In Dubai... and on the way

So we're in Dubai... 7 hours of airport waiting down, 5 hours left to go. It's actually kind of nice to sit and think about the upcoming days - traveling to the North to visit the children of Kaberamaido and the eRanger Ambulance in Gulu, which will begin on the 31st (Happy New Year's eve everyone).

During our first trip in March, we were privileged to work with the Asayo's Wish Foundation of preventative and direct healthcare. AWF runs an orphanage, the Children's Village, in Kaberamaido, Uganda, an area heavily affected by the war. The children definitely made an impression on us... and I miss them often. There are a few I think of all the time - 5 year old Peace (yes, that is her name), with an attitude like a 13 year old, 11 year old Moses, known fondly as "Punk", who frequently enticed us to chase him round and round the Orphanage, and a little boy who I spent a total of 10 minutes with, after he found me in a crowd full of village children. He was the saddest soul I'd ever met... he wouldn't speak, wouldn't laugh, wouldn't speak. All he wanted was to be held, and it broke my heart.

I'm excited to share that we'll be returning to Kaberamaido for a couple days on the way to the North to check out an eRanger (motorcycle) ambulance, and that we will get to spend some quality time with the children. Convinced that I remember this little boy for a reason, a good friend, Echibu Moses, is searching the village and surrounding rural areas to try and find him. *hoping, and praying*

How thankful I am for the gift of children... one day, when I have my degree and have finished the missions immediately placed before me, I hope to have a large family of my own. Having worked in Uganda, I realize what a great blessing it is to live in an area of the world with such incredible medical care. Once I am in a position to be preparing to have my own family, I know that I'll have all the care I need, and have a variety of options from which I can choose. In Uganda, where on average a woman has 7 children, many districts lack the infrastructure to provide healthcare to all women and children. In addition to the enormous burden of sheer numbers per health center or hospital, there are seldom the transport mechanisms that would allow the people in rural villages to reach health care facilities during labor, resulting in high maternal and neonatal mortality rates.

I can talk about this reality in terms of statistics, but I think that doesn't do it justice. Those "maternal and neonatal mortality rates" are lives, precious lives. When a mother dies, she quite frequently leaves several children behind, forced to help raise themselves and each other. They are required to grow up so quickly. I met a family like this in Iganga District. A mother, in addition to raising her 7 children, had taken in 8 orphans. When she died in childbirth, she left 16 children behind, including her newborn. I can't imagine being the eldest of 15, still a child myself, and trying to raise all my siblings as the sole care provider. I truly believe that childhood should be protected - a time to grow, and learn, and play. The death of a mother is so often not just the death of a mother, but the death of many other futures.

In a conversation Tina, Kristyn, and I had with Iganga Assistant District Health Officer, Dr. Peter Waiswa, he fleshed out the challenges the DHO faces: 1) Ambulances are expensive to fuel. 2) Ambulanes are too bulky to reach rural villages not on any main road. 3) Lack of training in emergency response. 4) Not enough supplies. 5) No centralized communication cetner. Yet, despite these difficulties, the DHO officials in Iganga are dedicated to their calls, and they worked with us to try and find a solution. Together, we found a program called eRanger, a motorcycle ambulance that runs on 10-20% of the fuel of a normal ambulance, is light-weight and able to reach rural villages.

Our new partnership between the Vassar Uganda Project, the Uganda Village Project, and the Iganga District Health Office, is working towards bringing a pilot eRanger Program to the subcounty of Bugweri in Iganga District, with its primary focus of transporting expectant mothers experiencing complicationg to local health centers or the Iganga Hospital as needed.

How excited we are to be participating in such an innovative solution... and how much it teaches me about what incredible people there are in the world from which I am blessed to learn.

We should learn from each other, work together, help each other. And how thankful I am to be learning from the eRanger Program in Purongo, founded by the Canadian Physicians for Aid and Relief. We're heading to Gulu on January 1st to watch them in action. Send us good thoughts... and we'll keep you updated!

~ Jacquie Law

March, August and Beyond

Check back here for updates from our January trip to Uganda. Postings should be available by New Year's Day 2009.

In the meantime, check out past entries from March 2008 here or updates from our August 2008 trip at http://www.vassarugandaproject2.blogspot.com/.

Our website has more information about our past trips: http://vassarugandaproject.org/projects.aspx.

Gloucester County Times article

Check out a great article about Vassar College senior Sarah Heathcote's experiences in Uganda: http://blog.nj.com/southjerseylife/2008/04/making_a_difference_1.html.

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.