Malaria and Mango Trees

“How can you be sophisticated enough to do cataract surgery but not know that you have to get rid of the flies in the operating room and the rat poop outside that’s getting tracked into the operating room?” wonders Dr. Bill Fridinger, the retired emergency room physician who has accompanied our medical team to Kaberamaido.

The level of medical care practiced here is in many ways astounding to us all. With no electricity or monitoring machines, the local doctor manages to successfully carry out complex surgeries. The doctor and medical officers here each have an incredible repertoire of abilities to treat conditions that would be referred to specialists in the United States. There are some other surprises.

Malaria

“The biggest surprise to me is how much malaria is here and the people’s reaction to it,” Bill tells me. “Among the kids at least, I think 80 percent or more have evidence of a recent malarial attack within the last few months.

“It’s such a fact of life that they just kind of accept it. Even when a kid dies, it doesn’t seem to cause an uproar, anything like that. A kid died last week at the orphanage. They’re just numb to it, I guess you could say. By all US standards, they’re having an incredibly bad epidemic at the moment, and nobody’s upset about it.”

Mango trees

The medical team sees very few injuries. Why? The mangos aren’t ripe.

The leading cause of injuries? Kids falling from mango trees. Kids here are warned not to climb the mango trees, but I can understand the temptation. Hungry kids, free juicy mangos for the taking, just a quick climb away. And kids will be kids, here as anywhere else.

Meeting the Children

Note: We have returned to the United States, where I have regular Internet access. I have written a series of blogs that I will post periodically in the next few days.

The moment we have all been waiting for is…a little awkward. I don’t know where the idea came from, but we had been under the impression that most of the children could speak English. We are disappointed to find that most speak only Kumam, the local dialect of Luo that is spoken in Kaberamaido. This makes interacting difficult.

The children are lined up in rows on either side of the mosque where they are staying until the Children’s Village Orphanage is constructed. They are beautiful—adorable—just as we had anticipated. But unlike the children we met in Entebbe, these orphans do not automatically smile and giggle at the sight of us. They look decidedly sullen. Perhaps they think this is how we want them to act—well-behaved?

To break the tension, Jacquie demonstrates juggling with limes. She offers to teach a child. To our surprise, he shows her how it’s done. One little girl runs off with one of our “balls” to eat it.

Dr. Bill Fridinger enthusiastically attempts to shake hands with all 160 children. His enthusiasm is mirrored by the orphans, who smile and giggle at his goofiness.

I’m not sure how to feel. I’m happy that the children get three square meals a day. Many others don’t. I’m also happy to find that their six caretakers are kind.

But the children sleep cramped into two small rooms, one for boys and one for girls. Each room is about the size of a master bedroom. Some children sleep on mattresses, others directly on the floor. Not only would this be uncomfortable, but my mind leaps immediately to how easily diseases can be translated in this overcrowded environment.

I’m also appalled to discover that the two pit latrines are cleaned only once a day. When I request to use the bathroom, I am met with warnings that the kids are “very messy,” and offers to escort me the half-mile walk back to the safety of our lodging’s bathrooms. I insist on using the orphanage bathroom in an attempt to avoid inconveniencing anyone, but discover a preteen girl cleaning it especially for me.

Nobody sees this living situation as ideal. That’s why Sarah Asayo has purchased land and is in the process of fundraising for the Children’s Village Orphanage, which will include many more rooms for the children to stay in, as well as teaching rooms, a medical facility, lodging for the matrons and volunteers, and other amenities.

We organize the children into two circles. We play Simon Says, Red Rover, Duck Duck Goose, and other American favorites. The sound of their laughter is priceless.

First Patient

Two women I don’t recognize are sitting outside our lodging when I first wake up. I assume they live or work here until several hours later, when the EMTs start scrambling and saying we have our first patient. The excitement is palpable.

The women are taken inside to the sofa in the living room. Jacquie and Dr. Bill Fridinger follow. The rest of us are told to wait outside for the time being.

A few minutes pass. Jacquie emerges from the building. “EMTs, I want you to hear what tuberculosis sounds like. This woman has volunteered to be a learning case." The EMTs rush inside with their stethoscopes at hand. I remain outside, out of the way.

I am writing my senior thesis at Vassar about treating drug-resistant tuberculosis in developing countries. I know how many people die from perfectly treatable tuberculosis because they do not have access to anti-TB drugs, which are very cost-effective.

When I come inside, the woman is laying on the couch, rebuttoning her dress. The EMTs have dispersed. I find Dr. Fridinger outside.

“That woman has HIV and TB,” he says. “She’d be in an intensive care unit in the United States. She walked here from three towns over. The people here are tough.”

I have read about situations like this, but it’s a different thing entirely to see this woman, sitting in the sun in her elegant yellow dress, with no water or sustenance for hours on end. I don’t know anyone who would endure this without complaint, and with such gratitude, even in perfect health.

I go into one of the bedrooms where some of the EMTs have congregated to debrief and pack supplies to take to the orphanage.

“What happened with that patient?” I ask, knowing we have no antiretroviral drugs and less than enough anti-TB drugs to treat one patient.

“Bill isn’t sure whether the hospital will give her TB meds because she has HIV and TB, and she’s going to die soon,” someone says. “They have limited resources, and they may want to give them to younger people who could live longer.”

I stare straight ahead and feel the weight of what I’ve just been told. It’s too much to handle. My eyes well with tears, and I try to hold back.

I am finally angry. Infuriated. My 50-page thesis rationally assesses how to allocate “limited resources” for anti-TB treatment in a “cost-effective” way. While I’ve acknowledged that it’s morally reprehensible to have to choose who to save, my “rational” analysis of who to treat suddenly feels beside the point. That this person may suffer and die from a disease that could be cured for the price of few frappuccinos is NOT acceptable—and it is certainly not the fault of the medical professionals.

I’m not fooling anyone with my attempts not to cry. “Just let it out,” Jacquie says. I’m frustrated with myself for being unable to control my emotions—patients should not see me upset, and I need to learn not to react. I fear I won’t be able to handle what I’m going to see in the next week. I try to hold back, but the tears trickle down my face, and I soon find myself weeping in Jacquie’s arms.

I don’t know if these emotions can be translated into writing. It is easy to be hardened against the suffering in Africa when sitting in the comfort of our homes in the US. But after meeting this woman, it is impossible to ignore her plight.


Update:

We are later told, to our great relief, that there are enough free anti-TB drugs for everyone, provided by the Ministry. However, HIV/AIDS treatment is not universally available because it is very expensive. A doctor told us that of 2,500 HIV-positive patients registered with the hospital, approximately 300 have access to antiretroviral therapy.

Photos: Arrival and Entebbe

Note: This post was written about four days ago. There are only four computers with Internet in Kaberamaido (Population: 146,000), and the one that I have some access to has only been working some of the time.

After 48 hours of travel, our group arrived in Entebbe, Uganda. The airport is on the shore of Lake Victoria, which I've been told is the mouth of the Nile and the second largest lake in the world. As we were landing, I was struck by how lush and green the land was. We had just made a stop at an airport in Ethiopia, where the land was patched with different shades of brown and there was no green in sight.

The airport in Entebbe:

The Asayo's Wish staff who had traveled to Uganda last year told us that part of the airport had been a tent. Now, it is a humble building that smelled strongly of paint thinner as we waited for our passports to be checked and our visas to be granted. We were amused by some of the advertisements on the carts and walls, many of which reminded Ugandans to pay their taxes to support Uganda's development:

A member of our group was dehydrated from the plane. We asked one of the women who worked at the airport to bring us water. One of the Asayo's Wish staff went to get Ugandan shillings to pay for it. To speed up the process, I tried to pay in American dollars. "For water?!" the woman asked, dumbfounded. I knew this would take some getting used to.

We had just spent a 12-hour layover in Dubai. It is one of life's ironies that Emirates, one of the most luxurious airlines in the world, was our least expensive option to travel to Uganda, one of the least prosperous countries in the world--and that we passed through Dubai, one of the richest places in the world, on our way to Entebbe.

When we arrived at the J Courts lodging in Entebbe, we took our suitcases full of medical supplies out of the vans. Amazingly, all the suitcases had arrived except for one:

Our group split up. Some of us went to get hour-long massages (for $15), which were a bit more full-body than we were used to. Some went directly to the beaches of Lake Victoria, where we were instructed not to swim. Five of us went on a walk along the dirt and gravel roads of Entebbe with Harman, a man from the Congo who was in Uganda to work as a mechanic for the UN.

Harman, Bona, Liz, Stef, and Sarah walked along the dirt roads of Entebbe:

The children we ran into thought we were hilarious. Once we showed them pictures of themselves, they were very enthusiastic about our camera:

The fish market on Lake Victoria:

We spent the evening hanging out and eating fresh, local Tilapia, chicken, cooked vegetables, and rice. A few of us went out to the Knight Riders club to check out the nightlife in southern Uganda. It was a small, casual nightclub with disco lights, different from something you could find in New York City only in that the patrons were virtually all black Africans (we got a lot of attention), the toilets were holes in the ground, many of the people elected not to drink alcohol, and there was a sudden, minute-long power outage in the middle of the night.

Some of us were sleeping in beds for the first time in three nights, so we were only briefly awoken by pouring rain. In the morning, several from our group went to Church, which they reported was small with concrete floors and folding chairs on the inside, but otherwise identical in terms of services.

We are now headed to Kaberamaido, the 17 of us and some of our luggage packed into a van. The paved but potholed roads will soon give way to dirt roads, and we expect the journey to take about seven hours.

Expectations

Photo: Sarah Heathcote and Jacquie Law prepare for the trip.

Note: We are now in Kaberamaido with Internet access for the first time. I will continue to update throughout the day.

"I guess the worst of my thoughts are those scenarios in which a young girl years younger than me would die because of AIDS or pregnancy after being raped," Sarah Heathcote confides to me.

Sarah is one of the eight EMTs in our group. As we lie in our room at the J Courts hotel in Entebbe, Uganda, mosquito nets dangling above us, we chat about our expectations. Sarah is not really sure what to expect to see and do in Kaberamaido. I grab my computer to record some of her thoughts.

"Most of the scenarios that have been going through my head have dealt with young girls either being pregnant, giving birth, or having to deal with AIDS," she continues. "So there's been scenarios of abortions that haven't gone right, and infections. Those are some of the situations that would be hardest for me to deal with, so I've been trying to prepare for the possibility that they might occur.

"Another fear of mine is that I would not have enough experience as an EMT to know what to do fast enough," she adds. "There's a concern that I would have to ask a lot of questions or might be getting in the way more than I'm helping sometimes. It makes me feel a lot better that we're not going to be without a physician's supervision."

These fears seem rational. We've been told that people in Kaberamaido know that medically-trained Americans are coming, and their expectations may be high. The EMTs are trained to do a limited variety of medical work. Dr. William Fridinger, who has volunteered to lead the team of EMTs, is a retired Air National Guard flight surgeon and emergency room physician from Oregon. He will be dealing with tropical diseases that he's never seen, although he has studied copiously in preparation.

"As an EMT, what are you medically-equipped to do?" I ask Sarah.

"Basically the idea is that we can take care of the little things—vital signs, dressing wounds—to relieve the doctors so they can take care of more advanced things," she begins. "But at the same time, it's always been my opinion that a doctor's job should not stop at the medical side of things. You shouldn't look at a person in terms of his pieces. You have to consider the whole person.

"So I would hope to be a comfort for the people we're treating and act as a sounding board for whatever they want to say. It's important to make patients feel comfortable, and show them that their feelings are significant."

Sarah thinks her skills can possibly save lives. "Even something as simple as cleaning a wound and dressing it properly would prevent someone from getting an infection that could cost them a limb or their life. Even these basic skills that I have can help immensely. I think the educational work that we're going to be doing is also a big deal."

The EMTs will split into groups to work with doctors at the local hospital; teach CPR, first aid, and hygiene to kids and adults at the orphanage; and possibly work with doctors at a medical clinic. Our group will also play with the children, go out into the village, and mark the land for the buildings of the orphanage. The ultimate goal, once the orphanage is built, is to build personal relationships with the people of Kaberamaido and to get them to take ownership of the orphanage to make it more sustainable in the future.

Like many of us, Sarah is most excited to meet the children.

"I think about playing with those kids and seeing them smiling and laughing like the ones that we saw earlier today," she says, referencing groups of children in Entebbe who broke out in laughter when we simply smiled at them. "If they're curious and they want to learn or play, I'm absolutely up for that. Showing them that they can be loved would be great. I guess that would be my biggest hope, that just showing them affection or brightening their day maybe would be a positive experience for these kids."

It reminds me of a comment made by Andrea Davis-Nichols, who is on the Board of the Asayo's Wish Foundation. She said that for the people we seek to help to know that we've traveled thousands of miles to see them almost makes our journey worthwhile in and of itself because it shows that we care and it gives them hope.

But Sarah and our group aim to give these kids more than hope. "Ideally through the education that we've been giving back at home, we could raise that $12,000 [that is needed to build the medical clinic], and groups would continue to come back," she says. "On this first trip, talking to people who are working here now will help us better determine the resources that would be of the most use to the children.”

Sarah is a senior neuroscience major at Vassar College. She was born in Cardiff, Wales and grew up in southern New Jersey. She's been an EMT for two years.

Jacquie's story, and some misadventure

Note: I am posting this entry from Entebbe, Uganda. We arrived here last night, after several days of travel, with (almost) all of our luggage. Today, we will travel to the orphanage in Kaberamaido. My next blog will update you on our travels.

"YOU'RE COMING THROUGH THE CEILING!" a muffled voice shrieked from the floor below. "STOP WHAT YOU'RE DOING, YOU'RE MAKING A HOLE IN THE CEILING!"

Disoriented, I dropped the box I was holding and stepped back off the insulation and onto the wooden boards that constituted the only firm ground in Jacquie's attic. We were storing 240 pairs of jeans donated that morning by community celebrity and organizer John Flowers after we appeared on his radio show. Apparently, we had overestimated the stability of the attic storage space.

Down the ladder in her bedroom, Jacquie was eying me frantically while yelling reassurances to her neighbor in the adjacent unit of her two-apartment farmhouse. I doubt her neighbor felt reassured, standing helplessly in her home as a wide crack creeped across her ceiling. I certainly didn't.

It was my first visit to Jacquie's house, and already I was causing serious damage. It was a rookie mistake--not what's normally meant by "humanitarian aid gone awry," but disastrous nonetheless.

To be fair, I wasn't used to farmhouse construction. Most Vassar students live in dorms on campus--within spitting distance of the dining halls and academic buildings. Jacquie, on the other hand, lives within spitting distance of horse pastures and alfalfa farms.


JACQUIE'S STORY

A devout Mormon, Jacquie prefers to live away from the revelry that sometimes characterizes dorm life. The most striking thing about her house, when you get past the dirt driveway and the classic character of the red farmhouse, is a Christmas tree that takes over the space in front of her refrigerator. A quick appraisal of her house leaves no doubt that Jacquie takes her faith seriously, and that the Uganda medical mission is a part of it. Framed pictures of Christ and a Mormon Temple--testaments to her faith--share wall space with dozens of framed photographs of Ugandan children.

If I didn't know Jacquie, I might have assumed from the photographs' prominent placement on her walls and next to her bed that they were of her siblings and cousins. But the children's ebony skin and dark hair starkly contrast with Jacquie's pale hue and blonde hair. And I had seen these faces before, gazing up from the Asayo's Wish Foundation website.

Jacquie has devoted the last seven months of her life to organizing medical supplies and care for children who she has never met. She has not made them into abstractions, as is so easy to do with humanitarian work. Instead, she has surrounded herself with their images.

"She's so cute, she makes me melt," Jacquie confided to me once, pointing to a little girl with braided hair on the background of her computer.

Jacquie has felt since she was two that she was called to medically serve in Africa. The details were finalized last year when she took Vassar Professor Timothy Longman's African Politics course. She wrote a human rights report on Uganda detailing the atrocities committed by both the rebel Lord's Resistance Army (LRA) and the Ugandan government against their citizens in the 21-year civil war. Horrified by the LRA's propensity to make children into soldiers and girl children into "wives" (read: sex slaves), she was determined that Uganda was the place she wanted to direct her help.

Jacquie has been an emergency medical technician (EMT) for three years, and has experience with humanitarianism, so she thought one of the nonprofits working in Uganda could use her as a medical volunteer. After two organizations told her they didn't need her, she was discouraged. Then, her aunt introduced her to Sarah Asayo.

Sarah, a Ugandan herself, founded the Asayo's Wish Foundation to help the plight of Ugandan orphans. The Foundation was in the process of opening an orphanage for 150 children, a number that would grow to 400 within a year. Part of the orphanage included plans to build a medical clinic. Jacquie volunteered to help found the clinic.

Eight months later, our team of eight EMTs, one doctor, and I have arrived to Entebbe, Uganda with tens of thousands of dollars worth of medical supplies to take to the orphanage.
Jacquie seems happy. "It's so beautiful," she said yesterday as we stood in the sunshine, gazing at the plush, exotic greenery in our hotel garden. "I feel like I'm home, and I never want to leave."

Today, we will travel to Kaberamaido, and the medical volunteers will soon begin seeing patients.


PREPARING FOR A MEDICAL MISSION

It's surreal to actually be here after months of preparation. We wrote brochures, made posters, asked Vassar's administration and student government for funding, applied for grants and donations, procured donations in front of grocery stores, made appeals to alumni, held a concert at Connecticut College, sent press releases, made radio and news appearances, picked up medical supplies, found a doctor to go with us, borrowed suitcases, and packed medical supplies. The EMTs took self-defense courses and learned how to start IVs in preparation for the trip. Jacquie taught the Vassar students a fieldwork course about human rights, humanitarianism, and Uganda's history and current political state.

There have been some setbacks. Problems with purchasing plane tickets (until a week before we left!), difficulties transferring money, having no way to get to the airport with 25 suitcases plus carry-on luggage (Vassar's fieldwork office came through with a bus the DAY before we had to leave)--and, of course, a little building damage.

But it's all worked itself out. I did not fall through Jacquie's neighbors’ ceiling. They were very understanding about the damage, and it has now been fixed. And above all, everyone has been very, very generous to us with money, donations, and going out of their way to make our mission possible. It has taken a lot of effort, on our parts and others, to get us here. Now, we have embarked on the first phase of our Project in Kaberamaido.

Embarking on a medical mission to Uganda

 

It must have reminded my Dad of the feeling he got when I announced I was going to drum for a band. Disbelief.

 

"There's only one problem," he said. "You don't play the drums."

"That's the thing, Dad," I replied, and he didn't need me to explain what was coming next. Dollar signs flashed before his eyes and he must have felt a twinge of the headaches to come as I diligently banged away on my rented drum set.

I'm not sure which images flashed before my Dad's eyes when, out of the blue, I asked him if I could go to Uganda. Perhaps he imagined my malaria-ridden body being evacuated from the country by helicopter. Or a sudden end to the 18-month cease-fire between the Lord's Resistance Army and the Ugandan government, revamping the 21-year armed conflict that orphaned so many of the kids we now seek to help.

Six months and countless hours of work have passed since Jacquie Law, a junior at Vassar College, first told me about her plan to help found a medical clinic in Kaberamaido, Uganda. She hadn't intended to tell me. She had come to speak to Vassar College President Cappy Hill during her office hours to tell her about the plan and ask for advice. After all, Cappy had worked as an economist in sub-Saharan Africa. As one of Cappy's student assistants, I sat with Law while she waited for the school president to finish an appointment. I asked about her plans, trying to sound casual.

"I'm helping to found an orphanage in Kaberamaido, Uganda," she said. "My work is primarily to establish a medical facility."

I could barely contain my excitement and my desire to get involved. I have always jumped at opportunities to help - I cooked for homeless people in Washington every Sunday through high school, and I drove to New Orleans after Hurricane Katrina to do relief work. Perhaps sometimes I've gone a little too far, like when my Dad took me to a fancy restaurant in Israel for my Bat Mitzvah and I spent the entire meal huddled beneath a car out front, feeding butter to feral cats.

Law showed me a binder detailing the plans of the Asayo's Wish Foundation to build an orphanage for 400 children. It became clear the Vassar students involved in the project were all emergency medical technicians with concrete skills to contribute to a new medical clinic. They would set up the clinic, provide medical treatment, and educate people about basic first aid. I tried to envision a role for myself.

It wasn't as hard as I thought it would be to convince Law I could help with her project. It turned out she wasn't in the habit of rejecting free help. Before I knew it, I was soliciting donations outside of Stop & Shop, making brownies for bake sales, issuing press releases and writing a constitution to make our project into a student organization on campus.

But I was not satisfied. I wanted to go to Uganda with the team of EMTs. Law was game. My Dad was not.

"I just don't want you to lose your momentum," he said in the concerned tone reserved for fathers.

It wasn't clear whether he thought it more likely I would meet a nice Ugandan man on the 10-day trip and never return, or that I would drop out of college to pursue humanitarian work while he footed the bill.

But I lucked out in the father department. My dad is a very generous man, and before I knew it I was happily (though dizzily) being poked in the arm with needle after needle of live and dead infectious microorganisms in preparation for the trip. We embark on Thursday.

People have donated tens of thousands of dollars worth of medical supplies to take to the clinic - prescription medications, defibrillators, stethoscopes, gauze, Advil.

Now the hard part - six Vassar EMTs, two Connecticut College EMTs, one doctor and I will pack whatever fraction of the 3,000 pounds of medical supplies that we can into the two or three suitcases each of us will carry.

Luckily, many of us will return to the orphanage in July, at which point the clinic will be fully staffed by medical professionals. We'll have a chance to bring more medical supplies then, in addition to shipping as much as we need.

We grow more and more excited as our departure approaches. And my Dad has really come around. He's added this project to his list of "Excuses to Shamelessly Brag about My Children."

I guess it doesn't hurt that I'll be surrounded by medical staff in case I contract Yellow Fever, and the Ugandan peace negotiations are making progress. Or maybe, with time, he's gotten used to the idea, just as he grew accustomed to me banging away to U2 and Led Zeppelin on my drums in our basement.

 

To find out how this project got started, check out the Miscellany News article.