The Rules... How to make it in Uganda

When I take people to Uganda I usually give them some simple rules to remember. If they follow my advice, they usually do pretty well. Here they are...

1) When in doubt, keep your mouth shut.
2) Forget about time, enjoy the relationships
3) Always keep a flashlight and a good pocket knife with you at ALL times.
4) Never promise anything, even a "maybe" will turn into a "yes" after you are gone

These rules, cover just about any situation in Uganda. Oh, sure there are others, but these are core.

They are list in order of importance, but by far the biggest is the first one. So many times I have seen Americans get into a situation by talking too much. I believe most Americans think that if they keep talking then eventually they say something that will make a difference.

The reverse is actually true. A wise man will listen carefully to what is said and take the time to think about the response.

Breakfast with MSF

Sometimes, while in Sudan, there were very odd situations. Times where somewhat normal activities were combined with very odd scenery.

One mission to Biem, Sudan, required refueling the aircraft part way through the mission. So I left the rest of the team in Biem, while I went with the aircraft to refuel. This was important since, sometimes these pilots would simply decide to go home instead of finishing the mission.

So we flew to a small village where we had a supply of fuel stashed. It happened to also have a small hospital run by MSF or Doctor's Without Borders. So, being the kind people they were they invited me for breakfast while we were refueling the plane.

Sitting in the compound with them I had a nice breakfast of French Toast (of course) and bacon. I felt a little bad, since about an hour's flight away the rest of the team was dealing with starving and sick people in the dust.

As I was sitting there thinking how peaceful it was in this compound. I happened to see something that I had never seen before. It was a bomb shelter. Not the cold War back yard stuff. This was the real deal. I asked them how often they used it. They told me not to worry the Sudanese government only bombed in the very early morning. Left unsaid was how the Sudanese government only bombed hospitals...

The Dangers of Helping People

Today I found a report about the recent attack and murder of two Ugandan Aid workers in Northern Uganda. You can read the whole thing yourself at
Uganda: Two aid workers killed in the north by suspected LRA rebels

The trouble with nearly every place that needs emergency aid is the security. I realized this truth to it full extent when we watched this year's hurricane destroy so much. In every case there was looting and violence. After Katrina the violence was bad enough to hinder the relief efforts.

What is it about these situations that spawns this kind of behavior. I don't believe that each person participating in the lawlessness was truely "needing" to do what they did for survival. So this idea that it can be ignored because it is survival, is flawed. Is it selfishness? How about greed?

The LRA's attach on aid workers only serves to destabilize and impoverish the region further. The LRA thrives where they can take advantage of defensless people. Those that are starving and impoverished make good targets.

Could this be motivating so many others? Could it be that the criminal element, even in the good old US of A is so similar to the criminal element in Uganda (the LRA). I think they are the same. I believe that the violence following each disaster was really just the criminals in the community (every community has some) trying to take advantage of people who were without defense. In the case of Katrina victims the longer this disaster could be perpetuated the more the criminals could profit from it.

We have to remember, when we read media reports, like those above, that we are not so different. We can not simply be upset by what we saw in New Orleans after Katrina, and ignore what happens in Uganda.

Our First Thanksgiving in Kenya

The first few months in Africa, we spent in Thika, Kenya. As you can see from this picture, my wife was very pregnant. We were wanting to do something different for Thanksgiving this year. While the people of Thika, on the surface, seemed to be doing quite well. We soon found out something different.

It turns out that as much as 15% of the population were starving. The community was dominated by the Del Monte corporation which ran a huge pineapple plantation. Thousands were employed at the facility. However, as usual there was a dark side to the story. As the employees grew old they were simply fired. With no retirement plans, and usually near crippled from a life of working in the fields, these older people would starve.

They would try and forage for some food, if they were lucky their families could help out. However, most would simply waste away.

We heard about this and decided to try and help a little at Thanksgiving... not a Kenyan holiday by-the-way. We spent about $70 and bought about 500lbs of food. Maze, beans, bananas, cooking oil, basics. We arranged to give out the food at a local slum/village.

It was amazing to me that at first no one showed up. Soon word spread though, and people came. They told us that no one believed that we were coming. They said that no "mazungo" or white person had ever helped them. There were amazed and we were ashamed. Think about where that really good pineapple came from the next time you eat one.

Murchison Falls

I realize this is not a very good picture... but this is Murchison Falls in Uganda. The entire Nile River spills through a 20 foot gap in the rock. Well, maybe more of "explodes" through the rock.


I'm not really sure how these falls got their name. My guess is that the famous Dr Livingson had something to do with it. One of his friends and supporters from back in England was a man named Murchison.

The really fun part about seeing the falls from the bottom like this, is the really sense of discovery. Once you are around the bend from the boat landing and out of site of the Paraa Lodge, there is no sign of civilization. In fact it is easy to imagine yourself on the first trip up river from Lake Albert. Passing game by the hundreds if not thousands. Then hearing off in the distance the roar and getting closer seeing the mist rising from the falls.

Finally, around that last bend in the river, the current is so strong, and swirling all around but you see it off in the distance. Really quite amazing. What did the first explorers think?

The Nile River and Big Crocs

This picture was taken on the Nile river near the Para Lodge in Uganda. I have taken this boat trip up the Nile many times, and this guy is always sitting the same spot.

I don't know how long crocs live, but my guess is that this guy has been sitting there longer than I have been alive. He is pretty much full sized about 15 feet or so... maybe longer. Of course it really doesn't matter since he would certainly have very little trouble dealing with me.

The Nile river always amazed me. Here in Uganda it is near the headwaters of the Nile, yet it is still a big river. It flows for many thousands of miles north through Sudan and Egypt before spilling out into the sea.

The number of cultures it crosse must number in the dozens. All of them have based their exsistance, at least in part, on this river. I heard that an expidition recently tried to navigate the entire river. I don't know if they made it all the way, but what a fascinating trip that would have been!

Universal Studios Bridge

One of my favorite bridges was one we called the "Universal Studios" bridge. if you have ever been to the Unversal Studios theme park. You may remember the bridge that "falls apart" when you cross it. Then with the usual movie magic pulls itself back together after you leave.

On the road from Yumbe to Arua, there are actually two bridges. The first spans probably 100' and is about 30' high. The second one is washed out... so I gues there really is only one bridge.

This bridge, gives it's history below. If you take the time to look over the side you will find several trucks that have crashed. Wondering what happened to them only takes as long as starting across the bridge.

Once you start, each plank pops up under your tires. So the trick is to try and drive over the two large steel beams that support the span. The trouble is that the beams are too far apart for a regular vehicle to cross with wheels on both. Now you are at a point wher you try to decide which side of the bridge looks worse. Then put your wheel on that sides beam.

Admittedly I never had any serious mishaps on the bridge. It just was a sort of sign of just how far out you were. It was also fun to drive across it with people who had never been in Africa before.

Somehow, ever time I made that trip, the bridge was always there. Everytime, I thought to myself that this is the last time. Yet there is was again the next time. It was a kind of symbol of the people in that area, at least to me. They were always so close to colapse, but somehow always mangaed to pull through.

Taking pictures of people

I realize that for some of the most interesting places and times in Africa I don't have pictures. It is a really simple idea, really. When I saw people in a bad way, wether sick or starving, my reaction was one of respect.

I know that I would not want people taking pictures of me while I was dying. On the other hand, with things like pictures, its hard to spread the word of the need. The people back home need a "face" to put with the tragedy. I think everyone knows there are "starving" people in Africa. What they often forget is that those are individual people starving.

Once in a while I would get a chance to sit down and talk with people about their lives. These were some of the most interesting times in Africa. More importantly, though, I would get a chance to develope relationships.

Relationships are key to working in Uganda. As much as time is as important in the US, relationship building is in Uganda (and most of the rest of Africa for that matter). When you develop a relationship, you commit yourself to know that person, and to some extent caring for that person.

It was easy for me to ignore people I didn't know. But I grieve for the people I do know, and who are still suffering.

What a strange sight...

I wish I had a picture to show you. The cargo hold of an Antonov AN-32 is pretty good sized. But when you pack many more than 70 people in it, the hold becomes very small. The sight was one which most people will never see. I had imagined what it would be like before I left on this mission, but I never thought it would look like this.

It was dark, the only light coming in was from a few small windows. There were only the jump seats for people to sit on. These were designed for paratroops and could fold up against the wall. All the space on the floor was taken up with strecher cases. Our medical team checked everyone, one by one. Almost wading through the people.

As expected there were quite a few stow-a-ways. Including one woman who could not move. She was in the advanced stages of TB, with probably a few days or maybe a week or two left. Someone had carried her on board and left her. The sad thing is that the Doctors had refused her during triage. There was nothing that could be done for her and would only take space from other who needed it.

I hated those kind of decisions. So that one person can live, another is resigned to death. Still here she was on the plane. Maybe the field hospital we were taking them to could at least make her comfortable. We made sure to put a surgical mask on her, she was coughing constantly.

Something else strange, now that I think about it... There were no children. In fact during our brief landing, I didn't see a single child. That's not right... What happened to all the children. Where they being hidden? Were they dead? Had they been taken into slavery? I don't know. This is the first time I remembered it.

During counseling sessions for Post Traumatic Stress Disorder, this mission was one I had a lot of trouble with. There are a lot of gaps in my memory. According to the Dr's this is normal. A kind of self protection mechanism. Something gets to stressful and my mind shuts down recording. Maybe this is why I don't remember so much?

Samosa's for Lunch

One of my favorite lunches in Africa were Samosa's. I preferred the beef but the chicken was good too. One time I ate a Samosa in the most improbably place.

We had flown into Biem, with and AN-32. Our plan was to spend less than 1 hour on the ground. The time it would take for a helicopter gunship to get from the nearest base to our location.

60:00 to go...

We had 7 tons of grain to off load, and as many as 60 patients to triage and board the plane. That is out of the 1,000's of people who where waiting to try and get out of there. With the Tsetse fly's biting us and the smell of gangrene and decomposition ripe, we worked.

55:00 to go...

Our medical team was off triaging the patients. I was talking with the local SPLA (Sudanese Peoples Liberation Army) to confirm the proper distribution of food. He ordered his men to start off loading the food.

45:00 to go...

Everything is still going fine. The food is being offloaded and organized into distribution stacks. I decided to take a few minutes to talk with some of the people. Try to encourage them a bit, see how they were doing.

40:00 to go...

I made my first call to the medical team. We had some nice FM radio sets to communicate with. No response... That's ok, they are probably busy. They still had 10 more minutes before we had to start loading patients.

30:00 to go...

I made my second call to the medical team. Still no response... Asked one of the guys with me to go and see what was going on. The food had been off loaded by now and the crew was prepping the cabin for the patients.

20:00 to go...

The medical team is coming back now with a group of casualties that they have chosen as having the best chance of survival if they reach the hospital.

18:00 to go...

I start counting the people we are boarding... in the middle of it, the local SPLA commander asks me to transport a couple of people as a favor to him. Sure, just one or two...

15:00 to go...

30 patients, but the group of 60 who the Dr's brought back is not getting any smaller. Some thing is not right. More people are boarding who are not actually patients. A quick check and found that most patients were also bringing someone to care for them at the hospital. A common practice in Africa... just not something I had counted on. "OK, ONLY PATIENTS, NO RELATIVES!"

10:00 to go...

At least 70 people are on board... the Russian Pilot is getting mad. He told me no more than 60. I am trying to stop them from boarding... but nothing is working.

8:00 to go...

"CLOSE THE DOORS!" I know we have not gotten all the people we wanted on board, who should have been aboard. The SPLA commander comes to me with not 1 or 2 passengers but over 10! "No, we can't take any more", and he understands.

7:00 to go...

The big cargo ramp is slowly coming up. It is being hand cranked by the load master. A Kenyan guy... he was trying to tell people to move out of the way.

5:00 to go...

The ramp is up, watching the hands reach in trying to get our attention was tough... but we were really close. Ok, now I just want to make sure that all of my team are on board. I look back through the crowd of people in the back of the plane... I don't see Ann.

4:00 to go...

I'm yelling into the radio. "Ann, get back to the plane!" "Ann, where are you?" nothing...

3:00 to go...

The pilot starts cranking up the left engine. It's loud... but the small crew door is still open on the right side. I am thinking about jumping out to find her... but what about the team. Dammit! Where is she!

2:00 to go...

The right engine is winding up. The load master and I are leaning out of the crew door. Here comes Ann, running around the back of the plane. The load master grabs her arm and pulls her in. He's a lot stronger than he looks.

1:30 to go...

The copilot comes out of the cockpit and asks me to go up front. The load master is closing the door. I follow the copilot into the cockpit. I'm not really sure what I am doing there.

1:00 to go...

We are taxiing down the strip of dirt and grass that we landed on. This doesn't look good to me. The pilot is calm though. He gets to the end of the runway and turns the plane around.

0:00 to go...

We begin the takeoff run. The power of the Russian planes is incredible, but we are loaded at over 200% capacity. The far end of the runway is coming up quick. So are the people who have gathered to watch. But with room to spare the big plane pulls up and we are airborne.

+3:00

We are finally "safe". I walk back through to the cargo bay. It is a scene like I have never seen before. I found the load master spraying "Doom" insecticide through the cabin, trying to kill all the bugs.

+5:00

I find the only empty place on the floor. A small space between the bathroom (non functional) and the cockpit wall. It's near the small crew door, and was cool. I slumped down and finally let myself relax just a little. The load master came and sat down next to me. He, too, was exhausted. I remembered I had some box lunches packed and pulled them out. Not much, but each had a couple of good samosas in them. I gave one of the lunches to the load master, and ate the other myself. They tasted good... until I looked up and saw the very sick and dieing people in the hold. Then I got sick...

The bite of the Tsetse Fly

It hurts, really bad. Tsetse Fly's are about one inch long. They don't like the bright sun, really only shade. They will bite pretty much any animal, but mostly cows and humans. Their bite is so strong, that they will chew through clothes.

My first, real encounter with these insects was in Sudan, at a place call Biem. We were planning on delivering about 8 tons of supplies the next day, and had arrived on a scouting mission. We flew in on an Antonov AN-28 from Loki. This is really only important because I remember the first bite vividly.

I had been standing in the sun, and it was hot. The equatorial sun would actually hurt my skin. So to escape from the heat I walked under the tail of the AN-28. I was looking for shade. What I got was a sharp bite to the back of my neck. I slapped at the bite thinking more of "shooing" away the insect. Only when I hit it I found it to be rather large. It turns out to be a Tsetse fly.

I didn't know much about them at the time. So I vainly tried to stay in the shade, only to be slapping at them constantly. So many bit me, and so hard, that my wife ended up throwing out my shirt. It had that many holes in it!

Later I found out much more about the fly, and its notoriety. It carries the African Sleeping Sickness. A horrible disease, which kills many African's each year. It's called the sleeping sickness, because you will progressively loose your strength over the period of about 1 year. Sleeping longer and longer each day. Finally, you will enter a coma and die.

There is only one way to treat the sickness. You need to take just slightly less than lethal doses of poison. The idea is the poison used is slightly more toxic to the parasite than it is to the human host. Hopefully the parasites dies before the human does.

The CDC told me that about 1 in 100 Tsetse fly's is a carrier in that part of Sudan. I must have been very lucky, I'm sure I was bitten by that many flies and more the next day. For whatever reason though, the odds worked in my favor on those trips.

Those two trips the one that day and another one the next day, were perhaps the most dangerous trips I ever made. I thought the danger was coming from the civil war. I had no idea that I was in even more danger from some flies.

So easy to be critical

There have been a lot of natural and man made disasters in the last couple of years. It is getting hard to keep up any more. Just in the last 10 months alone there has been the Sunami in Asia, hurricanes Katrina and Rita, the earthquake in Pakistan. Not to mention humanitarian crisis in the Dafur Sudan, Sahel Malawi, Niger, Somalia, and many more locations that I don't even know about.

So what do we do about it? What should our response be? How can we possibly help everyone?

In my experience there are a few responses that most people in the US use in these situations. The ostrich in the picture is a good example of those responses.

1) Bury their heads and pretend not to listen
2) Run away from any news if possible
3) Start pecking at anything that you can hide from or run away from

Think for a moment about your personal response to each of the disasters. I know my own response to Katrina was not something I am proud of... At first I did not want think that this storm was going to be any different from all the other storms to hit the gulf coast. Yes it would be bad, but not THAT bad. Next once I began seeing images of the flooding and the people in need, it was too much for me so I tried to hide from the news. Finally, once I realized I could not hide, because the news was everywhere, I began to point fingers.

Once I started to think about it, I realized something. Much of my personal response was because I could not do anything personally to help. Sure I could send money to the Red Cross, but really how much of that helps the immediate need and how much lines the pockets of Red Cross executives? I couldn't go there myself and help. So I thought I would do the only thing left... critize the people who were trying to help. Somehow, this seemed to make me feel better. I mean "if they had just done it my way" a lot more people could have been saved. "If I had been in charge of FEMA" the response would have been faster.

Really all this does is make me feel better, and only for a short time. I have worked with a lot of relief workers in Africa. Some from groups that most people critize a lot. The trouble is, I don't see any of the critical people actually working over there. The people who do get critised are really trying their best. It is not easy doing this stuff. The work is full of compromises. Much of the relief work around the world requires moral compromises on a daily basis.

For example, I feel very strongly about obeying the laws of the land, which ever land I am in. However, in order to deliver food aid to starving people in South Sudan, I regularly bent the rules of the Northern Sudanese Government. We would often deliver food to desperately starving people, knowing the that the rebels would come and take most of it for their army.

Unless you are willing to take that person's place in these disasters, don't point any fingers. Help them, help them to make better decisions by offering them a choice that doesn't require moral compromise. If you can do that you are really helping the people who need it.

My last bug story… for awhile…

One night I was camping in Midigo. I had a small tent, that was really just a mosquito net. I had stayed up late talking with some of the elders. After dark we set up a lantern and continued talking, but we started to attract the bugs…

While I wasn’t bothered at first, a huge beetle flew up my shorts and made its presence well known to me. My reaction provided enough entertainment for everyone to keep laughing for several minutes. They told me that only boys wore shorts, men wear trousers. Presumably this was to keep this sort of thing from happening.

I got to bed that night, only to remember that I had forgotten to call into the Emergency Operations Center (EOC). In high risk areas, I was supposed to check in once a day. Since the sat phone needed to be set up with a clear view of the sky, I had to get out of my tent and set it up about fifty feet away.

Once done with the call I went back to the tent. Only I found I had left my flashlight on and the entire tent was covered with bugs. When I mean covered, really mean that the bugs were so thick you could not see through them. The only good news was that the flashlight had been pointing away from the tent door and I was able to get into it with just a few bugs joining me.

Thinking things were over for the night, I turned off the light and tried to sleep. But there was this crawling noise. All of the bugs that where on top of the tent were now crawling down the sides and under my tent. The floor was literally moving. So I started smashing them. After a few minutes I realized just how fruitless this was. Falling asleep much later than I had wanted.

In the morning I lifted the tent to find hundreds maybe over a thousand smashed bug carcases.

Bugs, they knew about the rain…

Once the rains came, everything came alive in Uganda. It was like night and day. The seeming desert would bloom and everything would turn green. Cool breezes would blow at night. The air would be cleaned of all the dust. Most important the “white ants” would come.

We heard it one night. The sounds of celebration could be heard from every direction. It was really amazing. Singing, banging on drums, fires lit all around. We couldn’t figure it out until our chef, Vincent, told use what was happening.

Every year after the rains began; the white ants (flying mind you) would emerge in huge clouds from their nests. The children, who pluck them from the air, pull the wings off and eat them, consider these a huge treat. The adults will set up traps to capture them in bulk as they come out. These are either toasted to preserve them a little longer or simply eaten.

Most African love them. A few adventurous Americans try them, and find they taste a bit like peanuts, or wood chips… either way, I wasn’t interested. We would get them in huge numbers inside our house. After a few hours of flying around, their wings would fall off and we would sweep them up. At times we would collect mounds of them 6 inches high and a foot or more across.

Speaking of the Rains

The rains are a big deal in Yumbe district. They generally come twice per year. One is called the long rains and is followed by the short rains a few months later. The key is to determine when the rains are coming.

If you plant your maze too early, it will not get the water at the right times. However, wait too long and you miss it the other way around. I could never really figure out how everyone seemed to know exactly which rain signified the actual start. It would rain one afternoon and I would ask Abassi our house manager, “have the rains started?” He always answered with a “no, these are not the rains”. Then one day he told me that these were the rains.

Whenever they really started, they came down hard. We moved into our house in Arua during the dry season. We thought it was really odd, because there were amazingly large gutters running around the house and through the compound. These were two to three feet deep and about the same wide. Here we are in the middle of the desert and we need gutters like that???

As you see in the picture, yes, we did need the huge gutters. The rain would come down so hard that my daughter and a family friend washed their hair in the down poor! It would fill the gutters with fast flowing rapids. Then, after an hour or so, it would stop. A hot dry wind would blow in and the equatorial sun would dry everything. In another hour, you wouldn’t know that it had rained at all.

Morning Business

By most standards our compound in Northern Uganda was really primitive. Compared to the standards of the local people… well it was the nicest place around. It was quite an ordeal to build it though. I was there only for the first portion and got to see the end result much later.

Once we had found the right site, a place called Choro, we needed to clear the land. It was covered by high grass and scrub brush. With no tractors or other mechanical assistance. Just clearing the grass was difficult. It took almost 100 people working for several days. Slow going but worth it. The bare ground was important for keeping the snakes and other small but dangerous creatures out.

Next came the 1000’s of bricks. You can just buy bricks up there. You had to have them made on site. This required water, mud, straw, and firewood. Just the bricks alone required months to manufacture.

After all the prep work, the first item on the agenda was the latrine. I couldn’t stay there the entire time, so I hired some guys to dig the latrine and build the outhouse over it. I just didn’t realize that how deep they were digging it. I came back to find them over 100 feet down, through several layers of hard basalt. They certainly took the job seriously.

We later found out why it had been dug so deep. When the rains come to Choro they come in a big way. It is not fed by an aquifer, but the rain is so intense and comes in such a short period of time, the latrine hole gets filled up! Thankfully it also goes down quickly.

How far it is...

Getting Jet Fuel in the Bush

Sometimes working in Africa can be so different from working in the US, that the difference can not even be imagined. I remember one particular call I got from the US. It made me realize just how far out of touch the home office was sometimes.

I remember sitting with our main Ugandan operations person, Rashid, when we got the call from the US. They told us that they were sending a team over in two weeks. This team would arrive into Nairobi, catch a charter cargo flight and head to Arua. They wanted to do a minimum of three rotations.

So far so good. We asked what kind of plane they were coming in… it was an AN-32. This is a big aircraft. It can carry as much as 7 tons of cargo, and land anywhere. Code named “Cline” by NATO, this was a great plane, but a fuel guzzler.

“Ok, so you are bring fuel with you?” I asked. “No”, they said, “we are just planning on buying it at the airport in Arua.” Not only did they expect to find that much fuel (over 50 drums) but they also expected to purchase 21 tons of food! There isn’t that much food just lying around in surplus. Nor is there any fuel at the “airport”.

The airport is just a dirt strip. The town is just a dusty border town. All of this was completely lost on the people back in the states. They told me to get everything ready and that they would be there in two weeks.

In the US, this would not be a big deal. However, in Uganda, this meant hiring trucks to haul the fuel and grain up from Entebbe. At best this was several days worth of travel. Because of the large amount of fuel involved, it would be a great target for thieves, so we needed to hire guards. Then, once all of it was in Arua, it needed to be stored in a secure warehouse. Once the plane landed, we needed to haul the fuel from the warehouse to the plane. Pump the fuel up into the wings, by hand. Load all of the food into the plane, by hand.

None of this mentions all the permits, and forms to fill out. Finally, since the plane would be going into Sudan and back, there would be the army to notify, and visas to get for everyone. This was a really big deal. After the phone call, Rashid and I just looked at each other of a really long time. I know we were both thinking… these people have no clue.

Later, months later, it was ok to laugh about it. I realized just how comical it was for someone in Southern California, to try and plan something in a place like Uganda. How, with just a few sentences mentioned over the phone, weeks worth of work for dozens of people would get started. Somehow, mostly because of Rashid’s resourcefulness, we got everything ready.

It again reminds me of what the elder in Midigo told me. “It is a miracle that you have come all the way from America to this place”, he said, “He knows how far America is…”
I don’t think he or the people in the states really had any clue “how far it is”.

Feeding people...

During one of our clinics, a dear friend of mine and a doctor from the US accomplished some really incredible things. He realize, correctly, that there were many reasons people would come to these clinics, but probably 90% of the patients fell into just a few categories. He also realized that many more people would show up than could be seen in traditional US family practice.

So he came up with a triage plan that could be taught to lay people in the community. This way most people could be recorded, diagnosed and treated without having to “see” the Dr. This was a tremendous success. Treating several thousand people in as little as 12 hours with just two MD’s and two RN’s.

With this improvement came the need for volunteers. We made sure all of them knew that there would be no payment, but all of them and their immediate families would be treated. Further, we would provide the food. A lot of food, as it turns out. The women in the picture are preparing Cassava bread.

You remember the Cassava flour that they were pounding that very first visit? Well this is what they used it for. They would boil it until it became a thick, sticky glob. Each person would cut off chunks. Hopefully they would have something to eat with it. We always provided beans, which would also be boiled… for hours…

Notice the cooking style. This far north in Uganda, there was little or no access to “mafuta” or fuel. Usually, charcoal or kerosene is used in more urban communities. But here these items were very expensive. Cooking would often be done with as little heat as possible. I always cringed at having meat cooked in the bush, since it would often be nearly raw.

The logs they are using serve two functions. First, they hold up the pot, allowing air to circulate. Second, they are used to vary the amount of heat applied. By moving a stick in or out of the fire, they could increase the heat.

The really big downside to this is the loss of heat. Much more fuel (wood) would be used than needed if it was on some sort of stove. This brings up yet another development that many people have been trying to bring to developing nations. Efficient cooking stoves.

Water Etiquette in Uganda

A very important aspect of the Ugandan’s life is etiquette. Ugandans for the most part are soft spoken. Each person knows the rules and follows them without fail.

First, is the greeting. When greeted by a Ugandan who is a close friend, you will clasp hands, and embrace repeatedly. I have noticed that the number of embraces seems dependant on the closeness of the relationship. All the while you will continue to hold hands. Next, (still holding hands) comes the “news”… How is your family? Was the trip a comfortable one? Are you healthy? All of these questions are not merely a formality like it is here in the US.

Each question is sincere, and followed with more requests for detail. This concern is a sign of respect. As such I have had greetings last as long a half hour! I learned to always be prepared with questions of my own.

A variant of this greeting is among non-acquaintances. Here it is more important to show your social position with respect to others. My experience with the women in Midigo on the malaria night was the ultimate sign of subservience. Women in the village were considered the lowest rank. I was a special visitor, so they came on their hands and knee. At other times I have been in the presence of very high ranking government officials and made it a point to show them my subservience to them.

When in a group of people meeting to discuss a topic of importance, each member of the group is given a chance to speak their mind without interruption. Each member is of the group will be heard in respect. Arguments tend to be quiet and take place in slow motion. I have seen arguments take days of slow, respectful speeches to make a point.

Some of these discussions were so interesting. I would try and take in as much of the politics, and hidden meaning in these.

I choose the picture for this post, because it reminds me of the etiquette that flows through all of the Ugandan society. The picture shows the village women, near Midigo. They walk for many miles every morning, bringing their “jerry cans” to fetch water. Each woman arranges their water cans in order and each takes turn pumping water.

It is a well-organized tradition that has been maintained for thousands of year. This particular well is a modern installation, but the process is the same. The women sometimes sing songs while pumping to keep rhythm. Other times it is a place for gossip and updates.

Each women then places the can full of water on their heads and carries it for several miles back to their homes, like the woman who is in the background.

A couple of other things to notice in this picture. The woman kneeling in the foreground is wearing a school uniform. The girl’s school had closed down for a lack of students. Teenage girls are often required to work for their families, or are often married off early. This girl was once a student and now, is helping her family with water. The women pumping the water is dressed very nicely for a trip to the well. She was probably wanting to show off for the rest of the community who was gathered for the clinic.

The well is also interesting… but I should do another post on wells in developing nations. There is so much to learn about. 8-)

Cheap Meds... no not spam...

A lot is made out of the issue of medicine costing so much in the US. While in Canada, it costs considerably less. Well, let me tell you, overseas, it cost next to nothing.

For this out-door clinic we treated about 1,500 people in less than four days. A lot, by just about any standard. We treated them with medicine purchased from a reputable "in country" provider. Almost 1 ton of pills, no joke! The left overs we left with the local clinic to be disbursed after we left.

Here is the most amazing part though... all of that medicine cost us only $1,800 US. In fact, even with all the travel expenses to get the Dr's over there and purchasing the medicine and supplies, it still cost us less than $5.00 per person to treat them.

Compare that with the last Dr visit I had. $94.00 for 5 minutes time with the Dr. $60 for the medicine, generic, purchased at the local pharmacy. I didn't even have any travel expenses!

I know that there are a lot of differences between the kind of care we gave that day and the kind of care I pay for in the states. Really, though, was it 30 times better?

I'm not much of an activist, but this sort of thing really gets me worked up. For one thing, think of how many people could be helped if we all chipped in to the world health problems. Second, is the care we are getting for so much in the US that much better? Should there be changes?

Ok, so forget about the US for the moment. Think about this... a clinic operating in a place like Midigo, can be fully staffed and operated for as little as $3,000 per month. Bring that number up to about $6,000 and you have a 100 bed hospital with surgical capability. The alternative? 60,000 people with no alternative, but to die.

Medical Care in Midigo

I should probably describe Midigo town a bit better.  It is really more of a trading center than a town.  As I have mentioned before, there is no public services, at all…  There is a elementary school, and a secondary school.  A small health clinic is just at the edge of town.  The center of life is the market.

The health clinic has really improved a lot since I first visited.  When I first saw it, there was no food.  Each patient was responsible for their own food.  There was no medicine.  Getting medicine would require a 30 mile walk to the nearest town.  Even then there was only the most basic of medicine.  There was a single trained health care worker.  What they called a medical officer, something similar to nurse practitioner.

As I mentioned before, the child mortality rate was about 40%.  This little center had about 4-5 deaths per month from just snake bites!  They tried, they really did, but this was at the end of the line.  Midigo was the last stop before the frontier.  The Ugandan government just did not get up there.  Any supplies sent to them would get stopped at several larger towns on the way, and badly needed meds taken for emergencies there.

One of the first items on our list of work there was to get an idea for situation.  We brought a team of two MD’s and two RN’s, plus several lay people.  We set up camp in the secondary school (they were on break) and created an outdoor clinic in front of the medical center.  The local official sent word that we were giving a free clinic and waited to see what would happen.

The next morning we were astounded!  A minimum of 4,000 people were waiting for us to get started.  I drove down the roads and found a constant stream of people walking towards the clinic for miles around.  We had our answer, the problem was overwhelming.

The picture above is just part of the line waiting for medical care. A couple of things to note. First, the people are well dressed. This was a big occasion for the community. A social event as much as a serious medical clinic. So each person wore their "Sunday Best". The second thing to notice is the line of men on one side and women and children on the other.

This was something that would frustrate me to no end. Probably as much as anything drive me to anger. The priorities always went to the strongest. Whoever could push their way to the front wanting to get some free medicine, for really no medical reason. Left behind, and sometimes left to die were the weak who could not force their way front.

To deal with this problem, we would form at least three lines. One for the men, one for the women and small children and one for the school children (the teachers would bring them from class in hopes of getting them some help). I would stand and choose people from each line as I saw fit, trying to take as many of the really sick before the healthy men would start to complain. Then I would take a token man from the line.

Additionally, I would send our nursing staff to quitely walk through the crowds of people. They would greet the women and without drawing too much attention, examine the babies. Many, many times they would find desperately ill children, sometimes hours from death being shoved out of the way. So the nurses would take them one by one around the back of the clinic and bring them in for treatment. A lot of live were saved this way.

Nile Crocs are big too...

Ok, another really big animal is the Nile crocodile. The one in the picture is about 3 meters long. You can get an idea of it's size from the Monitor lizard in the foreground. The monitor is about 1 meter, give a little for perspective and the croc is about 3 meters or more.

The monitor lizard is there to steal the croc's eggs. The Croc looks quite capable of simply turning it's head and taking care of the egg stealing problem. However, for some reason, I never saw a croc attack a lizard. Although I suspect that if it caught the lizard digging eggs out of it's nest it would be a different matter.

Both of these animals really are incredible though... Both of them must be fully capable of surviving in this environment. Yet both are really tied to the destruction of the other. So maybe that was a little philosophical... But it is just really cool to see them together like this.

Cape Buffalo are Huge!

Cape Buffalo are huge animals. This pair was in the Murchison Falls game park in Uganda. To give you an idea of scale, the grass the are standing in is about 4 or 5 feet high!

Some people say they are the most dangerous animals in Africa. I think I just might agree. On at least one occasion we had these animals surround our SUV, and charge!

They are very defensive of their young. So a classic herd maneuver would be to surround the young in an outward facing circle. Then the males will attempt to drive off the attacker. In one case this was my wife! She was driving down the road and stopped to admire the herd of buffalo, only to see them begin to encircle her truck.

She says that is when she learned to drive fast in Africa.

Pleading

After my night of malaria and after my time pounding Cassava with the women, it was time to start work.  The elders had been meeting all night to talk about me and what was to be done.  They had a lot of things to work out.  There was a possibility of me bringing in quite a bit of development, resources and most of all money.  

They needed to find out who was going to get the construction contracts (they were thinking big).  Which areas would get the development first, what projects would get done.  Many things to decide.  When they were ready, I was invited into a hut and sat in a circle with them.

Once in the circle, I found myself being presented in turn with each request.  It was a very formal meeting, and one which was spoken in respect for each other.   Ugandan’s, rarely if ever raise their voices.  In fact, except for celebrations, I don’t remember a single raised voice.

While this was going on, a man approached the door.  He was holding a baby.

The men in the hut shooed him away, but he kept coming back.  I could tell from the glances at me that he wanted to tell me something, but the elders did not want him to bother me.  Finally, after watching him for almost 30 minutes, I asked my translator what it was that he wanted.

He wanted me to take the baby.  The mother had died shortly after birth.  With no formula, or medical care available, the baby was slowly dying of malnutrition.  The father had been trying to feed it anything he could find, but there was nothing to supplement a mother’s milk.

Now the baby was nearly 10 months and still weighed about 10 lbs.  I could see in the father’s eyes, the pleading look.  He could not speak English, and I could not speak Aringa, but we didn’t need words.  I knew that I couldn’t help.  We had a job to do, and if I was going to be effective in that job, some things I had to let go…

Sitting here, now, I wish I had done things differently.  I wish I had helped, taken the baby home to Nicole.  Anything would have been better than remembering the father’s eyes, his pleading…

The white snake that spits fire...

One of the stranger encounters was with the "white snake that spits fire". This is such a strange episode in my work, I'm not even sure how to categorize it. I pretty sure that it was a very spiritual matter for the Aringa, (people living in Midigo). For me that did not even occur to me until well into this story.

I was visiting a place called Choro a few miles from Midigo. We had planned to build our base here, and I was looking over the land for the right spot.

There are two small hills, really basalt outcrops, one on each side of the trail/road. If fact that is where the name comes from. Choro means "two hills" in Aringa. Well one was taller than the other and I decided I would climb it to get a better vantage point.

As I approached the hill, several men stepped in front of me. They told me, through the translator, that I could not go there. I was puzzeled. I had never been stopped from going any place before... so I asked why? The men told me that there was a large snake on the hill and it would harm me.

Hmmm... a large snake that would harm me... Most people I suppose would take that as a good answer and walk away. I got extremely curious though. A large snake in that part of the world could be a Mamba, or a Gobon Viper, or even a Cobra. All dangerous, but all rare sights. So I got excited, I started walking toward the hill again and told them I wanted to see the snake. They again stepped in front of me and stopped me.

This time they meant business. They told me that this snake was the "white snake that spit fire". Wow! Now I was really, really excited. All I could think of was that this was some kind of Albino snake, with a biolumonesence. I had never heard of any reptile that used biolumonecense. This could be the discovery of a life time.

Since they were not going to let me go near it that day, I thought I would find out all about it. I started asking questions.

"What is it?" - "The white snake that spit fire"
"I mean kind of snake is it?" - "A white snake"
"Why does it spit fire? " - "So that it can trap its prey"
"What does it eat?" - "Insects"
"Who has actually seen this snake?" - "No one"

uh oh, now I realize something is up. Still there must be some kind of truth to this story. For several weeks, any time I saw someone new, or one of the elders I would ask them about this snake. For the most part I found this to be a "boogie man" story.

The elders told me that their parents told them about it. They said at night they could see the lights up on the mountain (Midigo Mountain). When they saw the lights, they knew it was hunting. It seemed to live wherever there was trouble, a kind of omen. When the snake left the area, it was known that things were ok again.

Later as I traveled more in the region they told me about how the snake had been living on the hill nearby, but the snake had left just before I arrived. In fact they told me it had been near town, when I had first arrived.

More to the science of it. I discovered that there was a kind of lightning bug, that lived in the region. It was quite rare, but I did see it on several dark nights. I believe that this whole thing is a mixture of myth and a little bit of nature. They would see the bugs glowing, and believe the snake had spit them out. There was usually something going wrong at the time and it could be blamed on snake.

I wish I had more time to spend learning from them. This is one of those stories that I'm sure will be lost soon enough.

They did it!

A few years after I had left Uganda, I got the chance to return to Midigo for a few days.  The trip was much more emotional than I had ever imagined.  I remember visiting our house in Arua and break down into sobs.  There was so much of my families life tied up in a relatively short period of time in Uganda.

Well, back to Midigo… I was there with some of my good friends, one of them Rob Frear, was walking through town with me.  We began to hear a very odd, but familiar sound.

It was a diesel engine, running in the distance.  It was familiar to us, but completely out of place in Midigo.  No vehicles ever went to Midigo.  There are no sounds of civilization there only natural sounds.  Yet, we were sure we were hearing a engine.

The two of us walked through the village towards the sound of the engine.  By now you have probably put it together that it was the maze mill.  At the time though, that maze mill was completely forgotten by me.  We finally found the small shed were the sounds were coming from, and stopped about 50 feet from it, wondering what it was.

“Yi-EEEEE” came bursting from the trees near by.  Three of the original women, who were with me that night of Malaria and the next day pounding Cassava and finally when we delivered the maze mill years before, came running to me.  

It was really only when they showed me the mill that it all became clear.  They not only had kept the mill going, but hired an operator to run it.  Hired watchmen to guard it at night.  Built a nice shed with a concrete floor.  Even more astounding they told me how they had saved up enough money to purchase a second maze mill.  They were planning to install the second one in a nearby town.

You can not believe the joy!  This was the first real evidence that my family and I had made a difference, a lasting difference.  It turned out that there was even more that ha happened while I was gone, I’ll have to get to that on another post.

Maze Mill for the Women

One of the very first things I did as an emergency aid worker in Uganda, that was NOT emergency or aid, but rather community development.   I wanted to get a maze mill for Midigo. It took some work, I convinced my superiors that it was actually part of a plan to build an air base closer to Sudan.

However, it ended up, some of my proudest momements are surrounding this maze mill and that group of women who took care of me while I had malaria. If I had not gotten malaria that night, and they had not taken care of me that night, I would not have taken the time to learn something about the local women...

I do remember the day we delievered the mill very well. We had driven all day from Kampalla to Midigo. About 14 hours, mostly over the worst roads you can imagine. The roads were so bad that the door on one of our SUV was bent on it's frame by the time we arrived.

Driving into Midigo is such a happy time for me. It always starts about 5 miles outside town. The children know me by now. They are so excited to see us. They all hear our trucks and run our of their houses, with huge smiles on their faces, waving and yelling! This progression continues all the way to town. Where, by now everyone has gathered to see what the fuss is about.

We made sure the "womens group" as they call themselve, and each town has one, was brought to the front. We opened the door to the SUV and "Yi EEEEEEE!!!!" The women yelled this for a good 15 minutes or so as we unloaded it. Needless to say they were happy.

The maze mill was really just a good sized deisel engine, which had a series of PTO connections. The one we purchased had a grinding mill for one PTO and a small generator on another. We gave them two 5 gallon containers of deisel and hired a mechanic to set it up for them. However, there would be no additional support from us. We really wanted these people to take ownership of it.

Typically, these sort of things would not work out. Usually they would run for awhile, but no money would be saved and the first time it broke down, that would be the end of it. But I really want to give them the practice of putting this together. Perhaps the next time they would be able to take it further.

Getting past Malaria...

Well, I didn't even try the goat.  I just couldn't, it both looked and smelled nasty.  I know I hurt the feelings of the women who brought it, but I tried to make up for it later.

The next few hours I went into and out of sleep. My fever broke about dawn that next morning.  I walked out of the hut the next morning to a peaceful village in Africa.  The men had moved to another hut to let me sleep.  The soldiers were mostly gone, with the danger being a rebel attack during the night also gone.

Children were playing, not near me, I think they were scared.  They played just at the edge of the clearing.  Smoke from cooking fires mixed with a pleasant morning breeze.  It was a good morning.

Not too far from my hut were the same women who had helped so much the previous night.  They were laughing and catching up on gossip, while pounding cassava.    

I know this is a really rookie mistake, but I blame it on the post malaria weakness.  I decided to teach the women something about nutrition.  You see during my limited training back in the states I had found out that Cassava was nutritionally very poor.  It is a large “tuber” that takes about two to three years to mature.  Each one of the massive roots is about 4 inches in diameter and a foot or more long.  Think of them as huge potatoes.

These are pealed, boiled and dried.  Cut up into chunks, and spread out on a blanket or tarp, if the have some.  Once dried it formed a loose chalky white chunk or pulp.  This is then mashed in a large mortar and pistil.  

Well, that is exactly what the women were doing when I walked up to them.  One of them spoke some English, so she translated for me.  I asked why they were spending so much time on Cassava when maze was much more nutritious?    

They laughed and asked me if I have ever pounded Cassava?  Well of course I never had, I am from America were everything is done for us.  So they handed me the wood post that they had been using to pound the cassava.  It took me about 30 seconds to realize this was hard work.  They then pointed out how much softer cassava was than maze.

I discovered something important that morning.  I could never assume I knew anything about them or why they do the things that they do.  They were pounding cassava because there was no mill for many days walk in any direction.  They grew the cassava instead of maze because they had no way to grind the maze. 

I didn’t tell them then but I decided one of my first priorities was to get them a maze mill.

My first night in Midigo...

My first night in Midigo didn't really go like I thought it would. That afternoon I had my first run in with Malaria. Unfortunately it was just before a speech by the deputy Prime Minister a Mr Ali. I made it through my short speech and promptly passed out in the back seat of our Land Rover.

Pretty much the next thing I remember was arriving at night in Midigo. I would describe it as completely dark. Not a single light for perhaps a hundred miles. It was really dark. We had picked up our escort by that time. A platoon of Ugandan Army soldiers. I remember making a Sat-phone call to my wife in Nairobi. She was worried of course. I described my fever and body aches and mild delerium. I was a long way from any help.

She called the Emergency Operations Center for our group back in the US and they talked with a tropical medicine specialist, who thought it could be malaria. So they sent a page out to me, by Sat-pager, telling me what I had and how to treat it. Then 10 minutes later they sent a second message reminding me where in my medical kit the meds where and that I really needed to take it.

Wow, image that... More amazing was that the women of the village already knew all of this. They were quite concerned. I remember them bringing me some tea. We were in a round hut, and each woman entered the room on their knees and head down... Through the fever and the poor lighting coming from a single flashlight pointed against the wall, I could see these women coming towards me and I had no idea what to do.

My interpeter told me to hold my hand out to them. Ok, now I'm wondering if I'm getting married, (I'm not kidding they offered me a second wife earlier in the day). All of what I had been taught in western society, said that I was to treat women the same as men, yet here they where, on their hands and knees, before me. This can't be right? Not knowing anything else to do, I put my hand out...

They took my hand and pressed it to their foreheads. Then looked up at me an smiled, before backing out of the room on their knees. After that they seemed able to interact with me without much more fanfare.

These women, I later learned were selected to "take care of me". Thankfully, that did not include the entire African treatment of sleeping with me as well. They did show a lot of concern for me though. Brought me boiled water to take the anti-malaria's. Told me to rest and that I should eat when I woke up.

I didn't know that I would wake up so soon. I found out later that malaria can be very fast onset and very fast to receed once treated. I woke up at about 2:00am. The elders of the village were still in the ajoining room talking about me and what they should do with me. As soon as the women realized that I was awake, they insisted that I eat. While I felt a lot better, I was still very weak, unable to stand.

In a jesture that I thought was one of the most incredible acts I witnessed over there, they slaughtered a goat that night. The village was not doing well and that goat would have been saved for the most important of occasions, but they wanted to treat me right. After boiling the meat they brought it to me on a large plate. The very best parts... the stomach and intestines...