Sunday we went for a hike with a local guide and the standard side-kicks of a policeman and a park ranger. We keep being told that the armed ranger or policeman needs to be along in case there are elephants though how an elephant would maneuver through the Impenetrable Forest we’re not sure. We were fortunate that it was the clearest day we had experienced since arriving and the panoramic views were superb. At one point we could see the dormant volcanoes in Rwanda and the Great Rift Valley as it coursed up through the Congo. Indeed the trail we were on ducked briefly into the Congo.

Monday night we felt transported back to Lord of the Rings again as the sheet lightning was so prolonged and vivid it seemed as though the eye of Sauron was radiating out at us. Because we are up in the hills, the thunder and lightning really feel personal.

Rachelle and Thea have desperately missed their friends and usual routines of school, soccer, youth group, etc. but overall have coped with the enforced family togetherness. Doing grade 11 and 8 by distance education has been challenging for them. Our internet access has often been slow and sporadic. They have had to work in diverse, often noisy environments ranging from cramped hotel rooms to the cervical cancer screening room at Nyanga District Hospital (when there was no clinic on), and in 35-degree heat in the house at Karanda. It has been difficult to get into a groove and the four of us compete for access to the one laptop (Paul and I have found that providing written material/tables is one avenue for us to help out at the hospitals). Nonetheless the girls are making progress and I hope learning things from our various excursions, observations, and conversations. Their teachers have been flexible and understanding for the most part. Thea and Rachelle have also formed some friendships when possible. The high school girl who passed the note to Rachelle and who we gave a couple of pens and a Canada pin to in return gave Rachelle a lovely basket she had made. The activity both Rachelle and Thea have listed as their favourite in Uganda so far – building the mud hut – was the least enjoyable for me. They say it was the first time they really felt a part of something and that they had made a contribution.

Wednesday afternoon we had a tour of CIBC – Community Initiatives for Biodiversity Conservation. It is run by a local guy who obtained a degree in agriculture and returned to set up a training centre. He is raising tilapia, pigs, and chickens and growing a wide range of fruits, vegetables, and oyster mushrooms as well as harvesting honey. It is particularly impressive when you realize his only farm vehicle is a motorbike, all his outbuildings are constructed without the benefit of power tools, and all the harvesting is done by hand. His goal is to teach farming to alleviate poverty, hunger and malnutrition. Some of his clients are single mothers and others are people who used to hunt in the forest and no longer can. We had supper there. Millet bread has a texture akin to dirt and the girls renamed it millet gloop but otherwise we enjoyed the eggplant, tilapia, mushroom, cabbage, potato and banana dishes. Stopping by the Bwindi Bar for brownies was an additional treat.

Thursday morning, we got a call as we were walking down to breakfast that two permits for Gorilla Tracking had come available. When we were organizing to come to Bwindi the thought of gorillas had not crossed our minds. It was only on arriving here that we were alerted to the possibility and it became one of those “well we are here so it seems silly not to take the opportunity” things.  Lori was booked to teach that day so couldn’t go. They are strict in enforcing the rule that children under 16 can’t go so Thea couldn’t go either (despite the fact that she is taller than Lori and Rachelle and has way better endurance than the others in the group we ended up with). So Rachelle and I raced back, quickly changed, grabbed some water (but didn’t have enough time to get breakfast or put together a lunch) and headed to the meeting point.

It ended up being quite an epic day as we clocked 18km and 7 hours penetrating the Impenetrable Forest tracking the gorillas. At one point we had climbed most the way up a ridge when we were told the gorillas were on the move so we had to back-track across a river valley, forcing our way through the Impenetrable Forest. A true “hacking through the jungle” experience (and therefore not really low impact). Later on Rachelle had to stop me from sliding down into the ravine as there was nothing for me to get a hand hold on when I slipped. We did eventually reach the gorillas but it was not the peaceful sitting watching them at rest and play experience that you might imagine. It was more crashing through the Impenetrable Forest as they were trying to get away from us. At one point the Silverback charged straight at Rachelle and another gorilla crashed past me almost knocking me down. So it’s hard to know what to think about the whole experience. It appeared quite stressful and disturbing for the gorillas and we can’t imagine that it is good for them to be chased through the forest every day. It is my understanding that there are a few families of the now over 400 gorillas in the park that are “habituated” to human contact but I was left with the feeling that, if sentient, they would be thinking “Do you mind? I’m trying to have a crap here!” Others have reported a less intrusive experience. While it was amazing to see them in the wild and so close we have to admit to being ambivalent to the whole experience.

Another concern is that the park states that 20% of the (very large amounts) of money charged for the permits goes to the local community. However not a single group we have spoken to here has stated that they get government support. We have been told that there is a “process” to apply for money but no-one has ever been successful in jumping through the hoops. All the more concerning given that the creation of the park to protect the gorillas displaced the local Batwa and created many of the social and health problems the many volunteer groups are trying to manage.

We were very thankful that evening for the Thanksgiving meal the guest house provided. There were hospital staff and visitors from five countries and we all had much to be thankful for. We were particularly thankful for the drive home we got as the daily deluge had kicked in after supper.

We have mostly managed to avoid being caught in the daily deluge. Yesterday, however, Lori was taken on a hike up the local river valley just as the heavens opened. It rains a lot here. 1.4 to 1.9 METRES per year. But we are told that only 2 hours from here there is drought. It is hard to believe that 3 short weeks ago we were begging for rain and now we are quite done with it (we were relieved to hear Karanda has had some rain). The contrast of abundance and paucity is a theme here: from the contrasts in the weather to the contrast between the tourist lodges (and our own very comfortable accommodation and abundant meals) to the mud huts and shanties of the local population. Much for us to be thankful for.

After our morning of mud hut building, I think it took a week for me to get the mud out from under my finger and toe nails! Last Sunday we did the Batwa Experience, which involved hiking up a steep hill to learn how the Batwa had lived in the rainforest. We saw the homes they built, the snares they set, and the dances they performed. As mentioned in the previous post, in 1991 the Batwa were evicted from Bwindi National Forest to try to help protect the mountain gorilla population. The Batwa were not given land initially and have suffered many health problems as well as discrimination after they were displaced. They are between 4 and 5 feet tall and there are various theories as to why they evolved this way including less UV light in the forest therefore less vitamin D and poorer bone growth or simply that small stature was advantageous for climbing trees and moving through the forest.

Bananas are a staple here and are eaten fresh or cooked and mashed as well as fermented for beer. A potentially devastating problem over the past few years is banana xanthomonas wilt – a bacteria that causes the plant to wilt or to ripen prematurely and rot away. It is a concern in this area. A lot of tea is also grown around Buhoma as well as some coffee. Coffee is more lucrative; we were told that 10 kg of fresh tea leaves brings only $1 and it is all hand-picked.

For some reason I have been more homesick in Uganda. Perhaps it is just a function of how long we have been travelling or perhaps it is because we had a bit more of a bubble in previous places. Here our daily walk takes us through the heart of the village and past people’s homes, work, and schools. Rachelle had a sweet interaction when one of the girls we regularly pass as she walks to school and we walk to breakfast handed Rachelle a beautifully written letter wishing us a Merry Christmas and asking what are names are and where we are from. Rachelle wrote a nice letter in return.

Paul has continued to help during surgeries when possible and complete the list of OR inventory. Whereas at Karanda I spent most of my days in the pharmacy department, there are fewer prescriptions to fill and more staff in the dispensary at Bwindi Community Hospital (BCH). BCH has a nicely integrated computer system so the patient vital signs, preliminary diagnoses (including mid-upper arm circumference for children to assess nutrition status), and even whether the individual regularly uses a mosquito net are listed on the computer record along with the prescribed medications by the medical officer or physician. There is no pharmacist or pharmacy technician at BDH but the nurse dispensers are excellent. Once the nurse has dispensed the prescribed medications, the list is printed out and stapled in the patient’s book. If an infant is treated for diarrhea, the nurses spend time educating the parents about sanitation. Plumpy Nut for malnutrition is dispensed from the pediatric ward rather than the dispensary and again the nurses do a lot of education about infant nutrition and even how to grow a garden to obtain a range of foods. I had wrongly assumed that the medications used in Uganda would be similar to those in Zimbabwe. While the same little plastic bags are used for dispensing, there are certainly some differences in drug usage. There is less counting for pharmacy staff as more medications are supplied in strip packaging. Most of the antibiotics are the same but at BCH the anti-HIV medications are dispensed from a separate location to promote confidentiality. As for all patients, there was no confidentiality at either of the two hospitals in Zimbabwe for patients picking up anti-HIV medications but perhaps that lessens the stigma of being HIV-positive if it is just treated as another chronic illness. I can’t really decide which is better. Karanda had some steroid inhalers but a salbutamol inhaler is the only inhaled option for asthma or COPD at BCH. As a guide for the nurses, I compiled a table of timing of oral antimicrobials and notable drug interactions and am working at updating the BCH Antibiotic Policy. I have given two pharmacology lectures at the nursing school but get nervous and go through the material too quickly and end up dismissing class early.

On Thursday morning Paul and I watched the Patriotism Parade. During the week over 100 staff and community members had been attending classes before and after work on Ugandan history and the vision for 2040, as well as learning marching drills. It was quite moving to watch the drills and listen to the oaths the individuals recited echo off the chartreuse green hills. Thursday afternoon the four of us watched a local youth community development group do some traditional dances – we hear the drumming each afternoon so we felt compelled to go watch. The boys were fantastic singers, dancers, and drummers. It is difficult as there are many groups locally doing good work and requesting sponsorships and funding. We are even trying to spread our souvenir buying out over as many people as possible.

The girls and I have been trying to help out a bit at Redemption Song Foundation. Wendee is fundraising for a community water tap stand for a Batwa village and the girls have been posting the Instagram messages. It is encouraging to see how healthy the children who come to the weekly soup kitchen are compared to the norm. The love Wendee has for the kids is genuine and translated into practical caring. Seeing jiggers dug out of feet still distresses me. On Friday night we had a lovely supper at Wendee’s– her staff served pork with groundnut sauce, cooked plantain, potatoes, and rice balls coated in cassava flour and fried. I need to source some more of those or learn how to make them. After supper we watched the first Lord of the Rings, which seemed surreal when we had been thinking earlier in the week that the Batwa would be good Hobbits. Not to mention that we feel like we are living on the edge of Mirkwood when we look off our deck in the mornings. 

We had not been using the boda bodas (motorbikes) for transport but 10 pm seemed too late to walk the 3 km home. Wendee knows some reliable drivers and once I stopped imagining crash scenarios, the ride back to our accommodation was actually magical. Three to a bike did not feel too crowded. The sky was completely filled with stars augmented by sheet lightning and fire flies flitted by closer to ground. The insect and frog sounds of the night and alternating warm and cool air surrounded us. We arrived safely at the top of our driveway, the silhouette of the ‘Misty’ mountains overlooking us.

En route to Uganda we transited through Johannesburg for a third time and, in contrast to the previous times, had a relaxing few hours there. Immigration and Customs at Entebbe Airport was hassle-free and we were well looked after by our local hosts at the African Roots Guesthouse, who we were gratified to learn co-own the guesthouse. It was strange that Uganda actually felt cool to us – we were able to sleep under a sheet – and I didn’t feel guilty running water for a bath (although apparently Entebbe is relatively dry at present.)

After our overnight in Entebbe, we flew in a small plane to Kihihi, enjoying the spectacular views over Lake Victoria. We were met by a driver and after an hour and a half drive through lushness that seemed impossible after the starkness of Zimbabwe, we arrived at Bahoma.

There are many more tribes in Uganda compared to Zimbabwe. The official languages are English, Luganda, and Swahili but the local language is Rukiga. Uganda has twice as many people as Zimbabwe (Kampala is one of the fastest growing cities on the continent) and colonialism took a different track, with little appropriation of land from the natives. Nonetheless the transition to independence was not smooth. The years of Idi Amin’s rule decimated the country but things seem to be turning around.

Our accommodation – the Gorilla House – is right on the edge of the Bwindi Impenetrable Forest and it does almost feel as though we are living in a fairy tale with a massive rose bush climbing up and over the entry way; a deck overlooking the forest; and the air positively thrumming with bird, insect, and flowing water noise as well as drumming from the Batwa Development Project Centre at 4:30 pm most days. Because it is near the equator, the sun rises at about 6:30 am and sets at 6:30 pm, with more twilight than Zimbabwe but much less dramatic sunrises and sunsets. It rains daily, impressively torrential at times, with accompanying thunder and lightning. The absolute contrast with the drought in Zimbabwe is distressing. The humidity affects everything, e.g. toilet paper doesn’t tear properly, a piece of paper can’t be torn along a crease, and our pack of Wizard cards feels disturbingly clammy. Laundry takes days not minutes to dry.

Our excellent meals are provided at the Monkey House, 2.4 km down the road and adjacent to the hospital. Red-tailed monkeys scamper across the roof of the dining room and peer in through the window bars at us while we eat breakfast. The local children are more habituated to tourists than where we were in Zimbabwe so they will often come and take our hands while we are walking (and ask us for money). What continues to strike me is the paucity of toys for children. While I think sometimes a bit of boredom can stimulate creativity and too many distractions and toys aren’t beneficial for kids, I suspect a complete lack of any toys hampers the imagination.

It feels like a victory each time we manage to avoid getting hit by the various motorbikes and safari trucks on our regular walking commutes. Rachelle is starting to recognize each different driver based upon his riding attire and their bike adornments, but also on how much room they do and don’t give us pedestrians as they go tearing past. So we know which ones not to consider getting a ride from. It is fairly dark when we are walking home in the evenings and the sound of the Muslim prayer call competes with frogs as loud as motorbikes and various insect noises.

On Monday we had a thorough orientation to the hospital. The hospital was initiated by Dr Scott and Carol Kellerman, from California, and it is amazing what has developed in 15 years. Their initial motivation was to help the pygmy Batwa people who were relocated from the forest by the government to try to protect the mountain gorillas. The hospital has over 100 beds and includes several wards. There are well-coordinated outreach clinics and a nursing school. Uganda has been more successful than some other countries at limiting new HIV infections. TB rates are therefore also a bit lower than Zimbabwe but malaria still claims many lives. The pediatric ward was especially poignant as there are several children being treated for severe burns and some for malnutrition – we were surprised to learn that although the region seems very lush to us, some of the soil is actually quite poor.

Similar to Karanda, the mornings begin with singing and devotions. Paul has been spending some time in the OR and has been compiling an equipment inventory – fixing what he can, downloading manuals when necessary, and even putting English tags over German labels. 

One afternoon we toured a school next to the hospital. The conditions are desperate and we were heavily pressured to sponsor a child or make a general donation. We did have pens to donate (thanks Bruce and Shannon Ross) and are considering a donation through a third-party organization. (http://www.omushana.org/) The students danced and sang for us but we felt somewhat awkward as it felt so scripted. Not quite as blatant as the time-share talk we got signed up for in Kauai but uncomfortable nonetheless.

We have been spending some time with Wendee Nicole. She is a US journalist who started the Redemption Song Foundation to assist the local Batwa population through selling their baskets, running a soup kitchen, and teaching hygiene to children. We encourage you to check out the web site: http://www.redemptionsongfoundation.org.

With funding from the North Peace Division of Family Practice, on Friday we helped mud a hut with the Batwa Development Project. It was great to have two Americans along with us as it meant we got over half the hut mudded in the allotted time. It was a challenge for me. My running partners know I don’t even like to run through mud let alone get my hands and clothing smeared with it. The local population worked hard alongside and provided us with a meal of goat, millet bread, and tomato sauce. 

One of the many positive aspects of our travels I hadn’t anticipated was the interesting conversations we would have with people we came in brief contact with – the businessman from Cape Town on the same light plane flight as us, the two professors from Stanford University at our guesthouse in Entebbe who run a graduate course for people wanting to do projects in developing countries, the American in the Customs queue who has worked in wildlife conservation in Zimbabwe for 30 years, the psychiatrist and public health physician from England who have overseen programs in many countries. I think I’m channeling my mother’s penchant for talking to strangers! These conversations have provided us with insights we would otherwise not have had. 

Thank you for the music (and other things)

Despite the misgovernment and the misery it has inflicted on the citizens, the inefficiencies, the heat, the overwhelming disease burden we witnessed, in less than 2 months Zimbabwe and the people ingratiated itself into my heart and I was reluctant to leave. The landscape that initially seemed so stark revealed its beauty – the image of the round hut with the thatched roof is imprinted in my memory – and we met so many fascinating people. Paul and I wished we had had longer than 3 weeks at Karanda Hospital in order to follow through on a few projects. Paul pulled almost an all-nighter one evening in order to facilitate a MOIS software download and upgrade and doggedly updated the computers in various departments the following day. He also sorted out some software for reporting cervical cancer results. (A system had been donated and was being used but little training had been provided and staff were still having to tally results manually.) The pharmacy staff transitioned to doing order entry on the computer and this will save lots of time for month-end reporting. I admit I got comfortable in a routine and could have stayed in the known rather than adapt to the unknown of the next 5 weeks. Rachelle and Thea managed a fair bit of schoolwork despite spotty internet, taught some Origami and cat’s cradle at the school on site and counted tablets in the pharmacy.

Our meals at Karanda got increasingly interesting as our groceries dwindled (topped up with dairy products by the nurse instructors one weekend when they went to Harare). We became devotees of Mazoe, the cordial that comes in various flavours to be diluted with water. I was grateful for the toffee sauce that was left by the previous volunteer in the fridge as it was a taste sensation on pancakes for supper one evening as well as for the cinnamon as it meant I could bake a carrot cake. One day a patient insisted on giving me a Pfuko ye Maheu, a commercial drink that mimics their traditional breakfast – maize meal, milk, sugar. Shake well is imperative – the texture is disconcertingly gritty (and lingers between your teeth) but definitely a meal in 300 ml. We did manage to cater a curry and rice meal for about 13 people on our last evening as a thank you for various meals and hospitality we had been offered.

The music at Karanda was a highlight. The student nurses’ singing every morning was always beautiful and often sublime. The on-site radio keeps the energy at the hospital up during the day, although I found it made me a bit anxious when I was spending time in the out-patient department as it added to the chaos. The music at the Sunday church service was enlivening (more cow-hide drum!), although I felt particularly white and nerdy at the times when most people were dancing.

The sunrises on the walks we did several mornings before 6 am were spectacular and the sunsets each evening similarly stunning.

I was very appreciative of the range of books at the houses, specifically Alan Paton and Helen Suzman’s autobiographies, both of which condense the last 100 years of South African history from intimate perspectives. Robert Guest’s book The Shackled Continent published more than 10 years ago set out some suggestions for various African countries that, particularly in Zimbabwe’s case, have sadly been ignored. Why have the rolling water barrels not been adapted more widely? Perhaps simply the cost. Sekai Nzenz-Shand’s book Songs to an African Sunset describes how a woman transitioned from traditional life in a Zimbabwean village to going to university overseas and returning to Zimbabwe. And the Sue Grafton mysteries were a welcome diversion from the heat.

Our admiration for the Zimbabwean, American and Canadian staff at Karanda Hospital – many of whom have been there for decades – continued to grow over the 3 weeks. They work long hours in challenging circumstances with few supplies yet provide true care. They are professionally isolated yet have amazing skill sets; they work and live in close quarters yet are gracious and welcoming towards the part-time voluntourists like us. Daily they treat life-threatening and chronic diseases caused in large part by poverty yet retain a keen sense of humour and respect for the individual. In 3 weeks I did not get inured to the serious diagnoses on the patients’ notebooks that they all carry – anything from amputation resulting from injury or animal contact to opportunistic infections associated with HIV. It was heart-rending dispensing Plumpy Nut packets, prescribed for malnourished children.

We had the wonderful experience on our last day in Zimbabwe of attending UN day at the Harare International School that Dr Thistle’s sons attend. A UN official spoke movingly on the theme of Unity through Diversity and quoted the UN Secretary General’s remark that the current generation is the first that could end poverty and the last that could end global warming. Parents from over 70 countries provided the lunch and it was fantastic. Dr Thistle’s Zimbabwean wife Padrina makes an amazing Nainamo bar. A brief rain shower was refreshing (once we got our bags off the top of the Land Rover and inside.) That evening I was fortunate to attend another art exhibition with our hosts in Harare – so many talented artists in a small population. A dinner out that evening was accompanied by the cold beer Paul had been fantasizing about for 3 weeks at Karanda.

We again want to thank all those who donated items for us to bring – the nurses at FSJ Hospital who collected unused items from the OR, the school supplies others donated, the soccer balls Home Hardware donated, the Canada pins Bob Zimmer’s office donated, the soccer jerseys from the FSJ Soccer club, and the extra bags individuals donated. All have been received gratefully.

Thank you for the Music from Paul Mackey on Vimeo.

Thankyou for the Music