Monday, May 23, 2011

Anita's Introduction and Coming Home





Anita’s Introduction and Give-Away happened Friday and the wedding on Saturday. It was all beautiful. The Introduction is the most traditional part and went roughly as follows: A group of female relatives of the bride presented themselves to the groom’s family. The family looks for the bride, saying “Where is Anita?”. In this case, the group answered, “Maybe she’s gone to fetch firewood”. They are given an envelope of money and leave. The next group of female relatives presented themselves with firewood- but still not with the bride the groom’s family is looking for. Having said Anita might be fetching water and receiving the envelope, they left and the next group came back with calabashes. Ah, but still no Anita. Finally, they all came back with Anita. The groom’s family recognized her. Anita then had to find the groom among the relatives. She found him!

The Give-Away happened privately- a negotiation between two families for the bride price. And the wedding and reception were joyful- with a bubble machine, sparklers, confetti, and fireworks in the flowers in addition to the traditional dancers, singing preacher, and a hip-hop dancer.

Yesterday was my good-bye pig roast. (done, as all things here, with the aid of google and jerry rigging). We found a pig in the village last week and brought it home to the compound. There were some rough spots with the three guard dogs. I designed a rotisserie and had it welded. The project gardener kindly slaughtered and shaved it. And, mostly, the process went fine.

So I have said many good-byes and am on my way home. Unless something unexpected happens, this is my last blog post. Thanks for your interest! The photos are of the women with calabashes, Anita finding her groom, dancers at the reception, and Anita and Amos. (I’m sparing you photos of the pig.)

Wednesday, May 18, 2011

Shared Solar




Electricity is slowly, slowly coming to Ruhiira. Due to funding bureaucracy, the plan to connect Ruhiira to the Ugandan grid has been put off. But in the meantime, a shared solar project has gone up. Most of the time, solar power requires a considerable up-front investment for individual solar panels. This project is similar to connecting to the electric company, then paying as you go. A small building in the village has several large solar panels and good batteries to store the energy. About 20 homes or businesses can then be hooked up. To use the system, consumers buy scratch cards that have code numbers on them; they then dial into an SMS system using a cell phone and put the number in. (This is the way cell phone airtime and internet time/data is done here- you pay prior to use using scratch cards and once your credit is gone, the cell phone or internet stops working.) As you can imagine, electricity use is MUCH lower in the village than in the US. There may be one or two high efficiency bulbs and a socket for cell phone- no refrigerator, dishwasher, air conditioner, etc., etc. (and the guy who wanted to hook up 125 watt speakers was told no.) So people may buy $1-$2 of electricity at a time; $1 would buy about 10 days of a single 8 watt light bulb shining 3 hours per night. The photos are of the panels, Innocent, the onsite supervisor, and the first test run of the system. A website that shows more photos of Ruhiira with the lights on is http://sharedsolar.mech.columbia.edu/

Sunday, May 15, 2011

couldn't resist one more trip to Mgahinga




Despite just having made the 5-6 hour trip to Mgahinga National Park 2 weeks ago to track gorillas, I couldn't resist going back one more time. The inn there, a bed and breakfast called Traveler's Rest is SO inviting that staying there was half the reason for the trip. (Diane Fossey used to stay there sometimes.) On arrival, nasturtium petals are arranged on the towels and pillow- which I now believe in the definition of luxury. There's a beautiful garden with full views of the volcanoes and the cooking is great (suffice it to say that multi-course dinners with strawberry crumble for desert are rare here).

And then there's the park. The Virunga Massive is a chain of 7 dormant volcanoes, with 3 in Uganda. The borders of Uganda, Rwanda, and Congo meet here so at the top of Muhavura Volcano it's possible to plant an extremity in 3 different countries. The tops of the two other Ugandan volcanoes mark the border between Rwanda and Uganda. I had not planned to climb any of the volcanoes- I wasn't sure I could do it- but in the spirit of group cooperation with my travel partners we compromised on climbing the lowest, Mount Gahinga. Gahinga means 'pile of stones' and refers to its resemblance to the many piles of volcanic rocks in the surrounding fields. We were prepared for rain since the tops of the volcanoes are usually covered with clouds and rain falls throughout the year, but it was a gorgeous day. Gahinga is 11, 400 feet above sea level and we started the hike at 7500 feet. 58% of the small Mgahinga Park is covered by virgin bamboo forest so we walked though dense bamboo at the base. Bamboo stops growing at 10,000 feet and it was replaced by senecio trees, giant lobelia, and mountain heather. We walked 3 1/2 hours up and 2 hours down- some of the walk was steady uphill; other spots were stair-like; and then there were the ladders. The frequent ladders were made by cross branches nailed to uprights. I did many of them on all fours and on the way down did most backwards. At the top of the volcano was a 'crater swamp' which was otherworldly. Every 5 minutes or so a cloud would blow through and obscure the swamp, then it would pass and the swamp would reappear. The photos are of Mount Gahinga on the right and Mount Muhavura on the left (where the gorillas are) with Jackson in the foreground with his AK-47 in the event of aggressive animals, descending through the bamboo forest, and the crater swamp.

Friday, May 6, 2011

Tracking mountain gorillas





First the downside- the permits are really expensive and there’s been criticism of this type of tourism as gorillas can catch human disease.


Now the upside- I decided to see mountain gorillas before leaving Uganda and am grateful for the experience. Mountain gorillas -about 800 in the world- are found only in Bwindi Impenetrable Forest in Uganda and in the Virunga volcano (dormant) range, which sits on the borders of Uganda, Rwanda, and Democratic Republic of Congo. These are the gorillas that Diane Fossey studied. The national parks in Rwanda and Uganda (DRC is not a tourist destination) sell eight permits per day to see each family. We went to Mgahinga National Park in the Virunga volcano range. Tracking is an overstatement (though that’s what my official certificate says!). There are trackers who go out early in the morning and go back to a camp in the evening and they know roughly where the gorillas are. It’s rainy season and the volcanoes are often shrouded in mist even on otherwise clear days so we were fortunate to have a beautiful, sunny day. We climbed to 9000 feet before crashing though the forest to find the gorillas. The gorillas have been habituated since 1994, meaning that humans have been approaching them daily since that time (not closer than 21 feet). The tracker makes a sound like clearing his throat to alert the gorillas that we’re approaching but otherwise there’s no interaction; the gorillas ignore us as a non-threat. This family is made up of 3 male silverbacks, 2 babies, and 4 females and they chose to spend most of the one hour we were allowed to stay in a thicket. We were told that the silverback leader had fought the oldest silverback for dominance and won but the older male was allowed to stay with the group. The dense underbrush and sunny day (us in the sun, them in the shade) made photos tough though, thankfully, the people I was with were undaunted in their photo-taking and gave me theirs. The adults were mostly munching vegetation though periodically cracked off large tree branches to ‘play’. The babies, 10 and 12 months, were more active, climbing bamboo trees and then falling out as their weight broke branches.

Friday, April 29, 2011

Preparations for a wedding (and Passover)



My coworker, Anita, is getting married just before I return home. Weddings are big events here- often many hundreds of people- and are costly. The cost of the wedding is borne by the community so the invitation comes with a pledge card and often a budget. Clothes for the bride and her bridesmaids, food (e.g. one cow, 4 goats, 20 chickens, 30 bunches of matoke, 25 kg of cornmeal, etc.), spices, vegetables, fruits, drinks, decorations, and entertainment are included. I’ve been to one wedding planning meeting so far. The meetings can occur weekly and are attended by friends and family. They are conducted with meeting rules: there’s a chairman, attendance is kept, and minutes are read. The point of the meetings is to collect money. People who have pledged money pay up publicly and more money is collected. A ‘chairman’s bag’ for donations is passed initially and then the meeting goes on for more hours (sort of like a telathon), during which speeches and challenges for money are made. (I was asked to play the part of the village elder at the meeting to inspire all present to donate generously.)

The Introduction and Give-Away will take place the day prior to the wedding. These are traditional events in which the groom and his family come to the bride’s home. Part of the Give-Away involves a bride price, which is hefty. A number of cows are usually part of the deal, though Anita told me that money could be substituted. People wear traditional clothes to the Give-Away and I am very much looking forward to this part. The fabric choices are endless though the dress pattern is always the same. So my current challenge-so tough- is to choose the fabric and then a seamstress will make the dress.

The photos are of Anita helping me at the fabric store and, completely unrelated, my first Passover Seder, organized by my housemate Henry and attended by housemates from across the world.

Monday, April 25, 2011

Millennium Voice 102.2



Millennium Voice, a radio station with a broadcast radius of 50 km, is one part of the Millennium Villages Project. Lots of people have radios here- operated by batteries or solar- and the station was put up as a public service to play Runyankole and Ruchika music and to disseminate information. They do shows on best agricultural practices, gender discrimination, health topics, and entrepreneurship. There are large solar panels to power the station but there are challenges. I’m learning about things like why inverters help- ours is blown. And it’s rainy season so that the sun doesn’t shine all day every day. They usually use a gas-powered generator in the morning (a problem since gas, which is more expensive than in the US, needs to be carried in jerry cans by motorcycle on the steep and slippery dirt roads) though they are often able to turn it off by noon. My spot of fame on the radio says, "I'm Dr. Linda. I'm from the US. I stay in Isingiro (district) and I listen to Millennium Voice 102.2!" The line-up is Wake Up, Workers, local music mixed with call-ins (this week they talked about things like whether jealousy is good or bad and why cross-generational sex occurs), then Welcome Home. The DJ in the photo is ‘DJ Papa’.

Friday, April 15, 2011

Rwanda





Kigali, Rwanda is a 5-hour drive from Mbarara. Crossing a border is always exciting, but Uganda to Rwanda seemed particularly so. The language changes (to French, Swahili, Kinyarwanda, and only newly introduced English), the driving changes from the left side of the road to the right, and the country looks and feels different. The first thing any Ugandan says about Rwanda is ‘it’s so clean’. It is. It’s illegal to bring the ubiquitous plastic shopping bags into the country and there’s a once-a-month ‘voluntary’ Saturday country-wide community cleanup. Unlike Uganda’s widespread deforestation, Rwanda is covered with trees. It’s illegal to uproot a tree without permission and there’s one week a year for widespread tree planting. The toilet in the inexpensive guesthouse we stayed in had a faucet on the lid of the tank so that the water could be used for washing hands before it flows into the tank (my response was ‘of course!’). The landscape is stunning. It is lushly green with mountains and high volcanic peaks in the north. And everyone we met (with the exception of the unknown person who we think stole our driver’s cell phone) was friendly and helpful. My Ugandan housemate, Sam, would often get out of the car when we asked for directions to ‘experience’ the interaction and would typically return to the car with his arm around the person’s shoulders, talking and laughing. More often then not, the person would drop everything he or she was doing and offer to come with us to show the way.

And, of course, the history is different. We arrived on April 8, a day after the anniversary of the start of the 1994 genocide, during which 1 million people (out of a population of 8 million) were killed in 100 days. There is a yearly one-week commemoration with fires, ceremonies, and community discussions as well as other events throughout the 100 days. So throughout the country there were purple (for sadness) and white (for hope) banners and ribbons. We went to the Kigali Genocide Memorial where there are gardens; a museum that contains many photos, remains, and belongings of victims and that explains events before, during and after the genocide (including it’s roots in colonialism and the roles of hate speech and mass media) as well as rooms devoted to genocides throughout the world; and a mass grave containing 258,000 victims. There is a wall of names containing only about 1000 names, as the work of trying to name the victims is ongoing. From there we went to the Hotel des Mille Collines, the site of events depicted in the movie, Hotel Rwanda, and then to a church, which was the site of a massacre of 10,000 people who’d taken refuge there. It was profoundly sad. Yet the insistence on preserving the past- the overwhelming horror and occasional good-, on honoring the victims, and on talking as communities and countries about the events was extremely moving. Seventeen years later the events have immediacy. When we arrived at the church, a local leader had just come to bring bones for cleaning and burial that had just been found. The photos are of the garden dedicated to women, a statue of an elephant (who never forgets- though I just realized it's actually a gorilla) holding a cell phone (trying to tell the world), a flame in front of the memorial which burns for 100 days each year, and the church with the Rwandan flag at half mast.

Friday, April 8, 2011

Biking




A housemate from Holland (of course) found a place that rents bikes and we took a bike ride. The business sent someone with us apparently to make sure we wouldn’t steal the bikes (though there were 4 of us and one of him). Riding the dirt roads around Mbarara felt completely different than driving in a car. The day was gorgeous and the scenery spectacular. There was the predictable flat tire- these bikes and tires have been fixed and patched many times- but it turned out there was a man who repaired bikes 10 feet away. Bikes are used for transportation and to carry heavy things- multiple huge matoke bunches, chairs, other bikes. People don’t bike for pleasure here so a string of mostly muzungo bikers was enough to bring villagers out and empty classrooms of children who ran to the road to shout, “Muzungo, how are you?’ to which I answered a minimum of 100 times, “I’m fine, how are you?” We rode through small villages and down obscure dirt tracks through matoke plantations. The downside was that at about the half-way point, the ride became a bit of a struggle for me. I’m not sure what contributed most- the 30 extra years I had on anyone else, simply being out of shape, the substantial hills, the upper 80 degree weather, or the washboard dirt roads. But I made it and my bike-mates kindly waited for me at intervals (and my Ugandan house-mate likened our situation to ‘no child left behind’- humiliating but funny).

Friday, April 1, 2011

Birds


I’ve never been a bird watcher. But then, I’ve never been in East Africa before. I ordered a pair of binoculars after my first trip to a national park. And once I had them, I realized I did want to know the names of the birds I was seeing. So I ordered Birds of East Africa from Amazon on November 16. It arrived January 31 but was worth the wait! (We just got a package addressed to a prior project intern that had been mailed in 2009. The letter is going back to the states with someone who’s leaving; we’re eating the beef jerky but I’m not sure anyone is interested in the jelly beans.) I used to think that the way to see birds was to walk around and find them. I’m realizing that here the better strategy is to sit in my backyard and wait till they fly through. My only photo is of the Ugandan national bird, the crested crane, which I took in a national park. But, if interested, you can ‘google image’ the Ross’s Turaco, Eastern Gray Plantain-Eater, Speckled Mousebird, Double-Toothed Barbet, Gray-Headed Kingfisher, African Cuckoo, and Western-Violet Backed Sunbird - the prettiest of the 32 species that have flown through my backyard.

Friday, March 25, 2011

Children's Songs and Children



My Runyankole progress is not good. I have not been a disciplined student and aside from greetings and simple shop transactions my conversational skills remained challenged. Last week I asked my Runyankole tutor to teach me songs. It turns out that all the Ugandan popular songs on the radio are in Luganda- so not a go. He has come up with two varieties- children’s songs and religious songs (or a combination of the two). So I will share my progress:


Itwe abaana abaato
Kuritulikura
Tudyabo bohango
Kandi balingwa

(When we small children/ grow up/ we will become big/ and strong!- You can march to this one.) And:

Yesu nakund’ abaato, abaato, abaato,
Yesu nakund’ abaato, abaato n’kitwe!

(This is sung to the tune of “Merrily We Roll Along” and means Jesus loves small children…..like us!)

The photos are of the lovely babies of two coworkers.

Saturday, March 19, 2011

Helping Babies Breathe





I’ve spent much of this week going to the health centers with Innocent, a nurse who does emergency medical dispatching at the upper level health center and who is retraining staff in a protocol for newborn resuscitation called Helping Babies Breathe (HBB). My task is to support and coach Innocent. HBB was developed by the American Academy of Pediatrics, WHO, and others for use in low-resource areas. The goal of the protocol is to help those babies, whether they are misclassified as stillbirths or are recognized as having a heartbeat, who do not breathe spontaneously immediately after birth. Innocent and I have been making sure each of our six health centers has the appropriate, functional equipment (clock, suction bulb, newborn ventilation bag and mask)- which has been a formidable and not quite completed task- and are now making sure that all staff (most especially midwifes) are trained in the protocol and pass the written test, skills check, and simulation. The photos are of the very cool NeoNatalie doll, Innocent, one of the midwives practicing, and one of our health center groups.

Saturday, March 12, 2011

The Market



Buying food in Mbarara is a different experience than in Brookline. There is the central market, ‘supermarkets’ (which sell coffee, bread, cookies, oil, rice, pasta,etc.), the dairy (I think it was started by a Dutch man and it sells edam, mozzarella, parmesan-just available after they ran out in October and had to age a new batch-, and feta; it is worth the long, dusty walk), the pork butchers’ (Muslim butchers sell only beef and goat in the central market and the non-Muslim pork butchers are in a separate market; chickens are only sold live), and the wood or charcoal sellers.

The central market is joyful. The fruits (banana, papaya, mango, watermelon, jackfruit, pineapple) are abundant and inexpensive. The vegetables are all sold in groupings that cost 1000 shillings (45 cents)- so that’s usually 5 fresh, delicious tomatoes, a cluster of 5 onions, 4 green peppers, a large bowl of beans, a bunch of dodo (a plentiful green that sometimes grows as a weed), or a bowl of entula (a round vegetable related to eggplant). If you add it up, I could buy all of the above for $2.70. The longer I’m here, the more variety I find in the market; there’s a guy, for example, that gets a shipment of Chinese vegetables on Friday mornings. One of the tricks is getting it home. The huge papayas, pumpkins, bananas, and melons are heavy, the km walk from the central market to home is all uphill, and it is hot, which means a visit to the market most days I’m in Mbarara and a few trips on others. The photos are of my favorite vegetable seller (her display reminds me of the shrine to produce at Whole Foods) and the recently free-range chickens.

Friday, March 4, 2011

Health Day (and Tommy Hilfiger)





The Tommy Hilfiger marketing department was in the village this week. Their foundation donates a substantial amount of money to the project for education and health and representatives from their marketing department plus guests from Elle and Marie Claire magazines came to get photos, stories, and film. We are told they’re putting out a ‘Millennium Villages’ inspired line of clothing with a percentage going to the project. Completely odd but good for both the project and for selling clothes apparently. So watch for slick ads from Ruhiira, Uganda.

I went with them (lots of land rovers) to go to Health Day. Health Day takes place in different locations in the project periodically and is an emporium of health services. The project area is about 200 square kilometers and since villagers live up to 10km from a health center, the Health Days take place in in-between spots. There was a long line of people waiting to see a doctor or nurse and get medications. Next door were counselors to do pre- and post-test HIV counseling with the next door down being the HIV test site. Up the hill there was a room for antenatal care and another with one of the midwives implanting long-acting contraception. There was nutrition training, a room for adolescents to get care, a baby-weighing station, a feeding area for young children, immunizations, and agricultural displays. It was crowded and festive- lots of people getting services they wanted.

Friday, February 25, 2011

Election Follow Up

The election results came out Sunday- 68% for Musevani, 25% for the closest opponent. People seemed to take a long exhale- some with relief that violence was minimal and some with resignation. Stores that had been locked up for days opened- some of the grocery stores had almost empty shelves, presumably in preparation for looting. If Musevani had lost, people speculated that the military would have taken over (and Musevani is the military commander). If it had been close, it is likely that the opposition would have reacted more strongly. International observers gave a pass on the fairness of the elections though cited a heavy military presence as a source of intimidation, use of state funds for the ruling party, and some irregularities. Ruling party supporters felt convinced that the elections were fair. The leading opposition candidate called the observers 'election tourists' and he cited bribery, ballot stuffing, and wiping out voter names. I think that all of the opposition candidates have rejected the election results. They have called for peaceful protests, which people think may not be peaceful. At any rate, if they take place it will most likely be in Kampala, a long ways away from me.

Elections for local leaders took place on Wednesday. In Kampala, there were outbreaks of fighting after opposition supporters found stuffed ballot boxes in transit to the polls the night before the election. There was enough chaos that the elections in Kampala were called off about noon. So, no pictures this week as I've stayed away from fights and armed personnel carriers!

Friday, February 18, 2011

Election Day




It is election day for president and members of parliament. Political arguments have been the main topic of conversation during the 50 minute rides in the crowded UN Land Rovers that go back and forth between Mbarara and the project villages. Of course, I don't understand much of it as it's usually in Runyankole (and my studies, which have been sporadic, have sadly not yielded much). It's generally loud but people laugh a lot. And the arguments often run along the lines of peace and stability (pro-Musevani) vs. corruption, ineffectual government, and developmental stagnation(supporters of one of the seven opposition candidates). There's also been speculation about the likelihood of post-election violence. Uniformly people think the likelihood of violence is low- there's a moderate military/police presence and no one is optimistic that they would use restraint. There's also such a sense of inevitability about Musevani's victory that it will not come as a surprise to any faction when he gets the >51% needed to avoid a run-off.

Election day is a national holiday. It is very quiet in town, with many businesses closed. By law, campaigning had to stop yesterday so there are none of the music-blaring, poster-decorated trucks which have been present for weeks on the street. People have to cast votes from their home village or city and there are no absentee ballots so many Ugandans who work away from home have traveled. And about half the westerners I know have left the country. (IF violence occurs I'm quite close to both the Tanzanian and Rwandan borders.) My Ugandan housemate, Sam, and I walked to a few of the polling sites this morning. They are outdoors, ballots are paper and pencil which are then stuffed into large plastic boxes, and people get their thumbs stamped on registration but the polls otherwise look like ours- lines of people patiently waiting to vote. The Besigye campaign has been airing a radio ad asking people to arrive early, make sure there are no ballots in the box before the polls open, and stay late. So there are more people hanging around- more police and lots of observers.

Friday, February 11, 2011

Waragi




On the way to a health center one day, we came across a waragi ‘factory’. Despite the fact that it looks like an Appalachian Mountain illegal still, I was told that it is legal and taxed- though a bit unclear if it is regulated. Waragi is the local brew. It comes from a particular type of banana. Raw bananas are wrapped in banana leaves and after a few days the fluid is extracted to make ‘tonto’, a banana beer. After further fermentation, it’s distilled into a 40% alcohol drink. The copper tubes coil through a stream to cool the vapor and waragi is collected in the yellow jerry cans. Like a factory tour anywhere, we asked questions and found out it takes 7 jerry cans of tonto to make one jerry can of waragi. The waragi is then either sold locally for drinking or sold to distributors in Kampala who re-distilled it, add flavors, and bottle it for sale as ‘Ugandan Waragi’. I have taken the tiniest taste and will not repeat the experience. The upside of this industry is that it’s a good source of income for some and interesting for me to see. The downside is that Uganda has the highest alcohol consumption in the world- and no means for treatment of alcoholism at the village level. In the final picture, the seated man has just taken a straw from the jerry can out of his mouth.

Saturday, February 5, 2011

New School




Getting from one health center to another in the villages requires sharing rides in the UN cars that come to ‘the field’ from Mbarara each day. So on Monday I rode along with a visitor from one of the funding agencies- Millennium Promise Japan- who was in Uganda to look at the education projects that the organization is supporting. It was the first day of school after the long holiday break and we visited a new school that was almost ready for use. In theory, there is universal primary education for 7 years in Uganda. But a number of factors get in the way; while ‘free’, fees for uniforms and supplies are sometimes challenging for parents; schools may be far from homes as the majority of Ugandans live in rural areas (up to 5 km within the project area in mountainous terrain); and children, especially girls, are often needed at home to fetch water and firewood, work in the gardens, and care for younger siblings. Early in the project, the primary school enrollment was 76% though this doesn’t account for later starts to the school day and absences. The goals have been to make primary education truly universal within the project cluster and to improve the quality of education. Millennium Villages Project has built and upgraded schools and initiated school feeding programs. Initially the project supported 100% of the school feeding costs though parents have gradually been assuming responsibility by contributing bags of food (beans, cornmeal, matoke). Each school also has a garden cared for by the students so that parents now know that their children are getting a varied diet and they often send pre-school children with their older siblings. Early in the project, only 15% of children went on to secondary school. School fees and expenses (usually children need to board at schools away from the villages), early marriages, and parental bias against girl education prevent girls, especially, from going on to secondary school. So Millennium Promise Japan has started to fund secondary education for a limited number of girls who have gotten the top grade in their primary 7 exams. There is a running discussion about the wisdom of investing in a few children vs. using the money in general school improvement. Personally, I’ve met some of these girls who are so smart and deserving of this scholarship and I am convinced (with no proof) that this is a good use of funds.

Sunday, January 30, 2011

Back to work



I am back to work… and back to the main task at hand, namely trying to seed quality improvement teams at each health center. Quality improvement can take place at any level but tends to happen in large organizations with external pressure to meet certain goals (think indicators set by insurance companies at practices with support staff at Mt. Auburn). The task here is quite different; helping small rural health center staff to identity problems that are within their control by brainstorming and collecting data, making a plan to change the process, and follow up. In my first scheduled meeting for this week, I found one midwife completely alone in the health center with two mothers in labor and a line of mothers waiting for antenatal care outside. She had been alone (except for the gatekeeper and cleaner) for 6 days. At one point in the morning, she put down the first newborn in front of me- we found the suction bulbs I had brought with me and put one to good use- prior to jogging back to the delivery room. Not only was there not a quorum for a quality improvement ‘team’ but after 6 X 24 hours on call (and often up), she was clearly not in a place to participate in my project. Thursday’s meeting at another health center was a bit more successful- we had a group, we got through the agenda, and we planned for the next step- despite the whole concept being unfamiliar, the language barrier real, and the path of finding problems that are actually in their control daunting. The pictures are of the 4th level health center and one of my co-facilitators, Lillian, with her partner Sylvia examining a mother at a 3rd level health center (where Lillian delivered 5 babies in 5 hours on Tuesday!)

Sunday, January 23, 2011

Mombasa to Nairobi



At the risk of conveying that all I ever do is go on vacation, I will report on my latest and last trip with Holly. We met up in Nairobi, Kenya this week- she from South Africa where she went for a conference and I from Uganda- and went to Mombasa on the Indian ocean. Mombasa, as a port city, has a long history of conflict between the Portuguese (remember hearing about Vasco de Gama in middle school?), Turks, and Omani Arabs- later the British and Swahili. It continues to be the conduit for oil for Kenya, Uganda and Rwanda; and the stopover for international navies protecting tankers from Somalian pirates to the north. The 'old city' was built by the Portuguese in the 1600's and is a maze of buildings with narrow alleyways. The community is mostly Muslim but very multicultural- including Masai, Swahili, Indian, and Arab. Our driver, whose ancestors were from Yemen, spoke Kiswahili, English, Arabic, and Urdu. We went to a fort built by the Portuguese in the late 1500's that gave a real sense of people living there. While walking through it, I wished for pictures of the soldiers so I could imagine them more clearly- and then we came upon drawings on a stone wall done by Portuguese soldiers (like doodling) of boats, animals, each other, and the Turkish soldiers. We went to the spice market and the owner scooped one after another spice for us to smell- completely intoxicating. After Mombasa, we spent 2 days on the beautiful beach to the south, then took an overnight train with sleeper cars (I've seen enough old movies to have always yearned for this experience) back to Nairobi. The train was built in the 1950's and has not been updated since-our cabin looked a bit like a kitchenette from that time- and was great. The hot, humid start gave way to cooler, dryer air as we left the coast. In the morning, after breakfast in the dining car (white table cloths!), we hung our heads out the window for hours. We passed small villages and saw hundreds of zebras, gnus, and impalas and a few giraffes. My favorite part was seeing ostriches running from the train. And Nairobi was great. Despite it's reputation as 'Nairobbery', it seemed energetic, clean, and organized. The pictures are from the fort wall, the spice market, and the train.