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).