we've got milk

I’ve written about the BBB outpatient nutrition program for children with moderate acute malnutrition, but those children who have severe acute malnutrition (less than 70% of the weight they should be, given their height, or edema due to protein deficiency) get admitted to the health center for an inpatient nutrition program. Watching these kids recover is like seeing a miracle. Some of them are little more than skeletons when they come in, unable to stand or even lift their heads, and in a few weeks time, they can be smiling, energetic kids again. It’s beautiful. The picture above is of a boy named Kagadisa, who came in looking significantly worse than the picture shows, unable to sit up, barely able to keep his eyes open - on the brink of death. Discharged about a month ago, he's now almost unrecognizable, a relatively healthy looking little boy with a big smile and a swagger in his step. Of course, it doesn’t always work that way, but no where else have I seen such radical changes and recoveries.

This program is run in partnership with UNICEF, who provide the powdered therapeutic milk that we give to these children. A couple of months ago we renewed our contract with UNICEF, and our milk supply began to dwindle. UNICEF seemed to be dragging their feet, never getting us the milk for the program, and we broke into the very last box of it last week. After months delays and expectant waiting, I was starting to think that the milk wasn’t going to come, and we weren’t going to be able to feed these kids. That was a sobering prospect, but it’s a reality in a world of scare resources – I can’t feed everyone I’d like to. There will be people who starve, those who can’t be reached for one reason or another, be it location, corruption, lack of manpower, or lack of finances. This was saddening and infuriating, especially since we had a signed contract for the milk. UNICEF eventually said that they had shipped all of the milk to other parts of Uganda and had none to give us.

When the Myhres were in Kampala this week, Jennifer went to the UNICEF office to plead for the milk. I think she manages to pull off both indignation and emotional supplication simultaneously. Two days ago I heard that the milk was on the way. And this morning, I got a call saying that the truck was at the health center, so I made my way down to help unload and store the 70 boxes of powdered milk – 2100 packets of milk in total. The truly amazing part of the story is that we had only 3 packets remaining for all of the nutrition patients on the ward. As we were unloading, a boy came in with Kwashiorkor (a syndrome resulting very severe malnutrition), and it was great to know that we now had the ability to treat him. Praise God that the food arrived just in time.

A funny side note is that, somewhere in the bowels of the UNICEF system, someone decided that 60 scooping spoons was the appropriate number to accompany 2100 packages of milk. Those aspects of working with big organizations make me laugh, but I guess I shouldn’t complain. So, we’ve been really blessed by this all working out with UNICEF, but it does highlight the tenuous nature of a lot of the work that goes on here, and in much of Africa. Delays, misplaced paperwork, confusion, miscommunication - those things can be very costly, especially to a small organization like ours. Sadly, we’ll never be able to care for everyone we want to or to feed everyone who needs it, but as of today, we’re able to offer good food to a lot of kids teetering on the very edge of life.

King Leopold's Ghost

Here is a long overdue review of the book King Leopold’s Ghost, by Adam Hochschild. I think I’ve been reluctant to post this review because I’m afraid that I won’t be able to adequately convey the power and importance of the book, but I suppose that any review is better than none, so here it is, only a month after I finished reading it.

King Leopold’s Ghost is a seminal piece of history writing, combining objective statistics with emotional, passionate storytelling in relaying the history of the impact of Europeans in the Congo. The depth of Hochschild’s research is remarkable, giving the book instant real-world power and impact. The story is chilling, depressing, inspiring, and simply frightening. It is certainly not a light, easy read, but I don’t believe that any story about such a time and place could be. It is not, however, simply an historical work, as it chronicles the sad history of colonialism and horror in the Congo into the present day. Following a fascinating cast of characters – explorers, monarchs, missionaries, businessmen, and, importantly, Africans – this book unfolds a captivating and horrible story with remarkable depth of insight. Perhaps some of the worst terror of the book is that is exposes the things that normal people can do to each other, if enough money is at stake and other humans can be sufficiently dehumanized. Once of the greatest accomplishments of the work is that Hochschild manages to reveal the unspeakable brutality of the European colonists and the lasting devastation that it has caused, while avoiding falling into the trap of the “noble savage” myth. It’s the sort of book that makes one ashamed to be from a wealthy and powerful country, but that shame is not the point – rather, the point is the lessons that we can draw from seeing the exploitation of the weak by the powerful. I consider this book to be extremely important reading for anyone interested in Africa, human rights, history, or current events – in short, I’d say that this is an important read for everyone. As the Democratic Republic of the Congo continues to fall to pieces today, one of Hochschild’s most insightful and timely lines comes near the end of the book: “The major legacy that Europe left to Africa was not democracy as it is practiced today in countries like England, France, and Belgium; it was authoritarian rule and plunder.”

Over the mountains

This week I made the climb over the mountains to Fort Portal with various team members and visitors from the Sudan team. Fort Portal is the nearest sizeable town, but it takes over three hours by car over the winding roads around the mountains. Walking in a roughly straight line over the mountains, however, it’s only about 15 km from Bundibugyo – the trick is that, over that 15 km hike, you gain 5000 feet of elevation on the Bundibugyo side and then drop about 2000 feet on the Fort Portal size, making for a very steep scramble both up and down. Walking past Bakonjo houses and fields perched improbably on the slopes, we were serenaded by the endless calls of “Mujungu! How are you?” from children who would often start yelling at us when we were a hundred feet below them, and continue until we were well above them. We passed into the park that runs along the top of the mountains, walking through a serene bamboo forest and finding a 2 foot long earthworm. No joke. I guess that in this climate everything grows better, including worms. When we got down the other side, a 15 minute ride on motorcycle taxis had us in Fort Portal town, sweaty and dirty, ready for a big meal at our favorite restaurant and a warm shower at the hostel (Fort Portal has enough elevation that it gets cool in the evenings, something that is worth the trip by itself).

While talking to a store owner in Fort who I know, he asked how I came, and I told him that I came on foot over the mountains. Instantly, multiple shoppers looked at me in disbelief, commenting on how difficult that hike must be. It was one of the first times I’ve ever felt tough here, since usually, it’s we Bajungu who drive places in our typical hurried state, while Ugandans walk. This, of course, is all relative, and any feeling of toughness is quickly expelled while sucking wind, hands on knees on the steep trails, while 60 year old Bakonjo women with loads of firewood that must weigh 50 pounds strapped over their foreheads plod steadily up past me. It makes me think – here I am, doing this largely for fun, and here’s a woman, face wrinkled with the sun, back bent with heavy loads, feet flattened with untold miles of carrying firewood, who’s been doing this since she was a child, because that’s what needs to be done to survive. What different realities we have known in our lives. I’ve realized that here, life is largely spent doing the things that need to be done to live. Hours and hours a day walking to the fields, gathering firewood, hauling water, slowly cooking matooke – those are the things that seem to make up much of life. And those sort of things are the ones for which I don’t feel I have time. It’s hard for me, coming from my background, to put myself into the position of someone who has always know that reality.

Anyway, Luke and I headed back over the mountains the next day, making the climb twice in 24 hours. We made it in record time, just over four hours, literally running down the last half mile of steep trail into Bundibugyo (I’m amazed I didn’t sprain an ankle), and I’m still paying the price in the form of sore legs and aching shoulders. It was good to get out in the mountains, enjoying the scenery and glimpsing the lives of the people who make their homes on the slopes.

A tough end

On Thursday, my CSB boys football team played in the district final against Semiliki, to determine who would continue to the national tournament. In front of a huge, but rather well behaved, crowd, we got off to a great start, with several clear chances narrowly missed or denied by the goalkeeper. Semiliki were a bigger, faster team, and their average player was probably better than our average player, but we were the stronger team and outplayed them, especially in the first half. In the end, however, despite having more and better scoring opportunities, we didn't have an answer for their two very talented forwards, and although we twice came from behind, we ended up losing 3-2.

The boys were understandably crushed -ti clearly showed how important this is to them. Several players were sobbing - boys for whom this was their last chance, and who may never have been involved in something so successful. It reminded me of the end of my own seasons in college, and it was emotional for me just to see the boys disappointment. But it didn't end there. The whole school appeared to be in morning, and the wails, shreiks, and sobs coming from the girls dorms sounded just like the way that women mourn a death in this culture.

After the match, my words to the boys were simple. I'm proud of you. After watching the first game, it was hard to imagine that they would improve as much as they did. They were a coach's dream, as they responded quickly and deciscively to the things I was trying to teach them. They learned to play a controlled style of football that no one else in the district plays, and they became strong not by leaning on an individual superstar, but by supporting each other and playing as a team. When one of their top players got malaria, they rallied as a team and played wonderfully. When another top player got suspended, they pulled together and had one of their best matches.

So, with the season now over, of course I'm disappointed, but I'm more proud. I'm proud of what the boys accomplished and the progress they made. I'm proud of the obstacles they overcame. And I'm excited to get back out there and keep working with them the rest of the year.

Hooligans

If I thought the fans were poorly behaved last game, I hadn't seen anything yet. In the first of the two district semi-finals (in which we were not playing), there was a disputed call as time wound down, and a group of severely inebriated fans ran onto to pitch to protest. The mob grew until about 100 fans were running around on the field, and had taken the ball, threatened the refree, assaulted a policeman, and stopped the game in its tracks. I've seen bad fan behavior before, but this took the cake. My self-righteous indignation grew and my desire to try to control the situation got the best of me, and I ran onto the field to try to recover the ball, in the hope that if I did that, things would begin to settle down. I quickly learned that I'm completely powerless in the face of a mob. While nothing dangerous happened, I found myself in the middle of a screaming mob and I came close to getting into a fight - it was pointed out to me that mobs can be pretty dangerous, something which I'll do well to remember if that happens again. We couldn't even play our game, which was supposed to happen next, because the mob wouldn't leave the pitch and the referees wouldn't continue due to safety concerns.

I was, of course, extremely frustrated with the disorderly, dangerous behavior of fans, and disappointed that there is no system in place to punish them. There were only three policemen there, and one of them was himself involved in yelling at the referee. But I was also struck by my own self-righteousness and my need to try to control and fix every situation, even an angry mob, where I am clearly powerless. Never a dull moment..

A great win

On Wednesday afternoon, my boys from Christ School pulled off a great 3-1 victory over the other undefeated team in our group. This school is just down the road, so the rivalry was hot (including among the fans), and our opponents were bigger and probably faster than we are. It’s been a pretty amazing transformation that’s happened in the team this year. After watching our first game, where we kicked the ball wildly this way and that, held it too long yet never had control, it felt like coaching a different team, as we produced a convincing victory by controlling possession and building relatively organized attacks. It’s been great to see the boys respond to the things that I’ve been trying to instill in them, and there have been a number of cases where I pulled aside specific players, with whom I’m particularly frustrated, and seen them respond in great form the next day. Players who seemed incurable suddenly changing their ways, to the benefit of the whole team. I’ve had several community members approach me to thank me for coaching and say things like: “They are playing such good football!” “We never expected to see them play like this!”

Tempers ran high, as they do in most rivalry games, which included a number a yellow cards, a red card to one of my top players, and dozens of drunk opposing fans standing on the pitch, screaming at the referee and taunting my players, the head coach I work under, and me. And by the way, they were mostly standing within 20 feet of me, to trying to bother me as much as possible. Despite my many attempts to restrain myself, in the end I wasn’t entirely successful, and when a particularly drunk and obnoxious fan stepped on to the field, approaching my player who had just received a red card, and began taunting and harassing him, I couldn’t hold myself back any more. I stepped onto the field myself, grabbed him by the shoulders and threw him back toward the sideline. Needless to say, neither he nor his fellow rowdy opposing fans were very happy about that, but then again, I didn’t care so much about their happiness at the moment. I probably should have stayed above all of the fray, but I often feel obligated to try to maintain some semblance of order (definitely a losing battle), and at the time I was trying to stand up for my player.

So what’s the point of my work with the football team? Sometimes I stop and try to think about the reason that I’m doing things, the value in them. However, it occurs to me that in a lot of ways, what I’m doing is just living out my life among the people here. Not everything I do needs to have a noble or heroic reason behind it. Coaching youth football is the sort of thing that I’d do anywhere because it’s a part of who I am, so I’m doing it here. I’m also a firm believer in education being more than just academics, and I personally developed through playing football in ways that I couldn’t have in the classroom, so I’m hoping that the boys will benefit in that way. I’ve had some interesting conversations recently with some team members that have pointed out something else. Most of these boys have had very hard lives. Some are orphans, many come from broken, abusive families, and almost all of them have had very little success at any point in their lives. Things just don’t go well for a lot of kids here: their fathers beat them, they’re often sick, they do poorly in school because the education system is just bad. There are very few positive experiences and little positive reinforcement. Maybe just believing in them, when not many people do, is significant enough to affect their lives. It’s been pointed out to me that the simple act of scoring a goal, making a good pass, or winning a game could be one of the best and most significant things that’s ever happened to some of these boys. I’m hoping that this year they’re having fun, learning about hard work and dedication, being challenged, and having positive experiences that they might not have in other areas of their lives.

water, water, everywhere...

Rain. It’s something that doesn’t disturb us very much in our largely indoor, enclosed, motorized American society, but it’s something that drastically changes the rhythm of life here in Bundibugyo. Much of life grinds to a halt during rainstorms, as people stay in the shelter of their homes, not venturing out in the driving rains and the mud they produce. At first it seems easy to frown upon this and say things like “But we still work in America when it’s raining. Why can’t they work hard too?” When you think about, however, it’s clear that it’s a different situation entirely. People here walk almost everywhere. To get to work, someone might walk for an hour on a dirt road, and even a few minutes of walking in a tropical downpour can’t be a very unpleasant and dirty experience. Most people own very few clothes, and very few people own more than one pair of shoes (if any), so the cost of soiling or ruining them in the rain is extremely high. No dry cleaners here, nor is there a reserve of money that people can tap into if they ruin their shoes.

I’ve begun to realize what a challenge weather can pose to medical care – it’s something I never would have thought of before. Yesterday, it rained almost all day and was almost cold, so many people were greatly delayed in getting to the health center for the nutrition clinic. This provided me with no end of frustration, and every time I would think I was finished and lock up the store room, someone else would arrive, and I’d drag back out all the registers and distribute more food (of course, it was good that people were coming, it was simply the timing that was frustrating).

Then I drove through the now lightening rain in the afternoon to an outpatient satellite BBB nutrition clinic, arriving to find only 5 out of 25 mothers and children present. Additionally, none of the staff who had the keys that I needed to access the scale and record books had come to work either. That was when I really began to see the difficulties that face these types of programs here, since they are at the mercy of weather that can prevent people from traveling to reach the centers. So, due simply to weather, the majority of patients enrolling in this nutrition program didn’t get food this week, and I can only hope that that isn’t reflected in the children’s weight next week.

As I left the clinic in the late afternoon, a real adventure began. To reach that clinic, I have to drive across a river that’s usually about 8-12 inches deep at the crossing. I was a bit nervous about this, but on the way out it was high, but easily handled by the truck, and the rain was lightening. On the way back, however, as soon as we came within sight of the river, I stopped and both Baguma and I let out a short “Ah…” of dismay. In the course of the afternoon, the river has been transformed into a torrent of brown water and white foam, probably about 4 times deeper than I had ever seen it. The mother from the clinic to whom we were giving a ride instantly asked to get out of the car, too terrified to try such a crossing in a vehicle. After thinking about it, I realized that I didn’t have many options and that it almost certainly couldn’t be fatal (to us anyway, but maybe for the truck). So down the bank I drove, into the rushing waters, which soon covered the tires and tried to push the vehicle downstream. I was just praying that it didn’t reach the air intake in the engine, ruining the engine and leaving us stranded. When I was almost across, I hit something under the water (which hadn’t been there when I drove across) and found myself pretty well stuck. In addition to the tension and frustration of being stuck in the middle of a raging river, I also had a number of very drunk men yelling things like “You’re stuck!” and laughing at me, which did nothing to settle my mind. After a few minutes of trying to reverse, I got up enough speed to pop over the top of whatever I was lodged on (which turned out to be a huge stump that had washed downstream) and get up the bank on the other side. Somewhat humorously, the mother who opted out of driving across easily beat us to the other side, being supported and carried, baby strapped to her back, by a few men who make a business of carrying people across the river. Unfortunately, we didn’t escape quite unscathed, as in the next couple of minutes I realized that I had probably damaged the drive shaft and the steering bar, so now vehicle doesn’t really turn to the left (we have now dubbed the truck “the Zoolander”). That presents another interesting problem, as there are no trained mechanics or parts available anywhere this side of the mountains. I guess that off-roading is fun and exciting until it leads to real consequences.

In any event, the last 24 hours have shown me some of the difficult barriers to medical care and health programs in a place where weather affects daily life in ways that it’s hard to imagine as one coming from American culture.