Pharmacy in the Forest

We have just arrived in Nairobi, and are staying with Matt and Jess (their blog is linked to this one). Before getting into our experiences here, I must recount our adventures from the Bwindi 'Impenetrable' Forest. After leaving Lake Bunyonyi, we headed for the forest. This was easier said than done, as transport to and from Kabale is spotty at best. We were lucky enough to secure a ride in the front of a pickup leaving shortly after we got into Kabale- had we missed this, we would have been stuck for the day. We mzungos were given the front, less out of courtesy and more because we could then be charged significantly more than the locals (~20) who were crammed into the box (see picture). Needless to say, not everyone had a seatbelt! For six hours we plied the high mountain windy dirt roads, stopping frequently for buying things, bladder relief, and breakdowns (twice, break failure and flat tire respectively). When we finally arrived at the Bwindi Community Health Centre (www.bchc.ug) we were greeted warmly and invited into our rooms at the well furnished guest house. The Californian doctor, Dr. Kellerman, who runs this Church of Uganda health centre is well known throughout the area and even broadly in Uganda. The clinic has accepted over 100 students on internships from the US, Canada, and the UK. After treating us to a feast (including the best cinnamon bread in all of Uganda), we were taken on evening rounds in this 30 bed facility. There were various ailments represented, the most severe being a young girl with cerebral malaria. The course of treatment for this dangerous form differs only in its urgency and aggressiveness: the patient can die quickly without intervention. The next morning, we were invited to come out on an 'outreach clinic' in the forest Batwa peoples community. The Batwa are pygmies that until recently lived a hunter-gatherer lifestyle in the forest. The were ejected from their traditional homes when the forest became a national park, and unfortunately suffer stigmatization and struggle with integration into general Ugandan society. Shortly after their removal from the forest, the infant mortality rate was approaching 50%. Anyways, we took a landrover, stoked with drugs, and penetrated the impenetrable. After an hour's drive, we arrived at their settlement, where people had congregated in anticipation. Chelsea and I were assigned to assist a nurse-in-training in dispensing drugs of various kinds. The setup was as follows: The assembled people were given a number, saw the doctors in that order, came to our 'drug hut' with their prescription. Given all the constraints and considerations, diagnoses were expedited and made on best available evidence. We handed out mainly de-worming pills, quinine (for malaria) Vitamin A (for malnutrition) and antibiotics. Most patients were young children, suffering from malnutrition, intestinal worms, or both. The aim of the outreach was not only treatment, but also triage. We took the sickest of the sick back to the clinic for admission. We took five very young children suffering from malnutrition and related complications (infections etc.) accompanied by their mothers. As we all had to fit back into the finite environment of the landrover, Chelsea, two doctors and I had to ride on the roof racks! Again, not everone had a seatbelt :)
Those who came with us received prompt treatment, without which they would have died within the next 3-5 days (according to the attending doctor).

The pictures are of our pickup ride, examination by Dr. Paul (UK), and a young girl peering into our forest pharmacy.

Tranquilty and Germans in a volcanic lake

As mentioned in the last post, we are staying on a small island in the middle of Lake Bunyonyi, Kabale, Uganda. The place has amazing natural beauty, including strange birds and lake otters (the latter I have not seen). Here is an experpt from a tourist brochure: "Located 1962m above sea level and surrounded by steep sided heavily cultivated mountainous scenery. Lake Bunyonyi (the word means 'the place of many little birds') is about 25 km long and 7 km wide. With 29 islands dotting the centre of lake and depths varying from 44m to 900m. If the later is true it will make the lake the second deepest in Africa. The lake surface is a fresh 25 degrees celcius, bilharzia free and safe for swimming." The organization running this camp is particularly interesting, as they donate all proceeds to sustainability efforts and education in the area. To learn more, visit www.lakebunyonyi.net
Chelsea and I have made friends with two German ladies and one guy from Colorado- the former are remarkably bon vivant - there has had to be a special order (dug out canoe of course) of replacement beer!
The temperature is cool, the air still. Yesterday, while the ladies were visiting a local pygmi tribe, the three of us rented (2$/ day) a canoe and went to visit some surrounding islands. Closest to us is the Bwama island, which has a primary and secondary school, catering to students from the mainland and surrounding islands. Amazing- schools on a small island in the middle of a volcanic lake, in the mountains of Uganda. Why not?
The students commute each day by dug out canoe (several of which have been donated by the place we are staying.
Today, unfortunately, Chelsea and I are leaving for the mainland, as we hope to visit the Bwindi "inpeneterable" forrest where we have a connection with an American doctor running a forest hospital for the local pygmi population. Why not!?

I will end the post here, as my crepes with local fruit, cinnamon and honey are about ready (at a cost of ~$1.75) Why not.

PS- The girls Chelsea is showing the camera to are the ones, on the top of the mountain, who spoke to you, Karolina, when you rang the cell phone!

One thousand hills; zero platsic bags

Well, the number of plastic bags was not quite nil, but I had mine confiscated at the border. Rwanda, "The Land of 1000 Hills" does not allow the carvellas - cheap, ubiquitous, plastic bags, which are a scourge in Kampala- past its borders. This is part of an environmental effort that has paid obvious dividends, especially to the visitor from the comparitively polluted Kampala. Rwanda has rebuilt itself since the genocide, and is a much different city than Kampala. Apart from the prohibition on plastic bags (everyone uses paper for groceries), Rwanda is characterized by significantly more order than its Ugandan counterpart. The boda bodas (motorcycle taxis) are regulated, and have helmets for both passenger and driver. The streets are clean of plastic bags and bottles and excessive amounts of people. The people speak French, as well as local dialects.

Our time in Kigali was brief but memorable. We left Kampala on Monday morning, arriving in the early evening in Rwanda. The next morning, after meeting a fellow traveller from Vancouver (of course), we all went to the Kigali Memorial Centre (genocide presentation/memorial) It was a world-class facility telling a very disturbing tale. Pf note, the last module of the exhibit was that of "Lost Futures"- a feature on the children victims of the genocide. It was built from family records, and included a large photograph of a selected child, and information such as age, name, favourite food, best friend, last words, and cause of death. The ages ranged from 15 months to 17 years, and causes of death included the following: smashed against wall, burned to death in church, hacked with machete in mother's arms, stabbed in face and eyes, and shot. The Memorial grounds were built around several mass graves. There was a room dedicated to artifacts recovered from victims, and included identity cards (which helped fuel the injustice), cheap plastic crosses, car keys, and, most eerily, a tourist t-shirt from Ottawa. To top off the day, we had lunch at the Hotel Des Milles Collines (Hotel of a Thousand Hills), which is and was "Hotel Rwanda". Today, it is a luxury establishment, with absolutely no reference to its history as a safe haven for Tutsi people fleeing the genocide. The reader can imagine the strange feeling of drinking beer and eating sandwiches by the pool, all the while knowing the context. I am not sufficiently educated on the conflict to speak with authority, but would encourage people to learn about it. In particular, Lt. Gen. Romeo Dallaire, the Canadian in charge of the UNAMIR (United Nations Assistance Mission in Rwanda) has written a book titled "Shake Hands with the Devil".

The name 1000 hills is deserved. On our way into Kigali, we passed vast, monotonous, flat fields of tea, occasionally punctuated by large sloping hills which seemed to rise out of nowhere. The countryside is lush and appears full of vitality.

I am writing this post from Byoona Amagara island, on Lake Bunyonyi (a volcanic lake in western Uganda). We left Kigali this morning, and arrived in Kabale, Uganda shortly after. Chelsea and I hiked for roughly two hours through mountain trails to get to this idyllic lake. We passed traditional farms, a school in the middle of nowhere, mountain goats; yet managed to find a bakery for our regular starch/fat infusion. Not to fear, as the sweat rolls (with peanut butter) were worked off during our one hour dugout canoe paddle to the island. Here, we have met two German ladies and one guy from Colorado. It is raining now, and we're all on the patio enjoying after dinner refreshments. We'll be sleeping (well) in a Geodome- a type of sheltered, open walled structure on the lake shore. In short, the place is magical. To top it off, it dedicated 100% of its profits to sustainable community development in the local area.

The pictures are as follows: gardens at the genocide memorial (to the immediate right are rows of mass graves), me outside "Hotel Rwanda", and a young girl on the mountain trail leading to Lake Bunyonyi. Please forgive the orientation of the pictures, but it is too late to change it, and it took 40 minutes to upload them!

Wrapping up in K'la

Since coming back from Gulu, things have been quite busy as Chelsea and I try to wrap up all the little projects we have committed to. On monday, (Maternity, of course), I delivered another baby, and watched twins be born via "ceasar!"- nursing slang for a cesarian section. I also catheterized a woman (necessary because the baby will often obstruct normal urine flow. A collapsed bladder is also less likely to be damaged during during birth). Fun fact of the day eh!
Tuesday was a day of office work, and we took our boss and his wife out for lunch. On wednesday, we visited Hospice Uganda - a large, very well-run organization that focusses on caring for thoes suffering from AIDS and cancer. After speaking with those there, I came to understand the disparity in funding for cancer patients (in Africa generally) compared to those with AIDS. Many of the former are in equivalent pain, yet cannot access the aid earmarked for latter. Breast, cervical, and prostate cancers are the prominant ones, while lung cancer is relatively minor compared to in the West. The organization operates on an outpatient basis, and conducts home and hospital visits. We each got to acompany teams out to rural areas on these types of visits. The doctor would interview the patient, conduct a physical exam, and usually leave him/her with an oral solution of morphine.
In other news, there is some encouraging developments on the environmental front. There is a new company , funded by the Danish government, that has begun to recycle the plastic bottles (water mostly) from the downtown core. The litter in this country is rampant, especially in overpopulated Kampala. This litter traps water and dirt, promoting malaria, cholera etc. This came to mind because the hospice distributes the morphine solutions in these (used, washed) ubiquitous bottles; another good example of the good ol' 3R's.

A last apology about the pictures, I am still having trouble uploading them, but will resolve this soon.

A Guiness in Gulu

Finding the Irish staple at the Gulu Havana Club on a hot Febuary night was surreal enough, but it followed one of the most incredible days I have had in my life. This post is bound to be word intensive, as I am trying to recount the most singular day of Feb 16th. It began at 0700 when Chelsea, Adam (from Montreal) and I met at the Uganda Post Office in Kampala. We had seats on the 0800 Post Bus direct to Gulu in northern Uganda. Readers who haven't heard of Gulu, or the conflict in the north, are referred to the following sites: www.guluwalk.com, and www.ugandarising.com Both sites have Victoria connections: The Gulu walk was held in November in Victoria and across Canada (and the world) to raise awareness and money. Karolina, I, Sandi and Jamal (from VicHeart), and a contingent from Oaklands Chapel took part. The movie Uganda Rising was shown at UVic at the Amnesty International Film Festival last year. Anyways, back to the story.

The bus ride was most enjoyable: Chelsea brought coffee (rare-ish here) and lipid-laden baked goods, the middle America country music was blaring proudly (think Leanne Womak, Dolly Parton- I loved it by the way!), and the back of the bus read "God Bless". You can picture the scene. On the way, we passed baboons, scenery, etc. Once we got into Gulu (5 hrs later), we had very brief walk to Erin's residence (see Erin's blog linked to this site) at CPAR (Canadian Physicians for Aid and Relief). Erin is working with CPAR to plan and conduct conflict resolution workshops in the Internally Displaced People (IDP) camps. ** Don't worry, I think I'm through the acronymns**
Our timing was such that we were invited along with a freelance documentary maker to go to one of these camps and observe the conflict resolution training in action. Our experience is difficult to describe in words. Small, round huts with thatched roofs, many children, little infrastructure, goats, cows, ducks, chickens. These children would follow us mzungos around in droves like we were Santa Claus or something. The pictures will do this better justice. The advent of the digital camera has revolutionized, in my opinion, the photography of people in places like this. When you can take their picture then turn around and show them, they are amazed. People would be laughing, screaming, running to grab children, friends, just to see their picture. I spent a good 30 minutes just taking photos and then showing people. Their joy and wonder was unsurpassed by anything I have seen before- no exaggeration. One topless woman even strode up defiantly, hands on hips, for her personal shot! (unfortunately, not posted here!) At this point, I should make it clear that although I had quite the experience, and the people seemed happy, these camps are not good or healthy places. The people are dependent on imported food and clothes, there are scarcely any jobs, alcoholism is a problem, STDs are a problem. Things are getting better, but the situation is still grim.

The story continues, read on! After leaving the camp, we checked into our hotel rooms briefly before leaving for the Acholi Inn (named for the people of this region) for dinner. The transport was by boda boda- motorcycles that will take you anywhere in town. I have avoided these like the plague as I have seen how they drive (helmetless, weaving in and out, driving on sidewalks etc.), but peer pressure is a tough mother! At the Acholi Inn, I passed a young man wearing a Concordia sweatshirt. Within minutes, we were in a room with a dozen other Concordia students! The student society of Concordia is funding a 5 year project here, and will have student volunteers here on rotation the whole time. They have even bought half of the Acholi Inn as a base of operations. We ended up outside, around a bonfire, with beer and marshmallows (imported)- it could have been a typical beach or lawn in Canada. You can imagine the strangeness of it all. I pet a chicken. To top it off, Adam (with us in Kampala) recognized an old friend from highschool back in Quebec. Here in Gulu.

The last chapter takes place at the Havana Club, where they serve Guiness, among other things. The people were happy and friendly, the music lively and upbeat. I never in my wildest dreams imagined I would be singing and dancing in northern Uganda. The night went on and on, we met Ugandans, and heard lots of increadible stories of real life under the menace of the LRA. One girl's story in particular touched me, but is probably better told in person. We are going to church with her tomorrow before heading back to Kampala. Gulu is a much quieter and more peaceful town than Kampala- but it comes with a very dark history that I would urge all to explore. **Unfortunately, I am having trouble uploading the pictures, stay posted**

First comes love, then a committee

Hello everyone, less exotic but nonetheless interesting things to report this round. Since last "Maternity Monday" we have continued to work in the office, and design the protocol for the St. Stephen's laboratory. Last night, Jamie - a fellow microbiologist/biochemist from UVic popped by on her way to Rwanda where she is going to be teaching at a rural school. Her blog, www.athousandhills.blogspot.com, will be linked to from this site. We are taking her out to dinner tonight before she leaves early tomorrow.

Yesterday we were invited to a young couple's wedding committee, and I think it's a good idea to let you in on this aspect of Ugandan culture. Weddings here are extravagent- there are no drive-thru chapels! This requires money, and usually must be raised. The couple will gather together all their friends for a series of committee meetings where guests are encouraged to offer input on the upcoming wedding. The other, and most important facet of these meetings is fundraising. Guests are given a stake in making the occasion a success, and pledges are openly solicited. One man donated money, another ensured the groom's wardrobe, yet another his haircut. Another donated the venue for free, to loud applause. This committee will meet roughly 8-10 times before the date, each catered (and well watered too!). There are fines for those that show up late. Seriously. We, being mzungos were of course asked to speak, and offer our thoughts on the wedding. You can imagine how much was said!

Today was another "Maternity Monday", and things were as spectacular as before. We are getting better at listening to the foetal heart through the scope. Sadly, about 80% of spontaneous abortions are caused by malaria complicating pregnancy. The disease is a massive scourge, with a large percentage of hospital beds occupied by its sufferers. We also learned about hydronephrosis- where the baby is pressing against one or both of the ureters.

The pictures are of Chelsea this morning, the wedding committee, and a pregnant cat whom I have been feeding bread and scambled eggs to her delight.

Finally, a big African shout-out to Mrs. Mccullough for her birthday, I know she is an avid reader of the posts.

Leaving "the world where they pay no tax"

Well, it happened. We witnessed a birth. And three more. Two of which I "delivered". By "delivered", I mean I was the first hands on the slippery child as it emerged. I clamped the cord, snipped the cord, and persuaded placenta to follow child. I know, it sounds incredible, and it was. Chelsea and I spent most of monday in the Mengo hospital maternity ward. We shadowed the doctor in the morning, examining the pre- and post-birth mothers and babies. We felt uteruses (uteri?), and learned how to track the progress, in both growth and recession, of this organ. We listed to fetal hearts through fetoscopes, felt for the head (ususally just above the pubic symphisis), learned the formula for calculating expected day of birth, discussed ceserian sections, talked about the intreguing melanocyte migration during pregnancy (creating the darkened line through the naval on mum's belly), learned about the types of fluids that should and should not be coming out, and at what time. We talked about fetal distress, obstructed pregancies, false labor, true labor, induction, cervical dilation.... it went on and on. The nurses, midwives, and doctors were eager to teach, and then thanked us for coming! The young lad here is only 4 minutes old. The squishy object is the placenta. Capital!





The fourth baby (in case you have been counting) was born by ceserian section. We had met the mother that morning in the waiting area. Once dilated to 4cm, she was admitted into the labor ward. As she was a "prime gravida" (first pregnancy), labor was expected to be especially painful and protracted. She was there all day, in varying stages of discomfort. At one point, Chelsea and I were holding hands, being squeezed, and rubbing sore backs in adjacent beds occupied by writhing, vocal, young women. By evening, the doctor decided that she wasn't progessing (dilation, contractions) sufficently, and that the baby might be in jepordy. By 2030, she was taken into the theatre for the ceserian section. Again, fasincating. Baby was removed uneventfully, and mother seemed to do just fine.





There is so, so much more to the experience, as one can imagine.