Sunday, June 13, 2010

Africa on the Big Stage


I've been home in New Jersey for five days now, feeling a bit strange and not sure how the adjustment back to the US is going. People ask me, and I realize that I don't even know exactly what I'm thinking, and it all feels like a blur in a lot of ways. So, without the ability to process or reflect very much yet, I'll do what comes more naturally: talk about football.

The timing of this World Cup is perfect for me, as it gives me the chance to relax and enjoy the biggest event of the game that I love at a time when I need to relax and move slowly. It is also timely because I've just spent two years in Africa and am now watching Africa's first World Cup. Watching South Africa play Mexico in the opening game, the pit in my stomach told me that I was rooting whole-heartedly for South Africa. I celebrated when they scored the first goal of the tournament, a stunning goal from a player with the wonderful name Tshabalala, and predictically, the South Africans danced. I realized that in this World Cup, more than anything, I am pulling for the Africans. South Africa, Ghana, Ivory Coast, Nigeria, Cameroon - I just want one of them to go far.

It might seem strange, as all of those countries are very far from Uganda and culturally very different. They could be rivals. You wouldn't root for Argentina because you had spent time in Uruguay; you would hate Argentina. But this is different. An African team doing well would be celebrated across the continent, millions of people cheering for their "neighbors." Never mind that a Ugandan might know nothing about Ghana: they are fellow Africans, and the success of Ghana would be success for a Ugandan. Africa is a continent that is downtrodden, that has borne the yoke of colonialism, of slave traders, and of murderous rubber-traders, and now bears that of tyrants, of violence, of tribalism, of corruption, of poverty, and of AIDS. It has been said that Africa's biggest crisis is a crisis of confidence, and so I hope for the encouragement of seeing an African nation go far, of seeing people like them, people with whom they can truly identify, succeed on the world's biggest stage.

Am I dreaming? Maybe. But the excitement about this tournament is palpable in Uganda, and people are crazy about any African team when they come up against competition from outside the continent. I found that Ugandans don't seem to identify themselves strongly as Ugandans, rather they identify first with their tribe, and then as Africans (likely one reason that colonial boundaries can lead to African nations being dysfunctional, but that's another, much longer story). There is a sense of African-hood, perhaps arising from their shared skin color and their history of being ruled over by Europeans, which means that Ugandans could revel in a victory by Cameroon as their own victory. At least I hope so. That pit in my stomach is hope. Hope that so many people I know, and millions more that I don't, can take courage and confidence because of the world's biggest game.

So three cheers for Ghana, who secured Africa's first win with a victory over favored Serbia earlier today. May it be the first of many celebrations across a beautiful, downtrodden, and joyful continent.

Monday, May 17, 2010

Hanging In the Balance

Yesterday I had a frightening reminder of how dangerous road travel is here, and how precariously life is always perched on the edge, needing almost nothing to push it one way or another. On the way over the mountains, we came to a line of vehicles waiting, and we were told that the Kalita (the coach bus that connects Bundibugyo to Kampala) was stuck. Well, not only was it stuck, it was teetering on the edge of a sheer drop, having spun its wheels on one of the muddy corners and slid toward the edge. One back wheel was off the edge, but it had come to rest, tipped at a terrifying angle, perched precariously above a long drop. There were probably about 70-80 people on board, all of whom escaped without injury. Another foot or two to the left, and I doubt any would have survived - it was hard for me to guess where the bus would have stopped rolling.


A sobering thought for me was that I had contemplated taking the bus yesterday. A couple weeks ago, as I considered my travel plans, I thought that Kalita might be a good option. In the end, I opted to hire a car, a decision that I now consider to have been a very, very wise one. But it reminded me how little control I am in and how quickly life can change. The threat of accident or sickness striking at any time is a constant backdrop to everyday life. As recent events all over the world testify, this isn't unique to Bundibugyo or Uganda, but it does seem more obvious here than in many places.

Friday, May 14, 2010

football pictures






A few more pictures from the tournament. I hope to get Scott's at some point, but these will have to do for now.

Thursday, May 13, 2010

A goodbye party


My time in Bundibugyo is winding down, a sad realization, and one which forces me to think about how to say goodbye and how to communicate to people that I really care about them, even though I am walking out of their lives. The fact that I'm going to school makes it easier, I believe, as everyone here is eager for the chance to pursue studies, and just about everyone I've talked to assuress me that I'll be coming back here once I'm a doctor. Apparently about half of Nyahuka town is praying for this. What odds do I have against such petition?

As part of the goodbye process, I had a lunch party for a bunch of friends today, kids and young men who I've been involved with and gotten to know. I really do love many of the people in this group, and these are some of the ones who it will be truly difficult to leave. I was counting on about 25 people coming, but of course, with food is involved, about twice that many showed up at my house, many of them rather peripheral kids who I've seen but don't know. I bought spoons and plates this morning, but wasn't prepared for the numbers that came. A woman who prepares delicious Ugandan food did the cooking for me - if you thought I would be cooking Ugandan food for 50 people, you would be crazy. I've probably only cooked dinner for teammates abotu 10 times in the past 2 years. It was delicious, a big spread that was a treat for all involved, but even with chicken, beans, g-nut sauce, cabbage, sombe, and 22 cups of rice we had to carefully ration, and ran short of food by the time it came down to Vincent and me. The kids watched a movie (probably the main reason they like me) while some of the older guys helped me clean up, but the real fun started after that.

The sky grew dark as rain clouds rolled off the mountain, just as we were starting to kick a football around in front of my house. The rain broke as we set up the goals (reeds stuck in the ground about 2 feet apart), and we embarked on an epic, hour and a half long game of barefoot mud football. Vincent and I squared off against each other, joined by other kids between the ages of about 8 and 15, and laughter was the word as we slipped, slid, and fell all over the place. Face plants in mud puddles. Smooth slide tackles. Defenders falling flat on their butts. Sliding, fist-pumping goal celebrations. It was great to just run around in the rain, laughing, playing, having a good time. At the same time, we managed to play some decent ball, as a few of these kids are going to make some very nice footballers in a few years. By the time we were through my yard was left with about half the grass that it started with, and for the first time in 2 years I was about the same color as everyone else around me.

It was a fitting way to begin saying goodbye to these kids, as football has been a big part of my time here. Food, football, and laughter - all things that I have loved sharing with them in my time here.

Wednesday, May 5, 2010

The National Tournament, part 1



I'm back in Bundibugyo after 8 days in Masaka for the national secondary school football tournament with the Christ School boys. It was an experience to remember, without doubt. A week of contrasts; smiles and frowns, excitement and discouragement, sun and rain, joyful celebrations and maddening frustrations. I’ll put some pictures here, but the best ones will be those that Scott took, which I’ll post later.

We left Bundibugyo early in the morning in pouring rain, leaving me to worry for everyone’s safety on the tortuous road over the mountains, but despite sliding around a fair amount, we made it safely to Fort Portal and paved roads in reasonable time. Right as we left Fort, there was a sobering reminder of the danger of road travel, as we came upon the scene of a very recent accident, the mangled car lying upside down in a ditch, passengers still stuck inside. We pulled over and ran back to help pull them out, and based on the condition of the vehicle, I thought it was likely we would have to pull a dead body from the car. My first thought was to call an ambulance, only to remember that there is no ambulance. I was thinking about waiting for EMTs to arrive, to make sure that we stabilized peoples’ heads correctly, only to realize that there could be no such considerations. While there was a lot of blood, everyone was alive and we got them out quickly. Most had head wounds and were probably concussed, but we got them in a minibus that would take them to a hospital in Fort, where the driver would be reimbursed for his ambulance service. As we got back in our minibus and pulled away, I looked at the driver and reminded him to drive us carefully. All this, and we had only been gone for 4 hours.

The tournament itself was a good experience and a time of incredible frustration. The organization left plenty to be desired, but after two days all the schools had their players screened and registered. Two of my starters were not cleared right away, owing to slight discrepancies in their names on various documents, but after petitioning the disciplinary committee and meeting with them, the boys were cleared to participate. (In Bundibugyo, names are very fluid, and a person’s name can easily change over time, and additional names can be added or can fall into disuse, making these sort of procedures difficult. One of my players used three names on his primary school leaving exam, but now only uses two, almost getting himself disqualified in the bargain.)

I was accompanied by two Christ School staff members: Ajeku, an assistant coach, and Bwampu, the games master (and a former CSB footballer himself). Alex, the other coach, couldn’t come because his wife was in the hospital waiting to deliver, so significantly more responsibility fell to me. I sat in the meeting where we drew the teams into groups, and I randomly drew us into a group with the host school, St. Henry’s.

A word about the host school. St. Henry’s Kitovu is a massive boys secondary school, rolling in money from the looks of things. 1000 students, many dorms, dozens of classrooms, three football fields, flush toilets, three canteens (stores to buy food and supplies), and acres of space. I saw their O-level test results: 91% of their students scored in division 1, and only one person scored as low as division 3. To put in perspective how hard that is to achieve, it was a major accomplishment the first time that a Christ School student scored as high as division 2. St. Henry’s is also culturally on the inside, as Masaka is right in the middle of the Baganda people, the country’s largest and most powerful people group. In effect, St. Henry’s is the opposite of Christ School. It is old while CSB is young, it is wealthy while CSB runs on a tight budget, it is from an empowered place and an empowered people while CSB is from a forgotten district and a marginalized people.

All of this set the scene for a remarkable turn of events, as the organizers announced that the tournament’s opening match, occurring at the end of the opening parade and ceremony and attended by all other participants (and TV cameras and radio stations), would be played between the host school and Christ School Bundibugyo. My eyes got big and I turned to look at Bwampu, and we both burst into laughter. We were excited and nervous - excited at the opportunity on the big stage and nervous at the prospect of getting humiliated on it, emotions that seemed to be shared by the boys when we told them. It was a veritable David and Goliath (physically too - their players are a lot bigger than ours). This was the sort of story that movies are made of.

On the day of the game, the Coca-Cola banners went up, the giant inflatable Coke bottles were inflated, the Coke marching band played, and at the end of the ceremony, my boys walked onto the pitch through a big red Coca-Cola tunnel, with young children holding their hands, just like the pros do. There was a gleam in their eyes; they realized this was a once in a lifetime experience. I was a bit of a phenomenon, the only white face among thousands of Ugandans of all shades, and as I walked to the coaches area the cameras clicked the people chattered.

Well, no movie will be made of this story. Usually, the David doesn’t beat the Goliath, though you tend to hear about the times that he does. This was not one of those times. We came out strong, controlling possession, passing well, dominating the game to an extent that after 20 minutes, I thought to myself “We’re going to win this game.” Eventually, however, the greater experience of the other team paid off, in combination with our lack of exposure to high quality competition, and they exposed weaknesses in our defense that teams in Bundibugyo hadn’t. We were down 2-0 at the half, but I was still confident and the boys were still upbeat. The game ended 4-0, but the game was nowhere near as lopsided as the score suggests. Of course we were disappointed, but I walked away with my head up, and so did the players. Based on our solid performance, one good but moody player came up to me and said excitedly, "Master! We can win!" I think it was a moment of realization and confidence that, though we were from a backwater place, we could compete on the big stage.

Before I could leave the field, however, I was grabbed by several reporters from with video cameras and microphones, setting up a comical situation in which I could barely walk twenty feet without being grabbed for another interview. I guess I have now had my 15 minutes of fame. The match was broadcast on the radio into Bundibugyo, and while the scoreline wasn’t flattering, Bwampu began getting many calls from people who had listened and who felt like, from listening, our boys were doing very well and had the better of possession. I think that it was a moment of pride, even in defeat, for many of the players, realizing that they were representing their district and that people back home were following them and proud of them.

More to come when I have more time to write…

Friday, April 16, 2010

Fearing Like a Man

My hands are soft. I notice it most when cooking. People will grab the thin metal saucepans right off the fire with their are hands, unfazed. The first time I saw this, I assumed that the pan was not very hot, and picked it up to move it elsewhere. You can guess how that worked out, and the painful burns left me wondering how he could have handled it so easily. Occasionally, when a pan is really hot, I've seen someone grab a leaf or two and use them as insulation, I would still burn through the leaf.

The other day I was eating at a friend's house, and was in the little kitchen building with him and his sister in law, marveling at the toughness of her hands. A saucepan of boiling water sat on the crackling fire, to which she added maize flour to make posho (think grits). Posho, however, requires a lot of vigorous stirring, and these saucepans have no handles, so she firmly grabbed this blazing hot pan with one hand and began stirring with the other. Occasionally she would change her grip, probably for a break from the heat, but her hand was usually down on the side of the pan, basically among the flames that were licking around her fingers from below. She didn't flinch, didn't show a hint of discomfort. I told my friend how amazing this was to me, and he told me that women here have much tougher hands than men.

He told me about a saying that women have. When multiple women are together cooking, if one of them reaches for some leaves to protect her hand from the scorching heat of the pan, the others will ridicule her, saying, "Why are you fearing fire like a man?" Cooking is so much a part of the identity of women here, that one can be shamed for not having that food-preparation toughness, and resorting to the soft means of protection that men use.

I'm guessing it's callouses, and nerves damaged due to repeated burning, and simple toughness. One way or another, women here are tough. This discussion leaves out the fact that, before building the fire, women collect and carry the firewood. I've seen women who must be 70, tiny, frail looking, and hunched over, carrying on their backs massive loads of firewood that must weigh 60 pounds or more, bent almost 90 degrees at the waist, looking at the ground, slowly putting one foot in front of the other as they move up the road. It's incredible.

So here's to tough women who provide for their families, who spend most of their days doing the mundane things like hauling and splitting firewood, peeling matooke, and taking hold of blazing hot pans - and who don't fear like a man.

Sunday, April 11, 2010

Champions!


Christ School is the champion of Bundibugyo district! Yesterday, we met our biggest rival in the district final. Our first half was brilliant, and the boys did everything I asked of them: keeping their heads in a high-pressure game, possessing the ball, keeping it on the ground, good passing, organized defense, and a high work rate. The only thing lacking was our finishing, and we went into halftime up 1-0 when it should have been 3-0. Nevertheless, I was upbeat and pleased.

I could never have guessed what would follow, as the second half was absolutely horrible. We lost control, the boys lost their poise. I was screaming to my players, "Keep the ball on the ground!" Their coach would then immediately scream to his players, "Don't let them keep the ball on the ground!" One thing I love about soccer is that it is a player's game. The coach can train and prepare, but once the whistle blows, it's up to the players. There's no micromanagement from the sidelines. That aspect of the game drove me crazy in the second half. I was screaming, pacing, shaking my head, my heart pounding, my head in my hands, powerless. Coaching is an entirely different game than playing.

However, we held on for the 1-0 victory, and a wonderful celebration ensued. It took me a couple minutes to transition from my angry coach mode into victory celebration, but it was a lot of fun. One young player in particular impacted me. He's a good kid, very hard working, the kind of player I like to have, and one who will go on to be a big player for this team. He had come on as a substitute to give us a little more defense, and was injured late in the game on a nasty tackle from an opponent and had to be carried off the field, grimacing in pain. As soon as the whistle blew, his arms went in the the air, fists pumping, head back, with pain and joy in his eyes. He looked to me like he might start crying. The emotion in his celebration helped me realize how big this is to these boys. Some of them are orphans, all of them endure a lot of challenges, all of them come from a forgotten corner of this country. This victory which makes them champions may be one of the most meaningful and positive things to happen to them. And now they have the chance to represent their district at the national tournament. There was a crate of Mountain Dew for the celebration, and the boys opened them and shook them like champagne, a fun and happy sight. I helped carry the injured player over the the middle of the celebration so that he could join in the Mountain Dew shower.

Many of these boys have never been outside of Bundibugyo, and I'm excited to have the chance to go with them to Masaka for nationals. We'll meet taller, more skilled players. We'll meet schools with a lot more money. But we'll get to represent Bundibugyo - these 20 boys who get to go on a huge adventure, the biggest opportunity of their playing days. Seeing a new part of the country, opening their eyes, traveling, feeling good about themselves, camaraderie, confidence, learning, growth. That's what I hope for, and I believe it will be a good opportunity for me to invest in them and to show them that I care for and believe in them, even as I prepare to return to the US.

After the game, I told the players that we have a lot to talk about on Monday (not happy things, mind you), but that now was the time to celebrate. And that gave me some freedom to celebrate too.

Thursday, April 1, 2010

CSB 1 - 0 Bumadu

We prevailed in the district semifinals yesterday, against what was probably the other strongest team in the district, and we now advance to the district finals where we'll meet Simbya, our arch-rivals from just up the road, with a place at the national tournament on the line.

The match wasn't pretty, despite a beautiful diving header goal in the early minutes. I was missing two of my best players through injury and suspension, and despite the depth of the squad, we felt their absence. Our opponents, a team from Bundibugyo town, are the first team I've seen that also tries to play a similar style to ours; keeping the ball down, passing, control - as opposed to the fast, frantic, wild, and almost random kicking and chasing that prevails here. We didn't do very well at sticking to our game plan, as we seem to sometimes have trouble keeping our heads in big games, but we still managed to maintain better possession and keep a strong defense. The hard-fought match boiled down to a tense last few minutes, but we held on for the 1-0 victory in the fading evening light.

It was wonderful to see the excitement of the students and staff - people I've never spoken to running up to me congratulating and thanking me, dancing in celebration of a major win, one step nearer to the glory of being district champs. The sunset also seemed to celebrate with us, a beautiful sky from horizon to horizon, the orange light hitting the mountains, intense gold and bright yellows in the west, with pink clouds overhead and reaching over the mountains in the east.

We have a lot of work to do and a lot of improvements to make to be a really good team, but it was a good win and an encouragement to the boys that they can win even without some star players. I was proud of my boys, some of whom were asked to play positions they don't usually play, some of whom had subpar performances but fought hard anyway. Back to the training pitch we go, with confidence from a win, but with an awareness of weakness as well.

Sunday, March 28, 2010

A Bundibugyo Evening

Life here is simply not predictable.

Saturdays are busy - projects, football practice or games, streams of visitors and requests. It's also generally the night when all the singles have dinner at the Myhre's, which is always something to look forward to. I was late for dinner because I was trying to care for the Pierce's former dog Jessie, who now lives on the mission and has had a really nasty open wound, so I ran back to my house splattered with dog blood, showered, and ran up to dinner late (for the record, Jessie is improving greatly). When I got there, Scott was seeing a patient who has stopped by, so I took the meat and threw it on the grill, while Jennifer and the girls finished preparing everything else. We ate a wonderful dinner, as dinners at the Myhre's usually are, and we had just begun discussing what movie we would like to watch when Scott told me that a patient we had seen earlier was back and in need of care.

This old man needed a catheter, so we set up a relatively clean area on the ground in a small building next to the Myhre's house, sterilized some implements, put on sterile gloves and inserted the catheter. Nothing happened. The second try also failed. Since by this time it was 10PM, taking the man to Bundibugyo hospital wasn't a good option as he probably wouldn't be seen until morning, not to mention that the 30 minute drive over bumpy road would be sheer agony for him. So Scott decided to do a procedure then and there. He sterilized some surgical instruments, injected a local anesthetic, and proceeded to cut open the man's abdomen, stick a catheter directly into his bladder, and stitch him back up with the catheter still in place. Remember that this was late at night, so the only light he had was my headlamp and another flashlight being held by a neighbor of the patient. I stood by hoping, probably in vain, that I was being helpful, holding instruments and keeping light on the procedure. Just to review - surgery, blood, urine, on the floor, in the dark - but still well done. Scott told me I'll be horrified when I look back on this in medical school.

The degree of this man's previous discomfort became clear when, after all of this, these unpleasant procedures, this surgery with minimal local anesthesia, he looked at Scott and said "God bless you Doctor." Scott injected his thigh with an antibiotic that is apparently quite painful, and his parting words to us were, "You have killed my leg." After all of that, it was his leg that we killed.

It was 11PM, still terribly hot, and we were both wound up and not really ready for bed, so Scott, Jennifer, and I watched an episode of Prison Break, and I went home around midnight. I found my fridge out, so I had to hook up a new propane tank, light it, and take my second shower of the night, heading to bed at 1.

Animal care, grilling, tacos, surgery, TV, refrigerator maintenance - an evening with a bit of everything. Jennifer asked to me, "Won't it be boring to go back to a place where these sort of things aren't normal?" It seemed like a half-joking question. And my answer would have to be a half-joking yes.

Friday, March 19, 2010

Kick Off

We had our first football match of the season on Wednesday - it was supposed to be Saturday, but other teams are protesting and causing trouble, a frustrating story that I don't have time to relate now - always a big and exciting event. Especially in the last few months I've been spending a lot of time training the boys, usually at least five days a week for a couple hours. We have talent, and my goal is generally to bring some organization and tactical awareness to the game. The game started a mere two and a half hours late (we had to wait for someone to come and officially commission the match, but he needed to be picked up and driven to the field, and once he arrived he had to lecture everyone involved on the minutiae of the regulations. The bureaucracy here is mind-boggling), but within a minute we were off to a good start with a 1-0 lead. I was really happy with the way the boys played; they have come a long way since I first saw them. Like any coach, I was still frustrated with a lot of things and did more than my fair share of yelling - I wonder what the boys were thinking as I was screaming while we had a 4-0 lead - but it was a good match and was fun to watch.

Football season seems to bring the school together in a special way, and the joy that these boys have in representing their school and being supported by their classmates is clearly visible. Students and young children run onto the field after each goal, dancing and twirling in celebration. The girls beat drums, sing, and chant for the entire match. I think that the matches are a really encouraging experience for the players, and I hope that it's a chance for them to learn teamwork, dedication, and respect.

The game finished an impressive 6-1, so everyone was happy. Except for me, of course, as I was disappointed that we allowed a goal. But it was encouraging start to the season, and I'm hopeful that we'll have a successful year.

Friday, March 12, 2010

Hope


Kabasa went home today. He was admitted for about 6 weeks, and for the first three of those it continually seemed as though he was dying. He came in as a weak, malnourished child, swollen with edema, whose skin was falling apart and who lacked the strength to stand or even cry very much; he left today a happy, energetic boy with a little meat on his bones, running around the ward, throwing his ball to me, with a heartwarming smile on his face. Six weeks, from the very brink of death to curious, playful life.

I don't know what awaits him. At home, he won't get the same high quality milk and food that we can provide to the inpatients. Who can say what his future holds?

Still, Kabasa gives me hope. It is easy to despair in this place, but in the face of suffering, tragedy, and loss, he is a glimmer of beauty. A little boy saved from death. A life preserved. A father spared the loss of his son. I know I have said this before, but I'll say it again - because Kabasa is walking home today, a healthy boy holding his father's hand, I feel that the world is more right than it was yesterday. Undoubtedly, the world has a long way to go - several children this week have demonstrated that in gut-wrenching ways - but Kabasa gives me hope in goodness, wholeness, and healing.

"He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the old order of things has passed away."

Sunday, March 7, 2010

Tuesdays

I realize that I provide very little indication of what I actually do on any given day, so here's a glimpse of Tuesday, usually a very long, intense day primarily consisting of malnutrition work.

In the morning I go the health center to do rounds with Jennifer, starting with the severe malnutrition cases. A few of the kids on the ward now:

I first saw Asaba at one of the outpatient programs, and immediately referred him to the health center for the inpatient care that he needs. He's been a troubling case, not responding to receiving the therapeutic milk in the way that we usually see these kids recover. His weight is starting to trend upward, so I'm hopeful that he's finally on the right track.


Tumwine is absolutely pitiful, one of the worst cases I've seen since being here. His body is wasting away, every rib, vertebra, and most other bones are clearly visible, and he is so sick that he has little appetite for the F100 milk that UNICEF supplies to us, so he is another sad case of someone who made it to the health center, but can't seem to turn the corner. Jennifer has said numerous times that she doesn't expect to see him alive the next day, but he has somehow clung to life. Part of his problem is child spacing. His mother just gave birth days ago, so she had stopped breast feeding him during her pregnancy, which was too soon for him. It's painful to see him in such a horrible condition every day, but somehow he's held on, so I try to keep my hope for him alive too.

Finally, a happy story. Kabasa is an object of wonder for me. He's been admitted for a long time, and wasn't responding for several weeks. His protein deficiency had caused major edema, and his skin was deteriorating. About three weeks ago, I said to one of the nurses, "He's going to die by tomorrow. What can we do differently?" Since then, this seemingly hopeless case has been a miraculous recovery. Within days he started smiling, and by now his weight it shooting upward and he's a smiling, playful five year old boy who gives me an energetic high-five whenever I see him, and loves to throw a ball back and forth. Every time I look at him I'm amazed, he brings joy to my day and hope to my heart.

On the first Tuesday of the month we have our motherless program, which supports caregivers to be surrogate breast feeders for children whose mothers died in childbirth, so in the late morning I see these cases. We give beans every month to nourish these heroic aunts and grandmothers, so that they can be strong enough to provide breast milk for these unfortunate infants. Some of the kids to great, and some don't; some families are incredibly dedicated to caring for these kids, while some don't seem to be very invested and are probably looking for any handout they can get a hold of. But I'm always amazed to see aunts, already breast feeding their own child and often struggling to provide for them, taking on the responsibility of caring for another child, or grandmothers who haven't had a child in years but have managed to re-lactate, these wrinkled old women who throw 25-pound sacks of beans on their backs, strap them across their foreheads, and walk slowly, steadily away, perhaps having to cover many kilometers to get back home.

In the afternoon, I jump on a motorcycle with Baguma and head out near the border with Congo for the BBB program, an outpatient nutrition program. The road is always an adventure, especially with the recent unusually heavy and long lasting rains. Their used to be a bridge over the river we have to cross, but it has been gone for years and now the motorcycles drive across when the water is low enough, and men ferry people back and forth on their backs.

Here are some of the kids from the BBB program.


Some do wonderfully on the locally produced peanut paste and soy flour that we distribute, while others don't respond well, but outpatient programs will always have those issues. It's been a great learning experience for me, and I've encountered many interesting cultural issues. For instance, one of the big difficulties with these types of programs is that it is culturally almost impossible for a parent to give a certain food to one child - the supplemental food that we provide, in this instance - without sharing it between all of their children, meaning that often the malnourished child enrolled in the program might not even get the majority of the calories that we give them. But I've had great experiences, worked with some wonderful kids, seen spectacular recoveries, and have built a great relationship with Baguma.

We get back sometime around 4 or 5 usually, and I run down to Christ School for soccer practice. The season starts next week and their are high expectations, so we're training hard every day. After two hours of playing, drilling, talking, running, yelling, and encouraging, I make my way back up the road around 7, with the sun setting behind me, tired, thirsty, hungry, and aching, but usually it's a good ache.

Wednesday, March 3, 2010

Media Darling

A quick follow up to my previous post about the camera crews buzzing around on the pediatric ward. A couple of days ago I received a text message from a friend in Kampala saying, "I just saw you on TV! It was about malnutrition in Bundibugyo." I'm not sure who thought I deserved to be on the news. Maybe I have the look that Ugandan news outlets are looking for. I'll call it fame.

My friend was concerned about Bundibugyo - are things really getting that bad? Is malnutrition on the rise as dramatically as it seems? The answer is no, it simply hasn't been reported before. Certainly, the rapid population growth coupled with increased cash cropping aren't helping the situation, but it's simply a case where things have been bad for a long time, but only when the WFP pours resources into the area does it get covered.

It makes me wonder how much of the world is that way. How many horrible situations, how many tragedies, how much oppression are we blind to simply because we don't have the time, energy, or desire to know about them? Maybe it's simply that news networks don't show it, or maybe we would rather be ignorant. But if even many Ugandans have little idea about the severity of malnutrition in their own country - granted, in a remote district - how much do we miss? What might our world be like?

Friday, February 26, 2010

Big Happenings

Wednesday morning at the health center, and suddenly two shiny silver UN vehicles pull into the compound. I look on with some interest as people climb out, carrying cameras, video cameras, and notepads, people who clearly aren't from around here. Before I know it, the pediatric ward is abuzz with activity, people snapping pictures and taking video footage of some of the most pathetic malnutrition cases, and vying for Jennifer's attention, asking her questions and carefully recording her answers.

As it turns out, today was the launch of a major child malnutrition campaign in Bundibugyo, spearheaded by the World Food Program, and WFP staff and newspapers reporters were looking for information for their pieces on the project. The scene on the ward was unlike any I've seen, the mothers chattering back and forth, probably amused and confused by the commotion. Pitiful little Kabasa, a five year old with horrible malnutrition resulting in massive edema and his skin deteriorating, probably had 200 pictures taken of him, but he, and his father, seemed to like the attention. I was glad that the reporters also wanted to speak with the families of these kids, not only to the hospital staff. Perhaps people who never have a voice will be heard, or will at least feel that someone wants to hear. That, however, is probably overly optimistic.

When Jennifer mentioned one of the programs that I work on she indicated my involvement, and soon reporters turned to me with their questions. Mostly, I was afraid of saying the wrong thing, saying something that would somehow hinder efforts to address malnutrition in the district, or would cast the work being done in a poor light. But there I was, taking questions from reporters from the two biggest national newspapers in Uganda, and almost laughing that they felt that talking to me might be worthwhile. Finally, they asked me for my name and my title, so that they could site their sources. I froze - what is my tittle? I don't have one! But I can't tell them that. Some jocular titles that I've considered for myself here flashed through my mind - assistant bean counter, head of vermin control, nondescript duties officer - but in the end I stammered out something about being a nutrition worker with World Harvest.

It was interesting to hear these reporters talking to Jennifer and trying to get the one phrase that summed up the problem, the core of the issue, while she kept repeating that it is much more complex that any one thing. There's no one thing causing malnutrition here, rather it is a host of problems like child spacing, increased cash cropping, low education levels (especially among girls), and families splitting, leaving the kids with only one parent to provide. The outside agencies want the key point, the issue to address, the sound byte, the target, the money raiser, which isn't a bad thing to want, but the reality is not nearly so straight forward.

Today was the big event, a major gathering in Bundibugyo town, including members of parliament, the district governor, district health officials, and the WFP country director for Uganda. Of course, the program started about an hour and a half late, but here that's actually pretty good. A march through town, led by a marching band (this is crazy stuff for Bundibugyo) kicked off the event. Singing, dancing, and dramas about nutrition provided the entertainment, and in addition to the one or two hundred invited guests, there were hundreds of people who crowded into the open boma grounds to see the spectacle and listen to the speeches. There were some good messages, and while a lot of the program seemed to be just for show, and I'm still hazy on what the program being launched actually is, it was great to see the awareness of the need, and to hear of the commitment of the WFP to the district. This sort of activity and awareness could do good things for this place.

But one of the coolest aspect of the event was that the impetus behind it came largely from research done by World Harvest missionaries. The BBB program that I work on was started by Stephanie Jilcott, a PhD in nutrition who has published research done on malnutrition in Bundibugyo, and this program was furthered by the work of Scott Ickes, whose doctorate was based on his work with BBB. They have both recently presented and published research on malnutrition here, and this major WFP campaign seems to stem directly from that. One WFP worker who I met, an American, asked me, "So do you know Scott Ickes? I've talked with him about this program and we've look at his research a lot." It was thrilling to see the hard, and sometimes tedious, work of other World Harvest people paying off in such big ways - big enough that the UN and WFP are deciding to make Bundibugyo a major focus for their work in Uganda.

Sunday, February 21, 2010

What is going on here?

Several interesting, frustrating, surprising cultural experiences in the the last couple of days.

A good friend stops by my house in the morning, and I invite him in for tea. In seconds, he has grabbed a loaf of bread, cut himself two massive slices, polished off my peanut butter, and used a massive amount of jam in making himself a sandwich. Never did I indicate that I would feed him, nor did he ask - it was simply the obvious thing. It doesn't occur to someone here that I might want to save those things for later, or for another use, or to actually use some of them myself. It seems that in this culture, it wouldn't make sense for someone to have a use for something that would trump supplying a friend while he was over. Therefore, why would someone even need to ask? Also, the idea of saving for later isn't very strong in this culture, for a number of valid reasons, so it doesn't occur to someone that I might be trying to stretch this peanut butter over a couple months rather then weeks. This sort of thing is difficult as an American, and challenges me not to view everything through a narrow cultural lens and to be humble, open to other ways of thinking and understanding.

In meeting with the local chairman to report a recent break-in and theft in one of the houses, he began talking about the string of incidents at my house over the last few months, the have involved children coming in in-between the bars on my windows. The identity of one of the children has become clear, and unfortunately he is a good friend of mine. However, is discussing this, the official would never actually use his name. He said things like, "Your friend," or "That neighbor." At one point he even looked at me uncomfortably and said, "Sorry, I don't want to name him." Social harmony is of utmost importance here, and accusing someone of something, even if they are clearly guilty, is offensive and apparently unacceptable. This sentiment is so strong that, even in a conversation with me, away from those involved, an official can imply the identity of a boy who has stolen from me, but can't actually use his name.

I came across an acquaintance who was cutting lumber from tree he had felled, and he began telling me about the construction project he was using the lumber for. He had paid someone for lumber, but they refused to give it to him, keeping his money and the lumber. My response was to say that they had stolen his money. He replied that he had tried to get the lumber from them, but they had refused again, so he said, "So I avoided a quarrel, and decided to harvest my own lumber." Never mind that they took his money and didn't provide that which he paid them for - he avoided a quarrel. That was the important part. This was shocking to me. Most of you probably know me well enough that I definitely like to avoid conflict, but this passivity in the face of blatant dishonesty and theft still seems incredibly foreign to me. But I suppose that we all see things through the filter of our own culture - for him, the theft was not the most important thing, rather, maintaining social harmony, not making enemies, and not engaging in conflict was the highest priority.

These sort of encounters, along with many others that stuck out a little less in my mind, all of them occurring in 24 hours, are the sort of things that can make my head spin. Make me feel like I just don't understand people here, and give life a continuous background of stress. But they also challenge me, stretch me, force me to think about things in new ways, shed light on many of my presuppositions, and reveal my idols of control and respect. Cross-cultural living is wonderful and terrible, fun and frustrating, exciting and maddening.

Monday, February 8, 2010

Lessons in cooking, and life



One benefit of being almost alone in the district this week (it's just the Clarks and me) is that I've spent a lot of time with Ugandan friends. Yesterday, my good friend Vincent had me over to his house for dinner, and to teach me about local cooking. So when I arrived at his house at 6:15, I stepped into the kitchen and started helping out.

Now, kitchen is a relative term. This kitchen, and almost all kitchens in this district, is a small, free-standing structure made of mud packed onto a frame of wood and reeds, with a thatched roof and packed dirt floor. One the ground is a wood fire with three stones around it, which support pots and pans over the fire. There is no chimney. Where does the smoke go, you ask? Into my eyes. And lungs. Ok, most of it escapes through holes in the roof and through the door, but my eyes were burning the whole time, and I woke up this morning smelling strongly of wood smoke. The kitchen counter is outside - a piece of wire mesh suspended between four small poles, where food is placed to keep it clean and dry. There is one knife in this kitchen, and no cutting board; everything is cut while in the hand, pulling the blade back toward your thumb.

I arrived while the sombe was in progress, one of my favorite Ugandan dishes, made from cassava leaves. Vincent walked me through the process of making it, and I was glad to learn, and hope to give it a shot on my own sometime soon. Soon after I got there, Vincent's sister-in-law walked over and just started laughing at us. The sight of two young men cooking is so unusual that she couldn't contain herself. In American culture, it is common for women to be the primary cooks, but here, it seems almost unheard of, and certainly comical, for grown men, and especially married men, to cook. This led me to give me to give Vincent a lesson in American culture: in America, a lot of young men learn to cook, primarily to impress women.

One aspect of food preparation here that didn't immediately occur to me is that dishes are prepared serially. That is, first we cooked the sombe, then we cooked some vegetables, then we cooked the rice, then we cooked the g-nuts. All of this after Vincent and already steamed bananas and cooked cabbage, and prior to that, the firewood had to be collected and split, and the fire started. But the time invested is even more than that makes it seem, as the sombe has to be ground by hand, the rice has to be hulled with a mortar and pestle and have the hulls removed (which took over an hour), an I spent about 30 minutes pounding g-nuts, also with a mortar and pestle. Combine all of these activities, even with several nieces and nephews helping out, and we didn't eat until after 9. It was a great dinner, spent with good friends. I sat next to Aliganyila, to whom a previous post was dedicated, and had a great time laughing with Vincent.

The evening made me think about how different my experience of something as basic as food preparation has been. Yesterday, I almost cut my fingers off several times, while Vincent barely even has to look at what he's cutting in his hand. I buried my eyes in my arm when they filled with smoke, while Vincent hardly flinched. I felt like everything took a long time, and, well, Vincent did too, but he is used to cooking one dish at a time, and people here don't rush like we Americans do.

The smoke, the dirt, the arms tired from grinding, the heat, blowing on the fire, the darkness, the laughter, the silence, time passing - a meal. An experience of life. Simple, unremarkable, everyday life. The mundane. The activities that fill up days and years, the necessary things, the very fabric of experience for so many people here, and all over the world. I was glad to be there for it.

Thursday, February 4, 2010

Hitting the ground running

My first full day back was as busy as I would have expected, and then some. After sleeping only three hours the night before, I slept soundly until I was awakened around 7 by a thunderclap that rattled my bed, and I once again had no idea where I was for a few seconds. I set off down the road for the health center, greeting people on the road, and grateful for the cloud cover (I've already been told "You have changed your color, you are now very white").

Wednesdays are always busy at the health center, so I was trying to get back into the swing of things with Jennifer on the pediatric ward as well as working with Baguma on a nutrition program for ARV patients. It was good to be back there, but hard to see so many sick children again. The main event happened in the afternoon, as I went with Baguma for the opening day of a new site for our BBB nutrition program. He had trained community volunteers and taken care of the logistics in my absence, and I came back just in time for the big day. When we arrived around 1:30, there were about 20 mothers there with their children, and I expected that more would come throughout the afternoon. I spoke to the mothers about the program, lavishly thanked the volunteers, and then we began weighing kids and measuring their height in order to evaluate their nutrition status. We began to draw a crowd of onlookers, which didn't surprise me, given that this was a new event at this site, and that there was a white person there (this place is way out in the village). I wasn't prepared for what happened next. More and more children came, and I began to notice that most the kids we were measuring were big, chunky, healthy kids. Then I looked at the stack of papers for kids waiting to be weighed, it was growing rapidly. For every child we weighed, two more showed up. I realized that every mother passing on the road was stopping to have her child screened, and I was told that some women had run to their villages, shouting for everyone to come have their kids weighed - it was possibly the most effective community mobilization I have ever seen. Everyone, healthy, sick, and in-between, was coming to be weighed, probably in the hope of getting a free handout. But after measuring about 100 kids, with at least that many still waiting, we decided that Baguma would do triage, and send away all of those who were clearly not malnourished. Then we started to see the malnourished kids, and we finished weighing and measuring, but hadn't even started evaluating them, after three hours. After sorting through all of these papers, we decided on 17 kids who were in bad enough shape to qualify, and one who was barely clinging to life who I referred to the health center. As I started entering names and date into record books, the fun part began. Baguma demonstrated how to prepare the food we distribute, and watching him teach and engage with the mothers is a pleasure, even if I can't understand much of what he is saying. Then came the best part of my day - watching these malnourished kids stuff their faces with the nutritious food from the demonstration. It is simply beautiful. Whenever we do a demonstration at one of these programs, this brings joy to my heart and a beaming smile to my face - it gets me every time.

It was getting dark by the time we left, and we didn't get home until 7, officially the latest I have ever seen one of these program run. But it was great: eager mothers, competent and excited volunteers, health center staff present and helping, good food, smiles, crying, laughter. I felt sadness at working with pitiful malnourished children, and knowing that they may not improve, but also hope for recovery and excitement at the start of something new.

Wednesday, February 3, 2010

Return to Uganda

The north-east winter gave me a frigid send-off, and now, after several airline meals, some bottles of British Airways wine, cramped legs, laps around the cabin, too many movies, and not enough sleep, I'm back in Uganda, where I was welcomed by a wall of hot, heavy air as I stepped off the plane. I can't seem to find moderate temperatures. It's a transition to a different world, but the sights, sounds, and smells have a familiar feel this time around.

Kampala:
The thick dust that stings my eyes. Roads that are more pothole than pavement. Waking up with absolutely no idea where I was. Jetlag. Dogs barking all night; birds singing all morning. The loud, chaotic, lawless rush hour traffic. The hair-raising rides on a boda-boda, weaving in and out of traffic, but only once truly fearing for my life. The equatorial sun. Haggling over prices.The little boy who cautiously approached me and then took my hand and walked with me for a minute - he trying to tell me something, and I trying to tell him I don't speak any Luganda. The ubiquitous garbage heaps. Eating Indian food. The ash floating slowing down through the air like black feathers, and landing on my table, as well as any other exposed place in downtown, as a result of the burning of a major trash dump in the city. Meeting up for a lovely reunion with Heidi. Being completely overwhelmed by the prospect of shopping for the next few months, and responding by shopping barely at all.

The Road:
The first leg is four hours of pavement - using the term loosely - between Kampala and Fort Portal. No lanes: survival is the rule, and the bigger vehicle is always in control. Coach buses come hurtling down hills, swinging onto the other side of the road at breakneck speeds around bends, pushing other cars off of the road, always giving the impression of being about to roll over and smash through anything caught in their way. Children run along the sides, sometimes a mere foot or two from the cars going by. Cows saunter across, seeming unfazed by the vehicles screeching to a halt to avoid them. And the birds - massive, beautiful, tropical birds - swoop overhead, majestic creatures like the Great Blue Turaco and the Black and White Casqued Hornbill.
The second leg is the Bundibugyo road - to which I have dedicated a fair amount of writing in the past year - 3 hours of dirt, rock, craters, and dust. Dust in my hair, dust in my teeth, dust coloring my skin red. Running along the side of the Rwenzori mountains, there is often nothing separating the edge of the road from a drop of several hundred feet. It's beautiful, but the dry-season haze filled the air and shrunk the stunning vistas to small, fuzzy hints of grandeur. On the western side of the mountains, the slopes were ablaze. Fields are often burned periodically, but in the dry conditions and hot breeze, many of these fires seemed to have spread up the mountainside, through forest and brush. I heard it said that many young men sometimes burn land "stubbornly" - probably best translated "just because." Black and gray dominated. The further we came off of the mountains, the more green we saw, the more people we encountered, and the more cries of "Mujungu!" we heard, a sound that I had almost thought that I missed, but quickly remembered that I didn't.

I arrived in the early evening and had great reunions with the Myhres, Ashley, the Clarks, and my neighbors. Kids jumped all over me, telling me they were starting to think that I had lied to them, and wasn't coming back; their beautiful smiles and exited laughter were heartwarming. A clean house was a pleasure to come back to (Scott Will, you are the man), and I took a lovely cool shower to quite literally wash off the road before sharing a wonderful dinner at the Myhres. We sat around, catching up and telling stories long after dinner was over. In addition to all of these great things, there were no snakes, rats, or giant lizards in my choo. But I do hear there have been bats in my house. It's good to be back.