Mulago Slog Continues

Our afternoon lecture started with a prayer and ended with a prayer. "God- give us the ability to learn and work together as a team. .......". First topic of conversation: a gift for sister Annett (nurse) - a bag of 10 digital thermometers - which she then handed out to the med students because we have one digital thermometer for the whole floor. That is 1 thermometer shared amongst 150 people on the infectious disease unit where we don't have enough sanitizer to spare to wash it. So, everyone gets axillary temps- but that still is crappy infection control. Most of the time they don't even bother with vital signs anyway- I mean what can they do about whatever they find anyway? Second topic of conversation: there is no paper for patient records. There are no file folders left because they were used when the paper ran out. "This is not a problem" announces the Chief doctor on the unit "we just ask the families to buy notebooks". We then discuss a couple cases of death. "If God wants to take a life there is not much we can do"- this is said a few times by different African doctors. The cases are so rudimentary I could treat these patients- scary.
Yesterday at the hospital 6 died- I wheeled beds with dead bodies into the back room as family members hung onto the bed and cried. We start med administration at one end of the floor and work our way through 150 patients to the other end. I get yelled at everytime I go back to hang a second med for someone. I am used to keeping track of people- I remember what I've left unfinished. The nurses at Mulago have no idea what is going on with people they just give meds and keep going. Nothing is explained. If you are a family member, you are the nurse. You must remind the nurse of everything that needs to be done. News has traveled that I will come and help and so people are constantly tapping me on the shoulder. The nurses here could do so much more if they weren't so lazy and the attitude is "it's in god's hands anyway" .. "there's not much we can do". The patients also ask me to buy medications for them because they are poor and I want to sooo so badly. I just know the minute I start that- 150 people are going to be asking me.
Today there were IV fluids finally but no IV tubing. That made it hard to give people their IV antibiotics. There was also no blood for blood transfusions- not that they would waste that on a lot of people anyway.
My little soldier (who is 26- my age- I don't know why I call him little) with the upper GI bleed is still alive. Not exactly conscious, but still alive. Everyone is teetering on death there. Everyone. I don't know why I like him so much- because he's young and his soldier friend spends countless hours cleaning his bloody stool, bloody vomit. I want so badly to seem him monday when I come back but I'm really afraid I won't. With the ones who could use it and get better, I hand them out IV fluids and tell them to save them for later. I know I shouldn't but I can't help it. The young ones- are too young. Death is just a fact of life here. Most women have lost children and it is interesting to see how detached they are. There is nothing I can do about the lack of nutrition. We have feeding tubes but no tube feed. I just instruct people to force feed their loved ones. They all line up for porridge, which is the only food the hospital provides. Porridge here is some white, nutritionless, grain in milk. They get one mug per person. And that is if you have a family member to go and get it. People that don't have family go unwashed, unmedicated, unfed, no sheets, ..... Often another person, a stranger, will help them. But they won't buy things for them. Yesterday I found more than one person lying in their own shit and by the looks of things had been for days. There are no sheets so I couldnt change them. Today- I'm going to the market to get some. Here if you are strong enough to walk- you can walk home.

On a lighter note: went to the R Kelly concert last night which was the concert of the year. Thousands of people just lovin R Kelly. Remix to Ignition.. I believe I can FLy. It was just as entertaining as it sounds. Getting in was scary though. The line broke and everyone ran for the gate. As we started to get crushed (and I started to get the "shit shit shit"feeling), the crowd erupted as police started hiting people with sticks and firing into the air in front of me. I mean literally 2 people away from me. The color of my skin saved me from being hit. Nobody cares about the black man- not even Africans. We ducked and ran in. Then in the crowd to see R Kelly I was pushed into the middle of 2 fights. Then when we left, we hoped on the back of a motor bike. We are zooming between cars with the traffic and I here the screech of tires to look back and see a car loose control and hit the median like 10 feet away from me. My whole pack of guardian angels is still hard at work- even at 3am. We danced all night... again. I really love Kampala.

Day 2

Today we had no IV fluid so we couldnt even give meds till 1pm because we had nothing to mix them with. I only wrapped one body today- but two died over night. Families watched in amazement as I helped a woman dress. That just isnt done by the nurse. They were like this girl's got a Florence Nightingale complex. What else- I saved a life.. of that I am sure. And my little honey better be waiting for me in the morning cause I worked really hard to jerry rig oxygen and catheters and fluids. And it's hopeless really. 27 with upper GI bleed. For the most part, at Mulago, if someone has a something actually life threatening you just watch them die to save the supplies for someone who will most likely make it. I organize family members to help me carry the beds because none of the wheels work. O2 tubing is IV tubing cut and taped together. There are 2 IV poles and they are both missing all the wheels...hanging off to the side. There's so much left over supplies in the states that could help these people. I don't even know why they come. A lot of families say "let us go. we think he's gonna die".

Mulago Hospital, Kampala Uganda

So after networking for a week and doing things Pole Pole (slowly slowly) African style, I get us into Mulago Hospital- the national hospital of Uganda. We enter right into the heart of the beast- infectious disease ward.
There are not rooms. One big room with beds lined up. If there isn't a bed, your family buys you a mattress to sleep on. There are 2 nurses and 2 student nurses to 75 patients. Because of this, your family comes and stays with you. It's required really- if there isnt anyone, the nurse will ask "where are your attendents?". Your family buys you all your medical supplies from a store, all your drugs from a pharmacy, all your food from home, all your bedding from home, your clothing, your diapers, your bucket to puke in. Provided by the hospital is: bed if lucky, IV fluids - which were not available today ("we will probably loose a few to dehydration today" a doc says casually at lunch) , and IVs... oh and medical tape. The nursing team starts at 10am and begins administering medications to all the patients. This continues till 4pm. Family does bed baths, walks you to the bathroom, ties you to the bed when you are thrashing, etc.. The nurse only has time for meds and if you die. I started my shift with wrapping a body and ended it with wrapping a body.
"Come someone has died" he says with a smile on his face. I walk into the room to find a man lying on the floor in all his clothes: pulseless, cold, pupils fixed and dilated. Everyone- family members and patients- are just watching me as I wrap the man in a sheet and find some people to carry him to the "treatment room". No one is sad, no one is scared, no one even cares.... in fact someone cracks a joke.
Medication Administration:
There is a sheet at the end of the bed where the doctor writes what should be prescribed. The family takes the sheet to the pharmacy. The nurse takes the medications from the family and administers them and writes it down on the paper. I administered meds all day and I don't actually know what were any of the diseases I was treating.
I thought we would just be a nuisance but the nurses welcomed us. Just started telling us what to do. In nursing, your senior knows more- just listen to them. At Mulago- they were so nice, never judging our qualifications, just teaching us what they do so that we can help. I understand- because they need it. I taught how to properly drop NG tubes today and they listened... weren't annoyed with me at all. At the end of the day they said "thank you" all smiles....
In the midst of all the problems there are here, there are some things I would like to learn from Africa:
-how to laugh when you are scared
-how to laugh when you are mad
-how to laugh when everything is shit
-how to be patient
-how to be quiet when you don't trust a situation
-how go pole pole and hakuna matata
-how to drive a boda boda

Kampala, Uganda

When Chimp trekking falls through, we hitch a ride with a tour group back to Kampala. We shop in the market all day- something that never gets old for me.... and then out at night. We spend the weekend dancing and making new friends in our new home. When we arrive at our new house, things are mmm... not what expected. We are 30 min out of the city, working in a clinic- not a hospital- and staying with a family who eats at 1030 at night, doesn't want us out past 9pm and lives in a locked compound, and we are sleeping in a room filled with mosquitoes and no place to hang a net. Not pleased. But on the bright side I have not paid and my friends are coming in handy- picking me up and hopefully finding me work elsewhere. I really don't care how nice she is- just doesn't work for me. So today we are going to sort it out.

Murchison Falls, Uganda

It occurs to me that I may sound a little insensitive to the poverty in Africa. I'm not. My point is only that things are different here and I see positives with the negative. Positives that Africans don't articulate to me because they have nothing but America on the TV to compare their country to. I'm reading The Sum of Our Days by Isabel Allende and she so eloquently puts what Ive been noticing around me:
"At first it was difficult for Willie to understand my obsession with gathering my children around me, to live as close to them as possible and to add others to that small base to form a large, united family I had always dreamed of. Willie considered it a romantic fantasy, impossible to carry out on the practical level, but in the years we've lived together not only has he realized that this is the way that people live in most parts of the world, but also that he likes it. A tribe has its inconveniences, but also its advantages. I prefer it a thousand times to the American dream of absolute freedom, which, though it may help in getting ahead in this world, brings with it alienation and loneliness."

I'm currently in Murchison Falls, Uganda which in its day was one of the premier game parks. Poachers killed most of the wildlife but today Rhinos have been reintroduced and most of the other wildlife present has returned to normal numbers.
To get here we leave at 7am - sick again from something we ate haha. Get on the bus with shit tummies and proceed to travel from Rhuengeri, Rwanda to Murchison Falls, Uganda. This is a 48 hour journey. 14hr Bus, 4 hours sleep, 5hour bus, 3 hour matatu of death (breaks down twice, nearly kills 2 separate bicycles and when the African's scream you know it was serious. Even if they are still laughing. We skid all over the road in the van-with all 25 passengers braced for impact... and it is clear to me that I have a guardian angel- a team of guardian angels ;)), 1 hour ride in a mattress truck, half an hour motorbike with full pack= future back surgery. My boda boda driver's name is "trust" -right- which I find ironic for a number of reasons. He guesses that I'm 16 years old- as most people do. My little blonde friend is usually presumed to be 30 because they think her hair is white. This is funny for a few reasons: 1- this is not the first blonde they've ever seen surely because Africa isn't that isolated, 2- because people don't grey at 30 here, 3- because her hair is clearly yellow not white, and 4- because she's 23...... oh and finally because it really pisses her off. She's a diamond though and we wander around this part of Africa together- laughing and taking care of each other. Plus she knows all the songs from Mary Poppins- she's British.. not her fault, but me- I have no excuses.
We take a boat along the Nile- which is filled with hippos, elephants, crocs, and birds along the banks. We are riding up to the falls. It's "one of the most spectacular things to happen to the Nile" according to Lonely Planet: East Africa 2003- which, in our experience, is FOS (full of shit). But in this case, the falls are TREMENDOUS. They fill the word to it's full extent. We are blown away by its obvious power. We also go on a game drive which is beautiful but not all that impressive as far as animals go- giraffe, buffalo, elephant- no lions ;) Luckily we pay 1/4 price.

Random VIllages, Rwanda

So we decide to stay an extra day. Why? mmmm we never know. My friend Laurent drives us out to the lakes and Nikki and I wander down into the villages along the shore. We hear singing coming from the church so we decide to go. 10 minutes later we are addressing the congregation and being told that the minister is praising god for delivering guests. The children and adults are dancing and singing through the whole service. What strikes me about these moments is how nurturing the environment is here. The babies are everyone's children. The responsibility is shared. Babies are running around with knives, hitting each other over the head, 6 year olds are toting their infant siblings on their backs, moms lying back and watching it all happen. Moms are lying around together. The men here hold hands and hold each other. Sure everyone knows everyone's business but they obviously take good care of each other too. We receive a friendly greeting at all the villages we go to. Older women stop to receive us and invite us into their homes. At these remote villages we gather a crowd of about 20-30 people wherever we are. Everyone laughs and jokes with each other, hugs each other. This is the Rwanda that we were hoping to find and we did. This is the spirit that makes me say people in these small villages complaining about money can't see how rich they are in community. Once you have a roof and food and safety- community is the most important thing to a human being. We travel all day. We've prefected the art of hitching, the ability to communicate without knowing the language, and the ability to make people laugh when they have their hand out. I have spent 3 days on the back of Laurent's bike with a Swahili dictionary in one hand. From what I gather- he considers himself a cowboy.

Rhuengeri, Rwanda

We travel here to hike a volcano. This is more like it. Here the people stare- they dont smile... BUT when you smile their face breaks wide open with welcome. This is more of the Africa that I have the pleasure of coming to know over the past months. We climb the Volcano for 4 hours- but at the top is a beautiful crater lake. The other side of the crater is the Congo- so we bring an armed guard with us for "the animals". On the hike down- not only do I experience the inconvience of a dodgy tummy, but it begins to hale as I stop time and time again. The rain turns the mountain into a mudslide and we are covered by the time we emerge from the woods 4 hours later. My boda boda driver is waiting for me- an adorable boy named Laurent. He takes one look at me and shakes his head. Later when we get a flat tire- I draw a crowd of 20-30 people watching me try to scrape the mud from my shoes and body. Here a muzungu is fascinating. A man told me people like to see the muzungu tourist here because it means the security in the country is good. And it is. Its incredibly safe and pumped with forgien aid. We take long ice cold bucket showers when we get back .... just the thing for a hard days work. "I love Africa" Nikki says as a group of 5 men gather to watch us do our laundry. They have brought chairs for the occasion. Oh Africa.....

Kigale, Twanda

I woke up last night and realized that maybe I shouldnt have shared that bit about the banana ;) Yeah- it was funny at the time. So anyway- back to Rwanda. Went out in Kigale, Rwanda and it was a strange experience. The music was western, the clothing was minimal, the attitude was western. The club was the nicest we've been to. The boy outside the club tells me Rwanda is a bad country because there is no money- yet its the only place in Africa that Ive seen street lights, nicely paved roads, nice cars. I mean if you didnt look too closely you'd think you were in the states. No $- well that may be true for some. I have'nt seen a lot of the country but in Kigale there's a lot of money. There's a gloominess, a sulleness, a reserve... I can't quite put my finger on it. Then Nikki turns to me and says "the fact of the matter is that everyone here is either a victim or participated". Im looking around and Im remembering back to the morning when a young boy told me that all Americans are rich and the book in the bookstore that said "Millions- what our American neighbors are hiding" and I was struck by what it must be like to blame another country for your problems. Granted it is easier for me to get a loan- there are things that are easier for me. But- I get asked often to pay for people's schooling or car and I say- yes I would like those things too. The complaints are similar and it makes me sad that people here can't see how much they do have. America has it's own set of problems and that isn't witnessed by the rest of the world. That said- I know that I am priveledged. I just think that well- just because things are different here does'nt neccessarily mean disadvantage. I just feel like I would rather give money to a mother working in the feilds than to the random people that come up to me with their hand out. What if I stopped someone who looked wealthy on my way to work and said "hey give me some money".... it's equivilent.

Rwanda

We make friends with some Overlanders (people on tours in trucks) and they give us a lift to Kigale, Rawanda. This is cool for two reasons: one- it's free and two- we are traveling in style. The overland truck feels like traveling in an armoured tank- dealing with Africa is optional. We're are glad for the experience and glad to leave. We head first to the genocide memorial and it is effective. I cry through the whole thing. We sit outside in silence and put on our packs. When you look around this country you feel like you are looking at participants and victims and it's a bit haunting. People here stare and dont smile. More later..... computer dieing

Lake Bunyoni

To get to lake Bunyoni we hired a car from Bwindi. Much to our amusement we had a driver and his name was Jackson. Jackson annoyed us endlessly by asking us how he can catch a muzungu... which is a question we get asked like 5 times a day. "To catch a muzungu you must listen" we said " and have a boda boda, 5 goats, and an endless supply of chiapatis".... to this Jackson would always say "yes but how do you catch a muzungu" rendering him a lost cause. As annoying as he was- he let me drive and that was really fun till I backed the car into a hole. Not to worry- hakuna matata- me and some others just pushed it out again. If there is something I have learned in Africa- everything can be fixed, dont worry, just relax... if you dont know what to do just stand around and stare at your problem till something happens.
Our trip to Lake Bunyoni was a drive through the mountains- hence private transport- and it was beautiful. Farm land and jungle. At one point we looked at each other and realized we were really in the middle of nowhere. But 3 hours later we arrived at a town and asked Jackson to pull over so that we could take a picture of the farm land all over the mountains. When we got out we could hear "halo muzungu" echoing all over the mountains and when we squinted we could see little kids here and there jumping up and down and waiving, a mile away from us and each other. Lake Bunyoni was beautiful. We went and rented a canoe for a couple bucks and took it out to one of the islands. I turned out to be the only one who could steer the dug out canoe so I was dubbed Captian Jackie Sparrow for the day and my arms still hurt. Jackie, jessa, josey, justin- these are the names I respond to in Africa- mine is simply impossible. The way to paddle a dug out canoe is to go "slowly slowly" or else you do what is dubbed the "muzungu corkscrew" which we dabbled in for a few hours to begin with, going in circles and laughing. We even brought a local who proved to be useless at paddeling but at one point randomly blurted out that one could loose their virginity with a banana thus redeeming himself and becoming the butt of our jokes for the rest of the day. Oh Africa......

Bwindi Impenetrable Forest

The name lends itself to just about a million jokes but in all seriousness Bwindi is incredible. We took a 12 hour bus to get there and never even stood up once. At every stop people come on the bus to sell you fresh food anyway- we never noticed that we never got up which we realized means we are a little too used to Africa haha. So we took a truck through the mountains of Uganda to arrive at the Impenatrable Forest and it was stunning. Like many parts of the world - they farm landscape seemingly too steep to farm.. and people there dont see much muzungus- people just turned around to stare at us on the bus. In Bwindi it was different. A Gorilla permit cost us $400, so everyone there knows how much you paid and expect a cut for themselves. Despite this, we made a lot of nice friends in Bwindi and after a while they began to believe that we didnt have money pouring from our pockets. Seeing the Gorillas was nothing short of what it was famed by other travelers to see. There are 640 mountain gorillas in the world. I was 3 feet from one of them and he was looking me right in the eyes. We bushwacked through the rainforest following them for an hour. They are so human like. It was sweet to see how they took care of their young with such patience. Babies climbing everywhere, getting into all kinds of trouble, .. parents lounging, eating, scooping them back up. And when they travel the babies just hang on for the ride. I am so grateful to my family for pitching in for such an incredible Christmas present. You made me feel like a very lucky girl :)
In Bwindi we were impressed to see some really great programs that are actually working (this is not always the case). If you are looking for something nice to give your money to this season here are a couple of programs where the money is distributed responsibly:

Bwindi Orphan Development Center
http://sites.google.com/site/bwindiorphanage/

Bwindi Community Hospital
www.bwindihospital.com

Excerpts from my book:
A Long Way Gone by Ishmael Beah
Stories of a child soldier in Sierra Leone

From Rehab:
"Whenever I turned on the tap water, all I could see was blood gushing out. I would stare at it until it looked like water before drinking or taking a shower. Boys sometimes ran down the hall screaming "the rebels are coming". Other times, the younger boys sat by rocks weeping and telling us that the tocks were their dead family members. Then there were those instances when we would ambush the staff, tie them up, and interrogate them about the whereabouts of their squad, ammunition..... We were given school supplies and told to go to school between 10 and 2 but each time we were given supplies we would make campfires with them."

There are thousands of children soldiers around the world- but I was suprised to read that their are many in Uganda and 40,000 children commute in northern Uganda to larger villages so they wont be abducted at night and forced into serving.

New Years

Escaped to Kampala, Uganda- the capitol- for New Years and it did not disappoint. We met some of our muzungu friends from Jinja and went out. Nikki and I lost them- headed for somewhere more local and it was awesome. They shut down the street and had all the local artists perform till 6am. There were fireworks overhead and a snow machine snowing on us. They played the best oldschool, new hip-hop. Never in the states could you see your favorite artists performing all night. And they can dance.. Nikki and I danced all night long in a sea of Ugandans who just love to have a good time. No one was puking, no one was stumbling. Beer optional. It was impressive.

Jinja, Uganda

Uganda is a bit different. I hate to say this to all the lovers of Kenya but I think I like Uganda better. The people are friendlier, not so much prostitution, people don't hound you for money, and they even start with a fair price half the time.
Christmas- Nikki and I are staying on a Muzungu compound for our rafting excursion. It's well designed so that you never have to leave ;) However- we are addicted to local food and people. So we make some friends in town who invite us for Christmas. My christmas I spend cooking with 8 young women. They take us in like family and we work hard ;) Like I said Uganda is friendly. We go to church with them in a mud hut with beautiful fabric as the decorations. None of this strikes me as unusual anymore. In fact all I see is community and that feels very "Christmasy" to me despite the lack of familiar carols. Nikki hands me a dirty sock with rocks in it for christmas and an R Kelly Tshirt I had been eyeing for days. The rocks are for eating- like african vitamins- I wouldnt make this up. My christmas is complete. We go out dancing and it's packed. Its awesome. Territorial ugandans are fighting over women left and right and we are laughing and dancing. And then my whole family calls and I am so grateful that just like these Africans I am lucky to have my own community.
In the following days we recover entirely from Malaria but then eat pizza with telapia on it and get sick again haha.
We finally raft the nile which I call 'swim the nile' since we dump in every rapid causing me to yell at our guide "come on man, just give us one". And when 'the nervous nurses and dave' finally make it over our first rapid without flipping we are so excited that we are giving each other high-fives and missing half the time. Class 5 rapids - not a problem. But trying to kayak class 3s put me and nikki over the edge. I did it and with a huge smile. But I can say this "its no easy" and I was scared.