Tuesday, May 14, 2013

FINAL BLOG POST...My Ugandan adventure comes to an end!

Over our last two weeks in Uganda we traveled to two beautiful lakes, finished our research projects in our villages, wrote our final papers for medical school, had our last chronic care clinic and said goodbye to many of our patients and new friends.

Uganda was my first experience with a continuity clinic and after two months of seeing my patients on a weekly basis, I was sad to say goodbye.  It is very likely I will never see these patients again, and I can only hope I did my best during my brief interaction with them in my life.  This is me on one of my last days in the hospital, running around as usual, with lots of things around my neck: stethoscope, blood pressure cuff, and bag with my iPad, TB masks, malaria and HIV tests, (the essentials!), etc. 

Nelson (translator) and me talking to one of my many tuberculosis patients- he improved greatly and is finally ready to go home where he will complete the 6-8 months of treatment.

view of our apartment complex
fabrics at market
rain water catching system for running water in the village

cabbage being sold at market


Our trips to the lakes on our days off were filled with canoe adventures and relaxation.  Lake Mutanda is close to Kisoro and for about $5 we paddled in canoes built out of eucalyptus trees for 3 plus hours with guides, in search of Kabeka, the giant python.  We had heard that most people don’t see it (probably a marketing scheme), but of course wanted to try.  By the end we were racing the thunderstorm (and each other) home and had the best upper body workout in years, followed by a delicious meal with quite the view. So quite a successful trip.

Lake Bunyonyi, a much larger lake with 29 islands, is a 2 hour drive from Kisoro near the city of Kabale.  We stayed at a lovely eco-friendly hotel called Byoona Amagara and met a handful of worldly travellers with interesting stories.  A doctor from New Zealand taking a year to work in hospitals abroad, another Kiwi doing Cairo to Cape Town before moving back to Jerusalem for international law, a young Lithuanian woman working for the UN in South Sudan and her Spanish dentist-Phd-stem-cell-making-cancer-curing boyfriend, and wanderlust Israelis who had just finished their mandatory military years.  We had large family style dinners and talked of everything from world politics to the ethics of legalizing marijuana to our favorite musicians.  We read books and played cards and swung 15 feet in the air off a rope swing into the lake.  After 3 nights of fun and relaxation, we started to have a bit of island fever and we were ready to return to Kisoro for our last week in Uganda

running to Lake Mutanda (about 1.5 hr run)

Masha, me, Deus embarking on the search for the big python

dock at Lake Mutanda
panoramic view of the volcanoes from Lake mutanda

Typical mode of transport.  Also my dad's dream car.
the crew getting a ride home after an epic day on the lake

view on our ride home of the kisoro sunset


View from the dining room at our hotel on Lake Bunyonyi

Lake Bunyonyi

bird that hung out with me on the dock
lake bunyonyi...every night its like this...



Celebratory party at Golden Monkey and african drum circle...also inspired me to bring back two djembes / bongo drums...




The last few days in the villages were wonderful.  We focused on home visits and I enjoyed hanging out with my VHW’s, Benon and Suzanne, and their families.  I discovered the best “chai” tea ever in Buangana for about 10 cents.  They mash up fresh ginger and 3 types of local leaves (peppermint, a vanilla-smelling leaf, and one other) and boil everything with some cane sugar, then add the chai tea at the end.  I have tried replicating this recipe a few times, but can never succeed!  I will miss the yummy tea and the nice young boy who sold it to me—even though he always charged me a “mzungu” price, higher than the locals. 

During one of our last health talks on cancer in women, it took me a moment to understand why, at 9am, the group was so animated.  We had wandered into the “downtown” part of Bunagana, where the waragi producers worked.  Waragi is a triple-distilled, multi-grain alcohol mixture that if done correctly, tastes like flowery vodka (even though commercially its labeled as “gin.”).  I realized the clear liquid they were drinking that morning was not water, but waragi.  Most were women, eyes glassy and bloodshot, their children scattered around their feet, often lying in the dirt playing or eating bread, naked except for a holey t-shirt five sizes too large.  Surprisingly, they listened to Suzanne as she spoke of breast cancer warning signs, sometimes asking questions, and sometimes shouting out things that didn’t relate at all.   An elderly woman who I had met the day before, and who was known as a “town drunkard,” sauntered down to our group.  She interrupted Suzanne’s talk to shake my hand and then demanded that I take her BP (she had refused the day before).   After the talk was over, I was hesitant to even acknowledge this woman, as she was very intoxicated, but then I thought that I couldn’t pass any judgments, and I should treat her like anyone else.  I’m very glad I did because her BP was 180/100.  We talked for 20 minutes or so about getting her to a clinic to start medications, her alcohol problem and her lifestyle.  She laughed at me when I asked her if she could stop drinking alcohol…so we talked about decreasing the amount she drank daily. This was accepted as a slightly more realistic goal.  I saw her a few days later when she wasn’t as drunk, and we talked about the same issues.  I can only hope that she will seek care and take her medications.  What disturbed me the most about this small part of my village was the environment in which the waragi-maker’s children are growing up.  Alcoholism is a problem worldwide of course, and it was the topic of my research project.  Poverty, boredom or idleness, cheap, easy access and lack of law enforcement magnify the problem in this area of Uganda.  (If you have any interest in my research project, email me and I can send to you).  Enforcing laws, education and job creation are all desperately needed to help stop the propagating forces of teenage, and then adult alcoholism.
Nelson, my wonderful translator, showing off his sense of style.
Some of the audience members in my last talk to the villages on adolescent alcohol consumption and sexual behavior. We had over an hour long conversation afterwards on how the villagers could work toward fixing these issues.
Suzanne's family and me in the living room
Sweet potato, matoke, dodo greens and beans- my last meal with Suzanne!

My buddy Nobat with my sunglasses

One of our last days was spent at a Congo refugee camp near Kisoro, where as many as 5000 refugees can stay.  (At our visit "only 900" were at the camp).  The camp leader, Tony, is inspirational as he dedicates his life to helping those who had to flee with nothing from their country, which could no longer provide them the basic security we take for granted every day.

Congo refugees in their kitchen

Congolese Refugee Transit Camp near Kisoro

Overall, my 2 months in Uganda have been life-changing, challenging in ways I did not expect, and a LOT of fun.  What I will take home with me are two concepts that I will hopefully continue to practice the rest of my life.

Test my comfort zone.   It’s so easy for me to get comfortable in my life at home. Between responsibilities of school and starting a career in medicine and the luxurious life we live as Americans, I rarely find the need or chance to move outside my comfort zone.  I did while in Uganda and it has been one of the most enhancing personal growth experiences I’ve ever had.  I’ve learned more about how I react in situations, my weaknesses and strengths, and the limit to which I can handle certain things.  I feel more grounded, and yet freer knowing these things about myself.

Be of service.  There is always someone in the world that really needs help- and I’m sure one day that will be me.   Helping others is truly the best gift I’ve ever given because in the same gesture both parties are on the receiving end.  My favorite moments over the last two months have been with my patients.  While I may have played a role in dosing their medications or giving them words of comfort, they have given me  much more than that: trust, education about their body or illness, and lessons about the faith of the healing human spirit.   I am every so grateful for these opportunities and I hope that I will remember to be of service whenever I can.

Thank you for your love and support over the past two months—couldn’t have done it without you all—and thank you for reading!

Until the next adventure,


Vanessa

p.s. some pics from Kampala...

My drum and its maker- after he cut a third of it off! He re-painted the bottom for me and added a longer rope to carry with ease.
Kampala...very busy city (this is nothing compared to what its like during the week-- you can't drive here)

Thursday, April 18, 2013

GORILLAS * Villages- Public Health Work * Staying in the Village * Genies * The Congo Unrest

Gorillas…in the Rain (2 weeks ago…)  We woke up around 5:30am and headed north for 2 hours (on a very bumpy road in my dad’s dream car…Landcruiser thingy not available in the US) to the Bwindi Impenetrable Forest, one of the few homes of mountain gorillas.  This type of gorilla is only found in Uganda, the DRC, and Rwanda (http://mountaingorillas.gorillacd.org/), which is why they can charge $500 US per person for a guided tour, one hour with the gorillas, with a 95% success rate of finding them.  Luckily, April is the rainy season and there’s a $150 discount…and $350 seemed much more reasonable.  Plus it goes to a wonderful cause of keeping the gorillas happy in their natural habitat.

We met our guides at 8am and trekked for about 1.5 hours into a beautiful, dense, tropical jungle.  Most of the time we were quiet, or talking with hushed voices, waiting for our trackers to radio to us.  They had started off an hour earlier to find their previous night’s nest where they examine their remains to assess the state of their health—including both food leftovers and poop (normal vs. diarrhea).  Then they follow any signs they can find.  This is their daily job! Very cool.  

All of sudden my guide stopped on the trail, turned up into the non-trekked bush and started hacking a pathway with his machete.  We hiked up a VERY steep hill (we were often crawling, grabbing onto roots or branches to get up)…and finally after 30 minutes reached the family of gorillas.  Papa Silverback was sitting very happily under a big bush, tearing off branches with some serious strength (he weighs 500lbs plus), and stripping off the bark to eat.  He really could not care less about us and did not turn to look at us once.  His wife (they are monogamous and probably a much better divorce rate than any human) and their children were a bit more curious. 

The one-year-old male baby was happy to be our entertainment for the entire hour, and per our guides, was very animated and excited that day.  He climbed up and down the big bush many times, reaching the top, peeking over at us until he felt more comfortable, and eventually put on a little balancing/dance show.

His mother on the other hand…  We were trekking up about 15 ft to find her, and I was right next to the guide. When we reached a bit too close, she jumped out and beat her chest SOOOO LOUD.  In one swift movement I jumped behind my friend who was behind me, and pushed him ahead-- gesturing to the Mama-- here take this guy instead, he’s taller with more meat!   The guide laughed…he explained that she does this as a “hello” and also it’s a playful gesture. 

After taking 100+ photos each, we simply watched these rare, beautiful creatures from 10 feet away and I was mesmerized at how similar they are to us.  They are gentle, peaceful (unlike their cousin baboons), inquisitive, and nurturing.  Definitely a once in a lifetime experience worth the money- see pics below!



Village-to-Village Public Health Research

For the last two weeks we have been working in the rural villages where we visit each home with three main goals:
1.     Screen for chronic diseases (high blood pressure, asthma, epilepsy, heart failure, tuberculosis, HIV), take every adult’s blood pressure, and then refer them to an education or medication delivery program, or the hospital.
2.     Assess any other problems if someone in the household is sick and refer them to my clinic on Wednesdays.
3.     Complete 100+ research surveys that I created (with friend Eman) regarding adolescent alcohol abuse and its relationship to sexual behavior and HIV prevalence.

I was assigned to Bunagana and Gatsibo, two villages that are intertwined and ON the Uganda/Congo border…(more about that below re: the Congo war going on).  Asking people about their own drinking habits and then what they think teenagers are doing these days is mostly interesting, often funny, and sometimes very challenging.  A few people out of the hundred denied answering and claimed that we are getting paid to do this, and why should they help us, if we don’t help them.  The first time this happened, my translator was so upset, he stopped talking and just left.  I was somehow OK with it all, as I told myself if someone doesn’t want to answer the survey, fine, and they’re entitled to their opinions regarding who we are and our intentions, whether they’re right or not.  The second time, I took it much more personally and became quite upset.  Looking back, I realize that my reactions in such situations are often dictated by my mindset in that moment.  If I have enough sleep, breakfast, and am in a happy mood (this is most of the time I’d like to think!), I can handle this type of situation in a much more positive light.  The minute I take things personally, which happens when I’m sleep deprived, hypoglycemic, or stressed, my actions or words are not as professional.  My honesty here perhaps unveils a negative characteristic, but I think the best things learned in life are through making mistakes and admitting it to myself! I feel that I’ve learned a very good lesson before earning my MD; to mindful of my own state of mind.  And to take care of myself first because I will be able to take better care of my patients.

Most home visits are wonderful and very productive. I’ve referred over 15 patients to my clinic, one of whom we saw yesterday and discovered she has a serious neurological problem (leading diagnosed is spinal tuberculosis).  I’ve seen many things in the villages I’ve never seen before—elephantiasis, severe heart disease, and a family of albinos. 

Elephantiasis: 

A lovely woman invited me into her home a few days after I had taken her blood pressure. She had prepared raw honey from her beehive with home-brewed aloe-vera juice (with some other African medicinal leaves) for us!  The honey was delicious- and even chewing the honeycomb tasted yummy, but different from the honey.  The aloe-vera juice was also amazing- it had a fermented taste and reminded me of Kambucha (sp?). 
aloe vera
honeycomb, honey on the sides
Aloe vera juice, lemon slices 
Benon, Gatsibo’s Village Health Worker, giving a talk on Cancer in Women that I wrote with my friend Eman.


Benon, taking a villager’s blood pressure in the fields.

A strong-willed woman, and domestic violence victim, who we interrupted during weeding sorghum.  We discussed at length her health and decided to plan a meeting with the couple and the ‘elders of the village’ as an intervention and effort for change.

A gourd of some sort- used by the grandfathers to drink homemade beer from.
Nelson (my translator) helping with a survey

Little girl eating berries for breakfast (we don’t have them in USA…)
Sorghum- used for food and can be made into beer, the plant looks similar to corn



Co-Op meeting among villagers- these people function as a bank together.  They invest in each other’s productivity, crops, etc. and make interest by keeping their money with this group.  Yes, there are banks with ATM, but the closest bank is a 25 minute drive, or 2 hour walk, and not realistic for them.


 Staying in my village, Bunagana


Last weekend I had the pleasure of staying at Suzanne’s house (my Village Healthcare Worker).  Her children and husband treated me like their own family and by the end asked me stay longer!  Luckily her husband speaks very good English and Suzanne speaks fairly well.  During the day I helped in the gardens and around the house, mostly prepping meals and playing with her kids.  They taught me how to peel and cook matoke (plantains) and had a good laugh at my juvenile effort to peel potatoes. They can easily peel them so that the skin comes off in one piece…I think my best record was about 9 pieces.  Suzanne taught me how to make G-nut sauce- it’s delicious, healthy, and very common in this region (think of a ground almond-peanut taste with tomatoes and onions- and put it over matoke and rice).  In return, I made them banana-Nutella crepes…not exactly American, but very well received (we used chapatti instead of crepes- its like a thin naan bread).  I slept in a small room in the main house and felt happy that the walls were concrete instead of mud and sticks (less bugs).  There’s no electricity or running water in Suzanne’s village, so the bathroom is an outhouse in the back and it’s simply a hole in a wooden hut (BYOTP…bring your own TP).  Let me just say that the common idea of most of the men I know to go and sit on the toilet and read whatever, relax, or have epiphanies, is impossible when your quad muscles are the only things holding you up.  Plus there’s no real door and it smells pretty horrible, so you just wanna take care of business and get the heck outta there ASAP. Haha.

Through many conversations over dinner, I learned a great deal bout their culture- an advantage of no TVs, computers, or any distractions really (they live with the minimum!).  We talked about school, politics, dating and marriage customs, divorce, the standard of living in Uganda vs. the USA, among other things. We discussed the idea of the boredom of impoverished people and why alcohol is an easy solution.  Unemployment is a huge problem here and is the reason why so many teenagers start drinking regularly at an early age. Many can’t afford school or find work, so they scrounge for drinks from patrons at bars or steal alcohol (easy to swipe one of those Chief Waragi packets and put in their pocket). Or they can find alcohol brewed at home.  Urwagwa is banana beer, easily made at home, and very strong (pretty smooth I might add…).  We also talked about that the woman’s role- that they must feed their children—which takes up most of the day (no microwave, no supermarket). Therefore they have no time to go out with friends and drink, unless they have a job and have help at home (rare).  The men however, have this luxury, and sometimes end up spending all the family’s income on alcohol.  These issues are nothing new in the world, but it was interesting to discuss and compare with the USA.

Genies…

Something that is definitely not in our country is the fear of “genies” and going “underground.”  First, let me tell you that both villagers and urban, well-educated people believe in this concept.  So, if someone is very greedy and wants a lot of money, they can make a room up in their house for the “genie” with food, drinks, and gifts.  Genies are ghosts with human torsos, a long tail and hooved feet.  Then, the greedy person finds the egg of a special bird (this bird can apparently see better at night than during the day), and walks into a lake and puts the egg into the lake on a bed of grasses.  Another option is to put the egg down the toilet.  One can also exchange this egg for a white kitten.  (Reminder that toilets here are not flushable).  This is the act of “going underground,” and the genie will come to its room, take all its gifts, and tell the greedy bastard that you must sacrifice (i.e. kill) the person you love most.  The genie already knows who this is without asking, so one can’t just kill anyone.  In exchange, they tell them exactly how to make money-- A LOT of money, as long as they follow their instructions on how to conduct your business (if you don’t, you lose it all).  Often you are supposed to bury this loved one underneath the building you are constructing for business.  THIS HAS SERIOUSLY HAPPENED! I have seen from afar a few houses in my village of those who have gone ‘underground.’ They look like Spanish villas, have solar panels and their own mast for cable/internet etc.  In Kampala (the country’s capital) a man was imprisoned after sacrificing his daughter to the genies and then bribed the police for release with millions of dollars.  Human rights activists protested and the man was finally put in jail for life.I know there are many people who believe in ghosts and will do crazy things to appease them, but my jaw dropped at this story.  According to my translator, you can be wealthy if you are good businessman, but you can never be as wealthy as someone who has gone underground.  Interestinly enough, this fear is only 5-7 years old in Uganda, and originated in the Congo and Tanzania.

By the end of my home-stay, I learned how to cook, eat, dance, sing, go to church, and sleep like an African (wake up with the sun!).  Some photos of my wonderful weekend with Suzanne, Vincent, Latitia, Pious and Nobat are below…
Pious and Nobat, checking out their new visitor

Latitia starting a fire in the stove for dinner
Pious and his baby goat!
Suzanne shopping for shoes at market
Nobat, my buddy. He and I were enjoying sugar cane (so yummy!)
more baby goats..love

Local eggs being packed in dried banana leaves for wholesale
home-made ugandan bicycle, pretty rad
Left to Right: Mai (helped with surveys), Nelson (translator), and Suzanne (VHW) in Suzanne's home for lunch
Latitia and Nobat, before church
Kisoro market- where you can get all veggies/fruits for very cheap
Per Benon, a very helpful plant (and expensive) b/c you can boil the leaves in tea and it will kill ascaris (a worm that lives in your stomach and wreaks havoc- very common illness here)

The Congo…

For those of you that don’t know (I didn’t know much til I got here), the Congo has been unstable for 10+ years due to Congolese rebels (called the M-23) fighting with the government.  The Congo has the highest amount of raw material exports in Africa.  The most productive land is in eastern Congo, right next to Uganda.  Per a Congolese man I had the pleasure of speaking with at length (he was the uncle of the family I stayed with for a weekend), the government keeps this eastern part undeveloped on purpose (i.e. no roads/schools or gov funding) so that they can dominate access to the raw materials.  They have special planes that can fly in and transport all the mined materials, and therefore left the local Congolese with no business opportunity, no support, no schools, etc.  Thus, the M-23 was formed.  I have no idea how much of this is true, but it seems it is what most Ugandans believe as well.  In any case, this makes my town a bit scary. When I arrived there was no fighting, and a few weeks ago it started up again, but now I've heard its stopped. There are stories of Ugandan villagers having stray bullets hit their rooftops at night (this happened last year, no one was injured).  More recently, a “bomb” of some sort was fired on accident by the M-23 and landed between 3 houses in my village Gatsibo.  Luckily the older woman and children who had been there 15 minutes earlier departed for dinner…so no one was injured (it did not detonate- just the force made an impact in the ground).  The M-23 came over to apologize.  They very much appreciate their peacefulness with Ugandans as they provide business to them on the ‘black market.’  From what i've been told, no Ugandan has died from Congo warfare.  In any case, the whole thing makes me a bit nervous when I think about it, and it will be brought up tomorrow with my program director.  

Kids that followed me, Nelson and Vincent to the top of the Uganda/Congo hill
Just past the bean fields you can see a dug-out area on the hill- this is the start of the Congo and where the M23 keep a lot of their equipment. The beans are in Uganda.  The hill from where I took this photo acts as a protective barrier as most houses are in the valley.

Overall, my time spent in these villages has been amazing.  I mean, this is my daily “office”:
Saucer clouds over one of the volcanoes

Benon at a villagers compound- the thatch-roof hut is where visitors are greeted with tea
 Two and half more weeks left of my 9 week stay in Uganda…can’t believe it!  Thank you for reading.

Love, Vanessa