Blood: It’s complicated

An anxious mother stumbles into the clinic, carrying a fragile bundle wrapped in blankets and a faded kitenge. The baby boy – perhaps younger than one year of age – is breathing heavily and seems frighteningly pale for an African child. The MH triage nurse takes one look at the child and ushers them towards Maranatha’s version of an ICU, although it has none of the machines and gadgets one would find in an ICU in the west. As fast as can happen in a Ugandan setting, with a culture of people who cannot be rushed, the child is examined by a clinical officer, is cannulated, tested for their blood type, and then (with relief) the lab staff report that they have some blood available from the child’s blood group. The clinical staff let out the breath they were unaware of collectively holding, and everyone carries on doing the work that needs to be done.

In peak malaria season, this scenario may happen a few times a day. A common complication of severe malaria – especially in children – is anaemia.

I’m not a clinician. But basically, in this context, where severe malaria is really common, regular access to donated blood is essential. At MH, we sometimes transfuse several units of blood every day. Blood transfusion for these children is powerfully and phenomenally life-saving.

So, blood is important.

It is also frustratingly difficult to get our hands on sometimes.

The other day we had a call from Bundibugyo, a neighbouring district 60kms away. A child that had been taken to a hospital there needed a transfusion, and was extremely sick. Before the parents traveled, they decided to call ahead to the regional referral hospital, which is also in Fort Portal. They did not have blood. They then called another big hospital here, a Catholic hospital, which also had no blood. Then they called Maranatha. Our lab tech quickly checked the fridge and to our great relief, there was 1 unit of blood left, and it was the blood type of the boy. We told them to come. A rare win!

Every few months, MH invites the blood bank in FP to do a blood drive at the MH clinic, and we try to get as many units as possible donated. It’s quite a community day, actually, and fun.

The blood banks across Uganda, including the one in Fort Portal, were funded in part by some significant donors. But the donors have recently pulled out, and most of their funding is now from the Ministry of Health. With two old vehicles, and a small team of staff, they are expected to find enough units of blood to service about 8 districts – probably more than 5 million people. The blood bank is now expected to find this blood – miraculously – with no budget for transport and reduced staffing levels.   There are some pretty substantial challenges beyond the obvious time and resource constraints: there is not a culture or awareness in the general community around blood donation; there is no social pressure or reward for donation; with the majority of people poor farmers, people do not have time or resources to commute to give blood regularly; and with HIV (and other STDs) the highest in this region of Uganda, there is a substantial amount of blood that simply cannot be used, even if collected.

This epic wall of barriers to donation culminates in the variety of stressful situations we often have at MH, where there is just

Not. Enough. Blood.

When we are busy at MH, often our lab tech will find himself down at the blood bank a few times a week, begging for another unit. He will call the staff with the keenness of a 15 year old girl having her first crush, racing to the blood bank the moment there is a rumour of a few already screened life-saving-units ready to go. He knows all of the staff there by name. In emergencies, when there is really nothing left to do, we will send family there to donate and then wait around while the blood is tested and bring it back to MH. Of course, it was much more difficult in Kamwenge days, when collecting blood from the Fort Portal blood bank sometimes felt like an episode of the amazing race. We needed to send an esky with a public taxi from Kamwenge, with the request for blood signed by a certain MH staff. After bargaining on the price of this ‘service’, the taxi driver would take the esky to a supermarket in fort Portal town that had agreed to store a few icepacks for us, and then take it to the blood bank. Someone from the blood bank would pack the units for us (once they were available) and then organise another taxi driver to take the units back to Kamwenge, often tied on the roof of the vehicle. Once it arrived at the taxi park in Kamwenge, we would get a phone-call and go and pick it up, normally in a desperate rush knowing there was a child on the very precipice of life itself.

Basically, in a word association game, if someone mentions blood and Uganda, my immediate thoughts go to frantic phone conversations, empty fridges, the oxymoron of pale-black-children, and our shabby red esky that has been thrown into the work ute ready to collect blood from the bank on about a million occasions. Then comes to mind the afore-mentioned pale-black children’s chubby legs running around the ward a day-or-two later, defying the odds of the malaria gods by being an under-5-Ugandan-patient brimming with life.

The government referral hospital does not have the same record of transfusion as MH though. Their not-so-reliable transfusion record has been the focus of many a Ugandan’s frustration. To offer some context, the public health system in Uganda is broken. Staff often simply aren’t there, equipment is broken, drugs are often not available or shifted to ‘private pharmacy’s’ within the hospital, bribes are the norm, rooms are extremely overcrowded, health staff have low morale and some simply don’t care….

In this scenario, one can imagine there is much that could go wrong when a patient is in need of a blood transfusion. The stories that I have heard when quizzing friends and our own staff about their experiences when in need of blood are numerous and horrific: clinic staff demanding payment for blood, blood expiring in the fridge while people wait in the wards in need, patients being sent to private pharmacies in town to purchase the basic equipment lacking to give blood, unqualified staff overseeing the process or staff unavailable so the blood is never transfused…

All of these issues are of course irrelevant when there is almost no blood available, and so much demand, as has been the case in the past few months.

A few weeks ago, one of the Ugandan newspapers published a story reporting that recently at the Fort Portal referral hospital, 8 people died in ONE DAY due to a lack of blood. This, understandably, created a political storm of sorts, so much so that the Ministry of Health sent some high-ranking officials in expensive suits with shiny cars to Fort Portal to find out what indeed happened. Trying to understand what the problem is, so that it can be fixed.

But there are no easy solutions.

I wish there was.

The solution is for people to be free of poverty

The solution is for the government health system not to be broken.

The solution is for the Ministry of Health to take seriously their mandate to provide basic services to the population, and to be held accountable to this by an educated, politically engaged population.

The solution is for malaria to not be endemic in this population and take tens of thousands of children’s lives every year

The solution is for people to come to the health service earlier before they become anaemic, confident in the knowledge they will be looked after well.

The solution is for the culture of blood donation in the community to be changed

The solution is for more funding and greater resources and better systems and services

It’s one of the most all-consuming realities that I have experienced and have been forced to eventually embrace (kicking and screaming) while working in the developing world.

The frustration of discovering that poverty and disadvantage is complicated. And systemic. And cultural. And contextual. And economic. And political. And relational.

It’s just plain hard.

Blood is a beautifully tragic example of this.

If anyone tells me about an ‘easy’ or ‘simple’ solution to poverty and disadvantage these days, in any context, I smile. I listen. Then I politely disagree.

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Runner up

It’s a realm of life that has always alluded me.

When I was younger, but especially over the past 10 years, I have had very little interest in being cool. In the fleeting moments in my life when I have tried – I mean really tried – I would have to objectively say that it has been an epic fail.

This is all despite the futile efforts of my much more creative, stylish and beautiful sister, who seems to know at any given moment what all the kids are wearing and how exactly they wear it….

But over the past 5 years, Michael and I have become increasingly persuaded by the belief that fashion – particularly in regards to clothing retail – is an exploitative business, all round. Most garments made do not reflect the true nature of the costs involved, either to the environment but also to the tired, poorly compensated hands that have little choice but to make the garments under low-wage, exploitative conditions. I think most people know enough about this by now, so I won’t rant (but if you do want to know more, check out  Baptist World Aid’s Ethical Fashion Guide.

Of course, that is a reasonably inoffensive and convenient belief for me to have, given my failure in the fashion department. I understand that for others, this presents a conundrum of epic ethical proportions.

I was sharing with a Ugandan friend that I buy most of my clothes in Australia second-hand, as are a growing number of people in the West. It’s even become a ‘fashionable’ thing to do.

In Uganda, almost ALL clothing is second hand. Unwanted/second hand clothes are sent to Africa in big sacks, squashed into shipping containers, arriving from all over the world – Asia, Europe, America, Australia. They are then sold to market vendors in big bundles. These bundles are dumped in piles on big mats, on the ground, at markets all over Uganda. The best clothes are quickly picked out by boutique shop owners, who wash and iron the clothes, then display them beautifully at nearby shops. The mark-up at this point is often 400% or more – you basically pay for the convenience of not having to sort through piles and piles of unwanted over-or-under-sized clothes. I however, prefer the challenge of finding extremely economical items of clothing in the mounds.

The Fort Portal market

I was explaining to my Ugandan friend how in Australia, the majority of people buy their clothes new, from retail shops.  They buy clothes seasonally, based around what is the latest ‘fashion’, the popular style/colour of the season. This leads to a situation where most people are wearing similar styles of clothes at any given time. And people are sometimes judged (especially younger people) on how well they follow the current style.

My friend shook her head at me in pity “but that means you just have to wear what everyone else is wearing! You could even end up wearing the same exact thing!” she exclaimed, laughing in amusement. I could see that even the thought of this sounded horrifying to her. Proudly, she went on to explain that she loved the way it was in Uganda because then you can wear whatever you want, and be proud, knowing that no-one else in the country is putting on the same clothes as you. You are free to just be you.

I nodded thoughtfully at her response. It certainly isn’t the number one reason why I recoil against the retail fashion industry in Australia.

However.

The expression of one’s uniqueness is stunted by the pursuit of fashion. This is definitely my new runner-up-reason!

Riding off into the sunset

I’m pretty used to western Ugandan culture these days. There are still large chunks of it that are an absolute mystery to me, but after living here on and off since 2011 not too much phases me in the day-to-day of life here anymore.

But every now and again I have a moment where I am reminded of how deep the culture divide is between my home culture and Batooro culture.

Today I had one such moment.

I had just dropped into town quickly in the morning, to pick up a few things from the market.

I hailed a boda (motorbike taxi) to take me home, and I sat, balancing a few bags on my lap. While chatting (as I often do) it became apparent that the boda driver was trying to hit on me. It doesn’t happen very often these days, so it took me a while to realise this. I was obviously not interested, so he switched tact and declared that I should marry a Batooro man, proceeding to list all the reasons this would be to my benefit. At that point, I insisted that actually – thanks for the offer – but I was happily married with 3 children. He was not deterred though, contending that I could have a husband in Australia and a Ugandan husband here.

As tempting as this offer was, I replied sincerely “Cebo, I’m tired, I’m old, I’m busy with my children. Honestly, you don’t want me as a wife. Why don’t you try one of those young white women who come here for short trips? Maybe one of those might be better for you?”

He shook his head decisively. “No! You see in Uganda there is a saying: ‘it is always the old fat cows that have the best meat, those are the ones you need to slaughter!’

There was silence.

You are like the cow, he said, to clarify.

I almost fell off the boda.

Then I laughed.

What else is one supposed to do when one is compared to an old fat cow that will soon be eaten?

Needless to say, despite his request when we reached my place, I did not give him my number.

The Chaos

“But…our life is not conducive to twins! You need to find just one baby”

“I can’t un-find a baby Kim. There is definitely two in there.”

“Are you sure?”

“yep…I know what I’m doing!”

“holy crap”

“Yep…”

This conversation (with some more colourful wording  from both of us edited out for your sensitive ears) took place at the Maranatha Health hospital in Kabarole District, Uganda, in my husbands’ consulting room, as we used the ultrasound to check on my not-yet-showing belly.

It was the first of many terrified, frantic, awe-struck discussions around why God and the universe would see fit to give us the ‘blessing’ of twins.

My extended absence from this blog has been for this very reason; a reason I could never ever in a million years have forseen. But, twins we had.

It has been a long journey, this shedding of our previous ordinary identities, and our tumultuous-yet-triumphant transformation into Naalongo and Ssalongo [Rutooro words for mother-of-twins and father-of twins].

Somehow, someway, Michael and I survived 2016. The year of upheaval. Of reluctantly moving our family back to Australia due to the high risk nature of my pregnancy, for close monitoring. Selling our house in Oz, buying another, and moving in before the twins were born. Of finding work for Michael in Australia. Of overseeing the MH project from afar. Of coping with the sheer discomfort of the last few weeks of my pregnancy, carrying around 5 and a half kilos of baby inside me. Of expanding our hearts and lives as we met our new little people, William and Thomas. And then, the all-consuming sleepless, relentless reality of two newborns to care for. Newborns that didn’t particularly like the outside world very much (or sleep) and decided to express their discomfort very often and loudly (if only we had known it was due to allergy!). Newborns who decided the only solution to said discomfort was to breast feed All The Time.

It was a tough first 6 months. The hardest of my life. The combination of sleep deprivation and exhaustion has rendered the memories of those early days with the twins into the hazy, murky back-waters of my mind. I remember specific moments: Michael and I staring at each other over the table one night, glancing at (but not able to eat) our defrosted donated dinner, our toddler having a meltdown because he wanted our attention and we simply couldn’t give it to him, while each of us juggled a crying screaming baby, knowing there was at least a few hours left of wailing before sleep would eventually come. I remember the look of panic in his eyes that mirrored my own – “How do we ACTUALLY survive this!?!?!”

It wasn’t pretty, but we did survive.

And then sometimes, all the sleep deprivation and baby cries and breastfeeding exhaustion and baby eczema/allergy flare ups and toddler tantrums and my own intense feelings of inadequacy pulled me completely under in their swell and the only thing that saved me was my village grabbing me by the cuff of my shirt and pulling me out spluttering and gasping for breath – primarily my husband, my own mum, my mother in law, and then a multitude of different friends at different times taking a baby to hold, giving me a shoulder to cry on, cooking me a meal, playing with my first born little boy and reminding me that THIS IS A SEASON.

Sure there were lovely bits too. Snuggly new born cuddles. Watching Dave’s language explode with humour and insight. The twins holding hands while I tandem fed (they more often poke each others’ faces now!). Fun time with family and friends on the not-so-hard-days. My incredible support system showing me love. Sunny autumn days gathering walnuts from our tree. Imaginary fun with Dave. A thousand ways Michael has supported me as we walked in the thick of it together. Dessert nights with close girl friends to remind me of me. First smiles and then giggles. Pool play. Learning how to love another 2 humans. Warm, easy conversations with my own mum about motherhood…

And then, somewhere in the midst of it all, we decided that we would move back to Uganda. Uganda – and Maranatha, the organisation we founded – is home in so many ways, after all.  We have been living there on-and-off since 2011. So the decision felt inevitable, and right. The reality of course – uprooting our family, leaving our incredible Adelaide-based support network, heck, even getting on an international flight – was largely terrifying. But nevertheless, in April we packed up our house and our life and moved countries once again (dragging some grandparents along to help us on the long-haul flights), hoping we would find a house to live in soon after arrival!

With approximately 20 hours of flying behind us, we shuffled out of the familiar mugginess of the Entebbe airport – a faster speed was impossible – with my parents, 11 month old twins, a very overwhelmed and tired three year old, a double pram (not that we have used it since), 2 porta cots, 2 car seats, 8 bags of luggage, and eagerly looked for the person who was meeting us. After a couple of minutes of frantic searching with lots of stares and offers of taxis, Michael and I faced each other with dismay and realised that the person sent to pick us from the BnB was  either a)very late or b)not coming, two extremely likely scenarios in Uganda! In true Findlay laisse-faire style, Michael and I realised we had no cash on us at all, no working phones with Ugandan SIMS within easy reach, nor an address for the guesthouse we were going to.

We marched over to where the taxi stand was and after discovering my father had brought a small amount of Ugandan shillings from a previous trip, set about finding a taxi to bargain hard with. This was an interesting process, given I had no clear idea where in Entebbe we were heading to! Eventually we all piled into an SUV (with all our luggage there was actually only 3 seats available!) and drove in the general direction of the guesthouse based on my husbands’ super amazing memory. Along the way, we stopped maybe 6 or 7 times, showing motorbike taxi drivers the one photograph we had of the house, in the hope someone would know the place. Our twins and toddler loved the excitement, with David yelling at the top of his voice “ Look mummy another goat!” every time we drove past the multitudes of goats on roads.

On our first day back in Uganda (after finding our accommodation), we took a walk through a quiet neighbourhood. Walking along a dirt road, with only a sprinkling of houses right by Lake Victoria, there was a group of people lazily chatting in the shade of a big tree – some boda (motorbike taxi) drivers and several women. They turned to look at us, and then with mouths wide open their conversation ceased. After a respectable recovery time, the women started laughing and broke out in applause, which led to some dancing, until I felt like I was the star of some bizarre African musical featuring a set of miracle twins. It became apparent to me at that point that anglo-saxon identical twins are not a common occurrence here.

I won’t bore you with the gritty details of the first few months – finding a house to move into and making it suitable for us, getting over jetlag and reteaching our twins to sleep, adjusting to life without grandparent help and consistent power, finding the right people to help us out with child care at home, walking alongside of our 3 year old as he experienced intense culture shock and homesickness, re-entering MH and (for me) adjusting to being back at work after a long absence….

We are rebuilding our community here, slowly. Our staff, as expected, welcomed us and our kids back with open arms. And despite agonising almost every day if we made the ‘right’ decision for us and more significantly our children, I’ve come to the conclusion there probably isn’t one. Sometimes, I’m realising, the story isn’t supposed to be just about ‘us’ as individuals. Mark Sayers, a Christian pastor/sociologist, introduced me recently to the idea of people having 3 ‘stories’ – my story, a community story, and then a universal story. In the west, he argues that almost all of our life and decisions are made based on our individual story – what is best and meaningful and important to me. More than any other time in my life, Michael and I are trying to move away from this. Our decision to move back to Uganda, regardless of some of the challenges this brings personally, is born out of the inextricable weaving together of our personal story with the story and community of Maranatha Health, and our universal story of hope for a more just world. So that is why we are back here.

We try to take all 3 kids with us to work once a week. On those days, David hangs out with a crew of staff children who sometimes hang out at MH in the afternoon (or at the moment during school holidays, all day) with Ellen, the staff children’s carer on staff. Despite his limited Rutooro -he is learning slowly- he often leads the pack, with a group of them running around MH giggling and playing like they own the place. The crèche, a tiny room which is a third of an old shipping container, is now referred to by Dave as ‘my office’. William and Thomas, while mostly looked after when at the clinic by our very energetic young nanny Violet, wander happily around until they see Michael or myself and are reminded of their separation anxiety that seems to plague them still. The other week I spotted them both wondering into one of the wards, and then guiltily tottering out with mouths stuffed full of sweet potato that one of the mums on the ward feeding her own child had given to them. They certainly draw a crowd, and I often walk out to the MH playground to find a crowd of 3 or 4 people just staring wide-eyed, gaping at the site of 3 mzungu children, 1 who is about as gregarious as is possible to be, the other 2 identical in looks (though polar opposites in personality!).

Michael and I divide our time fairly equally now, between the clinic and home. We often swap over around midday, where one of us rushes home on a boda and the motorbike driver waits out the front for the other while we give a quick handover: ‘this email needs to be sent, this management issue came up, someone needs to talk to this staff member….” and “this child’s been tired, this was what was eaten for lunch, this load of cloth nappies is washed…”. I feel utterly grateful to have a husband who sees child-rearing as just as important a task and wants to share equally in that responsibility.

So this is life now. It’s messy, chaotic, busy, mostly unplanned, and so much less productive than it ever was a few years ago. I spend so much of my time feeling like I am on the brink of catastrophe, wondering if there is a better way to do ‘life’ here (or anywhere), but I think the answer is that in this season in life, just being a part of MH Uganda and raising our 3 children is enough.

I’m enough.

At least, I’m learning to be.

The fluke of geography

Due to a fluke of geography

I was born into a society that taught me I could do anything.

I was born in a country that places a high priority on all children having access to a reasonable standard of education, that offers social and financial support to those who can’t find work, and that gives government loans for university, and only makes you pay them back once you can afford to!

I was reflecting on this the other day, after an interesting conversation with a friend in Fort Portal. This friend has a low-end job, comes from a poor background, and will probably never move beyond these circumstances.

We were discussing the fact that David, my son, is currently obsessed with motorbikes. I was joking that I hope he doesn’t become a boda-boda driver when he is older (a motorbike taxi – an extremely ‘low end’ job with little prospects which often comes with a lifestyle of women and alcohol).

My friend reminded me that David is an extremely stubborn, head strong little boy, and will do whatever  it is he wants to do…no matter what I want for him!

I sighed, and agreed.

He then nostalgically described his primary school days, a time when he thought he could become whatever he wanted in his heart to be. He remembered his peers saying they wanted to be pilots, doctors, engineers, teachers. He shook his head and clicked his tongue in disgust at their naivety.

I asked him what he wanted to be, back then.

He hesitated, obviously embarrassed to share this with me. Quietly he spoke: ‘a doctor’. Following this, was a sort of half-laugh-half-sigh.

He continued…

‘you know, that was never going to happen. As a child, I didn’t realise. But Africa has a way of separating people – there are those that can manage, and those that can’t. ‘

I sympathetically agreed, listing all the hurdles with him – having to work and study at the same time, trying to find school fees, going to a government school where teachers don’t turn up for days so your grades suffer, trying to get into university – but not being able to afford the fees and bribes nor knowing the right people…

He explained that he could barely manage to finish S4 (year 10) because of school fees, and needing to help his family in their garden. By the time he finished, he was offered a job, and took it. Now, he said, ‘its fine – you manage what you can, and try to enjoy life’.

Then I offered thoughtfully ‘you would’ve made a good doctor’.

But in my mind I was thinking – this life is so UNFAIR.

Because I didn’t want to become a doctor, not in a million years. But I am pretty sure that if I really wanted to, and worked hard towards that goal, I could’ve managed.

I explained to my friend that I felt very lucky – almost guilty – that I had the opportunities I had purely because I was born in Australia. That even though neither of my parents finished high school (but went on to technical college), even very few people in my extended family have gone on to do further study, even though I went to reasonable but not amazing schools…I still easily managed to get into university.

It was easy to get a place, because there were so many places and so many courses and so many universities. It was easy to get the grades, because I had good teachers who cared about me and knew how to teach – which is mostly the norm in Australia. It was easy to afford, because the government paid for my course at the time, and I only had to pay for text books, which wasn’t much of a stretch even on my part-time salary whilst living out of home.

And that about sums it up.

The ease of it all.

Obviously there are children in Australia that face an up-hill battle to get an education, that don’t grow up in safe and loving homes, and that struggle for survival in a variety of ways.

But the majority find it easy.

Not because they are deserving

Not because they are so much more hard working

Not because they possess some gift or intelligence the rest of the world doesn’t

But because of the fluke of geography.

Pushing bananas up a hill...

Pushing bananas up a hill… (photo by Matt Curtis)

Mzee

Recently, Uganda lost an incredible man. Reverend Canon Ephraim Gensi died after a 2 year battle with cancer.

It still came as a shock, despite him being sick. Maybe because Ephraim was larger than life – everything about him seemed a little extravagant, impressive, super-sized.

His laugh

His generosity

His commitment to his faith

His love of his family

His fascination with new ideas

His humour

So I don’t think I can quite believe that life was actually able to leave him…

When I try to conjure him up in memory, all I can think of is him saying some cheeky remark or another to tease (normally about my marriage, or my lack of lots of children), and then laughing at my response.

Ephraim knew how to have fun.

It was one of the things I loved best about being around him. He was so jubilant. He didn’t let me (or anyone!) take life too seriously, which I have a tendency to do.

I’m not quite sure what I want to say to the wider world about the fact that he is gone, or why I need to write this in a blog. But I do.

Perhaps, most importantly, I write to acknowledge what an incredible influence he was on our life. I want for him to get as much of the accolades as he deserves, for Michael’s and my life’s direction and our work in Uganda.

In all honesty, without him, I’m not sure we would be living here.

Michael met Ephraim in January 2003. They immediately clicked and formed an unexpected friendship. Michael’s next trip a year later, Michael stayed in Ephraim’s house with his family and shared his vision (then as a young medical student) about a hospital he wanted to begin in Uganda. Ephraim was immediately supportive.

Years later in 2008, I had started dating Michael and was living in Uganda for 6 months, on my own. I stayed with the Gensi’s when I first arrived for a week. One of my earliest memories is of Ephraim doing what he always does – listening to the challenge I was facing, and then taking charge and coming up with a solution. In my first 6 months in Uganda, I was staying with a host family an hour away, and had had some ‘difficulties’ with the family.  I remember, after Ephraim heard about it from Pete (his son, who I had been complaining to) he asked me to come out on the front porch, and asked me ‘Now, what is the problem I am hearing with your living arrangements?’. He listened intensely while I explained, and then started in his typical way ‘Now, this is what we are going to do…’ as if it was his problem all along and not that of a 20-something volunteer he had just met who was crashing at his house. From then on, I spent most of my weekends at their place.

There are hundreds of people who have worked with us along the way to make Maranatha Health possible, both in Australia and Uganda. But it is only our own parents, a few close friends, and Ephraim and Margaret who have worked selflessly since day one to support our crazy ideals and the monumentally challenging reality of Maranatha Health, without ever asking for anything in return.

Since moving to Uganda in 2011, Ephraim and his wife Margaret (and their four -now grown up- kids) have provided us with a much needed family to be a part of. Anytime we were in Kampala, it was taken for granted that we stayed with them. That sense of belonging, when in a foreign culture, has been a wonderful gift to us.

The last 5 years has not been a walk in the park. In so many ways living here has been a lonely journey. Most of our Ugandan and Australian friends, while extremely supportive, cannot comprehend the day-to-day differences between our life here and our life back home in Australia.

But Ephraim understood. As the chairperson of MH and as our father, as someone who is incredibly Ugandan but understands western culture immensely from years of living outside the country, he has been there every step of the way – offering us wisdom, a sympathetic ear, his expertise, thousands of phone calls, his presence at dozens of meetings… all because he believed in us. We have often taken refuge at the Gensi’s house when things have been tough – the family listening to our rants, providing sympathetic sighs, and offering personal contacts and any help they could offer. Ephraim has always been at the forefront of this.

Ephraim, over the past 3 or 4 years, had spoken a lot to us about the importance he increasingly placed on leaving a good legacy, and of choosing to spend his life doing things with a higher purpose. His life, and his burial, certainly reflected this.

Ugandan burials are almost the polar opposite of Australian funerals. They often last all day (sometimes longer), and the person is almost always buried at their village home. Many people come and there is normally a big meal after the proceedings. For days after family and friends visit the immediate family to offer their condolences and spend time with the family, often sleeping at the house, bringing food, and grieving together. People came from all over the country to bury Ephraim. It was incredible. Over and over again as I walked around afterwards, I bumped into friends that I had met at Ephraim and Margaret’s house over the years. Almost all have a story to tell about Ephraim and Margarets’s generosity. Either they had been given a place to stay for a few days, a month, a year; Ephraim had found them a job; they had been sponsored through school; or had been counselled and given a shoulder to cry on when life was tough.

The reality that Ephraim was actually gone hit me as we arrived at the burial proceedings. We were an hour late, after 6 hours of driving and getting lost on terrible, potholed, dirt roads. There were thousands of people sitting and standing on the large grassy yard at Ephraim’s village home, spilling out from under large white tents up to the hedges behind. In the throngs of people, the loudspeaker booming speeches of Ephraim’s life, and a man greeting us and leading us to the centre and to the sad faces of Margaret, Peter, Caleb Esther and Rachel;…my heart beat sped up and I realized with a panic that mzee* is really gone. He won’t be coming back. It took all my strength not to fall in a sobbing mess – a response that would’ve looked extremely out-of-place in this culture. Instead I squeezed hands and patted backs and cried quiet tears for the mzee we all loved and took my seat next to them in the family tent, trying to focus on the ceremony.  The finality of death struck me – as if someone had slapped my face – and for the first time I realized that I really wouldn’t hear his laugh again. I wouldn’t get to ask him for any more advice. There would be no more philosophical discussions, and no more opportunity to thank him for all he has done for us. It was time to say goodbye.

So because I must – farewell Mzee. We will miss you tremendously. Words are not enough to express all you have been for Michael and I, and this world seems a lot bigger and scarier without you here for guidance and laughter. Thank God for you. Maranatha.

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Ephraim and Michael, 2003

Ephraim and David, May 2015

Ephraim and David, May 2015

Mzee – ‘old man, father,’ in many Bantu langauges.

Let’s call a spade, a spade

One of the (many) difficulties and pressures of running an organisation such as ours, in Africa, is saying no to people. Specifically, saying no to people back home who want to come and volunteer in an unskilled capacity. We often get sent email requests for volunteer opportunities, from people we know or people who have heard of us through a distant connection, or just people who have found our website over the internet.

We rarely get emails like that requesting to donate, or volunteer with MH in Australia.

Before I continue, let me set one thing straight. I am talking about unskilled volunteers.

But I must confess.

I have volunteered in an unskilled capacity myself, in Africa. The first was 3 months long. Then 6 months. The purpose was mainly to find out whether I could do this long(ish) term. Turns out I could, and did. But there were perks, beyond finding out that Africa would be my new home. Firstly, people thought I was cool (if you know me, you would know that is a very rare occurrence). Some also thought I was selfless, which I can guarantee was certainly not the case. It was great dinner conversation, and was highly valued in our experiential generation. It didn’t cost me very much, and it’s an easy, bubble wrapped way to travel to the developing world because in these experiences there are almost always people on the other end to host you,  plan your trip and show you the ropes (although in my case it didn’t quite happen like that!). Apart from all that, I had amazing experiences, met inspirational people, and learnt much.

Me with the kids from my host family in Uganda on my 6 month trip

Me with the kids from my host family in Uganda on my 6 month trip

Me with random Ugandan kids (every volunteers' ideal photo!)

Me with random Ugandan kids (the typical volunteer photo!)

Gone are the days when missionary/voluntary work overseas in developing countries was a long-term-mother-Theresa-endeavour full of self-sacrifice. Nowadays we get on a plane for a few hours, have a 2 week/one month experience staying in ‘quaint’ less-than-ideal accommodation, still get to update our facebook page from our phone, have all the logistics handled for us, (often) spend time with a bunch of good friends, and return as heroes to our home culture.  Who wouldn’t want that?

Voluntourism has become extremely popular both in the secular and religious world. Many churches provide avenues for this these days. They are often labelled mission trips. They are promoted and packaged in noble phrases such as ‘self-sacrifice’, ‘making a difference’, and my personal favourite ‘getting my hands dirty’ (because Africa is dirty???).

Some people I have met are ‘voluntourism’ addicts. Each time I see them they are going to a new national-geographic-type-destination, talking about the latest ‘build’, or posting photos on FB of cute fly-invested children from <insert exotic location here>.

But what purpose does it serve? What does it do? How do we perceive ourselves and others and the role we play when we go to other places? What do I think about my past experiences now?

With a little maturity, a longer term involvement in Africa, a pinch of cynicism from witnessing so much voluntourism gone wrong , this is how I see my experience…

At the time, I thought what I was doing was kind of a big deal. But I doubt I made a difference in anyone’s life. I’d like to think what I did had some positive impact. I certainly didn’t give anywhere near as much as I received and learnt. I was naive and didn’t understand almost anything of the cultural complexity that was happening around me. On reflection, I definitely did some damage.

Am I glad I went? Sometimes. I don’t regret it. But I know now it wasn’t about ‘helping’ the community I apparently went to serve.

It was about me.

So let’s call a spade, a spade.

When an unskilled volunteer spends two weeks, a month, 3 months, in a brand new community where they don’t have any understanding of the culture, the language or the context (which long term expatriates tell me all takes years and years to learn), it is going to be difficult to make much long term – or short term – positive impact. Most of the time, any money it costs to fly you there would be much more useful to the organisation than your time.

Of course it is important to travel.

To learn

To expand our world view

To see how other people live

To engage with communities who are remarkably different from us

Let me be clear. I am not calling for a complete end to unskilled volunteering. I simply want people to recognise that the primary purpose is to give the volunteer an experience rather than to alleviate poverty. Call it learning, discipleship, personal growth – IT IS FOR YOU!

But we need to RESEARCH. We need to try to mitigate the damage:

The aid and development agenda can become complex and confused when it needs to be combined with volunteering opportunities. Normally there is a community of people that will benefit from the project. This community are ideally prioritised and lead the decision making process within the project. However, adding unskilled volunteers from the developed world context adds an extra type of stakeholder. In essence, volunteers pay for and expect a certain experience, with associated outcomes. When expectations and outcomes clash between the community and volunteer group (as they inevitably do when the purposes of involvement are so diverse) those supplying the funds for the program (the volunteers) are almost always prioritised over the beneficiaries.  I have witnessed this time and time again in African NGOs. Programs therefore are then designed with volunteer outcomes in mind, rather than the community, so that programs may or may not benefit the community.

The majority of these populations we visit are extremely vulnerable and they don’t have funds to leverage decision making power. They are poor. They have been exploited by people for a long time. New research (here and here)  suggests that short-term volunteer work can be ‘potentially exploitative’ to such populations. Most likely, they will never have the opportunities, experiences, or choices you have access to without a second thought. And their lives won’t often change dramatically from the experience, like yours might.  Because of this, there is a big power imbalance between you and these communities. An exchange that takes place, where you receive a lot (to add to your list of ‘haves’) and they receive something small, or nothing – reinforcing that unequal power relationship. An interesting article I recently read used the metaphor of the developing world as the new ‘playground’ for the privileged few looking to atone for global injustice. In this scenario, ‘the poor’ are only framed in terms of their needs, with the volunteer coming to save the day.

Obviously, none of this is ideal.

So here are my final thoughts on unskilled volunteering, some things for you to ponder before you pack your bags:

  • Proceed with caution, and do your research
  • When you go, admit to yourself and others you are going primarily for you – not for the community you hope to serve. Be aware that voluntourism has become a big industry, making big money.
  • When you have a revelation while abroad about your extreme fluke at a wealthy life, let the experience change you and your lifestyle at home. Dramatically. Live simply. Live justly.
  • Be aware that unskilled volunteers are a lot of work for local organisations. Think of what it would be like to have a group of students rock up at your workplace in Australia. Now imagine that group were from Africa, didn’t speak English and didn’t know the first thing about Australian culture. What would you do with them? How would they help your workplace?
  • Local organisations often host volunteers purely for the potential financial return. Make it worth their while. However, when organisations (perhaps Maranatha Health) say ‘sorry, we don’t have any volunteering opportunities at this time’, please don’t be annoyed with us. Don’t stop giving to us. Respect us for it – we are simply putting the needs of MH and this community before your needs.
  • Get familiar with this very wise (and amusing, in a truth-exposing kind of way) website to counter the worst of voluntourism.

Thus endeth my  rant.

Punishing Girls

I was angry today.

My poor colleague (who also happens to be extremely understanding), was forced to listen to most of my rant, after another one of my cultural discoveries.

We have just signed a contract with a private secondary school in Fort Portal, to provide medical care for all their students as needed. After writing the contract, I sent it with one of the MH staff to the school, who later came back with a question.

The school had asked if we could carry out pregnancy tests on all the girls at their school, at the beginning and end of each term.

Immediately I was suspicious. I asked why this could possibly be necessary.

The school wanted to carry out pregnancy tests on its girls (mostly between the ages of 13 and 18) so that they could find out who was pregnant and then expel them from school.

Yes. You read correctly.

So obviously, we are not going to be the group that does the tests. That is not in the contract I wrote.

Today I learnt that the subsequent expulsion for getting pregnant is quite normal. Well, normal…and… Ugandan Ministry of Education Policy.  When a girl is pregnant, I was informed today that she shouldn’t attend school, and should be immediately expelled. Some schools allow them back after having the baby. Others don’t.

There are some exceptions, such as if the student is sitting their final exams. Wow. Generous.

The rate of teenage pregnancy in Uganda is high, at around 25%. A UNICEF report  from Uganda found that “Many schools use expulsion (implemented in a very public manner) as a disciplinary measure to deter other girls from getting pregnant. Shaming the pregnant girl through a very public expulsion has been shown to severely compromise girls’ ability to re-join the school.”

Of course when this happens, what a girl needs is a loving home to return to, but instead… “At the community level, most respondents noted that if a pregnant girl is expelled from school, her parents will send their daughter away due to the stigma associated with teenage pregnancies. Another common practice is to marry off the teenage girl to the man or boy who impregnated her”

Awful.

So let us back track for a minute. Why would she be pregnant in the first place, I hear you ask, if THAT is the consequence?

Let’s start with a few basic facts. It’s pretty much universally agreed (and is law in Uganda) that a girl under the age of 18 cannot consent and thus any sexual advances from someone older should be viewed as exploitative and coercive. Call it what you will – rape, paedophilia, defilement – there is very little choice for the child involved.

More important context: Of the many girls who have had sex at a young age, the majority had male partners that were 3 or more years older, and about 1 in 10 had male partners that were 10 or more years older. More alarmingly, a study at a secondary school in western Uganda found 31% of girls reported they had been forced to have sex. Other studies have similar findings, with sexual abuse of girls extremely common. Read more here.

Given this reality, one compassionately minded individual might ask then, why must it be the GIRLS that are PUNISHED?!

Imagine.

You are a poor 15 year old naïve girl.

You normally eat only twice a day. You go hungry at school.

A boda boda (motorcycle driver) gives you some extra attention. Perhaps he buys you a soda and some chappati.

After a few weeks, he propositions you to have sex. You either have no apparent choice in the matter, or you reluctantly oblige – you have been accepting his gifts, after all.

You start classes for the term. The nurse who is testing you informs you that you are pregnant. She also immediately tells the school principal.

A few days later you are told to leave the school. They announce to the school that you are leaving because you have become pregnant. You are publically shamed.

So you go home to your parents and have to explain. Your father yells at you to leave, as you are ruining his reputation in the village.

At this point, you have been raped, become pregnant, been kicked out of your school, publically shamed and then told to leave your home. You have no support or resources and will soon have a baby to look after.

All because this country allows this to happen to its young women.

Without even blinking its’ big, masculine, powerful eye.

It takes a village

Ugandans love children. As a culture they celebrate them fiercely. Everyone seems willing to smile and get down on their knees to say hello to a child. Babies are cooed at and admired. For women, bearing children is a sign of prestige and of strength.  I have earned a respect through motherhood that I tried futilely to gain for the duration of the time I lived in Kamwenge.

When I speak of African children, the oft quoted proverb ‘It takes a village to raise a child’ comes to mind. In my imagination, this phrase conjures up exotic images of intricate networks of beaded half-naked villagers working together for the good of the communities’ children. Our over-use of this saying in the West highlights the exoticism and idealism with which we frame our discussions of child rearing in Africa. I’ve heard it said that in the developing world, child–rearing is somehow a more ‘natural’ process, beyond reproach.

To confess, I have many times scoffed at this idea.

While I believe wholeheartedly that a village – a community if I may use a less exotic term – is essential for raising children (given how exhausting and monumental such a task is!) it is also true that if everyone is responsible, than in a sense no ONE person is responsible.  My time in Kamwenge exposed me to some of this –children neglected and uncared for, malnourished and left to be looked after by young siblings or distant relatives. I think I saw the worst of this, working at the referral health centre in Kamwenge.

There are many great and (in my opinion) not-so-great things about parenting ‘Ugandan style’, as there are in any culture. I don’t need to thrash them out here.

But one of my greatest reservations about moving back to Uganda as a family were some of those ‘not so great’ bits to Ugandan child-raising, especially when I plan to be a working mother here and have other women look after my son for chunks of time. I would think of all the opportunities that I perceived our son would be missing out on, not living in Australia; that I, as his mother, would be denying him, by making the choice to live here, away from his culture and community.

Before we arrived here, when I was super-stressed or having a moment of doubt, all the marvellous moments of my own childhood unravelled before me, as a taunting list full of red crosses, marking the experiences my own son would not have.  The freedom of playing in parks and exploring creeks, running through sprinklers in bathers on lazy summer days in our backyard, the safety of playing with neighbourhood kids, the amazing quality of suburban kindergartens and playgroups, and most significantly, a community of friends and family that were invested and involved in my upbringing. I feared that we wouldn’t find a community for him to belong to here.

However.

Slowly and surreptitiously

Without any intention or expectation

And in the midst of my concern that this could not happen…

A community has begun to form, winding its way around my son and through his little life.

After all, community is something that Ugandans know how to do.

I see it when I take Dave to our clinic, and he immediately squirms out of my arms into the arms of one of our staff.

I see it when he waltzes into the reception area at Maranatha, climbs onto the receptionist’s lap and begins to play with her phone.

I see it when he hears a cow moo, then searches for and is picked up by our security guard at the clinic, in a successful attempt to be taken to see the cows grazing nearby.

I see it when our landlady at the apartment where we stay buys him bunches of bananas so she can watch the ecstatic little dance he does every time he is given a banana!

I see it when Dave shrieks with excitement and then runs outside to play every day when his 6 year old neighbour (adopted by our American friends that live upstairs) arrives home from school

I see it when we take him to the shop where I buy most of our consumables, and the staff greet him with a big smile and call his name ‘Mandela!’ and produce a ball for him to play with while I shop.

I see it when we attend church on Sunday, and his Sunday school ‘teacher’ cuddles him and jokes that he is now her child, while I hold her little girl of the same age.

I see it when the cleaners or groundskeepers in the apartment block where I stay rush to help Dave down the steps on the compound where he continues to attempt death-defying acts.

I see it when we sit down for lunch and after polishing off his own g-nut stew and rice, he looks to see which woman on our staff will feed him some of theirs.

All these moments are small, but they remind me to take a breath and be thankful for the village here that is helping me to raise our son.

And perhaps

scoff at the proverb a little less.

Newspaper Notices

“Organisation ABC would like to notify the public that Mr False Acquisition is no longer working for our Organisation. Any interaction with this person is done so at your own personal risk….”

This is a common public notice in the newspapers in Uganda. Very common, in fact.

The subtext, one can comfortably assume in these notices, is that Mr False Acquisition was caught stealing money of a serious magnitude from organisation ABC, has been fired, and the notice ensures he can no longer manipulate his/her previous employment status for whatever shady deals he may wish to partake in.

Last week, Michael and I briefly contemplated having to place such a notice in the paper.

Last week, we also wondered for the millionth time if we will ever scratch more than the surface of this culture.

Last week, we parted ways with a staff member at Maranatha that had become a trusted friend, a brother almost, and someone we had always believed to be an incredibly integral protector of the mission of our organisation, Maranatha Health. Turns out we were wrong – this employee had been taking significant sums of money from MH*.

Last week, as you may have figured out, was a very sad week.

*sigh*

Of all the things that are hard about living in this country – I have detailed them in many of my blogs in the past so no need to elaborate here – the most difficult thing is getting used to deception.

Actually expecting people to give into the slightest temptation to deceive.

Having to assume the worst so that you can ensure finances are protected with layers and layers of accountability.

And somehow, keeping your heart and mind open to the possibility that people may not betray you. Because many people won’t.

Do I sound like a hardened cynic?

I thought I was. But this time, the betrayal hurt a lot. And so perhaps, I am not as much of the cynic as I thought (or hoped) I was.

There are always the little bumps in the road with Ugandan life. A job applicant misleads you about their qualifications. The waiter at the restaurant gives you the wrong change hoping you won’t notice. A friend forgets to mention they have a wife, or a kid, or a fake degree, or some equally bizarre thing to omit. The acquaintance asks you for a bribe to do their job. You find out the pastor who preaches integrity has a reputation for sleeping around. The child’s school fees you pay are actually cheaper than what was told to you.

But this is all just part of life. A kind of creative opportunism, if you will.

But when the people that actually join you in the messiness of life deceive you – that hurts. Immensely.

Normally I am furious at the big deceptions. We have experienced quite a few of them over the past 5 or 6 years. Normally I feel like screaming and hitting and exacting revenge and going home.

But this time, despite the closeness of this deception, I am not angry. I don’t feel like making anyone pay.

I am sad.

I am disappointed.

Maybe because I am a few years older. Maybe because I see the struggle and the shame for the individual concerned up close this time. Maybe because I have just learnt a bit more about how fragile and broken we all are.

But this time, it has been deeply saddening to see how crippling this deception is for those who commit it. To see how one stupid decision can spiral out of control and consume someone.  To see, for Ugandans, how difficult it is to resist this particular temptation – no matter what the cost.

Like the employee we have had to part ways with.

This deception has renewed my deep awareness that as much as I can build community and a life here, this is not my country, nor my culture…and will never be my normal.

At the best of times, I find Ugandan culture extremely confusing. At times like this, I find it is better to simply shrug my shoulders and remember that there is much of the cultural iceberg lurking underneath the murky waters of assumptions and appearances that cannot be seen. Rather than judge: pronouncing all Ugandans thieves; ignoring the complex realities of life here that lead people to unethical choices; generalising the immoralities of this country; neglecting so much of the goodness of the culture….

I instead pray that I will find the same sense of crystal clarity about the blind spots – the logs – in my own culture.

As if to remind me again of this lesson of difference, my son was playing with some of his stacking cups at work the other day. As per usual, he stacked them downward, one on top of the other, the only way it had occurred to me to stack them. Like this:

DSC01803

But after a few hours and a couple of different staff at MH playing with him and his cups, I quickly noticed something different. Every staff member who played with him stacked them the same way – differently to what my son was doing. They stacked them in pairs, facing each other. Like this:

DSC01810

Different – each way neither better nor stronger – but definitely different.

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*Our ex-employee is going to pay back the full sum of money taken