Wednesday, April 28, 2010
We bused from Dahab north to Nuweiba, another Egyptian vacation town that used to be an Israeli vacation spot but has been quiet and desolate since the arab Intifada. We got tickets to another fast ferry, but the trip didn't end up being as fast as advertised. We first had to wait in a huge hall with thousands of migrant Egyptian workers who take a slow ferry to Jordan to work. Once it started, the ferry ride was beautiful and as foreigners we were forced to buy first class tickets so we received wonderful treatment on the boat with a deck from which you could see Saudi Arabia, Egypt, Jordan and Israel. We arrived in Jordan about 4 hours late, as usual, found a taxi, some good falafel and humus and drove north to Wadi Musa, the gateway to Petra.
Petra is a Nabataean City that started around 600 BC, and came into prominence around 200 BC due to the spice trade passing right through its streets. The Nabataeans were polytheistic nomadic people who lived in the Moab mountains. They built Petra, an amazing city built into the surrounding rock of the mountains, into which they carved huge monuments and mausoleums. Petra had an estimated population of one million people at its height and was later taken over and continued by the Romans, who improved on the structures and also turned some of them into Christian structures. The city declined around 300 CE and was lost to history for milennia, and inhabited by Bedouins. It was rediscovered in the late 1800s and refurbished, and is now considered one of the wonders of the world.
The entrance to Petra is dramatic: you walk along a narrow 1.2 km natural water and wind carved canyon called the Siq, and emerge to marvel at the first and most well-known monument of Petra, the Treasury, a massive structure carved into the stone which is as dramatic for the approach as for the architecture itself. From there the city continues, and we soon realized, covers a massive area. Being the go-getters that we are, and only having one day, we spent almost 12 hours walking all over Petra, up hills, mountains, petrified dunes, we walked to beautiful viewpoints where we could see the Dead Sea. We saw the Monastery, the Royal Tombs and the Great Temple, all carved into the rock. Petra’s beauty does not only come from the awe-striking grandeur of the man-made structures, but also from its location, in a magnificent gorge of colored sandstone and clumpy mountains with views of the the plains separating Israel and Jordan. Since I have always looked onto these mountains from Israel, it was amazing to sea the perspective from the opposite side, east to west. We walked back to the modern world, through the Siq, as the sun was descending, turning the rock from rust to rose, and playing long shadows on the canyon walls.After spending the night in Wadi Musa, we caught an early bus to Aqaba and from there a taxi to the Arava border crossing to Israel, and easily walked our way through the border to Eilat.
Spending a few days in Jordan was wonderful. It was a different country all together from Egypt and while still retaining its arab character, Jordanians were calmer and less pushy, the country was cleaner and appeared more developed and more progressive than Egypt. There was more of a Bedouin presence, especially in Petra, where old ladies smoking marijuana joints sold souvenirs and men hawked camels dressed in traditional bedouin clothes for the tourists. It was exciting to be in arab countries for a few weeks, experiencing their culture.
Click here to link to the Picasaweb album of our trip to Jordan.
We spent the day on a boat full of Polish, Czech, and Russian tourists. Guy’s diving buddy was a Pole who spoke no english and the dive master, Mohammed, spoke fluent Russian, English, some Czech and Polish and Arabic. The best part of Hurghada was cheap, fresh sea food. We left on the ferry 2 days later to Sharm El-Sheik on the tip of the Sinai peninsula and bused north to Dahab, a chill place for backpackers and hippies on the shores of some of the most beautiful diving in the red sea.
Dahab was lovely. We hung out there for 4 days. Dahab was part of Israel from 1973 through 1981, When Israel held the Sinai peninsula. Dahab was a small Bedouin camp back then and Guy remembers going there as a kid when he lived in Israel to camp on the beach. The Bedouins are nomadic desert people who have live in the deserts of the Arabian peninsula as goat and sheep-herders. They are rugged desert people, setting up camp in the most inhospitable of dry, desolate desert. As times have changed, they have become more stationary wih permanent settlements, but remain fiercely independent and proud of their culture, resenting being told how to live or what to do and at times becoming violent towards their ruling government. As a place like Dahab became more commercialized, the Bedouins were pushed aside by Nile valley dwelling Egyptians and now live on the outskirts of town. Today Dahab is a full-blown tourist destination with a mile-long boardwalk on the beach lined with hotels restaurants and dive shops, but it still retains its mellow and bohemian feel and look. Every restaurant is a variation on the theme of a "Zula": Bedouin style hang out of low tables, big throw pillows on the floor and plentiful sheesha as well as sea food and juice smoothies.
Our time in Dahab was spent playing in the Red Sea, looking at the beautiful coral and marine life that is literally right off the shore. Guy dove and we both snorkeled. We also climbed Mt Sinai, the place where Moses is thought to have received the Ten Commandments. The trip was unfortunately the worst example of mass tourism as we summited at sun rise with about 500 other people. In the standard package, the only one available if you do not have your own car, everyone arrives at 1 am and is assigned a mandatory Bedouin guide to take you up the highway trail that is lined by Bedouins aggressively offering camels or Kiosks with coffee, food, and other tourist junk every 100 meters. The tourists were half the fun of the climb: Loud Spaniards and Italians, religious pilgrims, Chinese in hospital and ski masks riding camels, a Taekwondo team in their outfits, and mandatory Russians. The mountain's peak is at 8000 feet in the middle of the dry, hot, stark, rocky Sinai desert for which Moab, Utah was named after. The hike took about 2 hrs. up the camel trail and culminates in 750 rock-cut steps that took you to the top. We got there at 4 am and hunkered down in the cold night in our sleeping bag for an hour before the sunrise. Although not a solitary or spiritual experience for either one of us, and despite all the cigarette smoke and cacophony of languages, it was beautiful to see the sun rise over the desert mountains. We walked down the 3750 Steps of Repentance. We got to the bottom at 8 am and waited with masses for the Monastery of St Katherine at the foot of Mt Sinai to open and when it did, we pushed through (or were pushed by the throngs of pilgrims) to see the Church of St Katherine where a bush that is supposed to be a descendant of the Burning Bush still grows and a well where Moses hit the rock and made water appear.
We returned to Dahab tired from being up all night. We had 2 more days which we spent in or by the sea or chilling in the Zulas. From here we would catch a ferry to Aqaba, Jorda to the fabled City of Rose: Petra.
Click here to link to the Picasaweb picture folder
Wednesday, April 21, 2010
We left sub-Saharan
We spent 5 days in
Being the two voracious eaters that we are, we really enjoyed the food in
We saw some of the usual sights: In
The rest of our time in
Our second day in
Thursday, April 8, 2010
We made a change in our itinerary and decided to stop in
The trail meandered through varying ecosystems and alpine zones as we ascended into the clouds. We stayed at huts each night and, although we were blessed with very good weather, given that it is the rainy season, we were glad to have the shelter most afternoons when it dumped rain while we stayed dry inside. After spending our first night at Old Moses camp (3200 meters), we trekked through a beautiful glacial valley, meeting up again with some of the pre-historic flora that we encountered in the
Our wish came true and we awoke to a clear and star filled sky. Huffing up under shooting stars, we jammed up Point Lenana with our guide Dickson and one of the porters, Abu. The hike took us through scree fields, crystalline ice, and rocky scrambling and couloirs. We reached the top just as the sun was rising in the east for stunning 360-degree views of the mountain landscape. On a clear day, it is possible to see Mt Kilimanjaro (250 km away?), but we were not so lucky. We spent a bit on the top to celebrate and take pictures and then got out of the freezing wind and descended almost 8000 feet over the course of the day through still mountain tarns and along the rim of a massive glacial gorge, the largest in
Our last day was a massive downhill slog on a jeep road through rainforest that covered about 20 miles. The forest is home to tons of wildlife and we saw buffalo, monkeys and evidence (very fresh poop and massive footprints) of mountain elephants, hyenas, jackals and duikers. With sore legs and many tsetse fly bites we made it down to the town of
Because the mountain took less then we thought we had 4 days to kill in
In all we spent 10 days in
We are now in
check out all the pics at Mt Kenya adventures
Monday, April 5, 2010
I needed to start off with a serious needs assessment. I petitioned the clinic docs and staff to give me a room once a week and send me patients that could use PT intervention. While some wildly missed the mark -Septic knees diagnosed as “Tibial dislocation” and a Bell’s palsy- most cases could use PT services.
I also advertised myself to the front line folks, the Community based Volunteers and Health workers (CBV and CBHWs), 32 HIV positive clients and community members who’s job is to call on the clinic’s patients at home, make sure they are taking their medication, counting pills, advocating, bringing problems to the attention of the doctors, and maintaining communication with our patients in the field. These workers are an invaluable resource, as they are respected community members who know the community and have intimate knowledge of the slum, essential to successfully navigating an African community.
As I went out into the community, making house calls and visiting, I realized the extent of disability in the slum. Hidden in homes, carried on backs, sitting on stoops, people with disabilities were everywhere. Cerebral Palsy, malarial and congenital, drop foot from improper quinine injections, rickets, and trauma, leprosy and polio.
I knew that providing primary care to this ocean of disabled people as the only PT in the slum was not a sustainable approach, nor was KCCC addressing disability issues. However I didn’t know how to address something of this magnitude. So I started doing some research on the slowest internet connection known to man. I discovered 2 things: the first is that organizations have been addressing disability in Uganda since the mid 60’s, with some success. These programs focused on many aspects: advocacy, polio, leprocy, however, the majority of the organizations focused on children. Secondly, I learned about a rehabilitation concept adapted by the World Health Organization years back called Community Based Rehabilitation (CBR). CBR is a holistic approach to rehabilitation used where formal medical knowledge is lacking and medical infrastructure non-existent. The idea was to use a holistic approach whereby the community becomes empowered and educated to care for themselves. Since disability is more then disease, but a loss of function and ability to participate in the mainstream world, in parts of poverty stricken Africa, where inability meant death or life threatening burden to the community, CBR called on addressing disability from a cultural, economic, educational, and medical perspectives.I began to contact some of the organizations that dealt with disability in Uganda. I contacted and spoke with advocacy and educational associations, disability NGOs, the PT department at Mulago Hospital, Uganda’s referral center, the association for the blind and deaf. For every NGO or entity that I made contact with, many lead to dead ends.
Getting to understand CBR, I could see that KCCC was well positioned for such a comprehensive approach. We already had a successful micro-loan and income generation program in the form of a cooperative bank. We run a primary school and child counseling and advocacy, we have a medical clinic, a vocational training program, and most importantly, access to and trust of the community.
I began working at the vocational school, thinking that building adaptive equipment using local materials, and possibly training some of the staff and students was a good place to start. We built our first pair of crutches for less then $2, planing the wood ourselves the old fashioned way. I commissioned hand and knee paddles to be made as a prototype for use by people with polio who walk on their hands and knees. This generally produced the desired effect, interest from the staff and participation, curiosity at a new potential source of service, income as well as training and potential employment for students.
I also contacted 2 very promising leads; the first was a newly built surgical hospital called CoRSU, a well-staffed and well-funded orthopaedics and plastics hospital. CoRSU was pleased to make contact with KCCC, and after seeing Rusha and I on television after we ran the Buganda road race (if you didn’t read that blog entry, Rusha came in second, I limped along, but we both were interviewed on national television, which I think gave us some buy-in from people who saw us as famous mzungus) they were eager to partner with us. The most promising of partners was a place called Katalemwa Cheshire homes (KCH), a Ugandan NGO since the 60’s that provides comprehensive rehabilitation services in a CBR framework to children.
My idea was taking shape: I would train a small core group of KCCC staff who would become CBVs trained in the concepts of CBR and disability care and prevention. I would involve the different branches of KCCC, the bank, the vocational training center etc…for the holistic approach, and we would partner with KCH to provide rehabilitation services, education, and a new referral source for KCCC.
I pitched the idea to management, emphasizing that this approach is sustainable because most mechanisms were already in place, and that the main burden, that of rehabilitative care would fall on KCH while we would do what we already do best, community mobilization, sensitization, and using existing resources.
We chose a team from among our staff to become the CBR core group. These consisted of medical officers, nurses, counselors, teachers and CBHW. I lectured and we discussed various topics on a weekly basis (or whenever they showed up, or I was able to coerce them to come with the promise of soda): Disability concepts, advocacy, education and family training, diagnosis, pathophysiology, physical treatment, adaptive equipment and more. All at a very basic level, always emphasizing community sensitization, identification, and referral.
For a PT, or anyone for that matter, Uganda’s beliefs about disability are fascinating. Most people believe that disability and mental illness are punishment for a sin someone committed in a former life, or curse that was put on the family, or possibly Juju. Children are hidden in back rooms, under beds, and in bathrooms, never to be brought outside. Women are too proud of their womanhood to give birth at medical centers, giving birth in homes, in a pharmacy’s stock room, and paying the price when things go wrong. Disability and its cause are sometimes disease we in the West saw 100 or more years ago: Polio, Leprosy, Rickets, Cerebral malaria. We also saw post injection paralysis (Quinine, an anti-malarial, is injected directly into the sciatic nerve by an untrained person destroying the nerve and creating permanent foot drop), horrible and unnecessary trauma from accidents, osteomyelitis, and more.
I continued to see patients once a week in my little PT clinic, using the few basic things I brought: McConnell and athletic tape, Elastic bandages, and an ice pack. Practicing was fun, and Africa allowed for some liberties. I could prescribe medicines or order x-rays. The cases were interesting and diverse, from devastating strokes, acute osteomyelitis and septic infections, to back pain, trauma, and paralysis. Some were appropriate. Others not, some we were able to treat with good results, others with no effect, however, all my patients were grateful for the effort.
Together with KCH, we hashed out a proposal that would benefit both organizations. KCH would provide us with education, access for our patients to their rehabilitation center and services. They would also provide our staff with training, help us with our CBR program, and most importantly, they would provide quarterly clinic days, where they would come to our community and provide assessment, education, diagnosis, referral, and treatment to children with disabilities. In return, we would provide them with community mobilization, a venue, access to our bank, and open our school to children with disabilities.
I believed the first clinic day would cement the CBR program. Not only would we tangibly provide rehabilitative services to the slum, but the CBR team would get a hands on training day with an experienced team, KCCC would see the benefits of the program, and the community would get the care they required, spurring them to press KCCC to maintain the program when I left and ensure continuity and sustainability.
When clinic day came it went great. After a week of mobilizing the community by driving around the slum announcing the event by mega-phone on a pick-up, through community elders, word of mouth, schools, and the primary health clinic, the big day finally came. Despite heavy rain – an all-stopper in Uganda – 150 people came. We assessed 50 children with disabilities, providing diagnosis and referral and treatment. We tested and counseled 35 people for HIV. We had a full day of talks and demonstration, on saving and creating income, vocational training, disability awareness, and more. Both KCCC and KCH took notice of the turn out and the good organization and vowed to continue the relationship and help it grow. The community was thankful, and most importantly, children got much needed and deserved services.
My hope is that KCCC can sustain a basic CBR program. By sharing ideas, resources, and services, and creating a partnership whereby each partner brings what they are best at to the table. In this way, KCCC, with little investment and some basic training, can provide rehabilitative services to the community which it serves. In the end, like everything in life, I got the most out of the experience. As always, the intimate invitation to share a moment in someone’s life, and this time, someone as different from me as a slum-dwelling Ugandan, is what I cherish most, and the work in Uganda was some of the best I have had the opportunity to do in my life.