Even more pictures!

At an orphanage in Kampala

Another Sipi falls picture

Ndere Dance Troupe weekly performance

Additional Pictures from Uganda

Sipi falls in Eastern Uganda
Japanese tourists! Well, Yale residents behaving like Japanese tourists
Moi, doing some serious drumming

Northern Uganda Conflict 101

Parts of Uganda have suffered tremendously over the past 20 years. Some areas in the North have been caught in the midst of conflicts between rebel groups and the government. Specifically the Acholi people have borne the brunt of much suffering. Rebels of the Lords Resistance Army (LRA) led by Joseph Kony have targeted the Acholi for a variety of reasons rather too complicated to delve into. Unfortunately, children have been major targets of kidnappings and recruitment into the rebel resistance.

Two weeks ago, there was a peace festival in Kampala. The festival was over two days; it showed documentaries about two major areas with persistent conflict, Juba and Acholi-land, and held spirited panel discussions on the issues. Only after the documentary, Uganda Rising, did I begin grasping the magnitude of the devastating impact the LRA has wrought. Estimates of almost 50, 000 children have been kidnapped, forced to fight in the army, subjected to sexual slavery and compelled to do horrible things like killing their family members to prove loyalty to the rebels. The bulk of the rebel force is now made of such kids whose innocence has been stolen away. They do not know any other way of life. It is hard to fully understand the poisoned framework of these children’s reality. The have grown up in constant migratory rebel camps in very harsh weather conditions in Northern Uganda and Southern Sudan. The primary mode of survival has been by the gun; they use it to raid villages for a means of survival, for protection and now for self-preservation.

In the mid 1990’s the government of Uganda in a proclaimed attempt to protect the Acholi, who have been subject to constant attack by the LRA rebels, forcibly removed the Acholi form their villages and ancestral land to Internal Displaced People (IDP) camps. In all, about 1.5 million people were moved. Unfortunately, though the proclaimed goal appeared noble, the reality was starkly different. The IDP camps comprised of huts in very close quarters; there was no provision of farmland or a means for income generation. Worst of all, security at the camps was non-existent, or at best very lax. These same people who were moved for security concerns were abandoned in concentrated camps where the rebels still easily attacked, maiming people and kidnapping even more children. An entire generation of Acholi is passing without knowing any peace, many are displaced from the ancestral lands, many have no skills and can not even farm, many have never worked, many have been completely reliant of foreign aid all their lives. Grown men lounge all day in IDP camps, they cannot provide for their families; they cannot protect them. Women suffer from abuses from their frustrated husbands, rebels and even government soldiers. Children are helpless; they are again being forced into local militias to protect their IDP camps. 

Stories abound of the brutality these people have endured, lost limbs, machete scars, stub remnants of what used to be lips, noses and ears, and the unseen emotional scars.  There are also stories bravery and the drive for survival in the face of daunting odds. There are kids who walk tens of kilometers daily to attend school. There are those who keep living with the scars even after losing most of all of their family members. There are the night commuters who, before sundown walk several kilometers from IDP camps to the nearest big city to sleep in shelters, verandas and street corners to escape the violence at the camps. There are women who are caring for their young children though they are products of a rape encounters. The stories of survival are loud but have not yet drowned out those of human brutality.

Today, the situation appears better. IDP camps still exist, though they were recently disbanded by the government. The LRA rebels are currently involved in peace talks with the Ugandan government. There is reported better security in Northern Uganda with the rebels currently in Southern Sudan, just north of the Ugandan border. Amnesty agreements have resulted in many rebels abandoning the LRA for reintegration into society.

One story of reconciliation resounds. The Acholi people have as part of their cultural traditions a reconciliation ceremony. Rivals from different clans or families, or outcasts traditionally underwent this public ceremony to make peace. This ceremony is used today to reintegrate former rebel militants into the community.

Quote of the day.

When a rebel is rescued, the government says an Acholi child has come home; when one is killed, they say we have killed a terrorist. 

For more info visit:

www.invisiblechildren.com

www.ugandarising.com 

…And the beat continued.

Yesterday, 11:47 am, 6 year-old boy, TJ, died of respiratory depression. He was just admitted to the Cancer institute earlier that day. He had stage 4 Burkitt’s lymphoma. The tumor began in his jaw, 6 months earlier. It slowly spread from one side of his jaw to the other, then to other parts of his face. Unlike other cases of this type of cancer, his face was not grossly disfigured by a prominent mass; rather, he seemed to have generalized facial swelling. He had lost several teeth and his eyes were slightly more protruded. He had sought medical care, but for a variety of reasons, ranging from frank incompetence to the uniqueness of his presentation, his diagnosis was delayed. The oncology team examined him at around 11am that morning. He was found to have decreased level of consciousness, likely a result of metastasis to his brain. He also had involvement of his liver and spleen. We made a treatment plan and started him on IV fluids. At 11:42 am as the team continued seeing other patients on that ward, the boy’s mother called one the resident doctors to his bedside because his breathing seemed more distressed. All the resident could do was turn the patient on his side and watch alongside his mother as he struggled some more to breathe, until he stopped altogether; it was the end.

 

All the resident doctor and TJ’s mother could do was watch. This child was on a regular ward with about 15 other adults and children, many just as sick as he was. We did not have an oxygen tank close by, and with the limited resources, intubating or resuscitating him would have been futile. As everything unfolded with TJ, the rest of the team was about 20 feet away discussing another patient. TJ died, and other than the two resident doctors who were directly attending to him, no body else on the team seemed to acknowledge it; we kept rounding. The nurse isolated the area around his bed with a curtain. Most patients on the ward and their families understand the symbolism of the curtain; it is sometimes used multiple times a day.

 

Today, 9:25 am, 5 year-old, SE, died in his sleep. He had been on this same cancer ward for one week. He was diagnosed with ALL (acute lymphoblastic leukemia) with involvement of his spleen. He had very thing arms and legs but a distended belly. He looked quite stable 3 days previously and had been started on chemotherapeutic treatment. Yesterday, he had abdominal pain that worsened with motion and change in position, signaling a likely infection in the fluid accumulation in his belly. He looked jaundiced, very ill and had grunting sound with his breathing. He also had low blood cell counts and a fever of 40 Celsius. The oncology team re-evaluated him and decided on improving his pain management, giving him a blood transfusion and covering with antibiotics. SE’s father had been by his bedside all through his hospital stay; he was clearly becoming more frustrated as his son’s condition had progressively deteriorated while on admission. SE looked very sick and was unlikely in his current state to make it for much longer. Today around 8:45 am, four residents and I arrived at the ward to examine some patients. SE’s bed was right at the entrance of the ward, I was relieved to find him sleeping apparently peacefully; his blanket was being raised and lowered in a rhythmic fashion. He was still breathing. At 9:25, we were walking out of the ward as I took a five second glance at SE. There was no motion; “he must be fine; he was fine this morning,” I thought.  I had greeted SE’s father earlier that morning as he stood over his son’s bed, he was again in the same position as we left.

 

A few seconds after walking out SE’ s father grabs me to come examine his son. I glance at him for a couple of seconds and again seeing no motion. I beacon to the residents, jointly we determine he is pulseless, with no breath or heart sounds and fixed dilated pupils. He is peaceful and motionless. We tell his father it was all over. He cries, sobs and thanks us for caring for his son. We get the curtain and isolate his bed.

 

 

These two stories have been my most direct encounters with dying patients. Sadly, both patients were very young, both had cancers and both had potentially curable cancers. Here in Mulago, death lurks everywhere. It is commonplace to find patients’ beds empty on returning to the wards in the morning. These deaths in absentia are much easier to accept; you come in the morning and go along with the tasks of that day. But how should one deal with deaths that one personally experiences during your day. Should one call off the day to mourn the loss of one precious life or spend only but a moment consoling the family and getting on with one’s day? Are we expressing contempt for life or nonchalance by not stopping to reflect with the passing of a life? Can one actually afford to be introspective or distraught with each death in a setting where deaths occur and are experienced multiple times a day? Ultimately, how does one maintain ones humanity while also keeping the necessary focus to get mundane daily tasks accomplished?

 

Many questions, many questions and no clear answers!

 

                                                The End

 

Please take a moment to think about these two kids and many others who have died in Mulago without much notice. You can say a quick prayer for their families.

 

 

Quote of the day:

 

It has cost me 300 000 shillings on transport and medications. I have had to sell all the livestock I have. I am far from home and cannot work or farm to raise more money. Father of nine with a child getting cancer treatment at Mulago, about 500 kilometers from their home. (Many Ugandans don’t make 300 000 shillings in 1 year)

Some pics from Uganda

Some lovely kids on my trip to Sipi falls in Eastern Uganda
Edge House. I stayed here for the first 3 weeks
Mulago Hospital. National referral center. I work here
King Fisher resort at Jinja, close to the source of the Nile

So you call yourself a man…

I would not say I have given much thought to what makes the distinction between boys and men. I am sure some really knowledgeable people have spent their whole or some significant part of their lives studying and writing about the transition from youth to being a man.

You may ask,  “Why write on such a random topic?” I will respond saying that the topic is really not that random. Just under 50% of the worlds population has to make this transition at some point, though much less spend more that a few seconds contemplating what the transition means. But, the real reason is to tell a story of what this transition means for people of the Sabin culture in Northeastern Uganda. These people live in a relatively rural district less than one hour from Mbale, a major Ugandan city. I heard this story about 36 hours ago from a 21 year-old Sabin man I will call Mr P. I will try to narrate as accurately as my memory permits and will take as little liberties as possible embellishing the story.

Here it goes.

There are three times in life when you have a big celebration: first, when you are born; then, your circumcision; and of course, when you die. We do not celebrate big weddings because they are expensive; not many people have the money to have a big wedding. Circumcision ceremony is a very important part of our culture and they mark the successful transition to being a man. You cannot be a man until you have undergone the circumcision ceremony.

The ceremony is performed on boys of ages 12-14. It is a community ceremony; I mean a big celebration that everyone attends. The celebration takes place once every two years and this year is a circumcision year. It usually happens in the month of December, starting from the first of the month till about the second week depending on the number boys participating from the town. Participants come from all over, even from the US so far as they identify with our culture. I hope you make it to see this year’s celebration.

The ceremony itself is just a culminating event; the process starts as much as one month in advance. Participants start traveling to personally invite all their relatives all over the country to the ceremony. The relatives in turn make gift promises of bulls, land, money and other valuables to be delivered at the ceremony. The next step is intense preparations by elders in the community. The participants are coached, and their readiness for the ceremony is accessed. Then, the boys begin a pre-celebratory period of 2 weeks. They have a very unique outfit and anyone would be able to recognize them when you see them around. Initially they wear the outfits only at night, but as the day draws near, they wear the attire even during the day, and during the ceremony itself. Their outfit comprise a T-shirt and shorts, two sashes made from bed-sheet material over each shoulder to the opposite waist, one sash used in a belt-like fashion across the waist, and beads along the neck and each ankle. They also hold on each hand a dancing ornament made from a special monkey’s tail; the monkeys are hunted specifically for this occasion.

The day approaches with surprisingly little fear and trembling. The night before the ceremony is probably the most grueling; the participants have to dance and prepare all night till the sun rises. The events begin shortly after sunrise. The participants clad in their outfits line up in an open area of town. They are cheered on by a multitude that includes their family members as well as other random community members; every one is welcome. The people who have honor to performing the rites are specially chosen and trained elders.

The moment of truth arrives. There is a stage where the elder stands; he backs the crowd about ten meters away. In turn, each participants walks to the stage with his own knife, looks at sun in the horizon, places both his hands on a stand at a level just beneath his breast line and experiences the ultimate act. The process takes about 3 minutes. During this time each person does not flinch, sob, cry or show any expression associated with pain, and keeps his eye on the sun in the horizon. After each participant the performer washes with soap and warm water and moves on to the next. During my time, we all had a successful transition. Then the big party began. Anyone who fails is called a coward, ridiculed and becomes an outcast for disgracing the culture. Usually, everyone is successful since there are various stages of screening to ensure that only people who are ready get to the stage.

There is no anesthesia or pain medication used in the process. There are only very few complications; some may bleed too much while others may collapse dues to exhaustion from staying up all night. Occasionally, health workers are available for people who may bleed too much, but we also have local herbs that help. Rich people may also buy some pain medication and pay for stitching. Otherwise, there is no role for health workers; they do not perform the ceremony. However, it is also well known that some elders may be bribed to allow a select few to receive local anesthesia before, but this is all behind the scene.

Circumcision is a vital part of our culture. You cannot become a man without undergoing the ceremony. You have to feel the pain that your father and uncles felt. Anyone who successfully goes through with the ceremony can defend his family and the community in the face of any obstacle. Even doctors have said that circumcision is healthy and it prevents the spread of HIV. I don’t look down on people from other cultures who do not get circumcised or are circumcised as babies, but for people from our culture, you cannot not do the ceremony. You will forever be a coward and cannot own much, hold an important position or have a voice.

                                                 The End.

 

Quote of the day:

I got the knowledge freely and I pass it on freely, or the knowledge dies and decays with you as you end up in heaven or hell, whichever is closer.  Prof. B B. Infectious disease consultant at Mulago

Racial Profiling- Uganda Style

Here is one of the highlights of this past week.

There is much positive talk in travel guidebooks and amongst other Muzungus (foreigners) here about safety in Kampala. You can walk around at anytime, even till mid-night and beyond, without feeling threatened. I can attest to the above sentiments; I routinely stay at the internet café till about midnight and occasionally even later before embarking on a 13 minute walk back to my apartment.

On Thursday, I left the café at 1 am. As I walked back home I saw a black owl, about a feet tall, on a street signpost.  The post was about eye level; even though I walked on the far end of the road I was still less than 15-feet from the animal. The owl starred and twisted its neck about 180 degrees as it watched me walk by. Black owl, hmmm… probably a not-so-good sign.

Earlier that day, as a result of some changes in my living arrangements, I had moved to a new apartment about a block from my old place. On my way back from the café I decided to move a few last things; I had some clothes that I could not move since they had been wet from recently being washed. I put the clothes neatly in a small box that fit right under one arm and I had my computer bag around the other shoulder.

After taking a few steps outside the gate of the old place, a security/police officer walks up to me. I started chatting with the guy and told him I was moving; little did I know I was a suspect being questioned. The policeman had a huge gun, probably an AK-47 and a 6-foot long metallic rod; these accessories are routinely seen on security officers all over the city. The barrage of questions begun: “Who are you? Where are you from? Where are you going? What are you doing at Makerere University? How long have you been here? Why are you walking around at night? What are you carrying? Do you have any identification? What program are you with? ...” So I answer all these questions and explain that I just moved to the new place a few steps from where we were. Fortunately, I had both my Yale and Makerere IDs with me. I also had a flashlight, which I used to show him the clothes. He proceeded to checkout my computer; “How sure am I that you did not steal this?” I opened the computer to show him my name on the settings. All the while, I was going with the flow; I had everything he asked to see and expected to be ‘released.’

After showing him all the evidence that I was a foreign visiting student, –anyone would garner that fact from the different accent the moment I begun speaking to him –he decided I had broken the law. My offence was walking around Kampala past midnight. He went on to say, “I am sure you got a proper orientation when you arrived in Kampala, but you decided to do what you want. This is Uganda and that is the rule. I will have to take you to the station.” All the confidence I had till that point suddenly dissipated. What in the world do you do in the face of  an unreasonable officer with a gun? I was utterly on the losing end of the exchange, and I could not run. I attempted appealing to his reason again, but it seemed to go now where.

So my options were going to the station as well as either paying a fine of 20K shillings or spending the night in detention. Either way, I still had to go to the station; there was no bargaining. I told him to get the police vehicle and take me there immediately so I could get the ordeal over. The cop says,” There is no car. You will have to carry your things and walk with me to the station. Also, there is no guarantee we would release you after you pay the fine. We may have to keep you for the night for your own safety.” I cannot remember my exact response, but as I simultaneously said a prayer, I responded in an irritated and firmer tone. Reasoning with this cop certainly could not get me out of the mess and I had had enough of the pushing around. I made it clear that my options were paying the fine or staying in detention at the station. I was not going anywhere until he was explicit that doing both was not an option. I was not in a position to make demands, but what the h#$%. Then I said, “Do you want me to call the US embassy?”

About 40 minutes had passed with the back-and-forth. I was done talking, the cop continued blabbing and 5 or so minutes later decided that he would let me go.

If I were white, like other Muzungus, would this cop have stopped me? Almost certainly not. Would he have let me go if I did not feign being American? Probably not.

It has not being much of surprise to me that white folks in Kampala are treated differently, as it probably is the case in many African countries as well as other developing ones. But, what continually shocks me is the lack of regard we show when we Africans treat one another. From these few weeks in Uganda, it seems if someone is not a family member, employing you, richer than you or a Muzungu, you have the license to treat him/her shitty. People care so much for their family members, but the idea of dignity for humanity does not extend to people one passes on the street, patients one treats in the hospital or other regular folks. I would dare say that our lack of respect for ourselves and others is a major obstacle that must be overcome for true progress. Respect for oneself would translate to having the same expectations from others and from the government. Having the mindset of self respect and dignity does not have any monetary costs but yet is invaluable; all the loans and aid from the IMF and World Bank cannot buy it. Our obligations must extend beyond immediate family to the nation and humanity at large.

It is unfortunate that Africans are treated as second class citizens in the West and even in their own countries.

 

                                                The End

 

I still have other posts in the works; I’ll shoot for early next week. Other highlights of the past week: going on a Safari for the first time ever and seeing wild animals in the wild; my laptop dying, finding an Apple store and partially resurrecting the machine, and spending time on the cancer ward.

Quote of the day 

“We have so many floor patients today.” 3^rd year Senior House officer at Mulago  after a night of 70 admissions in the emergency department with about half of the patients with mattresses on the floor