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.

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.

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!