June 15th

June 15th marks ONE MONTH since my journey began! It seems like we've been here longer- we've packed so much into one month. And I know there is so much more to do in the remaining month and a half. Research, write a paper, get back to Kampala, figure out what we're doing in Kampala, then take off for Arusha, Tanzania and do our independent travel for two and a half weeks. Phew!

Today our research in the villages began. As is expected in Africa, nothing was on time and nothing quite went the way we thought it would. We spent the first half of the morning waiting for the health worker we were assigned to shadow (Alfred) as he saw patients in his clinic. We then started the travel to the villages. Let me tell you something, some of these Ugandan hills make the climb up to Horsetooth Rock look like a joke. Or for my Boise people, it ABSOLUTELY makes Tablerock look like the easiest climb you've ever done. And the Ugandans climb them all the time- traveling from one village to the next. Not only do they climb them, but they do it without shoes, while herding animals, and many women do it while extremely pregnant. Throughout the course of the day, Alfred took us to the homes of a few of his "mentally disturbed" (as he says) patients. The first girl we saw, a 17 year old, looked so sedated that she could barely keep her eyes open and herself upright. Alfred says she has been diagnosed with BAD (bipolar affective disorder). She started having "episodes" a few years ago- although it was unclear what exactly those episodes were- and she was forced to drop out of school and remain at home. She very clearly needs help, but the cocktail of drugs (including lithium) that is prescribed to her seems to not only be in excess, but we still remain unclear about how the diagnosis of BAD was even reached. Her family has trouble paying for the medication, and also experiences challenges trying to get from their village to Kabale Regional Hospital, across the lake, where her drugs need to be refilled. She also has two sisters who experience "mental distrubances," one who was not there, and another who sounded more like she has epilepsy than a mental disorder. She experiences seizures on her left side, which caused her to be sent to the mental, rather than the medical ward. After we left this family, we walked a ways and met another girl, 25, who was diagnosed with BAD several years ago. Apparently, "the genesis" of her condition started when she was told she couldn't go to school because her parents couldn't afford it. According to Alfred, this news was so stressful she started having headaches and tried to drown herself in the lake. This is when the family sought treatment in Kabale. From what it sounds like, she certainly had severe, episodic depression, but the diagnosis of BAD seemed completely unfounded and out of no where. It is as if they didn't know what else to do with her. They claim that it is a family problem, as her father was in bed when we arrived in the afternoon and wouldn't get out of bed. To Alfred, this means that BAD runs in the family. For mental health problems, there is no way to distinguish between grief or exhausation or sadness and clinical depression, schizophrenia, or bipolar affective disorder. Of course, I thought to myself as I spoke to these people, they experience episodic depression and can't get out of bed. They are poverty stricken. They are sick, exhausted, and they suffer in ways that seem unimaginable in other parts of the world. And there's the fact that the hospitals and health workers medicate them so heavily, seemingly without any proper testing or diagnosis... That's not to say that I don't think there are Ugandans suffering from diagnosable mental illness, like bipolar disorder. To the contrary, I believe there are many. But I don't think there is adequate professional healthcare or resources to help care for these people, or to understand what problems they are really experiencing. I mean, that seems like a silly statement after I say it- OF COURSE there are inadquate resources and not enough health professionals. We already know this. And we know there are many additional factors - monetary and cultural- that prevent people from seeking help for mental health issues in Uganda. 

I am now back at Entusi and fairly exhausted. It was a long day. Tavia and I need to figure out how to complete our interviews with participants of the mental health facilitation program by the end of this week so that we can spend the next week deciding how to code and intepret the qualitative data and actually write the brief for Jamie. I am hoping we have enough time to get this all done! At this point, we're just figuring it all out as we go along. And tomorrow we start all over again! 

Also, I'm not entirely sure who is actually following this blog, but if there's questions you have about Uganda or GLI, or there's things you want to see or know- please post a comment so I can address them or find out or take a picture!