… the clinic has an autoclave or does it?

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For those individuals who do not know what an autoclave is….. it is a device used to sterilize medical and laboratory instruments by subjecting them to very high pressures with saturated steam above 212 degree Fahrenheit or 100 degrees Celsius. It is like a pressure cooker but the one for the clinic is the size of a large old fashion microwave oven (2 feet by 2 feet by one foot)and it weights about 35 pounds.

In cleaning out the various store rooms for the clinic, I found this new, unused autoclave still surrounded by the manufacture’s bubble wrap. I could not believe my eyes…. I was wondering how to improve the sterilize process for the various pieces of equipment the staff use to clean wounds, change dressings or when we would need to suture a patient and then remove the stitches. I found a perfect spot for the autoclave but many of the staff had never seen an autoclave or one this small and so it was an opportunity for learning…

I read the manual to discover that not any tap water would do but a certain kind of de-mineralized water must be used. and not any wate…. so my search was on and I finally after a number of trips to Masaka I found a place where I could buy a 5 litre jug. Now, I could test the autoclave and see if it would work. The manual was passed around and various individuals who are responsible for the maintenance agreed that we could trial it….. but all that took time and the clinic was without its use. In the meantime, I ordered the special autoclave tape which indicates the process worked and had drapes or large wraps made from hospital standard material I had ordered from Kampala. I was not able to do a trial run before I left for Canada in August but immediately after my return, I was given permission to do a trial run… It was on a Market Monday when the autoclave was set up with water and a set of instruments to be sterilized. Within a few minutes, the device was off and I had over loaded the generator…… now. how do I or can I use the autoclave?…….. After a numerous of discussion, it was decided that we would attempt a second trial at lunchtime… between 1 and 2 pm. The generator would be turned off to the rest of the compound and the only power would be for the clinic. We had success… the process took just over 60 minutes and the autoclave functioned perfectly.

WOW!!!!!!!!!!!!!! We were in business….. Joyce, one of the nurse’s spent the next week cleaning all the various forceps, scissors and cutting gauze making up 10 packages ready for sterilization.

The plans for this past week were to sterilize each afternoon until all 10 packages were through the process…. Tuesday, everything went well, Wednesday I noticed that the device turned off and had not completed the process…. in fact it had overloaded the generator or so that is what it looked like to me. The maintenance men arrived to discover that the wall socket had been blown. Thursday, the socket was replaced and on Friday we tried one more time… without success. It could be a number of things including the wiring to the clinic…..the wiring may not be able to handle the power surge. It is going to take some time before anyone knows for sure the cause…..

Some one in the past years gave a very expensive gift to the clinic. Something which is needed and can be used….. in the meantime…. there are more questions then answers.

BUT I AM STILL GOING TO TRY AND FIND AN ANSWER……. in the meantime, back to the old method of cleaning equipment.

…..the dedication of children

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Last Saturday, I received a text from my neighbour, Samalie, informing me that her two youngest children, Ethan who is 1 1/2 years old and Julia who is 5 months old were going to be dedicated. But I had many questions… in what church was the ceremony going to take place? And was the text an invitation to the ceremony? And if so what was I expected to do or bring? The person I usually go to for information on Ugandan culture has been Samalie … so do I ask her these questions? I first spoke to the staff at the clinic and was given a variety of answers from the text was not an invitation to yes it was and I was expected to attend and give a gift of money.

I presented myself at the home of Samalie and was greeted with “Can you come?” So that answered my first question and then she told me the children were going to be dedicated by her husband in the remove village of Kamuli (came-moo-lee). I just learned that the word kamuli is the name of a type of small flower….Anyway, PJ, Samalie’s husband has been working in the village to build a church and a school for a number of years. I remember hearing stories of the road and how it has been impassable during the rainy season … and we are in the rainy season but the rains have not been too terrible and in fact the weather has been hot and dry most of the time. I was hoping that meant the road was good.

Samalie told me that they were going out that afternoon and I was welcome to come…. but if I wanted to I could come on Sunday and she would check and see if Mugabi would go with me. Finally, she told me that I did not need to bring a single thing….. Late that afternoon a vehicle was loaded up with them all including a goat. They did not return so had to assume the road was O.K…….

On Sunday morning, I was up and ready by 8:30 am…. and it was not until 10:45 that Mugabi arrived at my door with his two children all ready to depart. It took us just under one hour to follow the winding red dirt road with ruts or potholes so deep that you could destroy your undercarriage, your shocks and have a wheel disappear forever. It was a slow trip but the scenery was breathtaking…. rolls hills with one garden of matoke or Irish potatoes after another… It seemed like every square foot of ground was under cultivation. We arrived at 11:55 to the sound of singing. The service had begun.

Of course, Mugabi and I were guests of honour and we were directed by a lovely young man to seats at the front of the church. The building was constructed of locally made bricks with opening for future additions of windows and doors. The place was filled with smartly dressed young men and women, old men and women and lots and lots of children. I quickly learned that it was not just the dedication of Ethan and Julia but it was opportunity for each and every parent to dedicate their child or children. There were at least three choirs who sang praises…. one of them had on red T-shirts with the Canadian flag on the back. I could not help but smile……

I was exciting to hear PJ when he spoke about how children are a gift from God and they are not to be used or abused but treated as a very precious gift….treated well, given every opportunity for learning and education. The teaching was translated into two languages as well as English. The teaching, praise and worship, dedication of more than 20 infants and children was a very exciting and emotional time for me ……the service ended with lots of singing and praise just after 3 pm.

As this was a very special day there was food served afterwards. As a guest of honour, I was seated at a table at the front of the church and served some of the best food I have ever had in Uganda. They handed me a plate of rice with beef, greens, goat and cabbage. The beef and goat had been roasted and were positively delicious. The greens are some leafy plant they pan fry and the cabbage is wonderful…. I could not believe the amount of food I eat…… but it was truly a significant party when sodas are provided and I got a bottle of my favourite called Stoney.

After the service was over many members of the congregation found someone to translate and asked me numerous questions including how old I was …. they thought I was 70 (I was not sure that was a compliment) and did I have extensions in my hair… they wanted to touch it. They asked about Canada and my work in Kibaale with Samalie. It was very interesting to hear the sort of questions they were asking…. It was very clear that they did not know anything about Canada nor the fact I was the only white person living in Kibaale.

This little village is situated on top of a hill facing south towards Tanzania which is only a few miles away. It was a nice comfortable sunny day and an amazing opportunity to experience some more of Ugandan culture and see more of true rural Uganda. I was blessed.

……. my safari to give vaccinations on Sept 12, 2012

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Three times a month a few members of the clinic staff travel out to one of three villages to do vaccinations for babies and toddlers 6 weeks old up to three years of age. Last Wednesday, like usual I did the driving and we were heading for a very small village called Kisomole (kiss-omh-oo-lee). We hold the vaccination clinic under a giant tree and you can see it immediately you take that last turn in the road. On Wednesday, the rains came and it rained most of the late morning and early afternoon…. it was not a shower but a deluge. I was wondering if the road would be passable or would the mother bring their babies out….. 

At 3:30 we headed out with the sun shining. The first section of road is the main road going to Rakai. It is a dirt road and not well maintained… the ruts are deep and you can see the route water takes down the road….. but this is concerned a fairly good road. After a few minutes, we turned off on to a road wide enough for my land cruiser to travel down…. I have in the passed meet a vehicle coming the other direction and unfortunately, I was the small of the two so had to back up. I do a terrible job of backing up…. I dislike doing it in Canada and would prefer to never had to do it. i guess, in Uganda I am going to have to learn.

Well, today the road was wet and slippery… so I traveled  slowly and carefully. We had traveled a few miles when we came upon an old pickup truck. The only thing I could see was the back end and it was rusted and the frame bend or sagging to one side. The bed was filled with people and things… there were by my count 7 adults and one child, plus a large plastic bucket which looked filled with something, a few suitcases. The very end of the truck was laden with ten or more pieces of trees branches and large sticks and we had to wait while a few more pieces of fire wood we piled on the back….. there was no place to pass…. so I waited and waited and finally, I honked my horn.

 

The man putting the fire wood in the truck jumped at the blast of my horn and moved quicker …. the last of the wood was in and away they left. I had no option but to follow them….. and wonder if they were going all the way to Kisomole. The truck was so loaded that it was almost touching the ground at the back end so it was not a big surprise that when they hit a large rut and the truck bounce so did all the fire wood bounce right out of the truck and on to the road in front of me…. one piece at a time…. and now the road was blocked with fire wood….. I had to use my horn once again to catch their attention.   

The truck stopped and the man who owned the fire wood ran back and collected one piece of fire wood at a time… you could see that the wood was heavy…and he was tired. It was a slow process …. and we waited and waited and watched.

Once the fire wood was back on the truck and much more secure…. the truck moved off down a narrow part of the road…. less than a mile late, on the left side of the road was a very large bull with horns at least 2-3 feet long. A young boy was tending the bull and he was attempting to move him off the road before the truck passed but ……… the horns of bull ripped the mirror off the side of the truck. The truck stopped, the driver got out and so did two of the passenger … they spoken to the young boy while waved the mirror back and forth…. It was very clear from the behaviour that the driver and passengers were upset, even angry at the young boy…. in the meantime, the bull was standing beside the truck and his horns were continuing to knock off a few more things like a suitcase and a couple of pieces of the fire wood…… finally, they had the boy drive off the bull so no more damage could be done.  

I could not help but think that this was a comedy of errors…. I just wanted to get to Kisomole. Time was getting later and later…. we had to complete the vaccination clinic and be gone by 6 pm. I am not permitted to travel after dark which is 7 pm because it is too dangerous…. people walk on the road as well as animals. It is next to impossible to see them. 

The truck driver must have sensed my frustration and amusement so the next thing I know is that he is going faster ….. and then he comes to a large mud patch or a mud hole. He speeds up and then fish flops back and forth through the mud and almost does a 360 while flinging suitcase and the fire wood off in every direction. Of course, the truck stops once again and this time everyone gets out and runs in every direction to grab their belongings…… the staff are laughing aloud at the antics…… I think we all needed a good laugh!!!!!

A few minutes later…. the truck turned off up a path…. not even a road and disappeared. 

We, finally arrived at the tree where the clinic was held to find a few women and babies waiting for us. That day we only vaccinated a total of 23 babies…… but there were three newborns, one of whose mother needed some teaching and support for her breastfeeding because the baby looks poorly nourished. The trip was worth it. 

tooth care in Kibaale, Uganda……

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Over the past few weeks during my holiday in Canada, I have been asked many questions about various aspects of life in Kibaale including tooth care. Yes, we have a dentist named Noa (without the “h”) who comes to the clinic every two weeks on Market Mondays to see any patients who require dental care. At the end of each Market Monday, I always ask him how many patients he has seen and in the beginning I was surprised to hear that he would see such a large number of students, staff and Kibaale folks. One day he saw 49 individual patients. It would be great if he was filling cavities or cleaning teeth but the only thing Noa does is pull any and all teeth that are causing some discomfort or pain. Unfortunately, he does not always come which means that those students, staff or other community member who are suffering in pain with a tooth ache have to wait two weeks. On those days when he does not come, the patients are redirected to either our Medical Officer or comprehensive nurse so that those with an abscessed tooth can be put on antibiotics before seeing Noa the next time he comes to the clinic.

Tooth care in not just about brushing your teeth but what you eat and drink. At the clinic, the staff love their tea in the morning with teaspoon after teaspoonful of sugar. And when company comes to visit me in Kibaale, I have been informed that it is an expectation that I offer the person a glass of water or a cup of tea. I can serve a cup of tea without milk but never without sugar. I must always be prepared for guests.

The stable food of Kibaale and the surrounding region is Matoke. I have been told by the clinic staff that if they do not have Matoke as the evening meal they have not eaten. It is like us eating a large plate of only rice, pasta or potatoes. Matoke is a certain type of green banana which is peeled, wrapped in leaves and steamed for hours in a pot over a charcoal fire. Uncooked it is white and fairly hard but after hours and hours of steaming is becomes soft and yellow. A sauce is served along with the matoki. The sauce is usually made of tomatoes, onions and green peppers. These are the only vegetables they eat that I am aware of. Rice, posho, potatoes, beans, pumpkin, chicken, beef and fish are extras and served if affordable and/or available. The staff will occasionally buy a few avocados to share with their lunch. But they think that avocados are expensive at 200 to 300 shillings (8 to 12 cents US).

Fingerling bananas are the only fruit always available. Pineapples, mango, papaya, watermelon, oranges, and passion fruit are seasonal. The staff of the clinic are not willing to buy fruit…

So how do the folks in Kibaale satisfy their “sweet tooth?” Sugar cane is a popular treat…. they buy a small piece of sugar cane 8 to 12 inches in length and chew until the only thing left is the fibers which they spit out. Bottles of pop or sodas are available but too expensive for most at 1,000 shillings or 40 cents US. Many small business make up a sweet sugary drink and sell a cupful in a small plastic bag for a few shillings. There are the single candy for 100 shillings or packets of glucose (sugar) for 500 shillings.

The secondary students frequently request a “syrup” in stead of antibiotic pills or tablets….. in the past the staff have allowed the students to have a syrup. I have watched students walking back to class downing the syrup as if it was a drink…..Now, the clinic provides syrups to infants less than 6 months of age and no longer to any of the students………

It is sad to say that I have not found any toothbrushes or toothpaste in Kibaale…. and they are not readily available in Masaka. So how do the students, staff and community members take care of their teeth….. Noa, the dentist tells me that very few people know anything about tooth care. One of my hopes for the next year is to teach tooth care from brushing their teeth to increasing foods that are more healthy.

….. what 1,000 Ugandan shillings will buy

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I have been thinking about the cost of living in Kibaale, Uganda over the past few weeks and it all came to a climax the other day…. when I was told the price of fuel (gas) for motorcycles, cars, and lamps increased 300 %….. Yes, in one day the price went from 3,400 shillings for a litre of fuel to 9,000 shillings and it is expected to increase even more to somewhere around 10,000 to 12,000 shillings a litre.

But this may not make any sense to you….. so lets start with things that the average person in Kibaale would buy. For 1,000 shillings they can buy any one of the following: 5 large tomatoes, 1/2 kilo/ 1 pound of onions, one soda (pop), 3 large avocados, 4 green peppers, two large bunches of finger bananas/ 5 large bananas, 5 small chapatis, 10 small cassava chips, or 4 banana pancakes, two pens, two clear plastic rules, four receipts books or one large plastic envelop…….. these are some of the items which I have been able to purchase in Kibaale.

The staff of the clinic are paid a salary equal to those of a government employee. Besides their salary, the clinic staff receive free housing, free medical coverage as well as breakfast and lunch. The cleaning staff take home about 107,000 shillings while most of the nurses take home just over 250,000 shillings and still each one of them does not have any money in their pocket for anything extra. Some of them cook for themselves but many eat out on street food where the price varies from 1,000 to 2,000 shillings. The best restaurant in town, or the only restaurant I would eat in serves a complete Ugandan meal from 2,000 to 5,000 shillings per plate.

Each one of the clinic staff help support at least two or three other persons and some even more. I have heard that somewhere between 60 to 80% of the population of Uganda is unemployed. So, those who do have a job are expected to support their family and extended family.

In Masaka, the next largest city to Kibaale which is about 2 hours drive… the prices are much higher. 5 tomatoes cost 1,200 shillings and you will only get 2 large or three small avocados for 1,000 shillings. Chapatis cost 300 shillings a piece and a bunch of bananas is usually 600 to 700 and a soda cost 2,000 shilling. BUT in Masaka you can buy bread at 2,300 shillings a loaf; a can of tuna fish for 5,000 shillings; cooking oil for 7,000 shillings and 1/2 pound of butter for 6,000 shillings. My favourite restaurant, Frickadallen is part of Ugandan Child Care, a Danish organization. I love their Danish meatballs with potato salad and a side of a tomatoes and green pepper salad. This along a latte is only 22,000 shillings. A good deal to me for about $10 Can.

Unfortunately, the cost of medications is expensive…… the people who come to the clinic pay only 10,000 shillings but for that they get everything from consultation to all available treatments, blood work and any medications prescribed. The cost of quinine tablets for the treatment of Malaria is over 5,000 shillings. One cough syrups is over 2,000 shillings and most injectable antibiotics are at least 700 shillings per dose and most patients get anywhere from one to ten doses. No one goes home from the clinic without at least three medications… usually one for Malaria, one for some type of infection and a pain medication such as Tylenol.

1,000 shillings does not go very far…. the cost of living is quickly increasing in this part of Uganda and even the staff who have some money are very concerned about how they are going to survive…. so what about the village person who lives off the land. It is now the dry season and the crops are in……

…… what I do in the clinic?

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This is Africa and I am stilling trying to comprehend two things…. one is the length of time it takes to get anything done….. it still surprised me the amount of time and energy it takes to find an answer to a problem. What appears to be a simple problem often turns out to be more complicated that I would have imagined. The second thing is that there is always crisis which somehow I am expected to resolve. 

The clinic is open Monday to Friday from  8 am to 5 pm and on Saturdays from 8 am to 12 noon…. So I  usually arrive at the clinic around 8 am Monday through Saturday and I leave anytime after 5:30 once the clinic is closed…. except Saturday which is a half day and I leave around 1 pm.

Each morning, I am expected to go around and greet each of the staff….. and hear their news. There are 14 staff working in the clinic: three nurses, three assistant nurses, two laboratory techs, two house cleaners, one receptionist, one health and safety coordinator, one comprehensive nurse who can diagnosis, treat and prescribe, and a part time medical officer who works Monday, Tuesday and Wednesday. This little clinic sees  between 1,600 and 2,000 patients monthly…. that includes students, staff and members of the community. All this information has been kept on pieces of paper which  I am now attempting to find and put on an excel spread sheet…. It is huge learning curve for me as to what data is available, obtain it and then input it….. but it is coming together slowly. I am collecting data on who comes to the clinic each day: the number of students, the number of staff members, the number family of staff, and the number of community members plus the daily clinic receipts…… as well as our expenditures like cost of medications, salary for the medical officer, fuel and transportation costs for referrals and transfers to another facility for continued care.  

I work in my small office answering emails, preparing medications orders, input any new data and attempt to put order to the clinic….. it seems that the staff have gone many months without proper supplies and they have learned to live with less…… or learned to go without………. like proper mugs for tea and dish soap for washing up, towels, laundry soap, uniforms, boots, buckets and many more things I would consider an essential which they did not think to ask for.

Each morning the clinic needs power to function…. light to assess a patient, or insert an intravenous catheter or for the lab to process blood work…. power is essential. When we do not have power….. it becomes a crisis and now my responsibility to discover the reason….. for the past few months there have been numerous reasons why there has been no generator power….. from there is no fuel, the operator slept in, they cannot find the operator,  there is water in the fuel, someone is going to Kyotera a 90 minute round trip for fuel, and the breakers for the clinic have somehow been switched off. Searching for power can take me at little as  30 minutes but more likely most of a morning……….. 

Our receptionist daily needs change even though she has been told to keep 20,000 shillings in small bills in the safe……she comes asking advice for each patient who comes with no money or some money and need to be helped even though she knows what to do…… Just for your information, every person who comes to the clinic is served whether they have funds to pay or not.

The pharmacy staff come frequently throughout the day requesting one item at a time which they somehow cannot find in the pharmacy in spite of me stocking it well weekly…..even though each medication is in alphabetical order as per their decision, and labelled…… it seems that if the packaging is changed in anyway they cannot see it and therefore, assume that they do not have it. It is taking time … and they are learning to look for the label and check the designated spot but when the clinic gets busy and the work load increases the old habits pop back up.

After working in the clinic for almost 6 months, I am still amazed that I have not discovered every medication or medical supply required…… just this week, one of the nurse ask me if I had Vitamin K in my store room……… I was stunned, all I could think to say was that if I had it then you would have it.  Later this week,  I was told we were out of surgical blades. I did not know we used blades. A few months ago, I found scalpel handles in one of the store rooms and asked if these were ever used and did we need blades to go with the handles and was told “NO”….. it seems that at that time we had many blades and I misunderstood the answer. Now, Vitamin K and blades on my list of clinic needs and purchases.   

It has been come clear that there are times in the school year when many of the students are stressed over exams and getting good marks… their stress comes out in many forms from headaches, to upset stomachs and nausea and vomiting and as a result they arrive in the clinic…..  these symptoms are treated but the real cause also needs to be addressed…. the stress. The staff work hard to support their needs, talking to them, praying for them and now we have pastoral care once a week in the clinic for these types of issues both for the students as well as everyone else.

There was a young 7 year old student who presented herself to the clinic staff everyday for almost two weeks with various complaints……. all examinations, and lab tests were negative and this had the clinic staff wondering what was wrong. Finally, the family were called in…….. the staff were wondering if she was mistreated at home but the parents showed love and compassion for their child. They stated that she did not want to go to school……. after much discussion with the girl and her family it became clear that she did not like school and especially her teacher. The parents were told to bring their daughter back to the clinic the next day by which time, I was expected to have discussed this issue with the administer of her grade. The rest of that day, I spent  finding out who was responsible for the student/ who was the principal for her grade, discussed what we discovered in the clinic and ask if this student could be moved to a different class. Once the information was presented, the administer was very willing to move the student…..a week later, I checked up to learn that the girl was busy catching up on her homework, happy and making friends. 

My job takes me all over the compound and I get to speak with many interesting and caring teachers, administers, and staff ……each want only the best for the students.

Some told me that my life and job in Kibaale was a soap opera…. unfortunately, the stories are not the imagination of a writer but real………. real lives are touched each day by the clinic staff….. they do an amazing job with the little they have….. 

…..the bodaboda

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In Uganda, the motorcycle is known by the name bodaboda. I have not yet discovered the meaning of the word but maybe with time.

The bodaboda is the basic means of transportation throughout Uganda. Even in the small village of Kibaale there are many….. I think of it as a simple effective taxi. It can travel the main paved highways, on the red dirt roads or along the narrow footpaths…. it can go anywhere for a inexpensive price. A litre of fuel is around 3,500 shillings which is more than $1.25 US.

As I travel back and forth from Kibaale to Masaka I see many of them stationed at certain crossroads along the way from the big town to the small villages ready in a second to carry one, two, three or maybe four passengers to their village. Yes…. these motorcycles are the basic ones found in most parts of Canada and the USA, nothing fancy but they are used everywhere for transporting many people at a time short or long distances. I rarely see anyone wearing a helmet.

Some drivers own the bodaboda while other rent them….. but it is a job. Whatever there is a town, village or city….there is a spot where the bodabodas congregate for conversation, repairs and washing…. the driver work hard to keep the motorcycle functioning and sparking clean.

When I say is it the basic mode of transportation it is not just for people but everything else. I have seen 30 or more pineapples tied to the back of a bodaboda hanging down like tails or the double bed balance on the back so wide that I cannot see the driver, or numerous jerry cans for water bounding around like a yellow flower in bloom. The motorcycle carries luggage, large bags full of roasted coffee, stocks of matoki, cases of pop, lumber, bricks, wooden crates of fruits and vegetables, book shelves, and anything that needs to be transported including the body of a loved one who has passed away. I think I have seen almost everything somehow tied down, balanced on the back and transported on the main road to the narrow paths. It is amazing what the motorcycle can carry.

BUT….. they are very scary. I have not yet had a ride on one but they can get you from one place to other in Kampala faster than a car….. the congestion in many parts of Kampala is just as bad as the gridlocks in Vancouver during rush-hour. So, many business men in their suits and ties use the bodaboda as a means of quick transportation from one appointment to another.

BUT for me…. they are scary on the roads. They dart in and out between the trucks, cars and bikes as if they have the right of way. I have seen a mother carrying a new baby on the back between two other people, or a father driving his four children to school or an elderly couple holding tightly to numerous heavy bags of who knows what. It looks like it is a fine balancing act which goes well most of the time and then…… there are the time when things fall apart. Like the other day, when a bodaboda carrying three men plus the driver passed me on the wrong side, darted out in front of me as I was going up a steep hill on the dirt road into Kibaale. All of a sudden the last man of the bike falls off…. I almost ran over him. This is just of the many times I have watched the bodaboda a few feet in front of me drop off the last passenger. I watch to make sure the person is O.K….. but wonder if the person gets their ride free.

Bodabodas are a good thing but I wonder how many people are seriously hurt when the driver makes a mistake turning, passing or traveling up a hill and someone or all fall off. I watch these drivers and ponder the value of life….he is balancing the making of a few shillings with the health and well being of his passengers.

…….. yes, I finally got a flat tire

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It is Sunday evening and I am still in Masaka. I normally leave for Kibaale around 4:30 Sunday afternoon so that I can get home before dark. It is also I very beautiful time of the day traveling from Ssanje (sand-gee) to Kibaale on the dark red dirt road. The hundreds or thousands of colours of green vegetation, the cool evening air with its freshness and the quiet peacefulness of the numerous people slowly walking or riding on the road gives this part of Uganda a welcoming invitation. I always feel like I am entering into a precious and amazing world separated from the loud, noisy and busy world like Masaka and Kampala. But tonight, I am stuck in Masaka…..

I traveled from Kibaale yesterday morning before the heat of the day….. arriving in Masaka with plenty of time to shop for medications and other supplies for the clinic, do some grocery shopping as I was out of coffee before going to a birthday party. It was Alex 16th birthday and his family put on an amazing pool party with lots of homemade Greek food. Of course, it had to be home made because you can not buy anything like pita bread, or the various Greek sauces in Uganda. I was transported back to Canada to my favourite Greek restaurants but nothing compare with this delicious food. You could say that the food was good because I have not had any Greek food for over 6 months but you would be wrong…. the food was an gastronomic delight because it was made with lots and lots of love…….

I parked my large land cruiser inside the gates of the Danish compound beside the pool for safety. I did not want to leave it on the street with all the medications inside. The land cruiser did not appear to have any problems as I drove to the Timothy Centre but this Sunday morning…. one of the workers spotted the flat. On examination, the tire had a very large slash in it which cannot be fixed. There is no place in Masaka to buy tires. Someone has to go to travel three hours to Kampala for a new tire for the land cruiser….. It is not just the trip to Kampala that takes the time but will the shops be open and will they have the right size tire for the vehicle. I have no idea when I will be able to leave but I am in Masaka until it is fixed.

I am so thankful that the flat did not happened on my trip into Masaka or on my trip long the dirt road into Kibaale ….. in fact no time is a good time to have a flat tire. BUT I have to say, this has to be the best flat tire I have ever had. I am safe and everything is being taken care of by someone other than me. All I have to do is wait. This is Africa.

I am going to take this flat as a gift so that I can be still and relax…. caught up on my blogging, emails and sleep…….. I can not nothing to change the situation so I might as well enjoy the opportunity given me.

………..a disco came to Kibaale this week

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On Wednesday evening of this week, Kibaale had an outdoor disco, we might have called it a music festival. A truck with a loud speaker had been traveling up and down the roads around Kibaale announcing the disco. The cost was only 5,000 shillings or about $2 US. Not much but when you think that many folks in the area live off the crops they grow this was a lot of money. I asked the clinic staff if anyone was going to attend and was told by most that it was for the young. BUT how can the youth afford to attend. I guess just like in Canada, parent want to provide opportunities for their teenagers….. as there is nothing or no place for the youth to “hang out”. Yes, they have their chores of collecting water and helping in the garden but life in rural Uganda is changing…… 

The outdoor disco was about 1/4 mile down the road from the entrance to Kibaale Community Centre on a very large grassy field used for soccer matches….. an enclosure was created by a 6 foot material fence held up by metal poles…….. I watched the enclosure go up from the front of the clinic.

There was excitement in the air and the little town of Kibaale was alive with people…. everywhere. Everyone was dressed up in their finest…….. the town was filled with also of small “entrepreneurs” from the young boy selling soda (pop) and water  to the lady cooking some sort of hot meals, and then there were the vendors who wanted to sell blankets, dresses and shoes….. it was an interesting scene.  I kept thinking that this was like a old country western town where the rodeo came to town…..

The music started around 7 pm and it played until close to 1:45 am. The music was a mixture of classical, jazz, vocal, instrumental, country and western and a little rock and roll…… I enjoyed the various genre but the only problem was the volume…. it was loud. I think everyone for at least “10 miles” could easily hear the music…. so why buy an entrance ticket. I enjoyed the music for free…… but then I did not get to sleep until the wee hours of the morning.

By the time I arrived at work, 8 am…. the tenting or fencing was down and the only things left were the hundreds or thousands of bottles, bags, pieces of paper left covering the field…. it looks like a hurricane came through and this is what is left behind….. who knows when this will all be cleaned up. I guess the next time someone wants to use the field for a soccer match.

I spoke to many of the students, and patients in the clinic the next day but no one admitted to attending……  can this be rural Uganda?

Who knows what is coming to this peaceful valley next?

….it is only a short distance.

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Last Saturday afternoon I was planning on walking into Kibaale Village to buy some airtime so I could call Canada and the USA. I was going to walk with Namuliika, (nam-oo-leak-a) the comprehensive nurse I hired a few months ago. It would give me an opportunity to talk with her about various things happening in the clinic…..

My house is under construction and Dominic came to the clinic to ask for my keys……. he had taken down a half wall which had no purpose to made more space. He wanted to look at the hole and measure for new tiles…. So, we walked to my house, I dropped off my clinic keys and handed over my house keys…. I was off to town and would be back in 30 to 60 minutes.

The clinic closes at noon but we usually have a few patients whose treatment take them past noon and maybe up to 2 pm. The staff take turns staying behind and “keeping the guard” as I think of it. Susanne was suppose to “keep the guard” but she had made plans and asked Namuliika to stay…. So I decided to stay and talk with Namuliika. The first hour was busy as 5 of the 7 patients were quickly ready for discharged. There was a little girl of about 5 or 6 years of age and a beautiful pregnant lady both finishing the treatment for Malaria. We were talking when the father informed us his daughter was ready…… I thought the little girl still look very weak…… but the father insisted she was fine. That left the lovely lady…. she was only a few weeks pregnant and had Malaria as well. Her Quinine treatment was almost finished……… We were sitting waiting outside the front of the building when the young girl and her father left…..they had not even reached the clinic gate when the father was screaming something and running back…. his daughter was having a seizure. WHY??????? Namuliika nor I could understand the rationale….. but we had our own problems. The keys to the pharmacy went home with one nurse and the keys to the treatment room went home with another nurse….. I have not been aware of this being a problem in the past but it was a BIG PROBLEM today. I grabbed for my keys only to remember they were at home….. as I ran quickly across the field I saw my door was closed and wonder where Dominic was…… as I approached the door calling out his name, Dominic came around the corner.

With clinic keys in hand…. I ran back across the field and into the clinic…. the only keys I had were to the store room and we were hoping that the supplies we needed were available… and everything was there.

After a few minutes, the seizures stopped but her temperature was rising…. so further medications were needed….. as the race from the store room to the child’s bedside continued, the pregnant lady called out to let us know her drip was completed. I took out her intervenous…. and she told Namuliika her husband would be coming soon and she would wait for him at the gate….

We watched her leave and as she reached the clinic gate she fainted…. I looked at Namuliika and she looked at me and we both said…. what is happening? These two patients kept us busy for the rest of the afternoon….

At 4:45 we were discussing the fact that neither one of these patients could travel home safely….. they were both very weak and would need more time to recover but it was going to get dark soon. Namuliika spoke with the lady and the father about this problem….. unfortunately, they lived in opposite directions. Regardless of the situation……. I went for the land cruiser and by the time I returned, the husband had arrived and was ready to take his wife home.

There was no way the little girl could possibly sit on the back of a motorcycle. The father informed Namuliika that they only lived a short distance away………. so at 5:15 with Namuliika sitting in the back seat holding the young sleepy girl we departed following the father’s motorcycle. As we passed the only gas station in town, I commented that I had less that a 1/4 tank left but Namuliika stated…. “he told us it was only a short distance…” we followed the motorcycle up and down some good, bad and terrible roads and finally at 6 pm… we stopped. We had not yet reached his house but the road in front of me was not wide enough for my vehicle….it was truly a foot path. We could go no further…. the place where we stopped had a few people and they knew the father. So we felt O.K. to leave them there.

On our travels up and down the mountain roads…. we passed Asaph (Ass-off), one of the nurses enjoying the afternoon on his motorcycle…. his home town was somewhere on this road. It was after 6:30 when we reached Kibaale and saw Asaph walking towards us with a small bottle of fuel. We stopped and asked him where his bike was and he told us ……..” it was only a short distance up the road…..only a couple of kilometers.” I believed him and once again I traveled back up and down the mountains roads for more than ten kilometers before arriving at his bike……

Namuliika and I were hungry…. our stomachs were growling. We had not eaten since tea at 10 am… and it was after 7 pm. There is no McDonald’s, Burger King, Wendy’s or White Spot in Kibaale……we went to the only acceptable restaurant, to be told that their food was over….. it was all gone……. there was no matooke, no posho, no potatoes, no pumpkin, only some rice ……one piece of chicken and one piece of fish. The food was ready and the price was right…. only $3.50 for all the rice and chicken we could eat.

……. it was only a short distance home and this time it truly was.

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