Yesterday we had our quarterly food distribution for HIV infected women, the second of my time here, and it was a wonderful day. It was amazing to see almost 250 women show up, since there remains a lot of stigma associated with HIV, and these women are among the most marginalized people in this society. It’s even more remarkable that there is so much laughter and so many smiles among the women, even when they’re waiting in line at the community center for hours as we record their information. It seems to me that there is a real sense of community and camaraderie among the women, as they can sympathize with each others' sufferings (physical, social, and emotional) in a way that no one outside of that group really can.
I was in charge of weighing all the women and their children and measuring their height, and my day started off on the wrong foot. As I was weighing the baby of the very first women through the line – the very first – he peed all over me. This was no little trickle, this kid was hydrated. Not the way to start what was already going to be a long day. Jennifer said that I was now baptized. Luckily, that was the only time that happened all day, although throughout the day a puddle grew ever larger underneath the scale we use for the babies.
The other funniest part of the day was when two women, one after the other in line, set their cards on the table, and one of them also had a child health card. I had a rather simple method for keeping track of whose card was whose, but I got pretty seriously confused when I looked at these ones – both women were named Mbambu Grace. Both had daughters named Thungu Gloria, born a month apart. One card listed a husband named Muhindo, so I asked which woman was married to Muhindo – both claimed to be married to a Muhindo. At various points, we were certain that we had it figured out – each time a different way. After about 5 minutes of confusion, questions, women yelling and laughing, we figured it out based on where they lived – or rather, I handed them each a card with what I thought was the correct information, and I’ll never know if I actually go it right. But in a place with no social security numbers, where names can change from year to year (and some people struggle to remember the names of their children), and where birthdays are often not recorded, that’s just the way that record keeping goes.
It was special to see so many women, who are living with a fatal disease, just enjoying being together, and to have the chance to give them some food, some care, a smile, some encouragement. My attempts to speak Lubwisi provided a lot of comic relief to the women who attended (perhaps my most valuable contribution). It was wonderful to find a child’s negative HIV test results and give the good news to the mother, and it was heartbreaking to see the positive results. On some of the cards I saw the names of children whom I knew from the health center or nutrition work, only to see that they had recently died. There was a mixture of heartbreak and happiness that is hard to describe or understand.
Friday, February 27, 2009
Monday, February 23, 2009
Time for a rant...
Against corrupt government health systems. Not all government health systems are corrupt, I’m sure that some work quite well, but here, working with the government health system provides absolutely endless frustrations, and I can only imagine how hard it is for the Myhre’s, actual doctors who have been working in this system for 15 years. And I’m not talking about annoyances, though those are also plentiful; I’m talking about “people-are-dying-because-we-have-no-drugs” level of frustrations. For instance, there continue to be no gloves in the government health system in the entire district. Those little latex gloves that are used for absolutely everything – drawing blood, inserting IVs, running labs – there are none of them in the district health system, and there haven’t been for about two months. Take a second to think about what that does to health care. Very understandably, lab staff and nurses refuse to draw blood without gloves (HIV is common, and Ebola is still fresh in people’s minds).The gloves we use at the health center come from the Myhre’s personal supply, and we give them to patients who need lab work done. Otherwise, the lab tells them that they need to buy them at a pharmacy, something that is prohibitively expensive for some, difficult for others, and just seems wrong to me. It’s like saying “here’s a government sponsored health center, but you can’t access almost any care without paying.”
Next, there are no ARVs either. ARVs (antiretrovirals) are the drugs that are used to treat AIDS patients and can be very effective, extending life expectancy for years and drastically increasing quality of life. Every Wednesday we have a clinic where we distribute ARVs to hundreds of people living with AIDS. The only problem is that, for weeks, there have been essentially no ARVs in the district – not at the health center, not at the hospital. The money for them got siphoned off somewhere along the line, and despite constant promises that the drugs are “on their way,” they seem to remain on their way without ever arriving.
Next we have health worker accountability. Since health workers are government employees they are assured their salary, and they receive it whether or not they actually do any of the work they are being paid for. So, naturally, they often don’t show up for work. Sometimes not a single person in the lab comes to work, so no one can get malaria smears, TB tests, hemoglobin counts, or HIV tests, all of which are quite important in deciding how to treat a patient. Sometimes not a single nurse shows up in the paediatric ward. And some people don’t show up for weeks on end. Weeks. But they continued to get paid. Someone at the health center was talking to Heidi about the problem of health workers missing shifts and ways that the issue could be addressed, to which Heidi replied that she didn’t know the answer, because in the hospitals she worked at in the States, they would simply lose their jobs. The response was muffled laughter, saying that that is impossible here. It’s a very different paradigm.
Of course, the issues are more complicated than just that. One reason that there are no gloves is that a large shipment was rejected by the Ministry of Health because they didn’t meet quality standards. Quality standards are good, and I’m sure it’s necessary for the health system to improve, but in the meantime there’s no backup plan and it leaves us with no gloves at all, not even ones of low quality, so patients can’t get the tests or procedures that they need. The health worker situation is also complex. It’s very possible for a co-worker or superior to report these absences to the district health office, who could presumably take action, but this essentially never happens. The reason, so far as I can tell, is that people are afraid that, if they report someone, that person will place a curse on their family. Witchcraft is a big deal here, and this fear prevents people from holding each other accountable or exposing corruption. And when I think about it, the logic makes perfect sense. If I felt that a very real curse could be placed on my family, would I report someone for missing work? How would that be worth it? And so the cycle continues.
Next, there are no ARVs either. ARVs (antiretrovirals) are the drugs that are used to treat AIDS patients and can be very effective, extending life expectancy for years and drastically increasing quality of life. Every Wednesday we have a clinic where we distribute ARVs to hundreds of people living with AIDS. The only problem is that, for weeks, there have been essentially no ARVs in the district – not at the health center, not at the hospital. The money for them got siphoned off somewhere along the line, and despite constant promises that the drugs are “on their way,” they seem to remain on their way without ever arriving.
Next we have health worker accountability. Since health workers are government employees they are assured their salary, and they receive it whether or not they actually do any of the work they are being paid for. So, naturally, they often don’t show up for work. Sometimes not a single person in the lab comes to work, so no one can get malaria smears, TB tests, hemoglobin counts, or HIV tests, all of which are quite important in deciding how to treat a patient. Sometimes not a single nurse shows up in the paediatric ward. And some people don’t show up for weeks on end. Weeks. But they continued to get paid. Someone at the health center was talking to Heidi about the problem of health workers missing shifts and ways that the issue could be addressed, to which Heidi replied that she didn’t know the answer, because in the hospitals she worked at in the States, they would simply lose their jobs. The response was muffled laughter, saying that that is impossible here. It’s a very different paradigm.
Of course, the issues are more complicated than just that. One reason that there are no gloves is that a large shipment was rejected by the Ministry of Health because they didn’t meet quality standards. Quality standards are good, and I’m sure it’s necessary for the health system to improve, but in the meantime there’s no backup plan and it leaves us with no gloves at all, not even ones of low quality, so patients can’t get the tests or procedures that they need. The health worker situation is also complex. It’s very possible for a co-worker or superior to report these absences to the district health office, who could presumably take action, but this essentially never happens. The reason, so far as I can tell, is that people are afraid that, if they report someone, that person will place a curse on their family. Witchcraft is a big deal here, and this fear prevents people from holding each other accountable or exposing corruption. And when I think about it, the logic makes perfect sense. If I felt that a very real curse could be placed on my family, would I report someone for missing work? How would that be worth it? And so the cycle continues.
Friday, February 20, 2009
"Why are they killing us?"
I've posted about it before and you've probably seen mention of it on the news (at least I hope that American media gives it some time) - the situation in Congo is dire, with various rebel groups slaughtering and terrorizing civilians in the eastern part of the country. Thousands of people this year alone, with many more killed by diseases such as cholera that occur when people are displaced. As I was reading a couple of articles on the BBC website, I was struck by a particularly tragic aspect of this violence: most of these rebels are foreigners. The LRA is a Ugandan rebel group and the FDLR is Rwandan (comprised of some of the militias responsible for the 1994 Rwandan genocide). with only Nkunda's rebels being Congolese. These foreign groups take refuge their because there is so little governmental control in eastern Congo that it becomes a safe haven where they can hide from the armies of their respective countries. Recently, both the Ugandan and Rwandan armies have engaged in joint offensives with the Congolese army against the LRA and FDLR, respectively, a step which is almost certainly necessary if these hideous rebel groups are to eventually be defeated. But the consequences for ordinary Congolese civilians have been almost unspeakable. Since the rebel groups are in Congo, they are carrying out their vicious responses to these attacks against Congolese villagers. Various Congolese caught in the midst of the violence are quoted as saying, with disbelief, things like: "Why are they even here? Why are they killing us? They're not even fighting for our land."
Of course, the brutal murder of civilians is evil and heartbreaking in any country, and it would be every bit as terrible if they were Ugandan, Sudanese, Rwandan, or American. But it seems expecially tragic to me that these Congolese, inhabitants of a country that already has a terrible past, are caught in the middle of other people's wars and are the chief sufferers in someone else's fight.
Of course, the brutal murder of civilians is evil and heartbreaking in any country, and it would be every bit as terrible if they were Ugandan, Sudanese, Rwandan, or American. But it seems expecially tragic to me that these Congolese, inhabitants of a country that already has a terrible past, are caught in the middle of other people's wars and are the chief sufferers in someone else's fight.
Tuesday, February 17, 2009
It had to happen sometime
I’ve been remarkably healthy since getting here; In fact I hadn’t been sick in my three and a half months (pretty amazing in a place with germs I’m not used to and where everything is dirtier). Until 3AM last night, that is, when I was woken up by the rumbling of my stomach. Being sick is no fun any way you slice it, but having an outdoor pit latrine (cho) complicates things significantly. For instance, my legs are still sore from squatting, and the circulation to my feet was largely cut off. Between 3-5AM I probably made 4 trips out to the cho, but I was in such a daze that I can’t exactly remember. Add in a couple bouts of wretching and being startled by monkeys crashing through the trees in the dark, and the night was a real adventure. I am really blessed that Scott Ickes is visiting and staying with me – it was incredibly comforting to know that someone else was in the house, it just soothes the mind. But it’s hard being sick when you’re in a (relatively) new place. I realized that there were three things I really wanted last night – my mom, a toilet, and Campbell’s chicken noodle soup, none of which were to be found. It definitely has made me miss home all the more. But both Heidi and Jennifer have been taking good care of me, and I turned over a new leaf when I, against my instincts, actually listened to medical advice and stayed home to rest for the day, rather than running off to help train nutrition volunteers and playing soccer at Christ School (Mom must be proud). It was nice to get to sit around and just read and watch movies, since I seldom get a chance to do that, but I was still, of course, bombarded with people at my door. It was wonderful, however, to see some people’s very caring responses to my being sick – it made me feel appreciated and cared for in a pretty special way. So now, I’m just hoping for a night that doesn’t involve running to my cho through the dark.
Friday, February 13, 2009
Dinner conversations
Last night I had dinner at the home of some Ugandan friends, eating with probably about 10-12 family members and friends. Their hospitality was beautiful and I really enjoyed sharing food and an evening with them. When talking to one middle aged man, he introduced me to two of his young children, both of whom seemed thin and looked sickly. He explained that both of them have sickle-cell disease, a condition that we see quite frequently here and that kills many children (having one copy of the sickle-cell gene is good here, since it helps protect you from malaria, but getting two copies of it gives you sickle-cell disease). My heart instantly went out to these kids who have already lived very difficult lives and whose prospects aren't good, and to their family. It occurred to me - what are the chances of having two kids with sickle cell? If both the mom and dad have one copy of the gene, then each kid should have a 1/4 chance of having sickle cell (remember good ol' Gregor Mendel from high school biology?), so I thought it was certainly unlikely to have two kids with the disease. Then I asked him how many children he had, and he responded that he had 10 kids - it suddenly occurred to me that, with 10 children, two of them having sickle-cell is about what you'd expect. I'm not out to rail against big families - they're certainly considered a good thing here, and I'm not judging that - but in a place of great poverty and little access to health care they do often present problems and make each child's life harder. For one thing, there are more mouths to feed, more health care to pay for, and more school fees to pay - I know one guy who is the 10th of 10 children and his father could only put the first 2 through school, so now he's in his twenties and trying to pull together the money to finish high school so that his prospects might look up just a bit. Another problem we see often is that a breastfeeding mother gets pregnant right away again, stopping her breastmilk from coming in and leading to malnutrition and chronic sickness for her child. Oftentimes, a family could provide for 4 children well, but when they have 7 they can't feed any of them adequately. Now, at the same time, I've seen it work the other way. Sometimes, when one or both parents die, and the older siblings will step into that gap and care for their younger siblings, or care for cousins or something like that. This large network of potential support is potentially life-saving and is one of the very valuable aspects of large families and generally communal living, and it seems to me that that is probably one of the reasons behind the great cultural value placed on children. So, as with most swords, this one cuts both ways.
After dinner, we sat around telling riddles by latern light, and I was fascinated to hear African riddles since they tend to come from a very different way of thinking. I couldn't answer any of them, revolving as they did around specific cultural understandings of goats, leopards, rats, and the ways that life functions around here. Similarly, the responses I got to the one riddle I told (we don't tell as many riddles in the States, it seems) revealed how distinctly American it was and the differences in the ways of thinking about things in different cultures. So, my evening ws filled with good cultural interaction which stretched me, as it has the habit of doing, good Ugandan food, and good laughter. And to top it off, they invited me to spend the night with them, so I shared a single mattress in a dark mud house with a friend, in order to get both of us under the mosquito net and because that's how guests usually stay here. Suffice it to say that it wasn't quite the Waldorf.
After dinner, we sat around telling riddles by latern light, and I was fascinated to hear African riddles since they tend to come from a very different way of thinking. I couldn't answer any of them, revolving as they did around specific cultural understandings of goats, leopards, rats, and the ways that life functions around here. Similarly, the responses I got to the one riddle I told (we don't tell as many riddles in the States, it seems) revealed how distinctly American it was and the differences in the ways of thinking about things in different cultures. So, my evening ws filled with good cultural interaction which stretched me, as it has the habit of doing, good Ugandan food, and good laughter. And to top it off, they invited me to spend the night with them, so I shared a single mattress in a dark mud house with a friend, in order to get both of us under the mosquito net and because that's how guests usually stay here. Suffice it to say that it wasn't quite the Waldorf.
Thursday, February 12, 2009
Football Time
This week, I started training with the Christ School football (soccer) team. Working with the team had long been one of my plans, both because it will allow me to work with youth and to stay involved with the game, and now that school is back in session I’ll be down there 4 afternoons a week. While I don’t have an official title yet, it will be something like assistant coach or trainer, and I’ll be working with the head coach, a young Ugandan man named Alex, who is a lot of fun and is a wonderful player.
The guys on the team are mostly in their 3rd-6th year of secondary school, but some of them are about as old as me, since here in Bundibugyo people often don’t finish high school until 20 or 22. There’s a lot of football talent here, as guys grow up kicking a ball around from the time they’re very young (or a bundle of plastic bags bags, banana fibres, etc). And the level of toughness is incredible – a hard life makes for tough kids. However, I realize that a lot of the guys have never played a formal, 11 vs. 11 game of football, and I’m guessing that maybe that’s part of where I fit in, in helping them tactically as well as technically. Anyway, I’ve had a great time kicking a ball around with these guys this week, and I think it will be a really good way to get to know some of the students and interact with them in a more personal, meaningful way. Football is often called “the universal language,” since it is played all over the world and can be shared by people who share no language at all, and, as hokey as that sounds, I’m finding that there’s truth in it. When I’m playing football with someone, our shared ability and goal gives us an instant connection and understanding that can be hard to cultivate outside of the game. It's a way to interact that crosses cultures and language barriers remarkably well. This is not to say that it’s a sure-fire way to establish a good relationship, but it provides an instant connection that is quite significant, especially in a place like this, where I am so clearly “different” and so obviously an outsider, and where being those things is clearly considered a bad thing. I’ve also learned that I’m in absolutely miserable shape – Coach Russo would be terribly disappointed. I’ve been sucking wind out there, with the weakness of my lungs overcome only by my pride and my desire to play well. At least I know that my fitness will only get better as the season goes on.
So, now my afternoons are filled with two hours of football in the blazing sun and high humidity, with grass that is far too long, and with people whom I struggle to understand; but also with the game I love, a stunning view from the pitch of the snow-capped peaks of Mts. Emin and Gessi, camaraderie, crossing cultures, hard work, and a chance to share common ground with people with whom it might otherwise be hard to find.
The guys on the team are mostly in their 3rd-6th year of secondary school, but some of them are about as old as me, since here in Bundibugyo people often don’t finish high school until 20 or 22. There’s a lot of football talent here, as guys grow up kicking a ball around from the time they’re very young (or a bundle of plastic bags bags, banana fibres, etc). And the level of toughness is incredible – a hard life makes for tough kids. However, I realize that a lot of the guys have never played a formal, 11 vs. 11 game of football, and I’m guessing that maybe that’s part of where I fit in, in helping them tactically as well as technically. Anyway, I’ve had a great time kicking a ball around with these guys this week, and I think it will be a really good way to get to know some of the students and interact with them in a more personal, meaningful way. Football is often called “the universal language,” since it is played all over the world and can be shared by people who share no language at all, and, as hokey as that sounds, I’m finding that there’s truth in it. When I’m playing football with someone, our shared ability and goal gives us an instant connection and understanding that can be hard to cultivate outside of the game. It's a way to interact that crosses cultures and language barriers remarkably well. This is not to say that it’s a sure-fire way to establish a good relationship, but it provides an instant connection that is quite significant, especially in a place like this, where I am so clearly “different” and so obviously an outsider, and where being those things is clearly considered a bad thing. I’ve also learned that I’m in absolutely miserable shape – Coach Russo would be terribly disappointed. I’ve been sucking wind out there, with the weakness of my lungs overcome only by my pride and my desire to play well. At least I know that my fitness will only get better as the season goes on.
So, now my afternoons are filled with two hours of football in the blazing sun and high humidity, with grass that is far too long, and with people whom I struggle to understand; but also with the game I love, a stunning view from the pitch of the snow-capped peaks of Mts. Emin and Gessi, camaraderie, crossing cultures, hard work, and a chance to share common ground with people with whom it might otherwise be hard to find.
Friday, February 6, 2009
A rash of theft
In the course of the past week, unoccupied houses or buildings owned by the mission have been broken into three times. The first was Sunday night, when an empty house had the lock cut and some mattresses, bedsheets, and spoons were stolen. There was more stuff by the door, but it seems as though the commotion of us getting up to watch the superbowl next-door frightened off the thieves. Then next time it was a storehouse. Then, two nights ago, there was a seemingly well-coordinated attack that involved breaking into no less than 6 storehouses and offices and the community center and houses. These places included a school for the deaf, a literacy office that is working to record Lubwisi in writing and teach people to read and write in their own tounge, and the BundiNutrition office. Somehow, the soldiers who are always hanging around didn't see or hear anything. Among the things stolen, a motorcylce used for nutrition outreach programs (the one I was going to be using a lot) stands out in valuve, although we're trying to assess what was taken from the literacy and translation offices, since computers or other work from those that were destroyed could represent years of work. It's a discouraging time, to say the least. We'd appreciate your prayers.
At first, I could convince myself that this was just desperation. School fees are due, food prices are 80% higher than this time last year, and someone was simply resorting to theft to provide. But after seeing how persistant and coordinated these are, it seems like more than just desperation, it seems like malice. This turn of events is hard for me for a number of reasons. First and most obvious, crime is scary and it makes me feel less safe. While I'm reassured by the fact that no one is trying to break in to occupied houses, this spate of theft makes everyone a little more nervous. Next, it's discouraging. The things that were stolen were all being used for good purposes, all being used to help people in various ways - nutrition outreach for malnourished kids and their families, teaching people to reach the own language, educating deaf children, etc. It's hard because it makes me feel like our work is being rejected by the community. It makes me feel not wanted here. Now, I understand that there are legitimately people here who don't like us just because we're outsiders, but I also know that these are a small minority. In any event, it's discouraging. And third, it makes me think a lot about how we relate to the community. I like the idea of not separating myself from the community (this is probably largely because I'm new here and haven't yet been driven to the edge by the constant flow of people at my door) - I don't like the idea of guards and soldiers and barbed wire, which seem hostile and could be an impediment to relating to the community. But, when things like this happen, it's hard to think of what else we can do. It's as though our hand is being forced, requiring us to take those measures just to preserve the work we're doing and enable us to be here. So, all of this theft is difficult not just because stuff is being taken, but because it has wider implications for the way that we live here and relate to the community.
At first, I could convince myself that this was just desperation. School fees are due, food prices are 80% higher than this time last year, and someone was simply resorting to theft to provide. But after seeing how persistant and coordinated these are, it seems like more than just desperation, it seems like malice. This turn of events is hard for me for a number of reasons. First and most obvious, crime is scary and it makes me feel less safe. While I'm reassured by the fact that no one is trying to break in to occupied houses, this spate of theft makes everyone a little more nervous. Next, it's discouraging. The things that were stolen were all being used for good purposes, all being used to help people in various ways - nutrition outreach for malnourished kids and their families, teaching people to reach the own language, educating deaf children, etc. It's hard because it makes me feel like our work is being rejected by the community. It makes me feel not wanted here. Now, I understand that there are legitimately people here who don't like us just because we're outsiders, but I also know that these are a small minority. In any event, it's discouraging. And third, it makes me think a lot about how we relate to the community. I like the idea of not separating myself from the community (this is probably largely because I'm new here and haven't yet been driven to the edge by the constant flow of people at my door) - I don't like the idea of guards and soldiers and barbed wire, which seem hostile and could be an impediment to relating to the community. But, when things like this happen, it's hard to think of what else we can do. It's as though our hand is being forced, requiring us to take those measures just to preserve the work we're doing and enable us to be here. So, all of this theft is difficult not just because stuff is being taken, but because it has wider implications for the way that we live here and relate to the community.
Sunday, February 1, 2009
Pass the remote...
While I don't usually post about sporting events, this time I will. Today was Liverpool vs. Chelsea in the English Premier League, recently a great rivalry, with Liverpool needing the victory to stay in the hunt for the title. If you know how much I love to watch soccer, you'll know how excited I was to watch this game. You'll also know how disappointed I was that as of yesterday, the TV provider that carries all English Premier League soccer in all of Uganda was liquidated, leaving the entire country unable to watch the game. Typical. In fact, almost predicatable, since the Myhre's only got that TV provider three days ago and hadn't yet watched two minutes on it. So, BBC radio came to the rescue. I listened in tense agony as the minutes ticked by, until Fernando Torres scored twice for Liverpool in the last 5 minutes to snatch a 2-0 victory. It was in many ways a small thing, but it was an incredibly exciting one, and the Myhre's will attest to the fact that I was holding my breath, pulling my hair, and pacing around their kitchen, full of nervous energy.
And the next sporting event will be tonight, at 2:15 AM, when we gather at Myhre's for a super bowl party. That's right, even here in Bundibugyo Uganda, the super bowl lives. Having grown up in Pittsburgh, I have a soft spot in my heart for the Steelers, so I have my team in the big game. That being said, I don't particularly like American football. But somehow, I think that it reminds me of home, reminds me of the familiar, reminds me of what I've known in the past, and I think that the rest of the team feels that, so we're hoping it will be almost therapeutic. If only I'd thought to pack my Terrible Towel...
My sport watching plans and excitement are probably of little interest, but watching soccer, especially Liverpool, just makes me tick, and that's what's on my mind today.
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