Monday, July 28, 2014

beach days and cows


We left our spoon-fed tours behind and continued on our itinerary with a flight to Zanzibar. I've never done so many inter-regional flights on a trip before but we had been forced to fly instead of go overland because of time constraints. Another indication of how Africa is not very backpacker friendly: long distances with slow buses. So instead of a 24 hour marathon to get to Zanzibar by bus and ferry, we did the 1 hour flight for brevity. Our flight was delayed 3 hours but it still beat a full day on a bus.

Our introduction to Zanzibar was jarring. We were driving from Zanzibar Town (also called Stone Town) to our planned beach holiday on the eastern side of the island at Matemwe Beach. Our taxi driver was a jovial and talkative fellow who went by the name Mr. Jomba Jomba. It was sunny. Palm trees were swaying. We'd caught our first glimpse of the turquoise waters of the Indian Ocean. Paradise. Bliss. And then we hit a cow.

Yep. A cow. Jumped out into the road and Mr. Jomba Jomba hit the brakes. Tires squealed and we were greeted to a Zanzibari thud as the cow hit the front of the car. Dust flew everywhere. Marya and I had been thrown forward but no injuries. The front of the car was pretty crumpled and the cow lay on the road, struggling to breath. A small crowd gathered around the car. Mr. Jomba Jomba was shaking. It was a fairly traumatic introduction to the island and we were very lucky that the car did not spin or flip or that the cow did not come up through the windshield. All in all it was an experience I would not wish to repeat. And it made me thankful that cows are kept in fields constrained by fences in Canada. Unfortunately the cow was killed to put it out of its misery. I felt so bad for the cow owner because cows are such an important investment in Africa and to lose one could be devastating. I also felt bad for our driver since his taxi is his livelihood. The car was still running and we were, of course, only a few minutes from Matemwe. The car managed to limp into town.

Underwater safari

After a lengthy search for a hotel which included me hiking an hour and a half in the midday equatorial sun, we finally arrived at Seles Bungalows. The bungalows are beautiful and there's a chill restaurant which serves some of the most incredible food I've ever eaten. Reasonable price (for Africa) and way, way better than our original accommodation plans: the overpriced dump known as Ally Keys Bungalows. Overpriced, mildew-laden thatched huts with unbearably large spider webs and a concrete cave called a bathroom with a shower head over the toilet. If you ever plan a vacation to Zanzibar, avoid Ally Keys Bungalows.

Now we were in paradise. Remote, white sand beaches and palm trees lining a turquoise ocean. This is the stuff post cards are made of. I didn't even think places like this existed anymore. I thought any stretch of white sand this nice would've long ago been engulfed by Mexican-style high rises and resorts.

Our main reason for being here, beyond doing mandatory sun-laying and surf-splashing, was to attempt to do our PADI scuba diving course to become certified to scuba dive anywhere. Based on my awful experiences snorkelling I was pretty nervous. But using scuba equipment the last four days, I will say that scuba diving is about a thousand times better than snorkelling (Mom, even you could do it, though you say you can't snorkel!). I hate snorkelling primarily because water always splashes into your tube and you end up choking and hacking after inhaling salt water. Its also tough because you are forced to swim on the surface, battling waves that constantly dunk you under the water and push you everywhere. You end up wasting so much time battling waves and currents that you can't enjoy the fish party beneath your feet. Scuba diving eliminates both these problems. First, you can breathe all the time and never have to worry about water rushing into your tube. I was skeptical at first of this "regulator" contraption that supposedly allowed you to breathe underwater. But over the course of four days, the small black mouthpiece slowly earned my trust. Second, you go below the chaos of the surface into a much calmer and serene world below. A serene world full of hustle and bustle. So many fish! So much life beneath the waves! I'm totally clueless about fish and underwater life because Calgary was not a place to grow up learning about coral reefs. Looking around in the water, I'm sure I saw more species of fish in 4 minutes than all those animals I listed that I saw on my safari in 4 days. It truly is a fish party. It looked like a reef straight out of Finding Nemo.

Breathing underwater made me feel invincible in the water because, let's face it, the main problem people have with swimming is that they can't breathe with water in their lungs. They have to struggle to stay afloat to reach that sweet, sweet oxygen on the surface. This limitation of mere mortals is eliminated upon donning scuba gear! You don't even need to TRY to stay afloat any longer! Just breathe and waves, splashing, bad weather and your friend dunking you are no longer concerns....assuming you have air in your tank.

One aspect of scuba diving that I never considered before was the experience of weightlessness in water. It's probably the most challenging aspect (because, if everything is functioning properly, then the only other skill you need is...breathing). Trying to stay weightless is hard because you constantly fill your lungs with air and then start floating away or you exhale and then drop like a stone. It's also hard because everything in water has such a huge delay that you need to start deciding if you're going to run into that piece of coral way earlier than you would on land. This is made more difficult because things appear 30% larger underwater, thus throwing off your depth perception and making you look drunk and foolish. Despite the challenges and initial fears, we completed our PADI Open Water training and are now certified to dive up to 18 meters depth!


In a week, I'll be boarding a flight in Nairobi to go back to a familiar world: Canada. Home. It feels like I've been gone a long time. Long enough that, while not homesick per se, Marya and I definitely have a list of things we want to do and will appreciate when we get home (most of them involve food haha). And, as undoubtedly happens as you near the end of a trip, thoughts of home come back to mind. And, at this time, certain things are calling me back home more than usual. It's raining here today, somewhat fitting for the events back home.

It has been a wonderful and amazing trip that has been so long and with such varied experiences that I don't think I have as yet fully digested the whole set of sights, smells, sounds, tastes and feelings. East Africa is certainly a region of the world that I hope to visit again. So many of my irrational fears about Sub-Saharan Africa were completely unfounded. Problems abound as I've talked about in great depth and experienced first hand volunteering for Ainembabazi, but that certainly wouldn't stop me from visiting.


Thanks for reading.

Wednesday, July 23, 2014

phase two: uhuru and ngorongoro


I will be back in Canada in less than one week! The time spent here in East Africa has flown by, as usually happens with trips. Our trip has clearly been divided into two very different sets of experiences. Our time living and traveling in Uganda and Rwanda felt like a very rich and rewarding cultural experience where we lived like "locals". We ate local food and took local transport and had many eye-opening conversations with doctors, teachers and random strangers, all who call Uganda home. I became accustomed to local quirks like the subtle wave of your hand to call a cab or the casual method of jay-walking even if a car is barreling towards you. Even after we had left Mbarara, our time spent traveling in southwestern Uganda and Rwanda still felt decidedly "local": hitchhiking, taking local minibuses (called matatus), staying in local churches, and even getting tours of the local Rwandan hospitals. We felt like we were well off the tourist trail and even kind of got used to everyone staring at us. They stared as if we were wearing a giant clown costume. So "local" remains firmly in quotes because throughout the experience, we were still wholeheartedly foreigners worthy of a stare-down.

After stepping onto a plane in Kigali and flying to Arusha, Tanzania, we entered a world of pure and uninhibited tourism. Our plans in Tanzania first began with a 6-day trek up Kilimanjaro, followed by a 4-day Serengeti safari and then capped off with a beach holiday on Zanzibar. This is the quintessential Tanzanian itinerary and the reasons are clear: climb the highest mountain in Africa for bragging rights, see lions and elephants while singing "Circle of Life" and then relax on beautiful white sand beaches with a cold drink. It's the classic tourist trail and if you ever come to Tanzania, I highly recommend the itinerary, even if it is cliché.

Marya and I were so proud of backpacking a wee bit when in Uganda and Rwanda but that stopped when we got off the flight at Arusha. From then on we were spoon-fed like children by a tour company called BaseCamp. The travel forums said it was hard to backpack Africa and it's very true; if you want to climb Kilimanjaro you are required to go with a guide and arrange your own transport to the mountain because no public transport goes there; if you want to go on a safari, you need special permits and your own vehicle. BaseCamp was our lazy man's solution. I've never been on a multi-day tour such as this one. I've never been picked up from an airport by anyone other than family. So it was strange (and admittedly wonderful) to be like a child once again and let someone else arrange your food, accommodations and transport.

The tallest man in Africa

First on our spoon-fed itinerary was to ascend to the lofty heights of 5895-meter Kilimanjaro. The itinerary was spoon-fed but the trekking was certainly not. However, if you ever feel compelled to drag yourself up to the places where the frigid wind never stops and the air is all like, "I'm too cool to be up here so I'll just thin myself out", then I would recommend BaseCamp as a tour operator. Midrange prices, but so worth it! As a disclaimer, our amazement with the company may have been because of our exceedingly low expectations after bad experiences with other treks and tour companies in South America. For the trek, we were joined by Chris and Joel once again after they had done their own thing in Rwanda following the end of their medical elective in Mbarara. Marya and I had told them some horror stories of our near-death ascent of 6088-meter Huayna Potosi in Bolivia, so we were preparing for the worst. Because of this, we had also opted to take the Marangu Route up the mountain which was purportedly the easiest. As an extra caution, we even included an extra acclimatization day at 3700 meters to try to maximize our chances of successfully standing on Uhuru Peak, the highest apex of Kili.

I don't for a minute want to make the trek sound easy...BUT, the first 4 days of the hike are relatively easy. The path is wide and clear and almost always a very gradual incline along rolling hills and valleys. Furthermore, if you're climbing Marangu, you get to sleep in private, wood huts for the first 3 nights. Marya and I were expecting shared shacks with tin roofs and thin air mattresses but the huts were quite nice and the mattresses were so thick that we all slept like babies on the mountain. Flush toilets and even (ice cold) showers (which we never used). There was a big communal dining hall and our cook was a legend. If you want amazing, delicious food for a whole week, maybe you should climb Kilimanjaro. We were so well-fed that I'm pretty sure I gained weight on the trip which, for those that know me, should be a physical impossibility of the universe. This is a trek that can theoretically be done by anyone; one woman was doing it on her own as her 60th birthday present to herself. We saw another group of women who looked well beyond 70 although we never confirmed their age and maybe they'd just failed at anti-aging techniques.

Okay, now that I've spent the last paragraph making the trek sound easy lets follow up with some ugly facts. Firstly, it's cold. Even by the second night, the nights are chilly and by the time you get to the 4700-meter Kibo Huts (the last sleep before summit day) you're in long johns and thick jackets even at midday. Secondly, summit day is hell. The first 4 days are RELATIVELY easy, while still tiring and dusty. The 5th day is hell. You go from 4700 m to 5895 m, a 1200-meter gain. You climb at night. We woke up at 11:30 pm and, in a fog, we threw on our 6 layers of clothing and ate a small "breakfast". The ascent to summit first begins with a gruelling four hours of switchbacks up a steep scree slope. This is followed by a psychologically gruelling two hours along a freezing, wind-blown ridge which contains several false summits that destroy all remaining hope in your soul. Thirdly, it's really bloody cold. Did I mention that already? I'm pretty sure I would've lost fingers to frostbite if Joel hadn't had extra finger-warmers. The frigid wind along the final ridge is numbing and makes you lose all sense of sound and feeling. Fourthly, the air is really thin. I was getting bouts of nausea from altitude sickness as far down as Kibo Huts. Shockingly, I didn't vomit as I think my body realized that vomiting would only be a waste of precious energy that detracted from energy that could be used to gasp for air. By the summit, I think all of us had mild headaches and I was definitely mildly delirious which may have been due to altitude but more likely due to lack of sleep. I was in a fog as I reached the summit. I thought we had lost Chris and Joel and our guide. I said hello to someone, thinking they were Joel but they were actually some random stranger.  We were walking so slow, possibly slower than a literal snail, simply because we could not get enough oxygen to our muscles to move faster. Marya and I managed to will each other onward up the ridge towards to the summit.

Okay, now that I've spend the last paragraph making the trek sound so hellish that no one would ever willingly think to climb the mountain, let me say first of all that we all made it! It's a battle and a challenge but we did it! I stood up there for a few brief moments as the tallest man in Africa. We also had a beautiful, clear night with a moon so bright that we didn't even have to use headlamps for most of the ascent as we climbed through the night. And a clear night was capped off with a gorgeous sunrise high above the clouds. It's 6 hours of hell but you get a 5895-meter sunrise at the top plus 6 full days (minus 6 hours) of good times and easy trekking. Plus, you get to go DOWN after summiting.

Memorable moments of the descent were when we were motoring down the ridge, flying at breakneck speed compared to our snail pace on the way up; we came to a slight uphill along the ridge and all four us attempted to continue at our breakneck speed up this imperceptible uphill section. It left Joel collapsed on a rock, Marya doubled over gasping for air and me with fresh waves of nausea washing over me. It was a quick reminder that, even though we'd summited, we were still well above 5000-meters and had to go slowly! Even on the most insignificant-looking positive grade. The second memorable moment was that scree slope I mentioned earlier. On the way up it was a hellish set of unending switchbacks. On the way down, it was a fantastic scree run! Bounding down Kili through soft scree was a great way to spend a morning. We lost almost 1000 meters of elevation in less than an hour. Sweet, sweet oxygen, beautiful and thick.

Lion King is so accurate

After our successes on Kilimanjaro, our remaining activities were a breeze. Now, all we had to do was sit in a jeep for four days, watch cool animals and eat delicious food from the same cook who joined us for both the mountain and the safari. We bid goodbye to Chris and Joel as Chris headed to Europe and Joel to Zanzibar. Marya and I thought our safari was going to be with a bunch of other people based on how they do similar tours elsewhere in the world. We were shocked to discover that it would just be us, a guide/driver and a cook. A private safari?! I was expecting to be crammed into a bus full of gawking tourists and carted around in a somewhat contrived safari that took us through what amounted to a large zoo. This was not the case. All in all, this was one of the most amazing experiences I've had.

If you find yourself in East Africa and feel disinclined from subjecting yourself to the rigours of Kilimanjaro, I can still wholeheartedly recommend BaseCamp as a safari tour company. I would also say that, unless you are an avid animal photographer nut or an obsessive bird watcher, a 4-day safari is plenty of time. If you're like me, then your sole goal of a safari is to see an elephant and a lion and say, "cool, bro" and I would say a 4-day safari is perfect. Some people go out there for 11 days and, honestly, I think I would get bored. Giraffes' long necks and goofy faces can only amuse me for so long.

I would also say that unless you are an animal nut or a creepy leophile, then don't waste your time at other parks. Do Serengeti and Ngorongoro Crater. It's famous for a reason. I never blogged about it, but I went on two safaris in Uganda and, after experiencing Serengeti, I can safely say the Ugandan safaris were a waste of money and time, compared to the fascination of the Serengeti. For me anyway, as a "cool, bro" kind of ignorant, gawking safari tourist.

Let me also say that with any safari, there is a huge element of luck in what you see. And Marya and I got insanely lucky in our short four days. First of all, if I haven't built them up enough already, our BaseCamp safari guide, Fityayo, was unbelievably impressive and very authentic. He would take us away from touristy areas and drive out to more remote areas away from crowds. I swear he could spot a pair of lion ears 5 kilometres away. The things he spotted were absurd. And, importantly, he TRIED to spot things. Other tour guides just use radios, don't even look and wait to get a radio signal from another guide telling them where the action is. Fityayo didn't even use a radio. He spotted stuff all on his own.

With the help of our guide, we were lucky to see all "Big 5" animals. Lions, buffalo and elephants are easy. But we were super lucky to see an elusive leopard and we spent 2 hours waiting patiently for him to move out of his tree. He finally did and we got to see him just as the sun was setting. We were even more lucky to spot a super rare rhino in Ngorongoro Crater on our last day. This one was particularly impressive because Fityayo spotted it first, before any other guide did and it was so far away! It was a grey speck that appeared small even in binoculars. Because he spotted it first, we got some time alone with it and it walked closer and closer to us. Soon, a few other jeeps had driven by and saw us looking and suddenly, via radios, all the jeeps in the crater were converging on us (and the rhino) to give their clients a good view. We left when it got busy and I felt a misplaced sense of pride at having been there first even though it was all Fityayo. All I'd done is sit there, being a tourist.

One more piece of ridiculous luck is that we actually got to see a female lion stalk a warthog through high grass in perfect Nala-Pumba style. We watched the drama for nearly 2 hours and, it sounds corny, but my heart was actually racing the whole time as we waited for the lion to strike. A stalking lion is a terrifying sight. I never want to have those eyes on me as a target. Finally, Nala lunged when she thought she was close enough but, in a flurry of dust, Pumba got away. I didn't see it, but what followed was probably a conversation with a meerkat and a recognition of long lost friends between Simba and Nala.

The number of animals in this place is absurd. Giraffes become common place. Elephants become "meh". I think in the four days we saw baboons, giraffes, elephants, lions, lion cubs, leopard, rhino, wildebeest, gazelle, hartebeest, hyena, hippo, crocodile, zebras, monkeys, warthog, cheetah, vultures, ostriches, buffalo, tons of birds and probably a few other I can't think of. It's insane. And I was a skeptic beforehand. I thought it would just feel like going to the zoo except in a vehicle. But, thankfully, it felt so much more authentic than that. The authenticity was increased by doing a camping safari. No fences around the campsite and if you had to go to the bathroom at night you were to check the surrounding bush for the glint of eyes and leave the tent in pairs and pee near the tent. At night we heard a few lions one night and a couple other creatures sniffing around and walking near the campsite. Who says you can't sleep in the lion enclosure in the zoo?


I'll talk more about Zanzibar in my next post!

Monday, July 14, 2014

backpacking africa


Before we began our trip, both Marya and I asked the question, "can you backpack through Africa?" I decided to seek advice from the trusty internet and started by scouring various travel forums such as Lonely Planet's ThornTree. It seemed the internet consensus was, "Not really. No one does it. It's more dangerous and more difficult than other backpacker-friendly places like Southeast Asia."

But here I was, riding on the back of a motorcycle, whizzing across Uganda with a backpack strapped precariously to my back, hanging over the back of the motorcycle. Every time the driver accelerated or went up a steep incline, I felt the weight of the backpack behind me, attempting to wrench me off the back and send me to a far-off Ugandan hospital. Here In Uganda, motorcycles-turned-taxis are called boda-bodas. Legend says that the first motorcycle taxis used to transport people from border town to border town and, because Ugandans like to make names obvious, they named them "border-borders" which becomes boda-boda when you put on your African accent. It seemed fitting then that we were bodabodaing towards the sleepy border post of Cyanika which would lead us on into Rwanda. 

Mgahinga

We had just spent two nights in the equally-sleepy, one-street town of Kisoro in the shadow of three classic, conical volcanoes. Kisoro SHOULD be a backpackers paradise. It is full of relatively cheap guest houses, chill cafés and incredibly welcoming and friendly residents. In the surrounding area there are hikes, treks, gorillas, lakes and even snake tracking (for all those people that love tracking snakes). But the guest houses were empty. The cafés longed for hippies with dreads to sip their delicious African tea. The town is ripe for tourism but, as far as I could tell, we were the only backpackers in town. Occasionally, a convoy of shiny jeeps full of pampered tourists would roll through town on their way to a private gorilla tour. They probably came straight from Kigali or one of the nearby $500-per-night safari lodges but they didn't seem to stay in town. 

Perhaps Kisoro is not the thriving backpacker town it wishes it was because it costs $700 each to go on a 4-hour gorilla tracking hike which we opted out of to save our bank account. All the tourist activities are prohibitively expensive in Africa which in many ways is beneficial because it stops the gorilla treks from turning into a zoo as people file through to watch the gorillas for the same entrance fee (and experience) as the Calgary Zoo. Kisoro may also be lacking in backpacking hippies because the town is a windy, 7-hour drive from Mbarara with no bus services and only hitch-hiking via Toyota Corolla as the transport option. Or maybe it's because this town in southwest Uganda is only 5 km from the Congolese border where jungles are supposedly teeming with rebel groups, land mines, rape and murder. There are certainly reasons why this is off the backpacker trail but Marya and I were loving it. We basically had the town to ourselves. No touts. No scammers. No tourist traps. Just genuinely friendly, helpful people who give you a good price and reliable information. This could easily be the next backpacker trail following in the footsteps of Laos' hippie trail, assuming the Congo cleans up its act and Uganda brings tourist-friendly bus services to town. 

A year or two ago, the leader of a major Congolese rebel group was captured on the Ugandan side of the border about 3 km from Kisoro in nearby Mgahinga National Park. Mgahinga was the park that housed those three, picture-perfect volcanoes I mentioned earlier and it was Mgahinga that had brought us so far off the tourist trail as we aimed to climb the second highest of the three volcanoes: Mount Sabinyo. To ease my mother's worry, the Congo has supposedly become more stable in recent months and it was unlikely that rebel groups would be roaming the park. As an extra assurance, we were accompanied on our hike by a guard with an AK-47 who said the gun was primarily for insurance if we came face to face with an angry elephant or water buffalo. Perhaps this is more cause for worry because now we had to worry about rebels, angry elephants AND the guy with the AK killing and robbing us at gun point in the remote national park. So, you may be asking, why were we climbing this volcano? The somewhat silly and trivial reason for climbing the 3700 meter volcano was because the peak lay at the tri-point of three countries: Uganda, Rwanda and the Democratic Republic of Congo (DRC) which was a pointless geographical oddity that somehow made the mountain more appealing. The more practical reason for doing the hike was in preparation for our assault on Kilimanjaro planned a week later in Tanzania. It would be good to get our hiking legs back. 

The hike up Sabinyo was --in a word-- exhausting. The majority of the hike was along steep, mist-shrouded ridges that shot up to the sky like knives. The mist was thick and dulled all noise except for your own panting as you climbed higher and higher. Much of the way was so steep that they had installed rickety and precarious ladders that we had to scramble up; this was made all the more difficult because of the ever-present mist, which soaked the ladders into slippery death traps. The summit was anticlimactic because of the mist. I climb mountains for the views and the mist dampened that experience (ha!). But we did eat lunch in the Congo and I wasn't immediately swarmed by rebels, so it wasn't all that bad. Our guide didn't shoot us in the back and throw us off the steep, spindly ridges, nor did we encounter a rampaging elephant. On the descent, the clouds parted and we were rewarded with some great views of Kisoro, the Congolese jungles to the west and Rwanda's rolling hills to the south. We couldn't enjoy the views much because we were busy descending those slippery ladders which required great concentration. By the time we landed back in Kisoro, our legs were jelly. The hiking legs we meant to get back turned into screaming-pain legs the next morning. We could barely move. 

Rwandan hospitals

But move we did, on into Rwanda via boda-boda to Cyanika and then minibus from Cyanika to Gisenyi. Gisenyi is a city of about 400,000 lying on the shores of Lake Kivu with its western city limits marked by the Congolese border. Across the border is the city of Goma which has been in the news as the major centre in war-torn Congo and the major base for UN and other aid organizations in the Congo. It was attacked by rebels a few months ago, but the UN recently increased their manpower in the region and the UN, along with the Congolese army, have pushed the rebels back deeper into the jungles. Goma has also been in the news because the city was destroyed in 2002 by the eruption of nearby Nyiragongo Volcano. Lava flowed through the streets and buried much of the city like a modern-day Pompeii. Nyiragongo loomed large on the horizon. It was only about 5 km from Gisenyi. I have dreamt of climbing the volcano for years but, sadly, the volcano is currently closed to tourism. The Belgian director of Nyiragongo's national park had been shot a few months ago in the park, the corrosive ash spouting from the bubbling lava lake has destroyed the huts and rebels have lain landmines on the trails. Now, I love adventure but there is a line between adventure and stupidity. I left my Nyiragongo-climbing shoes behind for another day when the region is safer.

If rebels, landmines and lava aren't enough to deter you from the region there's more! Lake Kivu is a lake that will kill you if you aren't careful. The lake has been known to have "limnic eruptions" which are basically large amounts of CO2 and other gases which erupt from below and rise to the surface. Depending on wind, the cocktail of poisonous gases will glide into town and kill you by asphyxiation. The eruptions are rare, but we were still told not to swim in the lake unless you see locals swimming as well. And if the others' swimming turns to dying, then maybe you shouldn't swim there. 

So, in this land where everything is trying to kill you, it only seemed fitting that Marya soon developed a violent fever and stomach pains the first day we were there. I convinced her to go to the hospital despite her objections as she pretended to be fine while shivering violently. Marya had just spent a month treating people as a docta in a Ugandan hospital and now the tables had turned and she was the patient in a Rwandan hospital. The whole situation was made more difficult because most well-educated people in Rwanda speak fluent French but poor English. I also got to experience firsthand the inefficiencies that Marya had been telling me about for the past month. First of all, you have to pay for everything; from the meds and needles to the gloves and iodine the doctors use, you pay for it all. But, for some reason, the place where you pay and the place where you pick up meds and supplies are at opposite sides of the hospital grounds. So every time a doctor prescribes something or needs a test done, a family member or friend of the sick person would have to go wait in a massive line up to pay and then walk all the way across the hospital to wait in another massive line to pick up the meds or supplies. It was insanely inefficient. Despite the inefficiencies that seemed so reminiscent of Uganda, Rwanda's medical system was slightly better in terms of procedures, methods and availability of medicines and supplies. They actually cleaned areas before jabbing needles and had proper vacuum tubes for taking blood and stuff. 

It was a rough night in the hospital with Marya on rounds of IV medicines to get rid of the pesky parasites partying in her gut. Gisenyi was not a fun city. The hospital and the many geological methods of death aside, it still made me uncomfortable. The roads were all gravel and there were no street lights at all. The sun set at 6 pm and after that, the streets quickly emptied and became dark, dusty and dangerous. The layout of the city was very confusing and spread out making it difficult to get around. All I wanted was a good, quick, reliable meal that I could eat and bring leftovers to Marya. Subway? Opa? Earl's? Nothing. Never had I craved food from home so much. When your wife is sick in hospital, you don't want to be wandering around a foreign city, lost and in the dark, searching for a bite to eat. 

But hey, don't let any of this discourage you from visiting Gisenyi. Lovely city. 

Kwibohora 2014

We were very fortunate to arrive in Kigali, the capital city of Rwanda, on July 3rd, just one day before the 20 year anniversary of the end of the 1994 Rwandan genocide of the Tutsi. It was a weird twist of fate that Marya's sickness forced us to change our original plans so that we ended up in Kigali earlier than intended. She was on a concoction of drugs to stop the parasite party and was feeling significantly better but we still decided to head to Kigali earlier  so that we would be nearer to larger and better medical centres. 

Thus we ended up at Amahoro ("peace" in local language) Stadium in Kigali on July 4th which is Liberation Day in Rwanda. This day marks when the militia group known as the Rwanda Patriotic Front (RPF) entered Kigali and stopped the genocide. The RPF was then considered a "rebel group" lead by Paul Kagame. Twenty years on, Paul Kagame is the much-loved president of the small country and has helped lead the country to greater prosperity, as it is now one of the fastest growing African economies. Rwanda has made leaps and bounds in almost all indicators of development in the last 20 years, from healthcare to education to internet infrastructure to gender equality. 

I think Rwandans have a lot to be proud of considering the country was in ruins 20 years ago, with a million dead bodies littering the streets and bitter tribal divisions that led to deep distrust of even your own neighbours. It's impressive that the country rebounded and rebranded everyone as "Rwandan". The government no longer even acknowledges tribes. And in Amahoro Stadium, the stands were full of young Rwandans, many probably around my age who would have only been young children when the genocide happened. The presidents of Uganda, Kenya, Tanzania and Ethiopia were all in attendance as well as delegates from embassies for countries around the world. There were lengthy and impressive military formations, marching bands, traditional dancers and much pomp and circumstance. It was very cool and really gave a great taste of Rwandan culture considering we were only in the country for a short week. 

Paul Kagame gave a speech focusing on hope for the future and learning from mistakes. It was a very optimistic speech but the whole stadium certainly had a somber air around it. People sat quietly in the stands. There was some cheering and applause but most of the time it was shockingly quiet for a crowd of thousands of people. It blows my mind that everyone in that stadium over 20 years old likely witnessed or participated in slaughtering their fellow citizens. 

While in Kigali, we also thought it fitting to stop at the Kigali Genocide Memorial, which houses a very informative and disturbing museum about the events surrounding the genocide. I found that the most shocking part is how neighbours, friends, employees and bosses all turned on each other. Regular citizens participated. It leaves you with the eerie feeling as you walk around Kigali and see 40 or 50 year old men walking past you and you contemplate how many of them have hacked or stoned someone as part of a disturbing act of genocidal mob violence. The depths of human violence are often unfathomable. 

The disturbing facts of the past should not dampen the optimistic hopes for the future. Rwanda seems to have done an incredible job of learning from their mistakes and moving on. It seems to have been a concerted effort by the government, the military and the populace to create a highly successful state. It is a great example of the people themselves realizing how superficial their differences are. The end of the genocide was not imposed by foreign powers, it was brought to an end by the people themselves. As I read the news about tribal or sectarian violence in Central African Republic, Sudan, South Sudan, Syria, Iraq and Somalia, I wish more people could somehow, by some impossible act of popular consensus, follow Rwanda's example. 


Between the brutal hike, the hospital trips in Gisenyi and the depressing history lessons in Kigali, it might sound like our short 10 days backpacking through southwestern Uganda and Rwanda wasn't enjoyable. That's far from true. It was a great time with many memorable moments. It's a beautiful area of the world. In fact, it's one of the few places where I already have a list going of the things I want to do when I come back! It was a very brief experience, but we did manage to backpack through Africa, taking local transport rather than private safari jeep, staying in churches rather than posh hotels and eating at -- ok, food is our one weakness as we definitely ate out at fancier Western-style restaurants! I could go for some Subway right now...

Friday, July 4, 2014

village life in development


I hope you enjoyed Marya's post about the hospital. As long as you weren't squeamish about cauterizing and needles and tubes in horrible places, it should've been an enjoyable read. She kept it tame and failed to mention the time when I hid in my room as the three of them repeatedly stabbed each other with IVs for "practice". From my room I heard various comments like, "oh man, that was a great vein!" followed by "get some towels, we've got to mop this mess up". Marya appeared in the room with bandages on her hands and a crazed look in her eyes sniffing the air for the smell of fresh blood. In summary, doctors are weird.

Kyabugimbi Bushenyi Nyemyerande Kitwe: What a mouthful

There's no way to put this nicely: Africa is quite poor. And rural Uganda is probably one of the poorest areas of one of the poorest countries in all of Africa. I spent a short 4 days staying in a village called Kyabugimbi which is located in the rural district of Bushenyi, about 2 hours west of Mbarara. The village is 40 minutes from the main highway up a narrow dirt road which winds its way through the beautiful hills and valleys. This is a land where no kid wears shoes and walks 5+ km to school daily. This is a land where younger children who recently stopped breast feeding have swollen bellies from malnutrition as their bodies transition to a diet of cooked bananas. This is a land where everyone lives in mud huts and grows their own food, and anything they don't eat they try to sell at the local markets. This is a land without cars, without electricity, without indoor plumbing, without internet, computers or even cell phones (while cell phones seem to be ubiquitous in Mbarara and Kinoni). This place made Mbarara look like a modern metropolis full of modern conveniences like pavement and metal. Despite the poverty, it cannot be overstated how gorgeous the country is. It is full of lush green valleys and hills filled with banana plantations, fields of cassava, and dotted with mud huts and small villages. The whole landscape is criss-crossed with footpaths and trails linking houses. It was those footpaths that I became acquainted with over four days as I walked between 5 and 10 kilometres each day, conducting surveys with local families in the nearby villages of Nyemyerande and Kitwe.

There was very little English in these poor, rural locales and so I had been joined by Jane, the field coordinator for the Ainembabazi Children's Project (ACP). She had grown up in a nearby village but had managed to finish high school and attend college and now acted as my translator for the week in conducting the surveys. My teaching experience in Kinoni had little to do with ACP's direct work although the organization does have connections with the school. ACP's main program is out in Bushenyi district, working with kids and their families to improve the standard of living in the communities. About 30 kids in the villages are involved with the program and ACP has donated various bits of infrastructure to the local schools such as water tanks, libraries and teachers' living quarters. The organization has now just begun a pilot project giving micro-finance loans to the students' guardians in an effort to promote business and economic growth in the community. The pilot project currently involves just 6 guardians.

My task here was two-fold: first, I was conducting a survey for about 15 of the students, gathering basic information and ensuring they were maintaining their grades. The second part of the assignment was to conduct another survey for the guardians; for those 6 guardians who had received a loan, I was to determine how they used the money and ask questions about whether the loan worked to improve their financial situation; for those other guardians who were not yet part of the loan program, we were to give a similar survey to see if they needed or wanted such a loan.

It was a very interesting experience in so many ways. First, I got to see just how poor the rural education system is. Almost all the kids were failing their classes despite being first, second or third in their class. Second, I got to ask very pointed questions about the financial status of these poor families. Because of the nature of the survey, I ended up asking somewhat awkward questions that I would never have asked otherwise for fear of being rude or culturally insensitive. This included questions like: "do you struggle to pay for school fees?" or "is there enough food at home to feed your family?"

I think this week really highlighted some of the ideas I had been thinking about throughout my volunteer experience with regards to inequality and development. I've summarized these into 4 "lessons" I've learned through a variety of experiences.

As a disclaimer let me say that when I was in Nyemyerande or Kitwe I felt that the cultural gulf between me and these rural Ugandans was just too great. I could not fathom their mindset or worldview. I could only speculate about their wants and desires and hopes and dreams. I couldn't even begin to empathize with them because I felt as though I couldn't put myself in their shoes. Partly because they don't even have shoes.

Lesson #1: It's not about material possessions

This is something I'm reminded of time and time again when I travel. Material possessions are not a very good indicator of happiness or satisfaction. I find that we (as in Western foreigners) tend to place a disproportionate focus on material goods, money and the lack thereof. We see them in their mud huts without any modern conveniences and feel some sort of misguided sympathy for them that they don't have such things. As I walked around the villages, visiting these smiling and warm families, I often found myself thinking not why they had so little but why we have so much. They get by fine with a small hut, with a shared bed and a charcoal stove. They get by fine without computers or cars or microwaves or junk food or Walmarts or all this other clutter in our lives that we use to distract ourselves and make our lives maximally efficient so we can accomplish as much as possible all the time. They don't need any of it to survive because they have been surviving as they are for hundreds of years.

Lesson #2: Canada is better

It may not be about material possessions but it is quite clear that Canada has superior infrastructure. Canada is objectively better than Uganda. It might seem harsh or insensitive but it's true. Uganda is a wonderful place and there are pros and cons to the different cultures and lifestyles but Canada's pros outweigh Uganda's considerably. This is evidenced by the fact that Canada takes in thousands of immigrants every year. I have had teachers, students, taxi drivers and random strangers here ask if I can take them to Canada. I have had people ask how they go to Canada or if I can arrange something with the Canadian government to take them there. They are a happy people but it's not just me who thinks Canada is better, they seem to also agree. And, material possessions aside, Canada has wonderful things like: public healthcare, an awesome education system, well-stocked fridges, stores full of endless brands of things as mundane as crackers, consistent electricity, indoor plumbing, a strong currency, a wealth of natural resources, curb-side garbage and recycling collection, smooth roads, and a thousand other things which can safely be said to be much better than the alternatives present in Uganda.

The discrepancy between material possessions does not concern me. The discrepancy in infrastructure, healthcare and education is the most surprising. Canada is an amazing place to live and it is a strange act of fate that, by no merit of my own, I was born in a place such as this. But, like with material possessions, the norm is to have such things as indoor plumbing and smooth roads. How many times have I complained about the pot-holed roads in Edmonton? We, in Canada, EXPECT smooth roads. We EXPECT quick healthcare service. We EXPECT to have indoor plumbing. No home builder would build a house with squat toilets because no one would buy the house. These higher expectations can make us look like huge snobs relative to Ugandans. I feel like a recent Ugandan immigrant to Canada would be amazed and astounded by every piece of infrastructure that we take for granted. The Ugandans have an amazing ability to put up with terrible circumstances largely because they don't know any different since they have spent their whole lives putting up with the corruption, inefficiencies and the long bumpy road to Kinoni. Infrastructure, education and healthcare are the backbone of development and perhaps on these issues, Ugandans would do well to be brought up to Canadian standards so that they to expect to be healthy, educated and with access to roads, water and electricity.

It is in this regard that I feel most saddened for the people. Time after time on the survey, the students mentioned that they did not have enough food at home. Time after time on the survey, the guardians told us they struggled to afford school fees or textbooks. They are lacking in material possessions and also in necessities. But they are quite a happy people. I spoke to Jane about it and she basically said that the vast majority of Ugandans are happy with their place in the world. They are extremely thankful for what they have. They never complain. They have a love for life and a wonderful communal culture. They chat happily with strangers. They are smiley and energetic and I don't know if I should feel sympathy for them. Sympathy spurs aid but they are fine in many ways on their own. They are a capable people that can build their own way and development aid often seems like meddling. It's a conflicting feeling that I have. They don't need our pity but it also seems clear that our infrastructure is superior.

Lesson #3: Pave it and they will come

Despite those conflicting feelings, I will say a few things I've learned about development here.

Our first weekend in Uganda was mine and Marya's 1st wedding anniversary and we decided to celebrate by traveling to the beautiful Lake Bunyonyi about 2 hours southwest of Mbarara. We stayed in a nicer hotel which met our expectations and standards as Canadians. Indoor plumbing, electricity, wifi, and a beautiful view of the lake and surrounding countryside. We felt a bit like snobs especially after everything I just said regarding infrastructure and materialism. It was here that we met a lovely British couple who lived in nearby Kabale and were also staying at the Birdnest Hotel. The husband was the lead engineer for the engineering firm that had been contracted to pave the road from Kabale to Mbarara (which included the horrible stretch to Kinoni). This road upgrading project is part of a massive multi-government project to make a continuous highway from Mombasa, Kenya to Burundi (around 2000 km of road). It has funding from both the EU and China.

Roads bring economic development. They spur the transfer of goods, ideas and resources. They make the countryside safer by enabling faster communication and response of police or military. A good road network is the key to developing a country economically. This British engineer spoke about the lawlessness of the Democratic Republic of Congo (DRC) because of a lack of interconnected road networks. Southwestern Uganda used to be in similar shape with banditry and disappearances being widespread. But since the government began upgrading, paving and building roads, the country has become much safer. Trade has also increased both within the country and via international trucking. A new road means a new gas station which means a new convenience store and a new hotel for stopovers and it all snowballs into an overall bigger and healthier economy.

The conversation with the engineer was brief, but the more I thought about it the more I realized how brilliant road-building is as a form of development aid. It's a form of aid that I feel like most people don't automatically think of because we are focused on healthcare and education as per below.

Lesson #4: Good healthcare needs fewer babies

Every student I visited in Bushenyi had at least 5 siblings. The most I saw had 9. The least I saw had only 1 but that was because the two parents had died of AIDS before they could produce more children. These people now have access to a clinic in Kyabugimbi which can provide medication and treatment. They also now have one of the best hospitals in the country only a few hours away in Mbarara. As the healthcare system slowly lumbers toward a higher standard, the education system must follow. If people are educated, they tend to have fewer children. Currently, people are still producing many children, expecting some to die due to diseases which are now treatable. Furthermore, they are still producing children despite the fact that children are now a financial liability because of school fees. Before, kids could be used to help in the fields and markets, and some families still opt to have their kids work rather than pay for them to be educated. Uganda is already one of the fastest growing populations in the world and it will only get more pronounced if the infant mortality keeps dropping while the birth rate remains the same.

On the Thursday before we left Mbarara, we invited the medical residents over for dinner. These were the residents which Marya, Chris and Joel worked with most closely during their time at the hospital. Ishaq, one of the particularly chatty residents with a shockingly deep voice, began talking about the state of Ugandan healthcare and education. The education system is certainly lagging considerably behind the healthcare system in terms of attaining a Canadian standard. The schools are awful, overcrowded, and expensive. The teachers are underpaid and often lazy. The gap in quality of education is also very apparent between a city school and a rural school. The schools out in Nyemyerande and Kitwe were in rough shape. The teachers often left early and simply didn't teach their afternoon classes. Most teachers spoke little English despite the governmental requirement to instruct classes in that language. The buildings were literally crumbling to the ground. The textbooks were in tatters. Of all the students I interviewed, all were failing except one exceptionally bright girl named Rinah who managed to get high 80s in most subjects except, surprise, English.

I think the reason for the lag in educational quality when compared to health is because investment in education is very slow and intangible. It is very difficult to measure the efficacy of an investment in education. And, because of this, a potential donor may opt for a more tangible place to give money. With healthcare, a donor can give a hospital a new piece of shiny medical equipment that does a specific task that can save lives immediately. But with education, so much of the quality is determined by the teachers themselves rather than the supplies. There's no point in donating more chalk and desks if the teacher leaves halfway through the day. There's no point in donating English textbooks and new library buildings if the teacher isn't proficient enough in English to instruct the students. I think this is the biggest challenge facing Ugandan education. It's not a lack of supplies or resources but rather a lack of good, motivated teachers. Just this month, the government announced a 25% pay increase for teachers countrywide. That will help teachers be able to work more at teaching rather than holding down a second job to generate extra income. But what they really need is stricter requirements for teaching as well as bigger incentives to work in rural schools. Some of the teachers at the rural schools hadn't even finished high school themselves, and they were already teaching primary school.

Uganda has the goal of mandatory public primary education. They're far from that goal but one of the big things I've learnt about "development" is that it is not a task for the impatient. These things will take years and years and there is no formula for success.


And so, with that, we have finished our segment in Mbarara. It was a wonderful experience and so many people have asked Marya and I when we are coming back. For them it is "when", for us it is "if". It would certainly be nice to come back, but these opportunities don't come up very often. Many people here don't seem to realize how far away Canada is nor do they realize how expensive it is and how rare it is that people in Canada have months off at a time.

It has been good. All good things must come to an end. Now we move into the travelling phase of the trip with plans to first hit Rwanda for a week before flying to Tanzania to tackle Kilimanjaro.

Wednesday, June 25, 2014

docta!

I'm getting way too used to my role here. At home I shudder when someone calls me doctor, because I am soooo not qualified yet. But here, I respond to "excuse me, docta?" multiple times a day, and I'm beginning to enjoy it. Also, because the nurses here wear matching dresses and tiny little hats (like the size of a teacup), I never get mistaken for a nurse. I'm also getting used to a very different outlook on what health and healthcare means in Uganda (and much of the developing world) as compared to home. In Canada, the hospital exists for sick people to come and return to health. In Uganda, it exists for people to come when they are often about to die, and by being there they may avoid this inconvenience, and will be promptly sent home when they are no longer at death's doorstep. Returning to health is not always part of the package - there's simply not the space or resources. You may need to go home for that part. In addition, everything costs money. It's easy to forget when you go to the hospital when you're feeling a little under the weather that the painkillers or IV fluids or X-rays or CT scans or blood tests are all paid for from a secret fund somewhere. But here it comes directly out of your pocket, and when you are making less than $100 each month, this becomes a large burden.

On one of my first days here, I was hit with the repercussions of not having this nice little thing called Universal Health Care. Chronic kidney disease is a scary disease for anyone, anywhere, and the definitive treatment is eventually a kidney transplant that might take a while to receive. In the meantime, one has to undergo regular hemodialysis, during which your entire blood volume is flushed through a machine that filters out all the toxins in it, essentially making urine so your kidneys don't have to. This takes several hours and you are required to do it multiple times a week while waiting for that phone call that tells you there's a kidney available for transplant. Hemodialysis is nothing more than a intermediate treatment to keep you alive in the meantime. When our patient presented with chronic kidney disease that had gotten incredibly severe, I inquired, obliviously, "how does the transplant program work in Uganda?" To which the response was, "There is no transplant program in Uganda."

Here I was stumped. In the weeks that have followed, I have continued to be hit with the hard reality that the definitive treatments for many illnesses and diseases is simply not available here, due to lack of resources or funds. In this particular instance, I learned that the only way to get a kidney in Uganda is to either fly to India or South Africa, all, of course, at direct expense to the family. Moreover, you never know how long it will take for the kidney to become available, so hemodialysis must take place in the meantime, multiple times a week, at about $100 per session. So begin to imagine around $1500 per month, for an unknown number of months or years, followed by a flight to India, followed by the costs of actually having the surgery, then the costs of recovery, then the costs of returning home, then the costs of follow-up, then unknown potential complications for the rest of the person's life... and the patient is only 16 now. And any one of these steps might not be survived by the patient in the first place. Let's not forget that this family makes less than $100 each month. This particular situation almost made me cry.
Debt doesn't exist in the way we know it in Canada, where everyone has a mortgage, multiple credit cards, lines of credit, or families to borrow from that they will be able to pay back in a few years. This financial burden could simply never be managed. The family would bankrupt and starve themselves trying to cover the first few weeks of dialysis. We all know counselling patients is a big part of a doctor's job anywhere. Counselling takes on a whole new meaning when you're telling parents that it makes the most sense to let their 16-year-old daughter die rather than destroy their lives and their future trying to keep her alive for a few more weeks until the funds run out. Yet this is a conversation that is had by every doctor again and again for diseases that would be treated aggressively in any developed nation. Imagine chemotherapy and the decisions that must be made there. In the few weeks I've spent here, I have been present during many of these discussions, and the sorrow is massive. Very few life-prolonging measures are available or affordable. Some illnesses simply have no cure here.

It is not to say that there is no one who can afford the extensive care required for extremely sick patients. I have worked with a handful of wealthier patients, who you can generally pick out because they speak English and have been educated to high school and beyond. I use the word "wealthy" very loosely here because wealth is always relative. And many patients can afford a certain number of procedures and tests and medications, but every family has a limit of what can be afforded, and it's always a bit different. There also exists what is called the "PPF", or "Poor Person's Fund" (quite aptly named), and some desperate procedures and medications can be purchased out of that fund, but it needs to be used quite carefully to ensure its availability when most acutely needed. Just recently the doctors used the term "blanket sign", which they asked if I understood and I shook my head. They laughed at me and told me that when assessing patients and trying to determine what they will be able to afford, you can look at their blanket (patients are required to bring heir own bedding to the hospital). They said here in Africa, the patients will bring the best blanket/bedding they own to the hospital with them, so by looking at the state of the blanket, you can make assumptions about their socioeconomic status. A ratty blanket full of holes might indicate that they will not be able to afford even a blood test, while a lush, clean, quilted blanket means they will likely have the funds to pay for all treatment recommendations. This allows the doctors to plan treatment options that will hopefully be within the patients' budgets without offending them.

On the patient's chart, "occupation" is commonly listed as "peasant", which is a word that I've only heard in Canada coupled with the word "-vision", when referring to those unfortunate enough to only receive 3 channels on their TV. But there seems to be a large number of charts with this label on it. I don't fully understand what it means - "peasant" as in below the poverty line? "Peasant" as in currently unemployed? "Peasant" as in homeless? Never had a job? On sick leave? In Canada, you would usually use one of the above terms, because surely, everyone must be either in between jobs or a student. Not so in Uganda. Peasant can mean peasant for life.

I am also staggered by the number of charts labelled "NYY", which is code for "HIV-positive". This is done to keep some semblance of privacy for the patients when they are lying in a bed that is in the middle of a large room with 30+ beds lined up. Although the national HIV-positive statistic puts the number between 9-14%, it seems that close to half of the patients we see are NYY, and one doctor suggested up to 90% of inpatients at times. This is due to the major complications that can come with a positive HIV status, generally due to their immunocompromised status (much like someone on intense chemotherapy can catch any and all infections they are exposed to due to a severely compromised immune system). The worse the disease gets, the more illnesses that occur, specifically and primarily Tuberculosis. This disease is a huge jerk, and takes over all parts of the body whenever it feels like it, and wreaks all kinds of havoc. It also damages your immune function, so you can imagine that when TB and HIV get together they cause massive problems and a lot of death. I am learning so much about both diseases, which won't actually be all that helpful when returning to Canada. Both are rare, and when they do exist, there are specific clinics and specialists that are trained to handle them. But in Africa, you would be a fool NOT to know all the ins & outs of these diseases.

There are some things about practicing medicine here that might be considered "better", usually in that they're easier. However, this often also is as result of poverty and malnutrition. Never yet have I had to struggle to fit a blood pressure cuff around an arm that is too big. I don't struggle to hear audible breath or heart sounds through layers of fat, or have difficulty palpating organs through massive obesity. Many things that are internal are extremely easy to examine externally. Nutrition counselling focuses on "you need to eat more, and these are the best high-calorie foods to eat," rather than the complete opposite. Patients here also are so appreciative of the work you do and thank you for your assistance. Even in the cases where a patient sadly passes on or is faced with a difficult diagnosis, the family thanks you for your effort and your presence. I haven't yet met a grumpy or demanding patient. Rather, the people I have met here are some of the friendliest I have met anywhere, and always grateful. Also, they are sick. This may sound bad, but it is better than having a patient with a bout of gassy cramps in the ER in a panic or crying over a particularly bad paper cut. If they've come to the hospital, they really need to be there. However, this doubles as a curse, because the patients who arrive at the precipice of death have not had the luxury of a family doctor who could help manage their diabetes or run regular tests of their cardiac function. It is such a gift that we take for granted that we get to go for yearly physicals to make sure we're in good shape. (Which we all go for, right? RIGHT?!)

The way tests are done, results are received, and patients are cared for also varies wildly from home. Each patient has with them in the hospital an "attendant", someone who stays with them and is responsible for all of the above. This tends to be a family member, and people find themselves in a very difficult situation if they are without an attendant. When blood is drawn, it is given to the attendant, along with a requisition form, and they are required to take it to the lab, pay, and go back to receive the results at a later time. This also goes for sputum samples, urine samples, stool samples, etc. If the patient needs an x-ray, ultrasound, CT, etc, the attendant is also required to get the patient to where they need to be in order to pay for and perform that test. This becomes very difficult when the patient is not able to walk. Many family members will band together to carry a patient or perhaps find a wheelchair if they are lucky. We have a wonderful nurse/porter team in Canada who provide these services, making getting tests and results virtually effortless on the part of the patient and the family, but if you are without an attendant here, you are in a very rough spot. They are also responsible for feeding the patient and helping the patient relieve themselves (which usually means helping them squat down into a bucket next to their bed). Adding up all the patients plus attendants in the wards makes for a very busy, very LOUD, very un-private place to do rounds, histories, and physical exams - generally there are about 60+ people in the room, especially when you include the extra mattresses along the floor for the overload. It would be very difficult in Canada to get someone to join you in the hospital 24/7 to attend to your every need and meal - who would your attendant be? For SURE every one of you just said "mom".

Our hours vary day to day, but generally start around 8 or 9 with a case or research presentation, followed by Post-Take. This is when whoever was on call the previous night presents any new patients that arrived in the emergency department who are being admitted for treatment. Ward rounds with interns and residents follows (residencies are NOT paid positions here, so residents in Canada, be excited!!), which takes several hours, and what is left of the afternoons is spent on procedures, clinics, research, or in the emergency department. Afternoon Post-Take (whoever showed up to the ER during the day), is supposed to start after 5 sometime, so generally our days wrap up between 6 and 7. Whichever of the 4 of us is making dinner that night will take a few hours off in the afternoon to get ingredients from the street market and prepare food for when everyone else gets home. We have become quite adept at cooking with very limited kitchen equipment, one working element and a stove that only broils and has 1 temperature setting. We also make our toast over that one element and flip pancakes with a fork. (Please go thank your toaster and metal spatulas right now.) The hospital is across the street from the housing we are staying in, so the commute has been incredibly convenient (~5 minutes door to door).

The emergency department is divided into 2 sections: One is Internal (where we work), which is pretty self-explanatory, as it includes heart attacks, kidney disease, asthma, liver failure, DKA, headaches, vomiting and diarrhea, psychosis, etc. The other is anything trauma-related or musculoskeletal in nature - essentially anything you can see. Blood, breaks, bullets, car accidents, falls - basically whatever would likely end up in surgery if it was bad enough. This distinction can sometimes be very vague, and I think would be a point of stress in Canada, as so many problems could be classified by one or the other, or both, and would result in patients being sent back and forth. This happens here quite often, and it means patients aren't always getting prompt treatment. However, it allows specialists to work specifically with the patient population that they are best trained to care for. The doctors here are incredibly knowledgeable, excellent teachers, and have been so welcoming to us as we try to get our bearings and absorb all the information being thrown at us. I have a deep respect for these physicians working in an environment that is not always ideal, and giving patients the best possible care despite lack of funds and unavailable resources. I think knowing a specific treatment was available but not being able to provide it as an option would be very frustrating, but they doctors here work within what they have with grace.

Napoleon described medicine as "the science of murderers" after surviving a severe bloodletting. If you were unfamiliar with medicine and what it entails, I can understand why this might appear to be true. Medicine is, in a word, barbaric. This has become increasingly clear to me while watching, assisting, and performing procedures here in Uganda. In Canada, people are shielded from the intense violence of medical procedures - we drape, anesthetize, use numbing agents, put people to sleep, tell people not to look and perform procedures behind curtains to save individuals from witnessing the horror that is modern medicine. Sharp metal objects, blades, lasers, cauterizers, needles, wires and tubes inserted in terrible places all help form the backbone of this brilliant science that we practice in order to save lives and improve health. It's genius. It's phenomenal and unbelievable. But make no mistake, it is barbaric. Especially when the resources don't exist to numb, anesthetize, drape, or even hide a procedure from the other 50 people in the room by pulling a curtain around it. We are truly coddled in North America. Enjoy it. Appreciate it. Thank your local neighbourhood physician or nurse or lab tech or pharmaceutical researcher or the inventor of lidocaine. And while you're at it, thank modern medicine that we yell at people in Canada if they fail to thoroughly clean a region that's about to be injected or cut into. That is not the case everywhere.

Saturday, June 21, 2014

extracurriculars


Mr. Party and Mrs. Party

Abibu told me it was going to be a "small party that the Senior 6s put on for the younger classes". I thought this sounded like fun and so decided to make the trek to Kinoni on Monday, June 9th despite it being a national holiday with no classes. And now here I was, standing in front of the whole Senior 6 graduating class giving a graduation speech on the spot. The guys were all in cheap, rented suits wearing sunglasses and looking totally gangsta. The girls were all dressed in short skirts or gowns and had fancy hair pieces attached because on a normal day they all have short hair. Some of the mini skirts were very short.  So much for the supposed modesty my guidebook said was a must in Uganda. I spoke into the crackly, $5 microphone and said some brief words about the importance of education and the next phase of life they are entering. Cliche stuff like that.

The person I have befriended at the school and spent the most time with is Abibu. He is the 28-year old art teacher who just finished university and is in his first year of teaching. He has put the most effort into getting to know me and asking questions about life in Canada. But he tends not to explain things very well as evidenced by the fact that he failed to tell me that I would be attending the Senior 6's graduation day that Monday.

I arrived at the school just as the graduating class was arriving. They came in a convoy of Toyota Corollas decorated with streamers and balloons like at a wedding. I walked through the mass of people as they were all climbing out of their cars. I found Abibu and said, "oh, so it's their graduation!" And he replied, "yea I know." Like I said, he's bad at conveying ideas sometimes.

All the graduating students lined up in a procession with all the teachers at the back. The headmistress called me over and had me stand in the procession between her and the director of studies. I didn't really know what was happening but soon we were being ushered into one of the larger classrooms which had been decorated with streamers, balloons, and lights. All the rest of the students in the school were crowded around the entrance to the room, clapping and cheering. As each of of the students and teachers entered the room, the names were announced by the two MCs. The MCs were both Senior 6s and they were yelling names and jokes into the crackling microphones. It was a chaos of noise and confusion.

When I reached the threshold of the door the MCs both paused. I was nameless to most people and even if they knew my name, they still couldn't pronounce it. After a brief pause, the one MC introduced me as "the white man". And the whole school cheered. This is the first time in my life I have felt so white. My roommate Joel is "half black". His dad is from Rwanda and his mom is from Canada. It's weird how wherever you are, you get defaulted to the minority. So in Canada, I am "half brown" and Joel is "half black" because black and brown are minority skin colours and most of the population is white. Here in Africa we are both clearly "half white" because everyone is black. Random side story.

Anyway, all the teachers and the graduating class were soon seated in the room and I ended up sitting at a place of honour beside the headmistress. The rest of the school was pressed up against the windows, trying to catch a glimpse of the action. At the front of the room was the "head table". And seated at the table was Mr. Party and Mrs. Party. They were two Senior 6s who had been voted to those positions as an equivalent to Prom King and Queen. On Mr. Party's left was his best man, Mr. Kinoni. On Mrs. Party's left was her maid of honour, Ms. Kinoni. There was a cake cutting, a first dance and a variety of speeches including one from Mr. Party himself.

In trying to simulate a Western-style graduation, it seems they had mixed it up with a wedding reception.

There were also "performances" by various members of the graduating class. These performances usually involved the DJ putting on some Top 40 song and a few students dancing to it and lip-syncing with a microphone that was turned off. Dancing as they would in a club. I think the first dance for Mr. and Mrs. Party was some Beyoncé or Rihanna song and it got very...intimate. And the rest of those in attendance sat there and watched while these two did a great imitation of a sleazy music video on the dance floor. It was awkward.

There were some other great performances including a solid lip-sync of Taylor Swift's "Trouble" and a heartfelt love ballad which one male student lip-synced directly to the stone-faced headmistress. She did not seem impressed.

After about two hours of lip-syncing, grinding and speeches, the headmistress was called upon to give the final speech. Midway through the speech, she suddenly called on me to come up and say a few words. And that's how I found myself standing in front of them all, with a half eaten cake beside me and a tuxedoed Mr. Party looking at me over dark sunglasses.

Banana Discus

Teaching has been a small part of the experience at school and graduation was only one of the many distractions. On Wednesday of that same week, I arrived at school only to realize that all classes had been cancelled because it was student elections day followed by athletics after lunch. They don't have gym class here but rather, on some afternoons, the whole school goes to the football pitch (read: soccer field) to play football, compete in track and field competitions and play other sports.

This is Abibu's favourite day of the week. He got so excited and ran down to the field with a discus in hand long before any of the other teachers or students. The school is a little low on athletics equipment. The discus was made out of dried and compacted banana peels. I'm not sure how it was made, but it was quite heavy and had been fashioned into a pretty good discus shape held together by twine. The shotput was a large and irregular boulder. The javelins were pieces of wood with sharpened tips. And the football was made out of scraps of plastic, tied together into a roughly spherical shape. I was surprised how well it rolled and bounced. But the kids of course didn't care about the lack of "proper" equipment. They were all excited and started playing and competing.

The activity they all got most excited about was sprinting. Students volunteered to run and then lined up at the starting line. They ran barefoot and man, were some of the older students fast. There were two tall and muscular Senior 6s in particular that I swear were doing sub-eleven second sprints down the 100 meter track. They were so fast.

Abibu was the only teacher who participated in the activities. All the other teachers just watched and supervised. He is definitely a class clown and is hilariously non-athletic. He would line up on the sprinting line beside these tall, lean Africans who were a good three inches taller than him. He would run around and trip over his own legs. He's a jokester who treads the fine line between people laughing with him and laughing at him. But I think he enjoys the attention.

Samuel

As all the kids were doing these activities, I was hanging out and was approached by a 23-year old Senior 6 named Samuel. I had first met him on graduation day and he is a very chatty guy who speaks English very well. He is probably the student I speak to most often at the school. He bought me some sugar cane and we both stood around the field, chomping on the delicious stalk and sucking down the sweet juice.

He essentially told me his life story as we stood around on the pitch. I have no way to verify if anything he said was true, but he seemed very sincere. His mom and dad both died when he was quite young and he spent many years in an orphanage; he got involved with a sponsorship organization similar to World Vision and was sponsored by a British woman named Linda. Once in awhile, he would receive letters from her and she helped to pay for his primary school fees which also allowed him to board at the schools. Linda helped him buy a cow through the sponsorship organization. Cows are a hot commodity in Uganda and represent a good investment. Just as he was entering secondary school, she stopped writing and he stopped getting help from her. Samuel speaks with a hint of bitterness and confusion about why the help suddenly stopped. He said he went from secondary school to secondary school throughout the years because he often couldn't pay his fees on time so he would drop out or be kicked out. He has been at Kinoni High School for just Senior 5 and 6.

He is clearly quite a bright guy because throughout all this adversity he managed to get decent grades and speaks some of the best English I've seen at the school. He is also now the class council president for Senior 6 and had been a prefect in previous years. After he graduates, he hopes to go to university to study business but does not know how he can afford it.

It was quite the crazy story and it was very interesting to meet someone who actually received help from a sponsor child organization. There's so many organizations like this and I often wonder if they actually help specific individuals and to what degree. I'm a bit of a cynic about stuff like this so it was encouraging to hear him speak about the help he got from Linda. It is unfortunate that people stop sponsoring probably without much thought of the implications. It doesn't sound like the sponsorship organization really explained what had happened, leaving the kid confused. I don't know why the sponsorship organization didn't remain in the picture after Linda stopped sponsoring him. Samuel didn't really elaborate but it almost sounds like the sponsorship organization dropped him off their roster as well. Maybe he turned 18 and the organization did not support legal adults or maybe they thought he had gotten on his feet and didn't need sponsorship anymore. And there is likely some truth to that because he made it all the way to Senior 6 with good grades and will be graduating this year, which is a lot more than can be said of many Ugandan youth, especially orphans. Despite a little bit of bitterness in his voice at the suddenness of being dropped from the organization, maybe he should be seen as a success story of child sponsorship.

The cynic in me wonders if he's telling me all this in hopes that the mzungu will give him some money. The even larger cynic in me wonders if he's actually fabricating parts of the story to make me sympathize and give him more money. Is that terribly cynical of me? I have met so many "nice" people while traveling who later reveal themselves to just be hoping for a buck.

But I have spent a lot of time talking with him and he is such a nice, sincere and outgoing guy. He's clearly a natural leader and a lot of students seem to look up to him. He has never asked me for anything and it is probably me that has taken more interest in costs of living here as I end up asking about prices and dollar values. I've asked him about costs of school fees and university tuition and he told me his school fees are 57,000 Ugandan shillings per term and there are three terms per year. That's about $25 per term, which is the amount most people spend on a dinner at Earl's back home. He said university tuition is about 1.5 million shillings per year or about $700 CAD. That seems like a massive jump from secondary and it's no wonder that most Ugandans don't attend university as that is completely unattainable for the average income here. Many Ugandans are making less than $100 per month.

I don't want to fulfill the stereotype of the white man who comes, hands out a few 50,000 bank notes and leaves feeling like he's done something. I have taken a liking to Samuel though and I want to stay in touch with him to see if he manages to graduates and makes it to university. Neither email or Facebook are options as he does not have internet access in Kinoni. So the only way to stay in touch is via 18th-century letter-writing. The letter will have to traverse stormy seas with crews battling scurvy and mutiny. Will a letter even make it?

As we were nearing the end of our long conversation, his eyes lighted up as he remembered one gift he once got from Linda but sadly lost.

"It is like a plate that you throw upside down and on a nice day with no wind it can go very far! I really enjoyed it. Do you know these things?"

Uh...yea I do! I love frisbee! Immediately I wished I could find one to toss around with him. This is also clearly why I've taken a liking to him: he didn't even know what a frisbee was but still wanted one.  I'm thinking of sending him a frisbee via scurvy-laden boat with the Ultimate Frisbee rules attached. If I introduce Ultimate to Uganda I feel like some of those athletic Senior 6s could make a fearsome team.


P.S.

Usually I have been trying to post once a week around Wednesday. But this was my last week of teaching and I am spending the next week in a remote village in Bushenyi district about 2 hours from Mbarara with no internet. Marya will still be at the hospital so the next post will be an update on her experiences. She has had a whole different set of experiences than me!

Wednesday, June 18, 2014

bytes and bad grammer


Dahs Codil

Before coming to Uganda to teach, I secretly had this dream of being called Mr. Darcy by all my students and chuckling inwardly whenever they said it. I saw myself prancing through the halls, speaking in a fake British accent while all the students unknowingly referenced a fictional, 19th century Englishman.

What actually happened: I nervously entered my first class two weeks ago and turned to the blank chalkboard and wrote my name on the board. I said my name clearly with extra annunciation and then turned around to face the class. Blank stares. Confused and scrunched up faces. A few students attempted to pronounce it and awkwardly gave up halfway. I repeated my name and tried to get them to sound it out. More blank stares. I quickly gave up and moved on to talking about Canada and the students instantly brightened and began asking questions.

The teachers did not do any better with my name. The best they could do was "Dahs Codil". And because no one can pronounce my name, I am essentially nameless. The kids call me "teacher" or "sir" and the teachers call me "hey you" or "big man". My dreams of prancing were dashed.

Oddities of the system

Despite my lack of a name at the school, I've now been there for about two weeks and have gotten to know the school. Please remember the implications of that sentence. It means that I have braved the road from Mbarara to Kinoni over 20 times; twice a day for two weeks of work. To be fair, the driver I happened to get on my first day is by far the most reckless (that's not to say that other drivers AREN'T reckless, just LESS reckless). I have also ridden in dump trucks, on the backs of motor bikes, in matatus (small mini vans) and, on one glorious occasion, in a Mercedes-Benz with only one other passenger. Besides the one Mercedes-Benz incident, I have never gone in a car in which there were enough seat belts for all passengers.

When I arrived at the school with Loyce on my first day, I first met with the headmistress. She is a fairly cold woman who runs a tight ship but is very passionate about the school. Despite her aloof personality she is said to be quite understanding to students who cannot pay their school fees on time and she tends to take lots of students under her wing to help them succeed. Her rare smile is very warm and her compliments are very sincere because she does not mince words. She too appears to be nameless. Everyone calls her Headmistress or Madame. On that first day she asked what subjects I would like to teach and I said physics or math. She replied, "okay, you will teach English and computer" and it was very clear there was no room for discussion.

Via this mutual decision, I found myself teaching Computer and English to the two Senior 2 classes. I have about 12 teaching hours per week (3 hours for each English class and 3 hours for each computer class). It doesn't sound like much but between prep time, marking and commuting I'm gone most days for the full day. The Ugandan education system has secondary school going from Senior 1 to Senior 6. Senior 2 is roughly the equivalent of Grade 8 but, in what will be one of many oddities of the Ugandan school system, the kids age is not very consistent across the class. Some students are about 12 years old while the oldest are almost 18. This is due to several reasons: 1) kids start school at irregular times once they have the money to do so. Kids may start at 5 or 6 like in Canada, while others start much older; 2) lots of kids fail and have to repeat grades. I'm not sure if this is due to poor teaching or bad curriculum but one of the most likely reasons is that many of the kids are working or farming to help their families or to pay for school. Thus they can't focus fully on their studies; 3) records of birth are often unreliable so the kids may not actually know how old they are exactly.

All these factors mean that some students aren't graduating secondary school until they are almost 30! The oldest student I have met is 28 and she is (hopefully) graduating this year. It also presents strange circumstances because several teachers are younger than the older students.

When I met Mauricio, the tall computer teacher with pants that are always 2 inches too short, I encountered a second oddity: the computer curriculum. I had anticipated being in a computer lab teaching things like typing skills and Microsoft Office. The school has 30 computers (donated via Ainembabazi Children's Project) but that is not enough for all the students in the class and power is intermittent. Because of these two unfortunate facts, most of the curriculum is centred around computer theory, programming and computer function. Mauricio handed me the notes for the class and told me to simply dictate from them to the students. The school was very lucky to get a guy who watches YouTube videos about binary and ALUs for fun. I love this stuff and have a fascination with the inner workings of computers and the math behind it all. Because of this, I think I have been able to make the class more lively than simply dictation of class notes. However, I question the usefulness of such a curriculum for 13 year old Ugandan teenagers living in a remote, agricultural village. Would it not be better to get all the kids into the computer lab even if they were to share a computer? If the power is out, use the computer theory material as a backup to the more practical hands-on skills. Despite my love of bytes and transistors, this knowledge is not at all practical for these kids and probably bored most of them to tears. None of them will ever need to know about hexadecimal numbering systems and other computer theory concepts except for perhaps the rare student who goes on to study computer programming at a far-off university. But maybe there is some merit to it and maybe it's part of the curriculum in Canada for kids these days. I'm out of the loop with what 13 year olds are learning, whether in Canada or Uganda.

English is stupid

We all know deep down how stupid English is. But it is not until you teach it that you realize just how stupid it really is. It's just so stupid. Every rule has so many exceptions that it might as well not be a rule. There are often many ways to say the same thing and sometimes they have subtle contextual differences that are difficult to pin down. So many synonyms and homonyms and grammatical nuances.

This experience has made me question why "I had learnt to be kind" sounds wrong compared to "I have learnt to be kind". It is subtle differences like this that I have to explain to a group of Ugandan kids with limited conversational English. And, I mean, why say "I have learnt to be kind" at all? Doesn't "I learnt to be kind" have roughly the same meaning? But it doesn't, right? But how would you explain to these kids when it is appropriate or "right" to use one over the other? I don't even know. Does anyone know? I'm pretty sure even Peter, the smiley and energetic English teacher, doesn't have a clue. He handed me the text book the first day and said in a jokingly somber way, "good luck."

I've also learned (learnt?) the names of some grammatical constructions. Perhaps I learnt these things (have learnt?) long ago in elementary or junior high school, but they've long been forgotten. Perfective aspects and past participles are now my specialty. It has been at times embarrassing when I am in class and mix up verbs, nouns or adjectives. The students have a tough time with this and apparently so do I! For example the difference between obedience, obedient, and obediently. Which one is the noun or the verb or the adjective? (Trick question: none of them are verbs). Man, it's just a minefield; a grammatical war zone that would leave my past English teachers shaking their heads in disappointment.

If it's not clear already, English has been a challenging subject for me to teach. But it has nonetheless been enjoyable. It has been great to see the students go from being shy at the beginning of last week to a much more talkative bunch this week. They answer my questions and are very curious about Canada. If I ever run out of things to teach (I am terrible at judging time and never put together enough material for a class) I can simply get them to ask me questions about Canada.

What?

Yes, they can ask questions. Yes, they can answer my questions. But do I understand them?  Perhaps the most embarrassing aspect of teaching so far is my apparent ineptness when it comes to deciphering their accent. I'm not only grappling with an accent which includes bizarre pronunciation but also straining my ears to hear them as they often shyly speak barely above a whisper. I ask them to repeat once, twice, three times and by this time the whole class is shouting the word and I'm STILL not understanding. Many times I'll resort to them spelling it out letter by letter.

On my third day, I was teaching students about how a computer stores memory in RAM when one student put up his hand and asked, "what is bahseek?" I didn't understand and asked him to repeat. Soon other students were all joining in until the whole class was shouting in unison, "BAH-SEEK!" I'm sure I looked like a fool as I turned to the chalkboard and had them slowly spell the word "basic" out for me. The question was all the more confusing because it had nothing to do with the material I was teaching; he simply didn't know the meaning of the word and wanted a definition. Many times in the computer class, my lesson lapses briefly into an English class as I explain the definition of some word I've used.

I think I have gotten better at understanding them. This has been helped by them being bolder and more confident in asking the question. But this process of me asking them to repeat, the whole class yelling the word, and me dejectedly resorting to having them spell the word happens at least once a class. Perhaps this highlights my inability to understand the accent but it may also highlight their poor English.

English is the language of instruction in school and yet the students' proficiency of the English language is quite abysmal. All the work in all subjects is submitted in English but, as I soon discovered, the students writing skills are pretty bad and their conversational English is much worse.  Their vocabulary is surprisingly diverse though and I'll admit that there is a huge range in language proficiency. Some kids speak very well and can easily hold a conversation with me while others struggle to say basic greetings (bahseek). I don't know how they pass English class let alone classes like social studies which require reading and writing essays or science classes which involve learning a whole new vocabulary of physics, chemistry or biology. It is partly a generational problem as many of the teachers (including local English teachers) do not have a firm and commanding grasp of the English language. Peter, the English teacher, speaks the best English I've seen but he still makes some errors here and there and prefers to speak in local Runyankore. It is a strange environment when all the teachers in the staff room jabber away in the local language but then go instruct their classes in a non-native tongue. Everyone - teachers and students alike - would prefer to speak Runyankore if given the choice. And as a result of this preference, English remains a weak substitute throughout the country despite it being the official language of Uganda.

The students do seem to understand me quite well though and every time I leave each class they say in unison, "goodbye, sir and have a good day". And then they usually erupt in applause or laughter. That makes me chuckle anyway, even if I am not Mr. Darcy.