Wednesday, February 24, 2010

what is rusha up to??

So, as our time in Uganda comes to a close, I thought I would update you all as to what exactly I have been up to at our work, Kamwokya Christian Caring Community (KCCC). Mostly, I have been learning to be patient, to tolerate having things happen very slowly or not at all, to understand that not everything is fixable (in fact very little is) and I have been seeing a bit about how medicine is practiced in Uganda. Our mandate from AJWS was that we were not really sent here to do direct service and that we were to come up with something that would be self-sustaining so that it could continue when we are gone. Although KCCC sees many children in their general clinic, the staff was not particularly interested in feedback from a pediatrician, unfortunately. I do see kids once a week on my own and often make it up as I go along, learning about malaria and many other tropical diseases. I also help out in the weekly immunization clinic, mostly weighing babies and plotting their growth as well as trying to help the staff with lessons on normal growth and development or breastfeeding or nutrition. The clinic is held on the side of the church that the organization is founded from and up to 100 women cram into wooden pews that have been brought outside. They have immunization cards given to them by the ministry of health where their growth and shots can be tracked if they are lucky. Some women instead carry around a little paper notebook where things are recorded. None of the weights are ever plotted so its very hard to tell if the kids are growing properly or not, but this is the extent of well-child care for most Ugandan children and the immunization campaign is fairly successful. Although we see plenty of adults on the street with polio, it is rare to see a child with the disease. The babies are delicious and most of them, thankfully, are fat and healthy looking. We weigh them from a hanging scale similar to the one in the grocery store on which you would weigh fruits and vegetables. So amazingly cute!! Usually it is so chaotic with 100 women and babies that no teaching gets done, and the language barrier is hard, but we have been able to do some sessions and hopefully the community health workers will continue with the teaching.

The main bulk of my time here has been helping KCCC start a program for the prevention of mother-to-child transmission of HIV, or PMTCT. If PMTCT works properly, it can be 99% successful and babies can be born to HIV-positive women and themselves be HIV-negative. The basic steps are different than they would be in the US where we would do a cesarean section and tell the mom not to breast feed, as those are 2 ways to avoid transmitting the virus. Per the WHO in a developing country where most women deliver at home or in a random clinic and clean water and formula are a dream for most people, there process here is that: 1)the mom is on the proper HIV medication during her pregnancy to get the amount of HIV virus in her body as low as possible, 2) during the delivery the mom is given HIV medication if she was not previously on drugs and the baby is given HIV medicine directly after birth and then for one week afterwards to decrease the risk of having passed through the birth canal, and 3) the mom breastfeeds exclusively and continues on her HIV medication and does not mix in other feeds.

The program at KCCC was supposed to have started several months ago and was limping along with no direction, no clear understanding of what they were doing, no records or tracking and no buy-in from the staff when we got there in November. It was not until January that I had any clear sense of what to do, how I could help. Up to now I have written a budget and designed numerous work plans for the year. The organization is required to compile masses of reports for their donors on a monthly basis and everything is supposed to be accounted for, down to any notebook purchased. The bureaucracy is such that everything happens REALLY slowly (as those of you who know me, you understand that this is hard for me!) and there is often triple work to make all the reports. The donors dictate everything they want PMTCT programs to be achieving at all their funded sites, regardless of whether the activities are relevant for the community or the particular clinic. Most of what we are doing at KCCC is mobilizing in the community, spreading the word that we can prevent mothers from passing HIV along to their children during pregnancy, and making sure that our clients who are HIV-positive are on the proper HIV medications and that the babies get the drugs once they are born and that breastfeeding is done safely. It is actually a huge task and many things fall through the cracks, but here it is more about the general direction a program is taking, rather than details--which is, again, hard for me.

On a daily basis, this means that I am sometimes doing something as simple as making labels and cutting them and sticking them into a book that is used to record the names and information about our pregnant clients and babies. (Everything is recorded in these massive books and using an Excel sheet on the computer is a totally foreign and impossible concept, so information is missing or re-recorded and it makes it challenging to know what you are really doing.) Other times I am seeing clients with the doctor who is the head of the project, counseling mothers about medication and breastfeeding or the importance of delivering their babies in a medical facility as opposed to at home or in a "clinic" somewhere in the bush. Other times I am running a workshop or a training session about PMTCT with the staff of community volunteers that go daily into the field and meet with clients. I have been connecting with other local organizations, the Ministry of Health, the main hospital, Mulago trying to connect KCCC with these other resources for nutrition and pre-natal care. My favorite thing has been starting a monthly support group for mothers and pregnant women. The concept of a support group as we know it where people share their experiences and self-direct is not here, and it is more like a lecture session. The first group was awesome: 18 women and their babies or pregnant bellies attended, the counselor talked about disclosure of HIV and then we all had snacks (the staff ate before the clients) and watched 3 of the community volunteer staff members lip synch to some Christian songs in Lungada. In between, the women did get a chance to talk about how hard it is to disclose their HIV-positive status to husbands or partners who will leave them or beat them or stop supporting them, even though the likelihood that their partners are also positive is almost 100%. They also talked about giving their babies tea because they are not breastfeeding and cannot afford milk or formula. It was both amazing and heartbreaking, like so many experiences we have had in Uganda.

Three times I have been told that the funding for the project would be cut and I have visited the local offices of our donors to see that the money can be secured. The budget for the entire year is only $2500 (not including the drugs that we provide for clients) but the expectations of what we are supposed to do with that little money are pretty large. My low point was when the doctor who I am helping (or some might say pushing into doing this work) told me that he was relieved when they thought that the funding might not come through. I realized that maybe I want this program to work more than they do. The staff who were assigned to work on the project are already busy and a bit difficult to motivate. But the truth is that this place has gotten over 2000 people on HIV drugs and now these clients want to have babies and one of the best ways we can be effective in preventing new infections is through this project and I think that when we leave, even if they only hold onto a few things that we have started, maybe, just maybe, we will prevent some.

Monday, February 22, 2010

Mbale, Sipi falls, and the Abayuday

we just got returned from a weekend out east in Mbale. Mbale is a town close to the Kenyan border, about 4 hours by public taxi from Kampala. the trip was a consolation prize for not having the time to climb mount Elgon, the 4th largest mountain in Africa. Our first stop was Sipi falls, a series of tall waterfalls that cascade down the side of mt Elgon.

The trip to Sipi falls involves a public taxi toMbale, the 4th largest town in Uganda, but really just an African trading center. From Mbale we got into a random van. As you get out into the Ugandan bush, taxis become less frequent, and so anyone with a car becomes a taxi. Unfortunatly, as Guy was getting out of the van, his phone fell out of his pocket. Once we were sitting at the camp in the middle of a huge rain/hail storm and guy realized that he did not have his phone, we of course called it and an African man answered and promptly hung up when he heard a mzungus's voice. We played a game like that, texting that there would be a reward if the phone was returned with no answer. Eventually, a kid who works at the camp came by and knew the guy who was driving the van. He called him and lo and behold, the guy knew where the phone was. Apparently, after dropping us off, a boy had picked it up but that boy was then dropped off at the hospital in town and the driver needed to pay some policeman to help get the phone back. the driver was able to accomplish this task in all of 5 minutes and it was quite clear that he had taken the phone and was trying to save face while making a buck. The phone eventually came back (with some airtime still left on it, surprisingly) and Guy gave him 40,000 shillings ($20) to pay for the "policeman". Ah Africa....

After that small adventure, we had a great time in Sipi. The falls are beautiful and we hiked through small villages, matoke groves, and bull-plowed fields to reach all three of them. The water was fresh and cold and we had a good swim with some local boys (seems to be the theme) and drank some local beer with local farmers made of corn (disgusting and pulpy). Along the way, in the middle of a very steep downhill including rickety wooden ladders and no switchbacks, we came across a Ugandan farmer walking up the same trail balancing 3 bunches of matoke and a hoe, weighing upwards of 80 lbs. on her head. She was walking up the steep hill, including the ladders with her amazing load!

We left Sipi without any phone delays and carried on to spend Shabbat with a community of Ugandan Jews called the Abayudaya. This community was founded in the early 1900s by a Ugandan who was given jurisdiction over the eastern region of Uganda by the British while it was still a protectorate. He decided that Christian practice had strayed too far from the original intent of the bible and decided to rewind and follow the old testament, forming a group of followers that began to practice Judaism. Today Abayudaya have about 1000 members spread over eastern Uganda and focused around Mbale. They have a Ugandan rabbi who studied in Los Angeles and Israel and they read and speak Hebrew during services, keep kosher, wear Kipas, keep Shabbat and follow conservative Jewish traditions. Apart from that, the place is totally African: naked babies, chickens pecking the earth, laundry drying on bushes, women carrying things on their heads, kids chasing us and calling us mzungu, boda bodas etc... We were invited to attend Friday night services which started with drums and songs but continued as evening services would in any conservative synagogue. We met Itzchak Byaki, Samson Shadrak, Israel manumbamba, and Yael Gadongawe, what a trip! We did Kiddush at Israel's house using a local made Challah and Kosher grape juice imported from Kenya. Unfortunately we did not get a chance to hang out with the rabbi or any of the other community members because we had dinner with Isaac who runs the guesthouse. Shabbat dinner was "food" with fried fish.
The experience was surreal: Authentic Jewish service, discussion of the difficulties of being a Jew in this foreign environment and reading and reciting Hebrew with word for word translation into Lugandan. They focused on the ancient Jewish theme of strangers in a strange land, and of the meek holding the light of truth against the strong tide of the many. The Abayudaya run a Jewish primary and secondary school that is open to all and is reportedly the best school in Mbale. They appear to have support from western liberal Jewish institutions. They even have a Torah donated by the state of Israel. We were fascinated and found it hard to get our minds around the crazy contradictions of their life.

We made it back to Kampala in one piece and had an evening with my friend Rachel who was also a resident in Oakland and is now working in Malawi doing HIV/TB medicine through Baylor university. She was in Kampala with her mom on a vacation and it was really fun to catch up.

we have 2 more weeks of work here in Uganda and then the traveling really begins. stay tuned for more posts...

Click here for the link to more pictures from Mbale and the abayudaya.

Sunday, February 21, 2010

more pics

hi everyone, as time is getting nearer we have so many blog ideas but so little time. We are trying to entertain you with as much stimulus, both visual and intellectual as we can. You never know, before we leave we may bring you such blog entries as "museveni's favorite hats", "how many people can you fit on a boda?", and "ugandan english: quite really good."

for now, you will have to satisfy yourself with some links to some of the pics we have put up on picasa: just click the paragraph to link to the pics.

hope you enjoy the links, we will put more blog entries up this week, we only have a few weeks of work left, and then off to travel. see you soon!

Monday, February 15, 2010

Food glorious food, part II

For anyone who knows Guy and I, you will not be surprised that there is not one, but two entries on food. We love to eat and are eating our way through Uganda, both trying to eat traditional food and we are lucky in that Kampala has a large enough foreign population that you can actually get pretty good food that is not Ugandan as well. There are some amazing Indian restaurants, Ethiopian food, Chinese food, a Turkish place, some okay Italian places, a Thai restaurant that was not half bad, an amazing steak restaurant and we have heard that there is a Japanese/sushi restaurant, although we have not been brave enough to try it.
We are not starving out here, have no fear.

What is even more fun than sitting down in a restaurant to eat food and your favorite sauce, is eating street food. Some warn against this practice while traveling as it is probably the most likely reason to suffer gastrointestinal distress. We have found, however, that some of the best delicacies come from the street and they are dirt cheap and really fun to eat. Guy is more adventurous than me and has subsequently had 2 experiences with the wonderful antibiotic Ciprofloxacin, but overall we have been spared much in the way of problems and have gotten to know what people really eat.
Most people eat lunch and they eat a LOT of food--so much so that work in the afternoon is close to non-existent as everyone settles into a coma after consuming several pounds of starch. For breakfast and dinner, many Ugandans simply snack on the street. Almost everything you can get is fried in a pot or griddle over a coal fire b.b.q made of an old car wheel and is served in a flimsy clear plastic bag:

-chapati: a staple snack food made from flour and water and then fried in oil on a flat griddle pan and served plain or mixed with other snacks.
-samosas: filled with peas usually, but for extra - special occasions they are filled with meat.
-chips: (french fries), in a wok of boiling oil right there on the street
-banana pancakes: there are about 5 or 6 different varieties of bananas here and these ones are less sweet and mashed into a little patty and fried)
-fried dough that is slightly sweet, like a donut called mandazi
-chaps: thick chapati filled with some meat and then fried again....mmmm double fried
-kikomando (pronounced chicomando) which is chopped chapati with red beans mixed together
-other fried dough sweet treats that sort of resemble muffin-scones, but fried
-fried chicken or whole Tilapia, of course, served with chips
-and when in season, sauteed grasshoppers (ensennane)

But the king of the streets, the quintessential Ugandan street food is the rolex, called so because it is a rolled up chapati with an omelette inside. Though innocent before found guilty, it is probably the culprit of Guy's food poisoning both times. However compared to how much he eats the stuff, the odds are on his side, and well, its worth the risk. The rolex man mixes eggs with sliced tomatoes, cabbage, onions, salt and pepper and make a thin omelet on a griddle pan. The omelet is then married with a chapatti and rolled up like a burrito and served in a plastic bag.

In the late afternoons and evenings, the streets in Kamwokya where we work are lined with boys grilling meat. You can get a meatsicle, as we call it: a charcoal grilled skewer of salty gristle and beef cubes. You can also get decent, albeit scrawny and sometimes chewy, chicken breasts. Little sausages are very popular, either grilled or fried. All of the above come with chips and some cabbage of course.

In the morning, people take tea which can be "dry," meaning black or "milk tea" which is mostly milk and a bit of tea mixed together. Tea is accompanied by chapatti or a dry, corn-flour based, muffin-cake, or fried cassava sticks.

For most of this food, you need only to walk a few feet in any direction and you will find whatever you like for anything from 100 to 500 shillings (5-25 cents). People will set up a kiosk or booth under an umbrella and happily prepare your favorite treat all day.

My favorite type of food in Uganda are the fruits and vegetables. This place is so amazingly fertile, all you have to do is throw a few seeds in the ground and things grow like weeds. Almost every square inch of free land in the city ( not to mention the countryside) has something planted on it: bananas, potatoes, yams, sweet potatoes, tomatoes, name it. And the markets are amazing: massive avocados the size of a baby's head, cucumbers, egg plant, onions, various mangos, papayas, watermelons, pineapples, passion fruit, the list is endless. Fruit is sold as snack food as well. A pineapple can be peeled and quartered for you right there with a machete for 800 shillings (30 cents).

My very favorite new fruit is called jackfruit. Its about 2 times the size of a large watermelon with a spiny green rind. It grows on massive trees that grow like weeds in this country (and much of southeast Asia, I have heard.) When the fruit is ripe, people bring them to the street or market to sell, usually on the back of a bicycle and cut your choice of a piece on the spot. The tricky thing about jackfruit is that it has a very sticky sap inside that needs to be cleaned off your fingers or you knife or anything the inside touches with paraffin or something oil-based, which makes opening and cleaning them an art form. Once open, it is a yellow fruit with tear-shaped seed pouches that you tear out. The taste is a mix between banana and melon and it is sweet and unlike anything I have ever tasted. I eat a piece almost every day and even made a jackfruit cake the other day, much to my co-workers surprise. No one ever thought to make cake out of jackfruit before!
There is so much more to tell, stay tuned for our next food entry: things you eat that still move!

Food glorious food, part I

Oh Ugandan food, the stuff of legends. The Ugandan culinary culture ranks right up there with the likes of tajikistan, nauru, or lesotho. Not quite the delicate gnocchi of Italy, nor the perfected rack of grilled Tennessee ribs, Ugandan food is a utopia unto itself. However, ask any red-blooded Ugandan what their favorite thing to eat is, and without any hesitation, the answer will be "Food". Because by food they mean the staple around which every meal is centered, the hot liquid magma core of the ugandan food experience.
Ugandans eat food 2 times a day if they are lucky, meaning that due to the poverty level, many Ugandans eat a single meal a day. Food consists of the following:

Matoke: boiled, green plantains, mashed into a mashed potato like consistency. Matoke is not sweet, not salty, actually, like vodka, the best matoke is flavorless!
Posho: Which in surrounding countries is known as Ugali, is a millet-based cream of wheat like substance after it has sat in the sun a few days. flavor: none
Starch: name the potato, and they boil it! Irish, Cassava, sweet potato, yam, fried potato. the list goes on, but, you get the point.
Rice: white and brown, take your pick.

now, of course there are variations, and sometimes you even get bitter greens on the side or boiled pumpkin, but the above makes up 95% of your plate.

On top of the "food" you put a sauce, and this is where Ugandan variety really shines.
you can beans or you can have peas.
you can have meat, fish, chicken or Offal (intestines and stomach).
you can have G-nuts (pronounced with a hard "g", unlike Guinness which is pronounced Jeeness), a boiled peanut ( but they swear it is not peanut) made into a peanut buttery paste.
then you can combine the above, G-nuts with meat, G-nuts with fish, G nuts with get the point.
And so passes every meal, twice a day. We should admit, that Ugandans like to eat, and they do not skimp. They provide massive portions of the stuff, and heap it on like it was your last meal of Matoke, until lunch that is...
It is also cheap! the working man meal in the back of the wooden hut in the slums cost 1000-1500 shillings, (50-75 cents), while the more established "bistros" which we frequent are between 2500-3000 ($1.25 to $1.50).

Ugandans eat as above day in and day out, and they do not tire of the stuff, they do not change and god forbid they do not spice. The people know what they like and the Bugandans have spoken! give me the food!Now, Ugandans do have a special weapon in their arsenal of sustenance. One which they only pull out on special occasions....the big gun: Luombo. Luombo, or lowombo or lwombo, depending on the current spelling trend, is the above sauce options, but wrapped and steamed in banana leaf. So you have meat luombo, chicken luombo, fish and G-nut luombo, you get the gist. Luombo is nice, and if done well, can tenderize the meat unlike other stews, but mostly, it is the same stew wrapped in a banana leaf.

I must say, I do like the stuff, I think Rusha may be a bit more skeptical: the meat or intestinal tubes are not for the faint of heart and the heaping starch would give any Atkins dieter a stroke.
But there is a certain comfort in the knowledge that no matter what, you know what you are going to have for lunch today...and every day!

Saturday, February 6, 2010

Da Nile - Not just a River in Egypt

The Nile has become our respite from the hustle and bustle of Kampala. Situated only about 80 km east of the city, but depending on traffic can take anywhere from 1.5 to 4 hrs to get to. As most of you know, Lake Victoria, the shore on which Kampala sits, is considered the "source of the Nile". And here Jinja, located on the exit point of the river from the lake, is considered ground zero of the Nile's journey north to Egypt and beyond. The truth is I'm not quite sure why its considered the source, because the headwater of the Nile start in the highlands of Rwanda, where its rivers feed Lake Victoria. Lake Victoria itself is one lake in a series of lakes along the meandering path of the river. The nile is 4132 miles long and flows north, making it the longest river in the world. It is considered the primary reason for the rise of the Egyptian civilization, and made for exciting contests and stories among the greatest African explorers of the 1800's Speke, Livingston, and Stanley.

To us, the Nile has become a place to get away from the dusty relentlessness of Kampala. We have been here 3 times so far. Two at a place called The Haven and once for a weekend at Bujungali Falls for rafting.

The Haven is a serene river camp built by an inventive German who created a beautiful camp overlooking one of the class V rapids on the river. Apart from spectacular views of the river below, good food, and manicured lawns to camp on, the place is ecologicaly friendly and self-sustaining. The owner designed a rain water catchement system into the thatched roofs of the bungalows and uses the water and the height to run water to all his facilities without the help of a generator or pump. He also runs all of his lights on an array of solar panels.

We came here first about a month after getting to Kampala when Rusha required immediate R & R before she was going to get "American" on some of Uganda's challenges and inefficiencies, ie she was going to start yelling at people and demanding results before taking tea and spending 10 minutes on pleasantries before every conversation. We spent a short weekend here and were able to come back to K'la refreshed after playing in the (hopefully) Bilharzia-free waters, soaking in the sun and eating pineapple and mangos. We befriended some local teens and challenged them to a swim race, and you can imagine the shock to their machismo pride when Rusha beat them all. We swore that we would come back and here we are again, sitting on the restaurant's porch, typing a blog entry.

Our other Nile excursion was to Bujungali falls, a camp owned by a rafting company on the bank overlooking Bujungali falls, another class V rapid. This camp, while beautiful, carries a much diffrent vibe then the Haven, which is a bit more refined. Bujungali falls caters to the backpacker and overland crowd, and there the beer flows freely and adventure travelers abound. The camp runs a kayak school and rafting trips on the White Nile. The White Nile ranks among the mightiest white water rafting in the world, next to Zimbabwe's Zambizi River. The key is the massive quantities of water that flow, coupled with the speed elevation loss through the Ugandan portion of the river. the raftable section consists of 10 class V rapids, where the waves can be as high as 10-12 feet. The only reason it is raftable is because the river is so deep and the water so fast that if you do fall out, you are in lesser danger due to the relative depth of the water and can generally stay clear of under-cut rocks. Unfortunately, the rafting industry here is set to become extinct or much less exciting as a second dam is being built at Bunjungali falls (to feed the immense energy needs of East Africa) and will flood a large portion of the river, eliminating the half the rapids and changing the flow of the river downstream.

Bujungali falls is owned by one of the rafting companies and they let you camp for free duirng the weekend if you raft with them. We spent the majority of our time hanging out with a pair of nice German overlanders, who had driven their fully stocked landcruiser from Germany, through Turkey and the Middle East to Egypt and southward through Sudan and Ethiopia to Uganda. Their plans are to eventually make it to South Africa over the course of a year. The overland SUVs are a marvel to behold, with a rooftop tent, a kitchen, water filtering system, navigation/telecommunication/comuputer systems, a mechanic shop, and for the Italians, cases of wine and pasta.
We spent the day and night chatting up with the German couple and the next day we went rafting with them and some of our AJWS friends from Kampala.

Rafting the Nile is flat out scary. For those of you who have never flipped a boat into mighty class V waters, it is like being in an underwater head on car crash, only somehow you live on the other end. The trip begins just below the Owen falls damn, the main hydropower station of Uganda. After learning the basics of rafting along the quiet stretches we entered the series of rapids that make the Nile famous. From Bujungali falls, where legend tells of a spirit that is passed from generation to generation embodied in a human host who has to prove he is the Bujungali spirit by jumping into the falls. If he is the spirit he will float along unscathed on top of the water. If he is not, most likely he drowns. In the unlikely event he makes it alive, but does not float on top of the water, he is exiled to an island in the middle of the river, to live out the rest of his miserable life. Other rapids include: Silverback, Jaws, Rib Cage, Overtime, Total Gunja ("Totally Insane") and Itanda (the Bad Place). The rapids are truely massive, and in my limited rafting experience, would be unraftable if not for the fact that the volume and depth are such that it is safe to make mistakes. In all reality I think that some of the rapids would be considered a 4. The consequences, while scary, I believe are faily low, and we ended up capsizing once and throwing people out of the boat several times. Even still, when you are accelerating into a massive 12-foot wave or going over an 8-foot waterfall, its pretty thrilling. In between the rapids are calm parts where you can swim and listen to the guides tall tales, and eat pineapple, which rounds out a nice day on the river. We finished the weekend with a celebratory BBQ and a ride back to K'la.

Tomorrow will most likely be our last day on the Nile until we meet it again in Egypt. Until then, hakuna matata.