Christmas at Sipi

I have never been a big holiday person, but this last week has been full of good times surrounded by the right people. Early morning on Christmas Eve, a few of us jumped in the Delica and off we went up to Sipi River Lodge in eastern Uganda. Our friends cooked up a storm of amazing food and we all had a relaxing Christmas day of eating, drinking, and enjoying each other’s company and the good view of Sipi Falls. My time at Sipi was also a great opportunity to do some more paragliding. I did some solo flights and more exploring and flying with Steve Fisher after he and Des arrived on Boxing Day. It was great to get up in the sky again and fly around some new terrain. The area has huge potential; I ended up flying at over 5 sites with many more potential spots. The best part of flying at Lower Sipi is the view: once I was up in the air, I was able to enjoy the view of all 3 waterfalls flowing down Mt. Elgon. I have realized that the hardest part of flying here is finding a landing zone that is not full of kids. As I soared along this ridgeline, I looked down at the roads and goat paths to see tiny creatures running from every direction. I was in farming country, and suddenly, I became the mzungu falling from the sky. There were about 200 people surrounding me at the LZ on the first few days; by day 7, it was maybe down to about 50. Either way, I had plenty of company at launch, landing, and even on the hike out. Now I am back home in Jinja just in time for New Years. It was good to get away for some good company, flying, and even a little climbing.

Kampala

This week has had some long days for sure. I have made a few trips to Kampala for one of our patients; she is a 32 year-old female, mother of 4, who was diagnosed with Hodgkin’s lymphoma back in May. We began sponsoring her chemotherapy treatment in Kampala. However, after showing little improvement at Mulago Hospital, another biopsy was performed at the International Hospital and the diagnosis changed to non-Hodgkin’s lymphoma. It was sad news, since there is a much higher hope of surviving Hodgkin’s lymphoma, especially since she began treatment at such a late stage. Now it has reached stage 4.

Between treatments, I visited her at her home after her brother called saying she was not well. She was too weak to stand alone, with no appetite and vomiting for the last few days. She was complaining of pain on her right side and a tender right abdomen due to the cystic tumor masses that have spread to her liver. Although scheduled for another round of chemotherapy in a few days, I was worried she would not survive the drive to Kampala. We started her on oral morphine to help with the pain, and fortunately, she was looking much better by Monday. We decided to get her to the International Hospital in Kampala to continue her pain management.

I kept thinking to myself of the unofficial oath of medicine: do no harm. At this point, she is too fragile to undergo further chemotherapy. I discussed the options with her doctor. We decided it was time to discontinue treatment; the plan was to undergo blood transfusions to increase her Hb and counsel her to make plans for her children after she is gone. The doctor then spoke to her in Luganda, and I assumed told her what we had just discussed. I had offered to donate blood on Monday but all the nurses said there was enough (she is B+ and I am O+, the universal donor). Although I was hesitant to believe them, I left anyway.

I returned to Kampala yesterday after getting a hold of the doctor and learning that there actually was not enough blood for her. After donating in the lab, I walked upstairs to the Hope Ward to tell her that blood was coming her way very soon. Although I have donated many times, never before have I actually watched my own blood go to someone else, especially a friend and someone so dear to me. I began explaining that she will get this transfusion to boost her Hb and then she will come home to Bujagali in the next few days. She was very grateful, but then asked when she was going to get her chemo.

I took a deep breath, realizing that everything I had discussed with her doctor 2 days prior had not been explained to her. She had received no counseling and had not been able to mentally prepare herself for the steps ahead. I reached that point where I felt completely helpless; all I had left to give was a language barrier of emotional support and a pint of blood.

Paragliding Near Lake Victoria

After watching the birds catching thermals in downtown Jinja, I finally managed to go flying this last weekend. There has been too much talk and I was going a bit stir crazy; I had to go flying again. After arguing with security guards to let me scout a flying site on the Kakira Sugar Farm just outside of Jinja, I left and went to another ridge site and launched from a secondary school. All the kids were super excited when I showed up; they guided me over to the launch site where a friend of mine has flown before. It was a pretty tight, dodgy launch but totally worth it. It was great to get up in the air again and quite entertaining to have such a big audience, both launching and landing. I was able to get in 3 flights and catch a bit of lift, soaring with the birds. I looked down and watched the kids chase me from one end to the next; I heard screams of laughter and excitement as I made 180° turns. After soaring around for a while, I started to head down to land. I looked ahead to see the beautiful Lake Victoria, the second largest lake in the world and the source of the mighty fine White Nile; it is a pretty cool view.

It was a good way to spend my Saturday afternoon. I worked for a bit in the morning, went flying, and then hopped on the back on Muhammad’s boda-boda for a sunset cruise back home.

'Tis the Season of Circumcision

This weekend turned into an adventure of sorts. We had a net sale just outside of Mbale, a few hours east of Jinja. We packed up 600 nets and off we went. While teaching the session in Bugusege Central Village, we heard chanting and singing off in the distance as we watched crowds of people dance through the streets. People were dressed in banana leaves and covered in white paint. I realized it was circumcision season and the whole community was gathered for the day’s event. I saw countless people dancing in circles, then realized one of them was our driver, Francis; he had snuck off, dressed himself in his own costume, and joined the fiesta. He never seizes to amaze me. As I watched these groups dance and sing through the streets, I realized the soon-to-be circumcised males were 18 years old. Many of these tribes still practice circumcision for males at this age, and female circumcision for teen girls as well. If one shows any emotion of pain, he is not considered ready for manhood; many Ugandans are very surprised to hear that some mzungu males are “ready for manhood” 3 days after birth. As much as I try to respect cultural traditions, it is hard to not look at these practices without a medical concern. Multiple circumcisions are performed in these deep villages using one knife; it is anything but sterile. It is scary to think of the infections that occur because of this. Aside from the countless circumcision ceremonies that passed us during the 4 hours, we still managed to sell 380 mosquito nets. With the long drive to Mbale, it was a perfect excuse to stay the night and visit our friends’ place at Sipi River Lodge. It has definitely changed since last time I was up there in April when Ian, Fraggle, and Will were tearing it to pieces to start over. The lodge is up and running now and looking great.

Back on the Nile Special

After being back for a few weeks, I was finally able to make it back down to the Special for some big water play. It was great to get back on the wave and have some relaxing island dwelling with some friends. After a full day of work, I cruised down to Steve’s island and floated downstream for a sunset session on the Special. The next day consisted of chilling in the hammock, fishing for our 6 kg Nile Perch lunch, kayaking, and coming back to Jinja to organize for Timmy’s Biathlon Island Bender on Saturday. The biathlon bender was a great hit. It started with a day 2 trip down to Steve’s island; we had 2 rafts, plenty of kayakers, and any other type of watercraft found at the Jinja market (i.e. inflatable dolphin or whale). We had some good laughs on the river, then arrived at Steve’s island for a few rounds of croquet, swimming, and plenty of laughs and boos. As we watched the sunset, we all packed up for a quick float down to the Hairy Lemon for round two of the bender. I put on my dancing shoes and had a good time. Now I am back to work. It was good to get away for a long weekend of distraction. Hopefully more time will come soon.

7000 Mosquito Nets

This was another typical week of family planning and malaria education sessions, and all the other random things that come up when managing a rural health clinic. However, after all these net sales, the shed was starting to look a bit empty. Although I was not involved much in the logistics of getting the nets from India, we have been on call for the last few days. After getting shipped to Mombasa, we were not sure whether it would be a road trip to the Kenyan border or to Kampala to pick up the 140 heavy bundles of nets. It was an entertaining day to say the least. We packed up the Crusier and another Delica and started heading to Kampala after being told the nets would be ready on Thursday. However, we got another call saying they were not ready yet but needed to get out of the Kampala warehouse as soon as possible. Instead of making the long drive, we sat around on call, until the woman finally called at 4:00 PM saying they were ready and must be picked up now. She did not seem to understand we were coming from Jinja and it would be a few hours before we arrived, even though we told her multiple times. Anyway, we finally arrived and loaded as many bundles as we could into the Cruiser and Delica (each bundle holds 50 nets). As the sun was setting off in the distance, we realized we had to hire a truck for the remaining 5000 nets. Off we went on our drive home to Kyabirwa. As we caught up with Moses, our Delica driver, and did not see the truck anywhere in sight, I started dreading the possibilities of losing those other 5000 nets. It made me realize that we did put complete strangers on a truck with about $32,000 worth of mosquito nets.

Francis jumped on the gas and passed Moses, in search of this missing truck. Annie and I sat there, crammed in the front seat with our eyes on the lookout. We caught up to a truck with white bundles in the back; it was a sign of relief until we realized it was the wrong truck. When driving in the dark, big, white bags of rice look very similar to bags of nets. By the 5th truck we reached, we finally saw our bundles of nets still packed in the very same truck; we were relieved.

It was a good 15-hour day. Fortunately, some strong local men did not mind the extra work by the time we got the clinic at 9:30 PM. The shed is now packed to the brim and it is hard to even close the door. Although it was an expensive day of fuel, drivers, and village helpers, I was very relieved to have the 7000 nets back in our possession. We will see how long until we run out again.

Obama! Obama! Obama!

I normally avoid discussing politics with everyone, especially on an online blog. However, I decided to go for it anyway, so here it is.

It has been interesting to watch the United States elections from the other side of the world. With the 11-hour time difference between Uganda and the west coast, I sat around Tuesday night watching CNN. I finally had to go to sleep to distract myself as much as I could, receiving occasional text messages with an update on the election. Ohio, Florida, Virginia….I jumped out of bed and ran to the nearest TV. I found myself surrounded by Ugandans, and one by one, everyone worked his or her way into the room with an anxious look on his or her face. It was an international crowd of Obama supporters sitting together at 7:00 AM in the tiny village of Kyabirwa, Uganda; we had representatives from Uganda, Australia, England, Ireland, Canada, and only a few of us from the USA. We were relieved, excited, and exhausted as we listened to Obama’s victory speech in Chicago. It was an emotional morning here in Uganda; maybe there is hope in this world. On my walk to the clinic, countless Ugandan friends were as excited as I was. “Obama! Obama! Obama!” they chanted. I sat in the car on the drive to our net sale with my ears glued to the BBC radio. Some years down the road, I wonder when we will ask each other, “Where were you when Obama got elected?” Seeing it from Uganda has given me a different perspective. Obama’s picture has been on the cover of every local newspaper for the last few days. I have seen Ugandans wearing Obama shirts, or even trying to buy a shirt off of a mzungu. His name was even written on the back of a matatu. The world is watching, and now, the world is celebrating. People danced around the streets of Jinja on Wednesday night to celebrate the elections from a continent away.

Unfortunately, Obama has a mess to clean up: the financial crisis, two wars, the Bush Administration. It will not be an easy road to travel, especially living up to these high expectations. However, in his speech in Chicago, I believe he reminded us of the reality: this is not something he can do alone. As Gandhi said, “Be the change you wish to see in the world.” Although I believe American politics and citizens struggle to follow this concept, it is a good sign that we, as Americans, could stand up and take the first step: vote for change. Yes we can!