Wednesday, March 31, 2010

Ssemwange Mirazimu update

Remember the little boy with the hole in his skull? Ssemwanga Mirazimu? Well, before we get too far from Uganda and things get lost in the shuffle, i wanted to give an update about our little adopted boy.

I think the last time I wrote, he was sitting in Mulago hospital waiting for surgery and we had bought the supplies. This was back in January. There was a week delay from the original time we were supposed to show up because the operating room for the neurosurgeons, which are only available to them 2 days each week, was closed because a visiting team of cardiac surgeons were coming to the hospital. So, everyone was put on hold. We did get admitted, but unfortunately, during that hospital stay, after about a week, our boy was sent home from the hospital, actually, because he got a fever. I mean, why would a kid with a fever stay at a hospital to get treated?! He was told to return in one week's time, and after being treated for malaria by an outside clinic, we all trekked back to the hospital. When we arrived back, the pediatric neurosurgery ward was completely full with the aforementioned types of tragic patients, all waiting. This is the theme. I met mothers who had been there for 3-4 months, hopeing to at some point get a chance to be operated on. The problem is, the docs are only there a few hours each day (because they are otherwise at their private practices that actually pay them money) and the operating room time is so infrequent and the neurosurgery cases can be so long that only 1 or 2 kids get operated on in a day. Then there are the emergencies. Given that Mulago hospital is the only referral center for a country of 30 million people, it begins to make sense why so many are just sitting around.

The long and the short of it is that we were not admitted the next time we showed up. The ward was full. The nurses balked. My doctor friend (the surgeon) was willing to squeeze him in, but his partners were upset and when push came to shove, when I finally confronted them, it became clear that the surgery was never going to happen there. Our kid has a big problem, yes, but he is healthy, he is not in any acute danger, and he could not just jump the line of those who had been sitting for weeks. For many reasons, this would not work.
All this took several hours to sort out, up and down stairs from the ward to the clinic, talking to all the doctors on the team, being as graciously pushy as I could. But we were not finished. I was not about to give up...
Our surgeon, Dr. Kiriabwire, who had become my go-to person and seemed to be responding to professional courtesy and praise, thought that there might be a plan B when I asked if there was ANYTHING else we could do. He said he would contact the hospital where he has his private practice, International Hospital of Kampala (IHK), to see if there as any way to do the surgery as a charity case. We had a few more weeks of phone contact (ie, Rusha calls every few days to politely ask how things are going) and lo and behold, he said that his partners were in agreement that they could do the surgery at IHK!
The last week of our time in Uganda, really drawing it out to the very end, Ssemwanga and his mommy Sarah and I met at the taxi park in downtown Kamapala, easily the craziest, most crowded place I have ever been in my life. We found eachother and made our way to this fancy private hospital. Sarah could not believe how organized the place was: you registered and had a card with your name that could be found again, you were sent to a triage area to get vitals done, you met with a doctor who did a basic history and physical, you got labs done right there, and finally you went to the ward. We were put on the Hope Ward, a place for the hospital to care for patients who would otherwise not be able to afford their care. The hospital was quite modern with nurses on the floor full-time (unlike in Mulago where no one is there at night) and the capacity to take vitals, meals for the patients, bedsheets and clean bathrooms, doctors on call and reachable should anything happen... She was in total disbelief and was obviously uncomfortable in that environment. She had spent the only money she had to get her hair done before the hospital stay--one cannot show up at such a place without a new hairstyle! After a full day of logistics, we established that the surgery would take place on Saturday (the day before we were leaving for the west of Uganda) and I left Sarah to wait for a day. She did not want me to go and called often to ask for help. One time, when I asked he what was wrong, she said that she needed sugar for her tea. I fear I created a bit of a dependency problem. (She also asked if Guy and I could pay for the school fees of her other boy.)
So, the story ends happily. The surgery actually did happen. I swear, we were not sure it would until it did. We got a nice gift for Dr. Kiriabwire and we went to see him post-op and it was really one of the best overall experiences I had in Uganda. To see something through and have it work was so rewarding and rare. It will be hard to follow up on this guy. I talked to the mom, Sarah, on the phone from western Uganda and found that he was home and had already had a follow up with the surgeon and that all was well. She has no email and wanted my phone number in the US, but hopefully through some of our friends at the clinic at KCCC, we can follow her a bit and see how she and Ssemwanga are doing. He will not remember much, but we hope that this helps him to grow up and have a full life.

Monday, March 22, 2010

Bwindi impenetrable Forest, the Mountain Gorillas and Lake Bunyoni

After a well deserved and well needed night of sleep in Kasese, we re-packed our now lighter back packs and set out for 160 km trip to the southwest of Uganda, and Bwindi Impenetrable Forest. We decided to take the "long way" which took us through the heart of Queen Elizabeth National Park. After the usual Ugandan delays of waiting for a taxi etc... we finally arrived at an intersection with the main road and the Ishasha road which is a 100 km dirt road through the middle of no-where. As we arrived, a car packed to the hilt, topped by mattresses,bags and chickens was getting ready to leave. However, when the driver saw two Mzungus reaching his intersection, his face lit up with dollar signs and he approached us. We haggled for a price, knowing that on this remote road, on a Sunday, this may be our only chance to cross to the other side of the park. Then not knowing where he was going to fit us and our big bags into an already overstuffed shit-box, he told us to get in. There were already 8 people and a baby in the car, we made it 10!Two people were in the driver seat, 2 in the passenger seat (and a baby) and 4 people sat across the back seat, with 2 grown adults on the passengers laps. All this in a small Toyota sedan! This may have been the worst ride of our lives: 3.5 hours of dirt road in the midst of a stench of humanity that is uniquely African. We eventually arrived in Buhoma, our destination after a day of traveling and spent 2 days recovering, doing laundry, popping foot blisters and resting up for the next leg of the trip, which was to be a walk through Bwindi Impenetrable Forest NP. The park was established on the border of DR Congo to protect the mountain Gorillas, a group of about 700 animals left in the world that live in this park and another one..

On a clear morning, we met our guide/owner of the walking safari Asgario and, after the usual fee/guard/tip/checkpoint fee/NP fee/Walking fee/breathing fee... we set off to cross Bwindi NP from the north to the west walking 10 km in a beautiful primary rain forest. We saw blue, Colobus and vervet monkeys and some rainforest fauna.
We emerged on the other side and climbed a substantial hill through the farmland that starts within feet of the park borders and crested to the village of Nkoringo, where we spent the night. The hilltop camp where we stayed had stunning views of Bwindi to the north, and the Verunga volcanoes on the border with Rwanda to the south. We went to sleep in great anticipation of the next morning, when were to track the Nshongi gorillas, one of 4 gorilla groups in the Bwindi park.

We awoke early in the morning, broke camp, and headed to Nshongi. The mountain gorillas, made famous by the movie "Gorillas In The Mist", number about 700 in all, and are divided among several groups in Rwanda, Uganda, and DRC. About 5 of these families are habituated in Bwindi, and can be tracked by and interact with people. The gorillas exist only in these 3 parks, and so intensive efforts have been undertaken to secure their home environment, including the relocation of the Batwa pygmie peoples from the forest. The gorillas are tracked by sending scouts ahead to follow the path of leafy destruction they leave after their previous night’s nest. They rarely move more than a km or so a day. After a short briefing we walked to the forest's edge, and after 45 minutes, and barely into the primary forest, we came upon the gorillas. Our first sighting was a big silverback, the dominant male of the group, pickily eating marion fruit and farting. Slowly we encountered gorilla after gorilla, most lazily sitting, totally surrounding themselves with yummy vegetation, gorging themselves. Ohers were in trees. All were eating.

The group had 2 silverbacks, some new babies and all in all about 35 members. We spent an hour with the critters, which is all one is allowed. Sometimes, the views of the animals were amazing, being only 3-4 meters from the great apes. Mostly, though, it was through thick brush, or up in trees, or on the move. As someone said, you get to see lots of gorilla butts up in trees. The hour went by fast and it was time to leave and say goodbye.
The experience was interesting, and when you look into their faces and eyes, they do look like hairier version of us, however, in the long run, both Rusha and I thought that it was a bit over-rated at $500 per person for 1 hour. While you get to watch them closely and intimately, there is no real interaction with them and they could care less that you are there—you could almost be just another tree.

Our next destination was Lake Bunyonyi, landlocked amidst the fertile and steep hills of southwestern Uganda and bordering Rwanda. This is Uganda's deepest lake, and rumored to be the only Bilharzia-free water (we hope so). We arrived and stayed at a beautiful lakeshore camp that caters to overlanders - trucks of youngsters, heading across the African continent in an open air truck, stopping along to see the sights, usually from Cairo all the way to Cape town in South Africa.The camp was beautiful and manicured, with nice food and docks, and dugout, left-turn-only canoes. It even had an 8 meter high platform to jump into the lake from! We sunned ourselves, ate crayfish from the lake and hung out in the local market, to which farmers bring their wares in canoes from across the lake. We rested, swam, ate, and drank after the many kilometers of walking the week before.

To get back, we took a very long bus ride back to Kampala, during which the incidents included a bit of mob justice on a man who crossed the road on his bike in front of our careening bus, and almost caused an accident. Men from the bus jumped out, caught the poor guy, and whipped him with branches and punched him a few times. This is justice in the bush and I bet that guy will never anything like that again. After running a girls foot over on the way into Kampala (really the bus ran over her foot!) we arrived safely in Kampala where we spent a couple of days frantically packing, saying our goodbyes, and enjoying some decent food and coffee after 2 weeks of bush coffee and chicken and chips.

Our time in Uganda has been amazing, and a growing experience. We have met unique and wonderful people and friends, seen amazing things, and heard and experienced amazing stories. Uganda, you will be missed!

We are off to Nairobi, to climb Mt Kenya. After that we are on to Cairo, and then overland, via Jordan to Israel. We will keep every one up to date as often as we can, thanks for coming along with us on this journey.

Mwebale Nyo (Thank you very much)

Wednesday, March 17, 2010

The Rwenzori Mountains

Our first adventure as fully unemployed travelers was to head west from Kampala to the border of Uganda and the Democratic Republic of Congo to hike in some of the most remote mountains in the world, the Rwenzoris (the Mountains of the Moon.) The Rwenzoris house the highest non-volcanic peak in Africa and the 3rd highest peak overall, Margherita Peak on Mt Stanley. The Rwenzoris have been in a conflict zone for so much of the past 30 years that they have very little traffic and these days see about 500 visitors each year, making them extremely isolated and untouched and pristine. We signed up to do the “Central Circuit” which is a 6 or 7 day hut-to-hut trek that follows two rivers, the Bukjuku and Mobuku Rivers, in a circuit that passes below the 3 highest massifs in the range. As with most East African expeditions, a guide and porters are required and we met up with Peter, our guide, who has been taking clients into the Rwenzoris since 1971, and our 3 porters: Matthew, Gideon and Bonfast. Peter is from the Bakonjo tribe, the people who are native to the Rwenzori mountains, and while he is a bit past his prime, at 48 years old, he rocked the hike and put us to shame on the downhills.

The hike starts at the village of Nyakalengija at an elevation of about 1000 meters and climbs from there. The hike is a trek between huts that are 7-8 km apart, but covers elevation gain and terrain that make the distances seem far more challenging. Most of the hike is through bog, which if you haven’t encountered it, is thick mud, up to your knees or even thighs, that must be negotiated by walking on logs that have been placed in it, or by hopping from tussock pads or patches of grass, or basically anything that can keep you out of the deep mud. The mud us negotiated in rubber boots and waterproof pants and if you happen to land in the mud, you have to be very careful to keep your boot on.

Day 1 climbs 1600 meters of vertical and put us at the start of the circuit, a hut called Nyabitaba. On that first day we got our first glimpse of the intense greenery that can only come from one of the wettest places in the world, the Congo basin. The flora is enormous and moisture is everywhere, hanging on the leaves of huge, broad-leafed plants.

Day 2 is an introduction to the bog. After crossing the Bujuku River, we slogged uphill to 3500 meters, crossing kilometers of wet, sludgy, bog and neon green carpets of moss. If you didn’t get a walking stick at the start (as Guy did not,) your balance is truly put to the test as you negotiate little branches and rocks in the mud in order to progress. On the second night we slept at a hut that allows the first views of the glaciated peak of Mt Stanley as the clouds cleared for some minutes before dusk.

Day 3 we entered the surreal landscape of the Rwenzoris, walking through thigh-deep mud and little tussock hills (grass mounds that offer a chance to hop and avoid the mud,) the plants are unlike any we have ever seen and are endemic only to this range: purple cactus-like plants and bizarre trees. We were supposed to stop at the Bujuku hut, but we asked our guide if we could instead divert to the highest hut, Elena hut, that also happens to be the staging ground for climbing the highest peak in the range, and he obliged. So we trudged straight uphill to 4550 meters (about 15,000 ft) thankfully leaving the bog behind and entering a range of boulders, rocks, and sheer cliff faces at the base of the Stanley glacier. Now, here is where Africa works well: our guide, seeing our strength and interest in the peaks and Guy’s particular interest in mountaineering, suggested that if we were to compensate him appropriately, he would lead us up to Margherita Peak, the highest point in the mountains. We gladly obliged. We had been paralleling our hike with a couple who had plans to climb Marghertia Peak all along. Our job was to convince them that they wanted us to join them on their summit ascent and share their rope; our guide Peter’s job was to convince the other guide, who happened to be his nephew, that he wanted to share the equipment with us. Luckily, our hut-mates were

game for us to accompany them.

Day 4 started after a mostly-sleepless night of nausea and headaches due to the altitude, we were up at 4 am to attempt the peak. After several hours of hiking to reach the base of the first glacier, we roped up and put on whatever motley equipment

was leftover: Guy had a homemade harness and Rusha had ill-fitting crampons. Our guide was missing both and was hiking the glacier i

n rubber gumboots and a walking stick. Thankfully this sketchy situation was ameliorated after our companions decided to turn back after a semi-technical down-climb, and we were lucky enough to continue with their equipment: ice axes, crampons, harness, and rope. Our guide also got sunglasses from the other guide which made his life much nicer and made us feel safer that he could actually see. We proceeded to climb 2000 vertical feet on a crevasse-strewn glacier, then a short technical rock climb and summited 16,763 ft margherita peak (5109 m) in the clouds and gale-force winds, with enough time to document the moment and revel in our accomplishment: the highest Rusha has been in her life and the highest non-volcanic peak in Africa. We finished the day by returning to the hut and descending to Kitandara hut, at a much nicer elevation of 4000 meters to rest up.

Day 5 started with a climb to 4300 m (the highest point on the central circuit) and then descended steeply to a hut at 3900 meters, Guy Yeoman hut. We enjoyed not suffering from headaches or nausea but Rusha managed to touch some plant that caused her to have a major allergic reaction with some angioedema. Luckily the reaction was limited to eye and lip swelling and was improved with some Benadryl and Prednisone in the trusty first-aid kit.

Day 6, our last day, was an amazing amount of downhill. We dropped 2500 vertical meters (about 8000 feet!) Most of it was clambering over the usual Rwenzori terrain of rocks, roots, bog, and mud. It was steep and directly straight down. After several doses of Alleve we arrived back at our starting point in the village where we said our goodbyes to our group of porters and guide and hopped on bodas down to the town of Kasese, where we took our first shower in a week and fell exhausted into a real bed. The next day we left for Buhoma, the entrance to Bwindi Impenetrable Forest where we were to track the mountain gorillas.