Grand Canyon and Beyond

I do not want this adventure to end. The last month and a half has been full of excitement: I spent 18 days on the Grand Canyon with some dear friends of mine. It was a mini reunion of sorts, as 5 of us were in the same WEMT course in fall 2007. We always talked about doing a big adventure together during our course, and what better opportunity could we get than doing an 18-day private Canyon trip? The Canyon was amazing, yet again. Although it was my 4th trip down, every trip is a new experience and a trip of a lifetime. This place opens my mind and amazes me every time. It feels so magical and indescribable; there are new creeks and canyons to explore, new hikes, and new people for sharing the experience. We had great weather, and clear water until the last few days. When we pulled into South Cove, almost 300 miles downstream, we all wanted to drive straight back up to Lee’s Ferry and do it again. Aside from the Canyon, I had a great road trip. Brian and I did some flying at Woodrat in southern Oregon, then packed up our creek boats for some California creeking on our drive to Vegas. We stopped at the Forks of the Kern on our way down, and hit up the South Silver and EF Kaweah on our way back north. I am pretty sure I have some new creeks to add to my top 10. We also visited Yosemite, Kings Canyon, and Sequoia National Parks. So after rowing the Grand Canyon, creeking in California, flying in southern Oregon, exploring 4 National Parks, and spending time with dear friends and family, I would say this trip was alright. I do admit that it is hard to leave again. I am heading back to Uganda now for my next stint. It will be good to get back to work and spend some more time on the White Nile, but the recurring goodbyes are becoming too familiar now. Until next time.

Holiday Time

I am sitting here in Entebbe about to board a flight back to the US. The last 6 months have flown by, but it also feels like I have been here forever. Back in February, I got invited on another private Grand Canyon trip and I could not turn down the opportunity. I am now headed back to the US for a 6-week holiday. I am excited to have some time off, but most importantly, I am excited to get down the Grand Canyon again. I have realized that I should never pass up the opportunity for a Canyon trip with some dear friends of mine from back home. I may be stressing a bit more right now if I were leaving Uganda for good. However, here I go for a Grand Canyon trip and a road trip south, hopefully with some creeking and flying along the way. Let the fun begin!

Letting Go

The last few months have been sobering. We lost a few patients, a few staff members at NRE, and even one of our own staff members who used to work for us. Some deaths were expected, and others were not; it was a reminder of the fragility of life.

There is always one guarantee in life: death. Unfortunately, Judith was a healthy, 26 year-old clinical officer who was just about to finish her master’s degree in public health. She suffered a ruptured ectopic pregnancy. She started feeling sick late Friday night, and within a few hours, she was dead. There was no blood for her at Jinja Hospital and she died on the way to Nyenga Hospital to get a blood transfusion.

It is a sad story, and something none of us were expecting. It was a tough week, but as usual, after a day or two, everyone gets back into the swing of things as if nothing changed.

Anyway, things are still up and running, but it has been a bit busy and hectic lately. The kids were fun, but exhausting, and then Judith’s death. I think I am ready for a break.

Inner City Kids Come to Volunteer in Uganda

The Inner City Kids camp has been running since 2002 after Jessie found the funding to do a kayak school in New York with a group of kids from Upward Bound, a high school program for first generation potential college students from low-income families. The kids are from the Harlem area and have never been out of the big city. This year was the 3rd Uganda trip for the inner city kids. Most of the kids had done the kayak school and Rogue trip last summer, but it was everyone’s first trip to Uganda, let alone, out of the country. This year, we had 7 kids, from sophomore to senior year students, and 2 returning chaperones, Rosanna and Lee. I realized I have been working with Rosanna for the last 5 years after the first kayak school I helped teach back in summer 2004. The kids seemed to enjoy themselves. It definitely was not a typical spring break for these Harlem kids. The students had a great time volunteering; they helped teach malaria education sessions, completed follow-ups, learned a lot about malaria and even looked at blood slides infected with malaria, and most importantly, they kept the Ugandan kids entertained by teaching them some new dance moves. The kids also went for a rafting trip on the White Nile toward the end of their time here. Not a bad trip, eh?

Fresh Air Malaria Conference

I just returned from a 3-day conference in Kampala called “Counting Malaria Out.” It was long, but interesting to see what other organizations are doing in Uganda. Although it can be pretty brutal to listen to 3 days worth of Power Point presentations, I survived.

The most interesting part was seeing how many people are giving out free nets without any education or follow-up. The other disturbing part is the money. Being at this conference held at the fancy hotel in Kampala, I realized how much of this money going toward “malaria” is wasted. Much of the money goes toward the administrative side or big, fancy conferences like this, and may never actually reach the ground. It made me feel a little better that we do not even have an office. The “office” is in my banda, or wherever I want it to be.

Most importantly, I became somewhat grateful that none of our funding comes from big organizations, like the World Health Organization, President’s Malaria Initiative, or USAID. Because of this, I do not have to deal with the bureaucracy of people sitting in a nice office in New York or Washington, many of whom have never left the country, telling me how I should run a program in Uganda.

Aside from my ranting about free distribution, it was somewhat comical to be at the conference. I have never been one known for networking and dressing up for fancy conferences, but I did feel somewhat official. I have never been a good city girl, but I even returned to Kampala a few days later to enjoy the city life with some friends: ice skating, sushi, a movie, bartering cops after running a red light, and a trip to the airport to pick up a friend. Yes, I did have to remind myself we were still in Uganda.

Full Moon Paddle

There is nothing like paddling a run in the dark to see how well you know the lines. A full moon was the perfect opportunity to do a fun Silverback run. As I dropped down the entrance of the Hump, I realized it was probably the highest water level I have seen here in a long time. It was all good to go, but funny as I watched a friend disappear into the big foam pile down at the bottom.

After Bujagali, I floated on down, enjoying the view of the stars and the moon rising from the east. I thought back to all the fun full moon night paddles I have had over the years: midnight sessions on the Special, night rafting trips on the Nugget-Powerhouse run, or even kayaking the entire 34-mile wild and scenic Rogue River in one night. It has always been a test to see how well I know the lines, or just go with it, and hope for the best. Sometimes not being able to see things makes life easier.

My starlit daydreaming was put on hold as I floated through 50/50 to be greeted by spotlights and trucks hard at work. It was a reminder that Salini never stops. They are working 24/7 on the dam and it is one of the few Uganda projects that is actually making progress rather quickly. My friend and I looked at each other, wondering what kind of security they might be having on a night like tonight. We just realized we had to be faster than the one next to you. I figured if they did start pulling out guns, I would just flip and hold my breath as long as I could. We made it out alive, with a fun line down the new Silverback rapid at high water. No guns, no security that saw us, just maybe a few Salini workers wondering what these crazy kayakers were doing on the river at such a late hour. The first few rapids were under the moon, but the rest of the run was fully lit from construction work. Well done.

Staff Rafting Trip

After all these years of this project, which mainly employs Ugandans, none of our staff has ever been rafting before. Most do not even know how to swim, and generally still think we are crazy for being in the river. Some people avoid getting anywhere close to the river after the Idi Amin administration murdered thousands of people and threw the bodies in the river back in 1970s. The river was red with blood as the bodies floated downstream. I understand how these dark memories could haunt someone forever. Anyway, we finally managed to do a staff rafting trip. Everyone was invited to come, but only the brave ones were willing to go for the challenge. We took 8 of our staff members down the day 2 stretch, a mellower big water class 3 section. Only 2 of them know how to swim. However, by the end of the day, I managed to get Livingstone to jump out of the raft and swim downstream in the flats with me. I was impressed. They all had a great time and have already been asking about the next rafting trip. Who knows! Maybe everyone will leave us soon and start guiding for Nile River Explorers.

Salini Tour

Salini is the Italian company that is building the Bujagali dam, funded by the World Bank. Since the dam will flood out many of the homes of the villagers who live on the water, the World Bank is trying to be nice enough to help these people on a short-term basis. Salini has selected 4 surrounding villages on each side of the river to distribute free nets. Although this is against our protocol at Soft Power Health and we do not want any official affiliation with this project, we agreed to at least offer some training and beg them to at least educate the people about malaria and how to use their nets. We had a meeting with the woman who is organizing this project at the Salini construction site. Although she agrees in our subsidized net sale program, the big boss up top at the World Bank does not. Either way, Jessie and I were at the dam site for our quick meeting. Afterwards, we asked if we could get a tour, and sure enough, we were given our neon construction vests and a hard hat and off we went. We drove around the construction site to see the remains of our long lost rapid. The guy told us how cool it was that a particular part of the site used to be an island. I sat there, holding back my actual opinion, and looked down to see what used to be this amazing play spot called the Ugly Sisters wave. We then saw the turbines under construction, the rock-crushing site, and the hundreds of buses and Salini cars. The place felt like a city of its own. It was depressing, but interesting to see it from their perspective. We definitely did not tell them that we were kayakers. Silverback is still up and running. I have heard rumors that it will be around for a while, maybe even until April 2010. I am skeptical to believe what I hear, but we will see. I am enjoying it while I can.

More Flying at Sipi

After doing a few net sales outside of Mbale, we were able to go back up to Sipi. It turned into a good Valentine’s Day weekend of Jessie, Polly, and me. I was able to do a little flying again, which was good fun. A bunch of the kids have made their own mini parachutes now (small plastic garbage bags and some string). It is great to have them release their parachutes so I can see what the wind is doing. However, I am just hoping they do not jump off the mountain with their own homemade gliders anytime soon. Here are some more photos taken by Will Clark. Polly filming The mini parachutes Flying over launch Yikes Down at the landing zone. Quite a crowd!

Nomads #2

The last few weeks have been busy with work, play, and filming. Polly Green has returned to make her next video about the project here in Uganda. She made her film “Nomads” about 3 years ago, just when the clinic was opening. Now she is here working on a follow-up film and a little promo/fundraising video for us. It has been good fun, but always a little interesting to have a camera follow us wherever we go. Fortunately, I am just the sidekick, which makes me happy. Jessie, Polly, and I have been having lots of fun though; we have had plenty of net sales and family planning sessions, kayaking adventures, and dance parties. We have been trying to cram everything in to get those shots that Polly needs. We went down to Kalagala for a park and huck session and spent a little time at the Special before the low water started. Hopefully some of the footage turned out. I think Francis has been enjoying the camera as well (i.e. jumping on the roof of the car with the loud speaker before a net sale, or emphasizing the condom demonstration with the black dildo at the family planning sessions). I never thought I would become a stunt devil but who knew! Hopefully Polly has what she needs.

Inauguration

Today seems to be as much of a holiday in Uganda as it is back in the US. I sat down in the same place I was 11 weeks earlier, where I watched Obama give his acceptance speech in Chicago. There I was again, surrounded by plenty of Ugandans and a few Americans. We were all very excited to watch this historical moment. Today is the first time I have been proud of my president in a long time. It feels kind of nice. Who would have thought?

Blasting at Silverback

Well, Silverback has started to change again. After diverting the Ugly Sisters channel in August 2007 (date?), Silverback has become a bigger, surging rapid. However, the dam company has now started to blast on river left at Silverback. It used to be a nice, lush jungle but now it is full of huge, loose boulders that were pushed into the river. The channel has become a bit narrower and the standard line has changed. My first time down after the blasting, I cut hard right and still got pushed into the eddy on the top left. Rumors have it that Silverback will be closed off by the end of this month, but I am hesitant to believe it. We will see what happens.

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!

Back in Uganda

Hello again from Uganda. It is funny how some things never change; sometimes it feels like I never left. On the drive to Bujagali on Wednesday, one year after my last arrival, I was somewhat surprised how many old friends I saw. Maybe not surprised at seeing everyone again, but somewhat flattered they all remembered me. It makes me feel somewhat wanted and missed, something I never thought would happen. When looking back on the last 6 months in the US, I did not feel settled there at all. This is where I actually had a “home” and a bed that I slept in most nights. I chose to live in the back of a truck for my time in the US; it made it possible for me to finish with school in Washington, work as a multi-day river guide in southern Oregon, road trips to Idaho and California, and then paraglide back in Washington. However, as my time was coming to an end, I became tired of being on the road all the time. I was tired of meeting new people and saying goodbye. I was tired of not knowing where I was going next. I was tired of being alone.

Countless people have said, “Morgan, you are lost” since I returned. In Ugandan terms, this just means you have not seen someone for a while. But maybe I have really been lost. I was totally overwhelmed when returning this spring. I had work plans for the summer, but then life was totally open ended. I had ideas, but nothing set in stone. When this job came up, I decided to go for it. However, I admit that I was second-guessing my decision; it is always tricky going back to the same place and not having expectations. Fortunately, I am aware that this time is a totally new trip: I have a new job with more responsibilities and more stress. It is exciting and scary at the same time. I have been going over everything with Annie and I am glad I will be able to work with her until she leaves in mid-December. I have a lot to learn and I know I will still mistakes, but working with Annie will make this process a bit smoother.

Deep down, I know this was the right decision; I am passionate about public health and traveling. I enjoy living simply, which is much easier to do here than being surrounded by the consumerism of the United States. I am totally guilty of it as well. People have nothing, and they are still happy here; it reminds me about what truly matters.

Aside from training, we have had some more amusing days as well. The day after arriving, I went back to Kampala with one of our patients with non-Hodgkins lymphoma. She was going back for another round of chemotherapy, but it turns out the oncologist only works Monday to Wednesday; we turned around and came home. Then of course, we were supposed to have a net sale today, but we drove there and the mobilizer decided to cancel the session due to the rain. So I guess there has been a lot of driving without much accomplishment. I am not giving up yet though; we are still getting things done, just slowly, slowly. It is a bit refreshing to be back on Uganda time.