Roller Coaster Gulu

Hey everybody,

Just want to let you know that I am alive and well. Have now fully recovered from my hospital escapade, and am back to 100% health. This has been a bizarre week, and somewhat of an emotional roller coaster.  Since we had a four day weekend, we were able to do a lot of fun things around Easter time. Most notably, on Saturday night we went to a concert that the other SIT group (the people studying with the other program in Uganda) had organized. In their free time, they had decided to put together a free concert where a bunch of local artists would perform. It took place in a stadium just outside of Gulu, and by most estimates there were between 5,000 and 10,000 people attending that night. It was crazy to see so many people in one place (and on the Saturday night right before Easter, no less!) We found out that apparently at Ugandan concerts, the artists don’t actually perform live; instead, they play their pre-recorded tracks and either lip-sync or sing along into the microphone while dancing. The artists were pretty amusing, but obviously the performances weren’t that high-quality. The performances were separated by many dance contests, at which time I had to quite firmly tell many Ugandan men that I would not like to participate. They seemed to think it would be quite hilarious to see a mzungu try to dance (and in fact, it would have been quite hilarious, given my terrible dancing ability, which I was not about to display in front of thousands of people!) I am actually surprised that they were able to find enough Ugandan women to participate in the contests, because the crowd was almost entirely men. This illustrates the basic gender roles that operate day and night in Gulu (and much of Uganda, actually): the men are often seen out and about (usually socializing, sitting around doing nothing, and/or hitting on mzungu women), while the Ugandan women are at home working and taking care of the children. Women rarely go out on weekends here, even though Gulu nightlife is fairly expansive. Then when the man gets home, his wife is expected to wait on him hand and foot, even though he has been out having fun while she has been working. I’m definitely starting to become a little more bitter towards the men when I see them out having fun, because I keep thinking about their families and how they should be helping the family instead of sitting around and talking to their friends.

Anyway, to go back to the original point, the thousands of people in the aforementioned crowd at the concert were mostly men. My friends and I had to fend off quite a number of them who wanted to get our numbers or arrange to meet up again. I’m starting to get really good at giving excuses for why I won’t give them my number: “I don’t have my phone,” “I have a boyfriend in the U.S.,” “My phone was stolen,” “If it’s meant to be, I’ll see you again,” etc etc. Most of the men we meet are harmless, if a bit annoying in their persistence. It really helped at the concert that one of our male friends from SIT was visiting for the weekend, and when we were having trouble shaking any of our suitors, he would come up, put his arm around us, and introduce himself as our boyfriend. That tended to scare them off very quickly.

I have to say, though, aside from the slight amusement I get from wondering at the huge numbers of men who are suddenly interested in me, I am getting a little tired of the way that people try to use my skin color to their advantage. I’m realizing that it is really hard to make friends here, because while everybody is very friendly, when you start talking to almost anyone, you find that behind their friendliness is the hope that you will get them a visa to the U.S., or that you will pay for their school fees, or something like that. It’s hard to tell if anyone likes you for who you are, or if they only are interested because you are white and to them, white skin=money. I can tell them over and over that I am a student who doesn’t have money, but that won’t change their expectations that I have some sort of connection that will help them. I don’t know if it’s happening more often, or if I’m just becoming more aware of it, but here is an example of the odd skin color dynamics: I was walking to work yesterday, and about 5 minutes away from the hospital, a man fell in step with me. He greeted me and introduced himself as the owner of a shop I had just passed. He was probably slightly older than me—maybe in his mid-twenties. He told me he had been looking for a friend like me—a white friend—and thought that maybe today was his lucky day. I was totally blown away by that statement, and tried to ask why he was looking for a white friend, and to share my view that it doesn’t make sense to judge somebody by their skin color, but he didn’t agree with my reasoning. He tried to set up a time for us to meet again, but I declined. I had never felt so much like a collectible object in my life, and the conversation really turned me off from wanting to interact further with him.

It was still better than some conversations I’ve had with people, though. My least favorite is the interaction where I make eye contact with someone, and they immediately say “give me 200 shillings!” or “you give me 200 shillings?” There are many variations on this, but the general meaning is the same. It really depresses me when people don’t even put in enough effort to greet me normally, and instead just revert straight to asking for money. It makes me wonder how many white people here actually do just give out money like that. Because I certainly never do, nor do any of my classmates. Even though 200 shillings is the equivalent to about 10 cents in US dollars, it’s about the deeper meaning of such an act. If I were to give them money, it reinforces a mindset that I think is very dangerous, which is that people here are poor and helpless, and they must depend on the West to support them. I have definitely started to see a little of what some call “dependency syndrome” here, which is essentially the manifestation of the mindset I just described. I think that is partially due to the huge saturation of NGOs here. Since Gulu was one of the places hardest hit by the war between the Lord’s Resistance Army and the Ugandan national army, when the war ended, a massive amount of aid poured in. NGOs set up bases here, and the network of aid organizations has grown very strong. Now a lot of the foreign staff are being pulled out, and the programs are continuing, run by Ugandan staff, which is great in my opinion. I think the aid was necessary, but I don’t like the after effects that it has left. The truth is, Ugandans are totally capable of doing all these things without help. I had the opportunity to visit several rural health centers with the policy person in charge of nutrition for the district on Thursday (this was much like a real roller coaster ride, since the roads are so terrible), and from these visits it was clear that the NGO presence was strong in Gulu, but that it was making a very positive impact on the community, and it was functioning very well without foreign staff. It was actually very encouraging to see the way that the government health offices were coordinating the delivery of health-related services by different NGOs, so people were working together instead of working on several parallel planes. I think that perhaps it is helpful to get funding from outside sources, since Uganda’s economy is struggling, and the corruption in the government prevents a lot of money from getting to where it needs to go, but the staff of these programs needs to be largely local people. Which brings forward a dilemma I’ve been struggling with for awhile: If interventions to improve life quality and health are better/more effective when they are community-run, where does that put me, as an outsider interested in working to improve health in other communities? Because I was lucky enough to be born into a community with relatively fewer problems, does that let me off the hook for problem solving in this lifetime? Or can I still help out, just in a way that takes a back seat to the local community members who can do so much more because they know the people, the traditions, and the language? I hope it’s the second one, because I don’t think I would feel very good about my life if I didn’t use it to help others in some way.

Which might be why I’m feeling so frustrated about the way the practicum period of this program is going for me.  Despite a week of pushing hard to get away from my “work” at the hospital, I have been rather unsuccessful so far.  On Tuesday, I spent the day watching a two and a half year old slowly give up on life.  His name was Kenneth, and though his head was a normal size for a child his age, his body looked closer to that of a newborn.  He was receiving anti-retroviral drugs to control the HIV that had been passed on from his mother, and he was not responding well to the therapy.  The day was brutal; when I got there in the morning, I was informed that he was “very weak” that day, and it only got worse from there.  The nurses spent a lot of the morning trying to get an IV line in his hand to inject drugs, but had to keep re-trying because his veins were so tiny and hard to see.  I felt so bad for him, because I knew how much it must be hurting him, even though he was so weak he was barely crying when they stuck him with the needle.  Then his mother sat with him on one of the beds with the Winnie the Pooh bedspreads and cradled him while he drifted in and out of consciousness.  The head nurse tried to get the pediatrician to come evaluate him as his condition worsened, but it took nearly 2 hours for her to come.  I like to think that it took so long simply because she was so busy with the patients in her own ward, but the nurses also reported that she was receiving a phone call and talking with students, so she may have just been taking her time. When she got there, she promptly announced that the child was “very sick,” (thanks for the news flash) and prescribed oxygen and about four other drugs, 3 of which the hospital didn’t have in stock.  For some reason, the ward was slightly understaffed that day, so I got to help with starting the oxygen (yay for EMT skills coming in handy), and they injected one of the drugs into him, and his mother again sat and held him while his little body tried to fight its way back to life.  This was the scene when I left for the day, but the nurses told me that he might not make it until the night, and when I returned the next day, I found out that he had died minutes after I left.  I know this kind of thing happens, even in the U.S..  Sometimes there really is nothing you can do for someone, and death is a part of life.  I guess it’s always hard to see someone so young die, because that is not part of the natural cycle.  Also, I keep thinking about the circumstances that brought about his death, and it’s maddening because in other circumstances, he might not have HIV (maybe his mother was raped during the war and contracted it then; or maybe she wasn’t able to access pre-natal care where they test for HIV and give the appropriate prophylaxis to reduce the risk of transmitting it to the child), or even if he did have it, he might be able to effectively manage it, or at least he could have made it through this episode of illness if he was being treated at a hospital with more resources.  It’s frustrating, because I know this is actually one of the better hospitals in Uganda, because of the NGO/foreign funding saturation that I mentioned earlier, and yet they still give the very minimum of treatment.  For instance, Kenneth wasn’t even put on an IV drip even though I am positive he was massively dehydrated and unable to eat anything.  When I asked the nurse about it, she just said in this case they really weren’t able to do that.  I wasn’t quite sure what that meant, but I think it might be because they have such limited resources, and they knew that he was probably going to die anyway, so they couldn’t afford to waste resources on him.  It’s a harsh reality to accept, but I guess that is life here.  It just makes me feel really helpless to see these things, and know that there is nothing I can do to help.  I feel like I am wasting my time, and it is just depressing to witness that every day.  The good news is that today we discharged 3 patients who had improved a lot, and it was definitely encouraging to see them interacting like normal babies, in contrast with the very sick ones that are common in the ward.  I’ve started to just visit the hospital for a few hours each day, and then do other things in the afternoons, because it’s simply not worth sitting there all day and doing nothing.

Outside of work, life here is continuing to get even more strange and unpredictable every day.  As much as I am enjoying this experience, I think I will be ready to go back home in about a month.  We are in the midst of a massive cockroach infestation in our house, which has been fun, especially since my mattress is on the floor, not on a bed frame.  (We only have 4 beds, and when our fifth roommate came up from Kampala, she expressed her desire to sleep on a bed.  I realized how drastically my standards had shifted when I deemed this request as “high maintenance” haha. But I agreed to give up my bed for her, since I have no problem with sleeping on a mattress on the floor. I just tuck my bednet in around the mattress, and thus far haven’t woken up sharing the bed with any insects.)  Also, last night, our landlord showed up at our house at 11:30PM with 3 other men in tow, who he told us were plumbers who had journeyed from Kampala to work on the house, and that they would be staying in the house for 3 nights.  That was a surprise, but he didn’t seem to think it was abnormal, and we just rolled with it.  Luckily, the house is so big that we can inhabit one side of it, and they can sleep on the other side, and it has been fine.  The only problem is, they ripped out all of the tile and the pipes in all of our bathrooms today, because they are replacing them, which means that we are without a place to bathe and are back to using the pit latrine in the back yard.  I swear, when I get home I am going to be so appreciative of all the luxuries that are a standard part of life in the U.S., both the small things like running water, and the larger things like paved roads and quality healthcare. All of this is starting to wear me out, and I’m feeling a little homesick for the good old US of A. Solution? My roommates and I made Kraft macoroni and cheese for dinner tonight, and are making pancakes for breakfast. Nothing like some good American food to soothe the soul. Congratulations if you made it all the way through this massive post.  Peace to you all. ~CMK

Happy Holidays

I’m running out of creative ways to start these blog entries.  You can only say “greetings” or the equivalent of that in another language so many times before it starts getting a little boring.  So I’m just going to jump into it today.  As I write this, we are enjoying a holiday weekend here in Uganda.  As you may know, yesterday was Good Friday, and Sunday is Easter.  I’ve mentioned before that many people in Uganda are highly religious, so it shouldn’t be that surprising that they make a big deal out of Easter.  Both Good Friday and the Monday after Easter are public holidays here, meaning that everybody gets those days off (except perhaps people who work in the hospital, and who likes them anyway?).  It’s pretty funny, because people kept asking me what my plans were for the holidays, and I had no idea what they were talking about, because I basically thought of it as just another weekend.

It seems like both a lot and not that much has happened since my last blog entry.  We finally moved out of the hotel and into a house, which is really nice.  We got a great deal on renting it, because it’s in the process of being renovated (I’m watching 4 Ugandan construction workers put up curtain rods in our living room as I write this), but it’s actually a very high-end place.  I almost feel a little guilty living here, because it’s so far removed from the conditions that most people here actually live in.  We have running water (which works most of the time, though sometimes it stops inexplicably), electricity (though I don’t have high hopes for it, considering our experience with the reliability of Gulu’s electricity), and as of this morning: HOT WATER, which totally blows my mind.  I took a shower that wasn’t freezing cold this morning, and it was amazing—even if it was a bucket shower.  The house was totally unfurnished when we moved in, so we bought the bare minimum of what we needed to live here for a month—mattresses, chairs, dishes, pots, a frying pan, and a small kerosene stove.  The stove has been a little bit of a challenge to use because it only has one burner and most of us aren’t used to cooking on gas like that, but at least we don’t have to rely on the electricity to power it.  It’s nice to have somewhere to call home, if only for a little while.  It’s also conveniently very close to one of our favorite hangouts (which has the best internet I’ve encountered since arriving in Uganda), and within walking distance of town.

In other news, I realized that maybe I spoke too freely about my little encounter with malaria, and didn’t give it the weight it deserved.  I encountered it for a second time this week, and it was much less forgiving with me this time around.  In fact, to my surprise, I ended up spending a night in the hospital.  I’m dong much better now, but the experience has made me gain some appreciation for the severity of the illness.  It was a little disconcerting, because on Sunday I felt fine, but by noon on Monday, I had developed severe body aches and a fever, and was pretty sure the malaria was back.  When I went to the doctor a few hours later, I discovered that my fever had spiked up to 40.1 degrees Celsius (which I couldn’t put in context at the time, but I found out later that it translates to about 104 degrees Fahrenheit), and the doctor suspected severe malaria.  I had to get a fever reducing shot right then while they ran blood tests on me, and then spent the rest of the night getting IV antibiotics for a severe infection (which had shown up unexpectedly in the blood test), swallowing pills for malaria and fever, and getting my temperature taken.  Overall, I think I handled the whole thing pretty well, but there were a few moments where I almost lost it, like when the nurse who was about to take my blood for testing said she was having trouble finding my vein (direct quote from the nurse: “I want to prick while seeing, but I might have to prick without seeing.”  And me, alarmed: “PLEASE don’t prick without seeing!”).

Most of the hospital experience was rather unremarkable, actually.  The hospital staff were very helpful and pleasant; the doctor was attentive and knowledgeable; the equipment was fairly up-to-date, and there seemed to be enough of it.  I got a private room that had its own bathroom, which was pretty nice, and I didn’t have to provide my own bedding, as patients do at many health centers here. Notably, the hospital where I got treatment is not the same hospital where I’m doing my internship; the internship is at the government-run, free hospital, which is pretty run-down and very busy.  The hospital I stayed at is the most expensive hospital in Gulu (according to one of our friends), privately run, and seemed to have a much more manageable stream of patients.  And so again we encounter the dichotomy between the quality of services available to the average Ugandan and those available to People With Money.

I have now checked two new experiences off my life list (not the list of things I wanted to do…just a list of things I have done): getting an IV, and spending a night in the hospital.  I think that’s pretty good, if I made it to age 21 without doing either of those things.  It makes me realize how lucky I have been to have had such good health all my life.  As I was contemplating the IV hookup in my hand that night, I kept thinking about all the kids in the malnutrition ward where I’ve been interning, because so many of them have those for days at a time to receive IV meds.  I gained new appreciation for the way they put up with it so well, because it’s weird to have a needle hanging out in your vein all the time and it kind of hurts when they pump stuff into it.

I got out of the hospital on Tuesday, spent Wednesday resting, and went back to work on Thursday.  As I was sitting outside of the ward waiting for a friend, I waved to this little girl who was sitting against the wall of the pediatric ward (which is right next to the malnutrition ward).  A lot of the kids here are actually afraid of “the muonos,” as they call us (translation: “the whites”), but when I waved she got up as if in a trance and slowly walked over to me.  She sat down next to me and held my hand for probably 30 minutes, without ever saying anything. (I tried to talk to her, but she was very quiet and it seemed like I should just let the silence be.)  I don’t know exactly what happened, but I really felt a connection with this girl, even though I don’t even know her name.  She was probably about 6 years old, wearing a dirty pink and white Nike hoodie, and had an IV hook-up in the hand that she was holding mine with.  I don’t know where her parents were, because she was sitting alone when I saw her and nobody seemed to come looking for her. (Not altogether surprising because here, fathers are never involved with children who are admitted to the hospital, and I’ve always wondered how the mothers can stay with the child, take care of all their other children, and still run their household…I guess they must have to leave the children unattended at the hospital sometimes.) But it was amazing how much I felt was being said between us without words.  She was telling me that she was exhausted and hurting, maybe a little scared, and a lot lonely.  I wanted to tell her that I’d been in the same position just a few days ago, and to tell her how brave she was, that she wasn’t alone, and that it was going to be ok.  I hope some of that got across to her.  I woke up that night around 3AM and she suddenly appeared in my mind: the little girl with the soft touch and downcast eyes.  I wonder what happened to her.  Since it’s a holiday weekend, I won’t be back at the hospital until Tuesday, and she’ll probably be gone by that time.  I don’t know what it was about her that moved me, but she reminded me of whom I am working for: it’s her.  It’s her, and all the other children and adults who languish in that hospital from diseases that can be prevented so easily.  It’s her and every other child that suffers because their drinking water isn’t clean; it’s her and all the children who die from malaria because they don’t sleep under a bed net; it’s her and all the people who have been scarred by the effects of war that they didn’t ask for.  There is so much needless suffering here, and it all came pouring out to me through the touch of this young girl.  I’m pretty sure I will never forget her.  She will keep me on track; when I start to get tired or frustrated or absorbed in my own struggles, I will remember her and the things she so quietly reminded me of.

So thank you, nameless child.  You inspire me.  I will keep fighting for you.  And you are so strong; I know you will keep fighting for yourself.  Love and peace to you.