Since leaving Africa I (Paul) have been struggling with how to summarize our experiences in Zimbabwe and Uganda. After two years of organizing and planning it still seems quite unreal that it is all behind us now. As we whisk through Europe on very comfortable trains, already it seems so removed. The question is, “Did we change anything?” either in the places we went or ourselves.

At Nyanaga there is so little in the way of services that we could contribute little. The hospital does not have the resources to do much and the people in the community have so little they can’t afford to seek treatment. As a result, there seems to be a lot of under-employment. There are many skilled people not able to use the full extent of their skills in a place that so desperately needs them. One example is the nurse anesthetist who finds his skills are atrophying because he spends much of his day waiting for operations to happen (that often don’t). His work is mostly limited to spinals for c-sections and sedations for lipomas. It is an issue that the equipment and monitoring devices are also limited. He has no way of monitoring (or providing oxygen) to a patient in the “recovery” area and thus has to keep the patient in the operating room until fully awake and able to go back to the ward.

Lori had the similar experience in the pharmacy: there are so few drugs that the pharmacy is not very busy. The girls also had no role to play there. Nyanga was not used to having volunteers and so there was no structure in place to support volunteer work. Not that it is anyone else’s job to ensure we had something to do, just that it meant we felt we contributed so little despite the desperate need. We both feel that we learned a great deal from the staff at Nyanga but we are not sure what we contributed beyond some collegiality and someone for them to talk to.

A recurring frustration was that it doesn’t need to be this way. Corruption is painfully evident at many levels of government; there is no attempt to dress it up or hide it. The profligacy and waste at the expense of the population is distressing. I had the bizarre experience of being summoned to the hospital one Sunday evening as the local Member of Parliament was in attendance and wanted to meet me as the “visiting foreign doctor”. While he was a very pleasant and congenial fellow, the experience mostly consisted of me following around while he pressed the flesh. The most uncomfortable scenario was when he magnanimously offered to pay the pathology fee for a patient so that she could have a biopsy done and the whole ward applauded his generosity. It seemed a cruel irony that the very reason the biopsy couldn’t be done in the first place was because of the lack of resources provided to the community and the hospital while money was wasted elsewhere on personal comforts for those in the higher levels of government.

Zimbabwe appears trapped in a downward spiral while everyone is waiting for Mugabe to die. So many we spoke to appear to be in a holding pattern, hoping that things will improve. Unfortunately, it appears very unlikely that they will, even with a change of government. Thus, those who have the opportunity to leave, make plans to do so, Zimbabwe loses more skilled workers and the spiral continues.

Nyanga is located in a beautiful area, everyone there was so welcoming and friendly and the staff there are providing incredible service with very limited resources. We hope to keep in touch with Drs Admore and Alice and their family.

Karanda was quite the contrast to Nyanga. As a mission hospital supported by outside funding it has more resources than Nyanga; however, these were still very sparse compared with western medicine. Consequently, the hospital is much busier, sometimes ridiculously so. This disparity not only existed between Karanda and Nyanga but between Karanda and the nearby government hospital at Mt Darwin.

I certainly felt I was able to hop straight back in and continue the work I did last year. Lori too was able to quickly find a role in the pharmacy, be that helping with inventory, counting pills, discussing drug interactions, or helping them migrate dispensing recording onto MOIS. Lori and I could have spent longer at Karanda  (although the heat and the water restrictions were stressful). Unfortunately, I feel I have left some things unfinished.

I had come away from my experience there last year knowing there was lots that I snapseed-1could contribute but I was concerned that there was not enough for Lori and the girls to do if we spent an extended time there. This was the main reason we decided to split up this trip to include the Nyanga and Bwindi segments. With hindsight, we can see that both Lori and I could have found plenty to keep us busy at Karanda the whole time, the exact opposite to my initial assessment. However, a significant limiter was Rachelle and Thea’s experience. Possibly because we were only there for three weeks, but we found it difficult to find a volunteer role for them. They did visit the local school twice and enjoyed hanging out with Dr Thistle’s sons the week they were home from boarding school. Another major hurdle for the girls was the struggle to get schoolwork done. Despite having connectivity using a 3G modem, the network was so poor that they often couldn’t connect adequately to get any work done. This is another example of the administrative chaos and infrastructure neglect being foisted upon the country. It also didn’t help that the best (or least worst) spot for them to get connection was also one of the most fiercely hot places in our house.

Bwindi was a totally different experience. In preparing for this leg it appeared that there was going to be plenty for Lori and the girls to contribute as there were many programs at the hospital and in the community that were set up for volunteers. In advance, we were able to fundraise and schedule the building of a Batwa mud hut. (Thea and Rachelle both commented that this was the first time they felt they were able to play a volunteer role). My responsibilities at the hospital were less defined in advance but this was of minor concern as, usually, I can find work that needs to be done.

Unfortunately, we again struggled to find a role to play despite some obvious need. Here the reasons seemed different: the existing structures were robust enough that we were probably supernumery. My concern was that I was more getting in the way than being a help in the OR as they had their very practical systems that were working for them. Admittedly these systems were in place to compensate for the lack of resources but, nevertheless, they worked.  The same could be said for the community programs: the existing structures were such that they were doing what needed to be done relying on local resources and thus not dependent on short-term volunteers like us. The girls were more comfortable at Bwindi, however, and had more people to interact with.

The upshot of all this is that we received an education into the short comings of short-term volunteering and of our own abilities to contribute in this way. Not that we were unaware of this before going in and not that we didn’t contribute anything and not that we don’t plan to volunteer in the future. More that we gained an even higher appreciation for those who live and work in these communities or who have made long-term commitments – the type of commitment we don’t think we have the courage to make.

Lori and I have both observed that we have come away feeling somewhat less hopeful if anything. Particularly about Zimbabwe as there seems little chance of things turning around. Being immersed for just a short period in the stark realities of both Zimbabwe and Uganda was overwhelming at times. There is so much that needs to be done (not just in these countries) that one can easily get paralyzed by the Sisyphean dimensions of the task.

While in Uganda we were confronted with the challenging stance put forward by one author that perhaps all NGOs should “get out” as they are enabling the local government to avoid responsibilities. Bwindi was kind of a case in point. The local Batwa were displaced to make the park to protect the gorillas. Allegedly 20% of the high fees for Gorilla trekking go to the local community but not one of the (many) NGO/charities in the region reported receiving any money apart from a sign on a wall at the hospital recording help with building a wing 15 years ago. Reportedly the government provides just 5% of Bwindi Community hospital funding. None of the local schools we visited received government funding. So if the NGOs moved out…….

Back in Europe from Lori

We seemed to come full-circle after arriving in The Netherlands after Uganda. Prior to leaving Vancouver in early September, my sister’s Dutch mother-in-law gave us a package of stroop waffle cookies that provided a sweet treat while we were in the UK and early days in Zimbabwe and one of the first things I saw in Schipohl airport were packages of stroop waffle for sale. I knew the transition from Uganda to Europe would be jarring but it really did feel that someone switched a dial from 4-D to 3-D and turned down the colour, volume, temperature, and olfactory incursions. From the blue skies, red backroads, and brilliant green of the various plants and shrubs in Entebbe accompanied by the humid heat and the cacophony of traffic and hundreds of bird noises as well as wood smoke, fish, and sweat smells (most often our own) to, as Bill Bryson described the UK, the ‘living in tupperware’ overcast skies of Amsterdam with its muted colours and occasional whiff of baking and not so occasional whiff of pot and cigarette smoke and the mildly annoying drizzle versus the torrential downpour of Uganda. We felt as though we shrunk en route once we were standing among the tall Northern Europeans compared to the much shorter Ugandans, especially the Batwa people we encountered. We exchanged the need to duck out of the way of reckless motorcycle drivers to having to dodge purposeful cyclists. Renting bicycles and cycling in Amsterdam was much tamer than the Entebbe bike tour experience. Negotiating the flower market was a little tricky but not as taxing as the Entebbe open market and the only hills were minor slopes over the canals. However, I had hoped that living at an altitude of 1400 m for a month at Bwindi would have given me sufficient red blood cell production that I wouldn’t struggle at all cycling at lower than sea level in flat Amsterdam but I was still back of the pack and even managed to get separated from Paul and the girls at one point. With my nonexistent sense of direction, this was disconcerting.

Amsterdam has so many museums to visit. We managed to go to the Van Gogh museum the afternoon we arrived but I was so sleep-deprived that some of the paintings with the heaviest brush strokes seemed to undulate when I looked at them. Our second day we went on an excellent walking tour of the city and visited the Tulip Museum and I also ducked into the Diamond Museum. On Sunday, we went to the Anne Frank Museum and Monday Paul and I spent some time in the Rikjsmuseum.

We have been lucky to date in that no-one has gotten seriously ill (Paul and Thea both suffered short-lived colds and I got a lot of mosquito bites our last night in Entebbe) and we haven’t left anything important behind or had anyone deprive us of something important.

I carelessly wrote the above sentence tempting fate and Paul acquired some unwelcome passengers from a hotel bed….. A visit to a Swiss clinic in Budapest and several pantomime conversations with pharmacists has rectifed that.

Christmas markets have been a highlight here, beginning with a brief visit at a stop in Cologne and then exploring the ones in Munich more carefully and eating some of the street food, including a curry wurst. The markets in Budapest were even better than Germany, which is especially impressive when one realizes the markets would have had no Christian influence allowed during the 40 years of Communist rule. Now there are Advent wreaths and Nativity scenes everywhere. The choice of street food is even more carnivorous and varied than Munich’s. We are visiting fewer museums but did see the Deutsches museum as a family and Paul and I went to the State Museum in Munich. We went to the Terror Museum in Budapest, a record of the Hungarian Red Arrow Socialists then the Soviet-driven Communists’ cruelty during the post-World War II years. Sobering but remarkable to be able to witness how the city, the country and it’s people have recovered. So interesting that Hungary is significantly smaller than Zimbabwe in area and has fewer natural resources yet a similar-sized population and has managed to bounce back from decades of violent repression to become a “success story”. Notably Zimbabwe has had a much greater burden of disease and race inequality to combat but corrupt leadership in Zimbabwe has contributed a great deal to the different trajectories of these two countries.

We feel so fortunate to have met the people we met – healthcare professionals, patients, fellow Mick Thomas fans, other travellers, hosts in the places we stayed – learned about the countries we visited, gained some medical knowledge, and seen the amazing sights we have. We have missed our friends and family and wish everyone a peaceful and loving Christmas.

Mzungus Make Masks

During our last week at Bwindi Community Hospital Paul continued with the equipment inventory and teaching neonatal resuscitation and was a second anesthetist for several surgeries. One anesthetic monitor would repeatedly fade to white; the only thing that seemed to fix it would be to unscrew it, unplug then replug all the cables inside and then close it up again. Until the next fade out. On the weekend BCH had had a return visit by an English engineer who regularly returns to check on the small hydroelectric generator the community has but also to tinker with various parts of the hospital.  Even he was unable to repair the operating room tables, the main reason being that the hydraulic fluid had all leaked out in one and the electrical relays were fried in the other. In the process of pulling them apart and putting them back together we discovered the reason for a lot of the malfunctions. After each operation the rooms are cleaned by sloshing copious amounts of water on the floor (something that would never be contemplated in Zimbabwe, especially after 4 pm) and directing it out a drain in the wall to goodness knows where. The rust evident in the innards of the operating room tables was representative of the damage being caused to all the equipment. We had noted previously that everything at Bwindi seemed permanently “damp”, even the paper. So no small wonder the electrical equipment suffered.

I feel like I redeemed myself marginally during my last lecture on anti-fungals for the nursing school. 
On Tuesday Rachelle and I went for a crash course in carving gorilla masks (Christmas present spoiler). This was a challenge for a craft-impaired individual whose preferred artistic medium is cake batter and icing. What could go wrong with a large machete and a chunk of soft wood? Our instructor Gordon was very patient. He would demonstrate, we would attempt it on our own masks, and then he (or another bystander) would repair our attempts. At one point the entire nose on my mask got redone because it was not symmetrical. I definitely felt more comfortable when we exchanged the machete for the chisel and mallet. Even better was the tool for doing the fine lines of fur. By the end we were providing quite the entertainment for the crowd that had gathered to watch. 

Tuesday was the culmination of the Giving Tuesday campaign for Redemption Song Foundation that we were helping with. Thank you to all friends who contributed! We really enjoyed getting to know the children who attend the soup kitchen and being involved in the fundraising over social media was a learning experience for us. Hopefully the target can be reached and a water tap installed.

 One evening we got to sample jackfruit. Paul and I decided it has a texture similar to a lychee and although it smells a bit like old socks it tastes a bit like banana and a bit like vanilla custard. We would definitely choose to eat it again, although apparently it is difficult to serve without getting very sticky.

On Saturday Rachelle, Thea, and I had a basket-weaving lesson. Actually because our time was limited, Christine our teacher thought we should temper our expectations and just tackle making a coaster (Christmas present spoiler). I have so much appreciation now for the work that goes into making a basket. imgp5370That same Saturday ended up being in the OR the most he had the whole month. The scheduling of operations is somewhat open-ended and fluid so it was never always clear when the list  was going to start (but usually after “tea”), what operations were proposed and how many were planned. He mostly seemed to have to wait around and see what patient turned up and when.

I think the place we looked most white was at the church services. I could never get the clapping rhythm right in Uganda. Paul and I found Shona a bit easier to read than Rukiga. We were so happy when they sang Joy to the World at Bwindi. We were graciously said goodbye to multiple times. We felt somewhat chagrined each time as we felt really didn’t contribute a huge amount at Bwindi and there were others staying on much longer than us to actually do the work. This is a positive reflection on the strong organizational foundation built at the hospital in its short history and  the hard work of the full time local (and volunteer) staff. Thus we felt supernumerary at times and certainly not all that deserving of the effusive thanks.

On the last Saturday morning Paul went for a bike ride around some of the “back”roads around Bwindi with the guest house manager, Daniel. Not that the back roads were always much different from the “main” roads. It did feel awkward at times riding recreationally, sometimes through what appeared to be people’s front “yards” (for desperate want of a better word), while they were going about subsisting and surviving. However it was revealing to see a bit more of the region outside of the narrow strip that we traversed in our daily walk down from Nkwenda to Buhoma then back up again at the end of the day.

We had  quite the show for our last night of running the boda-boda gauntlet as we made our way back up to Nkwenda on Sunday evening. We had people, cows, goats, cars, trucks,  bicycles, vans, motorbikes all vying for the narrow strip of road, passing and overtaking each other with sometimes reckless abandon. Fortunately we competed our final “commute” without being knocked down or anything broken.

So a month after our arrival in Bwindi we made the return trip by road to Kihihi. The villages we drove through no longer seemed strange to us and the drive out to the bush air strip was surprisingly short. For some reason the trip from there to the hospital when we first arrived seemed significantly longer. Presumably it was the “launching off into the unknown” when we first arrived. Our flight path out took us up Lake Edward to Kasese at the foot of Mt Stanley on our way back to Entebbe. Just the weekend before there were clashes that resulted in the death of 14 police and 41 tribal militia . Fortunately the unrest had settled. So, while beautiful to see, it was nevertheless anxiety inducing.

We have guiltily immersed ourselves back into the luxuries of western culture all too quickly here in Entebbe: a swim at a nearby hotel pool and pizza and beer on the shores of Lake Victoria. We even took in a movie. That experience also highlighted the large gaps that still exist in Uganda. We were virtually alone in the theatre and were outnumbered by the staff. 

Yesterday we did a bike tour of Entebbe. On our bikes we again ran the gauntlet of the local traffic with the added challenge of negotiating our way through the open market. Our guide assured that the wall-to-wall-to-ground conglomerate of people, bikes, motorbikes and goods was actually still “quiet” and it didn’t get “busy” until later in the day! Our tour guide loves his city and showed us the party street; the highest point in the city; the beloved, but ragged, soccer pitch;the president’s residence; the golf course (oldest in East Africa) and the Lake Victoria Hotel. We learned that the hotel used to be named the Libya Hotel, because Gaddafi always stayed there when visiting the presidential residence across the road. (Have not been able to find a reference to confirm this:)

We ended at the botanical gardens – designed in the late 1800s as a research centre for tropical trees from around the world. The many trees are impressive as are the termite mounds. There are also vervet, colobus, and ring-tailed monkeys. Some scenes for the original Tarzan movie were filmed there and it still feels like a film set to someone from Southern Alberta unused to dense rain forest vegetation. The gardens were a peaceful respite from the din and noise, until  Paul was on the receiving end of a deposit from a Marabou Stork. Apparently it’s good luck if a bird shits on you in Uganda. Good luck for the bird maybe.

Today we visited the Entebbe Wildlife Education Centre which ended up being a unexpected wonder. It’s not every day you get up close and very personal with a rhino. Our very knowledgeable guide demonstrated that they very much like being scratched inside their back leg!

We do plan to do a bit more of a “reflection” with a subsequent blog post which we plan to pen as we pass through Europe on the way “home”. For now we will leave you with some photos of Bwindi, accompanied by some of the singing at BCH morning devotions.