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.

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!

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.

mbarara (em-bur-ar-ah)

Home is here

We have arrived in the town of Mbarara, Uganda. It's a relatively large town of 80,000 in the southwest of the country about three hours from the Rwandan border. It is wholly more relaxing, friendly and pleasant than the chaos of Kampala. We were supposed to do some sightseeing in Kampala before we left but the three of us looked at each other and said a collective "screw that" and instead made a beeline for Mbarara.

Here is home for the next month. On arrival we met Dr. Wilson, the slightly eccentric British expat with white chest hair flowing out of his shirt. He is the director at the hospital and he gave us the run-down on the town and where to find important mzungu hangouts before jumping in his jeep and leaving for London for two weeks.

We are staying in the guest houses on the university campus about a 15-minute walk to downtown. There will be four of us staying here: Marya, Chris, Joel and I. Joel is another medical student from Edmonton and he joined us in Mbarara last Sunday after visting his family in Rwanda for a week. The bedrooms are large and the kitchen and living room are even larger. Despite the size, this ain't your normal Canadian house in suburbia. Concrete floors, bare walls, and precious few pieces of furniture are the decor. Spiders are chilling in the bathroom and a friendly gecko frequents the kitchen from time to time. Electricity comes and goes and the fridge looks like it was built in the 1950s. It's a great place though and certainly beat out my expectations of what our living arrangements would be. And after seeing how locals live here, there is certainly nothing to complain about.


Kawinkeedink

I mentioned in a previous post the weird coincidence involving my volunteer organization in Mbarara being based in Edmonton. More coincidences followed when we went to the cafe down the road and saw a sign for Healthy Child Uganda, with the University of Calgary emblem beneath it. At the cafe we met up with Nichola, an old friend that Marya and I know from the good ol' days at Boulton Road; she is volunteering here with Healthy Child Uganda, an organization which seeks to make Ugandan children healthier...no mystery in their name choice. Marya had discovered that Nichola would be coming to Mbarara a few weeks before we left via a hilarious text message conversation that went like this:

"Hey, long time no see. What are you up to this summer?"
"I'm going to Africa actually. Pretty excited."
"What??! I'm going to Africa too! What country?"
"Uganda"
"No way! I'M going to Uganda! What town?"\
"Mbarara."
"I'M GOING TO MBARARA. I'm phoning you. This is too crazy for texting."

Turns out, Nichola is staying in the same complex as us in a bungalow about 30 meters away. I can see her front door from our front door. She's staying there and volunteering with a girl named Megan who, via more coincidences, went to high school in Cochrane. We've all come half way round the world and end up a stone's throw away.

It was an absurd set of coincidences that led us all to be living so close in Mbarara, Uganda, and it has turned out to be wonderfully helpful because both the girls have already been here for two weeks and therefore know all the local tricks and treats. Nichola took us to the market in town and made sure we didn't get ripped off by mzungu prices (30 cents for a fresh, delicious mango!). She showed us around town and gave us a similar low-down as Dr. Wilson minus the eccentric British accent and flowing white locks of chest hair. The market is a magical place full of anything and everything you could want from mangos and bananas to pots and pans to cows hanging on meat hooks and chickens which you have to butcher and pluck yourself.

Our bungalow isn't very well stocked with kitchenware but, laden with fruits and veggies from the market, we managed to scrape together a meal on our first night with Nichola and Megan joining the four of us at our place. Our kitchen only has two pots and one pan. We had one massive knife and my pocket knife for chopping. Only one element on the stove works but we also have one element on a standalone propane burner. Cooking for six with only two elements is a challenge in timing and efficiency. Everything takes much longer here: cooking, cleaning, showering, etc. It feels like we are only a few lost amenities away from camping. All we need is a few more campfires and s'mores.

The six of us had a blast and we've hung out a bunch since then as well. Its nice to have some friendly people from home to spend time with here and share stories with especially since all of us are having very different experiences.


Cheating death regularly

My first day of work was Wednesday, June 4th. I will be teaching in the village of Kinoni which is 30 minutes by taxi from Mbarara. I met Loyce, who is the Ugandan director of the Ainembabazi Children's Project and my main contact in the country; she took me to Kinoni for the first time so I didn't have to brave the journey myself as I wandered aimlessly, standing out like a sore thumb: a sore, foreign, mzungu thumb. As an aside, the local language here is called Runyankore and whichever 19th century missionary or colonizer translated the language into the English alphabet did a very poor job. For example, Kinoni is pronounced Chinoni; there is not even a hint of a "K" sound in the word. Other strange pronunciations abound.

The ride to Kinoni is not for the faint of heart. It is a potholed, single lane piece of asphalt full of trundling trucks, zippy motorcycles, bicycles and pedestrians. Oh and it also includes the most reckless and fearless taxi drivers I have ever seen in my life. The only way for me to get to Kinoni is, of course, by taxi. There were 8 of us crammed into a Toyota Corolla including a kid who was balanced precariously on my lap. The car was a manual and the driver had to reach through a sea of bodies in order to shift, or alternatively he would ask one of the passengers to shift for him. The speed limit on the road was between 30 and 40 because of the potholes, construction and large trucks. The speedometer always read 90 km/h whenever it (rarely) flickered to life. The rest of the time, all the gauges on the dash were dead. The driver flew over and into the potholes with little regard for the cars decrepit shocks. The trunk of the car didn't close and it would flap around like a kite every time we entered one of the potholes. Wham, wham, wham! It would pound the car, chomping away like a rabid animal.

In the distance, a massive truck was barreling down on us on this single lane highway. The taxi driver accelerated. Still closer the truck came. It flashed its lights. It honked. The taxi driver honked back...and accelerated. I closed my eyes as he jerked the wheel to the left and we went flying over the 3-inch lip of asphalt into the dusty gravel beside the road. The truck blew by us, mere inches from the open window where my arm had previously been hanging out of. The car fish-tailed wildly in the gravel and the driver jerked the wheel right as we careened out of the dirt and back up the 3-inch lip onto the potholed asphalt. The trunk slammed: wham, wham wham!

Another truck was approaching. And the taxi driver employed the same method of avoidance all while never removing his foot from the accelerator.

I am teaching there for three weeks and I have to take this road twice a day.

Thankfully the ride back that day was not quite as life threatening as my first experience. The driver drove 80 km/h instead of 90 and the trunk actually closed on his car. There were only 7 of us in the car which opened up a whole bunch more space. The potholes took their toll on this poor Toyota and we got a flat tire. Judging from how fast the driver put on the spare, I determined that this is a fairly regular occurrence. With a rickety and rusty spare tire in place, we careened back to Mbarara as I wondered how I would survive the next three weeks. Every day brings a new and bizarre experience on this road.

Prior to the drive, I was most nervous about teaching. After the drive and after meeting the headmistress of the school and various teachers, I think the drive is the more worrisome aspect of my volunteering experience.

I will write more about the teaching experience in the next post!

welcome to africa

First impressions

I stepped off the plane in Nairobi and took a deep breath. Whenever I travel to a new region of the world I always have this small, irrational worry that there will be some foreign pollen or dust that my body will reject and I will quickly die of a serious allergic reaction. I'm told that this is unlikely. But nonetheless it always goes through my head when I step off a plane.

Since I didn't immediately die of anaphylactic shock, I proceeded to pick up our bags. We were going to spend a night in Nairobi before flying to Kampala the next day. Marya and I were traveling with Chris, a fellow medical student from Edmonton who would be working with Marya at the hospital in Mbarara. He had never traveled to a third world country before but, surprisingly, Nairobi was relatively tame in terms of pollution, garbage and chaos. Maybe he - and I along with him - started to think this Africa thing wasn't going to too much of a culture shock.

Capital chaos

Kampala, the capital city of Uganda, certainly choked out those thoughts. Kampala was a "bustling city" on steroids. They took bustle to a whole new level. The centre of town was just a traffic jam. Cars didn't move. They just sat there. Maybe they were parked. I don't know. The streets were full of throngs of people. Music was blaring. Horns were honking. People were yelling. Loaded down with bags and guitar, we just had to focus on putting one foot in front of the other as we shuffled through the crowds from A to B.

Our main goal in Kampala was to buy a cell phone so we could phone our contact in Mbarara. I'm not sure if Kampala has figured out supply and demand yet but it seemed that there was definitely a supply-heavy market for cell phones. Every second store in the city is a cell phone shop. I have no idea how each shop turns a profit. I also have no idea where you go to buy anything else. If we had arrived in Kampala needing ANYTHING ELSE, we would be left helpless in a sea of cheap cell phones.

Chris and I each bought a phone and then the three of us shuffled through the mass of humanity to a nearby restaurant. We sat down for dinner and soon realized my cell phone had been stolen. Taken right out of my backpack pocket within ten minutes. It was my first time being pickpocketed. But, as I said, cell phones are EVERYWHERE. I feel like trying to pawn off a stolen cell phone in Kampala is like trying to pawn off a stolen doughnut in Tim Hortons.

We fell asleep that night to the pitter pattering of a mouse running around our room and thumping bass outside our window. Welcome to Africa.