The Pearl of Africa: Adventures in Uganda

Grand Canyon and Beyond

2009-06-15T10:10:00.000-07:00

I do not want this adventure to end. The last month and a half has been full of excitement: I spent 18 days on the Grand Canyon with some dear friends of mine. It was a mini reunion of sorts, as 5 of us were in the same WEMT course in fall 2007. We always talked about doing a big adventure together during our course, and what better opportunity could we get than doing an 18-day private Canyon trip? The Canyon was amazing, yet again. Although it was my 4th trip down, every trip is a new experience and a trip of a lifetime. This place opens my mind and amazes me every time. It feels so magical and indescribable; there are new creeks and canyons to explore, new hikes, and new people for sharing the experience. We had great weather, and clear water until the last few days. When we pulled into South Cove, almost 300 miles downstream, we all wanted to drive straight back up to Lee’s Ferry and do it again. Aside from the Canyon, I had a great road trip. Brian and I did some flying at Woodrat in southern Oregon, then packed up our creek boats for some California creeking on our drive to Vegas. We stopped at the Forks of the Kern on our way down, and hit up the South Silver and EF Kaweah on our way back north. I am pretty sure I have some new creeks to add to my top 10. We also visited Yosemite, Kings Canyon, and Sequoia National Parks. So after rowing the Grand Canyon, creeking in California, flying in southern Oregon, exploring 4 National Parks, and spending time with dear friends and family, I would say this trip was alright. I do admit that it is hard to leave again. I am heading back to Uganda now for my next stint. It will be good to get back to work and spend some more time on the White Nile, but the recurring goodbyes are becoming too familiar now. Until next time.

Holiday Time

2009-05-03T21:58:00.000-07:00

I am sitting here in Entebbe about to board a flight back to the US. The last 6 months have flown by, but it also feels like I have been here forever. Back in February, I got invited on another private Grand Canyon trip and I could not turn down the opportunity. I am now headed back to the US for a 6-week holiday. I am excited to have some time off, but most importantly, I am excited to get down the Grand Canyon again. I have realized that I should never pass up the opportunity for a Canyon trip with some dear friends of mine from back home. I may be stressing a bit more right now if I were leaving Uganda for good. However, here I go for a Grand Canyon trip and a road trip south, hopefully with some creeking and flying along the way. Let the fun begin!

Letting Go

2009-04-22T10:57:00.001-07:00

The last few months have been sobering. We lost a few patients, a few staff members at NRE, and even one of our own staff members who used to work for us. Some deaths were expected, and others were not; it was a reminder of the fragility of life.

There is always one guarantee in life: death. Unfortunately, Judith was a healthy, 26 year-old clinical officer who was just about to finish her master’s degree in public health. She suffered a ruptured ectopic pregnancy. She started feeling sick late Friday night, and within a few hours, she was dead. There was no blood for her at Jinja Hospital and she died on the way to Nyenga Hospital to get a blood transfusion.

It is a sad story, and something none of us were expecting. It was a tough week, but as usual, after a day or two, everyone gets back into the swing of things as if nothing changed.

Anyway, things are still up and running, but it has been a bit busy and hectic lately. The kids were fun, but exhausting, and then Judith’s death. I think I am ready for a break.

Inner City Kids Come to Volunteer in Uganda

2009-04-18T10:53:00.001-07:00

The Inner City Kids camp has been running since 2002 after Jessie found the funding to do a kayak school in New York with a group of kids from Upward Bound, a high school program for first generation potential college students from low-income families. The kids are from the Harlem area and have never been out of the big city. This year was the 3rd Uganda trip for the inner city kids. Most of the kids had done the kayak school and Rogue trip last summer, but it was everyone’s first trip to Uganda, let alone, out of the country. This year, we had 7 kids, from sophomore to senior year students, and 2 returning chaperones, Rosanna and Lee. I realized I have been working with Rosanna for the last 5 years after the first kayak school I helped teach back in summer 2004. The kids seemed to enjoy themselves. It definitely was not a typical spring break for these Harlem kids. The students had a great time volunteering; they helped teach malaria education sessions, completed follow-ups, learned a lot about malaria and even looked at blood slides infected with malaria, and most importantly, they kept the Ugandan kids entertained by teaching them some new dance moves. The kids also went for a rafting trip on the White Nile toward the end of their time here. Not a bad trip, eh?

Fresh Air Malaria Conference

2009-04-06T08:12:00.000-07:00

I just returned from a 3-day conference in Kampala called “Counting Malaria Out.” It was long, but interesting to see what other organizations are doing in Uganda. Although it can be pretty brutal to listen to 3 days worth of Power Point presentations, I survived.

The most interesting part was seeing how many people are giving out free nets without any education or follow-up. The other disturbing part is the money. Being at this conference held at the fancy hotel in Kampala, I realized how much of this money going toward “malaria” is wasted. Much of the money goes toward the administrative side or big, fancy conferences like this, and may never actually reach the ground. It made me feel a little better that we do not even have an office. The “office” is in my banda, or wherever I want it to be.

Most importantly, I became somewhat grateful that none of our funding comes from big organizations, like the World Health Organization, President’s Malaria Initiative, or USAID. Because of this, I do not have to deal with the bureaucracy of people sitting in a nice office in New York or Washington, many of whom have never left the country, telling me how I should run a program in Uganda.

Aside from my ranting about free distribution, it was somewhat comical to be at the conference. I have never been one known for networking and dressing up for fancy conferences, but I did feel somewhat official. I have never been a good city girl, but I even returned to Kampala a few days later to enjoy the city life with some friends: ice skating, sushi, a movie, bartering cops after running a red light, and a trip to the airport to pick up a friend. Yes, I did have to remind myself we were still in Uganda.

Full Moon Paddle

2009-03-12T23:35:00.000-07:00

There is nothing like paddling a run in the dark to see how well you know the lines. A full moon was the perfect opportunity to do a fun Silverback run. As I dropped down the entrance of the Hump, I realized it was probably the highest water level I have seen here in a long time. It was all good to go, but funny as I watched a friend disappear into the big foam pile down at the bottom.

After Bujagali, I floated on down, enjoying the view of the stars and the moon rising from the east. I thought back to all the fun full moon night paddles I have had over the years: midnight sessions on the Special, night rafting trips on the Nugget-Powerhouse run, or even kayaking the entire 34-mile wild and scenic Rogue River in one night. It has always been a test to see how well I know the lines, or just go with it, and hope for the best. Sometimes not being able to see things makes life easier.

My starlit daydreaming was put on hold as I floated through 50/50 to be greeted by spotlights and trucks hard at work. It was a reminder that Salini never stops. They are working 24/7 on the dam and it is one of the few Uganda projects that is actually making progress rather quickly. My friend and I looked at each other, wondering what kind of security they might be having on a night like tonight. We just realized we had to be faster than the one next to you. I figured if they did start pulling out guns, I would just flip and hold my breath as long as I could. We made it out alive, with a fun line down the new Silverback rapid at high water. No guns, no security that saw us, just maybe a few Salini workers wondering what these crazy kayakers were doing on the river at such a late hour. The first few rapids were under the moon, but the rest of the run was fully lit from construction work. Well done.

Staff Rafting Trip

2009-03-03T07:38:00.000-08:00

After all these years of this project, which mainly employs Ugandans, none of our staff has ever been rafting before. Most do not even know how to swim, and generally still think we are crazy for being in the river. Some people avoid getting anywhere close to the river after the Idi Amin administration murdered thousands of people and threw the bodies in the river back in 1970s. The river was red with blood as the bodies floated downstream. I understand how these dark memories could haunt someone forever. Anyway, we finally managed to do a staff rafting trip. Everyone was invited to come, but only the brave ones were willing to go for the challenge. We took 8 of our staff members down the day 2 stretch, a mellower big water class 3 section. Only 2 of them know how to swim. However, by the end of the day, I managed to get Livingstone to jump out of the raft and swim downstream in the flats with me. I was impressed. They all had a great time and have already been asking about the next rafting trip. Who knows! Maybe everyone will leave us soon and start guiding for Nile River Explorers.

Salini Tour

2009-02-23T18:34:00.000-08:00

Salini is the Italian company that is building the Bujagali dam, funded by the World Bank. Since the dam will flood out many of the homes of the villagers who live on the water, the World Bank is trying to be nice enough to help these people on a short-term basis. Salini has selected 4 surrounding villages on each side of the river to distribute free nets. Although this is against our protocol at Soft Power Health and we do not want any official affiliation with this project, we agreed to at least offer some training and beg them to at least educate the people about malaria and how to use their nets. We had a meeting with the woman who is organizing this project at the Salini construction site. Although she agrees in our subsidized net sale program, the big boss up top at the World Bank does not. Either way, Jessie and I were at the dam site for our quick meeting. Afterwards, we asked if we could get a tour, and sure enough, we were given our neon construction vests and a hard hat and off we went. We drove around the construction site to see the remains of our long lost rapid. The guy told us how cool it was that a particular part of the site used to be an island. I sat there, holding back my actual opinion, and looked down to see what used to be this amazing play spot called the Ugly Sisters wave. We then saw the turbines under construction, the rock-crushing site, and the hundreds of buses and Salini cars. The place felt like a city of its own. It was depressing, but interesting to see it from their perspective. We definitely did not tell them that we were kayakers. Silverback is still up and running. I have heard rumors that it will be around for a while, maybe even until April 2010. I am skeptical to believe what I hear, but we will see. I am enjoying it while I can.

More Flying at Sipi

2009-02-15T21:12:00.000-08:00

After doing a few net sales outside of Mbale, we were able to go back up to Sipi. It turned into a good Valentine’s Day weekend of Jessie, Polly, and me. I was able to do a little flying again, which was good fun. A bunch of the kids have made their own mini parachutes now (small plastic garbage bags and some string). It is great to have them release their parachutes so I can see what the wind is doing. However, I am just hoping they do not jump off the mountain with their own homemade gliders anytime soon. Here are some more photos taken by Will Clark. Polly filming The mini parachutes Flying over launch Yikes Down at the landing zone. Quite a crowd!

Nomads #2

2009-02-06T11:58:00.000-08:00

The last few weeks have been busy with work, play, and filming. Polly Green has returned to make her next video about the project here in Uganda. She made her film “Nomads” about 3 years ago, just when the clinic was opening. Now she is here working on a follow-up film and a little promo/fundraising video for us. It has been good fun, but always a little interesting to have a camera follow us wherever we go. Fortunately, I am just the sidekick, which makes me happy. Jessie, Polly, and I have been having lots of fun though; we have had plenty of net sales and family planning sessions, kayaking adventures, and dance parties. We have been trying to cram everything in to get those shots that Polly needs. We went down to Kalagala for a park and huck session and spent a little time at the Special before the low water started. Hopefully some of the footage turned out. I think Francis has been enjoying the camera as well (i.e. jumping on the roof of the car with the loud speaker before a net sale, or emphasizing the condom demonstration with the black dildo at the family planning sessions). I never thought I would become a stunt devil but who knew! Hopefully Polly has what she needs.

Inauguration

2009-01-20T22:10:00.000-08:00

Today seems to be as much of a holiday in Uganda as it is back in the US. I sat down in the same place I was 11 weeks earlier, where I watched Obama give his acceptance speech in Chicago. There I was again, surrounded by plenty of Ugandans and a few Americans. We were all very excited to watch this historical moment. Today is the first time I have been proud of my president in a long time. It feels kind of nice. Who would have thought?

Blasting at Silverback

2009-01-10T11:09:00.000-08:00

Well, Silverback has started to change again. After diverting the Ugly Sisters channel in August 2007 (date?), Silverback has become a bigger, surging rapid. However, the dam company has now started to blast on river left at Silverback. It used to be a nice, lush jungle but now it is full of huge, loose boulders that were pushed into the river. The channel has become a bit narrower and the standard line has changed. My first time down after the blasting, I cut hard right and still got pushed into the eddy on the top left. Rumors have it that Silverback will be closed off by the end of this month, but I am hesitant to believe it. We will see what happens.

Christmas at Sipi

2008-12-30T20:20:00.000-08:00

I have never been a big holiday person, but this last week has been full of good times surrounded by the right people. Early morning on Christmas Eve, a few of us jumped in the Delica and off we went up to Sipi River Lodge in eastern Uganda. Our friends cooked up a storm of amazing food and we all had a relaxing Christmas day of eating, drinking, and enjoying each other’s company and the good view of Sipi Falls. My time at Sipi was also a great opportunity to do some more paragliding. I did some solo flights and more exploring and flying with Steve Fisher after he and Des arrived on Boxing Day. It was great to get up in the sky again and fly around some new terrain. The area has huge potential; I ended up flying at over 5 sites with many more potential spots. The best part of flying at Lower Sipi is the view: once I was up in the air, I was able to enjoy the view of all 3 waterfalls flowing down Mt. Elgon. I have realized that the hardest part of flying here is finding a landing zone that is not full of kids. As I soared along this ridgeline, I looked down at the roads and goat paths to see tiny creatures running from every direction. I was in farming country, and suddenly, I became the mzungu falling from the sky. There were about 200 people surrounding me at the LZ on the first few days; by day 7, it was maybe down to about 50. Either way, I had plenty of company at launch, landing, and even on the hike out. Now I am back home in Jinja just in time for New Years. It was good to get away for some good company, flying, and even a little climbing.

Kampala

2008-12-18T07:25:00.000-08:00

This week has had some long days for sure. I have made a few trips to Kampala for one of our patients; she is a 32 year-old female, mother of 4, who was diagnosed with Hodgkin’s lymphoma back in May. We began sponsoring her chemotherapy treatment in Kampala. However, after showing little improvement at Mulago Hospital, another biopsy was performed at the International Hospital and the diagnosis changed to non-Hodgkin’s lymphoma. It was sad news, since there is a much higher hope of surviving Hodgkin’s lymphoma, especially since she began treatment at such a late stage. Now it has reached stage 4.

Between treatments, I visited her at her home after her brother called saying she was not well. She was too weak to stand alone, with no appetite and vomiting for the last few days. She was complaining of pain on her right side and a tender right abdomen due to the cystic tumor masses that have spread to her liver. Although scheduled for another round of chemotherapy in a few days, I was worried she would not survive the drive to Kampala. We started her on oral morphine to help with the pain, and fortunately, she was looking much better by Monday. We decided to get her to the International Hospital in Kampala to continue her pain management.

I kept thinking to myself of the unofficial oath of medicine: do no harm. At this point, she is too fragile to undergo further chemotherapy. I discussed the options with her doctor. We decided it was time to discontinue treatment; the plan was to undergo blood transfusions to increase her Hb and counsel her to make plans for her children after she is gone. The doctor then spoke to her in Luganda, and I assumed told her what we had just discussed. I had offered to donate blood on Monday but all the nurses said there was enough (she is B+ and I am O+, the universal donor). Although I was hesitant to believe them, I left anyway.

I returned to Kampala yesterday after getting a hold of the doctor and learning that there actually was not enough blood for her. After donating in the lab, I walked upstairs to the Hope Ward to tell her that blood was coming her way very soon. Although I have donated many times, never before have I actually watched my own blood go to someone else, especially a friend and someone so dear to me. I began explaining that she will get this transfusion to boost her Hb and then she will come home to Bujagali in the next few days. She was very grateful, but then asked when she was going to get her chemo.

I took a deep breath, realizing that everything I had discussed with her doctor 2 days prior had not been explained to her. She had received no counseling and had not been able to mentally prepare herself for the steps ahead. I reached that point where I felt completely helpless; all I had left to give was a language barrier of emotional support and a pint of blood.

Paragliding Near Lake Victoria

2008-12-07T11:16:00.000-08:00

After watching the birds catching thermals in downtown Jinja, I finally managed to go flying this last weekend. There has been too much talk and I was going a bit stir crazy; I had to go flying again. After arguing with security guards to let me scout a flying site on the Kakira Sugar Farm just outside of Jinja, I left and went to another ridge site and launched from a secondary school. All the kids were super excited when I showed up; they guided me over to the launch site where a friend of mine has flown before. It was a pretty tight, dodgy launch but totally worth it. It was great to get up in the air again and quite entertaining to have such a big audience, both launching and landing. I was able to get in 3 flights and catch a bit of lift, soaring with the birds. I looked down and watched the kids chase me from one end to the next; I heard screams of laughter and excitement as I made 180° turns. After soaring around for a while, I started to head down to land. I looked ahead to see the beautiful Lake Victoria, the second largest lake in the world and the source of the mighty fine White Nile; it is a pretty cool view.

It was a good way to spend my Saturday afternoon. I worked for a bit in the morning, went flying, and then hopped on the back on Muhammad’s boda-boda for a sunset cruise back home.

'Tis the Season of Circumcision

2008-12-01T18:04:00.000-08:00

This weekend turned into an adventure of sorts. We had a net sale just outside of Mbale, a few hours east of Jinja. We packed up 600 nets and off we went. While teaching the session in Bugusege Central Village, we heard chanting and singing off in the distance as we watched crowds of people dance through the streets. People were dressed in banana leaves and covered in white paint. I realized it was circumcision season and the whole community was gathered for the day’s event. I saw countless people dancing in circles, then realized one of them was our driver, Francis; he had snuck off, dressed himself in his own costume, and joined the fiesta. He never seizes to amaze me. As I watched these groups dance and sing through the streets, I realized the soon-to-be circumcised males were 18 years old. Many of these tribes still practice circumcision for males at this age, and female circumcision for teen girls as well. If one shows any emotion of pain, he is not considered ready for manhood; many Ugandans are very surprised to hear that some mzungu males are “ready for manhood” 3 days after birth. As much as I try to respect cultural traditions, it is hard to not look at these practices without a medical concern. Multiple circumcisions are performed in these deep villages using one knife; it is anything but sterile. It is scary to think of the infections that occur because of this. Aside from the countless circumcision ceremonies that passed us during the 4 hours, we still managed to sell 380 mosquito nets. With the long drive to Mbale, it was a perfect excuse to stay the night and visit our friends’ place at Sipi River Lodge. It has definitely changed since last time I was up there in April when Ian, Fraggle, and Will were tearing it to pieces to start over. The lodge is up and running now and looking great.

Back on the Nile Special

2008-11-24T08:44:00.000-08:00

After being back for a few weeks, I was finally able to make it back down to the Special for some big water play. It was great to get back on the wave and have some relaxing island dwelling with some friends. After a full day of work, I cruised down to Steve’s island and floated downstream for a sunset session on the Special. The next day consisted of chilling in the hammock, fishing for our 6 kg Nile Perch lunch, kayaking, and coming back to Jinja to organize for Timmy’s Biathlon Island Bender on Saturday. The biathlon bender was a great hit. It started with a day 2 trip down to Steve’s island; we had 2 rafts, plenty of kayakers, and any other type of watercraft found at the Jinja market (i.e. inflatable dolphin or whale). We had some good laughs on the river, then arrived at Steve’s island for a few rounds of croquet, swimming, and plenty of laughs and boos. As we watched the sunset, we all packed up for a quick float down to the Hairy Lemon for round two of the bender. I put on my dancing shoes and had a good time. Now I am back to work. It was good to get away for a long weekend of distraction. Hopefully more time will come soon.

7000 Mosquito Nets

2008-11-15T16:32:00.000-08:00

This was another typical week of family planning and malaria education sessions, and all the other random things that come up when managing a rural health clinic. However, after all these net sales, the shed was starting to look a bit empty. Although I was not involved much in the logistics of getting the nets from India, we have been on call for the last few days. After getting shipped to Mombasa, we were not sure whether it would be a road trip to the Kenyan border or to Kampala to pick up the 140 heavy bundles of nets. It was an entertaining day to say the least. We packed up the Crusier and another Delica and started heading to Kampala after being told the nets would be ready on Thursday. However, we got another call saying they were not ready yet but needed to get out of the Kampala warehouse as soon as possible. Instead of making the long drive, we sat around on call, until the woman finally called at 4:00 PM saying they were ready and must be picked up now. She did not seem to understand we were coming from Jinja and it would be a few hours before we arrived, even though we told her multiple times. Anyway, we finally arrived and loaded as many bundles as we could into the Cruiser and Delica (each bundle holds 50 nets). As the sun was setting off in the distance, we realized we had to hire a truck for the remaining 5000 nets. Off we went on our drive home to Kyabirwa. As we caught up with Moses, our Delica driver, and did not see the truck anywhere in sight, I started dreading the possibilities of losing those other 5000 nets. It made me realize that we did put complete strangers on a truck with about $32,000 worth of mosquito nets.

Francis jumped on the gas and passed Moses, in search of this missing truck. Annie and I sat there, crammed in the front seat with our eyes on the lookout. We caught up to a truck with white bundles in the back; it was a sign of relief until we realized it was the wrong truck. When driving in the dark, big, white bags of rice look very similar to bags of nets. By the 5th truck we reached, we finally saw our bundles of nets still packed in the very same truck; we were relieved.

It was a good 15-hour day. Fortunately, some strong local men did not mind the extra work by the time we got the clinic at 9:30 PM. The shed is now packed to the brim and it is hard to even close the door. Although it was an expensive day of fuel, drivers, and village helpers, I was very relieved to have the 7000 nets back in our possession. We will see how long until we run out again.

Obama! Obama! Obama!

2008-11-07T12:23:00.000-08:00

I normally avoid discussing politics with everyone, especially on an online blog. However, I decided to go for it anyway, so here it is.

It has been interesting to watch the United States elections from the other side of the world. With the 11-hour time difference between Uganda and the west coast, I sat around Tuesday night watching CNN. I finally had to go to sleep to distract myself as much as I could, receiving occasional text messages with an update on the election. Ohio, Florida, Virginia….I jumped out of bed and ran to the nearest TV. I found myself surrounded by Ugandans, and one by one, everyone worked his or her way into the room with an anxious look on his or her face. It was an international crowd of Obama supporters sitting together at 7:00 AM in the tiny village of Kyabirwa, Uganda; we had representatives from Uganda, Australia, England, Ireland, Canada, and only a few of us from the USA. We were relieved, excited, and exhausted as we listened to Obama’s victory speech in Chicago. It was an emotional morning here in Uganda; maybe there is hope in this world. On my walk to the clinic, countless Ugandan friends were as excited as I was. “Obama! Obama! Obama!” they chanted. I sat in the car on the drive to our net sale with my ears glued to the BBC radio. Some years down the road, I wonder when we will ask each other, “Where were you when Obama got elected?” Seeing it from Uganda has given me a different perspective. Obama’s picture has been on the cover of every local newspaper for the last few days. I have seen Ugandans wearing Obama shirts, or even trying to buy a shirt off of a mzungu. His name was even written on the back of a matatu. The world is watching, and now, the world is celebrating. People danced around the streets of Jinja on Wednesday night to celebrate the elections from a continent away.

Unfortunately, Obama has a mess to clean up: the financial crisis, two wars, the Bush Administration. It will not be an easy road to travel, especially living up to these high expectations. However, in his speech in Chicago, I believe he reminded us of the reality: this is not something he can do alone. As Gandhi said, “Be the change you wish to see in the world.” Although I believe American politics and citizens struggle to follow this concept, it is a good sign that we, as Americans, could stand up and take the first step: vote for change. Yes we can!

Back in Uganda

2008-11-02T18:21:00.000-08:00

Hello again from Uganda. It is funny how some things never change; sometimes it feels like I never left. On the drive to Bujagali on Wednesday, one year after my last arrival, I was somewhat surprised how many old friends I saw. Maybe not surprised at seeing everyone again, but somewhat flattered they all remembered me. It makes me feel somewhat wanted and missed, something I never thought would happen. When looking back on the last 6 months in the US, I did not feel settled there at all. This is where I actually had a “home” and a bed that I slept in most nights. I chose to live in the back of a truck for my time in the US; it made it possible for me to finish with school in Washington, work as a multi-day river guide in southern Oregon, road trips to Idaho and California, and then paraglide back in Washington. However, as my time was coming to an end, I became tired of being on the road all the time. I was tired of meeting new people and saying goodbye. I was tired of not knowing where I was going next. I was tired of being alone.

Countless people have said, “Morgan, you are lost” since I returned. In Ugandan terms, this just means you have not seen someone for a while. But maybe I have really been lost. I was totally overwhelmed when returning this spring. I had work plans for the summer, but then life was totally open ended. I had ideas, but nothing set in stone. When this job came up, I decided to go for it. However, I admit that I was second-guessing my decision; it is always tricky going back to the same place and not having expectations. Fortunately, I am aware that this time is a totally new trip: I have a new job with more responsibilities and more stress. It is exciting and scary at the same time. I have been going over everything with Annie and I am glad I will be able to work with her until she leaves in mid-December. I have a lot to learn and I know I will still mistakes, but working with Annie will make this process a bit smoother.

Deep down, I know this was the right decision; I am passionate about public health and traveling. I enjoy living simply, which is much easier to do here than being surrounded by the consumerism of the United States. I am totally guilty of it as well. People have nothing, and they are still happy here; it reminds me about what truly matters.

Aside from training, we have had some more amusing days as well. The day after arriving, I went back to Kampala with one of our patients with non-Hodgkins lymphoma. She was going back for another round of chemotherapy, but it turns out the oncologist only works Monday to Wednesday; we turned around and came home. Then of course, we were supposed to have a net sale today, but we drove there and the mobilizer decided to cancel the session due to the rain. So I guess there has been a lot of driving without much accomplishment. I am not giving up yet though; we are still getting things done, just slowly, slowly. It is a bit refreshing to be back on Uganda time.

Six Months of Update

2008-10-16T22:32:00.000-07:00

Sometimes it is hard to believe 6 months have passed. I have said this many times before, and maybe it is because I seem to take my life in phases of 6 months. I look back on my time since returning this spring and it is somewhat blurry. I finished up with Evergreen and received my pretty little piece of paper saying I have a Bachelors of Science. I put that degree to work by guiding on the Rogue River a bit, and I managed to squeeze in private trips down a few more amazing wild and scenic rivers: the Illinois, Middle Fork Salmon, and the Grand Canyon. I did a little climbing in the Olympics to enjoy the heavy spring snow pack, and then learned to paraglide this fall. I now have my pilot’s license for paragliding and it has been a good challenge to do something completely new; I was hooked on day 1. Aside from all the adventures, the last 6 months have been a bit sobering; I have made new friends and lost others along the way. A few days after helping teach a Swiftwater Rescue course, our friend died kayaking the Green River; he and his boat disappeared into a nasty sieve and did not submerge until the water dropped 6 days later. The river is always forgiving, until it is not. It was a terrible 6 days of feeling helpless, sad, and frustrated. I was reminded of everything my WEMT instructor, Tom Clausing, taught me about wilderness rescues and recoveries. Sure enough, Tom was killed 6 weeks later in a helicopter accident while bringing in a patient from the Grand Canyon; he was a flight medic for the park service. I have been reminded of the fragility of life and being down in the canyon made me feel so small and insignificant (in a good way). On the bright side, both Mike and Tom died doing what they loved. On a happier note, I was able to attend the wedding of my dear friends, Karl and Tara. It was a great excuse for a trip out to Jackson, Wyoming and a long weekend reunion with my mzungu “Ugandan family.” Plus, it was a great 3 days of celebration for the bride and groom. It is funny how we all bonded together so well in Uganda, and in all honesty, we spent a considerably short amount of time together. However, it felt like much more and it was great to see the strong connection between all of us again. Jim and Sheri are back in the States figuring out their next “home,” Shannon is still based in Bozeman, Anna had just returned from Uganda and is off to Nepal soon, and Karl and Tara are now starting their next phase of life together. As for me, I am at my next phase of life as well. I will be returning to Uganda at the end of the month to take over Annie’s job as the manager of Soft Power Health. It is for a somewhat indefinite amount of time, but I have committed to work through next summer. I am excited to get back, but it always seems to be a bittersweet return. I will leave behind some good friends, but when I really think about it, some of my closest friends are the ones out living the life and following our passions: we avoid desk jobs, we get our hands dirty, we play hard, and we have a little fun and adventure while we can. Be well, dear friends. I will try to keep everyone updated, but occasional emails and updates from all of you are much appreciated as well. Happy days.

Back in the US...

2008-04-29T16:37:00.000-07:00

Paved roads, running water and electricity, driving on the right side of the road, stop lights, pasty skin, everyone is speaking English….what is this? I am spotting countless mzungus, and it reminds me of driving around with Francis on “mzungu capture” in Kampala. However, now there are mzungus everywhere. I packed up my things and felt on the edge of tears; it is amazing what sunglasses can hide. I just wanted to bundle up in fetal position and escape – change my flight again and stay just a bit longer. I was just starting to pick up some work for guiding – with Nile River Explorers and Adrift – and then my day came to leave. Anna extended her stay again and is now working for Kayak the Nile. As I sat in the car driving to Entebbe, I watched the sun rise to the east and wondered if I would make it back. It will be refreshing to be somewhere else, and back into the multi-day river trips. The whitewater is not nearly as exciting as the White Nile, but guiding 4-day Rogue trips is far more fulfilling and rewarding. It is hard to believe that 6 months ago I was packing up and off on my way to Uganda. I had few expectations; the door was wide open and ready for whatever was to come. Sometimes it feels like it was just yesterday, but also ages ago. As I said before, I was definitely settled in Uganda, probably far more than I have felt in a long time.

Now I am back here in the States, unsure of the future plans. I am finishing up with school things and trying to put together a presentation to represent the work and experience I had in Uganda; however, no words can ever tell the true tale. It is one of the hardest things about traveling and trying to share these experiences. So what did bring me back? I was asked a few times to extend my ticket and guide for the busy summer season, but I suppose finishing up with Evergreen would be a good thing to do, along with a private MF Salmon trip in July, and a Grand Canyon trip in August. Now after that, maybe go back for some work on the White Nile before it is long gone, or meet up with some long lost friends on a trip to Nepal this September. Only time will tell.

My Last Goodbye

2008-04-22T15:23:00.000-07:00

I remember when I first got here and told myself I probably would not want to raft guide here; the responsibility of paying customers was intimidating with the big water and excess carnage. However, it has been a lot of fun to get back on the sticks again and pick up some work here on the White Nile; I also needed to keep myself busy for my last few days and I am reminded of how much fun guiding can be. And I am getting paid for this? Now I might actually be able to make it back to the States, although it is tempting to stay longer and keep working for the busy summer months. The group of Inner City Kids from Upward Bound in New York arrived here on Sunday evening. They have come for their weeklong spring break to volunteer with Soft Power Health and a day of rafting on the Nile as well. Unfortunately, I fly out during the middle of their trip, but luckily, I was able to see Rosanna again, one of the chaperones I have worked with over the years, and a few returning kids from years before. Again, it is short and sweet, but such an eye opening experience for these kids, most of whom have never left the city of New York. Coming to rural Uganda, or even the wild and scenic Rogue River in years past, is definitely a change of scenery.

I rallied some of the boys to come along for my last Silverback run before flying out tomorrow morning. The idea of leaving still seems surreal. As I carried my boat up the hill, with my back to the depressing construction site of the dam, I could not help but wonder if I will ever see this section of the river again. I hopped on the back of the boda-boda with Ronald driving me home; I am still not ready to leave. This is the most settled I have felt in years. After spending so much time here, it would be hard to never come back and see all the friends and connections I have made over the last 6 months. I have tried to say my goodbyes to everyone I know, especially my dear friends and co-workers at Soft Power Health; they have all been so generous and willing to take me under their wings at the clinic.

I am never very good at goodbyes. I guess I do have some things to sort out back “home” in the States. At least I might have my foot in the door now, either with Nile River Explorers, Adift, or Kayak the Nile. Plus, I am leaving my kayak here, so it might be my excuse to myself to come back sometime down the road.

Damn Dams

2008-04-18T13:39:00.000-07:00

As the clock keeps ticking, I have been spending my last few days on the water – a little teaching and plenty of playing. I went back down to the Hairy Lemon for a few relaxing days surfing on the Nile Special and the Club Wave, and now back to Bujagali. With the big plans of doing a Silverback run this afternoon, we arrived back at NRE and were delighted to read the sign: “Blasting on 18/4/08. Stay clear all afternoon.” I cannot help but wonder the long-term effects of the Bujagali Dam; after completion, it will likely wash out all the whitewater down to Silverback. This will definitely affect the local community, most likely more bad than good. It will probably lead to a decline in rafting and kayaking tourists, and therefore show a decrease in clientele at NRE; most of Kyabirwa village is employed because of this heavy traffic in Bujagali: raft guides, safety kayakers, shuttle drivers, staff at NRE campsite, bar, local restaurants, boda drivers, chapatti stand, etc. After flooding out the river, I would not be surprised to see an increase in malaria and bilharzia because the lake will serve as a perfect breeding site. Of course, there are arguments that the dam will benefit the local community with more electricity; however, my guess is that the electricity will likely be sold to neighboring Kenya and the private dam companies will benefit rather than local communities. Few people in these rural villages actually have electricity anyway. The power of money is disturbing, especially when the rich are getting richer and the poor are getting poorer, yet again. It is funny how we have started to remove dams back in the States because of the lack of sustainability; however, back here in Uganda, they keep on building new ones. Someday we will learn.

Another Day of Public Transport

2008-04-14T15:28:00.000-07:00

I sit crammed in the back corner of a matatu on a hot Monday afternoon. I can feel the sweat rolling down my back as I sit shoulder to shoulder and count the 23 passengers jam-packed into one matatu. There is nothing unusual about the busy days of public transport; I always laugh when I read the sign painted on all matatus: “licensed to carry maximum of 14 passengers.” I look around the matatu a little closer: a few crying babies, bundles of matoke piled on top of the roof, the smell of fish grilling on the front of the car, young, nursing mothers in the back, or maybe the 3 live chickens squealing and running underneath my feet. There is never a dull moment here. Everything is a bit slower, whether it is from transportation or the healing of a small, infected cut on my foot. Yesterday was pouring down rain and life was on hold here; the roads become muddy and unbearable, bodas are dangerous and impossible to drive, the markets are dead silent as everyone huddles under the trees and just waits until the sun comes out and shines again. I believe laughter has brought me a long way in life; I have learned to enjoy the most of it and a good sense of humor has saved me countless times. I peak through the tiny crack in the window as I try to gasp every bit of fresh air to cool off. I look off into the mountains of green, lush jungles; it almost looks like the Grand Canyon except covered in rain forests instead of the dry deserts of Arizona. It is a beautiful countryside filled with mountains, rivers, farms, and Ugandans who have lived a much harder life than I have. I still have a hard time believing I have been here nearly 6 months; it was not until the other day that I felt ready to leave. The transition phase is a tricky place to be: I had more or less stopped working with Soft Power Health, returned from traveling to Rwanda, and became sick and unproductive for a few days that I finally felt ready to move on (maybe another round of bilharzia for all I know). Maybe it is good that I will be leaving relatively soon; it might be my time to go and find a change of pace and change of scenery.

After living here, I will never forget to just sit back and relax; I have spent too much of my life in a hurry, running from one thing to the next. However, here I am now, sitting in a matatu that stops every 100 meters to add more passengers when I never thought it would be possible to fit anyone else. I laugh at the situation; sometimes the Ugandan logic makes no sense at all, but instead of going mad with frustration I am enjoying every moment while I can.

Land of a Thousand Hills

2008-04-06T14:07:00.000-07:00

After a beautiful drive through the endless hills of Rwanda, I understand why this tiny country in East Africa is known as the “Land of a Thousand Hills.” I had plenty of time during the 10-hour bus ride from Kampala to Kigali to enjoy the scenery. Along with the travel was the madness of being in a new country again: new language I do not understand, different currency, which of course, I found myself converting into shillings rather than dollars as a reference, driving on the right side of the road, all boda-boda drivers wearing helmets and even having helmets for their passengers, paved roads, rubbish bins throughout the city, pedestrians with the right-of-way for crossing the street, the list goes on! I believe people can even get a ticket for jaywalking. It was relieving in some ways, but I was ready to come back home to Uganda where I know how much a certain boda ride should cost, the normal price for food, and I am not expected to understand French. This trip to Rwanda made me realize, again, that I have been here in Uganda for quite some time and it does feel like home. Today, the 6th of April, marks the 14th anniversary of the beginning of the Rwandan genocide. It is still hard to believe that such a massacre occurred, killing 800,000 people during this 3-month period in 1994. And it all started as an ethnic cleansing of all Tutsis, or anyone married to, employing, or befriending a Tutsi. I walked through the dark halls of the Kigali Memorial Museum, looking at the photos, video, interviews of the survivors, and the remains of the murdered: leftover clothing, skulls, bones, and chains. The hardest part was seeing photos of murdered children with their names, age, favorite sport and food, best friend, last words before death, and the way each child was killed. The most common cause of death was “hacked by machete,” along with “shot in the head,” or “smashed into wall until stopped screaming.” I wonder where some of these kids would be today – maybe finishing up secondary school or being 22 and working at a rural health center. I always thought I had some hard times in 1994, but now I am reinforced of the insignificance of my own memories; I was not gang raped and butchered by a machete, or watching my family slaughtered in front of my own eyes. Sometimes it is hard to believe that every Rwandan over 14 years old has his or her own version of the story to tell.

It is scary that human beings have the ability to perform such violence and hatred toward each other. While looking back on all the genocides, it comes down to ethnic cleansing, religious segregation, poverty, or civil war: the Holocaust, Bosnia, Armenia, Cambodia, Namibia, Rwanda, and now in Darfur. It is funny how organized religion seems to have caused more war than peace. And now, outside the Kigali Memorial Museum, numerous massive graves bury the corpses of thousands of unidentified bodies from 14 years earlier.

My “Not” Going Away Party

2008-03-26T16:22:00.000-07:00

I was supposed to be sitting on a plane flying to London right now. However, I realized I was not ready to leave and extended my ticket last week. It sure is a common theme here in Uganda; I have come across countless people who have extended their stays. I am sure that a month down the road when I am currently scheduled to leave will feel similar in my fear and dread of coming back to the States. However, I decided to make the most of it and enjoy another 4 weeks here in Uganda. Instead of having a “not going away” bender for my supposedly last night (as everyone else seems to do), I made the most of the high water here and went down to Malalu, another great big-water wave that rarely comes in. After a good sunset session with some friends, we headed back to the Hairy Lemon and then had a good session on the Nile Special this morning. I am glad I am not sitting in London right now waiting for another plane to catch to Seattle. Someday it will happen, but another month here will not hurt.

I have not been working with Soft Power Health as much as before, which may be obvious by looking at my last few entries of trips to Murchison and Bwindi. I guess it is from a combination of reasons: plenty of new volunteers coming and handing off the work to them, or mainly running out of time to fit in everything I have been hoping to pack in during the last 5 months. I am trying to make the most of my time before the huge culture shock and reality check of coming back to the States.

Western Medicine & Witch Doctors

2008-03-23T17:26:00.000-07:00

Sitting at the International Hospital of Kampala on another rainy day, I try to give this 11 year-old girl some words of comfort; however, the language barrier continuously gets in the way. She has been sick for 6 months and suffered multiple convulsions, which led to her loss in ability to walk, see, and control her bladder. I knew deep down that the results from her CT scan would not be good; at least we might be able to figure out what has been going on for these painful months. She came into our clinic some days back, and it did not take long to decide we needed to head to IHK.

The moments, hours, even days, of waiting are too familiar. Of course, the CT scan was done on Friday morning, which means results were not interpreted until late Monday. The weekend of waiting seems like years. After multiple phone calls to IHK, I learn this girl has been suffering from increased ICP and cerebral edema secondary to multiple abscesses in multiple lobes of her brain. I held her CT scan into the light before she was rolled off into the operating room; these 4 large abscesses overtook most of her frontal lobe and part of her right temporal lobe. I was surprised that this dear friend was still fully oriented and could hold normal conversations (aside from my inability to speak fluent Lusoga). A few days later, I would see her lying in the ICU after her second surgery to drain the abscesses. It turns out that the abscesses were filled with fluid soon after the first operation, and they went in again to repeat the same procedure. We are still waiting on the pathology report and the doctors are unsure of the source of the abscesses or have much reasoning behind the diagnosis.

The last few weeks have been filled with familiar days of waiting in a hospital, knowing bad news is coming our way. I have had more moments of frustration and helplessness, wishing I could trade places yet again. The outcome for this 11 year-old girl is not looking so good, but she remains a strong fighter, unwilling to give up so easily. Her case is rather unusual, and on top of that, she is here in a 3rd world country where I was even surprised to see a neurosurgeon on staff at IHK. I wonder whether I am helping by trying to talk to the doctors and family, or just getting in the way. We had another boy with nephroblastoma from a few weeks back who failed to show up to the clinic for his ride to Kampala for further care. I spoke to his father a few days later and he said they did not come because he is getting treatment at another place. I was hesitant to give up so easily or trust the care he was getting if it was near his rural village. As I learned the other day, this 3 1/2 year-old boy died 7 days ago; his family was bringing him to a witch doctor instead of coming to Mulago Hospital in Kampala.

Maybe IHK or Mulago would not have had much else to offer this young boy; however, it is hard not to wonder if the outcome would be any different. Here in East Africa, there are still plenty of Ugandans who would choose the witch doctor over any health center or hospital. People still believe sleeping with a virgin can cure someone of HIV. I suppose it does not help if the South African president tells his people they cannot contract HIV if they shower after every time they have sex; he then fired the South African health minister for disagreeing with him. It is a scary world we live in, and hard to know my own boundaries of whether I am helping or just invading traditional practices.

Acting Career Begins

2008-03-12T15:06:00.000-07:00

I am not so sure how it all happened, but I ended up heading out to Bwindi to be an “extra” in some Swedish reality show. It was a last minute decision to go, but the producers called up Kayak the Nile saying they needed 5 extras to come out to Bwindi for one day of reality show acting; all food, board, and transport would be covered, plus some easy money for a day of acting. Without much knowledge of what we were getting ourselves into, 5 of us piled into the Delica at 5:00 AM Saturday morning and headed off on our 13 hour drive. It was a perfect excuse for a road trip, easy money, and plenty of time to enjoy the company of the 5 mzungus from 4 different countries: Wales, New Zealand, Zimbabwe, and the States. Basically, the filming we did is for the 10-minute pitch for a Survivor-like show where 13 people will be sent out into the bush for 21 days in Bwindi Impenetrable Forest in search of the gorillas. Their main goal is to show the similarities in behavior and interactions of humans and gorillas. Reuben was the “silverback” of our group and had plenty of his own women to put to work, whether it was building a shelter, gathering supplies, or leading the way through the jungle with machetes. Becks and I tried as hard as we could to have our “girly talks” by braiding each other’s hair multiple times while sitting by the creek with a camera in our faces. Hopefully they will be able to use 2 seconds of the footage for something. It was a fun road trip with easy money and a good excuse to make it back to Bwindi and spend an extra day at Lake Bunyoni on the way home. Of course, it is no true road trip without some car trouble. Overall, it all went smoothly. I never thought I would see myself getting into acting, especially reality television, but life has plenty of surprises.

Murchison Falls

2008-03-06T10:23:00.000-08:00

We just returned from a trip up to Murchison for the weekend. We were joined by Anna’s parents, who just returned to the States after being here for a quick 10-day visit. It was great to meet the family and a good excuse for me, Annie, and Anna to go up to Murchison and see some more countryside in the northwest corner of Uganda. We managed to not get eaten by hippos or crocodiles, which was a plus. Standing at the top of Murchison Falls was incredible and another moment where I felt so small and insignificant; it was great. Aside from seeing the hippos, lions, and amazing waterfall, I was disturbed by seeing signs of instability in northern Uganda. The remains of the Lord’s Resistance Army (LRA) attacks were not hard to miss; we passed by hundreds of homes for Internally Displaced People (IDP) and saw the remains of deserted burned trucks attacked by the LRA a year ago. Although things have settled down in northern Uganda in the last few years, the aftermath is still here. I spoke to a woman working with young victims of the LRA who were kidnapped for sex slaves or forced to be in the army at the age of 12. The disturbing past cannot go away that easily. It was just over 2 years ago that the owner of Red Chili’s (a hostel where we stayed for a few nights) was killed by the LRA. The sad thing is that, of course, the killing of one mzungu gets much more media than the killings of thousands of innocent Ugandans.

We sat around the fire one night at our camp in the delta. Maybe the lions would come visit later in the night, or maybe the hippos walking up from the water. I looked across the lake as the sun set into the distance. As beautiful as it was, I could not help but look into the wild lands of the DR Congo and wonder what is happening. Images of the IDP camps and burned trucks kept running through my head. The deserted lands remain a home of instability and violence. The LRA may have fled most of Uganda, but remains a problem in the neighboring DRC and Sudan. It was another reminder that I have lived an easy life.

UKC to Super Hole

2008-02-27T17:57:00.000-08:00

This weekend, we helped rally the Ugandan Kayak Club for a fun session down to the Super Hole. It was great to be a part of it (among the few mzungus allowed to come). We had about a dozen members from the club all outfitted and ready to go, loaded up the truck, hopped in the back, and off we went for a great Sunday afternoon on the water. I still find myself in amazement of how quickly Ugandans can learn. Some have only been paddling for a few weeks and they already have a solid roll and are shredding it up on the wave. Normally, I am not very good at being the camera bitch, but I was very happy to do so that day. It was fun to watch all the Ugandans kayak and loving every moment of it. We only had one swimmer of the day, but most the guys were already doing flat-water bow stalls and working on their next “big move” on Super Hole. Special thanks again to Karl and Tara for all their hard work to get the UKC up and running.

I have noticed that I have not been kayaking nearly as much as when I originally got here. It was great to be out paddling with the locals though. Sometimes being surrounded by too many mzungu kayakers makes me feel as though I am not actually in Uganda. However, I am not any better than any other mzungu here, but the kayaking scene in general can get a bit overwhelming. The scary thing is that I am scheduled to leave 4 weeks from today, and of course, it feels way too soon. There are still so many things to do, but I am trying to make the most of it, and we will see if that scary March 26th date remains the same.

"Mommy! Mommy!"

2008-02-17T15:40:00.000-08:00

I became a mom on Friday. I was not exactly planning it, but walked into the Welcome Home Orphanage for a malaria education session, and within seconds, I was swarmed by ten kids under the age of 4. I made friends instantly, and was quickly distracted from our education session. Luckily, we had plenty of Soft Power Health staff that day so I left the teaching to them and played with the kids instead. “Mommy! Mommy!” the kids would say to get my attention, followed by something in Lusoga or Luganda along the lines of: “I want to play on the swing set.” At first I thought my hearing had gone bad, but after hearing “Mommy” from most of the kids, I finally accepted it and realized I had become a mother overnight (at least, temporarily, which is way too familiar for all of these kids). It was overwhelming, not necessarily the energy spent playing with the kids, but more so from just wondering the reason why every child was there. I wondered how many of them were HIV positive, or at least how many once had parents who died of AIDS. Maybe the saddest part was seeing one of the kids wear a shirt that said, “my mommy loves me” right on the front. Wow. Maybe it is good that the kids do not understand everything in English.

February has always been a hard month; maybe it is the short, cold winter days among the other things that have piled together over the years. I look back on where I was some years ago and still find myself a bit stunned that I am here, alive and kicking it. Life is full of surprises, and I am sure there are more to come. The sun keeps on shining here in Uganda, no matter how many people are dying every day – AIDS, malaria, TB, malnutrition, war – but the living keep on living filled with smiles and high hopes, and that is what truly matters.

Running in Circles

2008-02-13T17:38:00.000-08:00

Earlier this week, I had another typical day of getting a patient admitted to the hospital in Kampala (otherwise known as malalu). Of course, it is not all that different back in the States. Rarely can someone walk into a big hospital and get admitted to see a specialist unless he or she has been referred by another physician or walk through the ER and be willing to pay loads of money for the “simple” process of admissions.

Anyway, the day was spent on tour of the Kampala hospitals. First, we went to IHK (International Hospital Kampala) but of course, we were shooed away from the private hospital and sent to Mulago Hospital, instead. Supposedly, IHK does not have an urologist. As we kept walking around in circles of hospitals and wards, I tried to keep myself amused even though our patient is a 3 1/2 year-old boy diagnosed with nephroblastoma 2 days ago. It is all fun and games until it is not. I was very appreciative to have the driver with me because he has connections at Mulago after his own 3 year-old twins were both diagnosed with tuberculosis.

We finally got our patient admitted to the hospital by going through the casualty ward. He was not really a casualty patient, but it was our only option at that point, and luckily, we managed to pull it off but still with the hopes he will see an urologist and oncologist in the next few days. I have been on quite a few trips to IHK, but never have I seen as much as I did in the casualty ward of Mulago. It is so easy to forget the poor: IHK is private and will outright refuse patients, whereas Mulago is sponsored by the government and all the healthcare is supposed to be free; however, who knows if it actually works out that way when the funding comes from the Ugandan government. I also have my doubts of our patient getting good treatment or even seeing an oncologist after initial care.

I have truly enjoyed working at our rural clinic here in Kyabirwa village, but being at Mulago Hospital made me witness the true shortage of medical staff. Maybe it was the fact that the casualty ward was full of trauma and emergency medicine patients and I sat and watched the ambulances coming in and out as we waited. After spending an intense month in Wilderness EMT school, it would be nice to try to use those skills more while I am here. Sometimes the afternoons in the clinic are painfully slow and I wonder if I could be more productive or helpful elsewhere. However, working in rural and 3rd world medicine sure increases my scope of practice; I may not feel as qualified as I should be, but sometimes I just get thrown in and go with the flow.

I have been asked so many times that the questions barely register anymore: “Are you a doctor? A nurse?” Well, not really. “Are you a social worker?” Umm…sure, sounds great. However, no matter what my background is, I still find myself getting much more experience here than I could back in the States. It could be starting an IV, distributing drugs in the pharmacy, removing stitches at the NRE bar with scissors, tweezers, and a headlamp, or walking home from the clinic and getting pulled into a family’s hut to see a 6 year-old girl crying and screaming while itching head to toe from ant bites. Ah hah! So what’s next in my life? Only time will tell.

Goodbyes on a Happy Note

2008-02-05T08:28:00.000-08:00

It has been a bittersweet week here at Bujagali as everything starts to quiet down: Jim and Sheri returned briefly and are now continuing their way south after being in Africa for over 2 years, Karl and Tara returned to the States after starting the UKC, a few of the guides went back to the UK to get some work done, and Jessie left for the States, leaving me and Anna in charge of the show for a few weeks. I guess it is one of the hardest parts about traveling: making friendships and connections and wondering if I will ever see them again. I am definitely planning on it; we will just see how long it takes this time. Luckily, we were able to squeeze in a few play days before everyone left. Will had to get some photos of all the rapids for a guidebook of the While Nile. Long story short: we took a raft down the entire 45 km so Will could get some photos. Originally I thought it was going to be a nightmare having a paddle raft with 3 raft guides and one “soon-to-be” guide, but we survived. It probably helped that Will just sat up front with a waterproof camera and took photos at the top of every rapid instead of actually paddling. We were all really surprised (and quite disappointed) by the time we made it through the Bad Place and still had only flipped the raft once at Bubugo (which was more so intentional than anything else). We did realize that when all of us were trying to dry flip the raft at Bubugo, it probably would not work out that well.

Of course, we made it down to the Nile Special right before dark (since we started after 1:00 that afternoon) and ended the day by surfing in the raft. We let out a little air, ferried on, and held on tight, laughing in hysterics as surfed a 16-foot raft on the Special. The lighting was not the greatest, but Anna still managed to get some good shots.

Annie returned to Uganda this last weekend. It is great to have her back, but somewhat surreal to hear about life back in the States. Of course, Annie did not make it easy on herself by only visiting the big cities one after another (i.e New York, Los Angeles, and Seattle), but it reminded me of how unexcited I am to get back to the States. Time sure flies by here, but luckily, Anna and I were able to keep things together while both Jessie and Annie were away. However, I am not that disappointed to put Annie back in charge of logistics, drivers asking for more money, monthly paychecks, etc. The language barrier always makes negotiating and planning even more exciting.

Beginning of a New Year

2008-01-21T18:56:00.000-08:00

This year has had an interesting start here in Uganda: riots in neighboring Kenya, skyrocketing fuel prices as a result, deaths of a patient and our dear friend from Mama Joyce’s restaurant, or telling a local friend he is HIV positive. I guess it has not been the best start to 2008, but oh well, I am trying my best to make the most of it.

On a happy note though, last week was the birth of the Ugandan Kayak Club; after all the hard work from Karl and Tara, all the gear has officially been donated to the UKC with special thanks to all the sponsors: NRS, Wave Sport, SR helmets, AT Paddles, and Astral PFDs. So after Karl spent 3 weeks fighting to get the kayaks and gear through customs, the opening began. It was great to be involved in this event; all the locals were very excited to be part of this co-op that provides access to all the gear for an annual fee of only 5000 Ush. However, no good deed goes unpunished; of course, 2 days after the opening of the UKC, 3 of our paddles were stolen while scouting some of the back channels. And they thought we would not notice that our paddles went missing? I am sure that hand paddling down Blade Runner could be an option as well. It was a frustrating day to say the least. The back channel “expedition” day definitely turned out to be a true mission, not necessarily the rapids, but more so running around the village and finding the guilty thieves. I have made a few trips back to Kampala to refer some of out patients to the International Hospital; I keep finding myself in disbelief that I am still in Uganda whenever I go to IHK. Everything seems so clean and up-to-date, however, there are still moments of frustration: misuse of antibiotics without ever doing a culture or not even looking at the wound to see if it has made any improvement.

My main goal of this week is to get a friend to the AIDS Information Center in Jinja for further work-up and possible ARVs depending on his CD4 count, and of course, sell some more mosquito nets and continue being the condom fairy. The good thing is that everyone who wants to join the UKC will be required to attend our malaria and family planning sessions; in the next week or so, I am sure Anna and I will be doing our best to get the nets and condoms distributed.

Looking Back on 2007

2008-01-03T21:15:00.000-08:00

Here it is again at the closing of another year—and another occasion where I find myself in disbelief of how quickly the last 12 months have passed by. This year has provided me with countless adventures and an opportunity to head off on my own excursion that has combined my passions into one.
It has been an adventure that is for sure: I have been working at the Soft Power Health clinic here in Kyabirwa, teaching malaria education sessions and family planning throughout the villages, HIV testing and counseling at secondary schools, and completing follow-ups to see how effective the mosquito nets have been. It is disheartening to witness how these tiny Anopheles mosquitoes are responsible for Uganda’s number one killer of pregnant women and children under five. Looking at red blood cells infected with the Plasmodium falciparum parasite sure makes this disease seem much more significant and dangerous than initially thought. Microbiology class back in the States never seemed as personal as it does here.

Of course, there are frustrating moments as well, specifically, accepting the limited access of healthcare available in Uganda. If back the in States, the patient would have seen a cardiologist years ago, gotten an MRI (which does not exist in all of Uganda), or had surgery for osteomyelitis long before it became chronic. It may be an asthma patient coming into the clinic, and the best we can do is hope we might have received a donation of albuterol some months earlier; if not, we just send him on his way and hope for the best. Aside from the moments of helplessness, the tropical medicine has been fascinating and far more than I could have ever learned in a classroom: malaria, filariasis, Schistomiasis mansoni (bilharzia), and best of all, jiggers! Among the mzungu staff/volunteers at Soft Power Health, we have already had a few cases of malaria and plenty of jiggers. I suppose the excess time spent enjoying the kayaking of the White Nile puts us at a higher risk of jiggers and bilharzia; however, it always seems well worth the risk.

I have found myself working with public health, yet avoiding traditional medicine for as long as possible – whether it is from an overnight evacuation of a friend with a fractured patella out of a 2000’ nearly vertical gorge in the jungles of Costa Rica, sitting in the back of an unmarked van running the Syringe Exchange Program in a fast food parking lot on a rainy day, or going from hut to hut to see if Ugandans have mosquito nets and are using them properly. Maybe traditional medicine and clean lab coats are just not for me; I just have to add a little excitement and get my hands dirty. It is life at its best, and it truly comes down to being surrounded be the right type of people who are willing to go the extra mile to make things happen (no matter how difficult or painful it may be).

All the events that keep piling together the more I work here in Uganda have been enjoyable. It has been a great combination of some of my favorite things: healthcare to the underserved, kids, adventure, kayaking, simple living, spontaneity, and being surrounded by a great family of Ugandans, co-workers, kayakers, and travelers. I am very content and excited to continue this drive and passion.

Nets, Nets, and More Nets...

2007-12-24T15:46:00.000-08:00

Sorry it has been a while. The last few weeks have been filled with net sales and long trips. Our hope has been to get people to buy nets for the holidays, and so far, it has been pretty successful. A few weeks ago, we made a trip out to Bwindi rainforest, the southwest corner of Uganda, for a few days of net sales. This area of Uganda (near the border of DR Congo) has no access to mosquito nets and is one of the poorest regions of Uganda. Just outside of Bwindi are the Pygmies; the Pygmies were kicked out of the area when the land became a national park for gorillas some years ago. The Pygmies are now the poorest population in Uganda and cannot afford nets. In years past, we have traded nets for jars of honey, but this year’s trading goods had quite the range: wooden carvings, bundles of matoke, sugar, and best of all, 2 eggs. It was interesting to say the least.

It was great to see some new countryside of Uganda; I think I felt cold for the first time in the last few months. I actually pulled out a warm hat at nighttime (yes, I know this is very lame). It felt like a whole new place though, and since Lusoga and Luganda are not spoken in this area, it was fun to watch Francis and Joseph (our drivers) get completely confused with the dialects in the southwest region.

It was an interesting trip, and definitely a fun experience to exchange nets for all the goods the Pygmies brought with them. It was good to get out and see some new parts of Uganda; the 14 hour drive out to Bwindi provided us with plenty of downtime to enjoy each other’s company.

Best wishes for the end of the year.

Nile River Festival 2007

2007-12-04T09:27:00.000-08:00

Things have been a bit busy out here on the Nile. Although everything still seems to happen on Uganda time, I have managed to cram in as much as possible. Aside from working at the clinic and seeing patients with malaria, right heart failure, hypertension, or other tropical diseases such as Filariasis and Schistosomiasis mansoni (trematode eggs), it has been productive. We have had more outreach net sales, follow-ups, adventures searching for referred patients at Jinja Hospital, and a little playing on the river, too.

This weekend was the international Nile River Festival; we had people from all around the world: USA, Canada, Ireland, Scotland, England, Sweden, New Zealand, South Africa, and best of all, local paddlers from our dear Uganda. It has been quite an event, and definitely a great 3 day weekend filled with plenty of competitions: the big air freestyle on the Nile Special, a 45 km endurance race from NRE down to the Hairy Lemon, and another 10 km paddle to Silverback followed by a boda-boda race back to NRE (of course the finish line for this race was through an obstacle course of rafts and a funnel of the sponsoring Nile Special beer for the final touch). The best score of all 3 events was the big money maker and the men’s champion was Ibra, our local Ugandan. It was great to watch him take home $2,000 as the grand prize. It was a good turnout though: there were about 40 men in the freestyle with fewer in all 3 events, and 12 women (I think it is the biggest female turnout yet). It was a fun weekend filled with plenty of worldwide kayakers and lots of locals here to compete and support the event. The flat water in the 45 km race was pretty entertaining, but luckily this part of the festival was done in partners, so Anna and I kept each other laughing and motivated throughout our 3:29:24 sprint. Good times. The best part is that CDC had a table at the finish line and they were waiting for all the dirty kayakers’ blood to test for S. mansoni (bilharzia). They are working on a study to see if S. mansoni is here in Uganda and were very surprised when I told them we had a case of S. mansoni at our clinic the week prior.

We have 2 malaria outreach sessions this week and a meeting with AIDS Information Center in Jinja to discuss continuation of free HIV testing in secondary schools around Jinja.

Check out Jaime's write-up on the Festival at http://www.kayaksession.com/nile-river-festival.php

Back to the Nile Special

2007-11-19T17:48:00.000-08:00

Hello again from the “real world” back here in Bujagali. We just returned after a weekend getaway to the Hairy Lemon – an island about 45 km downstream located right next to the Nile Special, one of the world’s best play spots. So after another week at the clinic and outreach programs, it was great to see some new scenery and take advantage of the high water here on the Nile.
The Nile Special is amazing yet again, and even better with the high water in preparation for CHOGM (Commonwealth Heads of Government Meeting). I think CHOGM has officially started as of today; I am very glad I am not in Kamapla for the queen’s arrival for the Commonwealth meeting. It has been a bit crazy around Uganda in preparation for this event, especially near Kampala and even Jinja; there has been a lot of road construction and other projects to prepare for the queen (I believe Prince Charles is even coming to Jinja to see the "source of the Nile"). It seems like it is becoming Uganda’s one chance to make a good reputation for itself internationally and they are definitely spending a fair amount of money for it. However, I somehow doubt that the queen will actually make it out here near Jinja or even be here for more than the 3 day event. Whatever works though.

The Special was great though. We had a good group of people out at the wave, including a few Brits soon to end their trip and then the whole World Class Kayak Academy group showed up last night (high school kids traveling around the world kayaking with teachers & kayak coaches). All the instructors were a lot of fun, and it was nice to see some kids out there shredding it up on the Special this morning. Hairy Lemon is a great place to be – good camping with 3 meals a day and only a 5 minute paddle to the Nile Special. We put in 3 good sessions each day (sunrise surf before breakfast, before lunch, and then a nice sunset surf). Full moon next weekend! Life is good.

Let the Madness Continue: The Adventures of Rural Medicine

2007-11-13T18:53:00.000-08:00

Yesterday was our third HIV Testing/Counseling session at the secondary schools outside of Jinja. We have paired up with the AIDS Information Center and offer education, free testing, and counseling to these students (a total of 264 students have been tested thus far). It has been a bit crazy for many reasons, but when is it not?
Godfrey, Jen (a PA student from Colorado), and I went to go visit one of our TB patients out in Kyabirra. It was another typical day in rural medicine. We left Soft Power and stopped at the Buwenge Health Clinic to get our patient’s isoniazid & ethambutol medications for the next month; however, the doctor with the only key to get the drugs was not there and could not be reached. So…we waited around for an hour until he came back; he gave us the drugs and we were on our way. However, it turned out we only received 2 weeks worth of medications, so long story short, we stopped at two more health clinics along the way and finally got our hands on another set of isoniazid & ethambutol. In other words, our hour-long drive to reach our patient in his village took about 3 hours overall (it was only a minor trek to find him once we got to Kyabirra). Jen and I kept joking that we were having our Paul Farmer adventures for the day, but this was definitely the mini version, so maybe next time.

Time is a funny idea here in Uganda. I have learned to put my anal-retentiveness aside and just settle with Ugandan time, where you just “go with the flow of the Nile” and add an hour or two until things actually happen. Jen and I were laughing pretty hard during the trip out to Kyabirra yesterday; it is always an adventure. Or maybe it was last week at Lugani Secondary School with a line of students out the door waiting to be tested for HIV; we had limited daylight left, no more clean syringes for 44 more students, and best of all, a matatu without functioning headlights (just a minor detail that would have helped if we knew beforehand). I thought it was funny about the headlights, but a few people did not seem to agree with me.

The good news is that all the students have been negative for HIV! I have been somewhat surprised, yet relieved; most of these kids fall under the categories of populations with increasing rates of HIV: sub-Saharan Africa, youth between 15-24 years, and rural areas with limited access to health care.

I have been enjoying all the fun mishaps that keep piling together the more I work here in Uganda. I am sure there are more to come.

Mzungu! Mzungu! How Are You?

2007-11-05T08:28:00.000-08:00

Hello from Uganda! It feels good to be back here on the White Nile; all the familiar faces are still around: boda-boda drivers, raft guides, locals, and a few paddling buddies from the trip in 2006.

So far, I am still figuring out my role at the Soft Power Health clinic. Last week, we went on an outreach education session in Bugaya village, and then a follow-up session in Muguluka to see how effective the nets have been in the last 4 months. We sold all 150 nets on Thursday in Bugaya and need more for our next trip out there. When asked how many people had malaria in the past, everyone in the crowd raised his or her hand. It was somewhat disturbing to see how many people this disease has affected.

Aside from Soft Power, I have gotten a few laps in on part of the day 1 stretch. All the boda-boda drivers are still here, including our regular drivers from last time, Robert and Moses. Robert has started kayaking since I last saw him last and it is great to be out paddling with him. The river has changed since beginning the construction of the dam a few months ago; the Ugly Sisters wave is now gone and all the water has been diverted to Silver Back, which makes it pretty huge. It is sad to say that this section of the day 1 stretch will be flooded when the dam is finished in about 4 years; it will have quite a financial impact on the river industry down here. However, I am loving the big, warm water while I can, and enjoying seeing everyone again.

Last night, Ronald took me on a tour of his local village. I was able to meet his mom and sisters, and then all his own kids running around, chasing us on the boda-boda. “Mzungu! Mzungu! How are you?” they scream; these kids were not used to seeing a white person (mzungu). It keeps amazing me how friendly and welcoming Ugandans are; they invite you into their homes without any hesitation, take you around villages, and strike up any conversation, or even let you drive their own boda-boda (it was pretty comical). I sure wish I could speak more Luganda, but maybe by the end of this trip, I will be able to get by.

Today I will be helping with an HIV testing/counseling session with the kids. We will see how it goes.

The Pearl of Africa - Here I Come Again

2007-10-29T20:39:00.000-07:00

I am sitting here in the mighty fine SeaTac airport. Although a minor delay in my flight off to London, I find myself feeling tickled with excitement. It is finally happening! I find myself in disbelief; it feels like it has been quite some time waiting for this to happen. All the fond memories from year and a half ago are running through my head, but now I am off on my own, ready to start my own adventure.

Back in March 2006, I headed off to Uganda, and sure enough, it turned out to be an amazing experience far more than what I had ever expected. The only downside of the trip was the day I had to leave. The idea of coming back to the States was definitely not top on my list.

I left for Uganda on my own, ready to see the other side of the world. I met up with some kayaking friends who had been spending some time there already. Home base was right near Bujagali Falls, about 8 km downstream of Lake Victoria, the source of the Nile River. It is a kayaker’s paradise; the river is warm and surrounded by a green, lush jungle. The White Nile has everything I could ever dream of: multiple channels with plenty of different lines, big drops, and best of all, world-class big water play boating. We spent hours surfing at the Nile Special, the Ugly Sisters wave, and the Super Hole. What truly blew me away was watching the local kids swim right above these huge rapids, or paddle around in their homemade wooden canoes while out fishing for the day.

Aside from kayaking, it was a great place to be: cheap camping, great local food, a fun, genuine culture, and memorable Ugandan style shuttles back to camp. My local “boda-boda” (moped) driver picked me up at the take out, and the adventure home was almost as exciting as the run itself. The trick was to straddle my boat between me and my driver and hold on tight as we bounced along the narrow dirt road. Trying to avoid hitting the trees and brush, or even herding goats, with the bow or stern of my boat always made an extra challenge.

On the “boda-boda” ride back, the road went through the farms, the small villages, the schools, and the mud huts these people call home. Tons of young kids would come running out of their huts as they saw us driving by with our kayaks. Their hands waved through the air with contagious smiles on their faces. “Jambo! Jambo!” I would yell back. I loved this place; I loved where I was.

Life was so simply lived, yet so terrifying and uncertain for all of these families. It could be malaria, HIV, malnutrition, drought, or the violence and oppression in Northern Uganda, but these people I encountered every day were filled with so much joy and excitement. They were friendly and curious, as was I. The river brought me to this place originally, but the interaction with the locals is what truly brings me back.

I feel very privileged to have had this experience, and very lucky to be able to go back to Uganda and help out with the malaria project (www.softpowerhealth.org). I will do my best to keep everyone posted during my adventure. Best wishes for the winter.

Final Thoughts on WEMT

2007-10-15T22:52:00.000-07:00

It amazes me how much can be accomplished in such a short time, whether it is emergency medicine, wilderness adventures, or the new friendships that form in only one month. All of this took place just outside of our own Bavaria, here in Leavenworth, Washington. And what brought such a fine group together? A month-long Wilderness EMT class sponsored by Rescue Specialists, Inc. Days were long - lecture time, simulations, drills, ambulance ride-alongs or ER observation time, and best of all, endless hack sessions. Don't worry, majority of us are unemployed, outdoor bums, so it fit perfectly.
Katy, with her impaled object through the gut.
And congratulaions to Justin for his newborn baby! It's a girl (I think).
Kasey getting ready for our Search and Rescue.

So, in the long run, I do wonder whether or not I will put much of this knowledge to use in Uganda. However, only time will tell, and sure enough, that time is very soon. Only two more weeks and then I will be singing my African tunes off in the far away lands on the White Nile. I am very grateful for the group we had for our WEMT course; it would not have been the same without everyone there. The last month has been intense, but definitely worthwhile. We covered a lot of information, even while trying to think schizophrenically (urban vs. wilderness medicine). It sure makes a difference when a hospital is only a 5 minute drive away. However, most of us do not live that lifestyle and that is what makes this all the more fun. Good luck to everyone from RSI; I hope we meet again sometime down the road.