A Volunteer Without Boundaries In Kasese, Uganda

Story by Mithai Avondstondt

First off, I would like to take a moment to recognize the people who helped make my trip to Uganda not only possible, but a success. I would like to thank Mary Lightfine at Volunteers Without Boundaries for all the time and hard work she put in to set up this project and taking the interest to help young people have meaningful experiences abroad. None of this would have been possible without her. I would also like to thank all my new friends in Uganda for the generosity they showed me throughout my stay. I am greatly indebted to Kiima Francis and his wife Imelda for opening up their home to me and Kiima Charles for coordinating my experience in his district and for making sure I got the most out of my local experience. Thank you to everyone else in Kasese for your help throughout my stay and for not laughing too much at

my attempts to speak Lukonzu. I would also like to thank all the generous people who helped me to raise funds for Volunteers Without Boundaries. Your support has been amazing. A special mention should go out to the Rotary Club of Coral Gables, the Rotary Club of Key Biscayne, Bob Hilson and Co, Kathy Bates, Yolanda Woodbridge, and all my friends for both their donations and support. I would like to send an extra special mention to Mark Fosbender at Micro Optics of Florida for his generosity in donating a fabulous microscope. I would also like to thank Robin Bairstow for getting me in touch with Volunteers Without Boundaries in the first place. You all hold a very special place in my heart. Last but not least, I would like to thank my parents for supporting my adventures.

As an introduction, before starting medical school I decided I wanted to volunteer in Africa for one month during the summer. As chance would have it, I came across Volunteers Without Boundaries and found out about a project they were setting up in Uganda with a local organization called Rwenzori Rural Health Service (RRHS) that focuses on improving health in rural areas of southwestern Uganda. As a volunteer interested in a health related field, I wanted to volunteer in rural health-care settings, help administer education sessions, and help with organizational aspects of rural African services. This experience was a great way to gain exposure to the health-care field in developing countries as well as general medical experience. It is my belief that the key to being a good doctor is compassion. Experiences such as this one helped mold my perception of humanity and will help me draw inspiration throughout my career.

Prior to leaving, I was made aware of the many dire project needs in Uganda so I started raising money in order to purchase a microscope to donate it to Volunteers Without Boundaries for use in this rural health project. In my efforts, I managed to come in contact with Mark Fosbender at Micro Optics who generously donated a microscope. Meanwhile, I

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managed to raise about $700 in donations. The needs in Uganda are great and Volunteers Without Boundaries is working diligently to find funds to provide safe drinking water and improve sanitation in Kasese. The donation money I raised was not sufficient to begin a water protection program so it was used in Rural Kasese, Uganda to provide other needed services such as health care, medicines, education and transportation. I would like to thank all those who helped not just me but the people of Uganda as well. I hope you enjoy reading about my experience.

Day 1 Fri 6/13/08 - Not Again

To keep up with tradition, my checked bag was lost. Welcome to Africa! (Although it should be noted it was the fault of the Dutch). On my trip to Thailand and Cambodia two years ago, my bag was lost for three days. Hopefully at 10am tomorrow I will have my bag. Always, always pack extra undies! After doing the lost luggage thang, I met my driver to take me to my guest-house. I was a little surprised no one checked my yellow fever vaccine record. I guess they were more interested in collecting the $50 for my visa. When I got to the guest-house, at the gate we

were greeted by the guard and his very large shotgun very much visibly by his side. Despite this warm welcome, this area seems very safe. The roads are all lined with HUGE houses, definitely an upscale neighborhood. The receptionist, Naomi, was extremely nice. I checked in, $40 for a single, not bad. Naomi had dinner ready for me: a very tasty beef or goat dish, cabbage, spinach, rice, squash, and G-nut. G-nut is ground-nut, aka peanut (called ground- nut because they come from the ground). It’s a paste that tastes like ground up nuts (quite simply!) with a color that reminds me of a hippopotamus. (purplish-pinkish-brownish). My first African meal! The meat and G-nut were very good, the rest was a bit bland. Salt would have helped there! The rooms are nice, bathroom clean, and I’m definitely looking forward to picking up my bag tomorrow.

The trip here was smooth until I found out about my bag. It was 8 hours from Miami to Amsterdam, I spent 24 hours there (with ALL my bags!), and then 8 hours to Uganda.

Day 2 Sat 6/14/08 To Kasese

I woke up this morning forgetting there was a time change (Uganda is officially 7 hours ahead of EST) so I was a little late in meeting Deo, my driver. Once we left, we went to the US embassy but they were closed since it’s Saturday. However, I did find out I can

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register on line. Deo then took me to a place to change money. The rate was slightly better than the airport and you can bargain the rate, but I think it would have been better to change all my money at the airport. That would have been a little less sketchy, and I think they’re more used to changing the larger sums of travelers. Plus airport security is around. Then Deo and I headed off to the airport to pick up my bag. I eventually got my bag, but at first glance it looked like it had been broken into. The zipper of the front pocket was completely ripped and there were slashed on the side and bottom. Later I realized that what probably had happened was it got stuck on something and that tore my bag up. Ugh. I don’t think someone would really have wanted to steal my sunscreen, bug spray, and tampons that badly. But dammit! Now I don’t have sunscreen, bug spray, and tampons! Malaria, here I come! After filling out the damaged bag claim Deo and I were on our way. It took six hours of anything from severe potholes to perfect pavement. We stopped once for bathroom and snack since we were late because of my bag. Deo is just one of those people who give off “good person” vibes from the moment you meet him. The whole drive he was very informative and a good conversationalist. It took about 6 hours total, and the roads had some decent potholes but was mostly in excellent condition. He is also a very good driver. My host dad Francis’s wife, Imelda, met me at a local guest-house in Kasese since Francis is in Kampala, and showed up the way to her house. The house, as basic as it is, is apparently one of the better ones in the area. Their lot is fenced by bamboo and a gate. There are 5 little units spread around. One for Francis’s family, one for the kitchen, one for the “bath”, one

for ?, and one for me and the housekeeper. My room has a bed, mosquito net, desk, chair, window, door to the outside, and a purple piece of gauze they call a curtain which does not provide too much privacy. They also have an outhouse. Francis’s wife Imelda is very nice. She has 3 kids: Moris, Doris, and Loris. Lol. Moris is currently away at boarding school. Doris is 8 and very outgoing. She speaks English very well. Loris, 4, is more shy but he seems like a cool kid. I spent the evening chatting with the fam. A bunch of people dropped by, to see the white person I think. Imelda’s sister, her eldest daughter?, someone else? And every time I turned around there was one more small bald head in the yard. The only way to tell the boys from the girls sometimes is the girls wear skirts. Pink shorts still mean a boy (aka Loris!). Dinner was pretty good. Goat, potatoes, beans, rice, and tapioca? Or obondu in Luconzu, the local language. It’s this doughy stuff that’s not too bad other than the occasional crunch of what I suspect is dirt. They eat everything with their hands, picking it up with the tapioca. For now, I use a fork. A couple of awkward moments came up when they asked about religion… I’m not very religious in any religion.

***Uganda Culture Note***

So all the cool kids in Uganda hang out on the side of highways. Sometimes ON the highway. There were a few close calls but no one seemed phased but me.

Day 3 Sun 6/15/08 So This Is Africa

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Today I had the day off. I took my first bucket shower of this trip. Thankfully they made me some hot water so it wasn’t too bad. I definitely need to improve my technique. I had a breakfast of scrambled eggs and French fries. No salt. As I was reading, I became surrounded by a few curious children. I gave them each a small piece of paper and a crayon and told them they could keep the crayon if they drew me a picture. They all loved it. Before I knew it like a billion kids were around. So now I have a billion pictures. Lunch consisted of G-nut, rice, steamed plantains (aka matoke), spinach and peanut-stuff (dodo), cassava, and avocado. Not too bad. Later on I was escorted by Josinta, the sister of Francis and Charles who also works kind of with Francis, to use the Internet at her office. At this point I rode my first bodaboda. A bodaboda is a bike or motorbike where you sit on the back and pay someone to take you somewhere. A bit frightening, but fun! The hired transport of Thailand, the tuktuk, seems like a luxury vehicle compared to this. After 30 minutes the Internet started working, even if slowly. In the evening Imelda took me to meet the LC1, who is like a village chief, to register as her guest. They gave me a visitors pass so just is case I have problems (?) I show my pass. When we returned to the house, miraculously there were no other children there so I had my chance to give Doris and Loris their gifts of crayons and notebooks. After dinner, Oliva the housekeeper brought me a bucket for night “short calls” (aka what we call #1 in the USA). Just in case there are thieves roaming during the late hours, I’m supposed to use to pee-pot in my room so I don’t have to go out. This should be interesting.

Day 4 Mon 6/16/08 Attack of the Visitor Books

Today, out of necessity, I finally washed my hair. I came up with the bright idea to use a water bottle like a shower head, which seemed to work well enough. Sanyu, a volunteer for RRHS and a police officer, picked me up in his car and we met up with Veronica, a clinical officer (more than a nurse, less than a doctor), and Margaret, a mid-wife. First we went to the RRHS office where I signed the visitors book and a note Charles left for me. Then the LC1 of this area came to meet me and I signed his visitors book. We then proceeded to the RRHS Chairman's office, police station, district health office, district political office. They all had visitor books! I signed eight in all. One man in the police station wanted a copy of my itinerary and passport. For me this all seemed a bit much and somewhat questionable, but I think all this presenting and signing is to a) satisfy the curiosity of nosy people, b) raise awareness of RRHS’s degree of involvement in the community, and c) should the worst happen, there are ways to contact the proper authorities since Kasese is a bit isolated. Sanyu returned me to my house by lunch but Oliva had fallen ill and was too sick to cook so he took me to the White House, a guest-house named for the color of paint on the outside and the color of people on the inside. I had curry chicken, which was tasty but would have been more enjoyable if my chicken hadn’t been tough enough to break my knife. Overall the White House seems like a nice place, with indoor plumbing, quite tempting…. Oliva seemed to feel better after I gave her some Immodium. When Imelda returned from work, she brought a fellow teacher and her daughter, a college student in Kampala on vacation. Rachael was very talkative and inquisitive. Her English was very good and I greatly enjoyed having a

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conversation with someone around my age. She’s studying to become a lawyer so we spoke mostly of university life.

***Uganda Culture Note***

When you first arrive people you meet will tell you “You’re welcome”. “Um, thanks? I’m welcome for what?” Not too hard to figure out it means “Welcome to Uganda!” but it’s still a bit strange to hear.

Day 5 Tues 6/17/08 So This Is Rural Health-care

Only 2 visitor books today! Phew! Sanyu picked me up at 9am, we picked up Veronica, and made our way down the road and up the mountain. Along the way we stopped at a market and bought lunch! Irish potatoes, beans, matoke, tomatoes, and dodo. In the market, they showed me “eggplant”. I then pointed out a different veggie which is what I thought was eggplant and they would have none of it. Obviously I was completely wrong. After a very bumpy dirt road, we finally reached Mukathi Government Health-care Center. First came the tour: exam room, in-patient ward, lab, drug storage, counseling room, and delivery

room. The clinic is organized but extremely dirty compared to anything in the USA. Especially the in-patient ward. The ward was over-crowded. Since there were more than four patients, there were not enough beds so mattresses were laid over the floor. Apparently when that even becomes too much, they have this barn like structure out back where they put patients. I was given a white coat and then had to explain multiple times that I was not a doctor and had practically no medical training whatsoever. It was a little frustrating that this wasn’t explained clearly beforehand. But otherwise straight to business. I was first taught how to take blood pressure. It was a bit tricky at first, but after a few tries and confirmations by the nurses I was getting the hang of it. I was then taught how they take histories, and Nehemiah the nurse translated for me. He was very patient with me and encouraged me to make a diagnosis from the complaints. In any case, he was there to confirm or correct me. Many of the diagnosis’s are not too hard: fever = malaria, abdominal pain = helminthes worms, chest pain = respiratory tract infection. This is definitely not the best way to treat people, but the facilities are inadequate to confirm anything. All they can do is treat the most common problems and refer anything complicated to the hospital. At lunch I found out the remaining patients refused to see anyone but the mzungu (aka white person, rich person, foreigner), which is ridiculous since I was the least medically qualified person there. It’s somewhat upsetting that no one there stepped up to say the people should be there to get medical help,

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not to see a new animal like in a zoo. After a long day we finally finished after 5:30. Veronica said there were about 150 patients today. Holy moly. By the time I got back home all I wanted to do was eat and sleep.

Day 6 Wed 6/18/08 More Rural Health-care

Back to Mukathi health-care center today. Veronica thought there would be double the people today than yesterday, and I think there were definitely more but not quite double. Hopefully word got out that the mzungu would be here for a month, so everyone doesn’t need to come at once. From 10-1pm, patients! At lunch Veronica went over their monthly epidemic papers with me. This clinic is a level 3, which means they can take in-patients but they are not a hospital so they can’t do things like surgery. One woman who I saw yesterday was in a coma today. She is pregnant and got severe malaria. They referred her to the hospital but she refused to go so they kept her there. The costs to get to the hospital are a big enough deterrent to keep people from seeking medical attention, even if once they get there the care is free. So low and behold since this woman didn’t go to the hospital where they have proper drugs and equipment for her, she was in a coma by the morning! While Veronica was showing me this patient, the woman’s husband showed up. Veronica explained that if she did not go to a hospital, she would most likely die. The husband literally ran out. He does not have/want to spend the money it would cost to hire a car to drive her to the hospital so he literally ran out on her. All they could do was keep her on dextrose IV. At some point in the afternoon they told me she woke up from the coma. More patients after lunch and surprise! By 3:30 we were done. Much better than 5:30. Veronica showed me how they test for HIV, their drug stock sheets, and how they do family planning. On the way back one of the nurses caught a ride with us back to Kasese. I found out that he only volunteers there and does not have a job because he can’t find one. A very knowledgeable nurse can’t find a paying job. So to live, he feeds his wife and himself off his garden. I got to use the Internet at Kiima Foods for a little and Josinta walked me home, so hopefully I’ll get to know the neighborhood a little better now. She also picked up some allergy medicine for me, since all the dust here has irritated my throat quite a bit. And when I got home, YES! TP! Imelda picked up some more toilet paper for me! I was starting to run low…. Later in the evening I showed Oliva my iPod video and she was absolutely stunned. It’s pretty insane that this thing costs more than she’ll make in a year, which makes me feel a bit guilty for taking for granted many of the things I own. I ate dinner and went to bed a little bit humbler.

***Uganda Culture Note***

As per Veronica’s beliefs – hair color should match skin color. My dark hair and light skin shouldn’t exist!

Day 7 Thurs 6/19/08 Private Clinic!

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The family is a little noisy in the morning. They wake up 30 minutes before I do. Although if I had a door that would probably have helped. Sanyu picked me up and took me to Alleluia Private Health Clinic. Holy crap what a difference between a rural government clinic and a private town clinic! This place is in much better condition than Mukathi. The exam room is about equal, but their drug stocks never run out. They have a permanent lab technician since this person is paid. But the biggest difference is the in-patient ward. They have at least 10 private rooms that hold 2 people each, with an actual mosquito net for each bed. Milton, a clinical officer, is very nice and good at explaining things. The first woman we saw had a one month history of vaginal bleeding. After lab tests ruled out a UTI, Milton determined that the probable cause was an induced abortion from taking local herbs. This is apparently a fairly common practice. We also saw a baby with pneumonia, and a child with malaria. And that was it! Because there are many less patients, there is time to explain things like symptoms, causes, drugs, etc. Then the subject of diabetes came up. Finally something I can contribute on! (I spent the past year doing research on diabetes.) Milton had a few questions that I was actually able to answer. I am kind of being used here, as a white person, to bring patients to the clinic to give them business. (They do offer certain services for free, but most are charged). But I guess people come in who would not otherwise seek medical attention, so I guess it’s not too bad a thing. I went to the White House for lunch, to use the Internet café, and to wait for Charles.

Charles was 2 hours late since his bus broke down one hour outside of Kasese, but I had plenty of time to use the Internet and relax. Once Charles got in, we went over many things about RRHS; how they started, where they’re going, what they want to do, what positions they have, how they operate. It was good to finally meet him and learn more about all that. He has a motorbike that Josinta, his sister, lent him for the duration of my stay so he, in turn, lent me his bicycle.

When we returned to the house, the kids were playing a horrible game. They had a small bird tied by its foot and this 5 year old girl was trying to fly it like a kite. The unsuspecting children let me see it, so I untied the string and upon further inspection realized that its wing was horribly broken. There was no way this thing would survive. I placed it on top of a high bush so hopefully it can die in peace instead of being tortured. The children didn’t understand at all why I took it and even Imelda was not at all fazed by this game. I hope the kids leave it alone. But I guess in a place with such poor human conditions, animal rights will not exist. Otherwise I showered while the sound of other birds tortured me. After dinner, Francis finally arrived around 10pm, so it was nice to finally meet him.

Day 8 Fri 6/20/08

Yesterday Charles gave me a bike to get to Alleluia Medical Center & around town. The front of the bike was stuck and the gears were set to the lowest possible setting, which resulted in an extremely painful bike ride down to Charles’s office to get some help. Charles

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was not there. Great. It’s a good thing Francis’s office is just down the road. Some people helped me with the gears but we then realized that the front brake was broken and stuck so they took the bike to get repaired for me. Luckily while looking for a bodaboda Charles drove by on his motorbike and gave me a lift. At the private clinic, I saw pediatric pneumonia, malaria, infected finger, numbness of one testicle, eye infections, vaginal infections, & more. There were many more people today than yesterday. A few came specifically because they heard the mzungu was there. Suckers! I headed into town for lunch and when I came back there were not too many patients so I was able to head over to Kiima foods for some computer time. At this point I feel much more adjusted than I was the first week. I am finally starting to learn my way around and that feels great. I can enjoy things much more. Still, it’s nice to connect back home so as to not feel so isolated. Having the bike and a way to get around is nice, too.

***Uganda Culture Note*** Introductory handshakes are quite long!

“Hello”

“Hello”

“Welcome”

“Thank you”

“How are you?”

“I’m fine”

“How’s America?”

“It’s fine”

“My name is…”

“Nice to meet you, my name is Mithai”

“Welcome!”

“Thanks!”

All while holding hands!

 

Day 9 Sat 6/21/08 Let There Be Light!

Today I went back to Alleluia Medical Center for the morning. I saw one positive pregnancy test, one 8-month antenatal check-up, high blood pressure, more UTI's, and one sexual impotency problem. We also did rounds in their wards. Lots of malaria cases there! I headed home for lunch. There was a Belgian girl working for the Belgian gov who came to Kasese to see Francis’s project and so she had lunch at our house. My mzungu sister! She has been in Uganda for 1.5 years so she had some good tips on things to do in Uganda. After lunch we had a meeting for all RRHS. It was great to meet some more fellow volunteers! All of them live in the local area. At this point, I handed over the microscope I got donated to their organization and everyone was thrilled to say the least. I learned some more about RRHS and got to ask more questions to see how I could help the most and form an opinion of where things can/will go. When I got back home, Francis had installed a new battery for the solar electricity and voila! My lights finally work! Yay for electricity! On top of that, “what’s

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up?” is starting to catch on, to help cut out the monotony of their usual English routine of “How are you?” “I’m fine how are you?” “I’m fine how are you?”, etc. It is a lively Saturday night outside, and as usual, all the surrounding children are hanging out at our house.

Day 10 Sun 6-22/08 Family Planning

In the morning, I tried to work on the RRHS website to no avail. I know little bit about making web sites, but the setup they have is very confusing. I think all I can do is correct some English and email those corrections to the person who made the website so they can enter it in. The unbearably slow computers don’t help any. There was a bit of a miscommunication about lunch so Francis took me to the White House to eat there, while Charles dropped off his wife at the site of our health talk. Mmmm, macrons with tomato sauce!

The village where we will be doing the health talk is the location of the proposed RRHS health clinic. The land has already been purchased and there is a sign to mark the site. Before the health talk, I was taken to the water tank that will be used to supply the clinic and village with clean water. Just a few minor repairs need to be done to fix one pipe of this tank and get things flowing. Then the health talk began! The topic today was family planning. A doctor volunteer with RRHS spoke with Miriam, Charles’s wife and a midwife, as his assistant. About 200 people showed up. Everything from oral contraception, injections, no-plans, condoms, vasectomies, and abortion was covered. They even spoke about how family planning had an impact on things like the nation economy, family health, education, and nutrition. Many of the people did not know anything about family planning or had lots of misconceptions. I feel these health talks really had a big impact on this population that was very eager to listen and learn. The whole talk was conducted in the local language and Charles or Miriam translated for me as we went along. After the family planning, I got up and did a short talk on how health care is run in the USA. I spoke about child immunizations, yearly physicals, US family planning, sanitation, and hand washing. The whole talk lasted about an hour and half. When I first arrived in Kasese, I was taken back a bit by what a small town it is, that is, until you see a village like this. Kasese now looks like NYC.

Day 11 Mon 6/23/08

At Alleluia MC today I saw UTI's, dental referrals, severe peptic ulcers, malaria, and wards. Most of the ward was filled with malaria and one severe pelvic inflammatory disease. I had lunch and Internet time at the White House, and then I met Charles to make my schedule for that week. Afterwards we had some errands to run! Pick up some food for tomorrow’s hike, photo copies, police office (to drop off my schedule), buy bike lock, and a visit to Bishop medical center! Charles wants to take me to a bunch of medical clinics to get a good idea of what Ugandan medical centers are like. Bishop Medical center is a bit bigger than Alleluia and the doctor who showed us around still complained the place was too small.

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Also, they had a dental office with great equipment, but no dentists to use them…. This makes me think of how RRHS has the people but lacks equipment!

Day 12 Tues 6/24/08 - Up the Mountain!

Charles was actually on time this morning and I was running a little late! But by 8:30 we were on our way! It took 2 hours to hike up the mountain, but at that time it was cool and cloudy with a plethora of amazing views to keep me distracted the whole way. Once we got to the Nyakabingo community, I saw the site where Charles wishes to set up a water storage tank and the sites the tank will supply. The top of this mountain is rough terrain. It’s hard to imagine how anyone lives there, especially with such scarce water sources. Once the reserve tank is built, it will be a very good thing for this community. We spoke with many of the people there to make sure they know about the proposed plans. The community will help with planting the pipes and some construction to give the community a better sense of ownership of the tank. When business was over, we met the other Charles, the man who coordinates with my Charles & RRHS for the projects in that community. The terrain sure is rough, but man is it gorgeous. A nice day, beautiful scenery, and some good exercise is just what I needed! We took a different way down and made it back to Charles’s house at 2pm. His wife had some rice and G-nuts ready for a well deserved lunch! Once we were done, I took a well deserved shower! My Ugandan sunblock did not work too well. I got fairly red since the sun was nice and bright by noon. So the rest of the afternoon I spent relaxing.

***Uganda Culture Note***

Many of the ladies here did not get the memo that big puffy sleeves went out with the ‘80’s.

Day 13 Wed 6/25/08 - Kilembe Hospital

So today is my free day. And after such an exhausting day yesterday, a good night’s rest is just what I needed! Unfortunately, it’s not what I got… what I got were rats! They were extremely active an kept me up from 4am-6am. Then when the light came up, the rats went out, but the family got up too and at that point sleep was impossible. Oh well! Francis will buy “rat boxes” today to take care of this problem. I got up and washed some of my own laundry to Oliva’s objection. It is a bit harder to wash in a bucket than you would think it would be. After using the Internet, Charles picked me up to go see what a full- sledged Ugandan hospital is like. Kilembe hospital is much smaller than probably any hospital in the USA. No AC, everything is open windows. The wards consist of one open room with beds lining the walls and middle. If more beds are needed, they just throw mattresses on the floor. I saw: men’s ward, women’s ward, maternity ward, surgery, pediatrics, physical therapy, dentist and HIV counseling. In the peds ward, I saw 2 malnourished babies which made me seriously question how something in that condition could still be alive. They had such defined

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cheek bones that would make the skinniest of models envious. No fatty cheeks like the Gerber baby, how a baby should be. It’s hard to explain how such a sight tugs at the heart strings. I wanted to cry, shout, or at least do something. All I did was move on. The hospital is pitiful compared to anything in the US, but very nice compared to Mukathi gov clinic. In any case, it’s the highest level of care one can receive in Kasese. Not a place I’d like to find myself, though. There are two other hospitals in the district, but I’m sure they can’t be too much better. Everyone I met wanted me to come back and volunteer. I’m not sure why since I have no medical training. I think just for the excitement of having a mzungu around. When we were done, we returned to Charles’s for lunch and then took a trip to the market. The market has clothes, shoes, suitcases, food, knick-knacks, but overall not too impressive. It’s definitely more functional for the locals than meant for tourists. I hope the markets in Kampala are a bit better.

Day 14 Thurs 6/26/08 - Merryland High School

Today I spent the morning at the RRHS office with Charles. I read some various documents, we discussed a few things, and scanned a rough sketch of the proposed RRHS logo to be sent to a friend of mine who does graphic design. After lunch we headed off to Merryland High School where the drama group put on a whole performance for me and the entire school. I, as the distinguished guest of honor of course, was sat by myself in the front with the 300 person student body facing me… a bit intimidating so I made Charles & Miriam join me. The students were quite good and very outgoing. I was definitely impressed! They sang songs and had a 2 act play about a student who got HIV and pregnant, and then died. The whole performance lasted 2 hours! It was very similar to the You Tube video Mary had up, but quite different when its performed live and specifically for you! And when I got home, there was a surprise… rat box! Now, normally I’m a huge animal advocate, but these damn rats have kept me up for the past 5 nights, not to mention the sanitary issues as they crawl all over where I eat. Oliva said she already got one. They previously only scampered across my ceiling (and quite loudly!), but now they’re entering my room and starting to chew holes in my stuff. I can hear them right next to my head. I know they won’t get through my mosquito net, but still. Hopefully I can get some sleep tonight!

Day 15 Fri 6/27/08

Sometime last night we caught one! This thing was huge! Like 8 inches long! Luckily a family friend had spent the night so he threw it out since Francis is in Kampala. Unfortunately, there are still more…. This morning Charles picked me up and we headed out to Mukathi Gov Clinic. It’s a different ride on the back of a motorbike than in a car. The day at Mukathi was not pretty good overall. I helped with taking histories and blood pressures of about 15 patients and then went to the antenatal ward. There I took the blood pressures of the pregnant mothers and learned how to palpate their abdomens to find the head of the

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fetus. I also learned how to tell how many weeks pregnant the women are by placing my hand on their abdomen and counting fingers. Then they taught me how to use a fetal-scope to hear the heart beat of the fetus. That part was rather difficult for me and I usually didn’t really hear it. I saw maybe about 20 mothers, so overall about ½ of the 100 people the last time I was at Mukathi! Lunch there was good, as usual. Veronica’s a good cook and Charles, too, since he helped! By 3:30 we were done! So I had time to use the computer and relax the rest of the evening.

Half-Way Point

At day 15, I’m a little over ½ way of my stay in Kasese, and ½ way my total time in Uganda. So I think it’s time for a little reflection. My first few days in Kasese were rather tough. It was a mix of my tentative schedule until Charles returned from Kampala, my electricity not working, bucket showers, outhouses, the dusty environment, and the feeling of being a bit isolated and lonely. This combo took me from extreme excitement of being in Africa to extreme overwhelming. I am normally a positive person and knew (hoped!) this phase would pass, but at the time I strongly considered moving to a guest-house with the luxury of electricity and indoor plumbing. At this point, I’m glad I didn’t. I’m now used to everything; I even have my bucket technique down! Francis, Imelda, and Oliva are as accommodating as they can be. From hot water for my baths to rat boxes to the gradual removal of Obondu from my meals. At this point, I have done a wide variety of things from rural & town clinics to visiting the hospital and hiking 2 hours to a remote village. Charles has been excellent at giving me a well-rounded experience. It’s hard to believe I only have about 1 ½ weeks left in Kasese.

Day 16 Sat 6/28/08 -

Pig Party

A couple Austrians who work with Francis are leaving, so they are throwing a party at Kiima Foods Agricultural School. Charles and I decided to take public transport out there. So around 10am we headed over to the Kasese taxi park. We found a sedan to take us for about $2.50 each. Six people ended up being packed into that small car: two upfront and four in the back. The drive took about 40 minutes as we made our way towards the border with the DRC. Once at the school, I met 7 Austrians who were all pretty big hippies. Dreadlocks, hairy arm pits, and all! They were all extremely nice. The day there was pretty leisurely. Charles gave me a tour of the compound while the men prepared the pig roast. I’m not a vegetarian but I’m still not a fan of watching those things. The rest of the afternoon I spent chatting with the ladies until Charles and I had to head back to Kasese around 4pm since we had to find a car and get back before it got dark. Finding a car involves waving down cars on the side of the highway in hopes that it is a) a taxi and b) has space. After maybe 15 minutes, one finally stopped. There were already 2 in the front and 4 in the back. There was no way Charles and I were going to fit… well not with THAT attitude! Oh, we fit! I

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was squished in the front with some man and Charles squished in with the driver. Quite ridiculous, but not too bad considering Charles told me they often squeeze 12 in one car. I have no clue where those extra four would go. We were stopped once by a police woman and once by an army guy with a gun. Nothing really happened either time and all 8 of us continued on our way after they were assumidly paid off. Cars are scarce and expensive and for a 40 km trip there’s no other option so I think the authorities are fairly understanding even if that definitely isn’t the safest way. Once back in Kasese and out of th sardine can, Charles and I stopped for some well deserved chapata and sodas. Chapata is what would come out if a tortilla and a pancake had a baby. Quite yummy! Then back home to bathe my dirty, dirty self!

***Uganda Culture Note***

Sunband (Sunblock) that is not sweat-proof is practically useless. Who doesn’t sweat while in the sun?

Day 17 Sun 6/29/08 -

Ants in my Pants

Today the morning was free. In the afternoon, Charles, Josinta, and I headed out to Kasika for a talk. In April they came to the area to talk to the community and find out why the people there live in poverty. They then made a report and returned to the community to report their findings. The purpose of this is to help the people understand so then things can change. The session went very well and after warming up a little, the community participated in voicing their opinion. Due to certain political aspects, this one community is often left behind. The condition of their land is not ideal to grow cash crops like coffee, mango's, etc. so places with more ideal conditions get free plants and investment from the government. This is why RRHS is trying to help these forgotten people and give them a good water source and set up the aid post. Throughout the session, ants kept falling on me from the tree, and yes, some even starting crawling in my pants! Very distracting. After the session finished, I returned home and relaxed the rest of the evening.

Day 18 Mon 6/30/08 -

The plan today was to head to Alleluia, but I could tell by the look on Milton’s face when I entered that he was not aware of the program. Charles!!! Well, it turned out Milton’s phone was stolen so he was unreachable. At Alleluia we had patients with UTI's, anxiety disorder combined with other issues, one unsolvable gastrointestinal/joint pain that we could not solve and had to refer, and a couple antenatal care patients. There were not too many patients so I left at 11:30 and headed over to the White House for some Internet and lunch.

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Man those computers are impossibly slow! Almost as slow as the cooking… but in a place like Uganda, it’s a good sign when they take a while to prepare the food because it means that everything is being prepared fresh and hasn’t been sitting around for too long. Hopefully. After lunch I returned to the house since Alleluia had little patients. Ack! No one home! I guess it’s kind of a good thing they’re doing work in their house so the gate was open and the workers provided some sort of entertainment. But otherwise I could not actually get into my room until Oliva came home two hours later since the door was locked. Ack!

***Uganda Culture Note***

Screaming baby goats are often indistinguishable from screaming baby children.

Day 19 Tues 7/1/08 -

Good News!

I spent a good part of the morning working on the RRHS website, basically correcting English and trying to make things sound a little less awkward. A lot of work and organization needs to be done on that website. After hypoglycemia started to kick in a bit, I headed over to the RRHS office to get Charles and grab some grub. We went to the Moonlight Café Restaurant. My potatoes were cold so I did not eat those, but the matoke and beans were nice and hot. After lunch Charles took me to meet the other mzungu in Kasese. She’s a girl from North Carolina finishing up her bachelors. Charles left me and I went with her and her coworker to their lunch. I’m definitely used to most things here and fairly well adjusted, I think, but it’s still nice to have someone of your own culture to talk with and perhaps vent a little. Once that was done I took a bodaboda to the office and I decided it was time to give Charles the good news. As I was raising money for a microscope to donate to RRHS, I managed to get one donated, leaving me with the money. After spending a few weeks here, I decided the money should be spent on medication, transportation to distribute the meds, and the start of the RRHS aid post (i.e. bricks). Charles was thrilled, to say the least, and Francis stopped by soon after to drop the plans for the aid post so we gave him the good news, too. We decided that the next day we would consult Veronica as to which drugs should be purchased and how much. She is very knowledgeable and due to her rural gov. clinic position, she is very aware of the needs of this population. Through all this excitement it started to get a bit late in the evening so Charles took me home. We had fish for dinner! Normally I don’t eat fish very much but they cook it quite well and it has become one of my favorite meals.

***Uganda Culture Note***

The stereotype in the US that black people like watermelon holds just as true in Uganda.

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Day 20 Wed 7/2/08 -

Shopping

Being an adult is great. Children are not allowed to do what they want, say for example, like eat cookies for breakfast. So sometimes, I like to eat cookies for breakfast just because I can. After my cookies, Charles, Veronica and I went over the drug priorities. We decided on aspirin, de-wormer, iron supplements, magnesium (for ulcers), 2 anti-malarials, and packets for distribution. These drugs can be administered on the spot and don’t require close follow-up. Something like antibiotics require closer follow up, so those are not ideal to hand out at something like what we’re going to do. Tuesday we will have a health talk in a rural village where there are no health clinics and afterwards the clinical officers will treat people and hand out necessary medications. After things were decided, Veronica and I went to town to purchase the meds. Charles took them back to the office, then Veronica helped me to buy some ebekwembe, or traditional skirts. I got six for family and friends back home and one for me to take to the tailor! Out of 6 meters of fabric they will make me one skirt, 2 shirts, and a head wrap. All for under $7! Lunch, then I bought a new duffel bag since my bag broke, then back to RRHS headquarters! So the ebekwembe comes from the DRC, and is sold in Kasese to people who then sell them in Kampala, so they are generally cheaper here than in the capital. The rest of the afternoon Charles and I went over some financial and logistical business, then back to home base after a very productive day.

Day 21 Thurs 7/3/08

-

Bricks!

First thing in the morning, Alex the lorry driver picked me up, followed by Charles. We then headed to the brick factory and loaded 2200 bricks on to the truck and headed over to Kasika. The bricks were unloaded at the proposed site and by the end of it all a good number of community members had gathered. As this visit was unannounced, everyone definitely seemed very surprised and grateful. It feels great to be part of the first step of such a good project. Now they have bricks and the aid post is that much closer! All the appropriate pictures were taken and Charles and I returned to Kasese. In the afternoon we went crafts shopping since the craft stores are not in the market, but scattered around quite a bit. Kasese is definitely NOT a tourist town. I returned to Kiima Foods to use the net and it started raining quite a bit! The first rain since I’ve arrived. After waiting an hour in vain for the rain to die down, I finally called Charles to take me home. Of course the second I got home it stops raining. Ah, c’est la vie! The rain added a small chill to the air, especially once it got dark.

***Uganda Culture Note***

To get married, a man must bring 12 goats, a blanket, bed sheets, and a hoe to the father of the prospective bribe. If one goat is not big enough, the father can refuse to count it and demand a bigger goat while keeping the smaller one.

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Day 22 Fri 7/4/08

The language barrier can still be quite frustrating. From my observations, there seems to be a large correlation between how well someone speaks English and their education level. So this morning was rather chilly due to the rain. All that was prepared for breakfast was dodo (green leafy cooked vegetable, like spinach). It was WAAAAAAY over salted. This is the first time since I’ve been here that I could not eat a meal. So Charles and I went to buy some biscuits, but I needed to pick up my bike to go to Alleluia, and somewhere in all of this Charles seemed to be saying one thing but doing another. It’s all just misunderstandings on both sides but some days it can get a bit frustrating. Sigh. After a breakfast of biscuits and getting my bike, I made my way over to Alleluia. In the wards they had one possible typhoid or HIV case, one malaria case, and a pregnant 15 year old with malaria. Yikes. Other than that today was a very slow day. We only had one out-patient with a UTI. Milton did a pelvic exam, so I got to see how that is done. At lunchtime, I left and headed to town for lunch after stocking up on some more biscuits in case of anymore salty greens…. At the restaurant I went to, the place was filled with mzungus. Fourteen in all to be exact! Holy crap! I was just here yesterday when I was the only one. After all this time of being one of the only mzungus around, it felt like I walked into the twilight zone. Weird. I presume they are part of a group, passing through town and just stopped here for lunch. I wonder what it’s going to be like going back to the states. Or maybe it’s just weird because I wasn’t expecting this here. After lunch Charles and I were supposed to see the Merryland High School group perform at a primary school, but a couple students got last night and had to be taken to the hospital so they had to cancel the performance. Instead Charles and I went to pick up my tailored Ugandan clothes and then met John, an advisor to RRHS and a very intelligent man. RRHS is lucky to have him as an advisor. When picking up my clothes, I of course had to try them on. I assure you, everyone there had a good laugh at me. They were pretty awesome though. I of course had to show my host fam, who also had quite a good laugh, but graciously showed me how to tie my head wrap. Later that evening, we spotted a rat in the living room. Oliva spent a good 30 minutes chasing it from couch to cough trying to smash it with her shoe to no avail. I don’t want the rat in the house but I was also kind of glad it was spared the death of being bludgeoned by a sandal. When it was clear we weren’t going to catch it, we set up a trap in the corner. An hour later the damn nouse managed to eat the food without setting off the trap! Oh, I guess one more night sleeping with the mice won’t make a difference.

***Uganda Culture Note***

Umm, Oliva doesn’t know what cheese is! I guess it’s too hot for it to keep with no refrigerators.

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Day 23 Sat 7/5/08 -

Watch out Polio!

There has recently been reported a case of wild polio in the Congo, so the surrounding districts are having mass immunization days to prevent the spread to Uganda. And I got to participate! Charles took me to Mukathi rural gov clinic where I spent the day dropping 2 drops of type I oral polio vaccine into the mouths of (some) screaming children under the age 5. It was actually pretty fun and an overall good day. Veronica hates black beans so I always joke with her on when she’s going to cook them, so for lunch she actually made them today. Lol. So after 7 hours of dropping drops into 400 kids Charles and I returned to Kasese and had some well deserved chapata and soda, then home!

Day 24 Sun 7/6/08

Today was a “free” day, but as usual, was never completely free. That’s ok, I rather be busy than bored. Charles and I spent the morning going over some computer stuff… the RRHS logo, the website. We took a break for lunch in town and I had to rest of the afternoon to catch up on some emails. In the afternoon we drove out to this wood carver’s workshop to pick up my new giraffe and elephant wood hangings and they look great! Of course, in African manner, the guy made them bigger and with “better wood” than what we had agreed upon so he wanted more money, so bargain, bargain. The original price was 20,000sh, he wanted 40,000, so I ended up paying 30,000 which is about $20. Not too bad. They really did come out nice though. As Charles and I were returning, dark, ominous clouds started blowing in. We made it back just in time before it started pouring. The weather here is hot and dry during the day, and nice at night so that either a t-shirt or light jacket would both be comfortable. When it rains though, it gets quite chilly. After dinner that night, the skies really opened up and showed me what rain is! And this is the dry season?

(To be fair, it hadn’t rained once until a couple of days ago.)

Day 25 Mon 7/7/08

After a delicious banana bread muffin breakfast, Charles picked me up early in the morn for the forest walk! It takes about and hour by motorbike into the mountains to reach the guides office in the Rwenzoris. We got our guide, paid the manager, and were on our way! Overall, this area inside the Rwenzori mountains has to be the most beautiful landscape I have seen in Uganda. The lush green mountain forests are indescribably beautiful. To my great luck, about 30 minutes into the walk, it started pouring. While taking my rain poncho out, I ripped the front zipper and later my sleeve on a fence. No one warned me I need rain boots for such an excursion so the boots lent to me by the gentleman in the office were at

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least 3 sizes too big even for my pretty-big-for-a-lady size 10 feet. I couldn’t help but slip quite a bit and look like a clumsy mzungu to the point where our amazing guide help my hand on any downward slope. Fortunately, the “four hour” forest walk only took 2 and we could start to dry ourselves over a hot cup of tea at their camp site restaurant. I would have killed for a fire place. We stayed there for a while until it seemed the rain let up a little and decided to head to the park’s main gate (We actually stayed outside the park, on the borders, to avoid the entrance fee). There were some sheltered sign posts at the gate which gave the opportunity for some Kodak moments while keeping my camera dry. On the way back, the further we got from the mountains, the more the rain let up. After a hot bath (I was filthy), Francis organized a goodbye dinner for me with Imelda, Charles, Veronica, and Sanyu. We went to Rwenzori International guest-house for drinks and supper. It was a lovely evening and we didn’t get back until 10pm. Quite a long day!

***Uganda Culture Note***

“You look smart!” = “You’re dressed nice!”

Day 26 Tues 7/8/08 -

Last Day in Kasese

So today is my last day in Kasese. I spent the morning running around doing last minute errands like bank, donation agreements, etc. The exchange rate in Kasese was actually better than Kampala, at least for traveler’s checks. After lunch we were supposed to head out to Kasika for a health talk and medical evaluations, but as usual we were late. Veronica was delayed from a meeting. The health talk on HIV was short – 20 min – before the madness set in! Veronica consulted patients while Margaret and I prepared packets of meds. All the meds were bought with money I raised before I came out here. We started around 3pm and by 5:30, I had to find Charles to tell him I needed to get home to pack. So to speed things up Margaret left me to help with diagnoses and I was left fending for myself with the meds. Utter chaos broke out when we ran out of paper packets for the meds. This insanity lasted for an hour, with a huge crowd waiting for their meds. Even when Veronica and Margaret finished their consults, there were still many meds to hand out. We finally finished around 6:30pm when it was starting to get dark. Man was I tired! But no resting when I got back! I still had to shower and pack. The evening finished up nicely and Deo even stopped in when he got into town. He brought a huge MONSTER van with him. I guess that’s what’s needed for a safari though. Once everything was ready for the next morning, I set my alarm and had my last night sleep (rats and all!) in Kasese.

Day 27 Wed 7/9/08 Queen Elizabeth

I woke up at 6am to leave at 6:30 and Deo & I headed off to Queen Elizabeth National Safari Park for a day of animals! The reason we left so early was to try to see lions,

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since they’re more active in the morning and evening. Deo smooth-talked the gate keeper (along with a couple shillings) to let us in without paying the whole entrance fee. The animals I saw were bush bucks, kobs, antelope, warthogs, elephants, hippos, buffalo, and crocodiles. And plenty of birds. We stopped for lunch at Mweya lodge, a super fancy safari lodge. Afterwards I took a boat trip down the river. We made one last attempt to see lions before heading out. Deo is very good at asking the other drivers around if they’ve seen anything. But alas, no lions. We left the park and headed to the town of Mbarara for the night. My hotels was quite crummy with band-aids patching the holes in my mosquito net. But I guess that’s what $15/night gets you. The food there was pretty good.

Day 28 Thurs 7/10/08 - Zebras

On the way back to Kampala we drove through another park that has zebras. Zebras are very shy so you have to be pretty quick with your camera. The drive to Kampala was very pretty. We got in around 4pm but headed straight through to Jinja! I stopped at 2 rafting companies; one seemed very popular, organized, and safe (Adrift). The other, Equator Rafting, was a bit sketchy but cheaper. I definitely felt more comfortable with Adrift and paying more. They have dorms on their site so I spent the evening there. In a weird turn of events, a guy (Ryan) I met one time at a medical school interview and ended up giving a lift to the airport was in Uganda at Adrift rafting at the same time as me! Crazy! But now I have some friends! After meeting the group he was with and a couple of cold ones, I hit the hay to get some rest for rafting tomorrow!

Day 29 Fri 7/11/08 -

The Bad Place

Today I went rafting. Ten rapids – 4 of which are class 5’s, the highest class you can take people commercially. Let’s just say I peed my pants a good bit and for a couple of moments I questioned whether or not I would be able to breathe air again (that would have been at “the Bad Place” rapid). But it was awesome! I loved it. On the bus ride back to Kampala I decided to switch hotels and stay where Ryan and his crew were staying. It was really nice to have people around to do things like talk at dinner!

Day 30 Sat 7/12/08

Today my new best bud Ryan and I met my friend’s friend and his wife for lunch. They just moved to Uganda and will be there for a year. Afterwards we hit up some markets trying to gather up my last minute gifts. Taxi buses in Kampala are super cheap – about $0.30. Traffic is quite horrible though. Later on we headed back to the hotel to share some pizza and watch our rafting videos. I would have preferred to eat Ugandan food while I still

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can, but maybe tomorrow, the others missed pizza too much. Afterwards we headed to a bar for a few Nile Specials (beer). We stayed until the bar closed and kicked us out… uh, at 9:30pm? That early? Good thing the guest-house still had beer! I’ve barely had any all month!

Day 31 Sun 7/13/08

My morning started off right with a COLD shower… brrrrrrrrr! After breakfast, we headed to another market to buy the last gift on my list – a mask for my pops. In the afternoon, I returned to the guest-house to pack up one last time. I think I was ready to leave Kasese when I did, but between safaris, rafting, and new friends I’m a bit sad to leave Uganda. A few more days to explore Kampala would have been nice. Oh

well! Back to Entebbe. Hopefully Sunday the 13th will treat my bags better than Friday the 13th did.

Mithai

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