Thursday, July 15, 2010

My Boda-Boda Driver

My consuming fear of motorcycles has been well-chronicled, but in Kampala, you can't avoid taking bodas. They are everywhere, traffic is horrible and constant, and to get anywhere quickly, you simply have no choice but to flag down a boda, haggle over the price, hop on the back of the bike, and pray.

As soon as I began riding bodas, I met a driver named Jon, who parks himself outside of my apartment complex, waiting for customers. Demure in stature and wearing an ever-present smile, I hopped on the back of his boda while going to a bar one night. Preparing to watch a USA world Cup soccer match, I was wearing my red white and blue jersey.

"USA!" Jon exclaimed! "I love USA!"

Before beginning our journey, I grabbed hold of Jon's arms and made a deal. "OK, Jon, you like this jersey? If you give me rides, charge me fair prices, and keep me safe for the next month, I give you this jersey."

I could virtually see Jon's mouth watering. He let out a high-pitched "Eeeeh!" and we sped off.

Last night, I called Jon to my apartment complex, needing a ride to meet a friend at a restaurant. I approached him, one hand behind my back, and we embraced. After chatting for a minute about how we were doing, I stepping back and brought my hand around, showing him the shirt he craved. I tossed it to him, and he grabbed it out of the air with glee. Hopping off his boda, Jon gave me a huge bear hug, not an easy feat given that I am at least 8 inches taller and 50 pounds bigger than he is.

"Thank you, Mr. Ross," Jon said. "I will wear it every day!" He drove me safely and slowly to the restaurant, and refused to take any payment.

This morning, I left my apartment to walk to work for the last time. Jon was perched on the side of the road, straddling his boda, chest puffed out and proudly wearing my red, white and blue jersey.

Last Day

My last full day in Uganda.

It's difficult to reflect on the last month, as I have encountered a full spectrum of emotions, and much more, during my time here.

One thing is for sure, I will miss this place. There is an aura of humanity here, a genuineness of place and people that I have not found elsewhere. Smiles and hugs are like currency, passed from person to person easily and without second thought at every turn. Ugandan friends excitedly grab my hand and walk me from place to place, eager to show me something new. Little children saunter up to me in the clinic, wary at first, until I stick out my hand. Their curious eyes widen, followed by a toothy grin, as they slap me high five.

I will miss the laughter in my office, the constant cultural comparisons that brought curious looks and never-ending giggles. I will also miss seeing the doctors and nurses working; they have a sense of purpose and devotion to their patients that is subtle, but breathtaking. I will miss the walks through downtown Kampala, a place that at first looked like utter chaos but, as I have gotten to know this town, exhibits a free-flowing, sometimes-manic, order. I will miss riding buses across Uganda, packed three into a seat built for two (small) people, as chickens wander on the ground, clucking and pecking at my feet, while Ugandan hip-hop music blares from the bus's speaker system. I will miss the boda-boda rides, the matoke and beans, the African sun, and so much more.

Of course, this is Africa. Poverty abounds, to the point that after a month, I often ignore it. Walking home from work yesterday, a coworker pointed to a collection of makeshift shacks, right off the main road, with disbelief. I recall noticing them on my first walk to IDI on my first day here, and then never looking again. In Africa, suffering blends slowly into the background.

I will never forget the faces at the clinic. Given how much I love this place, it is not difficult to forget that the people we are here to help are sick. Really, frighteningly, sick. Before Uganda, HIV/AIDS was an abstraction for me, a list of statistics chronicling the plight of a people far away. For me, far away meant Africa, or the other side of Washington, D.C. But these faces, they will stay with me. They are old and young, mothers and fathers, daughters and sons. Their faces tell stories of suffering, but they are resilient. Their faces are strong.

And, of course, the bombings of Sunday night will forever remain etched in my memory. I have seen a city at its lowest point, trembling and afraid. But I am also watching it slowly return to normal. Despite the repulsive efforts of those that want to do us harm, life always returns to equilibrium. The decency and humanity of so many will always outweigh the unconscionable behavior of a few. It simply must be so.

Perhaps my lasting memory of Africa will be saying goodbye to one of my colleagues, Benson, who I have written about before. Embracing, we discussed the bombings, my trip back to the United States, and my plans to return. I then thanked him for everything he had done for me, helping me to get adjusted, and explaining how the clinic worked.

Benson, HIV positive for ten years, smiled beneath his bushy mustache.

"You are most welcome," he said. "See you next year."

Wednesday, July 14, 2010

The TB Clinic

The tuberculosis (TB) clinic at IDI has come along way since its founding in 2008. Back then, only one nurse, Ariko Immaculate, was charged with caring for, and managing the files of, every TB patient that came to IDI. The clinic was housed in one small, cramped room indoors, a severe health risk considering TB is transmitted through the air.

When the clinic finally moved to an open-air space, Immaculate and her colleagues encountered a new problem: the rain. Housed underneath flimsy tents, rain would pour in to the clinic, soaking the doctors, nurses and patients, along with their files and medicine.

Almost two years after its founding, the TB clinic now has six full-time staff, sees up to 50 patients per day, accepts 30 new patients per month, and is looking to expand. The staff does integral work, treating patients co-infected with HIV/AIDS and TB, many of whom are in dire need of care. The HIV virus breaks down the immune system, approximately doubling one’s risk of acquiring TB. When a patient becomes dually infected, administering medication becomes increasingly difficult. Side effects intensify, more pills must be taken, and there are only certain kinds of ARVs that can be prescribed with TB drugs.

Faced with vexing challenges and forced to make difficult choices, the only way the TB team can survive is by working together. Medical officers Catherine Katabira and Peter Mbidde work closely with three nurses and one full-time staffer to make sure the clinic runs smoothly, and patients get the care they need.

Additionally, peer counselors at the IDI clinics interview new incoming patients, asking them if they are showing symptoms of TB, such as weight loss, constant coughing, or a high fever. If so, they are immediately taken to the TB clinic to be examined by a nurse. Then, the patient sees one of the two medical officers, before seeing a nurse to get their prescription and receive counseling if needed.

It’s an efficient, streamlined effort that requires maximum cooperation from the entire team, particularly at a time when money is tight. While a grant from a European organization has lessened the financial burden on the TB clinic, there is still tremendous need. There is no outdoor toilet for patients to use, forcing them to go back into the clinic and, in the process, risk the transmittal of TB to other patients. An x-ray reading box and other general supplies are also needed. Perhaps most importantly, there is no separate space to provide urgent care for TB patients who need immediate medical attention.

Despite the needs, the TB clinic staff dedicates themselves to providing excellent care to every patient they see, every day.

“This team has been great at improvising and trying to implement new things,” said coordinator Sabine Hermans. “We are constantly working to raise the level of care, and do it with minimum cost.”

One example of the team devising ways to do more with less is the food delivery program. Funded almost exclusively by donations, one of the nurses, Jennifer, delivers packages of food to the homes of patients who are too sick to venture out. It’s a cost-effective way to ensure that immobile patients have enough to eat.

The TB clinic also plays an important role in the research portion of IDI. As the team works hard to devise new and improved strategies to treat dually-infected patients, observations and trends are entered into a database and examined. A recent study showed that after only one year at the TB clinic, about 14% of patients were not finishing their treatment, down from 30%, a remarkable improvement. Two more studies are planned in the near future at the TB clinic.

Treating TB presents difficult challenges for the clinic staff, but because the disease is curable, unlike, HIV/AIDS the rewards are tangible. Dr. Katabira said that watching a patient diagnosed with TB correctly take their medication and recover is extremely gratifying.

“When you see someone get better, some one make it, that encourages us as a team,” Dr. Katabira said.

Cultural Observations

Getting over the trauma of Sunday night has been difficult for everyone in Kampala, but each successive morning makes it slightly easier. As my time in Uganda winds down, I have spent more time with my Ugandan coworkers and other friends, and our jokes have begun to return.

Today, over a good-bye lunch of delivery pizza from Domino's Pizza (coincidence? I think not...), my office discussed some of our favorite cultural differences about one another. The lunch ended with all of us holding our sides in laughter. With all that we have gone through, I can't tell you how good it feels to laugh.

Ugandans, for example, think eating cheese pizza is weird. Putting toppings on is fine, but just cheese disturbs them.

They also think it's quite odd that for breakfast every morning, I put my banana inside my chapati (kind of like a potato-pancake). It's like a crepe with banana on it (I'm only missing nutella), but this baffles my Ugandan friends.

Ugandans also think that iced tea is near-blasphemous. I understand the rationale behind this one; with few refrigerators outside of Kampala, it's difficult to produce ice in a country that lies on the equator. But even here in the capital, where you can find ice, they think it's abnormal. I tried to explain my iced-coffee obsession; they looked at me like I had three heads.

They also can't comprehend that they are sitting in a room with a Jewish person. When I told them I am Jewish, Angelina, Caleb and Diana almost fell out of their chairs. They touched my skin to see if their hands would pass through. This isn't anti-semitism; I'm just probably the first of the Tribe that they have met. We constantly laugh about this one.

I poke fun at the Ugandan accents (for example, if Diana says "You wear a hat, you have a heart, you get hurt and you live in a hut," it sounds like "You wear a hut, you have a hut, you get hut and you live in a hut"), their powdered coffee, and too many other small things to count. We all have a good time.

These inside jokes are remarkable not for their incredible humor or their window into different cultures. But the fact that we were able to kid each other and laugh together meant that life was returning to normal.


Tuesday, July 13, 2010


This morning, the sun rose in the east, my boda-boda driver drove too fast causing me to panic, and the coffee at IDI is watery and bland.

In other words, it was a normal Kampala morning.

Of course, the searing memory of Sunday night still looms. The death count rose to 74. At the hospital where I work, people still linger, waiting for any late news on friends and relatives. Doctors and nurses still look bleary-eyed, overworked and overwhelmed.

A city begins to recover, and I am both impressed and disturbed by the resolved of my Ugandan friends and colleagues. They are devastated, of course, but have plowed forward in a way that is surprising. Yesterday, my coworkers made small talk while I stared into space, shellshocked. Today, another colleague came and told me that they were going to play football after work, and he wanted to teach a mzungu how to play "the beautiful game."

People grieve differently, but I think living in Uganda has, if not conditioned people to tragedy death, at least exposed them to it in a way that I have not. Having barely slept the last two nights, I am still grappling with what happened. Ugandans, reslient and proud, seem intent on moving on as quickly as possible.

For me, the most difficult part of this entire ordeal has been reconciling that something so horrible could happen in a place so wonderful, and to a people so kind. After having lived here for a month, the stunning contradiction between the warmth and beauty of Uganda, and the cowardice and destruction of the bombings, is too much to bear.

Tragedies happen all over the world, and life goes on. For me, this has been an acute reminder that we live in a dangerous world, no matter if you are in Washington, D.C., Kampala, or anywhere else. The last 48 hours have been truly awful.

I'm looking forward to beginning the process of moving on, just like my Ugandan friends.

Monday, July 12, 2010

I'll Never Forget Today

Tonight, I'm sitting in my living room, drinking wine with my roommate Peace, and watching bad American sitcoms on DVD. It sounds like any other Monday night. Except that it wasn't.

Today was quite possibly the worst day of my life. After a sleepless night contemplating all that happened in Kampala last night, I arrived at Mulago National Hospital to see hundreds of people gathering outside. They were waiting to hear of news about loved ones. Some were crying, others were staring into the distance with hollow eyes, and still others chatted absentmindedly.

Going inside to offer my assistance to the Red Cross, I saw victims of the attacks on rolling hospital beds. Some were bloody and bandaged. Others were missing limbs. It truly looked like the aftermath of war.

It was impossible to work. I kept thinking about how close I was to meeting Peace at the Rugby Club. Had I not gotten a text message from a friend, I would have been at the bar where the second, more powerful bomb exploded. I also thought about her, what she saw, and what she felt. She tells me she's ok, but it's hard to know.

Rumors have flown around Kampala about what did happen, what could have happened, and what is going to happen. I heard that a bomber was on his way to the bar that I was at. I heard that two bombs were defused today in Kampala, sparing more lives. I heard that more attacks are on the way. I don't know what to believe.

It's unclear what my future plans are. On Monday, July 19, the day that I am supposed to leave, a meeting of African Union leaders will begin in Kampala. It may be prudent to leave before then.

Thank you everyone for your kind words and support. Today was a horrible experience for me, but my day pales in comparison to the hundreds that lost a friend or family member last night. I know lots of those people, and their ordeal is just beginning.

I need to get some sleep. Will post more tomorrow.

Sunday, July 11, 2010

The Bombings

I'm not sure what I am supposed to feel.

Last night, three bombs went off at popular bars in Kampala. The attacks killed at least 65 people, including one American.

My roommate Peace, a lovely Ugandan woman who is in graduate school at the University of Washington, was at the Rugby club, a big outdoor space where hundreds gathered to watch the World Cup final. At halftime, I was about to leave the crowded bar where I was to go meet her, when I received a text message.

"Two bombs have gone off, get out of bars."

The rest of the night is a blur. As information trickled in and rumors swirled, I was left feeling a weird combination of lucky and helpless. No one knew what was going on, and we all relied on whispers.

I could have been in that bar. I could have died.

Having worked on national security issues at the U.S. Department of Justice, I feel as if I have gone from watching a scary movie to actually being thrown in it. It is a surreal sensation, and even know, I'm unable to keep from shaking. Thankfully, everyone I know here has survived, and for that I am grateful. But it is a stunningly unsettling notion to think that so much death and destruction happened so close to me.

Immediately, flashbacks to 9/11 came racing back. Many of my emotions are the same, some are different. Perhaps I will write more about this when I have had time to process this ordeal.

The morning did not bring respite; in many ways, it has been worse. The national morgue is at the hospital where I work. Everywhere, people are gathered around wailing victims, consoling them, hugging them. I am too confused to know what I feel.

Uganda is a beautiful country, with kind, warm, generous people. Last night, evil tore through my adopted home, lowering a dark, bloody cloud on what was a joyous, boisterous evening in a fantastic place. In the world we live in, terror can strike anywhere, anytime.

I am shaken. To those that lost their lives or know someone that did, all of our prayers are with you.