The Big Six-O

One big advantage of living in Uganda is being able to do exotic things on big birthdays. This year took us to Eastern Uganda for my Big Six-0 and to the highest mountains we have yet seen in the country, with Mount Elgon, its highest peak, at 4165 metres. Our destination was Sipi Falls, a modest 1,800 metres above sea level, but high enough to be free of mosquitoes and cool enough to need blankets at night – a real treat.

We were staying at Lacam Lodge, which prides itself in being electricity-free, using gas for cooking and kerosene lamps to light the restaurant and bandas at night. Another feature was the toilets.

Being built on solid rock, digging ‘long-drop’ toilets is impossible, so instead the Lodge provides bucket loos. These look like ordinary toilets, but instead of a flush guests are provided with liberal quantities of sawdust to sprinkle as appropriate. It was ideal, and 100% effective in rendering the toilet odour-free. Every couple of hours one of the staff would enter the toilet via a back door to empty, clean and return the bucket (presumably ensuring the toilet was not in use at the time). This was a job we decided not to apply for, but to show our gratitude, left a healthy tip under the loo seat.

During our stay in Sipi, we were fascinated to be met by several groups of young people jogging and dancing their way along the road, singing, shouting and blowing whistles. We enquired of our local guide, Fred, what this meant and he told us with some pride that they were preparing for circumcision rites. He explained that these usually happen in the month of December in even numbered years. We thought of little babies, but no. Here, in the home of the Bagisu and Sabini tribes, circumcision is carried out on males, generally, between the ages of 16 and 26!

The ritual marks the transition into true manhood and qualifies the initiate to marry and take positions of leadership in the community. Initiates nominate themselves for the ritual in the previous May or June, which apparently gives them time to prepare for the event. I wondered how you could prepare for such an event. Circumcision is performed, with no anaesthetic, in public before family and friends, and even tourists can attend – although these tourists didn’t. Subsequently we noticed a number of young men wearing skirts – they no longer have to prove their manhood. Fred confirmed what we thought, again with great pride. He had been circumcised in his teens. Better to look back on than to look forward to, I thought.

That aside, Sipi Falls is a beautiful spot. There are four main falls, the last and longest of which provides a magnificent setting for Lacam Lodge. From our banda we could both see and hear the long and extraordinarily elegant cascade plunging 100 metres into the river below. It was a glorious view looking down into the valley and the plains beyond, towards the north-west and our home in Arua some 600 km distant.

On my birthday itself Fred took us along the edge of the ridge above the falls, and then steeply down into the valley itself. The slope was precipitous, involving some rather hairy walking/climbing, including an almost vertical ladder down part of the rock face, but it gave us great views of Lacam Lodge across the valley, and then the Falls themselves. As we descended, our daughter, Jo, rang to wish me a happy birthday and I received a birthday text message from friends in Doncaster, UK – a lightly surreal but delightful reminder of home.

At the foot of the Falls, out of the sunshine, it was very wet, muddy, slippery, and a little scary., but as we ascended back out of the valley into the sunshine again, we encountered a girl and young boy. Both were carrying great loads of bananas on their heads from the banana groves growing on the valley side. Being unable to balance anything much on our heads we were much impressed by their amazing ability to scale rock-face ladders with such a burden.

We stopped to talk to them as they, and we, rested on the way. The girl’s name was Emma. “It means ‘God is with us,’” she explained. “Of course, from Emmanuel,” I said, “Jesus’ name.” “You’re a Christian!” she responded with a bright smile, and told us she was a singer in her local church. She then sang us a song about heaven and the truth that if we trust in Jesus we will all be there together one day – ‘every nation, tribe, people and language’.

Our best wishes for a very happy Christmas and joy-filled New Year.

Health care delivery on the edge

Health care in rural Uganda is a million miles away from anything you might imagine if you have been brought up in UK since 1948. Yes, the NHS has plenty of faults and will never have enough resources, but it has an impressive way of swinging into action when anything life-threatening occurs.

Not so in Uganda. There are hospitals, yes, but they rarely have many, if any, doctors in them, and the nursing staff can be hard to find. When you do find them they may not be very quick to respond to patients’ needs, and the care is all done by ‘attendants’ – long-suffering relatives who volunteer to feed, wash, toilet and accompany the patient through 24 hours, sleeping on a mat beside the bed. Such is the tradition of extended family responsibility here.
There is nothing equivalent to a GP, unless you count the private medical practitioners who keep shop in the town and charge high prices for dubious investigations and treatments. And then there are the witchdoctors of course......

But on the ground in the rural areas are the health centres. These small buildings, often in remote locations in the bush, are the mainstay of healthcare for most. Of the five health centres run by the Church of Uganda in this Diocese, none has running water or mains electricity. A small solar panel might run a satellite phone and emergency lighting. Their equipment is old and battered, and they don’t have nearly enough of anything. They are staffed by a couple of nurses, midwives and nursing assistants, with perhaps a laboratory technician, a guard/groundsman and a cleaner. The staff live in at the centre in grass thatched houses like those of the community around. They provide out-patient consultations for everything from malaria to worms, from attempted suicide to HIV testing. They cater for a range of maternal and child health services including deliveries, family planning and immunizations. Some include in-patient facilities, and even those that don’t will put a mattress on the floor to keep a dehydrated cholera case under observation until he or she is well enough to move. None has a doctor or clinical officer.

Visiting Kei health centre for a meeting with staff and community members, I was reminded of the constraints under which they work. Kei is the most remote of the five health centres I help to supervise, but it is also one of the biggest and busiest. It serves an area of rural poverty very close to the Sudan border in the far north of the Diocese, and is reached by a terrible road that is regularly impassable in the rainy season. The health centre, like the region it serves, has seen its share of disturbance in recent years. But at present it is well run by Mary, a nurse In-charge who has a sweet but strong character, and is a very committed Christian.

After the meeting, while we were drinking tea and eating cassava and biscuits, Mary approached me to ask if we could take a seriously ill patient to the nearest government hospital on our way home. There are no ambulances here. She wanted to refer him because he had been an in-patient at Kei for two weeks, was deteriorating, and she felt he needed more specialist care. He has AIDS, and had a serious infection in one leg that was causing much swelling and pain. There were already five of us squashed in a ‘double cabin’ pick-up, which left only the open back of the truck available. But that was what was wanted. The staff and relatives spread blankets on the floor of the pick-up, then lifted the thin, frail man onto the back. One of his sons sat upright against the cab, cradling his father’s head on his lap so that the patient was as comfortable as possible on the rough road. We set off for the 20km journey with five of the family in attendance, together with bedding, cooking pots and personal belongings.

It wasn’t an ambulance journey I would have chosen for myself, but it was the only one available and the family were grateful. We left them at the hospital in Yumbe – the patient might get some medical attention there, eventually, but I doubt he will receive as much care and concern as he did whilst at Kei.