Wednesday, April 1, 2009

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.

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