Saturday, June 30, 2007

Notes on meetings, health care, and hospitals

Wednesday morning Mirjam, Lenne and I visited Naggalama hospital. We took a crowded matatu to the hospital, and when we arrived I was very surprised by the grounds. It was spacious, with several small buildings connected together, rather than one huge towering, cumbersome building. We didn’t have an appointment, but we never do, so we had to wait a half hour or 45 minutes to see someone. We interviewed a doctor there about the services they provide, and then we were shown around the maternity wards, the neonatal care unit, and the pediatric ward.

I wish I could have taken photographs of the wards where the patients were laying, but I couldn’t. I did take a few pictures of the neonatal unit, which was empty. It will really shock you, I think. It shocked me, but that doesn’t mean much.

The hospital reminds me of World War I and II movies – iron cots with plastic mattresses, a thin dust in the air. The hospital is open, without screens on the windows, and with few doors. The floors are covered in dusty red footprints and families sleeping on woven mats. The wards are open, with cots evenly spaced; however, the patients' family members and personal belongings consume the space between the beds.

The patients must bring (and launder) their own sheets. They must provide their own food. I have a feeling that families provide most of the care that one would receive in a Western (or at least American) hospital. In one room there was a long table, covered with a plastic mat and on it lay eight babies, whose mothers sat hovering over them. All the babies were receiving intravenous fluids for dehydration.

On the pediatric burn ward, we found four beds. On one of the beds there was something that appeared to be a box covered with blankets. It was actually a wooden cage of sorts, in which a badly burned child was lying. I was not expecting a child to be buried under those blankets and I was not following the conversation, so I didn’t even realize we were on the burn unit. When the mother removed the blankets from the cage (that is too barbaric a word, but I can’t think of a better one to describe it; it was just to keep the child still, and on his back) I felt this surge of despair. I wanted so badly to take a photo because it would have captured suffering without any words. But of course I could not. Nor could I allow my face to betray my complete shock at seeing this child.

I kept thinking of home, and of the sterile isolation rooms where American burn victims recover. Of the pain medicines that would have been coursing through his veins, and the care he would have received if only he had been born on the other side of the world. And this situation returned me to my original purpose here – the realization that all that I have, all that I am, all the potential I have realized and they have not, it’s just geography, and luck. I don’t deserve what I have, and he deserves so much more than he has.

The doctor told us that many burn victims survive, as long as the burns are not too severe. That seems to be the general consensus on survival here – as long as the problem is not too severe, one can survive. For example, this is a large hospital, but they do not have a surgeon on staff. They have only five doctors, who rotate into surgical duties every 3 months. They can really only perform what we would consider minor surgeries. They can do laparotomy “if we have an idea about what the problem is.” They can operate on hernias, and perform C-sections, but that seemed to be the extent of the surgical capacity.

There is a capability for blood transfusion, but only when blood is available. Blood is delivered once weekly, and if a laboring woman hemorrhages (a frequent cause of maternal death in Uganda) she will survive if blood is available. But often it is not. In our survey of health centers, two of the three level 4 centers that should be equipped for blood transfusion were not.

Naggalama had an ultrasound machine but it is now broken. The radiology staff is available Wednesday through Friday. The incubators work, “but they are local.” I don’t know what this means, but upon further questioning, it seems that premature babies survive if the case is not too severe.

Adults and children are treated for HIV/AIDS at no cost. But the doctor was unable to tell us how many patients they serve in that clinic, which means we also don’t know how many they must turn away. But it was promising to hear that treatment is free, and also nice to see “HIV damages the body. People with HIV need care and support.” painted on the side of the wall.

This afternoon we met with the health inspector of our district. He said the main problems in Uganda are poor housing, nutrition, sanitation, and water in the towns and cities. He talked about programs that they have tried, some of which have been successful. He also talked about several that have failed, including efforts to improve toilet and sanitation facilities in the area.

In talking with local leaders like the pastor here, the health inspector, and the head master of the school, everyone points to these same problems. They also mention that people do not know what do with what little money they receive and spend it inappropriately, that people do not understand causes of illness and how sanitation is related to illness, and that once people receive something for free they don’t want to pay for it at a later time. I’m not saying these things are necessarily true, but they are all problems that I have heard mentioned repeatedly.

My container mate Hannah, said she likes the Ugandan lifestyle because it is so easy. And by easy I think she meant easy-going, as in not hurried, scheduled, or stress provoking. After being in the villages it was difficult for me to see life here as easy in any way, but she has been here almost a year, and I’ve been here for two weeks, so what do I know? But to me life here seems very complicated.

It seems that when you want to provide assistance or relief efforts, so many things have to be considered. You have to think about how the government officials will react, and you must invite them to meetings, and engage and woo them. You have to think about whether your efforts are sustainable and what sort of impact they will have. You have to think about whether your efforts and ideas are culturally acceptable. You have to think about sources of water and electricity, and how you will recruit and retain certified staff. You have to think about the fact that it may be better received if a Ugandan runs the program, but they may not have the training required. You have to know if people will use it, and if they will even want it. We may see that they need mosquito nets and improved latrines, but they may want mattresses and blankets. It’s very difficult to navigate these cultural, social, political, and environmental issues.

Things that make me happy in Uganda

Picking the right day (sunny) to do my laundry

Being greeted with ten (or more) enthusiastic and genuine hugs from toddlers in the morning

Anneke’s gift - a dark chocolate bar

Passion fruit mixed with vanilla yogurt

Grilled bananas

Chapatis (they lend a little variety to the lunch time menu)

Riding on the boda boda and watching all the people cooking, washing clothes, hanging laundry, tilling the land

Children shouting “Hi Mzungu!” & “Bye Mzungu!”

Watching the monkeys swinging in the trees behind the containers

Looking at the unfamiliar crops, and learning a little more about agriculture

Father Abraham

The sounds of all the different birds and insects. (One bird makes a noise that sounds like an alarm clock.)

Seeing the school children in their uniforms, dancing and singing in a circle. There is something somewhat orderly and innocent about it, in this country where not much seems to fit that description.

The intense greenery that surrounds me.

The fact that I am learning to be a little more patient

The honesty (and sometimes sly manipulation) of children

The colors of the women’s clothing

The paraffin lamps in Mukono in the evening, and the fact that you can pass an hour eating and watching the traffic pass by and never grow bored.

Sunday, June 24, 2007

A Day in Kampala

This morning Lenne and Hannah and I went to Kampala. I was so happy to be seeing a new city. The sky was threatening rain, but we decided to take a chance and go anyway, and I’m glad we did.

If we want to travel anywhere outside of Noah’s Ark, we just walk to the main road, stand on the side of the road that indicates the direction we wish to go, and wait for a honking, speeding matatu (taxi driver). The matatus have no seat belts, and are always overcrowded; they do however, have these iron bars between the front seats and the back of the van, kind of similar to a police car. I assume it is to prevent the passengers from damaging the windshield in the event of an accident, though I’m not certain of its purpose.

While there are clearly rules of the road, Ugandan drivers are not so keen on following them, in my experience. For example, when we arrived in Kampala, our driver decided to plow through the center of a traffic circle, rather than going around it like everyone else. I haven’t decided which is safer, the boda boda or the matatu. I guess the matatu, but it is really the lesser of two evils in terms of safety. In terms of speed and efficiency, I’ll vote for the boda boda. To the drivers’ credit, I’ve only seen two traffic signs since I’ve been here, and one of them is a homemade sign on the compound that warns boda boda drivers that they’ll be fined if they drive any further into the compound.

The ride to Kampala (20 kilometers from here) is less than one dollar. And for that small sum, I was able to see the country a little more. I saw shops, farmers markets, the occasional truckload of chickens, women and children hauling babies on their backs and water, firewood, matookes, dried grasses, sweet potatoes, or baskets on their heads. It seems to me the most prevalent form of commerce is a small shop that sells airtime, use of mobile and land phones, and phone charging services. The next most common is probably the little stands that sell whatever fruits or vegetables were surplus in the family garden. Then I’d say it’s clothing, bed frames, groceries, paint shops, and a category we’ll call “miscellaneous.”

In Kampala we first went to the craft village, where I bought some art and other items that shall not be named, as they are Christmas gifts. I found it very hard to bargain with the shopkeepers, but luckily Hannah frequently came to my rescue. After the craft village we walked to Owino Market, which is a huge open-air market where you can buy just about anything. (Along the way, I ducked into a bakery and asked if they sold coffee much to the amusement of my travel companions, who told me I am such an American. It was worth a try, even if I was modestly ridiculed.) At the market, everyone called out to us, as always. People touched us as though we were some lucky bronze statue.

I am thankful that I am not blond-haired and blue-eyed like Lenne and Hannah, because they really got a lot of attention, especially from the Ugandan men. Everyone seemed fascinated by their hair and eye color. I was not as popular. But I didn’t mind.

We were so hungry by the time we arrived at the market, so we went first to the food stalls. (First let me describe the smell: it was a mix of sweat, sewage, and rotten meat. But luckily the smell was overwhelming at some times, hardly noticeable at others.) We went to the eating area, where you can walk past all these big pots full of dark liquids whose contents may or may not be recognizable. We found a stand with pots of pilau, some sort of curried peas, and g-nut sauce. But we left it because they did not have cabbage or greens, which we wanted. Shortly after leaving, someone grabbed my arm. Suddenly, they had cabbage. I think they bought it from another food stand. So, we ate two and a half plates of food, and drank fresh passion fruit juice.

I tried not to wonder too much about where they got the water to cook the food. I was also glad we passed the dishwashers after we ate. It was less than sanitary, I can assure you. But according to Hannah it is perfectly safe to eat there, and eight hours later, so far so good. After eating, Hannah wanted to buy these pancakes called kabalagala, which are made from flour and bananas. Apparently they were sold out, and she was disappointed – but not for long. A man caught up with us, with kabalagalas in tow. I am actually eating this pancake as I type. I can’t decide how I feel about it. It looks like a veggie burger, and has a tough edge, is really chewy and tastes like a cousin of banana bread. I don’t think I’ll chase anyone down to have another one, but it is nice to try new things.

After we stuffed ourselves we wondered through the market, where people have these tiny stalls packed with American and European clothes, probably from the Goodwill or one of those types of places. Only now they are neatly hung on a hanger, which is then attached to this iron lattice that is at least 10 feet tall. I do not have the patience to shop like this. But many people held up things they thought we would like, which was always interesting to see.

Other stalls sold watches, radios, plastic bowls and plates, silverware, food items, soap, dried beans, grains, sugar, peanut butter in plastic bags, every animal part you can imagine, eggs, fish, shoes, shoe polish, and towels. There were also these young boys running around carrying little containers of nail polish in a variety of colors; we later saw them giving pedicures to shopkeepers. We also passed people napping in their stalls, someone shoveling what I hope was mud and water but I fear was something closer to sewage, and people begging.

We bought some fruit and tomatoes, and pineapple slices. We were walking around eating the pineapple slices, and several people told us to sit down to eat. Apparently it’s not so kosher to walk around eating. After the market we tried again for coffee. We found a small bakery with a sign that said “bread, coffee and tea” so we stopped in. I asked for coffee with a little bit of milk, and got a pot of hot milk with maybe a half tablespoon of instant coffee. So, then I ordered a pot of black coffee, which was actually a pale amber color and tasted like hot water. So, I give up on coffee in Uganda. I quit. I surrender. Once again, my travel companions were slightly amused by my desperation.

We came home shortly thereafter, and had chips (AKA French fries; AKA Freedom fries) for dinner. It is Sunday after all, which means sausage, chips, and applesauce. I think tomorrow we’ll work some more on analyzing the data we collected from interviews with the villagers, and visit some health centers. The Noah’s Ark directors would like for us to also interview the Minister of Health, which should be interesting. I think I also will be chatting with the pastor here, who wants to know more about the United States.

I guess that is all for now. It’s 9 pm, and that is my bedtime here. It gets dark around 7, so 9 feels so late to me. It’s kind of nice getting up with the sun, and going to bed early. But I don’t think I’ll make a habit of it.

Saturday, June 23, 2007

For the Foodies Among You

Foods I miss (in no particular order):
tomato and basil salad
fresh greens
fugi apples
dark chocolate

Foods I eat:
For breakfast
If eating with the children, it's porridge from maize flour, water, sugar and some powdered milk
If eating with volunteers at the containers, it's peanut butter on biscuits (cookies), vanilla yogurt with passion fruit (from the roadside stand by the entrance to Noah's Ark), and passion fruit juice. Ok, and nutella sometimes.

For Lunch:
Everyday except Sunday we eat pinto beans with posho (a kind of cross between flour, rice and cous cous); On Sunday, it's a fried egg on bread.

For Dinner:
Sunday: chips (French fries) and sausage and Dutch applesauce
Monday: rice and cabbage
Tuesday: brown posho (which you pinch off, and eat with your hands) with meat
Wednesday: minced meat stew with spaghetti noodles
Thursday: rice with minced meat
Friday: matoke (a type of banana that is boiled and looks like a potato) with g-nut (peanut) sauce and some greens, the name of which I cannot spell.
Saturday: vegetable soup with bread

If it's a child's birthday, we eat pancakes for dinner, and the child gets a cake which is cut into literally a hundred pieces and the child passes it out to all the children. It provokes total chaos in the dining room.

A little on eating dinner with 60 children. It's not normal. They laugh, they sing, they argue, they vomit, they leave the table, they ask for more, they ask for salt, they ask for jam, they ask to "cuddle me" (sit in my lap), they yell. But they also know exactly which plastic cup is theirs, that they must eat all that is on their plate before they ask for more (which they are allowed to have), and they stack their plates (sort of) in a pile in the center when they've finished. After dinner we sing some songs and hear a Bible story. One of their favorites songs is that Lion King song, the lion sleeps tonight. Then after eating, they have to brush their teeth, go shoo-shoo or poo-poo, and get in to bed - a process that takes about one and a half hours. Again, amazingly each child knows his or her own toothbrush.

Developmentally, these kids know how to identify the few things that belong to only them, how to get the aunties' attention, how to feed themselves earlier than most children I know, when to be quiet - they really recognize routine. But in other ways they are very much behind, especially in speech and language and dressing themselves. Even children who are 5 or 6 years old cannot put on their own clothes. I have to help them dry off after their bath and put on their pants. It's really interesting the skills that are required for living in a children's home.

I wish I knew more of each child's story. I think that would explain so much about them, where they are developmentally and how their social skills are. There is such a book but it is in Dutch, so I cannot read it. But I can see the photos and guess why these children have so many needs now.

Thursday, June 21, 2007

The mzungus are coming! The mzungus are coming!

On Tuesday we met with the NACMU directors and Anneke to map out our project. I am working on the community appraisal with three Dutch volunteers Lenne (Anneke’s niece), Mirjam (a nurse who has been here for several months) and Renske (a lab technologist). The plan is for the four of us to go two by two (no pun intended) into the four villages in which 80 of the school children who attend New Horizons Nursery and Primary School (run by NACMU) live. These children were specially selected after a previous survey of community members to identify the most vulnerable families in the villages. So, we think that choosing to sample these families will give us a good picture of the overall living and health conditions of the poorest villagers.

Tuesday and Wednesday we designed our survey tool, which was no small task given the frequent power outages and printing problems. The NACMU directors and New Horizons’ Head Master approved of the survey questions, which was good. Then the Head Master called a special meeting of the executive committee of the school, so that they could hear our plans, comment, and then inform the villagers that the mzungus are coming. As I am the only native English speaker, I had the lucky task of presenting our plan to the committee. I was really nervous. I think it was obvious to the woman next to me, because she held my hand and patted my arm for about one hour. The meeting went well, and the committee agreed with the plan.

Thursday morning we started our survey of the villages. Lenne and I went to Nsambwe, while Mirjam and Renske went to Kinkubankima. We surveyed 10 homes each, noting the state of the house and building materials, type of toilet facilities, food supply, and asking questions about illness and treatment. I wish I could post the pictures now, so you could see how these families are living.

But, my hastily composed posting will have to suffice. Most live in mud walled homes with metal sheet roofing. Some have an enclosed pit latrine, and some have no latrine at all and just use the bushes. All families have a chicken or two, most had goats, some had pigs, and one had a cow. One grandmother keeps her goat in the kitchen during the night. By kitchen I mean a free standing tin shack in which there is space for a fire and a few pots and pans, and goat excrement everywhere. Many of the women are keeping their orphaned grandchildren, or children who were abandoned. A few of these grandmothers live in a home for older women, and their grandchildren stay there as well.

Most of the families only eat what they can grow, and their main crops are cassava and sweet potatoes. They eat carbohydrates almost exclusively. Most have to spend at least 45 minutes fetching water, but some spend an hour or more. They cook on open fires, and when the crops are bad or not plentiful enough, they do not eat. Every family said there is not enough food for the children to eat, and most noted that their diet is not balanced.

Most of the babies were naked and sitting in the dirt, and the older children maybe had a shirt or a dress that was tattered and soiled. Almost all the children had ringworm, and many had open sores on their legs from insect bites. Of the nine homes that Lenne and I visited today, three had children sick with malaria. However, here the word malaria also means fever. Most of the families do not see a physician or trained medical provider when they are sick. To avoid paying provider fees, they just go to a dispensary to obtain any type of medicine they think they need. One can walk to these roadside druggists and ask for antibiotics, or anti-malarial medicines and get it, as long as one can pay.

The families must walk three miles to and from the health clinic, with the sick child. The same is true for pregnant and laboring women. Most of these families cannot afford the boda boda (which is about 50 cents to the clinic). Often they do not take their sick children to the doctor because the clinics around here do not stock the treatments they need, and they are much too far away for people to reach them by foot.

The people were very kind to us, and always offered us the only chairs. They encourage their children to bow to us, which I was glad I was forewarned about. It’s very disturbing to me, but Mariska (the volunteer coordinator here) asked us to just accept that this is their custom, and not make a fuss about it. She also taught us how to shake hands respectfully to an elder or someone of high societal position, so it was good to be prepared for our visit to people’s homes.

The children followed us everywhere, shouting “Mzungu, Mzungu, give me a sweetie!” But I do not dare take candy with me because I think we would be mobbed by children.

Last night we had a dance party down at the containers. A troupe from Kamapala came and performed traditional Ugandan dances, with drumming and costumes and everything. It was really great, especially because all the Ugandan aunties really enjoyed it a lot and were familiar with the dances and the stories from the different parts of the country. The dance troupe was comprised of street youth and orphans, so it was really great to see them performing and taking pride in their art.

Well, that’s all for now.

Hope you all are safe and healthy, which, comparatively speaking, you are.

Sunday, June 17, 2007

Things I saw on my 3 hour walk

Probably a hundred children, all jumping and shouting, "Mazungu, Mazungu!" (Swahili for "white man")
banana, papaya trees
a woman making chapatis by the side of the road
a big tree, like the kind you always see in movies about Africa
many bare-bottomed chidren
little stands where women were selling tomatoes, pineapples, sweet potatoes and onions
a man riding a bicycle loaded with the grasses they use for roofing
men building a new village with brick homes with tin roofs
a small black pig
many speeding boda bodas
children playing soccer at an orphanage
about 20 roosters
30 baby goats
a boy washing his shoes
women pumping water from a well; they laughed hysterically when one of the Dutch men stopped and filled all their cans for them
men who said, "hello rich woman!"
many rolling hills
sugar cane fields
women hanging out laundry

A Sunday at NACMU

I awoke this morning with the idea that I should just fly home. I know I cannot do this, and I won't. But it is so tempting. When I arrived in Uganda, this woman in the customs line was saying to another woman, "I'm so glad you let me come along. I could never have done this by myself." And I thought 'how ridiculous.' Wow, am I eating those thoughts. And they are tasty, compared with minced meat stew and stale bread, let me tell you.

This morning I decided to distract myself with the children, so I went to the home and helped with the feeding and changing. I have decided that the bath assembly line is the most fun. At that time, the children are so happy to be getting out of their cribs, and it’s funny because every bath time seems to be a complete surprise to them. I plop their soapy little bodies in the water and they look at the water, look at me, look at the water, look at me and then laugh and splash and soak me.

Today I also attended the church on the compound. It was nice, though I had some trouble understanding it because the people spoke very softly. The Bible verse was Ezekiel 37:1-14; 37 is my lucky number. I decided to take it as a sign to stay. I thought attending church would be a good sign of solidarity to the Ugandan aunties. They seemed pleased that I came.

After church I went on a 3-hour walk with the Dutch volunteers. Again, I understood nothing that they said, which pushed me into speaking with our impromptu Ugandan guide. We wandered on to his property, and he offered to escort us through a jungle to the main road. I don’t know if he intended to walk us the entire way, but I talked with him for a long time about what the health needs are in his village and he seemed pleased that I was interested.

According to our guide, the biggest problem here is maternity care. He said many women do not have help delivering their babies, and that they have to ride on the back of bicycles to the nearest hospital, which is 20 kilometers from the village. Often there is no transport for women who need to be transferred from a clinic to a big hospital for surgery, and they must hire a car to get the laboring woman to the proper hospital. However, hiring a car for a person in labor (or any sort of medical emergency) is apparently twice the usual rate because the driver is risking carrying a dead person in his car, and then needing to drive the morgue.

Also, there are many accidents here, due to the number of boda bodas and the speeding and not paying attention to the road. Our guide said that it is very difficult to get anyone to stop and help with an accident, or to carry a person injured in an accident to a hospital, because often the driver / helper is accused of causing the accident and fined by the police. Also apparently there is no place close to here to set bones or deal with complicated injuries.

We are supposed to have our first meeting tomorrow to discuss the assessment project. I should know more about what I'll be doing for the next two weeks after that.

PS I cannot bring Abraham home, because in order to adopt a Ugandan child you have to stay in country for 3 years. So, since I am not interested in a 3 year stay here, no father Abraham for me. ☺

PPS I did have a very pleasant night last night talking with some of the other volunteers Amand (from Germany) and Conny (from The Netherlands – she arrived the same day as me and so far has been my salvation here).

PPPS I survived my first earthquake. Apparently I slept through it. Though I do remember wondering who would be rolling a suitcase around the containers at 11 at night. ☺

Saturday, June 16, 2007

Looking for Remedies

Does anyone have a remedy for homesickness? I am not familiar with this illness and it is plaguing me. Any ideas?

Thursday, June 14, 2007

First days (and a disclaimer)

(First, a disclaimer: The internet and electricity here are very spotty. The power has gone out four times since my arrival. This means that this blog will not be nearly as clever or insightful as I might have hoped. I plan to write a lot more when I return to the US. But due to time constraints and the unpredictability of electricity, I really cannot devote much time to writing.)

After 27 or 28 hours of travel, I finally arrived to NACMU last night. It was dark when we got off the plane, but I can describe the scene a little bit for you. It was surprisingly quiet for an airport. It smelled like a mix of Kentucky summer evenings, dry ice, and diesel fuel. A lot of people clamored into a disorderly line for visas, and many of them (mostly Americans) cut in front of me. After clearing immigration, finding my bags, changing my money and finding my way out of the airport I found Jimmy, the NACMU driver. We got into a well-used cab and drove about one hour to Mukono. We passed so many people - people walking in the streets, selling a variety of wares, cooking outside, washing clothes, carrying babies, piling into taxi vans. It was a terrifying ride and I'm really thankful it was dark. Otherwise I might have had to cover my eyes. We were speeding on a dirt road with lots of bumps and ditches, no seat belts, and previously fractured windshield. Perhaps I should have suspected such a ride when we thanked Jimmy for picking us up before he started the car and he suggested that we thank him upon arrival at Noah's Ark.

We finally did arrive, and were met by a volunteer who showed us to our "containers." I am not sure if these guest rooms were built or are recycled box cars, but that is what they look and feel like to me. There are three bunk beds in my room, although no one sleeps on the top bunks. The showers are in another container, and have only cold water. I woke up this morning around 10 am and unpacked, and went to the children's home. There I was eveloped in chaos and felt like the pied piper because everywhere I went I was followed by at least 3 or 4 small children who stuffed things into my pockets, pulled on my shirt, and scaled my back. Later I helped with the babies, feeding, changing, playing.

I will start my project on Monday, so for now I am just helping out with the children. It distracts me from my intense homesickness which I never in a million years expected. I mean I have traveled to 10 other countries, 8 of which were not English-speaking countries. So I thought okay, I can do this. How hard could it be? Wow. It's not the lack of luxury (although I think I would pay 20 dollars for a decent cup of coffee) it's the adjustment to Ugandan culture, Dutch culture, NACMU culture and the constant sound of languages I don't understand. I have never traveled alone, but I did not anticipate it being so problematic. I am trying to stay positive, and focus on the children.

I have a favorite already. His name is Abraham. He looks like a little old man, which is probably why he is my favorite. Everyone calls him “Father Abraham” because of his old man face. I am not sure how old he is. It is very hard to tell with these children because all of them are small for their age, at least to my American eyes. They have very thin limbs and large bellies and small faces. Most are developmentally delayed as well. They are quite friendly and love to just latch on and say “auntie, auntie.” All the adult staff and volunteers are called Auntie or Uncle. And like most little children, they love a new face so my attention has been quite the hot commodity.

I am trying to understand the routines here as it is obvious that there is one, but I do not yet comprehend it. With 75 children to bathe and feed and change and medicate, it takes a very orderly system to care for all their needs, especially given the lack of supplies to which Americans are accustomed. For example, there are no baby wipes or tissues. When the children have a runny nose, we just have to let it run or wipe it on their clothes. We use cloth diapers and cover them in these plastic wrappers, but they inevitably leak and there is always a huge mess in the morning to clean up.

The children are changed and bathed each morning, and we have a sort of assembly line for the bathing of the youngest children. I get a child out of his bed, take off his poopy clothes (no gloves, except in the very worst cases – I’ll spare you the details), wash him with a soapy rag, then transfer him to a plastic tub of water. There I rinse the soap off of him and he is allowed to splash around for a few minutes (which means I am soaked in water) and then I pass him to Renske (another volunteer) who then puts on his clean diaper and clean clothes. Then he goes back to bed until time to eat. So, in about 2 hours a team of 8 aunties has done this for about 35 children under two years of age.

It is very difficult to hear the children crying all the time. With 75 children, someone is always crying, pooping, screaming, stealing a toy from another child, or yelling “auntie! Auntie!” I know that these children are only alive because they are here, and they certainly get good care, but I don’t think we can give them all the attention they need. That is the difficult thing. But in talking with Mariska (volunteer coordinator) they say they have trouble turning down a child because they know that if they don’t take the child, he or she will certainly die.

Many of these children were found abandoned and left for dead. Moses, for example, was found in a river. Someone heard him screaming and rescued him. Now he screams quite loudly all the time, which the staff chalks up to a survival skill. Christy, one of the newest additions, was found wasted and dehydrated next to her dead mother. The people of the village put Christy in the coffin with her mother, because they thought she had no chance of surviving. A doctor who came to declare the mother deceased thought the child deserved a chance and removed her from the coffin. Now she is thriving and fat.

Apparently the Ugandan government will not allow NACMU to operate with just a small number of children. So, now they are building smaller family units, and they hope to hire widows or older women who need employment and have experience with children, to work as house mothers in a small unit with only 8 children.

I have been to Mukono town already, riding in an overcrowded bus taxi that kept stopping to accept more passengers. We bought some groceries and ate fries before riding a boda boda (old motor bike with driver for hire) back to NACMU. It was sort of exhilarating and terrifying at the same time. Exhilarating because I was able to see the countryside and feel the warm air. Terrifying because I knew if we were in an accident we would die (no helmets, bumpy roads, crazy drivers). Oh, and annoying because the driver kept asking me to be his wife (when I said I was married he said, “oh, well what can I do to get your friend?” – referring to the person behind me). He was also kind enough to ask after President Bush.

So this is most certainly an adventure, though a difficult one. I never realized how much I need other people, Rachel in particular. I realize now how much I rely on her to be my strength in difficult or stressful times. I never realized how important it is to have fellowship with other people, and to understand the language and customs of the people around me. It is very isolating to not understand anything.

Well, more later. The power is back on so I better post this.

Saturday, June 9, 2007

Some articles, info about NACMU (from 2003) (recent) (not sure when this was published)

And of course, the NACMU website:

Thursday, June 7, 2007

The Little Essay that Started This Big Trip

So here is the essay that I submitted for the NY Times Win a Trip Contest. Which I lost. But no matter.

I've always been acutely aware that the world is much bigger than what I know about it. When I was a little girl, I would lie in my bed and think 'I am in my bed, in my room, in my house, on Japonica Way, in Louisville, Kentucky, in the United States of America, on Earth, in the Milky Way.' I would also hold the corners of my eyes at a 45-degree angle because I wanted so desperately to be Chinese or something, anything, anyone but me. When I was eight I thought life abroad was surely nothing but glamour and glory.

But then as a freshman in high school, I sat in Mr. Carr's world civilization class pouring over National Geographic Magazine, dumbfounded as he explained why Ethiopian babies had flies all over their faces – they were too hungry to swat them away. Too hungry – an emptiness I'd never known and likely never would, thanks to the sheer luck of the draw. In Mr. Carr's classroom there occurred a tectonic shift in my thinking and I knew that I did not deserve anything I had. My life was not the life of that child in National Geographic by luck and luck alone, and for me that meant I owed that child my life.

Let's fast-forward, shall we? As 14 years speed past, the film will show you a rule-follower, a girl just a little too afraid to go against the grain. You'll see a girl who went straight to college and never changed her major, who graduated magna cum laude with a Bachelor of Science in Nursing and a determination to open fire on the propagators of injustice in this country and others. You'll see her go to Washington, DC, and work for three years administering experimental drugs to cancer patients at the National Institutes of Health. It was an important and tenuous first step into the big, bad adult world and at 21 years of age she succumbed to 401(k) plans, bills and a comfortable life in a new city.

At age 24, she notices that the patients she treats are all white, upper-middle class, highly educated people, yet the people she lives among bear none of those credentials of privilege. She quits her safe, tidy job at the N.I.H. and goes to work in one of DC's poorest, most crack-infested neighborhoods. At first when she walks to the clinic the neighborhood men call to her, "Hey white girl! Hey snowflake!" But eventually, they call her by her name.

For three years she works with a staff of 250 people, pushing against all the barriers that have been erected to keep the homeless where most people like them – out of sight. She finds the courage to tell a young woman she has AIDS. She pours betadine on stab wounds, clamps down hard on the severed artery of a neighborhood construction worker, encourages recovering addicts to keep coming back and mourns them when they don't. She goes to the morgue to identify the body of a patient who froze to death at a bus stop, because no one else wants to assume the cost of burying him.
By age 27, she realizes that none of these wounds really heal because poverty and despair lie at the bottom of each of them, festering. She leaves DC and moves to Seattle, Washington, to
return to school, where she hopes to learn how to do more than just damage control. Press stop.

I'm 28 now, and privileged to attend the University of Washington as a graduate student in public health. Oddly, I've found that my attendance at U.W. lends new authority to my voice. I want what I say to be accurate, not just for myself or my peers or my professors, but also for the world. I know that probably sounds quaint or at least overly idealistic, but I mean it. As a public health professional I want to serve as the mouthpiece for the millions of people whose voices are muted by poverty and disease. I cannot do that without experiencing it myself.

This is my last summer before adulthood resumes. Please, take me with you to Africa. I want to see clearly.


Some interesting facts about Uganda

Total population (2005) - 28.8 million
Life expectancy at birth - 49 years
Under-5 mortality rate (Number of children who will die before their fifth birthday)- 136 out of every 1,000 live births
Infant mortality rate (number of infants who die before their first birthday) - 79 out of every 1,000 live births
Adult literacy rate - 67%
(Females 58%; Males 77%)
Gross National Income per capita - $280 (in US dollars)
% of children under five suffering from underweight - 23
% of children under five suffering from moderate to severe wasting - 4
% of total population using adequate sanitation facilities - 43
% of total population using improved drinking water sources - 60 (urban-87; rural-56)
Number of children orphaned by AIDS - 1 million
Number of children orphaned by all causes - 2.3 million
% of women who had a skilled birth attendant present at delivery - 39

For comparison, the same indicators for the United States

Total population (2005) - 298.2 million
Life expectancy at birth - 78 years
Under 5 mortality rate - 7 out of 1,000 live births
Infant mortality rate - 6 out of 1,000 live births
Adult literacy rate - data not available
Gross National Income per capita - $43,740 (US dollars)
% of children under five suffering from underweight - 2
% of children under five suffereing from moderate to severe wasting - 6
% of total population using adequate sanitation facilities - 100
% of total population using improved drinking water sources - 100 (urban-100; rural-100)
Number of children orphaned by AIDS-data not available
Number of children orphaned by all causes-data not available
% of women who had a skilled birth attendant present at delivery - 99

Some will say corruption. Some will say it's God's will. Some will say they don't know. Some will say they don't care.

You don't have to know the answer. I certainly don't. I have some ideas, but I'll save those for another time.

It's my hope that you will be interested enough to continue reading this blog and learn more about how much of the world lives - so very differently than we do.

(data source:, country profiles, statistics)

Wednesday, June 6, 2007

A Midnight bus ride

Okay, so it was really 10 pm. But midnight sounds so much more poetic.

So I met my Uncle Bob and his boss, Greg, for a lovely dinner at the Oceanaire Seafood Room. I put on some decent clothes (which I did not iron, but no one seemed to mind) and took the bus as usual. After an evening of chatter about sights of the Pacific Northwest, the troublesome teenage years, birth order, addiction, poverty, political corruption, and a comparison of the virtues of Seattle versus the vices of DC, I headed home.

I walked 5 blocks uphill, in heels. With the click-clack of each step a passerby yelled "cha cha cha" in a sing-song voice. I passed a girl who limped, a man who rushed her, and three men dangling from a crossbar like noisy trapeze artists, drilling holes into the concrete overhead.

I stood and waited for the 16. My vision has become blurry at night, so I stood close to the curb to read the bus numbers as they passed. I looked up to watch the construction workers and the misting rain.

And then I was hit. It was a quick, acute thump on the arm. I thought perhaps a car had swerved and run into me. But then I looked down and saw white particles clinging to my pants and felt a thick, sticky substance on my arm.

I got egged! At the bus stop in Seattle, city of virtuous people who are polite to the point that it pains them.

No one laughed. No one screamed. There was no noise. Just egg running slowly down my arm, stomach and legs.

Finally the bus came. I got on and asked the bus driver for a paper towel. He hesitated until I explained that I had been egged. To that he said, "Well - that wasn't very nice!" I smiled and dabbed at the raw egg and tried to avoid thoughts of salmonella. And then I laughed and called Rachel.

She said she'd get the camera ready. I giggled the whole way home at the surprising absurdity of it all.

Cha Cha Cha.

Tuesday, June 5, 2007

How it all began...

When Nick Minas called me on a rainy Seattle morning I almost hung up. I thought he was calling about my expired credit card. I was tired of thinking about that expired card.

But then I heard the words "congratulations," and "finalist." I was truly puzzled, until I was finally able to form a coherent thought that did not figure my credit card into the whole schema. The contest! I was a finalist in the Win a Trip with Nick Kristof contest!

I ran around the apartment in circles and mouthed "I am a finalist!!!" to Rachel. She shot me a look that said both "congratulations" and "have some game!" Whatever.

I can't really tell you what happened for the subsequent hours because I was too excited to take notes. But what I can tell you is that I spent the following days religiously watching the Win a Trip site on the NY Times and on Kristof's MySpace page. I spent a week in total diarrhea-provoking anxiety, wondering if I would be THE ONE to go on a reporting journey to Africa with Nick Kristof.

On the eighth day, god created dissapointment. I learned I was not THE winner, but I was still special and all that jazz, and I was the winner of a $100 gift certificate to the NY Times store (which I have yet to receive).

I moped around a bit, but I didn't cry I'll have you know. I emailed friends and family to say I was not the one. I slumped in my chair at work and tried to settle back in to my anonymous life as student, friend, spouse, and dutiful reader of college essays. I tried not to think of what could have been. I tried to move on to the next dream (my mother's advice).

But then I realized that if I wanted to go to Africa so damned badly I should go. I mulled it over. I pleaded with Rachel, more than once, so she'd know I wasn't just on the rebound from the Kristof contest. She kindly agreed to support my efforts wholeheartedly.

So, I am going to Africa because who needs a Pulitzer prize winning journalist? Not me!

I leave on Tuesday June 12th, for the Pearl of Africa - Uganda. There, I'll work with an RN/PhD and her niece on a community assessment project in the Mukono District of Uganda. I'll be staying at Noah's Ark orphanage, home to 75 children who landed there for a variety of reasons. ( NACMU is hoping to establish a medical clinic and birth attendant program for the village families. Our work there will help to lay the groundwork for that project.

After the Win a Trip contest I realized that I had a captive audience who read my essay and were interested in what I had to say. So I'm gonna say it and I'm gonna say it here, on my brand new cleverly titled (thanks, Brian) blog.

For more about Uganda, stay tuned.