Week of March 26-April 1

A famous American journalist and author, David Lamb, said in his book The Africans that the only time an African is in a hurry is when he is behind a wheel. The Ugandan is no exception. Little wonder then that in spite of having the lowest vehicle per capita ratio in the world, our continent also lays claim to a fatal accident rate that is ten times higher than that of London and New York. Sensible car driving has simply refused to blend with our culture….

Once on the road, what matters most is confidence. Learn to sneer at other drives and in a traffic jam, ask the fellow disputing the lane with you if he just bought his license, unlike you who passed the driving test. When you approach a junction, never leave any empty space in front of you. Whether you can clear the junction or not, enter it anyway. A thick jam will build up on your side. Regard it and nod with satisfaction. Then look behind you in the rearview mirror and behold the nice, long snakelike jam growing longer by the second. Savour this all, take a deep breath and smile. Roll up your windows to close out the impatient hooting as the fellows you have blocked build up blood pressure like yours.

Like the British, we keep left while driving. But that is only while driving on a straight stretch. At junctions, left and right stop making sense – just take the shortest straight line to your objective. Jam on the breaks when you are almost head-on with the fellow from the opposite direction who insists on keeping left. What are brakes for, anyway?

- From How to be a Ugandan by Joachim Buwembo

I thought I would offer you Ugandan insight into the insanity that is called driving in Uganda!

This week was slow; we attended two days of child counseling classes with TASO counselors and then were taught the basics of counseling. On Friday, however, an American study abroad group visited TASO from Kenya, and one girl went to high school with a friend of mine from ENC, Amanda Fish. Another guy in the group attends Boston College, so he promised to show me around when I start attending in the spring. How funny!

On our walk to TASO, Aubrey and I pass a mosque. We’ve heard rumors about camel sacrifices there but had never actually seen the camels. Well, this week we lucked out and got to see two of them! After taking pictures from the road, someone inside the mosque grounds invited us in to take pictures, and the camel graciously slobbered Aubrey’s face.

Since Charles is back home in the States for a few weeks, Aubrey and I have become better at using boda bodas (bicycle taxis with an extra padded seat on the back) and picky-pickies (motorcycle taxis) to travel. We’ve definitely decided to stay away from the boda bodas in town, however, because they don’t have as much control in traffic (yikes!). Don’t worry, all you parents; we’re fine and we don’t travel after dark. We’re taking a mini spring break this week after TASO since we don’t have many practicum hours left and are traveling in two weeks to learn about counseling for LRA returnees in Lira.

Aubrey and I are currently house-sitting for the Howards, mostly so we can have a break from the nonstop flow of guests in the CURE guesthouse. Right now, two Welshman, Rob and Aowyn, are living there. Both of them are great and are working with a community development organization. Across the street for the next two months is Justin, a British medical student from the University of Edinborough. I’ve finally found someone to accompany me on Mt. Elgon!

Two American guys who’ve been living across the street since mid-January, Nick and Patrick, are leaving soon to head to Kenya, Tanzania, and Egypt (and who knows where else!). I wish I could just travel like that! They organized a boda boda race on Sunday, complete with cash prizes and a new bike for the winner. Patrick insisted on slaughtering a cow for a barbecue afterwards. Ha! The head was just sitting in a room next to their apartment yesterday. Gross. Apparently a Muslim has to cut the cow’s throat facing Mecca to make it acceptable for Muslims to consume.

Well, there’s last week for you! I’m sitting here trying to finish all of the papers for my practicum portfolio. I have two more papers, two revisions, and three reports. I will be ecstatic when I’m done; I had no idea it was going to be this much work!

Pictures!

new pictures!
http://enc.facebook.com/album.php?aid=2005622&l=9ee66&id=149000028


And I got into Boston College for grad school!!!

Uganda Makes Me Laugh Part 3

1. Eating with your hands is common. Even at a wedding reception, we were given beans, matooke, posho, meat, etc., and expected to eat it and not make a mess.

2. Cheese here tastes awful. That’s all.

3. Oranges are green.

4. We have two chickens in a plastic bag in the back of the hospital ambulance we’re currently riding. This is probably one of my favorite pictures because the chicken looks so ridiculous.

Oh look! I'm in our ambulance. And there is a chicken sitting on some cassava next to Christine's backpack.

5. Eight people fit quite comfortably on a four-person bench in the taxi-vans (matatus).

6. In our hotel room a few weeks ago, the first rule of hotel conduct on the door was, “Esteemed guests: Please do not throw your used condoms out the window or on the floor. Use the wastebasket provided.”

7. Potholes are everywhere. You just drive through them. Seatbelts? What? (these are some serious potholes. They're not even potholes...they're like ditches. But they're not meant to be ditches.)

8. The innards of animals are delicacies – the gizzard, liver, kidneys, the neck ….

9. The showers in hotel rooms are simply a shower head in the bathroom. It makes for quite a wet bathroom floor and toilet.

10. They like to eat whole fish. The eye is the favorite part. Mmm.

11. Cars have right of way, not pedestrians.

12. It is common to say, “Well done,” not necessarily as a response to anything. I don’t fully understand it yet. The proper answer is “Okay.” I still get flustered because it throws me off.

13. “You are lost” = “Where have you been?” We spent a few weeks trying to tell them we weren't lost and then realized what they were saying.

14. “Where are you from?” = “Where did you just come from?”

15. They pick their noses in public. No big deal.

16. Seeing squirrels is a big deal. I don't get it. There are lions and hippos and giraffes here. And squirrels are a big deal.

17. They say, “Yes, please” in response to everything. We haven’t really figured out why. It’s polite.

18. Cows roam the streets all the time. Goats climb trees. (These ones are just hanging out on the side of the road, which is quite common.)

19. We are celebrities everywhere we go. Why? We're white. (Kids are chasing our van here.)

Awful Roads and Cow Hoofs: Week of March 19

This is me not standing out in the crowd.

Melissa (Charles' wife) and Breanne

Melissa, Aubrey, Elyse (their daughter), and me before they left for the States this week

Sunday, March 18

I just learned that my friend Grace here is from a polygamous family. It’s funny when you learn all these crazy (to me) things about a different culture and then separate those you know from it. Her grandfather had 30 wives.

Monday, March 19

We went out into the field for home visits again today. We only connected with one client, however. Several were out, and one had died the previous day, which was sobering. The one client we talked to asked Aubrey and I for our clothes. There it was, the biblical commandment to give your shirt to the person who asks. The problem was, I wouldn’t be wearing much if I gave her my shirt. If I was a guy, I don’t think it would matter, but somehow I didn’t think it was a good idea!

We passed a beautiful two-story house surrounded by a large wall and intricate gate on our way back from the village. One of the Ugandans said, “In Uganda, if you have such a house, you must have deprived many people of resources.” They seem much more aware of injustice and inequality than we are sometimes.

Tuesday, March 20
ELISA HIV tests

After a talk about STIs and STDs (I have the worst time trying to pay attention to Ugandan preachers and speakers. I zone out because I can’t understand them half the time), we went out into the villages for HIV testing. Aubrey and I each went to different sites with a counselor on a TASO boda boda (bike with an extra seat on the back or motorbike). Visiting the home of a current client, the counselor explained HIV and its transmission and then offered to test those who were willing. Altogether, he tested 21 family members (and this was not a polygamous family!). After the results were in, the counselor talked to each person away from the group.

HIV testing in the community

I held a one-month-old for a bit while his mother was in counseling, and they asked if I would feed him since he was hungry. I said I hadn’t had children yet and therefore was quite unable to feed him, and they were shocked. I guess it’s just normal to always have a breastfeeding infant around, so if you’re holding a hungry kid that’s not yours, no big deal. Haha.
I think I want a motorcycle.

Thurdsay, March 22

The executive director of TASO Uganda came to our site today with a group from SIDA (Swedish International Development Cooperation Agency – http://www.sida.se/), most of them Swedish and one from Kenya, one from Zimbabwe, and another from Senegal. SIDA funds the TEACH (TASO Experiential Attachment To Combat HIV/AIDS) program.

We visited seven different sites with successful interventions. Most of the projects were similar to the ones I’ve described previously. Two of the clients today, however, were orphans. Kelly Flamos (http://blog.case.edu/kellio/), who worked with TASO last summer through Case Western Reserve University, helped build a house for a family of five orphaned children. The oldest is seventeen; both parents died of AIDS a few years ago. Only the youngest, who is probably about five, is HIV positive. TASO provides him with ARVs and other medical attention when he needs it. They also gave the children a bike so the oldest could more easily bring the youngest to the TASO center for ARV refills and any other services. Before they got the bike, the boy would wake up very early, skip school for the day, and carry his brother to the center. It takes about 20 minutes or more to drive to their house from the center.
The boy in the paragraph above

TASO is really doing wonderful things for the people of Uganda.

Friday, March 23

What a day! We drove out to Sironko district (almost to Sipi Falls) to visit clients in the mountainous region. As we got in the car, I asked Aubrey, “Is this the guy who drives way too fast?” She said, “No, I think the other guy is worse.” Boy, were we wrong! After leaving the main road, we began to bump our way up the switchbacks. They were probably the worst roads I have ever seen, and I promise you I have experienced some awful ones! Our driver seemed to think that racecar driving was the way to tackle these barriers, so we flew/jostled/tumbled up the mountain. I yelled, “What is wrong with you?” one time. I don’t think he heard me, but everyone else laughed. Needless to say, that was our last day in the field at TASO, so it looks like that driver won’t be responsible for my life anymore!

The mountains were breathtaking. I wish my camera could capture them, and I wish my words could describe them. I don’t even want to try!

We probably stopped at six different homes today; we were out in the field for seven hours. At most of the homes, we simply dropped off ARVs, but we did HBHCT (Home-Based HIV Counseling and Testing) at two of them. At the first house, we met a widower who is HIV positive and lives with his two boys. We tested the boys; all I could do was hold my breath. You can’t help but hurt when you have to test a six-year-old for HIV. But they were both negative!

The second household we tested had about 14 family members; two of them were HIV positive. The counselor said that one of the HIV positive clients was shaking and could not believe the news. I think we are too quick to separate ourselves from things like this. Especially when we only have to read about them. I try to place myself in their shoes, in their fears and challenges, and imagine what they must feel. I know I fail miserably, but it helps me remember that this is real life, that people all over Uganda are facing this awful reality every day.

On the way back, we stopped to drop matooke off at a counselor’s house and even took a 45 minute detour to a market to buy molokonyi. Cow hoofs. Disgusting. This culture is worlds away from my own!

My time here is coming to a close. I have about four weeks left, and I don’t know what to do with myself! I have 348 hours, so I only need to work for about two more weeks, and then Aubrey and I are hoping to head out to Kenya for our long-awaited spring break.

I want to make sure I get everything I can out of being here, though. I’m trying hard to focus on Uganda and the present instead of getting excited about graduating and being on a Summer Ministry team for ENC.

Uganda Makes Me Laugh - Part 2

1. They MUST iron their clothing. When Aubrey and I stopped by our friend Sam’s house to pick him up for church, he came out, saying, “Oh, I’m sorry, the power was out last night so I couldn’t iron. You will have to continue without me.”

2. “You are smart today” = “You look nice.”

3. Just because the receptionist said there are rooms in the hotel doesn’t mean they really have available ones.

4. They have wedding introductions AND wedding ceremonies, both of which involve lavish ceremonies, receptions, and dresses. Sometimes the wedding introduction is the day before the wedding. My goodness.

5. They pronounce words very differently. Leopard=lay-o-pard, Giraffe= gea-raf, divorce=die-vorce, Deuteronomy=due-tronomy, wafers= wah-fers

6. They’re blunt when describing people. “That old one over there,” “the fat one here,” etc.
One of the ladies in administration looked at me one day and said, “Oh, you are doing well in Africa! You have gotten fat!” (note to self: start running)

7. There was a patient named Cinderella.

8. Short call= going #1 and Long call=going #2

9. shift=move, pick=pick up (“I’m going to pick you at four.”)

10. If you’re new, expect to introduce yourself to the entire crowd and make a speech.

11. Men can have as many wives as they want.

12. “Happy New Year’s” wishes last at least a month after New Year’s.

13. To fund weddings, they hold weekly wedding meetings to get money from friends and relatives. The concept of the bride’s parents paying for the wedding is quite foreign.

14. Speaking softly is a sign of respect. However, it’s really annoying because I can never hear what they’re saying.

TASO & AIDS: Week of March 12-18

one of the beautiful little girls who is HIV positive

My favorite quote of the week: “Laundry is not one of my greater talents, but I do love ironing.” – Brian, 24-year-old employee at CURE. (I told you they like to iron!)

Monday, March 12 – Tuesday, March 13

We began our first full week at TASO (http://www.tasouganda.org/; my site is www.tasouganda.org/mbl.php). I was surprised to learn that many TASO employees are HIV+ themselves and even more surprised to realize that people with AIDS have a lot of hope for the future. Living positively with AIDS is one of their goals.

They start the patients off with septrin, a drug that basically wards off sickness since their bodies’ immune systems are weakened by the HIV virus. HIV attacks the body’s CD4s, which are part of the immune system (they call them “little soldiers” when talking to the children). When the person’s CD4s go below 200, they are put on ARVs (antiretroviral drugs) that cause the HIV virus to become dormant, allowing the body’s CD4s to rise again. Otherwise, the person would get sicker as opportunistic diseases continue to manifest themselves in the body.

Here’s Wickipedia’s explanation: “CD4 is also a primary receptor used by HIV-1 to gain entry into host T cells. The HIV-1 virus attaches to CD4 with a particular protein in its viral envelope known as gp120. The binding to CD4 creates a shift in the conformation of the viral gp120 protein allowing HIV-1 to bind to two other cell surface receptors on the host cell (the chemokine receptors CCR5 and CXCR4). Following another change in shape of a different viral protein (gp41), HIV inserts a fusion peptide into the host T cell that allows the outer membrane of the virus to fuse with the T-cell membrane. HIV infection leads to a progressive reduction in the number of T cells possessing CD4 receptors and, therefore, the CD4 count is used as an indicator to help physicians decide when to begin treatment in HIV-infected patients.” (http://en.wikipedia.org/wiki/CD4)

TASO works with clients to counsel them throughout the entire process, from pre-testing to death. They provide clients with food, ARVs, septrin, support, and income-generating projects. They work to sensitize the communities, dispelling myths about the disease.
On Tuesday, they held a general health clinic, so Aubrey and I took down the information of about 150 patients. Some of the names of their hometowns are crazy: Budaka, Namakwekwe, Bukedea, Sironko … you get the idea. Now try only hearing the names and figuring out how to spell it!

Wednesday, March 14

We played with the kids in the Children’s Play Center today. Most of these kids are aged 3-12, and most of them look fairly healthy. Trained counselors work with them, going through their ARV regimen and making sure they are taken care of. They read a comic book of sorts to the children that explains HIV, CD4s, and ARVs. It breaks my heart to see these happy children, knowing they are HIV positive through no fault of their own.

The first client we saw was a thirteen-year-old girl who attends boarding school in town and travels to TASO alone. She’s been on ARVs for about four years and has consistently attended TASO workshops and counseling by herself. I don’t understand.

these boys were goofballs. they don't look like they're HIV+, do they?

The funny thing is, I thought at first I would be uncomfortable working with so many people who have a fatal and somewhat contagious disease. But knowing that I can’t get it easily (you can only contract it through sex, sharing infected needles, receiving an infected blood transfusion, etc.) means that I don’t mind being around them at all. In fact, I feel very lucky to see their struggles and victories with this disease. It’s very encouraging in light of the disheartening situation.

Sarah, age 12, wrote this poem.

AIDS! AIDS!

Who created you?
You are finishing us all
You kill the young and the old
You are finishing our lives
What is your mission?
You are a threat to the population
Why do you rob a man of his good life?
Last week you killed our father
The other month you killed our mother
Now you are killing our brother
Leaving us orphans
We wish we knew where you live.
Where are you, AIDS?
The old and the young have died
The poor and the rich have vanished
The handsome, the beautiful, the ugly have disappeared
Because of AIDS, the killer.

Thursday, March 15

We did intake again today with a TASO employee and client named Doka. He’s 47 and was diagnosed with HIV a few years ago. At that point, he had two wives (remember, polygamy is not a big deal here), and one was HIV+, the other HIV-. The uninfected one left him. He went from 77 kilograms (170 pounds) down to 49 (108 pounds), and his CD4 count dwindled to 43 (a healthy person has about 800-900 per cubic milliliter of blood, I think). However, he began taking ARVs, and his CD4 count went back up. I honestly had no idea he even had HIV; he looks very healthy and happy. Again, it was so encouraging to see that life does not have to stop when someone is diagnosed with HIV.

We traveled to Mbale Progressive School (a secondary school) for a school outreach in which we showed two videos to a group of about 300 in a small room. They didn’t seem to pay attention very much. I guess it was a typical high school crowd, but it was frustrating.
I did see an ostrich across the street in someone’s yard, though! I’m going to go visit it before I leave.

Friday, March 16

These goats and the cage were given to clients to generate income

Friday we went into the field for follow-up again. We drove out of Mbale into the villages to check on a few income-generating projects involving goats, chickens, and cages for them. Driving through miles of lush green rice fields to reach the towns was amazing. I love driving through Uganda. I never get bored.

a home visit with the group. Seated L-R is Dennis from Malawi, Prisca from Zambia, a TASO employee, a member of the client family, and Aubrey. Dennis and Prisca are part of our TEACH group.

We also went to another outreach in another school, though this one was intended for the entire community. A singing and drama group from TASO presented songs and skits to explain AIDS, and several HIV-positive clients shared their stories.

Barbara, our supervisor at TASO, relayed two stories of confusion about transmission of HIV. One drug user was using needles without fear, and when asked why he wasn’t scared of contracting HIV, he replied, “Oh, I’m safe! I have on three condoms!”

Up north in Karamoja, there is a group called the Karamojong. I haven’t visited them, but they seem quite interesting. They hardly wear anything except for their AK-47s, and they believe that all the cows in the world belong to them (don’t ask me why). So they often raid villages and take their cows.

Anyway, apparently the Karamojong were given condoms as well so they could practice safer sex. So what did they do? They put on the condoms and wore them all day, took them off to pee, and then put them back on. They would take them off to have sex, and then put them back on (remember that these guys are in the nude most of the time anyway). Oh my.

Saturday, March 17

A friend here at the hospital visited today (Brian, the one who gave me that wonderful quote about ironing). He believes that there is not one person in Ugandan unaffected by AIDS in one way or another. “I personally have lost count,” he said. He has lost two brothers and a sister to AIDS as well as countless aunts, uncles, and cousins. This is a man from a well-educated, seemingly well-off family, and they are still suffering from this disease. I didn’t realize how much it has affected this country.

Uganda makes me laugh

Aubrey and I made a list of things about Uganda that don't quite fit with our own culture. It was really long, so I'll post it in segments.


1. Guys hold hands in public. It’s normal. However, guys and girls cannot hold hands. In fact, the bride and groom do not even kiss at their wedding. They just hug. “We would never kiss in church!”

2. Some of the appliances are European and therefore have European plugs, which are two thin, round prongs instead of the three large, rectangular prongs on the African appliances. To plug in these European appliances, I have to switch off the outlet and stick something into the extra hole so I can plug in the appliance. It cracks me up every time.

3. "That's okay" means "yes."

4. They all carry handkerchiefs.

5. We eat bugs in our food all the time and we just don’t care anymore. This is our closed butter dish. (Don't worry, we don't eat them in excess. haha.) They like to eat food in our fridge, too. Jerks.

6. “You are lost” means “You haven’t been around in awhile.”

7. They complain about it being hot all the time but put on sweaters, scarves, hats, and winter coats when it gets below 70 degrees Fahrenheit. (It is hot in this picture!!!)

8. “You are welcome” means “I’m glad you’ve come. Welcome.”

9. Ugandans speak really, really proper English.

10. To communicate, I have to slow down and enunciate every word, emphasizing the t’s and d’s.

11. To say yes, they often just raise their eyebrows.

12. Anything and everything can fit on the back of a bicycle: mattresses, bedframes, chairs, several chickens, several people…. this goes for cars, too.

13. The same rule applies to their heads. I’ve seen a man carrying at least 10 foam mattresses on his head.

14. Out in the village, the local bar is a pot of local brew surrounded by men with 6-foot-long straws.

15. Circumcision is a really big deal here. They have public ceremonies for them. When we went out to Sipi and walked around the villages, a friend of our guide actually had a whole roll of pictures of circumcision ceremonies and tried to sell them to us. I am glad to say that all three of us girls were able to pretend that this was normal. A few days ago, one of the two national newspapers featured a cover photo of circumcision. Wonderful.

16. Meat (think entire skinned animals) just hangs out in the market and wherever else a butcher decides to open up shop. When you buy a piece, they just whack off a chunk with a big knife. Check out this very nice goat below. At least he still has his tail. I think the other one is a cow.

(this guy is really whacking that meat ... you should have seen him. can you see the splatters on the wall? mmm....)

March 7-10: Trip to Gulu & Lira

Journal – March 5-12, 2007

Tuesday, March 6, 2007


Driving up through Lira onto Gulu reminds me that four months is a very short time in which to try to understand a culture and fully appreciate its beauty and its hurts. Simply watching the breathtaking landscape bump by as we ride in our little ambulance reminds me I have so much yet to see. Broadway’s version of the Lion King is the perfect soundtrack …. Africa is so beautiful and so wounded.


Right now we’ve just entered an IDP camp. The bandas (thatched-roof mud huts) are so close to each other you could reach into your neighbor’s window. I can’t imagine the frustrations of living in temporary housing in such close quarters for decades. We’re in northern territory now, where the LRA has ransacked and killed over recent decades. Who would have thought I would be driving here when I watched “Invisible Children” almost exactly a year ago?

Wednesday, March 7, 2007

Yesterday we actually got to visit the Invisible Children office (check out www.invisiblechildren.com). Adam introduced us to James, who gave us a tour through the buildings. There are sixteen mentors who act as role models for about 600 children who escaped from the LRA (Lord’s Resistance Army), and IC has started a Schools to Schools program through which American schools sponsor Ugandan schools. It was crazy to finally see the programs born out of all the hype about the Invisible Children in Uganda.


Justin Onen, one of CURE’s doctors, said that children still travel from the villages to the towns to sleep in safety away from the LRA. The numbers have diminished, but it still happens. I didn’t know how to feel last night when I looked out the window of my secure hotel room, knowing that there were children sleeping in the streets alone.

Aubrey with Weston Hall, a Salvation Army worker, at a preschool in an IDP camp

Today CURE held a clinic at the Gulu Regional Hospital; about sixteen patients came for follow-up. Aubrey and I wanted to see what other NGOs (nongovernmental organizations) did in the area, so we called Weston Hall of the Salvation Army, and he kindly picked us up and let us follow him around for the day. We visited UNICEF to discuss in-kind donations and funding proposals and then headed out to the IDP (internally displaced persons) camps. These people had to move out of their villages because of attacks by the rebel Lord’s Resistance Army a decade or so ago, and conditions in these makeshift villages are awful. If you’ve seen the Invisible Children update DVD, it shows a shot of IDP camps outside Gulu. Bandas are everywhere, and up to ten people can sleep in each one. I’m sure there is no privacy, not to mention nothing to do other than school and the occasional football (remember, that means soccer here!) game. The social worker there said that GBV (gender-based violence) is a huge problem there.

We visited a preschool, a tin roof with no walls. These children truly are poor. We see the poor at CURE, but these children’s clothes were completely brown and ragged. Their stomachs are bloated from worms and almost all of them have runny noses. But they happily sang us songs and eagerly reached to shake our hands: “Hello, mzungu!” The teachers encouraged them that someday that might achieve great things like us. I didn't know what to say.

Thursday, March 8, 2007


Carol Higgins picked us up this morning to take us to PATH ministries’s Okino-Waa (“Our Children” in Luo), an orphanage started by herself and her husband on the outskirts of Lira, a town a few hours south of Gulu. It was so encouraging to walk through their community and see the amazing opportunity given to orphans who were abandoned, whose parents died, or whose families were attacked by the LRA.

Aubrey and Christine walk into one of the homes at Otino-Waa.

There are about twenty huts in the community, each housing nine children and a woman who acts as their surrogate mother. Each house has bunk beds, a bathroom, a private room for the mother, and an outdoor kitchen and eating area. The children are given a monthly allowance of their own currency to buy things like soap and clothing from the orphanage’s store to teach them responsibility. A nice primary school (up to grade 7) is available for all of the children, and they go to boarding school for secondary school (secondary school covers 8th grade thru what would be 13th grade). Seeing these healthy and happy children living in wonderful conditions with loving mothers was wonderful. We can make a difference.

We ate lunch at one of the houses. I'm here with Mama Florence and her "kids."

Saturday, March 10, 2007


Aubrey and I started our first day with The AIDS Support Organization (TASO) yesterday. We’re enrolled in their TEACH program (I can’t remember what that acronym stands for!) for the next three weeks to learn about community support and programs available for AIDS clients here.

We spent yesterday doing home visits and discussing options for tackling problems that come with AIDS in Africa. We spent a few hours bumping through “roads” (dirt with lots of potholes; sometimes, it’s only a dirt path, and we just drive through the bush!).


One of the men told me to write about it so I could tell everyone in America “what the rural people live like.” He said, “We’re not sick, we are only suffering. We hope to live many more years.” His wife and four-year-old son are also HIV positive. I could barely look at the boy without a lump forming in my throat and tears blurring my vision of the hot African landscape. Sometimes I wonder if I can handle working with the disadvantaged.

Hydrocephalus 101

With Elizabeth at the Mbarara clinic. You can see a dent in the middle of her head where the CSF has drained. She's happy and recovering, though!

I've been wanting to explain hydrocephalus to everyone so they can better understand the conditions the hospital treats, so here's my unmedical attempt to do so!

Hydrocephalus basically means "water on the brain." There are four ventricles (cavities of sorts) in the brain, the two lateral ventricles, which are on top, and the third and fourth ventricles.

The choroid plexus produces cerebrospinal fluid (CSF), which flows around the brain and down the spinal cord (the arrows below show flow of CSF). CSF is a good thing, but sometimes one of the ventricles become blocked (usually between the third and fourth ventricles, I hear), preventing proper drainage of the CSF.

With nowhere to go, the CSF stays in the ventricles, causing them to swell with the fluid and putting great pressure on the brain. Since babies' skulls are still forming (remember the soft spot on their heads?), they grow with the increasing pressure, resulting in abnormally large heads.

Most of the hydrocephalus we see here occurs after the babies are born (PIHC - post-infectious hydrocephalus); it is mostly preventable. Hydrocephalus can be caused by blockage from tumors, cysts, swelling as a result of infections like meningitis, and other reasons.

Many babies born with spina bifida develop hydrocephalus as well. Here's where the hospital comes in. There are two surgical procedures currently available to treat hydrocephalus. The first is the ETV (endoscopic third ventriculostomy), in which the surgeon uses an endoscope to create a small hole on the bottom of the third ventricle to allow the CSF to drain. This has the highest success rate and requires less maintenance. However, an ETV does not work with all cases.

The second option is to insert a shunt. Basically, a system of tubes with a valve is inserted into the right lateral ventricle, travels out of the brain between the child's skull and skin down into the abdominal cavity, where the CSF can drain. Other types of shunts may empty into the heart or the lungs, but CURE mostly uses VP (ventriculo-peritoneal) shunts.

After the ETV or the shunt is placed, the CSF begins to drain, sometimes resulting in a large valley on the child's head. Eventually, this soft spot will close on its own, though it is at a very slow rate and the sides may overlap. However, the head size generally does not change, because the skull has formed as such, and bones do not change shape easily.

That is hydrocephalus in a nutshell. I am so thankful to be at a place that can repair these babies' heads and lives and give them hope.

further reading: www.hydroassoc.org, www.ifglobal.org/hydrocephalus

This baby looked a lot happier before this picture! You can see that his skull is slightly malformed. The surgeons were able to perform an ETV on him (you can just barely see the bandage on the top right section of his head).

Week of February 12

I apologize (again!) for the flurry of mass emails over the past few days. I'm trying to catch up with everything and move forward so everyone can be caught up.

Pictures from the month of January: http://enc.facebook.com/album.php?aid=2005189&l=0f7a1&id=149000028


I’m writing this journal on a Thursday during the beginning of our eight-hour trek from Mbarara to Mbale. I don’t really know what to think. I’ll let myself get comfortable in this setting, get used to the trash on the streets and dust that covers everything and the rags that clothe most of the children. It’s a self-protective measure, in a way. If I let myself feel about these things all the time, I’d be so depressed. But is this any better? I don’t think so.

I’m typing on a several-hundred dollar computer, listening to iPod music, and wearing $40-dollar shoes. And behind me on our little convertible ambulance/bus is a baby who is just hanging on to that precious thread we call life. A weak, gasping cry follows every shallow breath. I’m getting overwhelmed just listening to it. It’s strange; I’m listening to a song that says, “Once upon a time … we believed in miracles…” Not that I don’t believe in miracles, but it’s rather sobering. I hope this baby makes it all the way to Mbale.

This week I’ve been away from Mbale since Saturday. I traveled to Kampala for Dr. Rita’s wedding on Saturday. I sat on the end of a row, and when we went up front to give the offering, I completely forgot about my purse at my seat. Needless to say, my wallet was stolen during those three minutes I was away from it. Mom and Dad were wonderful and cancelled my two debit cards right away, and Charles (whom I’m starting to call “Dad”) let me stay with their family for the night and gave me enough money to cover me for the rest of the week.

On Sunday, I traveled to Mukono to visit Greg and the rest of the Uganda Studies Program students. It was fun to be in a college setting again, and I was able to attend four classes on Monday and Tuesday morning. Two of the classes were taught by Americans, and two were taught by Ugandan professors. One of the later classes was East African Politics, and the professor outlined the Statist Theory, which places the blame for Africa’s poor condition on its leaders. The fault does not lie in Western aid and the dependency it creates (as well as the conditions it places on its aid) or in Africa’s unwillingness to move past tradition and on toward modernization and development. There does seem to be a great amount of corruption among leaders here, even in Uganda’s President Museveni. It sounds like he started out as a great leader, but somehow he is still in power 21 years later. Ugandans are still hoping for a peaceful transition of leadership, since this has yet to happen.

I think it’s a mix of the three, though. It would be impossible to pinpoint one cause of such a large-scale failure to provide for people. I’m realizing how much more I need to read about the history and culture.

On Tuesday, we drove to Mbarara, a medical university town in the southwest corner of the country. Wednesday was clinic day, and we saw about thirty patients. There wasn’t too much for me to do, though, because I’m kind of useless when it comes to speaking to the clients. I did play with lots of the babies and worked on putting together the resource book. I feel useless here often, so I like to create jobs for myself in hopes of bettering the hospital somehow in my own way. Charles reminds us that just being with the clients is often useful in itself, but I tend to want to be doing things. I’m guessing there is a balance between just being with the clients and working to get things done.

I’m having a hard time concentrating because we’re passing plains now and I’m trying to type while looking for zebra. I think I’ll look out the window and type at the same time and correct the mistakes later!!

Miriam and I talked about social work again Wednesday night. She has such a vision for social work and her country. She wants to connect with current social work college students to provide them a network of support from practicing social work graduates in hopes of supporting them and given them mentors. Like she’s said before, social work is a developing profession here and is therefore not regulated by a set code of ethics. The NASW-Uganda is developing and will continue to change and grow through the conferences they are planning and dialogue. Charles is interested in starting an MSW program at Uganda Christian University with occasional visiting professors from abroad. I think that would be wonderful. Maybe I’ll come back for a semester. It’d be interesting to see how the foreign professors would be able to adapt to the culture.

And that was my exciting week. Laying in bed on Saturday night, I tried to feel sorry for myself because of my stolen wallet, but all I could feel was overwhelming gratitude and unworthiness at the chance to be in Africa for four months. My heart is still with Latin America, but I think Africa is stealing a different part of it.

Friday, February 16, 2007
I feel like I need to add an addendum to this entry. The baby made it back to Mbale and had a good night last night. Pray that it continues to get better.

Week of February 5

This week, I tried to buckle down and actually get some tangible work done. I’m feeling very comfortable at the hospital and enjoying my coworkers a lot. They’re still so welcoming, nice, and funny. Ugandans have a good sense of humor. (Maybe it’s because they eat things like minnows and meat smothered in fat – they need it!)

I finished gathering questions for the take-home book for the mothers; now I need to find answers to these questions that they will understand! I’ve gathered tons of information from spina bifida and hydrocephalus association websites, so I need to sift through it all and make it understandable.

I’ve tried to be aware of needs that I can help fill. The intake doctors and social workers are constantly explaining hydrocephalus, spina bifida, shunts, and ETVs and drawing pictures to accompany them. I’ve gathered simple diagrams outlining each condition or procedure and will print them out on a two-sided page, have that laminated, and provide each department with a few of these sheets.

Another problem is that the bathrooms are constantly misused by the mothers who are from villages out in the bush. They will stand on the toilet seat (and often miss), will go to the bathroom outside the toilet, or will put bags, diapers, gauze, etc., down the hole because they may be used to pit latrines or holes. To make the mothers aware of the workings of the modern toilet, Aubrey and I found signs online that show how to correctly sit on the toilet and not to stand on it. I spent so much time looking online for a good diaper picture! We wrote instructions in English, and I had staff translate into Luganda, Swahili, Luo, and Ateso.

I also discussed what sections need to go into the orientation video. There are so many rules of which the mothers are unaware; I’m hoping that I can make the video interesting and effective.

Miriam and I spent some time watching videos about hydrocephalus, spina bifida, and CIC (Clean Intermittent Catheterization), since children with spina bifida are most often incontinent. These videos are helpful, but we both agreed that we need to make them more culturally sensitive and relevant to our clients. She’s hoping to use parts of those videos in conjunction with videos we make ourselves. (I just don’t want to take on too many projects!)

After reading and looking at so many pictures of the conditions we treat, I feel that I know a great deal about them, enough so to explain to parents effectively. A few days ago, Miriam was busy doing an intake, so she put me into an office with an English-speaking couple. I could tell right away that they were well off, and this was apparent even in the fact that they could understand my English very well for the most part (what a relief!). The father was an accountant, and the mother works in a hardware store. I recorded their socioeconomic information, asked them where they’d heard of the hospital and if they understood their child’s condition. They did for the most part, and I expanded on the parts they left out. Then came the worst part: telling them they have to pay for the service. What the intake sheet says is,
"Our services are specialized and highly qualitative, hence not free. Well wishers from abroad, especially the USA, have helped cover the biggest part of the bill; we therefore request you to make a financial contribution of shs 750,000 to cover the rest of the bill towards the treatment of your child. How do you hope to meet the bill?"

I tried to pretend that I didn’t hate the fact that I was asking an African family for money and told them the surgery cost shs 750,000 and asked how long they needed to pay. The father said, “I can pay 500,000 now and 250,000 when the baby leaves.” That never happens. So I got extremely lucky for my first real intake. I took part in a few other intakes this week, but it usually ends with Miriam explaining things in their native tongue because it’s too hard for them to understand me. Sometimes Miriam will translate for me, but I feel like that’s a waste of time since she can do it perfectly well by herself. And I certainly don’t want to compromise the quality of service for the clients just because I’m in my practicum!

I’ve been concerned about figuring out case loads, but Charles suggested that when patients come in from Mbale, I make sure to spend time with them, check up on them, help them look for resources, and then do a field visit after they leave. Even though this is not what the social workers do here, it should give me some experience with case loads. I think it will help me focus on and get to know some of the mothers better, because there are usually at least 20 mothers in the ward at any given time, and it is hard to get to know them when there are so many.

Here’s a side note: I barely dodged a baby’s pee yesterday. I don’t think it will be long before a baby pees while I’m holding him. I’m pretty sure that’s inevitable.

Living where we work gets more difficult for Aubrey and me the longer we are here. It’s our home, but people can walk into it anytime without warning, especially our coworkers after hours. Of course, we like them, but sometimes they stay late, and I have work to do and just want to be alone. When Aubrey and I are here by ourselves, we usually are in our rooms relaxing or doing work. We certainly have our times to talk about life, though! It’s nice to have someone here all the time. I think we’re doing a good job of being together a lot but having our own space and times alone. I’m enjoying having her around.

Tomorrow (Saturday) I am going to Kampala for Dr. Rita’s wedding! Then I’m taking a long weekend and traveling to Mukono to be with Greg and the USP students until Tuesday afternoon, when I’ll travel to Mbarara for a clinic until Thursday. So I won’t be home for a week! It should be exciting.

Week of January 29

It still feels like I am settling into my place at CURE. It’s officially been a month now, somehow! While I miss home and school very much, I am happy here. Especially because there is a gecko crawling on the wall as I type. I love accommodating and adapting to the silly little differences like that, or changing my handshake, or having to stick things into the electrical outlet so I can plug in appliances! I can’t say I feel at home in the culture because it is so different, but I am enjoying being a part of it for four months. No driving will scare me when I get back home!
I have been talking with Miriam about differences in social work here in Uganda and in the U.S. As I said before, it seems to be at a different level, though universities are working to improve their programs. Charles would like to start an MSW program at some point, perhaps. Maybe I’ll come back and teach! Ugandan social workers do not operate by our Code of Ethics, but they use the British version, which is adapted from ours. She spends a lot of time on the NASW website, trying to learn as much as she can; she is always reading a social work book or literature about hospitals and disabled children. I hope she gets into Case Western and is able to pay for it. She is wonderful. She truly shows the clients that she cares for them.
Aubrey and I have both been feeling somewhat useless because there are so many barriers to helping clients. For one, we are mzungus, and being white automatically puts us in a different category of opportunity and money. Clients will often ask us to give their children toys, sponsor children’s school fees, or pay for some service. We have been told by Ugandan employees to say that we do not have these things. My first reaction when told this was to balk at lying. But in reading African Friends and Money Matters, I have realized that Ugandans place paramount importance on maintaining relationships to the point that they will lie to avoid conflict. In fact, it is somewhat rude to say, “No.” Therefore, I suppose that lying in this context is excusable. I still don’t like it, but I will donate to organizations in hopes that this is the best way to help the poor.
Another reason Aubrey and I both feel irrelevant to clients at times is the fact that we are young and not mothers. It seems that mothers sometimes look at us and think, “What can they do to help us? It’s not like they can come close to empathizing with our situation.” Speaking with the clients is also difficult. A few speak English fluently, but most do not. I have started asking staff to translate for me so I can communicate better with the mothers. Still, it is frustrating, especially when I have taken time to learn Spanish and it is useless here!
Miriam Ampeire (the social worker) and the other Miriam (the director of the Spiritual Center) have both told us that simply taking time to talk to the clients and hear their situations and hold their babies does great good. Coming from a society and culture that emphasizes efficiency and doing makes it difficult for us to feel like we are being effective. But I think we can find a balance in which we get things done but also slow down to simply be with the mothers and love them.
I focused on several projects this week in hopes of moving forward with them. Charles and Melissa (his wife) have both warned me that getting things done here is quite difficult because of cultural differences. With that in mind, I am trying to take charge of my little projects but include many people so they feel ownership in them and will continue them when I am gone.
I talked to Florence, head of the nursing department, about my booklet idea, and she gave me information on nutrition as well as other ideas. She agreed that a PowerPoint presentation on nutrition would be very useful. Aubrey and I also met with Miriam, the head of the Spiritual Center (yes, names get so confusing!), to learn about spiritual influences on the clients. We were surprised to learn that most of the mothers go to witch doctors, even if they’re Christians, for healing before they will come to the hospital. They believe that the children’s condition is due to a curse and will often blame the mother and the family for failing to do something or doing something to bring on the curse. So not only do the mothers have to care for sick children, they have to take the blame for their child’s sickness.
I grabbed Miriam on Thursday to ask the mothers in the ward about their questions, what they would like to know when they leave, and what would have been helpful to know when they came into the hospital. These answers were extremely helpful in formulating ideas for the booklet as well as the orientation video I’m trying to put together. Aubrey is gathering pictures to better explain the rules to mothers who cannot read (or speak uncommon languages), and I am trying to put together an orientation video so they will be less confused when they come into the hospital. This project is going to be a lot of work as well, but everyone I have talked to about it has agreed that it is needed. I want to be useful!
We visited the epilepsy department to learn what they do in that section of the hospital, since we have spent time in every other department. It was so interesting. The patient had to shave her head so the electrodes could be attached to measure brain activity. The two epilepsy nurses were gone; one was on her honey moon and one was sick, so Richard employed Aubrey and me to help him. Aubrey covered the electrodes in conductive substance, Richard placed them on Amanda’s (the patient) head and covered them with gauze and a special glue, and I cemented the electrodes to her head with a tool that releases oxygen at high pressure. Richard then plugged the different electrodes into different jacks to correctly record her brain activity. The goal is to record three different seizures in a patient in order to analyze abnormal brain activity and pinpoint the regions of the brain causing the epileptic seizures. Quite interesting.
This coming week I hope to make a lot of progress with the book and spend more time with the mothers as well. I am much more comfortable in the ward now and am enjoying getting to know the mothers and playing with their children. I hope to find material online about working with sick children so I can know how to better work with them.

Week of January 22

I apologize for the month-long break in posts. School work and activities have picked up, so I found myself putting off writing longer and longer until the thought of writing an update for the whole month became too overwhelming. So as a compromise, I'm going to post my practicum journal entries for the past month. I hope they will suffice; in the future I'll try to be better about it!

Here are some pictures of my trip to Sipi Falls a few weeks ago: http://enc.facebook.com/album.php?aid=2005116&l=80038&id=149000028

January 22, 2007

At this point, I think my journal reflections are not going to be as long, since things are starting to become routine. Yet at the same time, I know that I will continue to be challenged in ways I do not foresee and surprised by living in Africa.

This week held two large highlights for me. The first was participating in a rally sponsored by Mama Janet Museveni, the president’s wife, to promote faithfulness in marriage as a way to combat the spread of HIV/AIDS. Prior to the march on Tuesday, 300 couples participated in a conference outlining qualities of faithful marriages and how to make sure they happen.

(Here’s a side note: In Uganda, polygamy is actually a fairly common practice. Simply put, it is not a big deal and is even expected in some areas. Faithfulness to one’s wife is not a highly esteemed quality, either. A man could be married to a wife in Mbale and have a girlfriend in Kampala. Some Ugandans will ask even Charles if he has a Kampala girlfriend. It isn’t uncommon for the wife to know about the girlfriend; it is just a fact of life, apparently.)

About fifteen of the CURE staff took a bus to the Mayor’s Municipal building to march in the rally. After following the parade throughout Mbale, the crowd returned to the mayor’s place and listened to several speeches by government personnel and other local leaders, including someone from TASO (The AIDS Support Organization). The Minister of Health spoke as well, outlining tactics to reduce the spread of AIDS. Finally, Mama Janet spoke, giving the last speech of the day. Her love for Uganda is apparent, and her passion for reducing the spread of AIDS has had a profound impact on her country’s health. She was adamant about faithfulness in marriage and even suggested praying together as a way to promote togetherness.

AIDS, sex, and condoms are simply not taboo subjects of conversation here. Everyone is informed by posters, billboards, and the government of these issues and the measures needed to reduce the spread of this disease.

The second highlight of the week was a trip to Kampala on Thursday. Sylvia, the HR director, was invited to participate in a government workshop debating the implementation of the SHI (Social Health Insurance) Bill. The government presented their proposals, and the FUE (Federation of Uganda Employees) gave their reasons for being hesitant of the implementation of such a bill so soon.

It was very interesting to hear the different sides of the argument and realize how little I know about the workings of health insurance, especially in Third World countries. The Ugandan government has researched the SHI of Tanzania, Kenya, and other countries in similar situations to decide the best route to affordable health insurance for all citizens. The plan, however, is to take 4% of each employee’s gross salary for the SHI and require the employer to pay another 4%. In the end, this could cost employers a lot, since they have to pay the required 4% in addition to possibly paying the employee more to make up for the employee’s 4% cost. The FUE argued that Uganda cannot afford this blow in the private business sector at this point; there is no reason to further cripple an already struggling market.

The government officials and those heading up the SHI bill listened to the concerns of the FUE and agreed to hold another forum to discuss the differences and try to come to a “win-win situation,” as they said. It seemed quite democratic.

At the hospital this week, I made sure to visit more of the departments to better understand all its workings. I sat with Dr. Rita, who does initial diagnoses with the patients, and she explained hydrocephalus and spina bifida as well as the procedures to correct these problems. I think I’m finally starting to understand these well. It’s actually quite interesting.

As I continue to decide my place here and what I need to be doing with my practicum, I am realizing how different social work in Uganda is from that of the U.S. As Sylvia mentioned this week, social services in Uganda are in their infant stages. I am continuing to discuss these differences with the social workers here and trying to decide how applicable the Code of Ethics is here. I certainly don’t want to discount it, but a lot of it just doesn’t fit here. Fighting to adhere to the Code of Ethics would be a futile battle. But I will continue to dialogue with Charles about it as well as with the social workers, and hopefully we will come to some conclusion.

life is beautiful

January 16-17, 2007

A baby died Monday night. He had hydrocephalus in addition to pneumonia, malnutrition, and who knows what else. He had a strong heart, they said, and that’s the only thing that kept him alive for that long. They took him to the morgue and had him embalmed and then his mother had to travel back with the body. Wrapped and in her suitcase. On public transportation. Rebecca, one of the social workers, told me this, and of course I was shocked.
“This is Uganda, Sarah,” she said. “It happens all the time. It’s just life.” I really didn’t know how to react. How could I? It is just a fact of life here, as horrible as that is. The people in the guest house (Jean, Rich, Aubrey, and I) talk about it a lot, how change needs to happen at a governmental level, and it’s so complicated, and how on earth can we help fix things….
Already, I’m used to seeing babies with hydrocephalus. It just doesn’t shock me anymore. And yet I try to imagine my own child suddenly developing a large forehead and then his head ballooning disproportionately and his eyes starting to bulge from the pressure. It just wouldn’t happen! The mothers frequently ask me, “Do you see this in America?” Oh, I wish I could help them, could take them all home with me and provide for all of their families. Or at least adopt a few babies and raise them.
On a brighter note, this week has been really good. Aubrey and I have just been wandering around to the different departments to learn all we can about the facets of the hospital. Normally, we work in OPD (OutPatient Department), where the intakes and general diagnoses happen. Yesterday, however, we went to the x-ray department, and Ronnie explained everything you could ever hope to know about it, and we watched one (behind the lead wall to be safe, of course – don’t worry, Dad).
Today we went to physiotherapy with Joan (they pronounce it Jo-anne, though, so I am constantly calling her the wrong name), and she explained the different conditions that these children usually face – being spastic (having extremely taut muscles – they don’t move much) or floppy (the opposite), having club feet, and slow development in general. She worked with a few children, showing the mothers how to stretch the tiny muscles. Some of them are in so much pain during the physical therapy. I had a hard time watching.
I also talked to Sylvia yesterday about the possibility of putting together a resource booklet for the mothers when they leave CURE. We brainstormed and decided on a general information section (explaining hydro and spina bifida, etc.) as well as different regional sections outlining resources available for their specific districts. I’ve talked to the social workers about it and plan to talk to Joan, the surgeons, the nurses, the spiritual director, and the mothers to see what would be most beneficial for them. I’m really excited about it even though I know it’s going to be so much work. I just wish I knew how to make that work sustainable (the regional information will be outdated in a year).
One thing that is interesting to me is that confidentiality, which is extremely important in the American social work, is virtually nonexistent in this setting. The social workers meet with the mothers with doors opened and discuss clients openly. In the ward, a large whiteboard covers one wall, displaying each patient’s name and any comments (“Failed ETV”). I guess on the part of the mothers, it doesn’t really matter, since most of them are illiterate anyway and can’t read the board. But still, it’s an interesting component. I guess it’s too hard to keep things confidential in this setting, where all the patients are in constant contact and all sleep in the same room.
Things are getting easier. I learned how to count to twenty in Luganda yesterday. (Remembering all these words is a different story!) The compound is beautiful, with the banana plants, lush green grass, palms, flowers….we even picked an avocado today. (I finally got on Rich’s shoulders and unsuccessfully jumping for it! Oh, muzungus are so funny!) I’m starting to remember my way around town and frequently find myself visiting Cissy and Solomon’s (and little Lizzie, whose picture was in the last post!).

Thursday, January 18

Today we got off work a little early to participate in a Beth Moore Bible study with 15 other muzungus (remember, that means “white person”!). I’m so excited about having that fellowship and a time to just be able to be my American self without worrying! J Melissa also lent me a cookbook about cooking American food in Africa. Genius. I’m getting tired of eating just noodles, bread, vegetables, and fruit!
Hmm. I think that’s all I have to say. J

Week of January 8-14

With Breanne (Charles and Melissa's daughter) and Lizzie (Cissy and Solomon's daughter)

What a week! I’m sure that any week beginning a time abroad is one of adventure, mistakes, and culture shock. After packing up from the hotel, Charles picked up Aubrey and we headed out on a four-hour trip to Mbale from Kampala. I couldn’t stop looking at everything and all of the new words plastered to the cement buildings. “Mukwano” (“friendship”) is a common one. As we drove, I asked Charles about everything, from social norms and taboos to the differences in hand gestures, facial expressions, and words. It’s deceiving that they speak English here, because I sometimes forget that I’m still in a culture very different from my own, and I need to be careful to recognize that and hopefully avoid offending anyone. However, I do realize that being a muzungu (white person!) gives me a bit of an allowance to err and learn from it.

It is common to greet someone every day with a handshake and a “hello” (not “hi”!). People usually take the time to stop and ask how you are and I think it is expected that you return the favor. Even on the phone, they hardly ever just say, “Hi, I was calling about….” They always ask how the person is before continuing. They seem more willing to slow down to place more of an emphasis on the people around them.
On Monday, I woke up at 3 a.m. and couldn’t fall back asleep, even though I was hoping to sleep in to get rid of the jet lag. Aubrey and I met with Charles to discuss educational contracts and decide our goals for the semester. I was completely out of it, so after the meeting, I went back to the guest house to lay down.

Later, Jean Kapsner, a visiting nurse from Minnesota, took us to the market to buy fruit and vegetables. It’s a little different than buying perfect carrots in a clear bag at the grocery store! After a trip to the supermarket as well, we struggled down the road with bags in each hand full of pineapples, mangoes, avocados, carrots, potatoes (they call them “Irish” potatoes), and various cheeses and cereals.

Jean gave us an introduction to life at the guesthouse. To have potable water, we must first boil it and then pour it through a filter system (for taste). Washing the dishes involves cleaning with soap and then rinsing in bleach water. We can’t leave anything on the counters, or the ants will almost immediately form a line and come running. We do have hot water and can flush toilet paper; both of these small conveniences are a huge blessing!

After work, we went out to eat Indian food with the Howards, Jean, and Rich, who’s from California and has been working at CURE as an IT/everything guy for the past six months. He’s leaving on Friday to work with Invisible Children in Gulu. The Howards are wonderful and I’m so thankful they’re here and taking care of us. Melissa, Charles’ wife, is actually the sister of Joel Brubaker, a friend from Summer’s Best 2 Weeks. (The world is small!) They have two girls, Elyse (4 years) and Breanne (almost five months).

On Tuesday, we met with Charles again to clarify our goals and discuss our plans. We’ll be at CURE for two months, and then we’ll travel down the road a few miles in March to participate in TASO’s (The AIDS Support Organization) TEACH program for a month. After that, we sat in with the social worker, Miriam, and watched while she did the intakes for the clients. I sat through about four, but only one was conducted in English. There are about 40 languages in Uganda; English and Luganda are the most universal, however. Needless to say, Aubrey and I are working hard on learning Luganda!

It’s interesting to watch the intake, because most of the time the mother is the parent to travel with the sick child (here, we mostly treat hydrocephalus and spina bifida – I’ll write more about that later). Apparently, village women have little say in the household and are often illiterate. Traveling long distances, finding themselves in a strange place, and being told that their baby needs surgery must be very overwhelming. Many of the mothers cry when they are told the problem. We have been told that children with disabilities in the villages are often given names that mean “passing through” or the like. They are expected to be on earth for a short while and then die. Still, some of these mothers really care about their children and anxiously wait while their baby undergoes surgery, but some don’t seem to be very concerned. It’s almost as if they have already given up on the child.

Wednesday was our first real day on the job, since I finally felt that I had moved past the worst of jet lag (which, by the way, is awful!). Rebecca, another social worker, was finally in after a bout of the flu. After sitting with her through a few intakes, we went around to the ward, where the mothers and babies sleep. It smells awful. Think of a team of football players after practice, multiply that a few times, and put them all in a closed room. It’s not anyone’s fault that they don’t have deodorant, and I’m the one that needs to get used to it. It just gives me a headache right now!

There are about 24 beds available. At any given time, there are several babies sleeping on the beds, their poor heads ballooning with hydrocephalus, shining from the stretched skin and veined with large blood vessels. It’s obvious which children have spina bifida because their heads are normal-sized.

Wednesday was a difficult day; I was feeling overwhelmed by the communication disparities, different expectations between Aubrey and me, and a long work day. I went to bed frustrated but recognizing that sometimes things need to be hard so I can appreciate them more and learn in the process.

On Thursday I turned 22, which made me feel old. Oh goodness. But already I was beginning to feel more at home. It’s difficult for me to reach out and touch others with the knowledge that I may get sick or get a rash or something of the like. And I hate that so much. Jesus touched the lepers when no one else would touch them, and these women and babies certainly aren’t lepers! I have been taught my whole life to be extremely careful with germs, etc., and I know I must be wise, but I want to love fully more than being wise. I’m finding a balance, though. I’m careful to wash my hands (and try to be discreet) but also am finding myself more willing (and wanting) to just be with the mothers and babies and love them in any way I can.

It’s been a bit difficult, because Ugandans and Americans communicate so differently. I fear that I’m unintentionally sending the wrong message sometimes. The fact that many of the mothers speak no English is also an extremely large barrier. The English-speaking mothers will translate for us occasionally, but it gets frustrating trying to mime out what I want to say. The “come here” gesture is a bit like waving, and I have had mothers get out of their chairs and walk over when I was just trying to wave! They did not speak English, either, so I tried to mime that they needed to sit down and wait their turn for the lab. Oh, life is so awkward sometimes!
The weekend was wonderful. We met Sam and Emmanuel, two Ugandan medical students volunteering at the hospital, and they took us to the market again as well as Mbale Resort, which was beautiful. We had breakfast at Solomon and Cissy’s, one of the neurosurgeons and his wife, and spent time there with Sam and Emmanuel as well as their four-month-old, Lizzie. I also had the chance to go to Yussef and Nada’s, a Christian Lebanese family, with Melissa, Rich, and Jean. I found myself sitting at the table, looking around at the people I did not know just a week ago and feeling completely at home. I am happy to be here. I know it is not going to be easy, but some parts of it will be. I’m excited to learn all I can.