She arrived in a beat up Corolla

The other day a woman from the village was brought to our clinic.

Unconscious

Her body in shock

In the back seat of a beat up Corolla

She came with a few relatives and an educated man from Kamwenge town who was from the same minority tribe, found the woman, and rushed her to us.

The woman had given birth recently, at home, with only a relative to help her. She had come to us for antenatal a few weeks earlier, but had made the decision to stay at home for the birth. She and the baby had not been for a postnatal check-up. When the relatives saw the woman was unwell they delayed taking her to the clinic for days. It might be expensive, after all.

So there she was, her limp form lying in the car.

Then there was a lot of quick, fast discussion in Rukiga and English – between the well dressed educated man, the relatives from the village, our staff, Michael and myself. What should we do?

Could we admit her and try and help?

Do we have anything we need to treat this woman in such severe condition?

Could we find an ambulance to transport her to Fort Portal?

Would she die along the road if we tried to send her somewhere else?

Why hadn’t we already purchase our Oxygen concentrator that we desperately needed?

Did any of the other health facilities in Kamwenge have blood ready for a transfusion?

No.

Less than a week later, we now have an oxygen concentrator. We are almost set up for blood transfusion.

But the woman is already dead, so what use is that to her now, I ask?

Maybe one day…

I believe that men and women were created equal.

*gasp*

I believe that I can’t be bought or owned.

*gasp*

I believe in reproductive rights for all, regardless of race, age, religion…and gender.

*gasp*

I even believe that myself, as a woman, deserves to be treated the same as a man in my position.

*gasp*

Am I a radical? I think not. Well, maybe if I lived in 1940s Australia.

Or if I lived in Kamwenge, today.

*                          *                            *

Our staff, including Michael and myself, were eating matooke and beans for lunch the other day in our newly constructed shelter. They were discussing someone’s wedding. Deep in thought, one of our staff asked innocently… ‘Dr, do you have dowry in your country? How much did you pay for Kim?’

Michael explained that we don’t have such a thing. That he visited my parents to ask for their blessing, then asked me to marry him, to which I happily agreed.

Another staff member, a woman joined the conversation. ‘What about polygamy?’

I replied that polygamy is illegal. You can be put in jail. Even when a man cheats in Australia, he can lose his house and land if the couple divorces. I explained further about women’s rights, choosing my words carefully, aware of the presence of a woman in the shelter whose husband I had learned had taken a second (younger) wife against her wishes.

There was a great pause in the midst of lunch. A moment to digest this information.

Then a young shy woman, a staff member that has grown up in the village, speaks very little English, and that I have a strong infinity for spoke up.

“That means that in your country, women are equal to men.”

*                          *                            *

I was chatting to the clinical staff about a course that one of our staff would be sent to undertake, for contraceptive and Family Planning training. Another staff was sharing her experience with family planning programmes in the village. My ears pricked up – I am currently writing my Master’s thesis on fertility choices in Kamwenge, focusing on reproductive rights and normative cultural values/expectations that constrain choice. I asked about how women in Kamwenge received the idea of contraceptive advice/counselling. Were they opposed to it? The answer devastated me.

‘Some do not want. But there are many that do. The problem we are having is that husbands do not allow their women to use contraception…

.. A few months ago, there were a big number of women in my home village that got the implanon, in secret, so they could stop producing [having children]. But the husbands got very angry. Some were thrown out of their homes, their villages. Others were beaten.’

*                          *                            *

I hadn’t even given much of a second thought to the set of values around equality that I hold, when I lived in Australia. It was part of my assumed knowledge, growing up. In my teenage years, if anyone was to treat me differently – unfairly – because I was a woman, I would have acted with indignation and disgust, and the matter would have been settled, fair and square.

I’m not trying to say that Australia is the land of milk and honey, where women have achieved complete equality with men. But we are actually doing ok. We are on to the business of more minor stuff in the big scheme of equality these days.

Uganda is doing ok in some areas. They have one of the highest percentages of female politicians in the world, with a compulsory female MP position for every electoral zone. There are lots of female managers of businesses. Plenty of middle class women who go to University.

But if you even get close to village life, you can smell the stench of inequality rising from the thatched rooves of your average family’s household.

Beyond anything else we achieve in Kamwenge over the next 10 years, beyond any goal to assist people to escape grinding poverty, beyond even saving lives at the clinic…

…what I wish more than anything deep down in the justice-craving areas of my soul, is to start a movement of village women who believe that perhaps, just maybe, they could be equal with men.

That maybe they should have control over their reproductive choices; who they have sex with, how many children they have, or where they give birth.

That maybe they have the right to equal access in health and education.

That maybe they could be in a marriage without having to be one of several wives.

That maybe they don’t deserve to be abused and trodden on, beaten and bashed

That maybe they don’t want to be defined only as mother and wife; their value attributed to the number of children they produce.

That maybe they shouldn’t have to be the bread winner for their children, dig in the garden, cook, clean, and raise their children alone.

That maybe they have the right to have control over resources, including land.

That maybe they could fight for all of this.

Maybe one day.

www.maranathahealth.org

A crisis of categories

A very close friend of mine sent me an email a few months ago, asking me if I considered myself a missionary.

The answer to that question is filled with so much complexity that I asked if we could skype instead of trying to write my thoughts in an email.

It got me thinking again about our reasons for being here. Michael and I often have puzzling discussions about this, and consistently fail to come up with a satisfactory answer. Which box do we tick? Missionary? Volunteer/trainees? Expat? Immigrant? Which category do we fall into?

The problem with categories is that I always seem to fail to satisfy their requirements. I’m not really an ‘in the box’ type of girl…

For example:

The Missionary Findlay’s: Michael and I are driven in our choices/actions by our faith in Jesus as God and man, and the way he lived on earth. We feel strongly that God is FOR the poor and oppressed, inviting us to join him in what has been a massive adventure so far, learning how to live more like him and (sometimes, when we’re not feeling selfish) making our choices based on what we can offer this world to see it be a more just and loving place. The added bonus of following God in this way (to Africa, to set up Maranatha Health, etc) is that He has actually made us who we are so that we can do this – a perfect concoction of passion, past experience, internal wiring from birth and our individual skills + his intervention in a gazillion moments has meant we are not only able to run this Organisation but enjoy the journey (when I have a feeling many wouldn’t!). Our project is motivated, inspired and fulfilled by our faith and the faith of others around us. We also have a lot of similar desires as some missionaries – to connect with the local community, to become a part of the fabric of the place, and to live at a simpler standard than other expats*.

I am  often confused with the term missionary and its implications given that I see all followers of Jesus as having a joint ‘mission’ to represent our God of Love to humanity. Putting that aside, we are not, in my opinion, missionaries in any traditional sense. We are not here specifically to tell others about our faith – any more than I would normally share of my faith in any circumstance -, we don’t work with the church in any official sense, and we certainly have not gone to ‘bible school’ or any such institution (much to the disappointment of some Christians we know). We are not running a ‘mission hospital’; many who do this seem to have little awareness of development principles and even less ability to critique their ‘development’ work. We have set up an NGO and work in a professional capacity which is open for judgement by AusAID and the donor community, rather than a small group of churches.

The expatriate Findlay’s: In some ways we are like any other expatriates moving over here for a job opportunity in an NGO. We enjoy Uganda for the weather and the friendly people, we have professional roles that we are intensely committed to, and we love to have academic discussions about what this country needs/should have/is heading towards etc. We have friends in high places because the elite of Kampala are so interconnected and we enjoy rubbing shoulders with influential people that back home in Australia, wouldn’t even look our way. But that is about where the expatriate similarities end. Most big-shot NGO workers (who manage programs/projects) are exactly that: big shots. They drive around in vehicles worth well over $100,000, they live in Kololo (for you Adelaideans, think Burnside) in a big compound with numerous ‘house girls’, would not be spotted shopping at the local food market, if they attend churches they are full of other expatriates, they live at a higher standard than they would dream of at home because they are on western salaries, and almost their entire friendship group consists of other NGO managers, foreign diplomats, and international businessmen.

In contrast – we haven’t spent any time with foreigners (other than when our families came to visit) since we arrived. Our wage is at least a fifth of what managers with equivalent qualifications are getting (both Ugandan’s and expats) and the MH car is 22 years old (but doing amazingly well for its age apart from the suspension!).** I have never met an expatriate NGO worker in a management position that lives in a place like Kamwenge. Most live in Kampala, and at a stretch, in one of the bigger up-country cities full of other expats and all the mod-cons you could need: places like Mbarara, Mbale, Gulu and Jinja. I have been in many a meeting already, introducing myself as a manager at Maranatha Health who lives in Kamwenge, only to be met with disbelieving stares and raised eyebrows. Even Ugandan NGO managers fly in and out of Kamwenge in their big shiny white 4-wheel-drives for the day, happy not to have to even spend one night in my beloved village.

The volunteer Findlay’s: Many volunteers and Aid-workers-in-training come to Uganda. Whether it’s with a volunteer tourism organisation, a local NGO, the Peace Corps, or even something like an equivalent to Australia’s Young Ambassadors for Development (AYAD) program.  They are here for any amount of time from 2 weeks, or sometimes (as in the Peace Corps) 2 years. They often live in relatively remote settings (I think their used to be a Peace Corps volunteer living in Kamwenge) and live with locals, often in home-stay arrangements. They make a big effort to connect with the community, and often learn the language. They live simply (some of the time) and don’t get paid a massive salary (also, some of the time). In these ways, we feel quite connected to this group. We bump into people like this from time to time, and I am often encouraged by their enthusiasm, hard work  and idealism. I remember with fondness my volunteer days, when life was about learning and comparing experiences with other volunteers, finding projects to be a part of, and travelling to exotic places for long weekends.

But again, the similarities stop there. For one thing – we have a house, a place to call our own, where we have to cook and buy food from the market and do all the normal type living things that often these volunteers seem to avoid (as I did when I lived here a few years ago for 6 months in a ‘home stay’ arrangement). The other big difference is the level of responsibility. Many volunteers, when they meet us assume we are just like them – the donor who doubles as a volunteer.  But when we talk about the complexities of negotiating bureaucracy, the difficulties of cultural pressures when making management decisions, handling political issues, registrations, reporting requirements to donors, dealing with issues of theft and conflict… we look with jealously at their blank faces. When we tell them that we have built a house here and plan to raise our family in Kamwenge – most volunteers think we are joking. You can’t actually move here permanently?! This is the experience you ‘get out the way’ before your REAL life begins back at home.

But Kamwenge is our home. Which brings me to the next category:

The immigrant Findlay’s: Sometimes, it’s easiest just to define ourselves as migrants to Uganda – the answer with the least amount of subtext and baggage. We love this place. Uganda is our home, as I said. We have friends and what we consider part of our family here now. We have migrated here because we would love our children to have the kind of life that Uganda can offer- with a focus on community, relationships and away from the god of consumerism that seems to haunt our houses in the West. We like our lifestyle. We like working for Maranatha Health and we are able to have the opportunity to use our skills and expertise in a way that would be difficult to do in Australia.

The problem with defining ourselves as immigrants is that it neglects so much of the reasons why we came – the great overarching purpose of Maranatha Health and our sense of ‘calling’ (missionaries), our desire to set up an effective NGO here and have influence in the long term both inside and outside Uganda (expat NGO managers), our desire to connect with the community and our choice to live in a remote setting on a small salary (volunteer).

So I don’t know. Maybe we can be all and none of the above, depending on who we are with at that moment. If anyone has any suggestions to throw into the ring, let me know…

*I do think I have a slightly romantic notion of myself as somewhat of an anthropologist as well, and can become FACINATED at times with culture and interaction. I often find myself desperately determined to connect and become a part of this place in a way that perhaps I never will – not from lack of trying though…

**I do need to point out thought, that the fact that we HAVE a car in Kamwenge is an immense privilege that very few people have.

My one exception…

3 years of marriage today.

I’m not really into PDAs (Public Displays of Affection) – particularly on things like Facebook, twitter and whatever the latest social media site there is. I figure I’d prefer to just talk to my husband, face to face, since we live together. But I’m making an exception for today, as I reflect on the last slightly crazy year of our lives together.

My experience of marriage is pretty amazing, and for this I feel incredibly blessed. I often feel like the reason we have it so ‘easy’ in our marriage, the reason it’s so good, is because of our joint mission. Our joint purpose. Our togetherness that comes from being  ‘different’ from this world.  In our wedding ceremony, Michael and I featured a poem we both love that  reminds us of this…

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveller, long I stood

And looked down one as far as I could

To where it bent in the undergrowth;    

 

Then took the other, as just as fair,

And having perhaps the better claim,

Because it was grassy and wanted wear;

Though as for that the passing there

Had worn them really about the same,

 

And both that morning equally lay

In leaves no step had trodden black.

Oh, I kept the first for another day!

Yet knowing how way leads on to way,

I doubted if I should ever come back.

 

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

                                                                                -Robert Frost.

 

So, what do I have to say after being married to my favourite person in the whole world for the past three years?

Michael, Thank  you. The reality is a million times better than I could have imagined.

Thank you for choosing me over and over and over again.

Thank you for knowing me as well as you know yourself, and loving me anyway.

Thank you for sharing my vision for this world, so much so that it feels like a miracle.

Thank you for taking the road less travelled with me, and reminding me why we chose that path.

I love you.

“Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.” -Lao Tzu

The Power of One

It’s finally happened. The much desired, dreamed of, it-feels-like-this-day-will-never-come, inevitable luxury has arrived.

The Maranatha Health buildings are going to be connected to the newly built hydro-dam and we will have electricity for the first time. WOW.

I think I’m a little bit shocked. We have been waiting for so long that I think we had resigned to the idea it might never come. ‘Hope’ in Uganda is a dangerous thing. I think we have had over 30 conversations with the electricity company since April (when the President came out to officially commission and ‘open’ the dam) where they have fed us false fables of electricity just around the corner.   We have been promised everything under the sun – from connection within a few hours, a few days, a week, a month. Every week there is a new rumour in town, about a cousin’s, father’s, friend’s son, who lives near/works with/is related to someone from the company who is operating the hydrodam and knows the inside scoop. The latest I heard was that the dam ‘had a problem’ and ‘donors from out were coming to fix it’ in March.

But now it is happening. There are engineers driving around in trucks with wires and men walking around with legitimate looking blue overalls, and the Ferdsault office is open and has given us a lovely little certificate to say we are ready for connection.

Driving back to the site after paying our registration and connection fee yesterday, Andrew (the MH administrator) and myself were dreaming excitedly of all  the things we could now use/do/have once we are connected. For the first beautiful moment in months, we had allowed ourselves to hope:

• Guaranteed lights at night rather than Kerosene lanterns
• No more frustration at laptops running out of battery power at work or home
• A toaster, so we can pretend that Kamwenge bread isn’t stale
• An iron, so our clothes aren’t wrinkled  (I could never bring myself to use a charcoal iron)
• Hot water from our instant water heaters, rather than cold water showers
• And most exciting for me – A REFRIDGERATOR!

In Kamwenge, we will be one of the only residential houses with a fridge. I am aware that it is a massive luxury. I lay in bed at night actually thinking about that (sad, I know). But it will change my life. How?

I no longer have to buy and boil milk every single day – we can keep it in the fridge so it doesn’t go off in 24 hours. It also means one less saucepan to clean each day

I can cook food for several days and store in the fridge

I don’t have to shop at the market every second day, as tomatoes/carrots/beans etc won’t go off within a few days

I can buy foods from Fort Portal/Kampala that I can’t get in Kamwenge – cheese, fresh non-sweet bread, nice cuts of meat, sauces…. YUM

I can cut up a pineapple and not have to attempt to eat the whole thing in one go- they’re just a little too big!

I can have COLD drinks- juice, soda, whatever. It will be COLD!

We have had solar for the past few months. It is incredibly unreliable and only charges a laptop or two and some lights (on a sunny day when it isn’t too cloudy). Realising how little a solar panel generates and all the appliances it won’t run (irons, toasters, kettles, fridges) and monitoring our energy needs/consumption so preciously has given me a new appreciation for the luxury of power. Of light. Of convenience. Of temperature control. Of power consumption.

In Uganda, the 10% or so of the population that make up the middle class might have a fridge. Often they will have a toaster and kettle. Perhaps a water heater. A TV. Beyond that, everything is still manual. Household electricity consumption is still so minimal. Only 10% of the population of Uganda even have access to the electricity grid. Those that do, often go days without power at a time, due to the lack of power generation and government failures to deliver on infrastructure.

This is unacceptable. But you know what frustrates me more? That in Australia, we take the luxury of power for granted. There has been so much complaining coming from Australian newspapers I have been reading online over the past 6 months, about the carbon tax and electricity prices going up in Australia. The general gist is that people are annoyed – ‘its not fair’ – and the government needs to find a way to lower prices. We assume we ‘need’ all of these appliances and all of this convenience so our lives can move faster. You know what though?

We actually don’t.

Take it from me. I have lived without a lot of that stuff for almost a year. Even the basics – irons, fridges, toasters, TVs, kettles, washing machines, even lights, for a lot of the time. Let alone the other stuff – dishwashers, microwaves, water heaters, air conditioners, a million gadgets, the flat screen, donut/icecream/waffle makers, clothes dryers, hair dryers, spas, the 2^nd (or 3^rd) fridge, etc. *

Instead of complaining about the cost of electricity, what about we try and lower our consumption? Because all of this electricity – it has to COME from somewhere. Electricity is costly to generate. Financially and environmentally. And if the rest of the world tried to consume as much as we did, our planet would be destroyed tomorrow. The end.

I am not trying to preach. I’m not an idealist. I have lived in Australia for most of my life. I understand that you think you need all that electricity. I have only really learnt about my consumption in the past year. I’ve learnt this as I’ve seen what I can live without, as I have been forced to check every appliance I brought over here to see if it could run off our little solar panel and now, if we can afford the cost of running it off the main grid.

Rather than idealistic, I am trying to be realistic about the state of our world. The cost you pay doesn’t even come close to the real environmental cost of coal-generated power. So If you don’t want to pay so much for electricity, than reduce the amount you use. Start looking at how much you consume. Which appliances are ‘necessary’ in your eyes, and which ones can go. Whether you can do some things manually. I’m not asking you to use Kerosene lamps or candles, or boil your milk or water each day in a saucepan, or hand wash all your clothes and sheets and towels and dishes, or go without fans, fridges and air-conditioners, like me and everyone in my community does.

But I am asking you to care about the future of this planet

and own the choices you make.

 

*You will notice I haven’t mentioned laptops here – perhaps it is the exception to my post. I can’t live without mine! We are almost inseparable and I use mine (unless we have no solar power) everyday – for work, study and keeping in contact with people….

2011: The year of learning

I just said goodbye to the hardest year of my life so far…

*sigh*

I know that doesn’t mean much, considering I’m actually only 26 and have lived a pretty cruisy life by world standards.

But this year has been really tough. For a thousand different reasons. There are lots of other more positive adjectives though too, like rewarding, fulfilling, exciting, adventurous, unexpected, validating, and of course…learning. Learning, learning and more learning.

It’s a funny thing, how you learn a lot, develop your character and get over yourself a little bit when life is challenging and you get out of your comfort zone…

Even Paul from the early church agrees with me: ‘We continue to shout our praise even when we’re hemmed in with troubles, because we know how troubles can develop passionate patience in us, and how that patience in turn forges the tempered steel of virtue, keeping us alert for whatever God will do next. In alert expectancy such as this, we’re never left feeling short changed. Quite the contrary – we can’t round up enough containers to hold everything God generously pours into our lives through the Holy Spirit.’ (The message)

I have learnt so much this year. Sometimes I wish I could go back and visit myself, that naive girl at the start of the year, and tell her that it all works out ok. That things will be difficult but that through all the hard stuff, I ended up learning what I needed to learn, to be able to live in Kamwenge…

So how am I different from last year at New Years?

I’ve learnt about moving to another place. I’ve learnt…

How to say goodbye to some of my closest friends and still remain involved in their lives

How to live apart from my family

How to open my house for inspection and rent it out…

How to move my entire life to another part of the world

I’ve learnt about how to live in Kamwenge. I’ve learnt:

How to speak (a little bit) in another language

How to make friends in another culture so different from my own

How to cook using only food available in Kamwenge, including Uganda’s famous Matooke dish

How to use a cigiri (a traditional charcoal stove)

How to wash clothes by hand at a break neck pace

How to bargain so that I don’t get mzungu prices all the time

How to live without a fridge (something I’m still working on…)

How to light a Kerosene lamp

I’ve learnt a lot about running an organisation. I’ve learnt:

How to manoeuvre through a million bureaucratic-red-tape-scenarios

A LOT about construction, materials, and all sorts of building-related things.

How to manage staff with Michael (10 at last count…!)

How to work with the police to arrest someone who is stealing from you

How to conduct job interviews and board meetings

How to import a shipping container

How to use Quickbooks, manage finances, sort out legal issues, and put on a great event…

How to avoid paying bribes (although I certainly don’t have a 100% success rate with this one!)

I’ve learnt some extra bits and pieces that have made life easier. I’ve learnt:

How to grow cassava, matooke, zuchinni, garlic and a whole bunch of other food

How to drive a massive old hilux ute –reluctantly, even on Kampala’s chaotic streets.

How to pick milk from the dairy, boil it, and scrape the cream off the top for later

How to work 9-5 with my husband and still have a great marriage

How to (begin) writing a thesis – including all sorts of useful stuff about methodology, field research and ethics, things I use to have no idea about.

How to enjoy cold water showers!

How to LET GO of my drive for efficiency, timelines and plans and embrace ‘community’…

 

It’s been a big year. Here’s hoping next year is a little more chilled…

Patients or Profits?

Perhaps it has something to do with the lack of, and ineffectiveness of, regulatory bodies. Perhaps the training at many Universities is below par. Perhaps it is due to the everyday Ugandan’s powerlessness and incapability of demanding and knowing their rights. Or perhaps it is the simple truth that money-motivated-medicine around the world always seems to behave badly.  I’m not sure why it is the way it is – I will not presume to give an opinion on a complex issue I know almost nothing about.

What am I talking about?

Poor quality medical services – in this case the private system – in Uganda.*

The public system in many developing countries has a lot to be desired, and a thousand reasons why this is so. But the private system? The system with money and drugs and equipment and trained staff on good salaries?

I wanted to share a simple story of something that happened the other day that left me bewildered. Before I share my experience, let me first say that there are many intelligent, professional, trustworthy doctors in Uganda who practice very good medicine. Unfortunately, they are not by any stretch of the imagination the majority.

Michael and I stayed with our family in Kampala for a few days last week. One night, our brother Pete (who’s a year older than me) staggered through the door complaining of a severe headache that he’d had most of the day. It had come on suddenly. After a heap of questions, Michael was convinced it was a migraine and all the symptoms pointed to this – whatever the case, we decided to take him to the Gensi’s family doctor, a private middle-class clinic a block from our place where he could get some fluids and painkillers. We (Michael, me, and Margaret, our mum) loaded Pete into our car to take him. It was peak hour, and so we sat impatiently waiting in traffic even though the clinic was literally around the corner, as Pete moaned and threatened to vomit in the car. Eventually, Margaret had had enough. She instructed Michael to put on his hazard lights, ordered him to drive on the wrong side of the road, abruptly jumped out of the car and starting stubbornly walking into the oncoming traffic (have I mentioned before that you don’t mess with Bakiga women?) as Michael eased his way past the jam on the wrong side of the road ignoring the glares from passing vehicles. Her display of motherly love was quite astounding, but I didn’t know whether to laugh at the situation or hide from angry faces in the vehicles that Margaret had forced to the side of the road.

Arriving at the clinic, a small building with a consulting room, a lab and a few rooms with beds, we found the doctor reading his newspaper. After getting his attention, he took a very short history from Pete – like 2 questions. Pete was convinced it was a migraine and not malaria; after all he had had malaria dozens of times in his life and knew what it felt like. Clearly though the doctor felt he had gathered the info he needed and had had enough of interacting with his patient, because at that point he wrote some things on a piece of paper, ordered a blood test, and told us to wait. There was no explanation given. Pete, in the meantime, was struggling to stay on his chair due to the pain.

After a few requests from Michael, they led him to a room with a bed in it, and shortly after a nurse came in. They apparently had the results of the blood tests back, although no staff mentioned this. She came loaded with several injections and ordered Pete to remain still as she jabbed him several times. He had no idea what the diagnosis was. No conversation with the doctor. No idea what treatment he was getting. No permission was sought to administer the drugs.

Pete was still dehydrated so Michael requested they get a drip into him. Reluctantly, they agreed. The headache had lasted a long time, so Michael also checked for signs of bleeding on the brain. Something they had also not bothered to do.

In the meantime, we were all curious to know what was happening, and what the diagnosis was. (These patients and their demands, how annoying…) Margaret went to find the doctor, who informed her that Pete had a bacterial infection. No further explanation.

Eventually, we found out what they treated him with. The list is as follows:

• 1 shot of malaria treatment
• 1 shot of anti-nausea
• 2 shots of extremely heavy duty antibiotics
• 1 shot of an anti-inflammatory (this one was actually for the migraine and very helpful)
• 1 drip of glucose (used in patients with malaria), not helpful for rehydration

By this stage Michael was a little confused. He was convinced that all Pete had was a migraine, and he needed fluids and rest. So he asked the nurse to show him the lab results.

It turned out that Pete tested negative for malaria and negative for any bacterial infection. His white blood cell count was within the normal range.

After several hours, when he had slept and was feeling better, they discharged him and he came home. However, not without being told he would need to come back for the next three days, to have more anti-malarial and antibiotic injections. Up to this point, they had not mentioned money, but Pete was dreading the cost. From past experience, Pete estimated it would be around 300,000UGX  (A$150) or possibly more. That is big money in Uganda.

Now, I’m not a doctor. I have not been through medical school. But being married to a GP – wait – even visiting a GP on many occasions in Australia would have made me more equipped to deal with this situation than the doctor who saw Pete. Here’s ‘Kim’s General Practice Medicine 1-0-1’.

Lesson 1: Talk to your patient, gather a comprehensive history, think of all possible causes (not just malaria because it’s an easy diagnosis).

Lesson 2: Once you have a diagnosis, communicate this to your patient.

Lesson 3: Make sure your diagnosis is based on facts/lab tests/at least some semblance of science and NOT based on the fact that you can charge more money for medication if its malaria or infection (or both?!), which it clearly was not. If in doubt, run the tests again.

Lesson 4: If you are going to administer drugs, explain the diagnosis and medications to the patient and SEEK his permission to administer them. Again, communication is key! In Australia we call administering drugs without permission ‘assault.’

Lesson 5: Do not treat your patient for diseases he doesn’t have, so that you continue the spiral of malarial and antibiotic resistance that are out of control in places like Uganda where drugs are not regulated well.

Lesson 6: Don’t be a money-hungry incompetent idiot.

Thus endeth my rant for today.

*By the way, I don’t deliberately mean to exclude some of the terrible displays of medicine practiced in Australia – by a wide range of doctors.  Statistics show that the average private surgeon in Australia will operate many more times than necessary if there is a bit of money to be made and some fun to be had – often to the detriment of the patient.

 

Hamburger

With the birds singing and the breeze softly blowing through the trees and the sun setting in the Kamwenge sky, I had a flash of soulful peace rest upon me.

A moment of blissful beauty, where the world seemed to swell with intoxicating hope for a better day. At that moment, the words of Arundhati Roy filled my thoughts: “Another world is not only possible, she is on her way. On a quiet day, I can hear her breathing”

‘What aroused this grand moment of hope?’ I hear you asking…

It is the little things sometimes, that lead me to my happy place.

On this occasion Michael and myself were talking to one of our employees. A man of good Kamwenge stock – a village Ugandan, through and through, until a few years ago when he had the opportunity to go ‘out’ as Ugandans call any place other than Uganda (the Australian equivalent of ‘overseas’). He travelled to Kenya (which borders Uganda) to the big, bustling city of Nairobi. We asked him about his impressions of the place. After the usual – much bigger/busier/more developed than Kampala – we got onto the topic of food.

‘Eh, they have something very nice there called ‘hamburger’. It is soooo nice. Have you heard of it?’ He asked with innocent interest.

We explained that this food called ‘hamburger’ is also in Australia, much to his surprise.

In fact, we told him, there is a restaurant there that is very cheap and provides hamburger very quickly. You can find this restaurant all over the world! In thousands of locations, in many  many countries. All selling ‘hamburger’.

All over the world? This was big news to our employee.

We explained further about this infamous restaurant chain called McDonalds – and how people all over the world know it by a giant yellow M – the golden arches.

He had never heard of McDonalds. No idea it even existed. The Kamwenge community (and Uganda at large) is utterly untouched by this money-making, environmentally destructive, exploitative, obesity-generating monopoly that has taken over the rest of the world.

Thus bringing me to my moment of serenity.

And for any McDonald’s management out there reading my blog – leave my new country alone!

the word I spit out…

Corruption.

It is a word that I spit out, hard and quick, desperate to see it leave my mouth and my body and my soul.

Desperate for it to be purged and destroyed.

The Oxford dictionary defines it as this:

Corruption: dishonest or fraudulent conduct by those in power, typically involving bribery. The action or effect of making someone or something morally depraved

I define it as this: An evil that eats away at truth, humility and integrity. On a national level, it rages like a disease that seeks out and destroys the cells that are the lifeblood of a developing country emerging from poverty: representational, accountable democracy

And Uganda is full of it. Full to the brim.

One of the newspapers here recently published an article about a corruption index undertaken each year by ‘Transparency International’, ranking Uganda as the 2^nd most corrupt country in the East African Community, second only to Burundi. That means that Rwanda, Kenya, and Tanzania are all less corrupt than us.

I never quite understood why so many people raged against this disease; trying to find cures or vaccines or at least treatment for the symptoms. Missionaries I met in Africa in the past spat the word out, as I do now.

I used to laugh it off. What’s a $5 bribe to a policemen here? Or a quick under the table $20 to a government official there? It just speeds the processes up a bit. Adds a bit ‘extra’ to the shameful government salaries in this country.* An unofficial tax you might say.

But it is much more than that.

Corruption filters down from the top. It demonstrates a lack of accountability to the people to which government is mandated to represent. It violates the contract between leaders and their people, which states that leaders of a democratic state are there to protect and ensure rights.  It takes away any semblance of a system, so all you are left with is millions of informal interactions characterised by power and exploitation. The more power someone has over you and the action you are trying to achieve, the more money they can ask for.

For example

Earlier this year, I needed one signature from a Ministry of Health official, to recommend us to the NGO Board. Without that signature we could not be a registered NGO in this country. Without any sign of guilt but with a face of greedy entitlement, he asks for a 5 million shilling bribe. That is about A$2000. For one signature.**

Recently we have had a shipping container full of medical equipment brought into Uganda. We also had a few boxes of personal effects. Both are supposed to be completely tax free, under Ugandan law. Medical equipment for an NGO – tax free. Anyone who is changing residence to another country, is allowed to bring to that new country their personal items, tax free. Simple. An internationally recognised system. And yet we were forced to pay 1 million (A$300) – on my wedding gifts, on books I had collected since I was 10, on our mattress, on towels I had used hundreds of times before.

Our lawyer earlier in the year helped us get our NGO certificate. He was told the fees had changed for NGO registration, from 15,000 (A$5) to 3,000,000 ($1000). That is a big jump. We all protested, suspecting corruption. But they produced documents, official papers, even a government bank account to transfer the money into. So we paid half the money to start the process. Then we found out it was a fake syndicate, a group posing as the NGO board who had a contact within the bank, who was later syphoning the money from the account back to them and taking a cut. We never got our money back.

We are trying to help a young woman in town at the moment, as she begins her Diploma in Laboratory at one of the biggest Universities in Uganda. She has her sponsorship from someone already. She has been admitted. And yet as a Kamwenge local, a stranger to the power plays of big city life, she has requested us to help her negotiate the system. At every step she has met officials demanding bribes. Bribes to get her papers back. Bribes for official admission. Bribes to get a copy of the fee structure to take back to her sponsor. All she wants to do is study the course she has been admitted into.

The more in need you are of the signature/service/requirement/registration – the more you pay.

So the big men in big offices are the ones who take the most money. And so doing anything becomes a very difficult, long process, with little respect for official systems and dozens of ethical dilemmas along the way. You want to report it? You pay extra ‘fees’ to corruption boards and committees so they will actually bother to look into it. Except the big men can afford to pay them off, with the money YOU gave them.

Trying to get

          A business registered                                                                                                                           Any kind of registration/recommendation

          Anything imported

         A passport/visa/permit

         Land titles processed

        Your wife treated as she dies of obstructed labour

        A thief arrested

        A university transcript/results for your course

        The council road graded to your site

        Your child taught at school

        Out of a speeding fine when you KNOW you were travelling within the speed         limit

                          involves corruption

And of course, this ‘tax’ is higher, the more you look like you can pay.

No matter how long you have been here, how well you know the law, how well you know the real costs, how many times you explain you are not benefiting and this is a project for the community, or how many times you explain you are on a Ugandan salary*.

If only I didn’t have money-coloured skin.

*One of my friends who works as a full time worker at the local Kamwenge government Post Office earns 50,000 a month, which is about $18. That is NOT a living wage. She however, manages to remain honest and integral.

** For the record, we didn’t pay the 5 million! Not one cent of it.

*** Ugandans come up against issues of corruption as much (if not sometimes more) than I do. I don’t want to give the impression that we are the only one’s who have to deal with it! There are thousands of stories I could tell of my friends here trying to get all sorts of things done where they have been forced to pay bribes.

Note: I don’t normally write such scathing critiques of Uganda. Please note this is not an issue that has ANYTHING to do with Ugandan culture. It emerges from the culture of leadership.

The views expressed within are ENTIRELY my personal views and are not the views of the NGO that I work for.  I am aware this piece is a very candid account of my experience, but I believe strongly in the democratic process and the need to keep leadership accountable.

Broken bones and faulty machines

Michael, my husband, injured his hand about a month ago, and it was still hurting quite a bit, 4 weeks on. He was concerned that it wasn’t healing, and we wanted to get an x-ray to check that it wasn’t fractured and didn’t need a cast (something we were both dreading!! ).

Of course, there is nowhere to get an x-ray in Kamwenge.

So we begrudgingly piled into the car to set out on our fortnightly trip to Fort Portal, the nearest big town to Kamwenge. Fort Portal is a big town  (maybe 80,000 people? I really have no idea!) about 70 km’s away, and it normally takes about 1 to 1 and a half hours on a windy dirt road, surrounded by beautiful scenery – hills cultivated with maize, millet and matooke banana trees, a section of tropical rainforest with baboons along the way, and then rolling expanses of neatly ordered tea plantations, sprinkled with old houses left over from the colonial era. A beautiful drive.

But now that the wet season has well and truly come, the road is terrible. We crawled along for most of the journey, trying to avoid the gazillion pot holes and deep rivets in the road, all the time shaking our heads at the poor state of the roads. It took us over 2 very bumpy hours to reach Fort Portal for our day trip.

After getting all our other jobs done – recharging the internet modem, going to the bank, printing, getting stuff for MH ticked off the list – we looked around for a place to get an x-ray. First we tried a private clinic in town recommended by someone on the main street. We were told they are a clinic used by one of the main insurance companies in Uganda, and would definitely have an x-ray.

What I found was a small dingy room full of bored patients, with no staff in site. A woman who was waiting pointed towards the next room, where I found what looked like some makeshift outpatient rooms. It was only when I poked my head around the corner into a small store that I found a nurse. When I asked what I needed she was quick to tell me they had no equipment for x-ray here, but told me to try Kabarole Hospital – the Anglican church hospital round the corner.

Arriving at Kabarole, we struggled to find anyone to help us, just crumbling buildings and a freshly painted one labelled ‘private ward’. We approached the dispensary and after getting over his surprise that a white person would be there, the man shook his head as he told us the X-ray machine had been broken for some time. Instead, we should try another private clinic in town.

The next clinic wasn’t much different. Here, they were known for x-rays (it was even written on the sign outside) but unfortunately, the films were over and they didn’t know when they would next come. With a resigned sigh that conveyed almost no confidence, the women told us to try Buhinga.

Buhinga is the main regional referral hospital for this part of western Uganda. It is a government hospital. We have heard many stories of patients coming there to find doctors who will not see them without bribes, a lack of equipment and medications, and overcrowded rooms of very sick patients. Currently, this is where most people in Kamwenge get referred onto.

We were very lucky though. Or perhaps, more accurately, we were white. We found a nurse along the maze of undercover pathways that linked the hospital buildings, and she was friendly and happy to help us. She led us to the x-ray department, where we wove through dozens of patients sitting (or lying down), waiting for their x-ray or ultrasound. The doctor was pleasant and happy to do the x-ray for us immediately (and free), and although Michael’s hand was slightly fractured it was small and almost healed, so there was no need for a cast.

But as we were waiting for the film to develop, there was a little girl in line, needing to have her face x-rayed as she had a severe head injury. It was not possible. They were only stocking the half size x-ray films, which meant there was no way to get a full x-ray of her head. Her father, who looked poor and out of his depth in the situation, listened intensely as they told him he would have to take her somewhere else for an x-ray. I already knew from my experience that day that there were no other places in Fort Portal to get an x-ray and he would not be able to afford the transport to somewhere far.

Michael and I lived in Mannum a few years ago. In the small town of maybe 5000, they had a good x-ray machine. Compare this to Kamwenge, who in the town itself has about 20,000, but services a district of 350,000 people, with no x-ray machine.

It sounds clichéd but again it made me realise how lucky Australian’s are to have the health care system we have. As for me? I am not used to driving 2 hours on a muddy, potholed road just for a simple x-ray. I am not used to driving around to 4 different clinics in one big town just to find a working x-ray machine.

One day I hope and pray that this will be as strange to Ugandans as it is to me.