A Minor Setback

The past few weeks we have focused more on renewing relationships rather than being tourists, although Thea, Paul, and I did visit the Immigration Museum in Melbourne. We caught up with various friends of Paul’s from high school, internship, med school as well as my friend Leesa and we enjoyed BBQs, hiking, consuming lunches, and drinking wine. We were also fortunate to be able to take in a couple of events at the Melbourne Comedy Festival, including Simon Taylor stand-up and a Harry Potter improv for our niece’s 15^th birthday.

Paul and I travelled to Albury and en route had lunch with Mal and Jill, the couple we did the practice exchange with in 2001, as well as Kate, who was Jeryn and Liam’s carer 1-2 days per week. Euroa has had some positive changes since we were there and is maintaining its population, unlike some other rural towns. Mal and his partner developed an amazing new medical clinic, the local thoroughbred racing stable is employing a large number of people, and there is a lovely venue for weddings that is popular with couples from Melbourne.

In Albury, while Paul updated his obstetrics knowledge (i.e. got his necessary credits for the next three years), I was thrilled to spend time with my two housemates (and their partners) from my time in Echuca. It was a bit surreal meeting up in a different border town on the Murray River from the one we all lived at 25 years ago.

On leaving Melbourne, it was poignant saying good-bye to Paul’s brothers, our sister-in-law and the nieces; we have spent more time together in the past 12 months than ever before and the cousins had so much fun together. We are grateful to all our family and friends in Melbourne who accommodated us and entertained us. Also a special thanks to Auntie Noelle the Great (and David) who looked after us especially well while we were in Tassie. 
From Melbourne we travelled to Western Australia, with a transit stop for several hours in Adelaide so we could not only check off another state on our travels but see a dear friend and two of her boys. Michelle provided a delicious lunch and a rainbow over the pier.

In Perth we stayed with Paul’s cousin David and sampled the vibe of Subiaco. David took me around the Lions Eye Institute and I got to meet people I have known for years via email, corresponding about David’s manuscripts. David also gave me a tour of the University of WA and the campus alone makes me want to go back to university – stately buildings, numerous majestic trees, access to the river, an outoor theatre (!) and even an occasional peacock strutting around. Actually I’m not sure I could be bothered to go inside to attend lectures if I enrolled for courses there.

One evening our family wandered around the well-preserved port of Fremantle and watched the sun set, grateful for the opportunity to have witnessed many glorious sunrises on the most eastern point of Tasmania and now to view the sun setting on some of the most western geography. After sunset, we had dinner with a long-term friend and her family. I met Elise backpacking in Europe in 1988 and we last saw each other in person at her wedding in 1997. Elise also joined us for a walk in John Forrest National Park. We got to see Karen and Craig, a doctor-nurse partnership who worked in FSJ in 2002/3. Their curling mentors in FSJ will be pleased to learn Karen and Craig are members of the Perth Curling Club. With Karen, Craig, and their children, we had a full tour of King’s Park, which turned into a Full Monty-tour when a person experiencing ‘the best day of his life’ stripped down and cavorted on one of the pristine lawns. We suspect his day went downhill from there as the local constabulary arrived. As Craig said, at least the police didn’t have to worry about concealed weapons.​​

We had a wonderful time with Paul’s med school classmate Sue and her family in Bunbury. Our family did some short walks further south and two of the four (guess who) of us climbed the epic, 75 m high, Karri look-out trees. We tracked down some of the locations where the movie Jasper Jones, which we saw in Perth with David, was filmed. Gnomesville provided a cultural highlight.

Then Paul and I took his Dad and Sandra around the Margaret River region for several days. We visited the thrombolites, Cape Leeuwin, several wineries, the Boranup forest, Mammoth Cave, the Canal Rocks, and Busselton jetty.

Meanwhile the girls enjoyed hanging out with Sue and Steve’s girls. Notably Kate sacrificed studying time to take them to a cave and on a hike and they also got to go boating with friends and see dolphins.

Paul, Sandra, and John returned to Perth to catch the train to Sydney and Thea and I joined Sue and friends for almost 60 km of the Cape to Cape hike over 4 days – definitely the toughest physical challenge I have had in years. After hiking with a full backpack for several hours I was sure I resembled Quasimodo shuffling along the beach. The views were a helpful distraction; I think the western coastline scenery rivals that of the Great Ocean Road in Victoria. Sue and Steve’s friends were so welcoming and inclusive and the memories will last long after the sore muscles have improved. 

Our family reunited at Brisbane airport. Another friend from Echuca days, who we hadn’t seen since his wedding 18 years ago, met us for supper. Mick and Paul were able to commiserate about the patchy performance of the Collingwood Magpies this season and Mick and I caught up on mutual friends and career and life trajectories.

I was thrilled that we were upgraded at our hotel in Cairns to a three-bedroom apartment that was larger than the unit we occupied in St Helens for 3 months. We were spoiled with an amazing view of the esplanade and it was a treat to have a full kitchen and laundry facilities. Unfortunately, Paul suffered an L2-3 disc protrusion just before getting on the train in Perth and so was limited in the tour options he could choose during the course of the Perth-Sydney train trip. It is somewhat ironic that his most comfortable position is sitting up because when we caught the train from Melbourne to Perth 25 years ago, sitting up was the only choice. This time he had a compartment, where he had been looking forward to sleeping lying down for the three nights on the train. Nonetheless he was able to board another tourist train the day after we arrived in Cairns. He and I enjoyed the trip to Kuranda and a relaxed walk around the village, including a stop at the Australian Venom Museum. This is a delightfully tacky museum that also supplies tarantula venom for medical research. The gondola ride down over the rainforest was spectacular. We all went snorkeling at the outer reef one day, which was fantastic (even better than the Harry Potter Experience according to Thea). 

It really felt as though our time away had come full circle when the couple who generously hosted Paul and me in Victoria when we dropped Liam off at university in September were able to join us at our hotel apartment for a get together of several of the Canadian and Canadian-by-choice doctors attending the World Rural Health conference. We had also really looked forward to seeing a Zimbabwean physician couple from Nyanga at the conference but frustratingly they could not obtain visas in time. Paul has also met up with an American doctor who just finished a short stint at Bwindi.

Paul missed some of the conference attending physio appointments and getting an MRI but is doing an excellent impersonation of Hugh Laurie as House (although less irascible) using one of his hiking poles. We hope his injury proves to be a minor not a major setback to working in Katherine

Our time in Australia is half over and I have a confession to make. What I thought was just going to be a brief summer fling has blossomed into a mature love affair with Tasmania. Warning: extended metaphor ahead. We have been fortunate to live in several quite different places and they have all held their particular appeal for me. No feeling is the same as the adolescent rush I get when I am travelling back home to southern Alberta. The visceral response I have starts about Claresholm, heightens at Pincher Station when I can see what was my maternal grandfather’s and is now my uncle’s home, and peaks once I can see the mountains and then what was our home. Recently I had a similar reaction when a house we rented in St Helens had the same thermos I used going to elementary school. Although the thermos was the pinnacle of 1970s ugliness, bizarrely it evoked similar feelings to seeing the landscape of my youth.

Most of the five years I lived in Edmonton revolved around the university and surrounding area so that is where my fond memories are most intense. When I first moved to Echuca after I met Paul, I was overwhelmed by the sensations – incredibly hot dry days with intense, cloudless blue sky and the intrusive forthright friendliness of small-town Australia. After we got married we moved to England and I was amazed by the manicured landscape and ancient buildings. To me the UK was like the super popular guy at school who was good at everything and who everyone wanted to hang out with. Does one country really need a National Trust property around every corner; the countless talented scientists, authors, artists, actors, and musicians and lovely flowers and countryside? There were so many tourists and residents that I only felt I fit in or could get close to the UK in the more remote parts such as the Stiper Stones or near Clun in Wales. Fort St John, in contrast, was like the guy you would overlook if trawling on Tinder but who, once you met his extended family (Tumbler Ridge, Liard Hot Springs) and explored his great qualities (squished the Beatton mud between your toes; looked over the Peace Valley; got to know all the reliable, creative people), you realized it was a solid partner to raise your kids with.

But back to Tassie. The signs that summer was over were evident. The red lichen on the rocks seemed to fade, there were fewer birds of some species, our morning walks began in the dark, and most of all, the beach chairs I bought at the Reject Shop in January for $15 each had a price tag of $3.75 on the remaining two. Nonetheless, I was reluctant to leave Tasmania for the warmer temperatures of Western Australia and the Northern Territory. At this stage in my life I’m not looking for the guy in the flashy convertible, i.e. the intoxicating grandeur of the Rockies or the outstanding starkness of the desert  – I want the solid, reliable type: interesting history, good food to share, cute animals (I have never encountered a snake or croc in the wild in Australia), and the occasional thrill of crashing waves. Until the next landscape comes along…

Over less than 3 months we were grateful to have had 20 visitors in St Helens. (Embarrassingly for someone who abhors inappropriate apostrophes, I have been inserting one in St Helens when it does not have one.) We feel we deserve a commendation from the Tasmanian tourism board. A Mackey family friend from Melbourne was our first visitor and then a couple who are also long-time Mackey family friends bookended our time there. Friends from Fort St John had travelled the furthest (although they hadn’t travelled to Tassie only to see us). My sister and her family from Vancouver and Paul’s brother and family from Melbourne constituted the biggest group (9 in all – lots of logistics).

I was very happy to be able to show some of my family members parts of Australia I love. We were fortunate to have super weather for their visit and do activities ranging from yoga to bushwalking to touring museums and National Trust sites to relaxing on beaches. They were all very flexible regarding, at times, frenetic itineraries and changing accommodation (thank you to the numerous friends and family we imposed upon along the way: Noelle, John, Adam, Adrian and Suzanne, Chris and Marg, Peter and Bronwyn, Simon and Mel). Travelling from Melbourne to spend one night, my friend Leesa narrowly lost the title for shortest visit to St Helens when Phil and Chris from South Australia stayed less than 12 hours.  My brother-in-law Simon holds the record for most St Helens oysters and most Peanuts Galore consumed. We relished the opportunity to be the hosts rather than the hosted.

Paul is getting prepared for his stint at Katherine Hospital beginning in May. It will be quite the contrast going from the gentle rhythms of a solo practice in a quiet seaside town to the hustle and bustle of emergency and the operating room in a remote community. Well, apart from the guy who hobbled in the door at Scamander with a chainsaw injury to his leg that, fortunately, was “minor” enough Paul could repair it on site. The one constant is the administrative burden. He has had to complete countless modules on topics such as Fire Safety (29 power point slides) Hand-Washing (39), Aggression Minimization (32 slides) and many more. An easy solution to this last one. Maybe fewer slides!

He has worked hard at Scamander to try and build a foundation for the practice so that subsequent locums have detailed charts and summaries to draw on for each patient so patients don’t have to tell their whole story each time. In a short time, he has had the pleasure of learning the life stories of an eclectic group of people and hopes he has helped a few of them. However, the practice population is marginal and not really enough to support a full-time practice so his concern is that it may not last. Time – something that is terribly undervalued and unsupported in health care – was an important thing he was able to provide (because he was paid a fixed salary and it was relatively quiet).

For our last week, the girls stayed up in Melbourne as there didn’t see a lot of point flying them back to St Helens for just a week. They were kindly housed, first by their Uncle Adam down at McCrae then by the Northcote Mackeys who spoiled them rotten by taking them to the Twenty One Pilots concert. They very much enjoyed spending time with their cousins (both Canadian and Australian) as they have been missing people their own age and have, understandably, been a little lonely (and a little tired of their parents) at times

Before we reach Katherine we will be spending some time with friends in Western Australia then heading to the World Rural Health Conference in Cairns. Paul will be getting there (in part) by catching the (4 day) train from Perth to Sydney with his Dad and his partner Sandra. For some reason the girls weren’t interested in this option. Paul thinks they’re nuts to pass up on this epic opportunity. They share the same opinion of their father.

Like other islands, the coastline in Tasmania inspires many visual artists and we have admired the work of many and met two. Ornella Imber (http://www.zhibit.org/profile/nell73) paints Klimt-inspired ocean creatures and detritus and alluring red-haired women. Ornella’s husband Kim is a math teacher, surfer, song-writer, guitar player and we had a lovely lunch listening to him playing at Devil’s Corner winery one Sunday afternoon. Rachelle and I joined a group art lesson from a Kerry Agius (http://www.widewalls.ch/artist/kerry-agius), who recently returned to St Helen’s after living in Queensland for several years.

I’ve been delving into Australian fiction, catching up on the more recent work of favourite authors such as Helen Garner and reading ones new to me such as Charlotte Wood and Richard Crewe. I’ve also been reading some non-fiction, including David Hill’s The First Fleet. Too tragic to read more than a chapter at a time. 

As a family, we did some archery at the local club. The club members are keen to share their knowledge and the setting is wonderful – sounds of kookaburra and other birds and lovely trees and reflective water pools.

We are maintaining our interest in birds (we haven’t quite got comfortable with calling ourselves “bird watchers” just yet) Some green rosellas often visit the tree just outside our kitchen window but they are elusive when we try to photograph them.

We had a lovely 4-day weekend in Melbourne, staying with a generous family friend and enjoying meals at restaurants and a fantastic home-made pizza night at a friend we made on the music safari tour in Africa. Why had we not discovered Nutella and ice cream pizza before? The girls were happy to have some time with daughters of friends at a climbing wall and to hang out with their Northcote cousins. We managed to not add to the road kill count on our drive home in the dark from the airport in Launceston – lots of eyes gleaming in the shadows.

We have had many friends from the mainland have come to visit us and marvel at the mild weather and relaxed pace of life that the North East coast of Tasmania offers. We have done several bushwalks, checked out various beaches, and taken local boat trips within a wide radius of St Helen’s. Interestingly the Couta boat owner Les Sims was the boat wrangler for the movie ‘Light Between the Oceans’ and the boat had a small role.

Most unfortunately, on a steep section of the Wineglass Bay circuit walk Rachelle badly sprained her ankle, less than a year after breaking her collarbone snowboarding at Jasper last spring break. Paul, Thea and Streetie still managed to dash down to Wineglass Bay for a quick swim (the raison d’etre for the hike) then back up the hill to help Rachelle continue her long hop back to the car. Her style will be severely cramped while the Canadian cousins are visiting later this week. 

We unintentionally attended the local film society AGM, which brought back memories of the early days of the FSJ Film Society days. We really enjoyed the subsequent screening of the New Zealand film ‘Hunt for the Wilder People’.

After making it my New Year’s resolution for a couple of years, I have finally expanded my repertoire on the ukulele to more than three songs, thanks to the drop-in beginner ukulele group at St Helen’s. The very groovy bearded 30-something guy who eschews footwear has been a very patient teacher and the group members are very welcoming. One of the newer attendees is a grandmother who does wildlife rescue (including retrieving joeys from dead mother marsupials’ pouches) and has a dingo living with her in her motor home.

Paul’s general practice job has been relatively sedate, except for his interactions with Medicare. Like many systems we’re sure that someone, somewhere thought there was a valid reason for setting it up the way they did but at the front line, things don’t always appear to make sense. He is allowed to prescribe 1 Epipen but if he sensibly wants to prescribe the patient 2 so that she can have 1 at school and 1 at home, he has to ring up to get an authority. He has had an ongoing battle with Medicare about his recognition as a “specialist in General Practice” because of a mix-up with some paperwork. Medicare would keep changing things without notice and suddenly his billings would stop going through, resulting in a flurry of phone calls and Paul listening to the mind-numbing muzak. It is mostly sorted except for a 3-day period in February. To be pre-emptive, Paul had taken to listening to the muzak on a daily basis to ask (very politely) for updates. This was until he was told that his “case had been elevated to the highest level and that he just needed to wait and be patient and stop calling”. He certainly would be more than happy to stop calling once he was notified that the problem had finally been sorted!

Hence, Paul is still making use of the mild weather to head to Binalong Bay after work as much as possible, occasionally dragging a sometimes less than willing teenager along for some boogie boarding and body surfing. They have not quite joined the polar bear club but tonight Paul and Thea were observed with some amusement by the tourists on the beach in their winter parkas.

It is hard to believe that we are already nearing the end of our time here in Tassie. We will have a busy few weeks with the cousins coming to visit and then spending a week up in Melbourne. We will leave Thea and Rachelle up in Melbourne to have some “uncle time” with Adam while Paul and I spend our last week in Tassie, with Paul working and me tidying up the house and cleaning the cars and getting packed up for the next leg of the adventure…

Credit for this title must go to Paul Thistle in Zimbabwe. We have been feeling as though it is pretty great to be stuck in this state between the Tasmanian devils, Devil’s Corner winery and the Pacific Ocean.

We have adapted the more relaxed rhythms of life on the East Coast. Because we only have a mini-fridge in the unit we are living in, I walk the 5 min into St Helen’s most mornings for groceries and other errands. Paul drives 15 min the other direction to Scamander. I’ve been doing a bit of gardening around the unit and some writing projects and the girls are starting to catch up on their distance education classes. Thea and I are attending yoga when we can (the instructor picks us up on her way to class) and Thea is having flute lessons in Launceston, 2 hours from us, when possible. If the weather is fine when Paul gets home from work, we head out to a nearby beach. We notice whether the fishing boats are docked or at sea and have learned that a couple of the restaurants only open if there is a fresh catch. Paul and I are big fans of the signature Tasmanian dish, curried scallop pie. We are eating ground wallaby as it is cheaper than ground beef. Yes we’ve had “Skippy Lasagna”.

The girls mock us for our interest in birdwatching. However, we are enjoying getting reacquainted with the gaudy and garrulous sulfur-crested cockatoos, galahs, and rosellas and learning about the shore birds around St Helen’s, including the pied oystercatcher, the hooded plover, and the bar-tailed godwit that migrates from the Arctic to Tasmania, the longest nonstop migration of any bird. We have read that up to 1/3 of all birds in Australia can be found around St Helen’s. We think it was a bell bird that sounded like R2D2 was in the trees when we were on a nature walk. It has also been amazing to see some of the numerous types of eucalypts, whose variegated trunks remind me of the paint-by-numbers I would do as a kid. The banksia trees look like they are covered with fuzzy minions.

Paul is getting to know his patient base, which includes a lot of OEHs (old ex-hippies) and RFSs (refugees from society). He is doing a great deal of mental health and chronic pain management, which is what he expected and what he was prepared for. Nevertheless, it is still challenging in an region where there are few resources other than him. At least the fact that he is being paid sessionally means he has the time to spend though not always the answers to give. In contrast to the “FSJ workaholic” vibe of the Energetic City, most of the populace here are either semi, retired, working part-time, dabbling in artistic activities or on a pension of some sort.

Even he has been caught out by some of the Aussie shortened words. “Exie” was how one hitchhiker Paul picked up described a cafe (expensive). Launceston (our current equivalent of Grande Prairie for the FSJ crowd) is Launnie and unco is uncoordinated. A couple of words have had their meaning renovated. In FSJ the word lagoon is usually preceded by the word ‘sewage’ so lagoon had a negative connotation but here it is often an idyllic place to swim or bird watch.

I had a lovely week on the mainland with a good friend from university and her husband. We spent some time on the Mornington Peninsula, drove down the Great Ocean Road, and explored parts of the Yarra Valley and Melbourne with Paul’s generous aunt and uncle. Melbourne displayed its typically erratic (oxymoronic) weather. Although we didn’t attend the tennis, it was fun to soak up the vibe of the Australian Open around Federation Square. The one very distressing note was the pedestrians being killed in downtown Melbourne; we encountered all the police and emergency vehicles as we hadn’t listened to the news that morning.

Paul, the girls, and I had a 4-day weekend on the west coast; Thea was amazed we could drive across Tasmania in 4 hours. Travelling on the steam train at Queenstown that serviced the gold mine was enjoyable (especially for the trainophile in the family). We loved the phrase that was attributed to the early settlers: “it rains for 8 months and then the wet season starts.” and it was fascinating to compare the temperate rain forest (3 meters of rain a year) there with the tropical rain forest of Uganda. The moss-covered trees look more like statues than living trees. We also did a boat cruise from Strahan that went around MacQuarie Harbour and up the Gordon
River with a visit to the former penal colony of Sarah Island. Even with the excellent and informative guide it is hard to imagine the hardships endured at such a desolate and remote outpost. In Strahan we attended a wonderful performance of “The Ship That Never Was” about the last ship that was built at Sarah Island and how the convicts who built it used it to escape to Chile. Yes Chile! In true pantomime tradition there was lots of audience participation – Thea got to be the ship’s cat.

The weather en route home inspired us to walk around Dove Lake at Cradle Mountain, which we hadn’t planned on. It vies for the position of “our most favourite spot on the planet” as it’s beauty never ceases to astound. We think we saw more people in the national park than we had seen in all of Tasmania up to that point. Thea had a hilarious comment that the zombie apocalypse couldn’t happen in Tasmania as there aren’t enough people to sustain the zombies. We have attended mass in various old and interesting churches in small towns and in fact doubled the size of the congregation in Zeehan by our presence.

Last weekend, we again benefited from the unfailing hospitality of Paul’s aunt Noelle in Hobart and took in Salamanca Market and MONA (https://mona.net.au) with a family friend of the Mackeys who came from Melbourne to spend a couple of days with us. Thea says she feels scarred by the visit to MONA and the rest of us are still processing it, although we loved the building and the style of curating. From all reports, the museum has been a boon for tourism and exponentially upped the hip factor of Hobart and Tasmania in general. Thanks to Paul’s cousin David we now have a second car and a mountain bike to use.

We were so pleased to have Laurel and David Batterham, formerly of FSJ, visited us for 2 days. The weather was wet but we still got some nice views of the Bay of Fires and a pod of dolphins. It was helpful to have people we could discuss both FSJ and Zimbabwe with (one of their daughters who used to babysit Jeryn and Liam married a Zimbabwean and they live in Melbourne), as well as touch on the many other conversation topics that we did. Laurel also provided a great challenge for Scrabble and David was an assertive Wizard player.

There are many bushwalks and beaches we want to explore and have several visitors lined up to achieve these goals with during our remaining time in Tasmania. While the weather has been less ‘beach’-worthy the past 2 weeks, we have been grateful to avoid the >35 degree temperatures in some cities on the mainland.

There have been a few times since beginning our adventure in September that Paul and I were returning to places we had travelled to early in our relationship (Shrewsbury, Prague, Cradle Mountain). It doesn’t seem possible that we visited these places 25 years ago, although the day after a hike it does seem as though we have aged. Revisiting places is conducive to reflecting on experiences, opportunities, circumstances, challenges, and decisions.

Are You Going to Scamander Town?

The remainder of our time in Europe was lovely. When not touring around, Lori, Thea, and I managed to write and record a last-minute entry for the Mackey Family song competition, but alas placed second (again!) to the unfailingly adorable Chicago Mackeys.

Apart from arriving 7 hours later than scheduled in Vancouver and missing a Christmas Eve party, our four days in Vancouver were wonderful. It was super to see Jeryn and Liam, both Lori’s sisters and their families, her Dad, two of her second cousins, and a close friend from pharmacy. We reorganized our belongings, grateful to be able to store stuff at Camara’s. 
It was difficult to board yet another plane but once we touched down in the Australian sunshine, the trip seemed like a good idea. I managed to skip my birthday because Dec 29 evaporated as we crossed the international date line. We recuperated from jet lag by taking advantage of the hospitality of my Dad and Sandra. We were also pleased to catch up with my aunt and uncle, a family friend, and some high school and medical friends while in McCrae and Melbourne.

It has been great to be reminded of the friendliness of small town Australia. As we walked to the beach at McCrae one day, someone stopped to ask if we needed a ride and there have been many welcoming nods and greetings since arriving in Tasmania. The weather has been fractious – alternating hot and cold. The girls did brave the surf with their uncle Adam on a cold day. They were happier posing with the surf boards than paddling on them. Ironically we have all experienced more sunburns and and me and Thea more bug bites in Australia thus far than our whole three months in Africa.

I have been commenting to many about the different preparations required for Australia vs Africa. When doing the medical preparation for Africa my main concern was how to diagnose and manage conditions which I had no experience with. I did a tropical medicine course back in May but, of course, the information was as quickly forgotten as it was obtained. Also, patients don’t present nicely packaged as a disease but with complex undifferentiated symptoms which could declare as any number of diseases which, in Zimbabwe and Uganda, I would have very little experience with or knowledge of. In the end I didn’t do as much “undifferentiated” clinical work and my knowledge gaps weren’t overly exposed.

In contrast my greatest concern about coming to Australia was about relearning and navigating the system. Despite having grown up, trained and worked here, I knew that enough would have changed (or not changed) that I would be, at times, drifting aimlessly in an administrative sea. Into my second week here my expectations have been realized in spades (I already have many stories). The medicine is little different to that in Canada (no I have not had to treat any Tassie Devil attacks) but I have been spending a significant part of my time attending to system and administrative details that do nothing to improve patient care. In fact, my experience of medicine in the last four countries I have worked has only strengthened the notion that the purpose of medical administration and government is to try and impede access to care to either save money or divert it elsewhere. 

That being said, the work is a pleasant change and challenge. Being a newly opened one doctor clinic in a relatively quiet seaside town I am afforded a little extra time to spend with patients and try to start to build charts and care plans with them so that they can have a semblance of continuing care even though they will not be seeing the same doctor. It is extremely unlikely that a doctor would ever move here full time, particularly with the Australian government strangling General Practice (particularly rural General Practice) by freezing the Medicare rebate. I encourage everyone to read Atul Gwande’s latest piece in the New Yorker, and this other in the NYT about the neglect of “incremental” medicine.

http://www.newyorker.com/magazine/2017/01/23/the-heroism-of-incremental-care

https://mobile.nytimes.com/2017/01/19/opinion/sunday/the-conversation-placebo.html?smid=tw-share&_r=0&referer=https://t.co/NtW5fE5ahB

Apart from the challenges of battling the obscuris that is the Australian PBS, other challenges include having to draw my own labs and, gasp, having to do my own ECGs. However I remain thankful that I at least I have the facility to draw bloods and get them tested and have an ECG machine that works and doesn’t print out reports labeled “US State Department”.

Those on FB will have seen that we have been already making the most of our location. We are only 15 mins from Binalong Bay which is the southern end of the Bay of Fires. Not named for the fire-like appearance of the lichen on the rocks but in fact for the fires on shore observed by Captain Furneax as he sailed past as part of Cook’s second voyage. The days have(mostly) been warm enough and long enough for us to head to the beach once I get back from work. We originally thought we would be staying near the clinic in Scamander however our accommodation is 15 mins north in St Helens. It does mean I have to “commute” each day but it does work out better for Lori and the girls as it is only a short walk across the bridge into St Helens which is a larger community and therefore has more going on. Well a bit more: you still can pretty much cross the main street on a Saturday night safely with your eyes closed.

The pace of life here is very different. Everything shuts down at 830pm and most things are closed Sunday afternoon. A reflection of less hectic times. Tasmania is twice the size of Vancouver Island (curse the Mercator projection maps. Southern hemisphere geography is always distorted) but with half the population. A lot of people are here because they want to get away from it all or slow down. Well except when they are driving too fast on the narrow windy roads. The unfortunate victims of this are the many (mostly possum) road kills that present an extra olfactory challenge to the hardy cyclists who are already playing cat and mouse with the aforementioned speeding drivers.

Lori has always harboured a wish to live by the ocean and so was excited about moving to the east coast of Tasmania. Not to swim in the ocean necessarily but she does enjoy listening to the sound of crashing waves. Me, if the water is there, I feel I have to swim in it and, despite the cool (some would argue frigid) temperature of the water, I have been determinedly doing so. 

Already friends and family are queuing up to visit, a luxury we were rarely able to enjoy in Fort St John. We plan to use the weekends to explore as much of Tasmania as we can (you can drive across it in 4 hours) so expect more photos of remote beaches, pristine waterfalls and lofty peaks.

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.

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.