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 could 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.