resolution and newfound confidence, I've realized that the mistake that time was that Kris had me just start driving straight away through the most congested, chaotic, potholed areas (Kalerwe market, of all places!!!). I told him this time I first need to get used to keeping left, and operating a car where the driving wheel is on the left-hand side. Once I am very comfortable with that, I will tackle all the other challenges that driving here offers.

I have to say all of the young foreigners I know who have learned to drive here come from countries where they are used to keeping left, and operating a car with a driving wheel on the right-hand side (a "right-hand drive"). These people have had a HUGE one-up on me because it is hard to get used to the opposite! I realized that I didn't even know how much I had internalized using a left-hand drive and how bizarre it feels to drive from what would be the passenger's seat in an American car. You have to un-do what you have ingrained into your subconcious while driving. My big problem is not remembering to keep left on the road, but sensing how much **car** I have to my left, and how little **car** I have to my right as I'm driving. The tendency is to leave to much space on your right, and not enough space on your left because you're not used to catering to the bulk of the car that now sits to your left.

So on Sunday, I first started with driving on marram (dirt) roads around our house. This was good because I got a feel for the car (the turn signals are where you would think the windshield wipers are!), where there is almost no traffic, and learned the concept of "following the contour of the road," and anticipating potholes. I was feeling more confident, but still not entirely comfortable with knowing how far my car extended out to the left. I asked Kris to drive the stretch along the main road, and then I got back in the driver's seat on the road leading to Munyonyo resort. There is never much traffic there--although there is some, which I needed!--even on a Sunday. The road is paved and very smooth. I drove for about an hour all around the area getting used to the feel of the right-hand drive. On the way back, I drove back on the stretch of the main road! I ended the lesson feeling proud and confident--I can do this! We'll practice again this weekend--this time in a more congested area--and hopefully in a few weeks I'll be ready to drive on my own.

Our lovely Kampala home (Pictures!!)

2008-10-04T15:19:00.012+03:00

Finally took the camera out to take some pictures of our only partially furnished, but lovely home. Now you can see for yourself what our living arrangements are in Kampala, again all thanks to Doreen!

Me on our front balcony. Yes, that is Lake Victoria in the background.

Another balcony view, this time featuring Kris.

The stairs leading up to our place.

The living room (no couch yet--just a desk and chairs) as viewed from the dining room.
Our bedroom - spacious, bright, with a beautiful view (see next picture).

The view from our bedroom window. Oh, and that's our car at the bottom.

The kitchen. We just bought the mini fridge and cooker last night.

Separate toilet and shower rooms of one of our bathrooms. (Waaay better than bathroom at my previous Kampala flat).

Last night we went out with old friends and had a blast at Mateo’s. I love watching how everyone has grown and matured over the years. We all had so much fun together and I know it will be the first of many fun evenings in K’la. This weekend we are just chilling, maybe doing a bit more to get our house set up. Monday-Wednesday, I head back to the field. One of the things I hope to accomplish is to find a home in Mubende as well. It will definitely be much simpler than our Kampala home.

Back in K'la, more updates coming soon

2008-10-02T17:18:00.003+03:00

I arrived back in Kampala yesterday in the evening after three days of immersion in the field. I just posted (below) an entry that I typed from Mubende but didn't get a chance to post until now. Today, I've spent the day in the Kampala office doing some preparations for next week, when we will be leading a training on family planning for religious leaders and a stakeholders' meeting for the community-based distribution (CBD) of depo (birth control injections). There is a lot of exciting work going on and within a week I will be thoroughly immersed in it! I feel like this job will be the perfect level of challenge. I will learn and grow from it but not feel like I am too far out of my comfort zone or capability levels.

First impressions and the case of the missing mattresses

2008-10-02T17:15:00.000+03:00

I am currently visiting our two family planning field sites with the interim country director and a short-term contractor. On Monday morning, we drove from K’la to Ssembabule district via Masaka. Ssembabule town was smaller than I expected. It is about 2 hours past Masaka down a marram (dirt) road. MIHV has been on the current premises in Ssembabule since 1984! It is a lovely set-up a little bit outside of the town, with a living space and office attached and (very clean!!!) pit latrines out back. Ssembabule is quite off the beaten track and remote. It has no electricity or running water, so the office operates its computers and other necessary equipment using a generator for a few hours each day. The area is peaceful (at least when the roar of the generator is switched off), expansive, and green.

I met the staff at the Ssembabule site, all of whom were very welcoming. Many of them have been working for MIHV for 12 or more years, including the night guards and driver. When we arrived, our first order of business (after taking tea) was to have a meeting with the driver, who has been sick and become very weak. The three of us sat in his car with him as he pulled out his medical records and notes from the doctors he’s seen. He handed them over to us so that we could make sense of them and advise him on what to do next. We encouraged him to go see a doctor at Masaka hospital and told him he is too sick to be working, at least for the next few weeks. We asked about his support structure at home and encouraged him to spend the next few weeks resting as much as possible while he continues to see the doctor.

Next order of business: our staff updated us on the case of the missing mattresses. MIHV has a dormitory in Ssembabule with 16 beds. A couple of weeks ago they noticed four mattresses were missing off the beds. There is only one person with a key to that building, and two witnesses came forth to say they saw her carrying those four mattresses out of the building one evening. This staff member, a cleaner, first denied the accusations, then finally admitted she had taken three of them to use at a relative’s wedding. The staff member was so ashamed that she did not come into work the next day, and a few days later called to say she was quitting the job and that we could use her last month’s salary to pay for the mattresses. She said she was so ashamed that she had not only left her job, but she was leaving Ssembabule—and leaving her two children behind under the care of a relative. The staff were very concerned about the situation and we agreed that we would forgiven her for the mattresses and that we should encourage her to come back to work or at the very least come back to Ssembabule so she can live with her children.

So, these are the very first managerial issues I have encountered in my new program manager position. Certainly not in the realm of managerial issues that would come up in work back in the States!

We spent the rest of the day in meetings with the field staff. I am trying to learn as much as possible from these two temporary MIHV employees before their contracts end. They are both avid walkers and after work we went for a long (~2hr) walk through the village. The people we passed were all very friendly, definitely more shy about calling out “muzungu!” than Kampalians (Kampal-ites?).

This morning we woke up and found out that it was a public holiday for Eid, but we still worked in the morning with the Ssembabule staff then proceeded on to Mubende, about 2 hours’ drive from Ssembabule along a non-paved road. Although the road we used was not paved and through some very remote areas, it ran through President Museveni’s land and was thus one of the nicest, smoothest back roads I’ve ever been on.

I am now in Mubende, typing this from my guest house (and will post it a few days later, when back in K’la with internet access). The Mubende area is overwhelmingly beautiful. The town itself is larger than I expected but still quite quaint and set amongst a breathtaking spread of rolling, green hills. (I hear there are tons of great hiking excursions, many of them starting right from Mubende town.) This will be my part-time home for the next while and am excited for what will unfold in this little gem of a town. I’m still wrapping my brain around everything that’s happening work-wise and what exactly my job will entail. More on that later!

Forever misfits?

2008-09-28T20:27:00.000+03:00

Kris and I are getting into the swing of life back here in Uganda. I love life here and we’re already thinking time will fly by, especially once we start work. But we’re also realizing that we are destined to be somewhat of misfits, no matter where we are for the rest of our lives. We are a multi-cultural couple. We as a couple will never be entirely Ugandan nor entirely American but always in a grey zone in between.

The friends Kris has had for years and years suddenly find it funny that we’re living in a flat that costs about $300 a month to rent. They can’t believe we’d spend that much money just on rent! The expats we work with can’t imagine we’d spend so little on rent and imagine we live in a sketchy shit-hole (quite the opposite, actually—this is one of the nicest places I’ve stayed in Uganda thus far). I remember when I came to do my Masters internship last year, the woman at my workplace (an expat) in charge of helping me find housing said she had “never heard of an apartment in Kampala for less than $1000 a month.” When Kris asked his new boss for suggestions of where to stay, he suggested the $1600/month Golf Course Apartments! $300 seems pretty middle-ground (that elusive middle class!) to me, but everyone else views it as one extreme or the other.

Today we went to chill at Speke Munyonyo Resort, which is not too far from our home. It was actually my first time ever swimming there. We paid the 15,000 Shillings ($9) for entry and found ourselves in a bubble so inconsistent from the rest of Uganda that it felt weird. The composition of guests was probably 80% bazungu, 10% Indian, 10% Ugandan. Weird. But at the same time, it was relaxing, enjoyable. We weren’t the only interracial couple on the scene. Suddenly, PDA was totally acceptable. We could hold hands and even kiss! But at the end of the day, we both decided we don’t really fit in there either. We may go there every once in a while to chill out but not make a weekly ritual like so many bazungu and rich Ugandans do.

Tomorrow I’m starting work and will be going on a 3-day field visit to both of our Family Planning (FP) sites. I agreed to start working 2 days before my contract begins so as not to miss an opportunity to go to the field with the interim Country Director and short-term contractor whose contract is drawing to a close next week. I’ll get to sneak in 2 extra vacation days to make up for it later. We’ll be visiting both the Ssembabule and Mubende sites. I’ll get to meet the staff and we’ll be providing assistance to some program activities. I’m sure I’ll have much to write about after I get back.

I’m about to fill in my absentee ballot. Hmmmm….I wonder who’s getting my vote for President?

Not exaggerating - 10 breakdowns in one day!

2008-09-27T07:42:00.003+03:00

Oh, the joys of being in Uganda.

We’ve been having some car trouble with the car we bought early this week. We test drove it twice long distances, we had Emma inspect the vehicle and test drive it on three other occasions, we had 3 additional mechanics look at it before we bought it, we had two other friends who know a lot about cars weigh in, and we had it fully serviced after inspection—but despite all this we’ve still ran into trouble these last few days. The car has just been dying on the road. Until yesterday, the pattern had been we drive a short distance, it stops, we wait about 10 minutes, it starts again, we drive for two minutes, it stops again, we wait 10 minutes, it starts again and this time drives for the whole day with no problem. Well yesterday, the car just decided to give us even more trouble and the situation ended with 10 breakdowns in three separate cars over the course of one very long day.

Breakdown 1-2, Car #1, 8:00 AM, & 8:15 AM
Ok, this has happened every morning. By this point it would seem uncharacteristic if the car didn’t give out twice in short succession and then drive fine for the rest of the day.

Breakdown 3, Car #1, 8:20 AM
Uh oh. It’s broken down again, this time in a narrow portion of the road on a steep hill with very heavy traffic. We’re causing a jam and everyone who drives by gives us a mean look. Finally the car starts back up and we drive, but not for long.

Breakdown 4, Car #1, 8:25 AM
The thing gives out again, but this time Kris is able to coast onto a little dirt road turning off the main road. We try for 30 minutes to start it back up, but the car refuses to start. This time it seems it is dead for good. We call Emma. He says let me come. We wait in the car for three hours for Emma to finally get there. He comes with a clique of mechanics who immediately go to work on the car. They do something to allow the car to drive. They drive Car #1 (our car) to Caltex and lend us another car. As we are driving to town in Car #2, we watch Car #1 stop three more times on the road.

Breakdown 5, Car #2, 12:30 PM
We can’t believe it when the car Emma lent us while he worked on our car also stopped as we were driving it. This turns out to be a minor hiccup and the car starts up again in 5 minutes or so. But we still call Emma to let him know he gave us a dud. Emma says he’ll have another “very reliable” car for us to drive in the afternoon. We go to the gym, Kris drops me in Bugos for my meeting at MIHV, and meanwhile he drives back to Caltex to exchange cars again.

Breakdown 6, Car #3, 6:15 PM
Kris picks me up from work in the new car that certainly didn’t have a “very reliable” look to it, but looks can be deceiving, right? As we are driving to Garden City to meet Andrew, we notice the car making funny noises. Then the car decides to break down in the middle of a roundabout (the one right by Garden City) during heavy rush hour traffic. To make matters worse, the double indicators were also broken, so we just had to sit there without indicating any trouble as we tried to restart. A police officer came over and asked what the problem was. He told Kris, “You go get some of those bicycle boys to give you a push. You can’t remain in this location—we are in heavy jam! You go now!” Kris sprints across the street and flags down two bicyclists and asks for their help. Meanwhile I’m sitting in the car in the middle of the roundabout and getting lots of weird looks from people. Kris hops back in the car as the bicycle boys push us through the roundabout as the police officer stops traffic, and then onto the curb. We call Emma saying it’s probably just the battery. He comes quickly and gives the car a jump. It starts back up and we manage to drive to Garden City. Andrew calls a few minutes later saying he won’t make it to Garden City because he is having car trouble! (I guess we’re not the only ones with car trouble today!)

Breakdown 7, Car #3, 9:00 PM
After having some drinks at Garden City, we come back down to the car and it doesn’t start. We pay a special hire guy to give us a jump start and we’re on our way. We’re so fed up at this point, we just want to get back home.

Breakdown 8, Car #3, 9:20 PM
The car starts making weirder and weirder noises, protesting the fact that we were driving it. I am sitting in the passenger seat, trying to will it to just get us home, when the car breaks down right in a congested area of Kabalagala just when the bar scene is starting to heat up. Kris goes to look for someone to give us a jump again, and I’m sitting there now trying to will myself to be invisible! We finally get the car to start again and off we go.

Breakdown 9, Car #3, 9:50 PM
The car starts making louder and scarier noises as we drive. Now the indicators (turn signals) have stopped working and Kris has to stick his arm out the window to indicate turns. The car sputters to a stop in front of another bar, not too far up the road from the last one. A guy working at the bar comes out to tell us we have a flat tire (in addition to the dead battery). As we’re still sitting in the car, he runs off and comes back with the tools to change the tire, recruits a few idle men to help, and does the whole deed in under 10 minutes. We get the battery jumped again and manage to start driving again. The car is still sounding funny, but we are getting close to home. I am getting hungry and fed up with the whole situation and just want to get home…but that can’t happen just yet.

Breakdown 10, Car #4, 10:20 PM
I can see the Engen gas station, the landmark where we turn off from the main road to get to our flat, and the car gives out again. We try restarting it for about 30 minutes and recruit the help of an Askari (guard) to help. No luck. The car has jammed. Home is so close but so far away. We ask the Askari if will watch the car overnight if we leave it parked there and he agrees. We call Emma to update him on the situation, and he is in disbelief. Meanwhile Emma updates Kris that while they thought our car was fixed, they had just found another problem. Poor Emma, he feels so bad and he’s such a faithful friend. We don’t want him to feel bad because none of this was his fault! Kris and I manage to find a special hire to take us (and all the bags of stuff we’d bought at Uchumi) back to the apartment. We finally get home at about 11:30 PM.

Oh, the joys of living in Uganda. But really, it’s more hilarious than complain-able.

What kind of noises do you hear in the night?

2008-09-26T06:55:00.002+03:00

I went to get my haircut the day before I left MN, and my hairdresser (who thought it was really **cool** that I was moving to Uganda the next day) asked an interesting question. “What kind of noises do you hear in the night over there?” I liked this question because it was so original. Nobody has ever asked me that before about Uganda…or anywhere else for that matter. I answered that it depends if you’re living in town (traffic, men bickering loudly, construction noises, matatu conductors shouting out routes) or outside of town (cows mooing, cocks cocka-doodle-dooing, church congregations singing and praising, exotic-sounding birds). The Muslim call to prayer is also a widespread phenomenon in Uganda, which you can hear throughout the day (including the early morning) from just about any position. My worst ever-ever nighttime noise experience in Uganda was when I lived in Blacklines house and they decided to spend three or four consecutive nights tearing up concrete and using this extremely loud flattening device to smooth new blacktop—all in preparation for Chogm.

Well, after our first night in the new flat, I have a new answer for my hairdresser. I hear schools. Our flat is absolutely gorgeous (especially the breathtaking view of Lake Victoria out of all of our front windows). It is spacious; well-laid out; with functioning everything, in a prime location not too far from the main road, a supermarket, a gas station. However there is one drawback—the back of the apartment building faces a primary boarding school. During most of the day, they are relatively quiet (when in classes, when eating, etc) but during their free times/recess you hear the usual ruckus of a school playground: children shouting and calling out, teachers raising their voices to discipline the children, laughing, singing, etc. While this has proven slightly annoying (especially when the kids woke up at 5:30 this morning) I think we’ll get used to it and compared to other noises in the night from previous homes in Uganda, it will pale in comparison. I also think if we keep our back windows shut that will make a huge difference, since our bedroom and most of the flat faces the front.

I will be posting pictures soon of the apartment (probably once we have some furniture in it). So far all we have set up is the bedroom. We got a lovely handmade bed, a nice firm Ugandan foam mattress (the most comfortable mattresses in the world, in my opinion), a mosquito net, bed sheets, and a duvet set. For some reason I’ve noticed towels and bed sheets and blankets are weirdly expensive here. Almost everything else is way cheaper than at home but for some reason blankets and towels tend to be about 3 times the cost. Kris went with Henry and Solom to negotiate the price on the bed, while I did some household shopping at Game (the department store a-la-Target) with fixed prices. I wanted to avoid the furniture shopping so we could avoid getting scammed with a muzungu price. Next up, we want to get a couch, a desk, a dining table with four chairs, some little side tables, fridge and cooker, and patio furniture. I think the patio is going to end up being my favorite “room” of the house because of the gorgeous view that I can’t stop raving about! The amount of stuff we have left to get is a little bit daunting. Because furniture shopping isn’t a simple task here but rather several days’ running around. Even more daunting is the fact that I have another home in Mubende, which I’ll need to first locate, then furnish. I think it’s going to take several weeks until I feel fully settled. The bed is totally finished though, so that makes a huge difference!

In other news, we got our internet set up. The modem is a nifty little USB device about the size of a computer mouse that doesn’t have to be plugged into a power source or a phone line or anything like that. Just plug it in to your USB drive and you can use the internet ANYwhere you can get a UTL phone signal (which is basically everywhere!). It gives you the freedom of wireless and is actually surprisingly fast (much faster than Café Pap wireless). We get unlimited internet access through this for about $100 a month. That definitely sounds expensive, but I think it’s worth it for the convenience and Kris will need it for the consultancy work he is continuing to do in the US.

Yesterday while checking our email, Kris and saw a Yahoo news headline that said “McCain suspends campaign.” For a few seconds, we thought that McCain had dropped out of the race…but then we realized he’s just pulled his ads and is planning to skip the debates! Great news about Obama being up in the polls though!!! I’m trying to remain hopeful and meanwhile everyone here loves Obama!

I visit the MIHV offices in Kampala today for the first time to meet with the interim Country Director (CD) and make plans for my start of work next week. I'll be going to visit the two Family Planning field sites Mon-Wed with the interim CD.

Praying for Internet connectivity

2008-09-23T11:02:00.000+03:00

Day two and all I can think is, ahhhhhh it feels great to be back!

We’ve been staying at Kris’ parents house in Mpererwe but will soon be moving into the gorgeous flat Doreen found for us in the Bunga area. We went to visit the flat yesterday and it is beautiful, spacious, brand-new, with a breathtaking view of Lake Victoria (pictures to be posted…eventually). While living smack-dab in the center of Kampala last year was fun, that was a phase I am glad is over. This new place is a bit outside of town (and yes, there will be a jam associated with our daily commutes) but it is peaceful, beautiful, relaxing out there! Next up we have the daunting task of buying furniture and appliances and household items. You can’t just make a single trip to Target and—voila—have a fully furnished pad. No, it takes lots of running around, bargaining, visiting many handmade furniture spots along the roadside and figuring out how to get it to the new place. However, thus far everything I’ve dreaded as being “daunting” (finding a flat, buying a car, figuring out an internet plan for home) has actually turned out to be surprisingly simple and easy. Not that Kampala has gotten friendlier or easier to navigate, just that I now have literally dozens of beloved friends and family who care about me, look after me, and would help me with anything! I feel so loved and well looked after here!

But it is a bit daunting that I will have to furnish not one, but two homes. The Bunga flat as well as a home (I have yet to locate) in Mubende! The good news is my work is paying for all the furnishings and appliances in Mubende, but the bad news is I still have to find them! I’m sure I’ll have colleagues on the ground at the field site who will be more than happy to help me, however. I’m very excited to start work although I am grateful for this week to relax before work starts. Our friend Henry hooked us up with comps for the Jinja Nile Resort, so Kris and I will make a 3-day escape to the beautiful resort overlooking the River Nile for some much needed R&R. We leave tomorrow.

Kris went to meet with his new boss, Fred this morning and I am sitting waiting for him as I sip a delicious almond latte at my fave coffee shop with wireless internet (none other than Café Pap). I first met Kris’ boss in probably September of last year at an HCP function (he is married to one of my former HCP supervisors). Fred is Kenyan, married to a Minnesotan public health specialist, and I thought instantly of the similarities to me and Kris! Within 30 seconds of meeting him, when I told Fred that my then-fiance was back in Minnesota getting his MBA, he talked about how much he wished he had an MBA. I remembered that encounter for months to come, knowing that Fred and Kris would have a lot in common. Sure enough, when Kris was networking to find a job and suggested he contact Fred, it turned out to be a perfect match. (Janani helped make the initial connection, as she ended up doing a 3-month stint with Fred earlier this year).

Kris’ dad, the eminent doctor-reverend-professor, is working to start up a business venture using his expertise on gaps in the health sector (more on that later). Anyways, he explained to us last night that he’s hit a major snag in starting up the business: tediously slow internet access at his Makerere office (he’s been managing to check one email a day!). Last night as we had our nightly family prayer session, he asked God to please grant him internet connectivity. I don’t mean to make light of a serious situation and an earnest prayer, but I’ve never heard anyone pray for internet connectivity before! It really amused me! With such a brilliant man with great ideas and energy it is tragic that internet is the only thing holding him back. Kris and I are going to help research internet options for him—probably at the same time we look into setting up internet at our new flat.