For the past three weeks I’ve been living in Ibulanku, a small village in Eastern Uganda. The Uganda Village Project Obstetric Fistula Team (5 of us total) live in a guesthouse adjacent to the Ibulanku Community Health Clinic and across from PADI, an Australian-funded locally-run NGO that sponsors it.

Even though I spent three months in Uganda last year, my experiences here have been far, far different. Kampala is a giant metropolis compared to village life, and this time I’m not sheltered by the private SUVs and hotel accommodations EngenderHealth (international NGO) provided when I did go up-country last year.

Instead, I walk 25 minutes and ride a mini-bus for another 20 to use the internet in the nearest town, avoid liquids after 7 pm to avoid the 50 trek to the pit latrine (aka hole in the ground) in the dark, and pump water for bathing and drinking from a bore-hole across the road. Regardless, we are still living at standards FAR above those around us and those we work with.

Our research is community-based, meaning community health workers from the clinic (also serve as interpreters) take us into deep into the village to find women with fistula and sisters. We ride bikes and motorcycle for hours on narrow dirt paths cars would not fit on, and interview them with as much guarantee of privacy as we can in their straw-thatched mud huts.

The people here are very friendly and receive us mzungus (white people) warmly. Little faces appear in our windows and doorways frequently, as children in the village are curious to see what the mzungus are doing. And news travels fast – everyone knows what’s going on and know that we’re here.

The Uganda Village Project term is half over – in three weeks the volunteers leave, and I’ll be around for another week and a half to wrap things up…This weekend I’m in Kampala for some business and also for some fun – visiting friends here who are leaving soon and celebrating Daphne’s 24^th birthday party (daughter of host family). Being here is quite a culture shock! And as I catch up on emails, learning of my friends back in the U.S. beginning new jobs and new lives and my cousin getting married, and hear the occasional hip-hop/R&B song, pangs of nostalgia hit. But at the same time, I am excited to return today to Ibulanku, with the soft, high-pitched, sing-songy greetings exchanged at the start each conversation, the cows and chickens and turkeys and kids in our yard, and the calmness and slower pace of village life.

Lastly, to follow up from the last post, I have also heard theories (well, from one person) about the fluctuating dollar in relation to Southern Sudan’s government (or attempt to form its own government) using the US dollar as its currency and subsequently purchasing goods from Uganda. Other news in Uganda – Miss Uganda 2007 was recently chosen to compete in Beijing for the Miss Universe title, but controversy holds that she is ugly and undeserving and it’s all a conspiracy.

1: plastic bags have been banned in the country

in an effort to protect the environment (without an organized garbage disposal system), the govt has banned plastic bag importation into the country. these next few months will serve as a transition period to get rid of bags already in country, and a full ban on plastic bag use will be in place in the fall.

2: the US dollar is losing value

CHOGM (commonwealth meeting for former british colonies) is being held in kampala in november. in addition to crazy amounts of construction on roads here, giant new hotels and such are being constructed for the foreigners...which means a massive influx of US dollars into the country for these projects, causing devaluation of the USD. last summer, 1 USD = 1800+ Ugandan Shillings. When I arrived last week, I exchanged at 1578 Ush/1 Dollar, this week it has dropped to 1550 Ush, with further declines expected. Compare this to the USD high of 2000 Ush, and the rather steady 1850 for the past year, at least. crazy. i need to exchange now!

3: fistula preparations/meeting with ministry of health/pushing through uganda IRB

all is going well preparing for fistula research, had to go through quite some formalities and meetings to make self (and Anderson, and the study) known...awaiting official uganda IRB approval and need to swing by ministry of health a few more times.

also obtained fistula prevention drama script (yes, a full length play!) from engenderhealth, will hopefully find a drama group to perform it and tape it!

in kampala for these two weeks setting up, will be going to "the village" soon! and only averaging 2 mosquitos bites a night so far...not bad...tee heee hee

One week from today, I will have arrived in NYC after passing through Nairobe and Dubai. As Doreen (daughter of host family) has been saying for the past few weeks, “Alice’s days here are numberrrrrred” (frown). And I don’t feel ready to leave; in the past 8 weeks I have become quite attached to this place, the people, the hospitality, the scenic landscapes….and so much more. My time here is running out, and I already feel nostalgic about leaving even though I haven’t left yet.

Not ready to leave

Since I came to Africa alone, I expected to spend the summer in solitude. Little did I expect to not have *any* idle time, and even feel that I don’t have enough time to say bye to everyone I have connected with here. There’s my Ugandan colleagues, Ugandan University friends, my host family (especially Daphne who I’ve spent the most time with), and Daphne’s friends. There’s also expats – American, british – here for medical school electives, research, volunteering and various other things. Some I’ve definitely connected with, others frustrate me…but there is still “muzungu solidarity.” Then there’s the pocket of Chinese people in Kampala, who I met at a Chinese restaurant, then went to one of their homes a few times for dinner…and they even helped me get chopsticks, soy sauce and a Chinese frying wok for my host family – it’s not available in the stores, one has to bring it from China. The people I’ve met and spent time with here have definitely shaped my experience. In conversations with Ugandan friends and visits to their homes, I understand more of the culture…with expat friends I learn of other mediums to do international work…with my friend Tina, who just graduated from Univ. of Michigan, whom I met in Uganda thanks to mutual friends (in Michigan), I experience Ugandan culture in her home, and experience a bit of America when we go out clubbing with her brothers. Also, in America, if you smile or greet someone you don’t know, they look at you strangely. In Ugandan, I am so noticeably different and people will stare and even shout things (muzungu! China! Marry me! I love you!)...other look at me strangely…and still others seem afraid to talk to or approach me. What I’ve learned is the Ugandan thing to do (and also to break the barrier as a foreigner) is to always have a smile on your face and greet people the local way. It’s really impressed me how much people respond; and makes me happy that with the patients I encounter at our field sites, most of them don’t speak English but that simple smile and nod of acknowledgment is returned with an equally warm greeting, and allows me connect with them. Some giggle and chuckle, the children jump up and down – all have beautiful, genuine smiles.

Surprisingly, I haven’t gotten homesick. There’s enough opportunities to hang out with expats when I start to miss America, although I want to soak in everything here when I can and haven’t felt the need to do “expat” things. And everywhere I go, I hear Western music anyway – sean paul, 50 cent..and they *really* love shakira. While I do miss friends and family, people here are so hospitable and friendly that I’ve made more friends than I can keep up with.

I’ve learnt Ugandan traditional dances (some serious African buttshaking and “dance of the cow”), how to make chapattis, Luganda, Luo and Ugandan English, fancied roadside food – roasted bananas and maize are my favorites, gotten used to being in the dark most of the time…living without power and sometimes without running water…and learned how to communicate and connect with Ugandans. (note: Ugandans are not all equal, significant regional and tribal differences exists that seems to contribute to disunity among the people)…

The family is throwing me a farewell party today (we got up ridiculously early to make juice) – I don’t think any gift can repay them for all that they have done for me, they truly treat me as one of their own daughters. The other homestay would have cost me $5 a night, but here they are hosting me not for profits, but as a kind gesture on behalf of a mutual friend….which means I need to get them a really really reallllly nice gift (it would be offensive to give money as if it’s rent).

Will reflect on work and travels in next blog

On work:

Obstetric fistula: injury of childbearing; hole between birth canal and bladder and/or rectum developed after several days of obstructed labor; the baby usually dies and the woman is left with chronic incontinence – she cannot control urine and/or feces flow through her vagina. She is often abandoned by her family and shunned by the community due to smell…as she is also likely to be young and poor to begin with, she is unable to support herself....

Traumatic gynecologic fistula: results from direct trauma: violent/gang rape, thrusting of guns barrels, beer bottles, sticks or other objects into the vagina, cultural injuries (female genital cutting, for example), gynecologic surgery. Common in conflict-ridden areas where rape is used as a systematic weapon of war – such as in the Democratic Republic of Congo.

90% of fistulas can be easily repaired for $200-300, but misconceptions of it being difficult, lack of trained doctors, and lack of incentives to operate (fistula clients are poor and unable to pay), and general lack of acknowledgement of the issue in many societies perpetuate the problem.

Fistulas are rare in developed countries but occur in many developing countries due to poor maternal health care, young age of mother, etc….EngenderHealth in Uganda works with the Ministry of Health, foreign surgeons, and local hospitals to train local surgeons and subsidize the cost of repair for clients. Other fistula work include radio prevention messages and promoting men as partners to balance gender equity.. The majority of work by EH is actually in family planning (condoms, IUDs) and integration of AIDS services into reproductive health services.

During this first week of work, I read numerous documents, reports, analysis about the Ugandan health sector, maternal health, and fistula. Over the next few weeks, I will travel to hospitals outside of Kampala on site visits, spend some time developing a fistula client database for a hospital that just received a laptop, assist with and document fistula repair training camps for nurses, surgeons, and counselors, and interview fistula clients for donor reports.

On life outside of work:

I am living with a family Joseph (GYPA) introduced me to – they are really sweet people who treat me as their own daughter. I was planning on braving matatus to work, but luckily a woman in the office lives close to the family and is kind enough to drive me everyday. There really isn’t “public transport” here, but plenty of matatus (minibuses) that have defined routes but no defined timetables or stops – one must be able to discern, from the shouts of the conductor out the window, where it is going, squeeze into a seat, yell “Mumsawo” when the desired location is reached, and hustle out of the vehicle ASAP while plopping coins in the hands of the conductor. Unless, of course, one is a “muzungu” (white person) – in which case exploitation and paying triple or quadruple is common. Riding matatus is an art – I haven’t quite mastered doing this on my own yet..but will hopefully be independent by the end of summer…without getting lost too many times….

Having power only half the time is definitely something to get used to…although EH has a generator and the family has a pretty powerful gas lamp…I am getting used to the dark though. The drastic power cuts really only started last fall, and are expected to continue for a number of years until dams are fixed (Lake Victoria is running dryer and older dams aren’t providing enough power). The street I work on is full of NGOs, and the nicer and more expensive restaurants/stores around reflect that….as my boss put it, some expats can live and work here and never experience actual Ugandan life. Personally, I am still trying to get used to the air quality, which has supposedly gotten worse in recent times due to drought…use of diesel and leaded fuel can really be toxic….

Otherwise, I am really enjoying my time here. Ironically, I came to Africa with three outfits, lots of meds, and was prepared to “rough it”. The family I am staying with is upper class and won’t allow me out of the house with wrinkled clothing, nevermind wearing an article twice before washing…in fact, on my first day of work, the girls (the two sisters I share a room with) had me wear one of their suits to “look smart.” They find it curious that I don’t shower every day, insist that I eat 5 meals a day, and are so sweet as to check up on me multiple times a day to make sure I’m ok. Tomorrow we’re going to their village in Mbarara (also where their housekeeper is from), and I will don a traditional African dress alongside the family in a ceremony to meet potential in-laws.

today is the last day of GYPA, and as everyone is packing up to leave fr the US, my adventure in uganda is just beginning. blpease excuse the past post, antimalrials make one delirious, i swear. i am excited to really immerse myself in ugandan culture, with the homestay i will be living in, the many friends i have made here and finally leanring how to get around by myself. i start work tomorrow - 7:30 am, and will post more later!

Wedneday, June 21st:

Outside of the GYPA safety net, I have been immersed in “truer” Ugandan life for the past two days – albeit still with Faith and her, by comparison to the rest of the country, rich urban friends. A chronology of new experiences:

11 am – First boda boda (motorcycle) ride, extra terrifying because 1) I was very weak and nauseous 2)my laptop was in a bag in a basket in the front 3) Faith and I both sat on the cushion meant for one person, me gripping onto her for dear life and praying we didn’t fall off. That’s right, despite my lack of organized religion, I was so terrified zooming in and out of Ugandan traffic on unpaved roads that I was praying to *something* to survive the journey.

12 pm – ride matatus (minibuses with semi-planned routes but no timetables) to the taxi park – a huge lot of tons and tons of matatus lined up at different posts displaying destination, people walking around selling things on poles to passengers in matatus that havne’t left yet (they leave when full)…this is when I realized how GYPA has sheltered us from the chaos of Kampala transportation. I also discover that English is not as widespread as I had thought.

2:30 pm – Finally arrive in Ntinda, a nice neighborhood of the most developed and cosmopolitan city of Uganda (Kampala, the capital). The nice houses are juxtaposed by mud huts; animals roam around, and roads are even bumpier and have more holes than the streets by the University. The dwelling of Faith’s friends consists of two rooms with a bathroom attached to one (no door).

4 pm – unexplainably dizzy, weak, and delirious, I began to question everything about my body and possible illnesses. I broke down and cried, careful not to disturb Faith and Andrew in the room next door (as in, the only other room in the house). In my delirium, I began to miss…something. I was so incredibly uncomfortable – couldn’t eat, wanted to throw up, couldn’t move – I missed the small comforts of home and people I’m close to. I thought about the meaning of “comfort zone,” and decided I wouldn’t be so miserable if I wasn’t so sick and wanting to throw up constantly.

6 pm – electricity is out. power is out more than half of the time, but we didn’t notice at the University because power isn’t removed there.

7 pm – Another boda boda ride, this time to a clinic nearby. The doctor does the standard temperature taking, weightin etc, then orders a blood test – a generator is turned on to regain electricity, a nurse pricks my finger and smears blood on two lab slides. After, the electricity is removed again. The doctor spends a good 10 minutes explaining to me that despite not seeing malaria parasites in my blood (peripheral), my white blood cell count is on the low end (most infections significantly raise WBC counts) and I have other symptoms of malaria. Ironically, I had suspected my sickness to be side effects of the preventative anti-malarial pill I took the day before.

A supermarket is below the clinic that Faith hangs out in. It’s owned by her friends that we are staying with. It seems that all of the brothers of this family owned store + friends hang out there until it closes every night sitting in cars outside of the store.

10 pm – as I lay in bed, I hear conversation nearby – a seemingly angry male voice and a female whimpering. I worry that is Faith’s friends yelling at her – perhaps for bringing me over? I feel powerless and disturbed, but then realize it’s neighbors talking outside. I can’t understand the language, but I am still disturbed…Faith says they are just “playing”.

11 pm – Faith heats water for me to bath. Unlike the dorms, there is no running hot water. I stare at the basin for awhile, trying to figure out how to possibly wash my hair and clean myself...the basin is barely large enough for me to sit in. I can’t remember the last time I took a bath…

12 am – supper: chicken.

?? am – it is raining, and water sprinkles onto my face. it sounds like a waterfall, or I’m floating down the Nile. I have never heard such a violent downpour…Faith, sleeping next to me, seems undisturbed.

The next day: I visit a different clinic and find out that, in fact, I don’t have malaria. I’m bummed to have missed the Gulu trip with GYPA, but realize that I have many opportunities to go in the coming months…and living a more “Ugandan” life with Faith made me question my notions of comfort, the thin line between sickness and discomfort (I wonder if the rides in the matatus and laying in dampness and darkness made me feel sicker than I actually was)…as much as I want to immerse myself in the culture, do I really want to share a bed (and very tight living spaces) with Faith for the next two months? What are the limits of my “comfort zone”?

Sunday, June 18th
Seventeen American students, one Ugandan student, and two tour guides set out to roam West Uganda’s *best* mountain: Lake NKaruba Natural Reserves. We hiked up a dirt path to “the top of the world,” oohing and aahing at the incredible sights – mountains and lakes and forestry as far as the eye can see. Rain had just fallen, leaving behind a somewhat overcast sky and cool air. Rays of sunlight burst through grayish blue clouds, lighting up large patches of land….. so dramatically beautiful - much like a painting. In fact, standing on that hill, with a 360 degree panoramic view, I did feel like I was in a painting.

We had left later than we planned that morning and thus began the hike late. With so many people, it was inevitable that this mini hour long “walk” took almost two. At two to three hours before sunset, we embarked on another one – this time to see a waterfall – that should have been two hours long.

This second walk led us, staggered and paired off into twos and threes, through exciting patches of sugarcane plants that we snacked on and banana trees with leaves large enough for me to wear as a shirt. It also brought us face to face with Uganda’s most destitute: rural farmers living in this mountainous region below the international poverty line of $1 (developed by the World Bank in 1980’s, somewhat problematic). As a child, when I wanted to depict a “house”, I drew a rectangle with two windows and a door in between and a triangular roof on top. And that is how the houses, scattered throughout the greens (lack of better word) looked. They are constructed of reeds and mud and do not have plumbing or electricity, The children, many of whom must travel off the mountain to attend primary school if they are lucky enough to do so, wear tattered clothing and run around barefoot, cheerfully greeting visitors with “How are you! How are you!” repeated over and over. The adults are equally friendly; presumabley they’ve seen muzungus before. In fact, they have seen them enough and learned to also say (perhaps the only other phrase of English spoken), “Give me bottle” or “Can I have some money.”…Peeking into their homes and seeing toddlers running around pantless or shirtless, I want to.

The dirt path becomes uneven and winds through more exotic forestry I’ve never seen – cornstalks seven feet tall, trees with beautiful upside-down bell shaped flowers. The sun begins to set as the dirt path gives way to no path – we must follow those in front to find the path obscured by grass taller than us. The sun produces powerful, virbrant rays behind a mountain – “the circle of life” - before the sky turns pink and purple. We finally wade through bushes and stalks to a steep hill, where sounds of water are heard. I literally ski down the dirt path, grabbing onto stalks on either side to brake. I don’t fall, but many other do and end up sliding down on their bottoms. It was so difficult going down the hill that I can’t imagine actually climbing up. After a good agonizing 10 minutes of hiking down what felt like a vertical slope, we climb over large, intertwining roots and finally emerge to see the waterfall. By then, it is getting dark and within a few minutes we are ushered to head back. But with seventeen people and only two tour guides, the process is much slower than we expect. Long before we reach the main road (and by that I mean a distinguishable dirt path, as opposed to the lack of path we are still wading through) it gets dark. We only have three flashlights, suddenly one of the tour guides has disappeared – supposedly to find a boda boda for a girl who couldn’t make it all the way on foot. After a bit of arguing on whether to wait for the last few or have the first few start heading out, a bit of freaking out, a bit of frustration, a bit of some trying to take control and simply chaos in general, we finally gather everyone and decide to keep an stay in an even spaced chain. The second tour guide leads us to a fork in the road, and we follow him one way. After 10 minutes, he stops, and asks us to rest here for a few as he goes to find local boys to lead us back to a path. We turn off the flashlights to save energy and douse ourselves in bug spray. As if perfectly timed – there is a flash in the sky. “Did someone just take a picture?” “No, it’s lighting.” And it begins to rain. By then, it is 9 pm. So there we are – cold, hungry, wet, tired, lost. I wish my camera still had battery life to tape this “Blair-witch project” meets “Road Rules” meets “Leadershape team building” adventure. The boys come and lead us to the main path, after few miles of walking in the dark, albeit on a path finally, we finally hear music – ah, civilization! Trek a bit more, and we finally reach our bus.

For us, it was an adventure, a scare. For those who live in the mountains, ending the day’s activities at dark and trekking up and down the steep slopes for water is normal activity. It is such a hike up and down the hills – I wonder if their children go to school. I wonder what the inside of the mud huts look like, and types of social or health infrastructure is available to these people. The tour guide had told me that part of the money raised through tourism is put towards a local orphanage.

As I passed the houses, I thought of the Namuwongo slum area. The children wear much more tattered clothing, and fewer speak English here. They stare at us, the muzungus, wide-eyed and ask us for money. Lily’s comment – “the difference between urban (non-slum) and rural areas of a particular African country is greater than differences between countries” – runs through my mind. I want to empower, not simply give aid. But how would I interact with people on the same level when simply by my ability to enter their community (as opposed to them entering mine), I am so much more privileged? Will they really treat or view me as an equal?

Saturday, June 17th:

Thirteen hours from nyc to dubai, 6 hour layover in dubai, 5 hours to nairobe, 2 hours to Entebbe and another hour in a matatu (mini bus) later, I finally arrived in Kampala, Uganda with 16 other delirious, sleep-deprived students with Global Youth Partnership with Africa. In the past few days, we’ve seen the best and (almost) the worst in Kampala, which, still, is of the more prosperous and developed southern region of Uganda and quite disconnected from the conflict-ridden north.

The urban Ugandans I’ve met so far are very friendly – clearly this is a high contact culture of greetings, telling the whole story, and relaxing, unlike the US. Every interpersonal contact begins and ends with a greeting and handshake or hug, no matter with the custodian or Minister of Health. People here are also very beautiful – we Americans began feeling ugly in comparison.

To update, I’m halfway through a group immersion/travel experience with GYPA and will be going to Fort Portal and Gulu (where Invisible Children was filmed www.invisiblechildren.org). We met with craft-making women of slum areas, former child solider know working on reintegration of them into society, Minister of Youth and Education, and countless others making change one small step at a time. Yet, I feel that we have been quite sheltered – staying in the nicest dorm of the “Harvard of Africa” (Makerere University) and shuttled around to tourist areas with Ugandans holding our hands. The ignorance and cultural insensitivity of some people in the GYPA bother me, but such must be part of the group learning experience. I really dislike feeling like an American tourist, and further dislike being exploited as one – especially through activities advocated by GYPA. The women’s group from the slum, through GYPA, started an Income Generating Activity: craft making and selling them at American prices to foreigners. One on hand, they are cheap in American terms and I want to lessen the wealth gap, but by charging such ridiculous amounts (10,000 shillings for a necklace = $6, but 3-4 decent restaurant meals) it creates an unsustainable source of income where there MUST be a middle man and a medium to reach foreigners…and the way the women raised prices as they saw our willingness to pay made me feel like an exploited American tourist. The members of my group, after ooing and ahhing about the project, then decided that EVERYONE should chip in 60,000 shillings to by the women 10 sewing machines without consulting everyone. There isn’t room in their workplace for 10 sewing machines, and there are different ways of investing aid money – I would rather invest in infrastructure or education. I guess my message is, while these sums of money are small and we can spend them casually, they mean so much to those around us that it is disrespectful to throw money around and only furthers the wealth and power gap.
Today we visited the slum areas these women are from. Most of the residents are internally displaced people (IDP) from the North forced to move there after losing land and family to the 20-year civil war. There is apparently a lack of unity with a north-south divide, with different cultures, languages, religions (despite English being the national language). There is no running water or sewage system in the slum. It felt like another world – children running around barefoot in trash and dirt, goats and cows sharing roads with humans, but with the bustling spirit of 10,000 living in a cramped area but thankful to have at least that.