“You often meet your destiny on the road you take to avoid it.” – Chinese proverb

Dear friends,

Reading your e-mails has been a treat. Thank you all for being so supportive, making request, giving me direction, requesting photos etc.  I guess you all prefer e-mailing instead of commenting on blog.  Maxime, thank you for requesting I post a link to donate to Kissito. It’s in the works. Hatim, thank you for sending me Fiona’s latest album. Perfect timing for today’s long and bumpy ride. Oh, and good call on the Mophie, very handy. Had I not had it today I could not have brought you guys these great c-section videos.

A lot of you have asked me to break down the health care. It’s hard to do without making these post long and tedious, but here’s the basics…

It’s no secret Uganda’s health care system is cracked. The government allocates 9.3% of total national budget to health care. So they claim. Uganda’s healthcare performance is still ranked as one of the worst in the world by the World Health Organization. The country is ranked 186th out of 191 nations. A Ugandan’s life expectancy is among the lowest across the globe. In Uganda, one in every 200 births ends the mother’s life, around 1 million people are living with HIV and although malaria accounts for 14% of all deaths, less than 10% of children under five are sleeping under insecticide-treated nets. There is a hierarchy to the health system. The clinics are rated levels 1-4, General hospital, Regional hospital, and then National hospital.  I personally cannot tell a huge difference between the levels as they are all lacking. Level one does not have a structure. Picture someone in a village who can distribute basic medicine (pretty non-existent) Level 2= small structure(building) where  common diseases are treated. Level 3=treats basic disease and has a maternity area with midwife. Level 4 treats diseases plus maternity, plus surgery. Our level 4 is Bugabero clinic(c-section videos happened here).  Next step up is a General hospital (similar to level four) Our’s here is the Mbale, regional hospital.  The only National hospital in the entire country is in Kampala. This is where one goes to see any specialist. One in entire country!

Don’t picture any of these clinics actually functioning like anything you’ve seen in the U.S. For example, the government might come in and build a small structure, supply a few beds, minimal meds, and employ a few staff, but they don’t actually show up. The places literally sit empty. When paid by the government no one monitors if you show up for work. Many employees have to walk miles to work (not much incentive) and don’t have the staff or infrastructure to run effectively. For example,  Wanale clinic was built three years ago (it’s still empty).

Kissito (and standard NGO protocol) come in, supply meds, equipment, staff, trains staff, and generally try to get the place to actually function. To do this, NGO’s have to offer “Top Up’s” which is a performance based bonus pay on top of government salary. Reform is slow. Pay is based on skill. The head nurse at Bugabero makes 800,000 shillings/monthly=400 dollars. Most staff makes around 175US monthly from Gov’t (gov’t jobs are known as shit here). The employees hired by gov’t  don’t have access to monies to supply adequate care. Most drugs disappear, and record keeping is a horribly dated and inaccurate. Everything is hand written and carbon copies is a new concept.

The first day I traveled to Wanale clinic, Robert (clinical officer) explains that the meds are locked in a box and he has not been able to get the key.  Easy right, we’ll get the key. Don’t think like an American, were in UGANDA. His superior, (hired by the gov’t) is the only person allowed access to the key. Sadly, he never shows up, and when he does the med count is questionable. In this culture you don’t question your superior. To override them or have someone fired could take years, a painful arduous process requiring the  Ministry of Health.  That’s where NGO’s save the village. And, the money comes from big-hearted donors like you/us. We don’t make the rules, we suffer through them along with everyone else. I can tell you NOTHING would happen without them, so you can understand there is constant drive for funds…and yes,  if we sacrified one bar night out,  a fancy dinner, a new pair of Italian boots, and send that money here it literally saves 10 or more people’s lives. Money goes a lot further here. Who’s gonna start a Nat’l health fund on Kickstarter? If we all gave 5 dollars a week…

So, enough of that for now. This would be more interesting if I had a beer, but that’s against house rules. On the flip side, there are a lot of amazing people here working hard for their community despite being paid nothing, like Dr. Sabiti. He sleeps less than 5 hours a night, is always smiling, performs surgeries around the clock, drives hours around town, working hard.  He expects to be in the Ministry of Health in 5 years. He has my vote! Many of the staff he supervises walks 4 plus miles to their clinics, and are honored to work under his supervision, learning better ways.

On the bumpy non-tarmacked roads we head out to 5 clinics today.  Yeah, more bad, and I mean BAD gospel music in Spanish. Tyler moans from hours of being jolted around. Dr. Sabiti’s witty banter keeps us laughing.  He starts asking us how often we look at our private parts in the mirror. Oh, yes, I found my tribe! I think I have this on video. We see Michael ( a clinical officer) walking on the side of the road. We swerve over and tell him to get in( his clinic is 5 more miles). Dr. ask him immediately, “How many times do you look at your private parts in the mirror.” Without skipping a beat he answers,  1 more hour of entertainment. Great minds think alike!

Last stop is Bugabero clinic, level 4.  Dr. grabs me to observe an emergency  C-section before we head home.  We run back to the “theatre” which is what they call surgery rooms here. I’m asked to take off my sandals and put on a pair of crocs. Interesting. I throw on scrubs and enter. Everyone is laughing and surgery starts with Dr. singing a prayer. I confidently get my I-phone ready to record. Let’s do this. I’m asked to pinch the patient’s  throat as the nurse is shoving the breathing tube down. I can feel the tube entering her body as she tells me to squeeze harder. Dr. starts cutting and I’m suprisingly fine. I pan around as the nurses are checking their phones and giggling. His incision hits the uterus and water squirts across the room.  Blood starts pooling between her legs. He starts pulling her flesh apart similar to stuffing a turkey. The room started closing in on me and I felt reality slipping. I left the room three times to avoid passing out. My apologies for the series of bad videos. By the end of this month I suspect birthing will be routine. Whatta day! Here you go!

Our crew jokes  a lot. One of the running jokes around here is that Tyler is “uncircumcized.” That’s a heated topic around here. Bamasaba tribe believe circumcision is a right of passage into manhood. When a boy is 16 or so they are circumcised by a smaller knife/machete. Before HIV awareness was introduced into the scene the same knife was used on everyone. Now each person gets a new knife. This still happens but not amongst most people here. When Tyler went to the hardware store the man behind the counter asked “Are you  circumcised”? He answered, “yes”, although he doubts the man thinks he has been indoctrinated into true manhood b/c it was done at birth. I keep trying to find items we might need to send Tyler back to the hardware store. 🙂 Lots of circumcision puns( by locals) around here.

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Another day, another night

I’m exhausted, but it’s not like African woman to complain. I can learn something in this category. Today I worked from the office reading grants, health sector strategic plans, Uganda’s Ministry on Health’s Nat’l Nutrition strategy…you get the point. We just ate dinner and all I want to do is sleep, but noooooo, Tyler and I have a skype interview with channel 10 news in Roanoke at nine. I feel like i’m gonna yak cause I just took my Maleria pill, (again). Actually I’m lucky cause I have only been nauseous once or twice. The Doc just took our house mate Keisha to the clinic to get a malaria test, as she started displaying all the symptoms a couple of hours ago. We will know soon, and if she test positive she’ll be treated with medicine fast. The beauty of living with a doctor and being fortunate enough to afford western medicine.

Upon request I took pics of dinner tonight. Fiona cooks for us. I’m falling in love with this women. She’s sassy and wears beautiful African garbs that her tailor makes. She’s gonna take me to town Sat so we can get some material to make me a dress. I’ve never had a dress made for me-let alone an African dress, how exotic. She bakes cakes in a crock pot, and leaves the chicken sitting on the floor overnight. This woman isn’t afraid of anything. I ate that chicken tonight btw, stay tuned. The food here is surprisingly great. I must admit I was a little worried but I’m pleased to say i look forward to meals. The 150 dollars I spent on power bars won’t go to waste as Dr Sabiti eats Cliff’s protein bars like candy.

I’m posting pics from the community concert that was held in town the other night. As I’m writing this a million things are going on in our living room. Elizabeth is requesting we wear Kissito attire for this interview. Sizing has been an issue with the printed shirts they ordered. Check this pic of Tyler. I tried to offer to pay him to wear this in the interview. How American of me. Okay, can’t focus, too distracted, must get SLEEP.

Ps. Keisha’s test results=no malaria

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Mulembe, aaaaaaiiiiiiiii!!!!

Weekends we have free time to venture, unless of course we’re working. The work is never done. Today, Tyler, Keisha and I decided to hike up the mountain to the falls. Right behind our street the village spans up into the mountain. We started our trek up the narrowing dirt roads filled with cows, goats, chickens, lush farmland. The beauty is endless, the land is overwhelming. I’m reminded of the concrete I surround myself with and how unhealthy it must be. In the short time I’ve been here it seems perfectly normal to have a goat in your house, animals in your yard and bare feet on the ground. It actually seems unfortunate to live any other way.

We’re routinely greeted with smiles and laughter. Mulembe, aaaaiiiiii! Most families here in the Manafwa district speak Lugiesu among other languages, most speak English, some better than others. All the children yell Muzungu,(white person) how are you? Some say, how are you I’m fine.  Mulembe, aiiiiiiiii, (Hello) Uryena (or-ee-en-ah) How are you. Kasila (all is fine). These three phrases will get you far. And of course bana bange mulembe (hello my children). This happened the entire trek. Everyone exchanges laughs b/c apparently it’s funny to them if we speak Lugiesu, and they are so damn cute speaking English.  Everyone greets you.

I like talking to the goats, the children find this very funny. I want to find a white goat so I can point at it and yell Muzungu, mulembe! Humor translates everywhere. Ugandan goats are quite frankly the cutest in the world, who knew goats could be so adorable. As we make our way through the village smiling, all i feel is wholeness. I am whole! I get gratitude now. ( Solar, a double entendre for u).

We make our way to the base of the falls and lose our path. An older women shifting cargo on her head leads us up a steep climb. We make water motions and point toward the falls. I’d go wherever she tells me too, I don’t doubt she knows the way/ a way to something I need. We climb, we lose our path again. Standing in the field we see a man with his machete. Relief. Machetes are tools here and a common site. I find most things in this place oddly soothing. He guides us straight up the mountain off trail. I won’t go into detail as my mother reads this blog, but let’s just say I’ll take the path next time. We made it to the falls, carefully balancing our footing, searing in the sun, out of bottled water. Blissed out! We successfully crossed over the falls,  trekked down, relieved, content, safe.

The golden/red sun is melting behind the fields, the smell in the air is unmistakably African. The sounds of happiness echo throughout the hills. The temperature is perfect…This is the moment I’ve longed for.  The love I feel is immeasurable. My heart is full!

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“You can stand right there if you want, but I’m movin on”

I’ll try to keep up with posting, as to not lose any subtleties. This is hard for me. I’m anxious yet practicing silence in equal proportions…

I arrived in Mbale, Uganda after a blur of long flights, layovers and a lack of sleep. In my delirium, I conveniently figured out a way to jump in front of an incredibly long customs line, somewhat accidental, and moved on through in an hour, got a visa and made my way out to find my ride 6 hours northeast of Entebbe. Dr. Sabiti the chief medical doctor picked me up. He covers the entire Masaba region which has 14 districts (villages). Dr Sabiti is employed by the government as well as Kissito health care international. Kissito, an NGO forms PPP’s (Public Private Partnerships) with rural clinics to better sustain them and provide actual health care. These partnerships are essential for providing even the basics, and I mean basic, health care for Ugandans. More on this later.

Dr is a riot. We drove 140 mph the entire way back, over bumpy dirt roads, making our way home. Goats and small children line the side of the roads, but that’s no reason to slow down. Finally, I found a place where they drive like me. Throughly entertained by the constant street pandemonium, I grabbed a coke and decided, what’s another 8 hours of no sleep. Driving seems to be the only fast activity around here I’ve noticed so far. Everything else moves very, very, very, very, s l o w.

Mbale has an equatorial climate. Picture deep red soil contrasting lush foliage. Banana tress splatter the rolling hills and mountains. It’s a Basquiat painting come to life.

My first few days I got to do quite a bit of traveling. Every trip takes several hours as the dirt roads are bumpy. Driving through villages the entire way, speed is an issue. In our house there are six of us currently. Dr Sabiti, Tyler, Keisha, Carlos, Carolina and me. We all have different assignments at different locations etc. A few of us ventured up to Wanale. Wanale is an hour up the mountain. Wanale is an isolated village with no health access. Carlos and Carolina are implementing a malnutrition feeding program into the area as well as everything involved in opening a new clinic. I will be working with them in Wanale, as well as with Dr. Sabiti in the Mbale clinic. More later:)

Next we visited Bududa, another remote village where the landslide just happened. We spent hours in town getting medical supplies and water to drive up to them. You can walk into any pharmacy and buy any drugs you want, providing you have the money. We meet Red Cross in town and coordinated efforts. Everyone works together and joins forces to meet the end goal. So far I’ve noticed all the NGO’S, missionaries and workers pull resources. Everyone genuinely wants to know who you are working with and how they can team up with your organization to distribute supplies to the community.
Note= Give me some time to figure out this blog thing and balance work with pleasure…patience my friends, patience

Children in Bududa

mk

Mbale, in town

village life

home

Tyler getting interviewed by local media

Kissito/us bringing medical supplies to Red Cross

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Where to begin…

The first time I set foot on this continent I landed in South Africa, Delegation on Medicine program. I’ve dreamed of returning ever since. The culture here and the backdrop that is so different from my own fills my heart in ways I never imagined. Getting the opportunity to volunteer with Kissito Healthcare International for altruistic reasons is a passion of mine, but admittingly, this journey is for selfish reasons as well. Leaving our comfort zones ain’t easy, but the reward for doing so is worth every amount of suffering. This is a culture of community, survival, connectedness, perseverance ,this is village mentality, this is a tribe. My days in the States meet me with urgency, worry, thinking of what to do next, planning my future, consumerism, propaganda… what happens when you just “be”, live off the earth, sit in the grass and play with your family, watch the sunset, harvest your own food, laugh with Muzungu (white people) walking by, know your neighbors, hold hands with strangers, and connect on a frequency you just can’t find back home? Welcome to Uganda!

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