Pictures from today

Morning boat ride:

First glimpse of the village:

The health center:

Medical supplies for the whole village:

Alfred, health worker for Health Center 2

Waiting for the doctor:

Some faces of the people we met today:

Local porridge! (I didn't drink any today!)

Brite and some villagers. One is a community health worker and another is the mother of one of the girls we met today:

Chatting together after a long day:

Waving goodbye from the boat. Many of the villagers told us how important it is to them that we are here with Brite and Alfred and that we are working on such a difficult issue that has little support. And we aren't even doing much, but I hope the outcome in the long run helps. 

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! 

Some photos from this morning

Reflections on the Hospital

Lake Bunyonyi is clear and calm this morning. It is reflecting the green of the hills, the blue of the mountains and the white of clouds to create an illusion not unlike a glass marble, all the colors colliding together in the middle. It's a perfect morning to sit and write. 

Yesterday, Tavia and I went into town to visit Dr. Catherine Apio, Head of the Private Wing at the Kabale Regional Referral Hospital. We brought along Thomas, one of the Entusi staff, because he wanted Catherine to look at his three year old son, Travis. Travis was burned on his chest by hot water about a year and a half ago and Thomas was concerned about the scar and Travis's itching of the scar. I don't know too much on the medical side of things, but I told Thomas that it didn't look infected, and that it was raised and large because it is what is called a keloid. He hadn't heard this term before. We took Travis in to see Dr. Apio and she told him the same thing, prescribing hydrocortison for the itching and to prevent infection. With time, she said, the keloid may reduce in size, but Thomas was surprised to learn that Travis would have a scar his whole life. In addition to giving Thomas medical advice about Travis, Catherine also offered advice to Thomas and his wife about their family and their lives. "When your husband comes home from work, have him do the dishes and clean the house. No one ever died, no one ever lost a hand from doing the dishes" she said (I liked her more and more as she spoke). She continued that the Rukiga men (the tribe here in Southern Uganda) drink too much and don't work to support their children or their families. She said she has been surprised to see how much and often the men "booze" here. But, she told Thomas that because he is employed by Professor Jamie and because he works at Entusi, he is doing a good thing for himself, his family, and his community. Interestingly, Thomas seemed surprised to hear about the boozing and the lack of work done by the Rukiga men. Certainly he is surrounded by hard workers, here. But according to Catherine, that is not the general culture. 

After Thomas left, we sat in the clinician room with Catherine as she saw a few patients. She counsels everyone in the same way she counseled Thomas. One schoolgirl she saw only knew how to speak Lachiga and Catherine asked her why this is. Catherine says she is always surprised to hear the answer: that they are comfortable here, will never go anywhere outside of Kabale, so there's no reason to learn English. Catherine tries to explain that there is a whole world outside of Kabale, and the importance of learning outside of what you can see. How true that is for everyone. Something else that is different about Catherine (besides speaking loudly about what is on her mind) is that she tries to explain to her patients what condition or affliction they have, what she is going to test them for, and what they should continue to do about it. This is not a common medical practice. She says she sees patients all the time who were prescribed something by a doctor, but they don't know what medication it is or why they are taking it. One woman came in with a headache, nausea and vomiting, saying she had been to her local clinic but that she still didn't feel better. Catherine asked her to show us the medicine the clinic had prescribed and it turned out to be a multivitamin. Catherine told her those were useless for her and to give them to her children. She then sent her for testing for typhoid and malaria. Another man came in (was carried in more like it) and had extremely labored breathing, a severe cough and looked like he was in intense pain. Immediately when I saw him I thought his symptoms looked familiar. Sue enough, Catherine told us she thought he had aspirational pneumonia and she was going to admit him. Unfortunately, he was also a seropositive individual on ARVs and diabetic. They gave him some pain medicine and admitted him. It didn't look as though the pain medicine had helped at all. I thought of my experience in the hospital with pneumonia back in December, and can't imagine that I would have survived without the intense medical care I received. Let alone to be HIV positive as well. 

Following a few cases, Catherine started us on a tour of the hospital. We started at administration. The vision of the Kabale Hospital is "a center of excellence providing a high quality, general and specialized health services for a healthy and productive population in Kable region." We first toured the public part of the hospital, led by a man named Thursday, beginning in the dental ward. I was surprised by how many people were waiting in line for dental care. There must have been at least 30: men, women, and children. We entered the clinical room and found that there were three rooms with chairs for dental work, one dentist, and a few people who looked like assistants and students. They see a lot of gum disease and tooth decay, the dentist told us. Many people do not brush their teeth at all, many use a stick only. I watched as they pulled a tooth from an elderly woman in the next room. Yanked a tooth is more accurate. She had her eyes winced in pain as they twisted it out of her mouth. As soon as they got it out they had her up, blood on her chin, cotton in her mouth, and on her way out the door. She stumbled a bit as she tried to steady herself getting out of the chair, but just moved out of the clinic and on her with her day. What must it be like to have that kind of pain be a part of your daily existence. From the dental clinic we saw wound care, injections, the pharmacy, safe male circumcision, and HIV testing and counseling- all on the public side. Males are encouraged to get circumcised from age 15 to 49 to prevent the spread of HIV and other STIs. Culturally, they don't believe in circumcising babies- a lack of education about the spread of HIV also likely contributes to this. They had one room where they perform the procedure, and it looked like it was both a procedure room and a storage closet. Boxes everywhere with only a small partition for privacy. 

The lines for every ward were very long and it looked like people knew they would be waiting for a while. Catherine was great because she asked lots of questions and seemed like she was learning more about the public side of the hospital than she had before. She's only been on the private side in Kabale for about two months. It seems as though there is very little interaction between the private and public side of the hospital, as she had to introduced herself to everyone we met. After we saw the departments in the medical ward, Catherine took us to the HIV counseling and treatment center. Patients will first meet with a counselor who triages their care and decides where they need to go next: pharmacy, clinician, blood testing, etc. They do CD4, CBC, and viral load testing. There is also a research center where they are conducting a project to determine if nurses should be considered qualified to distribute ARVs. There simply aren't enough doctors, particularly in the regions that are far away from hospitals and Health Center IVs to care for seropositive individuals and monitor their ARVs. We learned about the difficulties of drug adherence and also of simply getting people tested. Many are too afraid and would simply rather not know their status. 

After we toured the HIV wing, Catherine left us in the care of Sister Jacqueline, who is the head nurse for the private wing. She took us to the eye clinic and we spoke with the doctor there for quite a while. He told us that nutritional deficiencies cause a number of eye problems, and they also see a lot of infection, glaucoma and cataracts. Many people also suffer consequences after they use local remedies and herbs for their eye problems. Jacqueline then took us to her office where she fed us tea, a banana, and these sesame balls that sort of resemble bird food but taste delicious (especially when dipped in peanut butter, we later discovered). Jacqueline is the epitome of what you imagine a nurse to be: she's strong, confident, takes charge, and is also caring, loving, and concerned with everyone else around her. She made sure we properly hydrated and then we continued our tour. We saw the records department where they are attempting to reorganize everything. There were files and binders EVERYWHERE. It looks like they are making good progress on their filing project, but as everything is written by hand, the paperwork is absolutely out of control. We then saw the public maternity wing, pediatric wing, immunization wing, gynecology wing, TB wing, and surgical wing. The difference between the private and public side is vast. There were so many children in the pediatric wing that some children and babies were placed on blankets underneath cots with other children. And then parents and relatives were sort of piled up in between these cots. Jacqueline told me that when they reach capacity they simply have to turn children away. How horrible that would be. Especially if you had traveled a long distance and spent a lot of money to see a medical professional, which is sometimes next to impossible, just to be turned away. We saw one little girl getting a blood transfusion right in the middle of the room. She was sitting up drinking some milk, and I assumed she was about 2 years old. Jacqueline informed us that she was here for malnutrition and anemia, and was actually 5 years old. The pediatric wing was difficult to see. All of the public wings were difficult to see, really. They are doing some really good work, but people are often not receiving adequate care. Mothers who give birth are given 24 hours in the wing and then they have to leave. It's  just enough time, the head nurse told us, to ensure they get some food and know how to breast feed. We headed back to the private wing, and Catherine took us around to show us the difference and to ask for our input regarding some ideas she has for improvement. Catherine is full of some amazing ideas, and she's not afraid to tell anyone who will listen. Actually, she's not afraid to tell anyone whether they are listening or not. We found out it costs 60,000 USH (Ugandan shillings) to deliver a baby in the private wing with no complications. That's about $20. The private wing has three different room types: private room, self-contained and executive suite. The private rooms have a shared bathroom with the rest of the wing, self-contained has its own bathroom, and the suites have a bathroom, wardrobe, and small private balcony. Catherine is also working on getting TVs in the suites. Again, the differences between the two sides (which, by the way, are only about 100 feet apart) are drastic. We learned that on the private side patients and families must sometimes bribe the doctors to receive the care that they need. 

It was a very full day. We saw so many things, met so many people. We were definitely ready to be home by the end of the day. On the way back to Entusi, we chatted with Thomas about his family and his life. In Uganda, dowries are still required before marriage, so he was explaining to us how he saved up 2 million Ugandan Shillings to give to his wife's parents before they were married. I asked him about this, to explain how he felt about it. He told me that you can't just go take a daughter from a family. You have to pay for her. Offer something. He asked me how we do marriage in the United States, if dowries are still accepted. We told him no. He said he thinks the culture is changing in Uganda, too. But it's no wonder women are treated as they are in Uganda when they are bought and sold like a commodity. Many of the women at the retreat told us how there was no celebration when they were born, how there was disappointment. How they were not allowed to go to school: "You are going to become a mother, and you don't need education for that." These women had to fight to receive a basic education. And had to fight more to receive education at a university, to find a job, to be taken seriously.

And yet. 

We consider ourselves so far "advanced" in the United States when it comes to gender equality, so far beyond this, and in many ways we are. But in many ways still we are in the same. There is an underlying belief that women are worth less than men. There is a belief in the exchange of a woman from her parent's house to her husband's house. In a transfer of her identity from her father's name to her husband's. There is a belief that women are only capable of becoming mothers and nothing else, and if they become mothers AND something else, then they are therefore not good mothers. There is a belief that women's sexuality belongs to men. And that if she "gives it up" she is a slut, if she "protects it" she is a prude. As if it is something that can be given away or protected. There is a belief that if she is too powerful, too loud, takes up too much space, she is "bossy," a "bitch." There is a belief that a woman's body does not belong to herself. That her body exists and her choices can only be made within the political and social context that men in power allow. There is a belief that women and men have different inherent traits, and thus subsequently different roles to fulfill within that political and social context. Differing from these traits and roles is costly: for both men and women. We have certainly come a long way for women in the United States. For non-heterosexual, non cis-gender, non-white, non-male, non-Christian, non-conforming, non-silent people. But we have to be careful before giving ourselves a self-congratulatory pat on the back. It is important to look back and remember how far we've come, but we must also simultaneously be looking forward at how far we still have to go. 

Kabale Regional Referral Hospital

Tavia and I went to the regional hospital today to shadow a really amazing doctor. I will write all about it tomorrow but here are some pictures from the day:

Here's me and Tave with Thomas on the way to town:

Dental Clinic:

Waiting in line:

Thursday, who showed us around:

Catherine talking to a little boy and his grandma at the clinic:

Pharmacist in the HIV clinic 

The snack Jacqueline provided:

You have to read this label:

Here's Jacqueline:

The medical records room:

Jacqueline speaking to a group of visiting students:

Pediatric wing:

Family members waiting outside at the public maternity ward:

Dr. Catherine Apio: 

June 11th

The last couple of days have been extremely busy. We've listened to lots of speakers and had many conversations about development and what it means to be a woman in the United States and in Africa. One of my favorite speakers to listen to so far was Clare, an LGBTQ and human rights leader here in Uganda. She spoke about growing up as a child unable to acknowledge who she really was. Obedient. Afraid. Conforrming. Those are the words she used to describe herself. But who does conformity benefit? It certainly wasn't benefiting her. In the wake of an extremely dangerous anti-gay bill she decided silence was no longer an option. The legislation called for the death penalty for those who are gay. Clare spoke of how the culture of fear and homophobia and hatred started grow as a result of the bill and she no longer recognized "her Uganda." After coming out in Uganda, many people are disowned by their families and their communities. They are considered to be dangerous, and assumed to have an "agenda" to turn all children and future generations gay. (Sound familiar?) Clare says that the anti-gay bill was used as a diversion to keep people from paying attention to more important issues: infrastructure, employment, health care, etc. There is a community of LGBTQ people here and they greatly rely on one another for support, as they often can't turn to their families. Clare has started a chapter of PFLAG here and is trying to get parents and allies to join the fight. She told the story of a mother who speaks on behalf of PFLAG now because she disowned her son when he came out to her. He moved away, contracted HIV, and died a few years later. She is now trying to educate people so they don't make that same mistake. 

Clare says she is hopeful because she sees the struggle that other countries have had to go through to achieve equal rights, and the struggle they are still going through. She asked for our help. In awareness, in funding, in support. She says she wants nothing more for herself and her community than equality, respect, and the right to thrive. We haven't even achieved that in the United States. I think of my best friend who has been denied that even by his own family. The strength and tenacity it takes to thrive in the face of that. I think of the energy it takes to live every day in the face of hatred and adversity. How exhausting it is. I then was reflecting, and have been reflecting a lot, about the importance of having a seat at the table and being able to tell your story. The importance of voice and space. The power of this should not be underestimated or undervalued. 

Clare also told us about the Uganda she was raised in, her Uganda, believes in and practices Ubuntu, which is why she has hope. Ubuntu roughly translates to human-ness or human kindness. It is the belief in a universal bond of sharing that connects all humanity. I wish we could all practice Ubuntu. I wish we could stop the cycle of hatred and of violence. How can we not see that those are connected? 

Yesterday I spent the day driving to and from Kigali to help the twins, Sarah and Stephanie, get to the airport. It was a long day getting from Uganda to Rwanda and back again. I got back late last night around 10:30 and was pretty much ready for bed. Instead, I arrived at Entusi in the middle of a massive dance party, and Jamie convinced me to join in for a while. Today is more of a free day so I'm hoping to catch up on some writing, reading, and maybe some laundry. For the rest of our practicum Tavia and I will be working on mental health research and writing a brief for Jamie and for the GLI. This has publishing potential so I'm really hoping to put in some good, quality work.  We will also be shadowing a public health worker and a doctor at the local regional hospital. There's a lot to do in three weeks. Following that, we will leave Entusi and head back up to Kampala for about 10-12 days. I don't exactly know what we're going to do there, but our practicum hours may be completed by then so we may have time just to hang out. On July 14th we'll leave Uganda and fly to Arusha, Tanzania to start our adventure! Arusha, Tanzania - Zanzibar, Tanzania - Harare, Zimbabwe- Victoria Falls, Zimbabwe - Lusaka, Zambia - Home!