Wednesday, April 28, 2010

Jordan and Petra, the Rose City

The last stop of our overland trip to Israel was Jordan. Throughout this part of the journey, we have made good time, and apart from the small glitch in Hurghada, things have gone smoothly and on time. It has been amazing to follow the story of the Exodus, at the right time of the year, just after Passover. We started in Cairo as the Israelites did, when they were slaving to build the great pyramids of Giza. Then we went south to Thebes (Luxor) and crossed the desert to the Red Sea. We split the Sea of Reeds with a high-speed ferry rather than an act of god. We climbed Gabel Musa (Mount Sinai) and received the sunrise over the Sinai desert. Later we toured the Monastery guarding the burning bush. Finally it was time to make our way to the Moabite mountains, to Petra, and to Gabel Haroun (Aaron's mountain) the resting place of Moses' brother and mouthpiece, the land which the Israelites wandered for 40 years, waiting for a new generation to rise, and the mountains from which Moses looked onto the land of Israel, never to enter. We would eventually cross into Israel on foot, through the Arava gate, from Aqaba in Jordan to the resort town of Eilat in southern Israel....But first we had to get to Jordan.

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.

Egypt II: Hurghada and the Sinai Peninsula

After busing from Luxor, we got stranded for a 2 days in Hurghada because the ferry across the Gulf of Suez to the Sinai Peninsula, of which there are only 4 a week was canceled due to high seas. Not that being stuck on the Red Sea is a bad thing, but Hurghada is not the first choice. Hurghada is a resort town that has been taken over by Eastern Europeans, especially Russians. A strand of 1970's style hotels, interspersed with half built skeletons of unfinished projects and construction site beaches and pharmacies advertising Viagra and Cialis. All signage is in Russian, Polish, and Arabic, no English. The town seems an interesting combination of Egyptian Muslims who work the town, their devout lifestyle interacting with scantily and inappropriately dressed Russian men and women, drunkenness, and an overall Russian good time. The Egyptian men involved in the tourist industry of scuba diving and hotel industry have embraced the eastern Europeans and many of them speak Russian and some also speak Czech and Polish and sometimes the language of love with the female tourists if you get our drift. We used our time there to play in the water. The Red Sea is most famous for its clear water and beautiful coral reefs. Over the years, much of the coral has been destroyed due to poor stewardship, however, the coral is still some of the best in the world and the marine life prolific. The water is a constant temperature year-round, a bit chilly, and the beaches are mostly pebbled but the life under the water makes it a world-famous destination for diving on the cheap. All though the best diving is off the Sinai peninsula around Dahab (our eventual destination) we spent a day on a boat and Guy got to dive while I snorkeled for as long as I could stand the cold water and my fears of being alone in open water.
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

Egypt: from Cairo to Hurghada

We left sub-Saharan Africa by plane, flying from Kenya to Cairo with a stop in Addis Ababa, Ethiopia and a touchdown in Khartoum, Sudan. Cairo is a massive city,of 20 million people and traffic, noise and pollution to match. A clean air day in Cairo is worst than any of the worst dangerous ozone days in the states. It feels nothing like the Africa we left in Uganda and Kenya. Egypt is overwhelmingly Muslim (90%) and has become more conservative over the past 10 years. Most women at a minimum cover their heads, and many wear the full abeyya (black robe with head covering and only their eyes showing through a slit in the fabrc.) The Egyptian past is the history of the world’s civilization and has intricate overlapping civilizations melding and conquering each other. Its history starts in 4000 BC with the ancient Egyptian dynasties and the unification of lower and upper Egypt. It is followed by Roman and Greek history, the Mamluks (Turkish slave-soldiers), Chrisitians and Muslims the 7th century AD. Today Egypt is a modern country that is vibrant, alive with tourists and comerce. It has many problems, including a faltering economy and high unemployment, overpopulation, dissatisfaction with a longstanding regime, and tension between extreme Islamists and moderate muslims, but vibrant and alive with modern commerce and tourism.

We spent 5 days in Cairo, basing ourselves from our very budget hotel in the middle of downtown and explored from there. Cairo is most alive from the late afternoon until 3 or 4 in the morning and at night the city is so bright with street and store lights that most drivers don’t bother to use their lights. The traffic is thick and constant and despite traffic officers on most corners, cars keep coming and pedestrians play a game of frogger to get across. Luckily our time in Uganda prepared us for dodging cars. Everyone in Egypt smokes, all the time, and the most popular pastimes seem to be sitting and drinking tea or coffee and smoking sheesha, flavored tobacco smoked through a water pipe. We joked that you can sit down on any stoop, anywhere, and out of nowhere someone will run over to offer you coffee or tea. Men and women lead pretty separate lives and women do not hang out in the coffee shops.Most women are covered up, some so much so that they wear gloves and even a veil covering over the eye hole of the abeyya (head covering). The majority of the clothes stores however, have store windows with tight Western outfits, miniskirts, tank tops, leggings and very scandalous lingerie, all displayed next to conservative traditional black robes and head scarves. At first we thought the Western clothes were for tourists, but they are not: they are for these same women who can’t show an inch of skin outside the home but under those black robes, let me tell you, they are wearing some sexy underthings for their husbands!

Being the two voracious eaters that we are, we really enjoyed the food in Egypt in general, and especially Cairo after the long stint of bland African food. We found that the best food was always at small, hole-in-the-wall places that were down little alleyways and definetly not in the Lonely Planet. We ate a lot of taamiyya (like falafel but made from fava beans), baba ghanoush, tahina, flash fried mini eggplants and peppers. We tried fuul (mashed fava beans, tastes a bit like refried beans) which is the national food and koshary (rice and pasta mixed with garbanzo beans, fried onions, lentils and a vinegar-tomato sauce) both of which are very popular for being filling and cheap (50 cents for a meal). All the meat is delicious and grilled over open coals. In Cairo, we drank our weight in fresh juices that are literally the entire fruit pulped in front of you into a glass: sugar cane, mango, orange, carrot, strawberry, melon. We also ate our weight in desserts that Egypt is famous for, most of them fried or filo dough seeped in rose-water honey. Every meal was preceded and post-scripted with a Turkish coffee, thick grounds boiled with sugar and cardamom that is drunk in a shot glass. On almost every street corner there is a metal water cooler that dispenses cool water that is free and cups are provided—the water in Cairo was fine to drink, if a little too chlorinated, and it was so nice not to have to search for and horde water in bottles. Arab hospitality permeates the culture, and we heard that these coolers are often donated by wealthy families as a gesture and to help prevent dehydration,

We saw some of the usual sights: In Cairo we visited the Egyptian museum, a disorganized but ridiculously extensive collection of ancient Egyptian treasures, statues, sarcophagi (tombs) and mummies. The ancient Egyptians fine-tuned mummification and even kept their pets as mummies after they died. We spent a day at Giza, visiting the pyramids and the Sphinx. Giza is a suburb of Cairo, about 15 km south of the city, and the pyramids are a small island in the middle of cars, apartment complexes, businesses and all the pollution of Cairo. The pyramids are impressive and starkly beautiful, and the desert beyond them is vast and hot and flat. There are 3 of them and 4000 years has done little to chip away at them, although a mamluk Sultan in the 1100s tried for 8 months to destroy the smallest one, it only resulted in a tiny defect in one side. The touts that Egypt is famous for were in full-force at Giza, and we were assaulted by people trying to get us to ride their camels and donkeys, buy stone models of pyramids and scarabs, take a tour with them, take their taxi. They come at you from every side, “You want camel? You know how much? Very cheap. Come on, take my camel. Why you want to walk?” Many forceful La, Shukran (no-thank you’s) are needed to fight them off, only to run into another one a few yards away. Such was our experience in Egypt in general, and frankly the only thing that was difficult about being here. The touts are everywhere on the tourist track, offering felucca boat rides on the Nile, carriage rides, spices, alabaster Sphnixes, taxis, tee-shirts, belly dancing costumes, sandals….pretty much anything your average tourist needs, really.

The rest of our time in Cairo was spent touring different parts of the massive city. In Islamic Cairo we spent a day walking through old alleyways, and visiting some of the 100s of mosques, including the oldest mosque in Egypt, meandering through the famous Khan al-Khalili souq (market), seeing the gates of the old walled Muslim city of Al-Qahira, that became Cairo. We spent a day in Old Cairo which houses Cairo’s Coptic (Egyptian Christian) community, (10% of the population is Christian and the Copts were in Egypt before the Muslims took over) and the oldest and one of the only synagogues left in Egypt. We strolled along the Nile, had coffee and sheesha and played shesh-besh (Backgammon), got lost in neighborhoods, ate and ate again and walked miles through masses of people and cars. I even went for a run along the Nile one morning and quickly realized that this is decidedly not something that people do here, especially women. We both really enjoyed Cairo, despite its reputation for hassle, and found people to be friendly and welcoming and warm.

From Cairo, we took a very uncomfortable overnight train ride along the Nile valley south to Luxor where we spent 2 days seeing the Temples of Karnak and Luxor and the Valley of the Kings. Luxor is the ancient city of Thebes, famous during ancient Egypt’s Middle Kingdom and the monuments were amazing. Sleep-deprived, we set out for the Temple of Karnak, a massive complex that was expanded upon by several centuries-worth of pharaohs and now encompasses over 2 square km of columns and pylons (entryways to temples) and obelisks and statues and walls covered in hieroglyphics singing the praises of the pharaohs and gods. Luxor had a worse problem with touts than Cairo and we were more aware of the masses of tourists, groups of Eastern Europeans in inappropriate scanty clothing, Asians in hospital masks, Egyptian school groups, package deals through resorts, backpackers such as ourselves. Of course the guards in every part of the temple were on hand, offering to show us a “secret” part of the temple for a baksheesh. Baksheesh is a social lubricant in the Arab world, its how business and relationships happen, and its basically a little tip to help get things done and has been bastardized for tourists to the point where people will put their hand out after doing small things like opening doors, putting your backpack underneath the bus, giving you directions, or sometimes nothing at all.

Our second day in Luxor was spent on the west bank of the Nile at the Valley of the Kings. We took the people’s ferry over and rented bikes that we used to get 8 km into the desert hillside that houses the tombs of some of the most famous pharaohs and nobles and queens of ancient Egypt. We got to see 3 of the tombs, massive tunnels dug deep into the rock, leading to burial chambers. The walls of the tombs are decorated with drawings and hieroglyphics, detailing the instructions for the pharaohs to reach the afterlife. Many of the drawings still have the original color from thousands of years ago and although none of the treasure or mummies remain in the tombs (they were stolen by tomb raiders or are housed in various museums) the enormity of each project and the beauty of the art was humbling. We visited the Temple of Hatsehpsut, built into the rock, honoring one of the 6 female pharaohs to rule ancient Egypt and the Colossi of Memnon, 2 massive statues that guarded what is now thought to be the largest temple to any pharaoh that ever stood, but is now a ruin. The Collosi are covered with Roman graffiti, a reminder that tourists have been coming here for thousands of years to see Thebe's sites.All throughout, we barely scratched the surface of what there was to see and do. It seems that anywhere they dug in this Nile valley they found remains of ancient civilization.

We left Luxor on a bus for the Eastern coast on the Red Sea, a town called Hurghada where we were to catch a ferry that would take us to the Sinai peninsula where we would continue our Egypt adventure.

For the Picasa web album of Cairo and other pictures, click here.

Thursday, April 8, 2010


We made a change in our itinerary and decided to stop in Kenya for a week seeing as we had airline ticket vouchers to use from the Tanzania forgotten tickets incident. We flew from Kampala to Nairobi and timed our visit, lucky enough, to meet up with our friend Sarah Judkins who also happened to be in Kenya. Marc Bloch, a friend who lives and works in Nairobi coordinating the east African efforts of Caritas, a swiss NGO, helped us organize a cheap hotel in a nice part of town, and helped make a big city much smaller and more manageable. Our intentions were to climb Mt Kenya, the second highest mountain in Africa and we were feeling pumped up from our big climb in the Rwenzoris several weeks before.

Mt Kenya is, like most east African summits, a massive extinct volcano. It is a mountaineer’s mountain with the possibility of multi-pitch technical rock and ice climbs on massive granite pillars and walls. Since we had no gear, we chose to climb the highest non-technical peak: Point Lenana. We made arrangements in Nairobi with porters and a guide, Dickson. We were to hike the Sirimon-Chogoria route. The route starts on the northwest side of the mountain, climbs up to the summit circuit, over Lenana point and down the eastern flank. The hike is supposed to take about 4 days and covers about 10-32 kilometers per day.

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 Rwenzori Mountains. That afternoon we arrived at Shipton’s Camp (4200 m), the staging ground for Pt Lenana. The camp, set at the base of the glaciers and high peaks of Mt Kenya, afforded gorgeous views of the summits when the clouds cleared, and we got a chance to gawk at the monster walls of the mountain’s peak who’s highest point clocks in at over 17,000 feet and involves a 2-day technical rock/ice climb to reach. Our more modest goal was Pt Lenana, at 4985 meters (16,300 feet) and we were hoping for a clear night with no rain as our ascent was to start at 4 am the next morning.

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 East Africa. The landscape on east side of the mountain was dramatic and pristine and the valley below opened up into vast green hills. The day’s end brought us to the park edge at 2700 meters and we spent the night at the simple Mt Kenya Lodge, complete with a fireplace. Our guide Dickson and Guy went foraging for stinging nettles, a Kukuyu treat, and Dickson taught us to cook them and had us drink the broth (to strengthen the joints for the next day’s descent).

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 Chogoria where we spent a night in a too local hotel and caught a matatu back to Nairobi the following day.

Because the mountain took less then we thought we had 4 days to kill in Nairobi before our flight to Egypt. We celebrated Sarah’s birthday with a tasty Italian dinner and saw her off to her adventure at Tenwick Hospital in Western Kenya. We spent time in coffee shops, playing on the internet and catching up on errands. We had the privilege of attending the Passover seder with the Kenyan Jewish community that is made up of a whole mish-mash of members, Israelis, Expats, and Jews whose families have been in Kenya since the early 20th century, many of whom came in anticipation of the formation of the state of Israel in east Africa, as was almost the case. When this didn’t materialize, they stayed.

In all we spent 10 days in Kenya. The thing that struck us most about the time there was how different Nairobi (and even rural Kenya) is from Uganda. Nairobi is big, cosmopolitan, modern, and developed with a diverse population and despite having the reputation of being the most crime-ridden city in Africa, we found it safe. While there remains plenty of economic, political and social problems in Kenya such as rigged elections, crime, and tribalism, Kenya appears developed, people seem purposeful, more educated, and more worldly then its neighbor to the west. The roads were paved, commerce ticking, and industry seemed everywhere. Electricity reached deep into rural areas, and there was an overall feeling of more order and less chaos. There were noticeably less children, even in rural areas, no hordes of naked babies running everywhere. As mzungus we were not as much of a novelty, but we didn’t get to witness slum life as intimately as we did in Uganda. We both agree that we feel lucky we got to spend time in Uganda, a county that feels like it is more in the throes of development then more established Kenya.

We are now in Egypt, making our way up the Nile from Cairo to Luxor, then to Hurghada on the Red Sea and by ferry to the Sinai Peninsula. Stay tuned for more stories and adventures.

check out all the pics at Mt Kenya adventures

Monday, April 5, 2010

Guy's project in Uganda

As most of you know, we were sent to Uganda by AJWS To work as capacity builders in an NGO. We were partnered up with KCCC – Kamwokya Christian Caring Community – a church-based, grass roots organization dedicated to providing services to one of the more impoverished areas of Kampala: the 60,000-person Kamwokya slum. The slum is a mix of Uganda’s poor: the downtrodden, northern refugees escaping the LRA, South Sudanese, Congolese, orphans of war and HIV, lepers and polio victims.KCCC knew I was a PT, but they didn’t quite know what it means. Uganda, a country of 33 million people, produces 20 PTs a year, or 1 PT for every 1.65 million people, this is quite an improvement over a few years ago, when Uganda’s Makerere university produced only 10 a year. The Human Resources director, an amicable chap who thought PTs cured tuberculosis thought I might be best used in the dispensary, or pharmacy. Soon, Rusha and I realized that if we did not take the leading role in directing our projects, we would both be doing fairly trivial things, and not using our skills effectively.
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.