Waiting in Kampala

I picked up my daughter Holly last Saturday at the Entebbe airport and we spent much of the week exploring Kampala. I’ve only experienced the jam-packed, noisy, hot, and dirty parts in the past but with more days of exploration we found wonderful restaurants and cafes on shaded patios and great performances. We tracked down almost all the art galleries in Kampala. The best performance was at the Ndere cultural center where three dance troupes from Uganda, Rwanda, and Burundi performed with traditional music. There were string instruments, a xylophone, and lots of drums. The dances from each country were very different. The Rwandans were tall, slender, and their movements were sinuous. The Burundi men carried huge drums on their heads and were able to drum and dance while carrying them- it was the kind of performance that makes you gasp. The Uganda dancers did quite an astounding amount of shaking (especially bums). My son Max was supposed to get in the night of the 21st but had the misfortune of flying through Frankfurt. His first alarming email suggested he’d be in on the 26th at the earliest as thousands of travelers were in lines that were 6 city blocks long waiting for bookings. He met a woman with 2 small children who had been in the airport for 5 days and saw multiple episodes of police being called to break up scuffles between passengers vying for places in line and escalating arguments between airline staff and passengers (he said the staff always won). In what seemed like an amazing stroke of luck, he arrived via Addis Ababa only a day late. So we have made our way to Mbarara and then to Lake Bunyonyi. It is Christmas morning, sunny and in the mid 70’s; I am on the deck of our furnished tent looking out onto the lake and listening to birdsongs and the occasional wafting Christmas carol. The photos are of Father Christmas and two dancers. Happy holidays to all!

Morning walk to the health center

Mornings are my favorite part of the day here. I love my morning basin bath, which is always warm no matter how long I have to wait to heat the water. It is almost always sunny in the morning with the drenching rains coming mid-day. The kilometer walk to the Ruhiira health center is all downhill and the view looks out onto the hills and valleys beyond. Often the clouds look like they’re resting in the valley. There are not a lot of birds in Ruhiira as the hills have been deforested by need for firewood, but the birds that are here are beautiful. There’s an iridescent blue bird called a sunbird that resembles a hummingbird and a lovely bright yellow bird with black wings that I haven’t identified (My copy of “Birds of East Africa” is on its way from Amazon). One day a small funnel wind lifted a dried matoke leaf many feet in the air and it twirled around for minutes as I walked down the hill before being deposited back in the same garden. There are usually women of all ages hoeing in their fields and matoke plots, many with babies strapped to their backs. On Second Eid, a public holiday here, there were about 40 people kneeling in rows on cloths laid out in a field by the road, men in front and women in back, chanting prayers. One day bunches of children gathered around me as I walked, never passing me but keeping time with my walking. I tried brief runs, abrupt stops, and backward trots- I'm not sure if they knew the game but they didn’t miss a beat. The photos are of health workers walking towards the health center and some children who accompanied me one day.

Richard's Wedding

There were 3 office weddings on the same day last weekend. A few people managed to hit all 3. My housemates and I arrived in a caravan of boda-bodas at the church for Richard and Hellen’s wedding about 20 minutes late. When we saw a crowd gathered in front the church, it appeared we

had missed it. But no- when I walked up to take a photo of the wedding party I realized I didn’t recognize the groom. It was an earlier wedding so we were in time. Then several coworkers arrived and suggested we go to another wedding in a different location and come back ‘when the wedding warmed up’. So we got in a car, drove to a different wedding, stayed long enough to see the final vows (this wedding had been scheduled to start 3 ½ hours prior), and returned to the first church. We entered the church as it appeared we were just in time but no- we were told ‘not yet’ as it was another wedding party. Richard’s wedding finally did start about 2 hours late. (I’m not sure in how many countries you would show up late for the wedding, then decide to go to another wedding, and still be on time to see the vows). A reception followed at a beautiful out door ‘reception garden’. Music vacillated between traditional Ugandan music and American country western. There were traditional dancers for entertainment, great food, and lots of beer. There were long, long speeches starting with a testimonial from Hellen’s employer. Despite the employer saying 4 times that she was keeping the speech brief, the master of ceremonies told her an equal number of times to stop talking (it didn’t seem to shorten the speech). The speeches continued with Richard’s employer, a political leader, and Anglican Church leaders before the queue reached the multiple family members on either side. I am going to try to convince one of my children to import one wonderful part of the tradition, when and if they get married, called ‘receiving the gifts’. After the wedding party dances into place, each of the guests dances up to the bride and groom to give their gifts (and yes, we muzungos danced forward).

Grasshoppers and Eggs

In Runyankole, one of the words for November means ‘month when the grasshoppers come’. People look forward to this because some people make a lot of money catching them and most people like to eat them. Although some people catch them in long grass, the biggest operations use a technique at night time in which there are very bright lights to lure the grasshoppers, smoke to spatially disorient them, large metal sheets used as funnels, and big cans to catch them once they’ve hit the sheets and fallen. The grasshoppers are sold in the market and on the street. This morning, our groundskeeper Gerevase brought us a gift of a cup of grasshoppers. He had done the work of plucking the legs and wings from them. (For the squeamish, try not to picture the fact that the grasshoppers are still alive.) They are then fried slowly- no oil as they have their own- and salted. We briefly debated whether to incorporate them into the omelet or have them separately- the person who strongly wanted them separate won. They are crispy and salty and delicious. For those who find it hard to imagine eating them, note that Ugandans here think that crayfish I bought from a lake we visited, potatoes with skins, and eggs sunny side up are disgusting. I like that the images look like a cooking show and think that the PCC should insist Amee bring them to the next luncheon!

Ssese Islands

Housemates and I took a trip to the Ssese Islands in Lake Victoria. The distance seemed so manageable- but maps can be deceiving. Getting there took 8+ hours and required a walk in the rain, a bus ride, a ‘special hire’ (similar to our taxis but unlicensed), a 45 minute ferry ride to the largest island, and a ride on the back of a matoke truck. Each episode of movement, of course, was preceded by long waits, discussions, and negotiations. The truck- in addition to having a beautiful view and being cheap, dirty, and uncomfortable- had a problem with the starter so that every time it stopped (which it did frequently to unload matoke, cornmeal, or metal doors) it wouldn’t start until the men on board jumped off and pushed it (forwards or backwards depending on the slope of the hill) until the driver could pop the clutch. My housemates did some of the pushing to the delight and hilarity of the other passengers. The 20 km ride took 90 minutes and we arrived after dark at the hotel. The following morning we awoke to a beautiful vista of Lake Victoria and the sounds of many unfamiliar tropical birds. A steep walk to the beach went through rain forest with monkeys and more birds… and then it was back to the 8+ hour trek back. We substituted a special hire for the truck but it didn’t shorten the trip. Before leaving home we had agreed that the trip itself might be the highlight as there was a subtle indication in the guidebook that it wouldn't be straightforward. Highlight, frustrating, exhausting, and fun would be accurate.

Mbarara Thanksgiving

We at the Mbarara MVP Intern House introduced about 25 colleagues to the joys of Thanksgiving. The menu was not too different than I’m used to and it WAS a joyful way to give thanks. Similar to my usual habit, I spent the day cooking and then shared a feast. So the menu…Turkeys are hard to come by here and no one at the market knew where to find one. One of our co-workers, who manages the Millennium Villages Project radio station, solved out problem by advertising on the radio. We got a response and the turkey was transferred to our house. The turkey, billed to us as 8 kg, felt light on arrival and our efforts to fatten it didn’t work- it didn’t like the cornmeal we tried to feed it but at least spent the last two weeks happily pecking for insects and grass in the yard with the chickens. Thanksgiving morning started with walks to the market and to a location where people produce and sell charcoal. Midmorning, a Muslim colleague arrived to slaughter the turkey so that he and other Muslims could eat it. Once de-feathered, the turkey disappointingly looked like a large chicken though the upside to the scrawny size was that it was small enough to fit into the oven. Our oven now has a thermometer and we were able to start the cooking at 450 and then lower the temperature 100 degrees by opening and closing the ‘door’- the turkey came out beautifully. Also on the menu were goat stew, chapatti, mashed potatoes, carrots with honey and cinnamon (a family recipe from an American housemate), creamed doddo (a local green), mango chutney (no cranberries here), fruit salad (fabulous tropical fruits), pumpkin pie (my efforts at tracking down a pumpkin were successful and although the pumpkin was green and striped on the outside it otherwise was really a pumpkin), and a papaya pie. Completing all items with the oven, one gas burner, an outdoor fire pit, and a small charcoal stove (borrowed at the last minute from our groundskeeper) was chaotic by the end- as it always is for me at home.

Tracking chimps

Each park has its own attraction and the main event at Kibale Forest National Park is tracking chimpanzees in the tropical rain forest. The rangers started habituating the chimps to humans in 1991 by finding them and standing ever closer to them. They don’t feed them or disturb them in any way, but the chimps have apparently come to realize that people are neither predator nor prey and ignore us. We got a late start from the guesthouse in Fort Portal. Despite arriving for breakfast at 6:45, breakfast did not get fully underway until 7:30. Then, after wolfing down pancakes and bacon, the rental 4 wheel drive from Kampala did not start. Thankfully, the people I was with were quite clever, knew to check the starter fuse, turned it upside down- and the car started! We then drove at a breakneck speed, despite all realizing that 8am here doesn’t really mean 8. And when we got there about 8:30, the park ranger told us we were right on time. (The British couple that accompanied our foursome and were well decked out in boots and rain gear did really get there on time, though). We then started walking with Ruth, our Chimpanzee tracker, through the rain forest. The park is almost 800 square kilometers and our goal was to find the trees with chimpanzees. How does one do that? The clues to follow are recent dung, recent nests (they make a nest of branches high up in trees to sleep in every night), knuckle prints in the mud, and- most helpful- their screeches and barks. We saw the dung, nests, and prints but walked for 3 hours without hearing many calls. Even without the chimpanzees, the rain forest is a beautiful and fascinating place. There are a lot of other primates and we saw groups of red-tailed monkeys, collobus, and mangabees. The red-tailed monkeys are the best to watch as they crash around, leaping and swinging from one treetop to the next. The floor of the forest is densely green and there are some flowering/fruit bearing trees (figs and an apple-like huge tree) that the primates feed from and lots of types of fungi. I kept my eyes on the ground while walking most of the time since there are also red ants that can crawl up your legs and bite. (The day before, on a walk between crater lakes, I paused to look at monkeys, and then realized I had a hundred black ants on my shoes, socks, and crawling up my legs. Black ants are horrifying enough and I had strong incentive to avoid the red ones, whose bite is more painful!) I had mentally prepared myself to accept happily that we would not find the chimps- but then we heard the calls! After another 15 minutes of walking we found a group of 7 chimpanzees in two trees- an old male who sat in the same place the entire time we were there, two adult females (one in heat), a younger adult male, and 3 babies. They initially stayed high up. The young male then started edging the female in heat down a tree trunk about 20 feet from us. Once on the ground, with leaps onto each other, shows of strength by the male as he grabbed trees and tried to uproot them, and cacophonous calls, they continued mating (started in the treetops). The babies then made their way to the branches just above us and swung around the vines with each other in the very cute way baby chimps do. The photos are of Ruth and chimps.

Working

I've had some time (traveled to Kampala), electricity (none when I returned to Mbarara), and internet (none in the village) issues so no posting last week. I’m circling back to describe what I’m actually doing here in Uganda (besides going to game parks)! My assigned task was to evaluate how well the health care system works in preventing maternal and newborn death and to set up systems for health care quality improvement. I’m not doing direct patient care; I’m diagnosing and treating ‘the system’. ‘The system’ includes community health workers, health centers, and a referral center (the referral center has medical officers capable of doing surgery in addition to other staff- By the way, with 3 years of training after high school and 1 year internship they do C-sections and laparotomies among other surgeries and treat newborns, children, adults, and pregnant women and I am humbled by their capabilities). Staffing is low (e.g. 2 midwives to cover 24/7 at some health centers and no other support staff in the middle of the night) and resources are very limited (imagine, e.g., delivering a baby when the gas for the lantern is stocked out and the attendant is holding a candle) but the building blocks of the system are in place. I completed the baseline assessment in about 8 weeks. What looked like a narrow job description has broadened since almost every part of the health care system affects quality of care in maternal and child health. So, I’m working on a number of projects and in the last two weeks have …. met with midwives at 3 of the 6 health centers to organize quality improvement teams (it is an unfamiliar idea for staff at this level to improve quality so it is a SLOW process); organized the medication and supply room at the project office, restarted a bin card system, and talked to the New York office about finding an open source computerized medication inventory system- this is part of a larger project to improve the supply chain of medicines and other supplies to the health centers; met with a health facilitator to design a program to track and follow up HIV+ mothers and their babies; continued analysis on the cause of stillbirths; helped develop a list of indications for ambulance transfer to a hospital for mothers in labor with complications and a format for communication; developed a training on estimating blood loss; and went on more home visits with community health workers and student interns- in other words, a little of anything that might be relevant! The photos are of two of the very hard working midwives, a meeting with community leaders to discuss ways of increasing the number of women who deliver babies at health centers, and two of the student interns dressed for the weather (upper 50’s).

Baking a cake

Some things are complicated to accomplish in Uganda- baking turns out to be one of them. A few weeks ago, I bought some

cake at a local bakery for a birthday celebration. The cake I purchased looked

enticing. The pieces were put in a black plastic bag and I brought them home, taking care not to smash the cake. On setting down the bag at home, however, I realized that my care was unnecessary since the cake was likely about three weeks old and similar to balsa wood in consistency. Since I would never again buy anything from a bakery shameless enough to sell that cake, I started planning on finding my own means of p

roducing the next birthday cake. People here do not own ovens, however, and all cooking is done on either gas rings or charcoal. I experimented with a steamed pineapple upside down cake- not bad but a little rubbery in consistency. My initial plans for an outdoor oven were inspired by google and links sent by family and friends- I learned the appropriate internal dimensions, the right thickness of the walls, and the insistence that the door be exactly 63% of the internal height. Had I had a local Home Depot, I suspect that I would have followed this advice. However- this is not the case. I enlisted the groundskeeper, Geravase, to help me after scrounging in hardware stores failed to yield any materials I could use and after hearing that he knew how to build a kiln for bricks, which sounded pretty similar to an oven. Since neither of us seemed able to communicate our vision, though, we decided to just buy some bricks and work out the building process after. So on Saturday morning we walked to a side street where the hill had been dug out for clay and there were a number of kilns with piles of bricks. We bought the 60 bricks that Geravase estimated we would need ($3) but were then faced with the problem of how to get them back the 1 mile uphill road to the house. To avoid the expense of hiring a car ($4.50), he found a man with a wheelbarrow and we haggled over a price for transport ($3). Unfortunately, a) only 30 bricks would fit in the wheelbarrow at one time and b) the weight of even 30 of these bricks was great enough that the strong wheelbarrow owner couldn’t push it. Since Geravase stayed behind to guard our bricks, this left me to pull the wheelbarrow by a rope while he pushed it. We did eventually get all the bricks home with considerable sweat and strain. Once there, we were left with trying to figure out how to build the oven with the 60 bricks we had (a negotiated process since everyone had a different idea- by the way the 63% rule was tossed) as it was unthinkable to go back for more. The results are pictured. We tried it out on Sunday using charcoal and baking a chocolate cake (which baked in about 10 minutes with the bottom burned but was actually pretty good after I sawed off the bottom) and a shepherd’s pie. I am committed to becoming a master.

More animal adventures

I went to Queen Elisabeth National Park this week. And yes, there were more astounding animal encounters! Queen Elisabeth is

very large- 1978 sq km. The park is in Africa’s Rift Valley- site of a fissure in the earth’s crust thousands of miles long with sinking of land in between the plates. The park is a wide, flat valley surrounded by mountains. Within the park, there are two large deep lakes (one of which is shared with Democratic Republic of Congo), which are connected by the Kasinga Chanel. We reached the park about 8:30am as our plans for an arrival near dawn were thwarted by a. the driver oversleeping and b. one of the car tires requiring air which we were unable to locate despite stopping at 8 gas stations- we finally pulled off the road to a shop where a mechanic filled the tire with a bicycle pump (this worked fine until the tire developed a flat in the middle of the park). It is against the rules of the park to hike because of the carnivorous animals so we drove after picking up a guide, Eddie, in one of the nearby villages. Within the park there are abundant Ugandan Cob, a type of antelope that is the national animal. There are also lots of warthogs and water buffalo. Most of the water buffalos we saw were in small groups of 1 or 2 and the Eddie referred to them as the ‘losers’- having lost the male fight for supremacy and, therefore, off by themselves. We did see a herd of hundreds of water buffalo- unclear to us which was the grand winner in the herd. Despite the park having 3000 elephants, though, it was surprisingly hard to find them. Ditto for the 5 prides of tree-climbing lions. But…after some hours of looking and then stopping for lunch, Eddie heard that a lion had been spotted about a kilometer from the restaurant. So we got back in the car and looked some more. Despite the fact that Eddie was driving (and the rest of us staring out the windows), he spotted a lioness in a tree about 200 feet off the road. The assumption was that the rest of the family was sleeping below her. We then took a boat ride in the channel and saw hippos, water buffalo, iguanas, mongoose, crocodiles, and thousands of birds. And after rounding a bend we came on 3 elephants cooling in the shallow water and feeding- a truly thrilling experience. We later saw more by the side of the road and we stopped to look. One elephant looked mildly annoyed (flapping ears) but appeared to be retreating- until it turned towards us, trumpeted, and started charging the car! (This is why guides say to keep the car running.). RE: the photos: You may need to enlarge the tree picture to see the hidden animal. The elephant is annoyed with us. The other picture is of a fun, interactive display at the park headquarters.

Hot Springs

A few weeks ago, I visited hot springs about 2 hours from Mbarara with my fellow intern housemates. The trip there felt long- we had to locate a gas station that had gas first; it was raining hard on and off; and the road conditions are sometimes ‘a challenge’- first road construction that inexplicably consists of miles of speed bumps every 50 yards then many miles of dirt roads. There were no signs announcing the location of the springs until we reached the sign stating we’d arrived. On reaching the springs we entered another world. Steam rises from boiling water that emerges from between rocks. The water spreads out to a series of several pools and, in the other direction, joins a stream. There is only a slight hint of sulfur smell. The rocks we walked on were heated so that although it was cool and drizzling most of the time we were there, our feet were toasty. A little removed from the source of the heat, the water is warm but comfortable and about 40 Ugandans, mostly unclothed, were bathing. The waters are thought to have spiritual and physical healing powers. There were people on crutches, people praying, people bathing, and people drinking. At one point a women stood and began preaching, leading enthusiastic songs, clapping, and chanting of praise. The photos are of the springs and of Henry, Moses, Carol, and me.

Smelling Ruhiira

I’m taking a stab at the smells here in Ruhiira. I can’t say I ever tried to describe the smells in Brookline and Cambridge, but I know that the odors of my own house, my garden, my car, and Mt. Auburn Hospital are different than here. Although the rains are here, they are not enough yet to sustain any crop besides matoke so there is fear of famine in addition to the ongoing difficulty of getting water for cooking and washing. Yesterday it did rain to everyone’s great relief and the extraordinarily fresh smell of plowed earth and wet vegetation when the sun came out again, replacing the usually dry dusty smell of mid-afternoon, made me feel euphoric. I will not dwell on the pit latrines- I hated them at Girl Scout camp and haven’t gotten used to them since. ALL trash- including the ubiquitous plastic bags and water bottles- is burned here so there is the occasional waft of acrid smoke. Cattle and goats graze in town and along the road to the health center so there is that musty smell of animals. In the evening, skewers of goat meat are grilled and ‘rollex’ (an omelet between two chapatti) are fried near our compound. Over the weekend I picked out a beautiful rooster at the market and we slaughtered, plucked, butchered and cooked it (I was mostly an observer/learner) - all smells that many may be able to imagine (I will note that the taste of this free range local chicken was fabulous). There are smells to matoke and posho (a corn meal porridge) cooking but they are subtle. At night there is the paraffin smell of my candles. The most frequent smell that gets my attention is that of burning wood or locally made charcoal (wood put in high temperature kilns to carbonize it). People spend hours cooking here in the morning, mid-day and night. The cooking is either outside or in a small kitchen or part of the house that allows smoke to escape between the upper walls and roof. Sitting in a health center or walking down the road, the smell comes to me. I don’t know how to describe it- it is not harsh and I think of it as smelling ‘flat’, not like the woodsmoke from fireplaces or charcoal grill smells I’m used to. Despite the fact that I know that widespread use of charcoal and wood for fuel is not environmentally healthy (deforestation and CO2 production) I have started loving the smell. It always stops my thoughts to make me look around and enjoy the place I’m in at that moment. You will have to use your olfactory imagination with the photos: of the trash dump, goat, and bathing area on the other side of my wall, of Sam- a Ugandan intern housemate- with our chicken, and of an indoor kitchen.

The Bats

It is bat season at the intern house is Mbarara! For those who have seen "The Birds", recall the early scenes in which people are curiously looking at the sky at the extraordinary number of birds congregating. (For anyone who hasn't seen it, do see this creepy Hitchcock film.) As the bats started coming a couple of weeks ago, this is what it felt like and, of course, having seen the film, we wondered 'what next?'. On the first day, one of my housemates got lost while running and was able to find his way back by the funnel of bats descending into the trees around our compound! We think the bats are fruit bats. There's a park in Zambia where 8 million bats migrate through. I think it is thousands at our house. The bats migrate for feeding during the raining season here and I'm told they'll leave in November (as I stare into the trees, people frequently stop and chat about the bats). We have been reminded in 'fun fact'-type websites that bats are the only flying mammals and their wings are webs between their fingers. These particular bats rely on eyesight and smell as opposed to echo-location and eat fruit and nectar. They cluster in the trees for much of the day but are very active in early morning and at dusk. The chattering about 6:30am is SO loud. I awaken every morning knowing that the bats tend to stay high up but wondering if I remembered to close my windows the night before.

Lake Mburo

I went to my first national park this week and hope it's the first of many! My guidebook calls Lake Mburo an 'underrated gem' and I think both descriptions are apt as I saw 6 other tourists while there. The park is about one hour from Mbarara- not far but with some logistical difficulties. Public transportation would take hours so we (a housemate and I) booked a car with a driver I've used before. After we started, he told us that most gas stations in Mbarara don't have gas so we spent the first 30 minutes locating one that did. Just outside the park, the landscape is typically agricultural with matoke plots, goats, and herds of Ankole cattle (native cattle with dramatic horns). Once inside the park, there is bush and, astoundingly, we very quickly started spotting warthogs, herds of zebra and impala, and troops of baboons. We took a boat ride on the lake with a park ranger who stayed close to shore so we could see birds and animals. We saw scores of hippos, cooling for the day in the water (we learned that there is one 'bull' and many 'cows' in a group, that they are active on land during the night where they eat 40-60 kg of vegetation each night, that the bull will not accept any other males in the group- even a baby-, and that they lack sweat glands so cool in the water). We saw incredible birds. The most beautiful is called a malachite kingfisher and google images has better pictures than I do. The vervet monkeys on shore were likewise hard to photograph with much detail but added to the sense that 'I can't believe I'm in Africa!' After the boat ride, we took a 2 hour hike through the bush with 2 other tourists and an armed ranger. He told us that the gun is to shoot in the air when water buffalo act aggressively. There are lions, leopards, and hyenas in the park but they are hard to find, especially in the middle of the afternoon. We tried two watering spots before finding animals in a pasture area. Lake Mburo is the only place in Uganda to see zebras and we saw hundreds. They scare easily, as do the many antelope-type animals (impala, elands, topi, bushbuck, waterbuck) and baboons so we didn't get very, very close but at one point on the walk we saw that there were zebras in every direction. The water buffalos we saw were not so skittish but have poor vision and the wind was blowing towards us so no need for the rifle that day. It was all amazing and I felt immense gratitude of being in that place at that time. The photos are of impalas, a zebra, a mother and baby hippo (who separate from the herd), and the lake.

community health workers

This week I was able to walk with community health workers (CHWs) as they did their rounds. Each one has about 200 households (all officially identified, by the way, with the male head of household) and visits them all in a three month period. Some families, e.g. those with children less than 5, a pregnant woman, or a child with a fever, are seen much more frequently. For those of us struggling in the US health care system with tracking indicators and follow-up, the system here utilizing the CHWs is great and getting tighter. They work for several hours six days a week. They walk from household to household during afternoon hours because mornings for them and the other villagers are spent in their gardens (translate that to matoke plots), especially during rainy season. So on each afternoon, I met one of the CHWs at the nearby health center and we started off on foot down steep hills along barely perceptible paths in the matoke plantations until we reached a house. Until this week the houses all looked roughly the same to me- small houses built of mud-ash-dung on a wood frame with corrugated iron roofs. I am now seeing the details- those people who have planted avocado and peppers or flowering plants, those whose houses are pristine despite packed dirt yards and packed dirt floors, those who have plastered the walls with a clay-lime mixture. Most of the houses have a main building with a small living/eating area (as small as 4 X 6 feet) with either wooden benches or seats with cushions and sleeping areas. Light comes from the open door and sometimes from small windows. Other buildings include the kitchen, which has gaps along the upper walls but without a chimney to let out the smoke from the wood or charcoal fire, a latrine, and an enclosure made of matoke leaves for bathing. Once inside the house, the women and children were welcoming and hospitable (of course laughing at my limited Runyankole and the presence of an omuzungo in their house). The CHWs know their families well and had preplanned what topic to discuss- child growth, family planning, or fever (they carry malaria kits). I'm currently helping to organize a project in which Ugandan Christian University community health interns, CHWs, and clinicians will visit every one of the 1050 households in the Ruhiira parish (1 of 8 parishes in the project area) starting Monday to test as many people as possible for HIV, promote family planning (to include bringing and implanting a 5 year contraceptive), encourage deliveries in the health centers, provide bed nets for anyone who lacks them, and reinforce the many other public health messages of the project- so I'm sure I will have ample opportunity to do more visits. The pictures are of Edward, a senior CHW, measuring a child's arm to monitor growth with Josephine, one of the interns, and Edward in front of the kitchen.

the rains have come

The rains are eagerly awaited here and they have arrived. They come in August-September and again in the spring. The people in the village are now busy planting crops other than matoke, which grows year round, and the dust is being replaced by mud. When it's not raining it can be in the 80's but the temperatures have generally cooled. Many of the villagers wear parkas and wool caps (though I haven't seen mittens) when it's in the upper 60's and I think it gets to the 50's at night so people talk a lot about how cold it is. The rains are intermittent, though occur most days. Last night there was an outside showing in the village of health films sandwiched between Ugandan music videos- the first was an entertaining film about a clean water supply and the second a graphic film about sexually transmitted disease which was less amusing- and despite thunder and lightening throughout the films, the rain held off till the end. The rain can be intense, pouring buckets for 30 minutes and then blowing over. On one 15 minute walk from the trading center to the health center during a driving rain, I arrived with shoes almost unrecognizable from the splattered mud and mud half way up my legs. So this weekend I'm in the market for gum boots (which I think is a generic name for knee high rubber boots) since next week I'll be accompanying community health workers as they walk from home to home and I plan to be fully prepared with umbrella, rain poncho, and my gum boots. The hail that fell is not obvious in the first photo; the second photo is what the Ruhiira countryside now looks like much of the time. Thanks to all who post comments, and Peter, I appreciate your faithful responses!

bus to Kampala

After six weekends in Mbarara, it was time for a change of scenery this weekend so I boarded a bus yesterday for the 5 hour trip to Kampala. My guidebook and Ugandan contacts told me that I should use one of two bus companies, but after locating where they board (which is by the side of a road instead of my first two guesses- the two bus yards in town) I found out it would be hours before they left. So with some trepidation I got on a different bus that was heading to Kampala. Other companies have reputations for frequent stops, drivers who drive fast and pass frequently on the narrow roads, long delays as the bus waits to fill-and overfill- completely before moving, and frequent breakdowns. I did get a seat (after the driver called out "Omuzungo!"-(white person) and led me to it) and, although the bus stopped about 30 times on the way, we got to Kampala safely and without breakdown. In Kampala, the bus ride ends on a jampacked street that has a bus yard, two minibus yards (which my guidebook calls the two most chaotic taxi parks in Africa- which I suspect is saying something), and markets shoehorned in every vacant lot and alley. I was completely disoriented, but after declining rides from at least 10 boda-boda drivers dangling keys in front of me, I asked for directions to the city center. A crowd gathered to discuss the best way to get there and a man eventually told me to follow him as he led me briskly through alleys and markets to a main street leading to my hotel (thankfully he was wearing a bright green hat, shirt, and pants which allowed me to keep him in view as people inevitably pushed between us). The stay in Kampala itself was somewhat less exciting than the trip there but I started exploring the city, went to the National Museum, and had my first great cup of coffee since arriving. I can vouch that Kampala is a city that never sleeps (at least the street that my hotel faced; I learned too late that the inside rooms are the best bet). The pictures are of the gridlock at the bus yard (a still photo doesn't capture that fact that vehicles are supposed to be moving but aren't) and one of the many roadside stops (like an outdoor rest stop with long lines of grills and people rushing up to and onto the bus with grilled meat and maize, samosas, sodas, and gum).

Learning Runyankole

I've spent a good part of this week starting to explore the mysteries of Runyankole. I NEED to learn this language. Except in official meetings and when someone is speaking directly to me, all the talk (and lots of laughter) is in Runyankole so I feel like I'm missing so much of life here. Also, most people in the village speak no English so even to get my basic needs met I need the language. I have bought what I think are the only Runyankole grammar and phrase books and have a tutor in the village for Monday-Wednesday and a tutor in Mbarara for Friday-Sunday. Some of the things I learned this week: Most educated people don't read and write Runyankole. Despite spending their whole lives speaking it, they were taught in school only to read and write English, (This is changing and there is now some curriculum in Runyankole literacy) which I think explains some of the incredible variation in speech (some people say... and some people say..; also lots of variation in spelling). According to my grammar book, Runyankole is an 'agglutinative' language. It starts with root words and adds on prefixes, infixes (new to me- it's when you stick the extra part in the middle of the word) and suffixes. All the words in the sentence tend to agree with subject but there are 13 different classes of subjects and the agreement for adjectives, objects, etc. are each different so all very confusing. This is to say nothing of modified verbs and their tenses. I am learning more about parts of sentences than I ever learned for English. But, I think because of never studying Runyankole themselves, no one was able to explain to me why a word that meant the same was different in different contexts. The grammar book was written in 1957 and is a bit dated. Some of the phrases I'm meant to memorize are, "The smith forges spears", and "How fine the cows are!". I'm passing on the first, have committed the second to memory. I've been asked (by Americans) what the language sounds like. (Try to tell someone what English sounds like!) Here goes- There are lots of syllables and, because of the agreement of words and probably just because, there is repetition of syllables- e.g.'please to meet you' is "nashemererwa okukushanga". R's are rolled. There's a lot of "ch" sounds though it's written 'ki' and 'ky'. Most people speak very fast and, in sentences, connecting vowels are dropped. A lot of friendly chats are loud and sound urgent and there tends to be lots of laughter. There's about 6 ways each of saying 'ehhhhh' and 'hmmmm', ranging from 'ok' to 'are you kidding?' to 'how great!' to 'how terrible!'. Runyankole is a tonal language though I don't even know enough to understand when it makes a difference. I learned last night that to say noon, you say six. (1 o'clock is 7 o'clock and vice versa). No one could explain why but my trusty grammar book says time is counted from dawn so there's daytime hours- time from 6 am- and night time hours- time from 6pm. Since this is the equator, it's conveniently consistent! I have been ready to give up (it seems so impossible) but last night someone repeated word for word (a very short conversation) an interchange I had had with a shop keeper a week ago and told me how enthusiastic the shop keeper was about my attempts; and I can now pick out some words in conversation. Putting together the meanings of sentences will have to wait!

health care and elections

I've spent another week in the village and another week with failure of technology- this time my computer wouldn't even turn on! I have learned a lot about putting things in perspective since arriving here, though, so failure of this machine now ranks a bit lower on the list. In any event, it started working again and I am grateful. I spent the week observing at a hospital in one of the MVP villages. I watched deliveries, observed an HIV clinic, and went on hospital rounds in addition to interviewing staff and examining records. There is considerable drama in watching people care for serious illness in the context of profound poverty, understaffing and very low resources. Tests, treatments, and amenities that I've taken for granted are not present (x-rays, many blood tests, consistent availability of medications, water, electricity in some health centers, sheets on the beds, food for the patients). Since my task is quality of care, I've found room for improvement but what is being accomplished and the energy expended in trying to improve the system is impressive. Besides the drama, there's a lot of waiting- another life skill I'm learning about. Some random thoughts: In Ruhiira and throughout the country elections will take place at the end of August. On many days, trucks with singers and dancers pull into town to campaign (I have no idea if there's a political message but the music is great) for a candidate. The pictures are of my favorite candidate and Ruhiirans enjoying the music. Yes, the milky way is beautiful in Ruhiira. And I'm reading The Namesake by Jhumpa Lahiri that starts out at Mt Auburn Hospital (!) and Banana Cultures (of course) about the importance of the banana in history. I would appreciate any recommendations for books (especially that are available on Kindle since others will have to wait!)