Healthcare Uganda Style

Ugandans are good at improvisation. They have to be. If you haven’t got a drip stand in the mission hospital, you hang the infusion bottle on the slats of the louvre window. There are no 20 ml syringes today – no matter, just draw up 5 mls four times from the bottle of intravenous glucose, using the same needle each time to pierce the (non-sterile) rubber bung. The drug of choice for meningitis is out of stock? Well, we have a couple of other antibiotics in stock, so we will try one of those. If that doesn’t work, we’ll try the other one.

But improvisation really comes into its own in community healthcare. A child health clinic can be set up anywhere, provided there are a few shady trees, a wobbly table and chair or two, and a handy branch from which to hang the weighing scales. During the long wait for immunisation or treatment, mothers dress and undress the babies in the shade of the 4x4 in which the team came – underneath the chassis. Well, it’s cool and dry, and the babies don’t seem to mind looking at the grimy underside of a very old Toyota.

The old woman in the picture is in her 80s – although average life expectancy in Uganda is 50 years, there are some who live to old age. And she can still sit comfortably on the floor to have her blood pressure taken! After this clinic for old people, which was held in her house, she produced a meal for the healthcare team of matoke (plantains steamed in a parcel of banana leaves) outside the house on a charcoal stove. Kitchen gadgets, even pots and pans, are redundant here.

But sometimes improvisation is not enough. A mother turned up towards the end of a rural outreach clinic carrying a small child, very sick with malaria, in her arms. She had gone to her local health centre, and been told the child needed to get to hospital quickly. The health centre had neither drugs to treat the baby nor transport. She heard our team was doing an immunisation clinic under a tree in a nearby village, and that we had a vehicle. She walked with the child for an hour or so to find us.

We packed up the clinic early and put mother and child in the vehicle with us for the 20km drive back to the hospital. The child was unconscious, with laboured breathing. There were no blue flashing lights as we drove back at normal speed, the team chatting among themselves. The mother was silent, with an expression on her face that suggested little hope and a familiarity with loss. Just as we drew into the hospital gates, the baby died.

Some transport was found to return the mother and dead child to her village.

Malaria is largely preventable, and deaths from the disease almost always avoidable. If the mother had used a mosquito net, if stagnant water near her home had been drained, if she had given effective medicine at the first sign of fever, if she had got help as soon as the baby deteriorated ……if……if……….

Living Out Of A Suitcase

The Guest House at the Ugandan Protestant Medical Bureau (UPMB) in Kampala is comfortable enough, but still the prospect of living out of a suitcase for four weeks in one of its rooms didn’t fill us with delight. Nevertheless, the Ugandan Nurses Council decision that Anne should complete one month working in a Kampala hospital to receive her nurse registration meant that we had little option.

UPMB is situated in the Mengo district of Kampala on the Balintuma Road. Walking from Albert Cook Road past Mengo Hospital and down Balintuma Road after dark can be an exciting business. There are no street lights, so avoiding the open manholes and stray pieces of reinforcing rods emerging from the pavement is an art, not least because headlights on full beam from oncoming traffic tends to blind the poor pedestrian. Then closer to the Guest House there is no pavement at all and recent ‘slashing’ of foliage along the side of the road has resulted in a tangle of branches and other sharp objects for the unsuspecting walker to trip over, possibly into the path of oncoming boda-bodas (motor-cycles) with no lights at all or, veering off course, falling into a storm drain.

The main reason we stayed at UPMB was the cost of its rooms - a very reasonable 37,000 Ush per night (c.£10.60). But there is no lounge, you have to pass an Advanced Driving Test in order to park your vehicle in its restricted parking area, and meals are served in a large and cheerless room often with empty tables because people who stay here frequently eat out.

We ate out on our first evening, and walking back along the Albert Cook Road past a petrol station, saw a small crowd gathered there. There, in the forecourt, was the body of a man who had been shot by the petrol station’s security guard shortly before. The story appeared in The New Vision two days later.

But there are benefits living here. For Anne, Mengo Hospital, where she is based for the month, is only five minutes’ walk away, as is the Church of Uganda Provincial Office (for Allan’s benefit) and Namirembe Cathedral. But there is a much more significant benefit, to meet other people who stay at the Guest House.

This is the reason we eat here every other day, simply to meet people like Ernest Sempebwa. Ernest is a Ugandan, easily well into his ‘70s, who for many years lived and studied in the UK, at one time looking after all the Ugandan students who came to London University. He is very well educated, and his thinking and conversation are razor-sharp (even first thing in the morning), but seasoned with a wonderful sense of humour, genuine humility and a lively Christian faith. He comes to UPMB with a team of others (old and young) who are in the process of producing a new translation of the Bible into Lugandan (the local language of this region). They have been working on it for 18 years! A teacher by profession, Ernest, and those he is working with, can transform the dining room with their sheer energy and enthusiasm.

The same is true for cosmopolitan conversation and Christian fellowship with other Ugandans, Germans, Canadians, Kenyans, Americans, South Africans, South Koreans, and so many others. The picture above is of a group of health workers from Rwanda, Judy, Michel and Jean who were on a course in Kampala. We had a great evening with them and this picture is just a token of the rich experiences we have enjoyed even in our four weeks living out of a suitcase in a single room at the UPMB Guest House in Kampala.

Perhaps it’s not so bad after all.

Defining Rubbish

Coming from a society in which disposing of rubbish is an increasingly complex and costly business, and a visit to the dumpit site has become almost a form of recreation, it is delightful to find ourselves in a community where, it seems, very little is counted as rubbish and obsolescence is practically unheard-of.

When we bought our 1993 Toyota Prado Landcruiser, it was hailed as a ‘new’ car, and in truth it is relatively new by Ugandan standards. Most cars on the road in Uganda start their life as 10-year-old used-car imports from countries like Japan. They are then subjected to the most severe road conditions imaginable and many are kept going long after they should have been written-off.

But this is true of so many things. Many of the items we dispose of are gratefully retrieved by Lucy (our home-help) for her own use: old plastic squash bottles can be used for storing kerosene, cooking oil or other liquids (and yes, we know of the dangers to children); old saucepans and casseroles with loose handles, or no handles at all are still perfectly serviceable for Lucy; and an old, not very attractive, battery-driven clock which had given up the ghost, she retrieved saying she knew someone who could mend it.

Which brings me to the bowl and the flip-flops in the pictures.

A plastic bowl might cost around 3,000 USh (80p) in a hardware store in Arua, but if your monthly income is, 40,000 Ush (£12) or less that’s a great deal of money. So, when it suffers from plastic fatigue, you mend it.

The same with flip-flops. Anne bought these for 1,400 Ush (c.40p). It’s her second pair. The strap on the first pair became detached from the sole. She was going to throw them away, but Lucy wouldn’t hear of it. They can be mended for 100 Ush (you work it out!). Anne is looking forward to taking delivery of the repaired pair very soon.

Good Food Costs Less At ...........

At first sight, Arua’s fruit and vegetable market seems to offer little to the Sainsbury-trained eye. Familiar with the vast choice available in the average British Supermarket (next time you go shopping count how many varieties of lettuce, potato, tomato or carrot you can find), the limited options in Arua come as a bit of a shock.

What tomatoes shall we buy? Well, there are lots of them, but there’s only one variety, and none of them looks too good. Certainly they’d not find their way into an Asda store or on to a British market stall, and if they did nobody would buy them because they’ve got so many black marks on them.

Are carrots on sale today? Perhaps not in the market, but you might just be fortunate enough to see a woman (always a woman) on the road, carrying a bowl full of carrots, bananas or avocados, probably the produce of her own piece of land, grown to earn a few shillings to help the family income.

Potatoes, though, are here in plenty; two varieties: sweet (not the sort we’re used to) and Irish (that’s the sort we are used to). You can buy a regular bowlful, or a large bowlful, but none of them round and all impossibly difficult to peel.

But in reality you can usually get everything you need in Arua Market: onions, cabbage, lettuce, peas (sometimes) green and chilli peppers, cucumbers, courgettes (occasionally), and plenty of fruit – pineapples to die for, oranges (green), lemons (also green), passion fruit, bananas, and the most amazing avocados for 500 shillings each (that’s about 20p). Unfortunately mangoes are out of season at the moment, but only about a month to go!

There are other benefits too of shopping in the market here. Although you don’t have much choice in what to buy, there is a great deal of choice in who to buy from. The sellers are generally all very good humoured and don’t really know the meaning of the word ‘competition’ or time. This means they won’t hold it against you if you buy from someone else. That can spell problems for developing the local economy, but it does make shopping a wonderfully social activity as you meet so many different people selling their produce who like to ask where you come from and how many children you have. It also gives you a chance to practice your Lugbara (the local language) – and they love it when you try. Gales of laughter and delight greet even the most simple expression or phrase you attempt. But possibly that’s because you’ve got it wrong and are saying something truly ridiculous (or rude) without realising it!

The other great benefit of Arua Market is that everything tastes really good, and the last thing you would ever want to do is to waste any of it.