Matewa Outreach Visit

On Friday morning, a mother came to the clinic clutching her child of two months. She seemed emotionless. The child weighed a mere FIVE POUNDS. In almost 8 weeks, the child had not gained an ounce, and even lost weight since birth. Sam, the most senior staff member and nurse, came to Dr. Lisa for guidance. Dr. Lisa has mainly been busy reconstructing the administrative side of the clinic and making sure no one is cheating the village of their right to health care or embezzling money. Little things like that. But today she was a clinician. And a woman caring for a child. And a concerned community member.

This woman has given birth to 8 children. Four have survived. She is unable to breastfeed the child and in the eyes of the culture it is almost that there is something physically wrong with her. In order for the child to survive, it must have some source of nourishment. The western way would be to get to the market and buy this child some formula. Or maybe find another mother who can nurse this baby back to a healthy weight. But in rural Uganda, these are not options. The family cannot afford to buy milk and the only condition another mother would nurse is if the biological mother has died.

So we look to the Community Health Educators. I have been teaching these representatives to get to the homes of their neighbors and assess the conditions. Educate them on what it means to eat a healthy diet…Where to put the chickens at night instead of next to their child…How to obtain clean and reliable water…Where the patients can receive help if it is needed. The CHE’s were reluctant to help this woman and but were receptive to encouragement.

Down the mountain we went. Past the clinic, past the moonshine pots and the market, past the school and the field, and any passable roads. There she was holding her baby and next to her were her three other children. She yanked on the arm of the next oldest, maybe two years old. She brought him to his feet as he wobbled and his malnourished belly began to show. He was outfitted the same as his older brother: just a dirty t-shirt. The oldest daughter smiled as if to have no idea of the devastation surrounding her.

I was led by two CHE’s. One was Patrick, the assistant director, and the other was Joseph, a representative of the area. We talked about most importantly getting food for this family. The infant is the most pressing need but the two younger boys are not in good shape. The mother cannot breastfeed because she is not eating.. A heartbreaking cycle. And the conditions of the home. I choked down the emotion as I toured the sleeping arrangements, the kitchen, and the latrine. Mom and dad sleep in the bed a few centimeters larger than a twin and the children are on the floor next to the chickens.

Tuesday’s teaching was a continuation of Maternal and Child Health. It was similar to the rest of the trainings where I was jumping around using “ooh ooh ooh” sounds to illustrate a woman in labor. I’m glad Jake’s video footage didn’t include that one. But this meeting was slightly different. Ugandan shillings started to pile on the table in the front. The community has agreed to come together to help this woman. It was also a teaching moment. I told them that this money only bought them time. They will need to come up with a long-term plan to educate this woman and involve her absent husband. Developing countries do not need white people to come in and give them money. They need a plan of sustainability and careful approach to uphold tradition and culture.

For now, the family will eat. Forever, they will be in my thoughts.

Nile Special

Jinja!!! The source of the Nile, and from what we hear, a haven for ex-pats and tourists, sits about an hour and a half from Kampala and about a 4-7 hour trip from hour village. We took a private matatu that the clinic hired for their employee appreciation party and they dropped us in Mbale, the next nearest large town. In Africa time, we were "keeping time". About 2:30 for a 1pm departure. After some expected and unexpected confusion, we arrived in Mbale.

We made it to the crowded, dusty taxi park and found a matatu bound for Jinja that they call “express”. Jake and I sat in the way back with a younger guy and his three chickens. Live ones, of course. I kept feeling them brush against my ankles. And the express was anything but. We kept stopping for people to get out at their respective market areas and huts followed by the passenger-rounder-upper sticking his hand out the sliding door to pick up another. We arrived at “THE round-about”, although most East African cities have many. We were unsure if it was the right one but we hopped out into the darkness anyway. We ran back to the round-about and nabbed the first boda boda (motorcycle) to take us to Bujagali Falls and the source of the Nile. All of the drivers offered us a very high “mzungu” or white person price, but we negotiated and made it safely.

Rafting the Nile was fun, and exciting, and life-threatening, and all the things that white water rafting is supposed to be. Plus it was the Nile. So that was good. And our campsite just north of Jinja had showers with a view. They were cold and it meant baring some of my goods for a few of the passers by but I jumped at the chance.

We drank Nile Specials, the local beer that sips like a fine wine compared to the sorghum concoctions we’ve been drinking in the village. Dr. Lisa and Karissa met us that evening and accompanied us into town the following day. We bought some souvenirs, most likely all made in china, and had lunch at a mzungu cafe. The guacamole was less than satisfying. I should have known better.

Coming back to Matuwa was surprisingly comforting. We have only a few short days left in the village before we head to Nairobi and finally safari. We have some work to do before we leave and a Ugandan goodbye is never hurried. Maybe we should get started now.

Private what? Private Parts.

I snoozed late this morning after one and a half sorghum brews (BTW, ew) last night that rendered me slightly hazy as the sun came up. I would have felt guilty if Jake ran off without me so I set foot on the same road I tackled Monday. The one that beat me up into thinking I had Malaria. That one.

I tried to run easier this time but running easier meant walking. So I walked some. My travels to Kenya were only about 20 miles or so but the hills here are much worse. And the footing is terrible. Mostly dry cracked clay that forms little nubs and obstacles with every step. Ugandan children wearing tires strapped to their feet are taunting me and laughing as I can barely gasp for air. I am pretty sure Coach George would be proud anyway.

I finished my run and downed two fresh-as-they-get hardboiled eggs and was surprised to feel slightly chipper. I spent some time organizing some of the outreach props and completed my lesson plans for this week’s teachings to the Community Health Educators. Essentially a teacher of the teachers. Funny though, I’m not a teacher. I wore a dress to try to at least look the part.

In Africa time, we started on time. 3:05 for a 2:00 meeting. The CHEs are an interesting bunch. Anthony is apparently the Outreach Coordinator but has the leadership skills of a lemming. Very sweet though. He likes to teach using the “the sky is blue, the sky is what? Blue” method. It’s hilarious. “If you eat food that is spoiled, you get dehyde what? Dehydration. If you have syphilis, you get corrosion of your private what? Private parts.

The next day...(internets here are pretty moody, also why I can't get my fonts to match)

I woke up this morning feeling tired and weak. I thought for a second I might be getting sick but realized I have been sleeping only a couple hours a night since we arrived. Plus I’ve been running the equivalent of a killer hill workout everyday. Yesterday we hiked back up to the top of the nearby peak and brought with us Dr. Lisa, her husband Doug, and her sister Carissa. We made it up and over the top to a dense rainforest-like terrain. There were three men preparing to carry firewood all the way down. They took off down the mountain carrying their shoes and the firewood and we never caught up to them.

The first item on the agenda was an introduction with the Secondary Program with some of the students on holiday while Uganda takes the month of January off of school. They range in age from about 14 to 18 but most are guestimates and no one really knows their birthday and therefore how old they are. Jake brought out the video camera and taught them all the critical pieces to operate it and informed them that they would be helping the clinic by filming a video by the end of next week. Ugandans love to be in front of the camera and I think this is going to be a perfect project for them. Tomorrow will be story-boarding.

My responsibilities for the afternoon were to teach the Community Health Educators again. The topics I was responsible for were Nutrition and Mental Illness. I felt much more engaged today and I think I got through to most of them on several important points. I chose to put a great emphasis on Alcohol Abuse and I think there were a few light bulbs. Patrick taught today and never said anything particularly profound but the crowd seems to really like him. Jake and I gave him some beef jerky at lunch and I think he might be more addicted to that than his Marwat. (the moonshine stuff, that is)

Next stop, Jinja and the source of the Nile.

Bupoto

Bupoto, (actually, Matuwa) is a village, inside a Parish, inside a District, within a Sub-County, within a County. I think I have the order jumbled, but that’s generally how it works. We are within walking distance to Kenya, yet most that live here have never seen it. The village sits nestled into a rock wall that appears impassable and many of the townies will never test their pipes on the climb. For the strong, willing, or unknowing, along with the very poor farmers that inhabit these hills, the rewards of the hike come in the form of a view that brings tears to your eyes.

The first day I spent lying in bed in some purgatory between what I thought was malaria, and exhaustion from running the mountains for just over three miles. (I know, a bit dramatic) THREE MILES? Mr. Wanda, the founder of the NGO we are working for, warned us that the running is tough. There is about a quarter mile in front of our room where the hills roll and I would consider difficult but runnable. Then you hit the down. And more down. And it goes all the way down. I crawled back up chasing buzzing bees and school children. Anything to get me up the hill.

Things turned up after the nausea and chills went away. I jumped into a Community Health Educator (CHE) meeting and listened to the volunteers from the village banter about their compensation; something they call appreciations. Note: key word volunteers. Then the PEP meeting. That is the Patient Education Program. They were a bit less ornery but the meeting still lasted much longer than it should have. For some reason, the attendees of both meetings required a strict agenda that they insisted could, and would, be amended. I'm reminding myself...this is Africa.

The room is plain. And perfect. Jake and I have made it a home with a mosquito net over our door that I call the screen door. There are two twin beds fully equipped with nets, a unit of shelves, and a table for some fruit, glucose biscuits, and other snacks. There is a kerosene lamp that serves as our reading light in the evenings and our Petzl head lamps guide us to the pit latrine. Ah yes, pit latrines. I miss my toilet.

We are sharing great laughs and unforgettable smiles with both the villagers and the staff. Patrick, the Assistant Director of outreach for the clinic and Chief Village Moonshine Drinker has shown us the way to nearly everything the village has to offer. Right away he introduced us to the gathering to drink some sort of fermented sorghum and something else mixture that looks like Ovaltine that hasn’t been mixed up all the way. He hosts about 6-10 takers at a time with long tubes that make it look like some sort of Arabian tradition. No, I didn’t try it. Patrick has been said to be a brilliant teacher and motivator and he knows EVERYONE. Stay tuned for more on him.

Roadside Chickens

We landed in Entebbe, just off the shore of Lake Victoria around 2:15am. The airport was quiet at this late hour and we easily got our visas and our luggage. The drivers were waiting with a crooked hand-written sign that read Emily Norton and Jake Klim. And we were off.

The remaining hours of sleeping time were spent at a small inn somewhere between Entebbe and Kampala. I didn't sleep much though as I snoozed through most of our 24 hours of travel. There was a mosquito net over my head and a gecko of sorts on the wall but I was comfy. It was really humid so a tank top and shorts was overdressed. But I slept.

Caitlan, the volunteer coordinator for AAH in Bupoto arranged the day for us to include several stops along the way to the village. First stop, internets and snacks. Second stop, lunch in Jinja. This also happens to be the source of the Nile. Our drivers picked up some chickens on sticks and plantains but brought us to a more "Mzungu-friendly" cafe to fill our bellies. The food is fine but those chickens sure looked tasty.

The roads are not as bumpy as I had anticipated so a nap might be in my future. For now, I will finish my lunch and figure out this exchange rate.