Archive for January, 2008

visitors, visitors

            It has been a long time since we last posted and it will take more than one post for us to catch-up, if we even can. A lot has happened over the past month-and-a-half. First, Shira Billet and Yoni Pomeranz came to visit and within two days of their departure Yonit Lax arrived!! We had a great time with all of them; we had an opportunity to do and see things that sometimes you don’t get to do when you actually live in a place.

            Shira and Yoni arrived in Uganda with two suitcases full of protective gear for the health unit donated by members of the Princeton Jewish community. Ok, so we didn’t really thoroughly post about the ebola outbreak in Uganda on our blog. It was quite a scary time here until the outbreak was under control and we didn’t want to scare everyone. Basically, the outbreak began in one of the most western districts in Uganda and Mbale. Where we stay is very far east (basically, on the border with Kenya). But, ebola is transferred through body contact, like hand shaking, and is fatal (well, there is no cure but not everyone who contracts it dies). Anyway, we did inform our visitors of the outbreak, and immediately Shira and Yoni inquired whether our clinic was properly equipped to handle an ebola patient. Unfortunately, we were not. And, although ebola never reached Mbale, we are really happy that Bushikori Christian Health Centre now has the protective gear necessary to deal with an ebola patient (if the need, God forbid, arises again) or any other highly contagious patient, even with tuberculosis, a more common illness treated at the health unit.

            But Yoni and Shira came with more than protective gear; they arrived in Uganda with the funds to purchase a gas-backed refrigerator, which will allow the health unit to begin offering blood transfusion services, a project that has been in the works for about one year but has been unable to begin due to insufficient power back-up. Offering blood transfusion services will reduce the number of patients that have to be referred to Mbale regional hospital 5 miles from BCC in town. Remember that being referred often means waiting by the side of the road for an overcrowded taxi that will probably not even drop you at the hospital but a distance away. Malaria (the most commonly treated illness at the health unit) patients often need blood transfusion as malaria attacks the red blood cells. Additionally, I just heard today about a mother who delivered in the unit a few weeks ago and had to be referred due to extensive post delivery blood loss. We are really grateful to the Princeton Jewish community for providing these funds and I look forward to keeping you updated about the progress of the transfusion services.

            (We will hopefully be uploading more pictures soon but in the meantime you can see pictures of the protective gear and the fridge at http://picasaweb.google.com/wleverts/PhotosFromHealthUnit.)

            While we were not busy working at the health unit, Shira, Yoni, Adam, and I went to Jinja to raft on the Nile River in class 5 rapids, some of the best rafting in the world, supposedly. We traveled to Jinja just as the violence with Kenya was beginning and while no fuel was being brought into Uganda. So, at each step of our journey, we were a bit concerned that we would be stranded. And, in fact, as the days passed, more and more stations reported having no fuel, and those that did really hiked up their prices. Anyway, the night before rafting we stayed at a backpacker’s hostel overlooking the Nile. While we were exploring and trying to walk toward the River, we noticed a few monkeys above us just hanging out in the trees. It was cool to just spot monkeys on our walk when we were not in a national park or making any concerted effort to see them.

            We stayed in a pretty small room with six bunk beds and a very low ceiling, probably only an inch or so above the mosquito nets for the top bunk. As we were preparing to sleep, we heard some pretty loud flapping and realized there was a bat between the mosquito net over Yoni’s bunk bed and the ceiling. Shira and I were pretty scared, ok, very, very scared and both admitted not going to the bathroom during the night in fear of the bat! But as I mentioned in a previous post, mosquito nets protect against more than mosquitos!!

            After breakfast the next morning, Yoni and I had to figure out how we were going to raft with our glasses. It is unlikely that when thrown out of an upturned raft in rapids, one’s glasses will stay on. So, Yoni and I tied strings to our glasses – it was some fashion statement, let me tell you. But, it was worth it, since at the end of the day we both had our glasses, despite being tossed around in the rapids. We got decked out in helmets and life jackets and then traveled to the river where we got into large rubber rafts with a very friendly guide. We had a great time on the water and despite being very, very scary, we also enjoyed the rapids, although none of us seemed too eager to do it again.

            After the more rugged accommodations, the four of us were all happy to return to Mbale, where Shira and Yoni stayed at a small hotel (more like a bed and breakfast without the breakfast) just down the dirt road from our place! We had a wonderful Shabbat and then escorted them to the airport on Sunday. It was hard to say good-bye but are very happy and grateful that they came, even if just for ten days.

            Yonit spent much of her two weeks here volunteering at the health unit. One afternoon, Yonit and I traveled with one of the nurses to a nearby village, where the health unit holds one of its seven monthly outreaches. At each outreach, with the help of government funding, the health unit offers the community free immunizations (mostly childhood immunizations but also tetanus) and deworming twice yearly. When we arrived a man brought us a small table, two chairs, and a bench. We hung a cloth scale for infants from a tree branch and then waited for community members to arrive. Even though the outreach is called for two, when we arrived at three, nobody came for almost half an hour and the crowds didn’t show up until closer to five: village time. As we waited for the first people to arrive, Yonit asked the nurse what the brown liquid in the bottles was which looked like dirty water. She explained that the children were soaking this brown carob looking fruit and before we could ask more questions, she had sent a kid up the tree to pick us a few. Inside of the brown shell we sticky apricot tasting seeds, and, of course, a few ants.

            Anyway, the nurse administered the immunizations to children, pregnant mothers, and adults, as everyone sat around and watched (of course, the crowd was bigger since two bazungu, whites, were there). The babies are supposed to be weighed every month to monitor growth and after the immunization, the nurse advises the mother about child-care (like when to start feeding a child which foods) according to the child’s age. Immunization records are kept on a card that the mother brings each time. So, Yonit and I mostly helped with record keeping (as we could not administer the immunizations), and even this was quite challenging since most of the people who came for the immunizations do not speak English. Oh, and there are some immunizations that children receive at birth, like the first of four polio immunizations and a tb vaccine. Well, children who are weeks old who come for immunizations and haven’t gotten them were not born in health centers, or at least not brought to a health center within days of birth. Which brings me to the next point…

            According to New Vision, one of the local papers, 58% of births in Uganda do not occur at health centers. Many births occur in the village at people’s homes or with the assistance of a traditional birth attendant, who at this point has been given training about basic health practices to be able to identify when a mother needs to be referred to a health unit or, for example, to know not to leave a baby laying in the placenta, which greatly increases the chance of mother-to-child transmission of HIV/Aids. Yonit, Heather (a woman traveling with her husband for the year, who is spending a month living and volunteering with the Abayudaya), and I went with Zauja, the head nurse at BCC, and Boaz, the mobilizer (the point person between the health center and the community) at BCC, to visit five of the nine traditional birth attendants (TBAs) that BCC supports. We traveled from village to village over the course of 3.5 hours on the back of bicycles. On hills, when the bicycles could no longer carry us, we had to walk beside our “riders.”

We had the opportunity to see the structures in which mothers give birth. BCC provided the iron sheets for the roofs of the structures and the community provided the materials for what were mostly mud huts so as to discourage the TBAs from having women give birth in their homes, where people eat and sleep. Most of the women only had fiber mats on which women delivered (one had a plastic covered bed, which makes it easier to clean, and another had a regular mattress covered with sheets). Most of the women reported facilitating two to three births a month. One woman complained of being called in the middle of the night to people’s homes but often not even having the paraffin in her lamp to light the way or see the mother and child. The oldest of the women we visited has been facilitating births for over four decades already. Her daughter is also a TBA and her granddaughter is a trained midwife, who actually works at BCC! These women don’t get regular salaries and many complained of the mother’s not even being able to pay the $3 they ask for their services. Despite this, the women are dedicated to and proud of their work.

            Yonit, Levert, Adam, and I traveled to the Ssese Islands on Lake Victoria for the last two-and-a-half days of Yonit’s visit. We left Mbale very early to make sure that we caught the one (very nice) ferry that travels to the island each day. We made it in plenty of time as each leg of the journey ran more smoothly and quickly than it could have or usually does. We had a great time on the island, where we relaxed both evenings near a campfire on the beach. With a guide, we took a canoe ride, where we saw many different birds, including an eagle and egrets, to the shore where many young men were busy fishing. They canoe out into the lake, place down big nets, and then hall them in. The one woman on the beach was sitting next to a big pile of fish and scraping off the scales one fish at a time. We spent the rest of the morning and early afternoon walking through a (small) tropical rain forest to what our guide told us was the smallest town in Uganda and it was small. The town had two gas stations, one doesn’t even have a name. We had a great time and made sure to catch the ferry at 8am the next day.

It was a real pleasure to share our lives and experiences with them, although sometimes challenging to synthesize our past with our present. In many ways having them here reminded us how different life is back in America, where people have ovens, more than one burner, power stays on consistently, people don’t live in mud huts, health facilities have all the drugs that patients need, hospitals serve patients food (here family members have to sit outside the ward and cook for their patients), and much more. We would really like to thank them for making the trip here, for being interested in our lives, and for being such great guests.

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Kenyan Elections

By now I think it is safe to assume that almost everyone knows about the elections that took place in Kenya on December 27, 2007. According to the Kenyan constitution, a president can serve a maximum of two terms. In 2002, President Moi completed his two terms and President Kibaki took over after winning the election. So, Kenya has seen a peaceful change of power. President Kibaki has only served one term, so according to the constitution could stay on for another term if re-elected. But, for weeks before the election, Kibaki realized that his opponent, Raila Odinga, son of the vice president under Jomo Kenyatta, Kenya’s first president, was a significant threat. For weeks before the election, polls showed Odinga leading, but only by only a small margin. I don’t think that in all of sub-Saharan Africa, an incumbent has ever lost a re-election. Incumbents have only lost power at the end of a term limit, or through a coup. So, to some extent, there was hope both in Kenay and internationally that Kenya might serve as a model for a peaceful change of power. On December 27th and 28th as votes were being tallied, Odinga was leading by a substantial margin (more substantial than in the pre-election polls). But after the updates came through on the morning of the 29th, there was an announcement that no more votes would be publicized until the next day. On the 30th, it was announced that Kibaki had come up from behind to “win” the election by a mere 300,000 votes. Within hours of the announcement of his victory, the President was sworn in before a very small crowd. And, almost immediately (actually even prior to the final announcement) accusations of rigging and even rioting began. Kibaki is a member of the Kikuyu tribe, also Jomo Kenyatta’s tribe, while his opponent Odinga is a member of the Luo tribe. Much of the post-election violence has been aimed at the Kikuyus (banks that they own have been burned as was a church where many Kikuyus were seeking refuge. Even former President Moi’s house was burned because of his pre-election support for Kibaki). Much of the population thinks that the Kikuyus have an unfair proportion of power both politically and financially and, as the rigging indicates, some of their leaders seem unwilling to share this power. The clashes have left over 300 dead and many more injured, not to mention all of the people fearing for their lives and trying to escape the violence by fleeing from their homes. As the violence escalates, Odinga and Kibaki seem to each be insisting on terms that make it impossible for them to even meet to discuss the current post-election situation. Just today, this seems to have changed: http://www.eastandard.net/news/?id=1143979878 and http://www.nationmedia.com/dailynation/nmgcontententry.asp?category_id=1&newsid=113914. The head of the electoral commission admitted yesterday that the election results may not be accurate, but before he could unequivocally state whether there had been rigging, he said he would need to see the original voting records, which he had yet to see and which he could only look at with the court’s permission. It seems quite clear that rigging took place during the election considering that one district had 115% voter turn out?!? Many Kenyans are disappointed and shocked by the extent of the violence, considering that their country had really been the pinnacle of stability and economic strength in the region for decades already. But many are also repulsed by the unfair election and government endorsed disruption of the democratic process. Kenyans don’t seem to have faith in the government institutions being able to solve this problem considering that the incumbent was the one to rig the election and that the attorney general, also a Kikuyu, has the exclusive power to grant or deny certiorari to any case which comes to the high courts. Is it lack of faith in the democratic process and government institutions that incites people to violence? Only time will tell what the outcome of all the violence and chaos will be, and whether Kenyan democracy will emerge with minimal damage.

And how does this affect Uganda, Kenya’s western neighbor? Well, being a landlocked country, Uganda depends on Kenya to import a wide-variety of goods, most importantly, petrol! That’s right, for days, Uganda had no petrol coming into the country, which meant that many stations ran out of fuel and those that still had fuel hiked up the prices significantly. From paying 2400 shillings, $1.50 per liter, gas stations started charging 6,000-10,000 shillings, $4-$7 per liter (around $16 – $21 per gallon)!!! Obviously this affected the cost of transportation but also it definitely slowed down the economy as people had to assess the value of transporting goods or whether to increase prices once goods arrived at their destination. Airplanes leaving Entebbe airport may have to refuel in Tazinia, Rwanda, or even Kenya. Luckily six trucks arrived from Kenya yesterday and supposedly 150 more are on their way. If things don’t get better, Uganda will have to make arrangements to transport fuel through Tanzania and across Lake Victoria, a longer and more costly route.

We are all praying for a peaceful end to this post-election crisis.

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