ashis.org

UgandAshis 59 Musings

2009-09-19T11:11:00.000-07:00

UgandAshis 59 Musings

September 19, 2009

Dragonfly

Dragonfly
Why?
Do you dip your wings?
In puddles of water
Are they flaming things
Tell me later

Yogi meets a dragonfly
Snap
One less dragonfly

http://en.wikipedia.org/wiki/Dragonfly
And they are predators that eat mosquitoes.
One should love them

Less is more!

Pondering peace
Wondering who is
Going to take the first step.

http://en.wikipedia.org/wiki/Alma_Ata_Declaration
Health for all by 2000 declared in 1978

OK

Now

http://www.un.org/millenniumgoals/
The assessment, launched by UN Secretary-General Ban Ki-moon in Geneva, warns that, despite many successes, overall progress has been too slow for most of the targets to be met by 2015.

Same, same but different?

Namaskar,

Ashis

UgandAshis 58 Congolese dancing stick

2009-09-19T10:53:00.000-07:00

UgandAshis 58 Congolese dancing stick

September 19, 2009

The local mosque has a muezzin calling for the evening prayer. It is almost Eid and many of the people around Kansanga are Muslim. Because of Ramadan and the riots last week night life in Kansanga and Kabalagala has been very quiet lately. The one thing that interrupts the silence are Premiership Soccer matches, then pubs are full and people are cheering.

As I dangle in the yellow hammock I can see three lizards working their way through a cloud of mosquitoes in a stalking yet distinguished style. If only there were more lizards and fewer mosquitoes. Our green yellow black eyed friends are working hard but the odds seem insurmountable.
The black kites were circling the house in pairs today. Wondering what they are messaging? And I recall the title of this story; ‘Congolese dancing stick’. It is a wooden carving from Beni, eastern Congo about 80 years old. I am to trace the history of the artifact but holding it in my hand gives a feeling that it is a powerful symbolic tool. The face is Cubist (but from a pre Cubist era), the hairs are made of beads from Germany, the end of which have Cowry shells (http://en.wikipedia.org/wiki/Cowry). The body of the lady is made out of blue and white beads and her legs are covered in a leather dress.

One can imagine this magnificent carving being the middle of elaborate dance ceremonies. Congolese love to dance. Perhaps it has a role in fertility rites? If only this lady could sing her song. What she has given me is an appetite to study her history and more general the history of wooden carvings in African. In fact she is the ‘core’ and for now ‘only’ piece of my collection. Given the fact that the Congolese market is around the corner I am bound to start buying more of these lovely pieces. A great thank you goes to my compadre Ecke who is a German bead expert with a collection of several 100.000 beads. As I always joke he can tell you were a bead comes from by smell only.

Given my passion for birds I am going to shop around until I find the right bird mask for the right price. Another thing that I am looking in to is much more practical: seats for my house. There are beautiful carvings waiting to be part of my house. Then as a last area of interest I am looking at artifacts related to medicine. For example I saw a beautiful wooden sculpture of a man representing the small pox. It are questions I would love to ask my students in the course culture and health at Mountains of the Moon.

Enjoy the photo and let me know what you think. Artifacts are still available but are getting harder to come by. It is a good time to start collecting therefore. Always great to learn and embrace art.

Namaskar,

Ashis Brahma

UgandAshis 57: Riots in Kampala II

2009-09-14T09:29:00.000-07:00

UgandAshis 57 Riots in Kampala II

September 13, 2009

Friends around the world have commented about the fact that so little about what has happened over the last couple of days has made it to main stream media. True there were stories on CNN and BBC. So information did trickle down.

When you Google ‘Kampala riots 2009’ of the first 30 entries only ten are from traditional media (Daily Monitor 3, New Vision 1, Independent 2, BBC 1, RFI 1, France 24 1, Guardian 1. It seems that finding up to date information your best bet is to follow links through Google or on Twitter (#Kampala, #uganda) or bloggers and blog sites.

Google ‘Kampala riots 2009’ news and you get 246 results, ‘Serena Williams US Open 2009’ news 7356. Yes tennis popular and yes having a tennis player shout at a lines woman brings back memories of John McEnroe but really is it that more important?
http://www.techmasai.com/2009/09/11/what-the-african-cyberspace-is-doing-to-monitor-the-riots-in-kampala-uganda/ gives all kinds of information about what has happened in Uganda over the last few days. It seems internet is the place to be to get citizens reports, pundit opinions, gossip, facts, back ground history, academic information, factoids and all other forms of information.

Then again relatively few people in Uganda have access to Internet therefore blocking a radio channel (the prime form of information transfer in Uganda) or filtering Ugandan television channels is extremely effective in giving a ‘rosy’ picture of the events of the last days.

One journalist had been arrested immediately after he blasted the government in a live talk show on a big television station. Arguably one has to consider the incitement that a radio/television station can create (remembering that the conflict will be solved rapidly and that loss of life and goods will stop. It takes only a few bad men to spoil all people in one area. Cohesion intra and inter tribes need to be addressed and media should be given a free AND fair platform remembering the role of the flaming hatred that Radio Mille Collines incited in Rwanda during the Genocide in 1994.

Through my Facebook, Twitter and g-mail account get tens of requests if all is ok and that people are praying for Uganda, my family and myself. That I am fortunate with that is crystal clear.

Images speak more than a thousand words. I can write for you that we saw the police station in Ntete burnt down to the ground. Up to a certain level of violence can be manifested through descriptive idioma. Yet when one realizes that the Batwa (pygmies) are set to suffer from in-equality nothing is doen . There still will be a up-hill battle awaiting those people that have a migratory (hunter gathers versus agriculturalist versus pastoralists)

Awaiting the results of free and fair elections is the story. As for today I think that the violence has reduced significantly and that more or less due to the heavy military presence in town the riots may well sizzle out.

Let us hope

Namaskar,

Ashis Brahma

UgandAshis 56 Riots in Kampala

2009-09-10T16:55:00.000-07:00

UgandAshis 56 Riots in Kampala

September 10, 2009

Fairly recently I decided to leave war and conflict ridden countries behind and I settled for Uganda. True it had a patchy recent history in the Northern part of Uganda where the Lord Resistance Army had been terrorizing by a child soldier army and a sex slave army. However compared to my last posting near Darfur in Chad it is night and day. So much that as I type this piece my parents are with me in the car. They have been able for the first time in 5 years to visit me in a project where I am working.

Uganda is an amazing place, kind people and in many ways it reminds me of India. Today a darker side has come to the fore front. As I may have written about in the past: Uganda consists out of about 56 tribes so of which historically have a king or a chief. None of the tribes has more than 10% of the total population and the largest tribe is the Buganda. It is in their heart land that Kampala was built next to their capitol called Mengo.

Today the kabaka (king) of the Buganda was set to visit a neighboring district. There had been some minor riots so the trip was disallowed. That sparked violence and riots between supporters of the kabaka and the police. So far 5 people have been killed. Tear gas has been used in several neighborhoods and cheap elements have taken advantage of the situation to go rioting.

Here we stand stranded 5 kilometer outside of Kampala waiting for the police or military to clean up road blocks to proceed to go home. Underlying the riots of today has been a steady increase of irritation between the government of Uganda and the cabinet of Buganda. One of the core issues is the fact that Kampala has been built on Buganda land and the Buganda feel politically marginalized so that they demand an own city state for their kingdom’s capitol.

If we go back in history all kingdoms were abolished under a previous Prime Minister Milton Obete. Under a lot of discussion kingdoms were reintroduced by the current powers that be. It seems that creating strife between tribes is the common way to keep the current regime in power. Here a group called the Bunyala was supported in their opposition of the Buganda.

It is sad to see the endless manipulation of good people. Some here feel that this situation will fizzle out and others have expressed that this may be the final nail in the coffin of the Buganda kabaka ship. On the radio however all club nights are announced it will be business as usual. The riots have been displaced to the poorer suburbs out of city center. And it quite well understood that the military will step up if the rioters do not stop with their road blocks. Awaiting the cat and mouse game.

Namaskar,

Ashis Brahma

UgandAshis 55 Marabou hits electrical wire

2009-09-10T16:35:00.000-07:00

UgandAshis 55

August 28, 2009

Marabou hits electrical wire

Just as I wonder about a title for this piece I see a Marabou stork fly in to an electrical wire. As he dangles up and down for a moment or two his weight is finally too much and he manages to release himself from the wire. Slightly ruffled yet ever elegant he flies on.

This piece will be about what has been in the news the last week:
Slightly ruffled yet ever elegant he flies on.

This piece will be about what has been in the news the last week:
Universities raise their tuition fees by 40% after not having done so for over 15 years. Students promise to go on strike

A former Under Secretary of the United Nations Mr. Otunno is back in Uganda after 20 plus years to see if he can run against the incumbent president Mr.Museveni.
Droughts in the North and East lead to many cases of adult and child malnutrition. The minister for emergency and disaster does not make a good impression while munching away at a banana and meat claiming those people in Arua and Iteso are lazy.
We reached home and I left the piece as it was
Namaskar,

Ashis Brahma

Ugandashis 54 Lecture 1 - Half Moon Monkey Mountain

2009-09-10T16:03:00.000-07:00

UgandAshis 54

August 28, 2009

Lecture 1 – Half Moon Monkey Mountain

Tuesday evening and I am sitting in the office chatting away with the head of the public health department. Convinced my first lecture is Wednesday evening we are talking about our new students at the long distance learning program. It is quite an enterprise and exiting to be part of. Students in 5 countries (Kenya, Tanzania, Rwanda, Sudan and Burundi) I stroll to the board and to my amusement I see that the lecture times have changed. Instead of Thursday I am lecturing on Tuesday. In fact the third year has just missed 3 hours of lectures.

So Wednesday the students had a new chance. The topic was vaccination and the course is called ‘Control of Communicable Diseases II’. The first hour I am sure I must have flustered some of the students as I was talking of the opportunities of web 2.0 , pod-casts, vod-casts, digital epidemiological mapping of outbreaks, open source texts, pub med, power point and e-mails. Only 2 out of 6 that had showed up had an e-mail address. It is time to change that fact. The lecture we were in had about 15 computers and the next door computer lab has 50 computers available and a reasonably fast internet connection. Then again the lecturers share one computer from 1997 for the 9 public health lecturers as supplied by the university. It is why all lecturers tend to buy their own laptop.

Back to the class I had a blast talking about the constraints and opportunities of drawing up vaccination program point in case the refugee camp in Oure Cassoni Chad. We also discussed the failure of the eradication program for poliomyelitis in Nigeria. The third hour I had the students group and think of the different step to design and implement a vaccination program in a population of refugees. Their contributions were highly sensible and the exercise was fun and educational. As a group they are birds of all kinds of plumage. There are clinical officers, high school leavers, district medical evaluators and a teacher. First class had a turn-out of 50%. Their year (the second year) is 12 people.

With my parents and my house mate Liz we visited the new compound near Saca lake. It is stunning and it shall be a pleasure to be lecturing there from next year. In fact the compound shall be opened with the graduation ceremony of last year’s students. The total number of students should have been around 700 last year and this first year’s enrollment seems to be around 650. These numbers need to be confirmed but the university has a big impact in Fort Portal and the surrounding areas. For many students travelling to Kampala or Mbarara would simply not be affordable and here is a brand new university with a hortus in their backyard. What more could a student wish for?
Perhaps a sighting of a monkey on the mountain.

Namaskar,

Ashis Brahma

UgandAshis 53 A young patient with typhoid fever

2009-09-02T05:22:00.000-07:00

UgandAshis 53

August 28, 2009

A young patient with typhoid fever.

Textbooks describe the progress of untreated disease. My young friend has been in the hospital for over 5 weeks now. Typhoid fever is a manifestation of Salmonella typhi. In the lymphatic nodes of the gut they multiply and can cause ulcers. These ulcers can perforate and that is what happened to my young friend. For about a week he stayed home without visiting a health worker when he finally came he had what we call a peritonitis. Stool and pus were floating in his abdominal cavity. Rapid surgery was performed and he seemed to improve until seeping through the abdominal we saw feces coming again. It was back to theater for our young man and again he did remarkably well. A necrotic part of his gut was taken out and the gut was repaired. This was a week ago.

Since a week he seemed to be improving very slowly until 3 days ago again the incision wound of the abdomen was leaking feces. This means there is another perforation. The surgeons in the hospital have 2 days they operate although for an emergency there will always be a place – so we thought - .

Over the last weeks we have been blessed with 4 new interns doing surgical rotation and 6 fifth year surgical students. One would say enough hands in the house to do all surgery. What you also need for a surgery are operation theater nurses and an anesthesiologist. So the last 3 days we have had surgeons checking in on our patient and pediatricians treating the sepsis and dehydration but we had no anesthesiologist available to do the narcosis.

It is a long time I have worked in Africa and I am sure that in certain ways my way of working has become pragmatic. There are moments that I do get itchy. Tracing the anesthesiologist and the senior surgeon (a complex surgery awaits) was not an easy job and I was not the first trying to do it. Yet somehow I have done my best. All are aware of the patient. Now to pray he is operated today and is not asked to wait till after the weekend. And then that the operation is a success.

Every morning when we do the round he smiles at us and asks us how we are doing. For the amount of pain he is in he hardly complains and his family takes care of him around the clock. At one point 5 of his relatives were admitted in the hospital. He however is the only one remaining. The others are home and healthy.

I have discussed this delay with many doctors and sincerely feel it is not a lack of will or interest. The bottom line is that the anesthesiologist (senior) works for obstetrics and surgery at the same time and he cannot split himself into two people. Patience for the patient is required.

Namaskar,

Ashis Brahma

Post Scriptum our young friend died yesterday of a sepsis.

UgandAshis 51 Coming and going

2009-08-23T13:04:00.000-07:00

UgandAshis 51

August 22, 2009

Coming and going

Over the last weeks and months a steady flow of visitors is coming and going. Dr Nard was one of the first to come and after 5 weeks his girlfriend Lonneke joined us for another three weeks. To shake Nard out of the Western cocoon on his first night I took him to some of the more rough bars in town. It was a memorable night where a culture shock could clearly be felt. After some days we travelled to Fort Portal to see the different institutions I worked at. With his every friendliness and remarkable easy going colleague students and patients warmed up to him rapidly. Even if looking back perhaps the so yearned for clinical hands on experience was not as much as hoped for working in such a different environment with lack of resources (simple dentistry tools and basic medication), a different level of theoretical knowledge and practice made a huge impact.

As I hoped for the Ugandan experience led to promises of future visits –with or without the Smile Train an NGO that send teams out to operate and educate how to operate on children with a cleft palate. This is one of the big motivators for him to start training in surgery of everything between the eyebrows and the clavicles to quote him. Besides the medical side of the story we had a blast. From ‘War craft’ to ‘Marabou Squatting Team’ to ‘Spotted Francolin’ to ‘Gorillas’ to ‘BBQ and wine’ to ‘LINK buses’ I am blessed to have had him here for 8 weeks.

The last three weeks of the journey Lonneke joined us and they had an amazing trip around the country with safaris in ‘Queen Elizabeth’, ‘Bwindi’, Murchison’s Fall and a rafting adventure on the Nile near Jinja. Beginner’s luck or not they saw: chameleons, lions, leopards, giraffe, elephants, long crested eagles, spotted francolins, the crown crane, alligators, hippos, rhinos, kobs, water buffalo, green mamba, green velvet monkey, baboons yet Nard missed out on the yellow warbler. Lakes, savannah, mountains, volcano, rivers Uganda has it all.

Yet beyond all the countries beauty what really matters here are the great people. The flaming chicken of the Persian Boyz had become their second home in Kampala. When they left a host of people queued up and one after the other they had beautiful gifts for the new friends. A sheesha was an amazing gift and given the pleasure with which they both smoke sheesha it must get a central place in their new home in Utrecht.

Luckily we will meet again in one month when I visit the Netherlands. Some things Nard and Lonneke have in Uganda; new friends, a medical library, the chicken/sheesha joint of the planet, opportunity to do well, to learn and enjoy.

At one moment when everything that was arranged seemed to be a hoax – some friends stepped up and I am sure the trip was one not to forget.

Namaskar,

Ashis Brahma

UgandAshis 50 Fort Portal jazz

2009-08-16T03:27:00.000-07:00

UgandAshis 50

August 14, 2009

Fort Portal jazz

Over the last weeks I have been talking more and more with professor Ecke about the public health school. For its 4 years a lot has been achieved and a lot more needs to be done. There is a team of about 9 lecturers who all have another full time job to assure proper income. Institutional memory is in the mind of the staff and is not available on paper. As I write this we are one week away from starting a long distance course yet a lot of the teaching material is not yet ready.

Coming in as a foreigner and imposing your way of working without considering the local customs and culture obviously will not work and at the same time some of the western mindset is required to assure a proper learning environment for the students. I shall give an example; to streamline the lectures and modules it is of utmost importance all the lecturers come together to discuss their individual preparation of the topics, avoiding repetition and assuring gaps are minimal. Aiming for common methodology and use of materials yet calling a meeting where all show up is near impossible given the prior responsibilities of other jobs.

It is easy to criticize yet to remain constructive is much more difficult. I did not come to Uganda assuming I know everything better. As much as I learn on a day to day basis there are things I can contribute at the same time. And how do you contribute to a teaching module when you receive the goals and objectives of the module after asking for them for 4 weeks? One can say that things arrange themselves in Africa yet for the quality of preparation of lectures it is of the utmost importance that there is clarity in what is required.

What I am doing is what I love doing – teaching and the topics are near to my heart; culture and health and control of communicable diseases in the first semester. With the help of professor Ecke and the local doctors and lecturers I am sure I will have a blast while lecturing.

The house I am staying in right now in Fort Portal is the base for 4 muzungus helping the university to move forward. It is never to be underestimated how much the university as a whole and the public health department in specific has achieved. It is at the same time a state of mind to wish the courses get better and more elaborated. Eventually the university is aiming for different health science related courses as well as well as a master’s level course.

To achieve all those reachable goals there has to be a strengthening of the way we work. A do-able job and one that at the same time is a process that will need to take place over the next days, weeks, months and year to come.

Namaskar,

Ashis Brahma

UgandAshis 49 Fort Portal blues

2009-08-16T03:11:00.001-07:00

UgandAshis 49

August 14, 2009

Fort Portal blues

Zuco 103 is playing in the background and I am reflecting on the day. It started with a ward round on the pediatric ward. One of my patients is a 7 year old girl with chronic osteomyelitis (bone infection) of the right leg. Often we have to ask patients to go to the pharmacy to buy drugs. I never realized that we have run out of canulas (to give i.v. drugs with). Therefore the patient’s family members have to go and buy it. The mother of the child was crying – and as I asked why she told me that she did not have the required 1000 shilling ($0.5) to buy the canula. Clearly I slipped the nurse a banknote so the young child could start her intravenous antibiotic treatment. The girl however has a poor prognosis as the treatment is at least 4 weeks in the hospital and the mother has to hustle for food for the two of them.

Another child has a similar problem. He is crying and shouting while complaining of severe abdominal pain. To rule out some of the possible causes we asked for some lab work to be done. As I returned the next day I realized that the sickle cell test had not been done. To do this test you require a certain chemical which is cheap yet is not available at the hospital. The discussion I had with one of the laboratory technicians was frustrating. He was narrating a story of chronic under supply of many chemicals and supplies. When I then asked him if I could do a blood film myself he became very defensive. It was not really possible unless I would come the next afternoon. In the mean time the patient is not responding to all the different drugs we are giving.

Still in the ward we have an 8 year old girl who had meningitis and is currently suffering from the neurological deficits that have remained after the infection. She has a lack of appetite, cannot swallow properly and is too weak to sit up. Another baby was admitted with failure to thrive, oral thrush and a chest infection. The baby is 1.5 months old and her mother is HIV positive. It is likely the young baby has HIV as well. A large proportion of our patients has malaria with vomiting, convulsions and anemia.

One of the most remarkable things about the pediatric ward is to see how fast children can rebound from potentially lethal disease. With over 100 admissions per week there are 1-3 deaths per week which is a very low number given the late presentation and the severity of the majority of the patients. Every day I visit the ward I learn and aim to teach as much as I can the clinical officers, nurses and young doctors that join me on the ward round. As my colleague is out to a training the work is mine to do and I Love it.

Namaskar,
Ashis Brahma

UgandAshis 48 Online teaching

2009-08-16T02:00:00.000-07:00

UgandAshis 48

August 13, 2009

Online teaching

E-learning or long distance learning is high up on the agenda of Mountains of the Moon University. It is to expand the number of students and to respond to a group of students who cannot come to Fort Portal for all the lectures yet wish to do training in Public Health. It was a good day today as I flipped through a DVD to find that the Oxford book of Public Health was available on it. Preparing lectures has become easier. There were also several other books available to prepare lectures with.
Then during dinner all of a sudden an idea came to find. As the online students are not in classes why not record the lectures of all the lecturers and deliver them either by CD or by pod cast format. In this way all lectures of the public health courses can be made an available at any given time and students can revisit a class as well. In an ideal world power point presentations should be added to the curriculum but it seems that many of the lecturers have difficulties creating them.
It will be about 2 weeks more before classes start and I am starting to find more and more material to start classes with. It also helps that I am staying in a house right now with several of the lecturers of different courses of the University. Remember that a proper access to Internet is lacking and that the library for the medical faculty is very limited. Students here are asked to rote learn, are read to from a text book and questions are seldom asked. I heard today we have at least 50 candidates in the first year. It is another 12 days before the first years start and the second and third years will be starting in 5 days.

Professor Ekke and I are hoping to start with several lectures we will do together. I am much looking forward to it. The lectures will be recorded and posted online so eventually all that are interested can see what is happening at MoM University. We also discussed the role that medical students from the USA and Europe could play in the development of the University over the next years. At first we may aim at several knowledge, attitude, practice and behavior studies of the indigenous tribes as to know which direction our future research should take.

In the mornings I go to the hospital to do some rounds and in the afternoon I return to prepare my lectures. The dogs and my lovely house are a good reason to return to Kampala and first I will have Lonneke and Nard come and visit me in Fort Portal. Right now they are enjoying the mighty park of Queen Elizabeth. What a pleasure it was just to drive through the park. And as my parents will be visiting from August 23 I hope to get in another visit to a nature camp.

Namaskar,

Ashis Brahma

UgandAshis 47 Golden monkeys

2009-08-16T01:49:00.001-07:00

UgandAshis 47

August 13, 2009

Golden monkeys

The king of the monkeys meets his match. After a two hour climb up the mountains though bamboo forest we find a troop of golden monkeys. Their skin radiates in the sun and as they chew on the leaves we get to look at this habituated group. After about half an hour I end up watching one eye to eye from a distance of about 2 meters. I see in the eyes of this adorable creature peace. He is munching away at his leaves assuring the youngsters in the troop are safe and that the tourists get a good opportunity to take photos a plenty.

The park is one of the smaller wild parks in Uganda and lies on the border with Congo and Rwanda. Three volcanoes are home to wide range of mammals, birds and reptiles. Nard and I have declared to be big fans of chameleons so everywhere we go we look for this well hidden reptile. He climbs trees to find the colorful reptile as I lie in the grass to check out the bushes from my hide out.

Being half monkeys ourselves we managed to yet one of our fellow visitors irate. He was focusing on making photos of the monkeys and did not appreciate our jokes driving the monkeys away according to him. Our theory however is that his bad vibes made the golden monkey disappear all the time. Yet he did make some good photos and we pray we will receive them by e-mail. Great new world.

To help us find the monkeys a morning crew of park guards has gone up to track the monkeys so the tourist can find them easily. Some of the camp guards know a lot on flora and fauna in the park. As far as I can see on the map Uganda has 11 nature parks and having seen three I am sure I want to see the other 8 as well. Each nature park has been so different so far and it gives a longing to see more.

One of the sad things about the nature park is that the original inhabitants of the park, the Batwa (pygmies) have been booted out of their cave home in 1990. As compensation they received homes and lands outside of the park. Yet not being used to houses led them to sell for a very low price to the local population. As it is today several of the families live a homeless existence. Unfortunately the same thing has happened in Bwindi Park. Not for everybody the setting up of a nature park has been a big success. Yet it seems to fall in a tradition in the world where the hunter gather lifestyle is having a hard time to remain on this planet.

One day we will look back and see we have preserved certain groups of monkeys and that the humans that used to live in those areas have disappeared.

Namaskar,

Ashis Brahma

UgandAshis 46 A long journey

2009-08-15T18:18:00.000-07:00

UgandAshis 46

August 9, 2009

A long journey

A nine hour drive from Kampala through Mbarara, Kisooro led us to the Rwandan-Congolese-Ugandan border. The park is known for a group of mountain gorillas and several groups of the Golden Monkeys. Once again this country surprises with a variety of natural beauty. Towards the end of the end of the journey we have seen the African eagle, long horn cattle in Muyankole land, impala and the yellow warbler.

The stretch of highway from Kampala to Mbarara is the most deadly road in Uganda. Potholes pop up every 100 meters and the driving of the average driver can be called reckless. Our driver Gad is a well experienced one and luckily so as we are pushed off the road on one or two occasions. The further we drive to the South West the more breath taking our view becomes. The road’s tarmac has disappeared and the last 60 kilometer takes us a long time as the road winds its way up and down through the mountains. We can see volcanoes, rain forest and soaring eagles in the air.

On the road I am reading Dian Fossey’s book: ‘Gorilla’s in the mist’. Most people have heard of the movie with Sigourney Weaver in the lead role. The story is about the region. Although she worked in Congo originally with the war lord’s and the increase of violence she eventually had to flee to Uganda. Her work had to be restarted in Rwanda where she encountered a lot of activity of poachers. Today one of the major sources of income for the three countries in this region is gorilla tourism. There are less than 500 mountain gorillas to be found in the world and all in this region and the neighboring Bwindi national park.

Dian Fossey’s object of study, the gorilla’s eventually where poached and killed. To satisfy the need of certain zoos around the world gorilla babies were captured. Gorillas however protect their youngsters to death so capturing one baby gorilla can easily lead to the death of 10 adult gorillas. It is horrifying but true. Dian Fossey’s live also ended in drama – it is not clear who killed her – but she was killed after having studied her gorilla groups for over 15 years.

Back to the journey I can only say one thing about Uganda – what a magnificent country. From savannah to rainforest to mountain range to hill land, lakes to river land. All is available here. It is not for nothing that one of the highest densities of plants and animals in the world are found in this country. Draped across the equator ancient forest is the home of the varied flora and fauna.

If you have the chance; come and visit this country. As far as the safari goes I have a feeling it is better than Kenya. And if you love birds you cannot miss out. Chameleon lovers – fly in straight away – chameleons are a plenty.

Namaskar,
Ashis Brahma

UgandAshis 45 Three birds

2009-08-15T18:05:00.000-07:00

UgandAshis 45

August 6, 2009

Three birds

As I came home yesterday three brown ibises were perched on my roof. I stopped and admired these flying creatures. No bird can top the marabou and yet this one gives it a run for its money. Their conversation felt like the muppet show’s old grumpy men. Haa haa haa aaa – aaa haa haa haa. In Uganda it is whispered that these majestic birds can put children to sleep with their loud yet remarkable sounds.
While observing it was as if one of the birds wanted to fly off while the other two wished to remain longer. Finally after a long discussion – 15 minutes – with decreasing daylight they flew off to their nesting place.

My home in Kansanga also has a kite swooping near the balcony and then a bit further off are the marabous. The birds are in my mind as Bob Marley just sang his ‘Three little birds’ on the computer. Often I have patience for slow Internet connection – these last days however – I have lost it.

Trying to send an e-mail to interested people about my forthcoming tour has been a near impossibility. Let us forget downloading power point presentation or articles on the two topics I will be teaching classes on starting August 17th. Culture and health is class 1 and class 2 is control of communicable diseases. Over the last weeks I have been plodding along to make sure I have some information on a power point format so the long distance students can also learn along.

It seems so easy – Internet is a world-wide phenomena yet proper broad band does not really exist in Uganda. Yesterday’s newspaper did not make matters better. As parliament reviewed the budgets they were astonished to see that the cost of extending the cable that runs under the ocean is three times as high as in Rwanda despite the equivalence in distance to Mombasa. The following was decided as long as the costs are not clarified the budget will not be cleared. This leads to a delay in Internet connectivity.

The digital divide is clear and evident. One of the current things PGHF and its volunteers are doing currently is making video interviews with people who are making a difference in Uganda. There is a website on hold in the USA because uploading information is such a hard pain in the neck.

Complaining does not add to suffering – it can however explain to people why simple things on the World Wide Web are just not simple.

On a high note this time tomorrow we are off to Kisooro and eventually Rwanda to see gorilla’s. It feels like a good time to take a break. A lot of good things have happened over the last months and it is time to appreciate the beautiful nature and landscapes of Uganda. Now things are settling I can plan more trips around this phenomenal country. Beware I may be able to upload some nice photos.

Namaskar,
Ashis Brahma

UgandAshis 44 Bruno and Yogi

2009-08-03T09:07:00.000-07:00

UgandAshis 44

August 2, 2009

Kampala, Uganda

Bruno and Yogi

The two mixed Belgian-German shepherds are growing like crazy. Even Bruno is turning into a chubby potato. Of the two Bruno is the one that is more active and who loves to bite all day while Yogi is mellower and also much bigger than his brother. Thanks to the hard work of Nard and Ismail they now have a doghouse to call home. It is labeled as the Yogi house with lotus flowers and on the back of the house is a label of secret society called the Marabou Squatting Team and an L.Y.S.I.A.S. emblem.

The two of them play all through the garden and it is a joy to observe the canines. After about 2 months Amir will come back to Uganda and Yogi will have to get used to being the only canine in the house. As always Nard and I are very busy to find him a Marabou friend. We have offered up to 60.000 shilling and have sent several squads of MST members out to collect the golden Marabou egg. Yet so far we can use some help in our quests.

As to the other animals in and around our compound there are the ever present kites; yesterday one swooped down and caught a rat. After due consultation we were assured that our dogs are too big to catch. Then there are the ever present frogs which have Nard enthralled. To date I cannot understand why and I know that Nard does a victory dance after seeing them. Anecdotal historical evidence shows that there are snakes in the garden, small and to make it dramatically poisonous.

Bruno and Yogi in the mean time rule supreme, adored by all, peeing everywhere, nosing around. Yes these two remarkable fellows are indeed brilliant. They give the house a feeling of a home.

Talking about homes given the fact that I spent about 4 days a week in Fort Portal nowadays I am bound to find myself a nice place there. As it is there are some accommodations for guest lecturers and I shall sign up for them the next time I come. It seems the Internet is ok there so I will give it a shot. Another advantage is that there are great people living there as Prof. Ecke. He invited me to a 2 day walk to the area of the Bakonzo, a tribe of small sturdy people living near the Ruwenzori Mountains. It is a beautiful area and there may be a lot of traditional healing taking place there.

The Bakonzo are also isolated from mainstream Uganda so it will be great to get to know some of the people working there. I was told that at one time in history the hospital was working very well with expatriate doctors but that currently the hospital is out of drugs a lot. If we forge links and connections there we may be able to help.

Namaskar,

Ashis

UgandAshis 42 Newspaper Clippings

2009-08-03T08:54:00.000-07:00

UgandAshis 42

August 2, 2009

Kampala, Uganda

Newspaper clippings

Man steals bag from muzungu (white person) and gets 5 years prison versus police high ranking officer steals 175 million shilling ($80.000) from the pension funds of his staff getting 4 years. Talk about class injustice. In the first case the judge reasoned that the thief may bring a bad name to Uganda abroad and therefore must be punished severely. The police officer well...it is as it is.

There is an ongoing discussion in the newspaper about the benefit of the 1.5 bonus scheme on application for females introduced in 1990 at Makerere University for public sponsorship to assure higher percentage of enrollment. From 1990 to today the percentage has shot up from 25 to 49%. However girls still lag in mathematics and science, yet dominate arts courses. (If I recall correctly 80% of the first year law students are females). Critics talk about the discrimination against boys. Positive discrimination or affirmative action has always been scrutinized. Yet on the basic level when a family has 4 girls and 3 boys (Ugandans fertility rate lies at 6.9) and cash is lacking it will be the boys sent to school and the girls kept home. Girls have many more hurdles to jump from primary education onwards to even have a fair chance at education.

The issue of Bunyoro is getting front page coverage. The issue is about the oil rich region which for decades has had influx (migration) of many tribes so much that the original inhabitants (Bunyoro) are now a minority. President Museveni after long deliberation has now come with a report recommending all leadership position in the region to be secured for Bunyoro tribe members. Uganda has 64 recognized tribes (3rd schedule of the Constitution February 1, 1926) and the country is slowly being divided in more and more districts (from less than 20 in 1986 to over 100 today). Inter tribal tension in certain districts is on the rise, especially in resource rich or resource poor areas. The report has inflamed the migrants to Bunyoro as they claim it is their constitutional right to be represented as Ugandans where they live by their own candidates.

Elections for 2011: the scene is heating up as the opposition seems to be uniting with as one of their main attempts to propose one presidential candidate for all parties. Also they want to highlight the failed promises of the NRM (National Resistance Movement), the greed and corruption by those in power since 1986.

Kampala lies in the heart of the Buganda kingdom. For years it has function as the seat of both the kingdom as well as Uganda’s parliament. Of late there has been a move to wrest away Kampala from the kabaka (king of Buganda) and make expansions to Kampala City Council. This has lead to tensions between the parliament of the Bugandas and the central government. Currently the Buganda parliament is raising a petition hoping to get 1 million signatures.

Namaskar,

Ashis

UgandAshis 41 Exams

2009-08-03T08:38:00.000-07:00

UgandAshis 41

July 29, 2009

Fort Portal, Uganda

Exams

Trembling hands, stuttering candidates, patients that escape and marabou’s that disturb the silence. It has been a hectic three days. One hundred and forty candidates in our department have been reviewed. Twenty minutes for a long case (one patient: history taking, physical examination, laboratory and treatment) and fifteen minutes for a short case (any question goes)

The great thing about taking exams of a long list of clinical officers (about 70 so far) is that you get to review the entire history taking process, physical examination and differential diagnostic thinking yourself. Some candidates are confused or nervous and some shine. After a long day of exams questions as: “What is the seat of the soul?” rise. These questions are to the general bewilderment of the candidates.

There is a very serious side to the exams as well. Unlike medical students who after qualifying after 5 years of study need to be supervised for at least a year the clinical officers will be in charge of a health center without close supervision. That means that the first criteria to judge are: “Is the candidate a risk to the population at general? “ Then we look at the relative strength of the candidate as compared to the others, a mediocre, good or excellent candidate. After that the two doctors discuss what their score of the candidate is.

Some of the students have spent their three years reading their books and rarely came down to the wards. It shows during the exams. Others are so good they present the cases with confidence without reading their clerked notes and that is a pleasure to experience.

Once again reviewing over 50 patients it becomes clear that HIV/AIDS and malaria are major issues in Fort Portal. Despite a government program supported by the international community patients are still without their antiretroviral drugs and essential anti-malarial drugs are often missing.

Our students were examined in a pediatrics, surgery, obstetrics, medicine and public health. This is a healthy and extensive mix of the different disciplines of mother medicine. Friday their exams are over and I know there will be some heavy partying. As soon as their results are out those that have passed their final exams are off to their respective new posts all over the country. This is a good reason for me to visit them wherever they are and to see more of this beautiful country. I think that at least 130 out of 140 will pass their practical exams. Congratulations to all of them. Tomorrow morning 8 exams remain.A piece of cake and at last rest for our patients, some of them have been clerked by over 6 students. It was also the reason some of our patients ran away from the hospital.

Namaskar,

Ashis

UgandAshis 39 Medical Apartheid

2009-08-03T08:25:00.000-07:00

UgandAshis 39

July 27, 2009

Fort Portal, Uganda

Medical Apartheid.

In the LINK to Fort Portal today I read 200 pages of Harriet A. Washington’s book Medical Apartheid: The dark history of medical experimentation on black Americans from colonial times to the present. (ISBN 978-0-7679-1547-2 and www.medicalapartheid.com) It is a lively book and after coming off the bus (reading with my headlamp as the bus had left 2 hours late) I was affected by its wealth of information and calm description of a long history of mistreatment of groups of people. In a way it reminds me of the book ‘Mismeasure of man’ by Stephen Jay Gould. It is sad to see how the powerful position that medical professionals have can be used against entire population groups.

Here are some topics the book addresses:
1. Imaginary black diseases as drapetomania (insane tendency to fleeing slavery), hebetude (laziness leading to mishandling the owners property), dysthesia Aethiopica (desire to destroy slave owners property), struma Africana (so called African TB), cachexia Africana (eating clay, earth, dust)

2. Polygenism or the belief in separately evolved species

3. Dr James Marion Sims who experimented on seventeen female slaves with genito-vesicular fistula without anesthesia despite it being available in the 1830’s to the 1840’s

4. The circus Africanus (showing a pygmy in the Bronx Zoo together with a gorilla and a orangutan and the St. Louis world exhibition as late as 1906 and 1910)

5. The institutional grave robbing and body snatching for decades for the medical schools (1770-1973)

6. The Tuskagee Study where between 1932 and 1972 at least 399 were told they would be treated for syphilis but in fact where given no treatment to follow up their progress of disease

7. Mississippi appendectomy, an unnecessary surgical procedure leading to uterus amputation (and defacto sterilization) on healthy black and/or mentally challenged women. This was done on thousands of women in the USA until the seventies.

8. Injection of plutonium-239 to unknowing patients to test the most dangerous chemical we know. Done from 1945-1994 by the U.S. Atomic Energy Commission.

It makes me think about how medicine can be used to keep a certain power construct in place. Keep the people barefoot, knocked up and ill. It is a way to control people. Sad thing is that as we speak today vulnerable groups are being used for large scale experiments, testing new drugs in Africa and Asia (remember the Constant Gardener). I cannot wait to complete this book and just wanted to share a tip of the iceberg of problems this book addresses.

Namaskar,

Ashis

UgandAshis 38 Mad Professor

2009-07-25T05:17:00.000-07:00

UgandAshis 38

July 23, 2009

Fort Portal, Uganda

Mad professor.

Yesterday I met Professor Ecke. A German pediatrician and public health specialist with 100’s of years of experience in Africa. He has worked in at least 30 countries and is currently attached to the Mountains of the Moon University. As we were swopping stories I was informed that hunger makes the devil eat flies and if you are in Congo rats and cockroaches become delicacies. The fat of the cockroaches is highly nutritious and is called embryonic fat. He hops around Africa and Germany. Nowadays he spends 4 months in Africa a year.

His latest affiliation is with the Mountains of the Moon University. And yesterday we started off by chatting in the Tooro golfclub. It is the oldest golf course in Eastern Africa and a beautiful one. We talked about African art that he collects, the methodologies of teaching and the acceptance of the difference in reasoning in the Western and African mind. Proper cross culture reasoning and his way of making it all work: no more questioning, blanking the mind and accepting what is.

When you work in Africa as a European it is very likely goal will want to change everything, make things more efficient, smooth and polish things up. You can wonder however if what you achieve is sustainable as mentalities differ; saying yay and acting nay is a piece of cake. As you leave the scenario what you perceived to be a permanent change is often temporary. Then you start questioning everything and seeking for the answers. A new stage of confrontation following this can be a letting go. To paraphrase the professor: “It will give your wings wind and make you fly.”

Back to the school he is infectiously positive and has asked me to prepare for 5 lectures with him. He prefers paper and pen, hands and feet instead of power points and it can work. What should be fun is the dual presentation one coming from the clinical angel and one from the public health angel. His biggest strength is grant fishing. He is labeled the grant shark in Germany. He was a professor by 32 has a multitude of degrees and in the end is a very humble, wise and funny gentleman. It should be great to learn from him.

Today we put him in front of a camera and we talked about art, medicine following our common passion the river Nile. He is like an encyclopedia of Africa. We talked and talked about malnutrition, schistosomiasis, tuberculosis. Onchocerciasis, rural Africa and how to remain positive in a setting often seen as so dark and violent. To end with another quote: “When you come to Africa you love it or leave it!” He came at age 16 with a car through the Sahara and has never left it.

Namaskar,

Ashis

UgandAshis 37 Yogi's BBQ

2009-07-25T04:58:00.000-07:00

UgandAshis 37 Yogi’s BBQ

July 20, 2009

Kampala, Uganda

Friends, food and music make a magnificent evening. Saturday night Nard and I decided to throw a party. The house and garden make it a great place to have one. And the main reason was to reveal the name of my furry ball of hair. An occasion as such merits a hosts of guests so we settled for a barbeque for about 25 people. It ended being a mix of Persians, Dutch, Indian, Ugandan and French people living in Uganda. The plan was simple emulate ‘la grande bouffe’.

Local fruit and vegetable vendors, the bakery and butcher were all emptied of stock. There was beef, lamb minced meat, boerewors, chicken, tilapia, a pasta salad, potato salad, fruit salad, sheesha and more. To assure large quantities of meat could be prepared at the last moment I had to rush out to acquire a Ugandan style mega barbeque.

From 18.00 Joy, Nard and I were in the kitchen marinating the meat and fish, preparing the salads, organizing the tables. Guests started arriving around 20.30 with DJ Nard manning the turntable, chef cook Ashis on the BBQ and Joy assuring all food preparation churning meat by the kilo. To be on the sure side tons of food was prepared and we will be eating a while from the remains.

Around 23.00 I picked up the guest of honor to introduce Yogi to the crowd. It must have been an impressive event for the 26 day old puppy. The charmer was passed around like a hot dog and received an overdose of hugs and kisses. At around 00.00 I took a shower and put on my black suit. On the way out I kidnapped the dance hungry people for a night of wild dancing. Dom bolo, afro beat and Michael ran smoothly. I had never really barbequed but food is food. Given the help of my friends I enjoyed Jackson tributes were on the menu. I hear that the party in the house lasted till about 05.00.

It was great to see how doctors, film makers, accountants, travel agents and restaurant owners mingled. As the party was impromptu we did forget to invite some friends and there will always be a next time. Specially now there is a barbeque in the house the house feels more and more like a home.

As contacts were exchanged people like doctor Dickson met Debra and Joy who will be filming his work in Mubende soon hooked up. I missed my friend Joseph dearly he was in Hoima for work. This is another reason to give a barbeque soon. Today we spend recuperating, some had a hang-over and the party was great. For Monday and Tuesday planned a visit to the Red Cross Uganda Youth Section is planned and then off to Fort Portal to continue with the clinical work and the teaching. Staying in Kampala is also required to download teaching materials from the Internet. Well keep the fingers crossed even now it is very slow.

Namaskar,

Ashis

Ugandashis 36 Half Moon Monkey Mountain University

2009-07-19T08:29:00.002-07:00

UgandAshis 36 Half Moon Monkey Mountain University

July 17, 2009

Fort Portal, Uganda

Yesterday was a good day. After missing out on all meetings of the public health team organizing the bachelors of Public Health course for the last month and a half I finally got hold of the team. The bachelor’s course is aimed at high school leavers and medical staff (nurses, midwives and community health workers). Because of that the course is taught in the evening and in the weekends. Also we are setting up a long distance component.

The university is a brand new one about 4 years now and it currently has 600 students enrolled. The public health course had about 25 students last year and there should be an increase this year to about 40 students this year. Students come from the Fort Portal region mainly and there are also Rwandese, Tanzanians, Sudanese and Ugandans enrolled from all over the country.

The course stands out for several reasons. One of which is that instead of the normal Masters course this is a three Bachelors course and the approach is a non doctor dominated one. The philosophy of the school is that Public Health can be practiced by all trained people and not just doctors. In the work and in our study we are trained from a curative perspective, hospital and technology heavy.
At the meeting we were distributing the courses. For the first semester I will be teaching Culture and Health to the second year students and Communicable Disease Control II to the third year students. The second semester I will be teaching Communicable Disease Control I to the first year students and Disaster Management to the third year students. For these courses I have 4 weeks to prepare. I shall be online a lot and sniffling through the library.

Next week I shall check out the library. From what I hear from my fellow teachers there are two main problems: First a lack of human resources and secondly a lack of resources. There is a lot to do and the team that is on the ground has done a lot of good. The first batch came out last year and in September the second batch will qualify. Plans are in progress to have a Masters course and a long distance course.
For this yea r the faculty will be in Fort Portal and next year the plan is to move to the new university complex. It is near a lake with a view of the Mountains of the Moon. It is stunningly beautiful. It has been a good day. A little dance was done. For my colleagues I have nothing but deep respect. Setting up a faculty with a core group of 6 in a city with 46.000 people is pretty awesome. I shall be writing more about it soon. We kick of August 15th. I cannot wait to get started. For those of you with power point presentations feel free to share.

Namaskar,

Ashis

UgandAshis 35 Pediatircs III

2009-07-19T08:21:00.000-07:00

UgandAshis 35 Pediatrics III

July 14, 2009

Fort Portal, Uganda

What happens to a child with HIV/AIDS?

Well in theory all children have access to government service called the Joint Clinical Research Centers. What needs to happen are in a simplified and summarized explanation:

1. Diagnosis needs to be confirmed by a blood test after voluntary counseling and testing for the parents as well as the child. Given mother to child transmission is the most common route to develop HIV/AIDS mother and father need to be counseled. Often the diagnosis of mother and father is made when a child falls ill.

2. Once the diagnosis is made a work up is done using certain blood values (CD 4, total blood count) and/or clinical impression WHO HIV/AIDS criteria by a doctor. The grades range from I-IV depending on which group your symptoms can be classified the child will fall into the inclusion criteria for receiving Highly Active Anti Retroviral Therapy (HAART)

3. Before treatment is started underlying opportunistic infections (e.g. tuberculosis) need to be treated. Due to drug interactions between HAART and anti tubercular drugs (ATB) TB is treated first.

4. Prophylaxis (oral antibiotics, cotrimoxazole) is given to avoid diarrheal disease (Isospora belli, Cryptosporidium) and pneumonia (Pneumocystis carinii)

5. Emphasis is given to proper feeding. A nutritionist explains what are the high energy good quality food sorts to combat the illness.

6. Treatment with HAART is started and monthly the blood values are checked and follow up and treatment of opportunistic infections is done.

7. Common malignancies as Kaposi sarcoma and lymphoma are actively searched for.

8. Common infections as oral thrush (Candidiasis) are treated

9. Psychosocial support is organized for the patient and its relatives. Destigmatization of HIV/AIDS is still needed. Joining groups of People Living with HIV/AIDS (PLWHA) is advised.

10. If and when a good family support system exists a child can live for years on treatment. Reaching child bearing age which then leads to a whole new set of steps to be taken.

11. Many of the children I see are the exception. Too many children die undiagnosed and untreated as the hospital is out of reach of their parents. Remember this referral hospital services 2.5 million people and has a mere 400 beds.

12. Conservative estimates point to 1 million HIV/AIDS infected in Uganda. At least 25% are children. Also there are many HIV/AIDS orphans. HIV/AIDS has been around in Uganda for decades.

Namaskar,

Ashis

UgandAshis 34 Pediatrics II

2009-07-19T08:12:00.000-07:00

UgandAshis 34 Pediatrics II

July 14, 2009

Fort Portal, Uganda

So what do you do after a terrible start of the day as described in the last blog?
You go do the ward round – after all another 80-90 are awaiting you in 40-50 beds and several children of them on the floor and so are their parents eager for advice and treatment for their children. While we discharge about 10 children another 5 are lining up to be admitted. Those that can be sent home on oral drugs are sent so we can admit the sickest patients waiting on benches for a shared bed. One of those children was convulsing, another was one month old and about 1 kilogram. His mother had expired one week after giving birth of HIV/AIDS. His father had bottle fed the child for 3 weeks but it was not doing well.

As stated most of the patients have malaria, diarrhea, HIV/AIDS, pneumonia or a mixture of the previous. White ravens do exist as well and are a good starting point for discussions between the medical students, medical officers, nursing staff and myself. A learning experience for all and often it leads to a better treatment plan for the patients. As the young doctors and Nard ask many poignant questions I learn a lot myself.

One of the white ravens of the day was a child with a bad chest, shortness of breath, reduced air entry on one side. She had been examined by 5 people and all of them had missed one vital point. The heart beat was felt and seen on the right hand side. The medical officer and I noted it at the same time and asked the medical students to check the chest, heart and lungs. As it a very rare condition they also missed the diagnosis. It is called dextrocardia and may be seen in a syndrome called situs inversus which then leads to a multitude of organs in chest and abdomen to be located on the opposite side. She was also an orphan and the parents of the children in the bed next to here were helping her with feeding.

As our X-ray machine has run out of film we cannot take required X-rays to access her lung and heart function. Also an ECG machine is lacking let alone an echocardiogram. Given her social and financial status we will treat her symptoms and do a work up as good as we can. I am sure we can hoodwink her to the OTA clinic to do a chest X-ray.

As we rounded up our ward round I asked the nursing officer what had happened to the 1 month old malnourished baby. The last I saw of it a naso-gastric tube was inserted and an intravenous drip. ‘Oh’ he said the child had passed away. Those deaths are sadly just the tip of the iceberg as most patients do not reach the hospital.

Namaskar,

Ashis

UGANDASHIS 33 PEDIATRICS

2009-07-19T03:01:00.000-07:00

UgandAshis 33 Pediatrics

July 14, 2009

Fort Portal, Uganda

Nard and I strolled from our hotel to the hospital in the morning at around eight. To make sure we would be on time we woke up at seven and I had kitogo (banana with beef in a gravy) while Nard suckled his milky tea. When we arrived at the hospital I called on of my doctors colleagues to find out he was in Kampala. Then I called the nursing assistant he was about an hour drive away in Kasese. The medical officer was not in either nor was the nurse. (Later I found out the nurse was around trying to find the key to access the medical cupboard)

A young girl, daughter of the dental assistant was sitting awaiting medical attention. She had a high grade fever, convulsions, erratic breathing and was slipping into a coma. The most common cause for these symptoms is severe malaria. On investigations of the child it became clear she needed urgent treatment as her heartbeat was slipping to a rate of about 20 a minute and her breathing became more and more labored. Also looking at her conjunctivae an estimation of her hemoglobin (red blood cell count) would be about 1-2 representing a deep anemia.

By now the medical officer, nursing officer and the nurse had showed up. And still no key to the medical cupboard, or emergency medical kit. One hour gone and the child was rapidly getting worse. We sent for diazepam to control the convulsions and tried to get an intravenous line in. Left and right arm, leg to no avail the veins where collapsed. By now there were 4 people working on the child and almost all required drugs and equipments were available.

Alas too late for the young child. It always feels bad to lose a patient and to lose a 6 year old is even worse. Later in the day as we were reflecting on the situation I noted that she was from a relatively privileged position. She was living in Fort Portal with a mother working in the hospital. Less hurdles to clear and yet it was not enough. Cerebral malaria kills rapidly. Of our about 100 children admissions more than half have malaria.

If you happen to stay in the hospital with your mother and sibling one of the most common hospital acquired infection is malaria. Despite most Ugandans having gone through multiple bouts of the disease in life there is still under diagnosis and under treatment. Anti malarial drugs are generally available over the counter and it makes many people use the drugs in non optimal ways. Remember the story I wrote about Grace a couple of blogs ago.

With wide spread use of bed nets, public information, available treatment malaria remains one of the major killers in Africa. And those that die are generally the young like today.

Namaskar,
Ashis

UgandAshis 32 Return to Fort Portal

2009-07-19T02:49:00.000-07:00

UgandAshis 32 Return to Fort Portal

July 13, 2009

Kampala, Uganda

It has been a pleasant weekend in Kampala. We have been scouting the city, visited Lake Victoria, spotted birds, with the good old Maribou as a favorite. As I danced the weekend away, Nard had a small bout of fever. We stayed back an extra day to make sure he is ok. There were two impromptu dinner parties. What is needed in this house is a sound system!

The DVD player is working and it seems I can be playing some computer games on my little laptop soon. Today at around 1500 we will be boarding a bus back to Fort Portal. Nard will be extracting teeth and I will be working at the pediatric and medicine ward. Also there is the ongoing teaching of the medical officers at the ward rounds and the theoretical sessions. Then I hope to be allotted one of the modules in the public health course.

Akiki aka Eveline will be having some guests so we hope to be lodging for 1 or 2 nights at Professor Edward and Phoebe’s house. The view from their house is spectacular and so is the banana cake. Internet connectivity will be mediocre and this time I will cook an Indian meal for some near and dear. There is a well stocked shop called Andrew & brothers and all Indian spices required are available there. Cooking is fun and relaxing.

The maternal and child health clinic should be about to open and if it takes off like the clinical ward OTA (www.outreachtoafrica.org) is bound to take off even more. As to PGHF, under the cover of the NGO we will be shooting short documentaries, pod-casts and vod-casts. And await the outcome of the project proposal rounds. The web site will be up and running soon now Joy has joined us.
Climate wise this place rocks also the people are laid back. Life just strolls by.

Namaskar,

Ashis

UgandAshis 31 The furry ball of hair

2009-07-14T12:39:00.000-07:00

UgandAshis 31 The furry ball of hair

Kampala, Uganda

July 13, 2009

Snuggled in between my chest the keyboard and my bed sheets is a furry ball of hair. Black with brown and a tinge of white, 3 weeks old yawning and cute as cute can be. With a father called Fokker (after the Dutch airplane) of German shepherd descent and a mom of mixed German shepherd and Mechelse shepherd it is a long haired dog.
Mahdad has installed some photo shop like programs on my laptop so I hope, Internet allowing I may be able to send you a photo of my new friend and future house guard. Still without full vision he is currently trying to type some messages on the board. His eyes are still blue. This lovely dog was a gift from my friend Masoud and is one of the sweetest things I have ever received.

There is a saying in the Netherlands ‘Huisje, boompje, beestje’ translated it is ‘House, tree and animal’ . The proverb is about settling. I am sure to travel more in my life and at the same time it is the closest I have come to settling in a long time.

After a brief interlude in which the dog had peed in my bed and drank a whole bottle of milk he is now chewing on the defunct UTL modem. I am sure he wants a proper bed, blanket and some things to chew on tonight. To become a guard dog is the goal and mostly to be a friend.

I am still looking into names; it will likely be something Indian, mythological and pronounceable by Ismael and Emmanuel. Both guys are very happy to take on the care of the dog. Especially when I am in Fort Portal they will take excellent care. Surely the dog will grow. Out of the batch of his brothers and sisters I was told he had something special. Masoud even said he looks like me; hairy and chunky. The dog is always active and on the move, drinking and exploring the world.

For now I am off to get him a basket, in the near future he will be moving into the guard’s house in the day and roam the garden at night. First he can be a puppy. It will be fun training him. Fortunately all the other guys in the house have had many dogs before.

The charmer he is I am sure he will be flooded with affection and endless streams of milk. Once a name sticks in my mind I will post it. My little friend is crying for his bottle.

Namaskar,

Ashis

UgandAshis 30 The seven curses

2009-07-14T12:35:00.000-07:00

UgandAshis 30 The seven curses

Kampala, Uganda

July 10, 2009

My house mate Mahdad and my friend Masoud have opened up their fancy fast food joint. This being Uganda however nothing comes easily.

1. Curse of the name
The brilliant name Chicken King has been taken and is registered, now the name will be Flamin’ Fast Food

2. Curse of construction
That what was supposed to take 3 weeks ended up taking up double the time. Builders disappeared, materials delivered in the wrong size and color. Roofs repainted in a different color. Holes poked in the roof. No wonder the bill more than doubled

3. Curse of rainfall
One night as the clouds over Kampala unleashed their heavy waters the roof partially collapsed

4. Curse of the window
Head butting a glass door can once but here it happened twice. When replacing the measured glass door on return the window fitter came back with a glass window 5 inch shorter than needed

5. Curse of the electricity bill
Opening up the shop with a slight delay on day 2 the power was cut for 24 hours as the other people in the building had not paid their bill

6. Curse of the cooks
Rotation is currently a well tried system in soccer teams, having 2 cooks rotate through in 3 days however is quite a turnover

7. Curse of ailment
Mahdad decided to try out if he could fry his hand in the cooking oil: second degree burn wounds. Masoud on the other hand is trying if he can burn a hole in his stomach.
Despite all the tragic comedy, the hardships, bullshit this place is bound to be a happening place. In my book the best sheesha’s and chicken in town. A deadly killer combination it is. All the best guys and with the third eye firmly installed at the doorpost things can only get better.

Namaskar,

Ashis

UgandAshis 29 Medicine in Fort Portal

2009-07-10T01:43:00.000-07:00

UgandAshis 29 Medicine in Fort Portal

July 7, 2009

Kampala, Uganda

Today I have taken time to write. It was not a lack of inspiration or ideas to write about. I shall try and be more consistent over the next weeks and months. There are so many stories to tell fresh they may come alive even more.

To start off we helped out organize a house that will function as a maternal and child health clinic in Fort Portal for OTA. An operation theater and birthing stools are to be placed, staff has been recruited and the walls of the patient rooms are being painted. Basically all requirements to run a clinic like this are being put into place. For now I am just advising and there may be a moment in the near future I get more officially involved.

As in the first OTA clinic where I am getting involved in patient care and procedures as pleural taps. Imagine one of your pleural cavities holding 2 liters of fluid. Shortness of breath and painful breathing will follow. A differential (simple) to think about is an infection (Tuberculosis or pneumonia), or a malignancy (small cell carcinoma or mesothelioma). We are hoping for an infectious cause because it is treatable. The pleural tap ended up being 1.5 liter and we are awaiting the culture and other lab results.

The hospital work is getting more challenging mostly in a positive sometimes in way to teach patience. As I went to do ward rounds on Saturday I found no nurses in the hospital in the pediatric, female and male medical wards. I waited around for an hour, searched for medical officers in training to have 3 show up instead of 10 (usual number). Then my class was cancelled as there was nobody. The reason for the absence of the clinical officer students was evident – they have their final examination coming up in one week.

A good talk with the principal followed and I shall focus and the students that will become third year’s from next week. Focusing on history, physical examination, differential diagnostic thinking, investigations and treatment plans. The best thing it sharpens my clinical acumen, as for all questions I ask I get questions back and I review my books a lot in Fort Portal. I shall do ward rounds with about 12 students at a time for about 2 hours and give a 2 hour theory session in the afternoon 2 -3 times a week.

As far as the medical work in the hospital itself – my friend doctor Pariyo has asked me to do his pediatric rounds 1-2 times a week, the other days I will do the rounds at the male/female medical ward.

One of the bonuses this week was when I found two 5th year medical students from Gulu University. They are eager to learn and have a deeper level of understanding then my clinical officers. Either way it is good to learn and teach at all levels. Gulu is on my itinerary and I have an opportunity to go next week meeting up with an NGO that wants me to teach a course for village health workers as well as meet up with the medical faculty there.

Finally for this blog: the public health course at Half Moon Monkey Mountain will be starting with at least 30 students in August, there is a flood of applications. Once I get my designated topic I can start preparing my course work for them as well.

Namaskar,

Ashis

UgandAshis 28 Art meets medicine

2009-07-10T01:32:00.000-07:00

UgandAshis 28 Art meets medicine

July 7, 2009

Kampala, Uganda

For a few years I have been experimenting with all kinds of media to communicate health, human and spiritual messages to different audiences. This blog is one of the examples. Then there is a website: www.ashis.org , a host of online presentations on Darfur, news paper interviews, television shows, the CBS 60 minutes ‘ Searching for Jacob’ documentary , radio interviews on PBS/BBC The World. Most of it relating to my experiences on the border of Chad and Darfur in the refugee camp Oure Cassoni. The main goal is by telling of stories, sharing of experiences to give people around the world a view of people on ‘the other side’.

Despite the World Wide Web being a massive source of information I feel that the 800 million or so Africans have a very small voice on the Internet. Also the information coming from Africa tends to be much skewed. Negative stories of wars, violence, dictators, corruption, rape and spectacle seem to be the rule. For every negative story I am sure 100 positive stories can be told. And there is a time and place for these stories as well.

Alone however it is my perspective of in this case story telling on Uganda. So I am happy to tell you that with three Ugandans for now: Debra, Joy and Ronnie we have decided to meet, brainstorm and come up with different ways to use the different forms of media to communicate stories to the world. All have experience with media: Debra is a social activist, working with an orphanage through art exhibitions, film making and events to bring social messages of gender, orphans and HIV to the world. Joy is helping me out getting organized and has done text and video editing besides having a prior career as a world class butterfly stroke swimmer. Ronnie is a creative millipede; music editing, video editing, filming amongst other things are his interests. He has worked for Eveline’s OTA (Outreach to Africa) as well. Check out their videos online (web-address to be added ASAP).

You can feel blessed in life to meet an inspirational person and they are willing to work with you. How about you meet 3 and they will form the nucleus of what hopefully will be and uplifting loose media confederation of movers and shakers that wish to communicate honestly about the beauty that is Africa.

Tonight we have our second meeting and I am sure we shall be churning out internet videos on you tube, seismic as well as documentaries on Ugandan television, interviews for Ugandan and Internet radio soon.

I cannot wait to be involved and have articulate, authentic, inspirational Ugandans speak about their projects be it art or medicine. Let us bridge this so called Internet divide.

Namaskar,

Ashis

UgandAshis 27 Time flies

2009-07-10T01:23:00.000-07:00

UgandAshis 27 Time flies

July 7, 2009

Kampala, Uganda

Wow two weeks and no writing.

Too long

Let us start saying that since about a week a friend, fellow fraternity brother and future surgeon Dr Nard from the Netherlands has joined me. He is in his first year of his specialization in facial surgery and this is his first visit (and time to work) in Africa. Some of the good and bad of Uganda has happened to him over the last few days.

First I would like to congratulate him and his girlfriend for buying a house in Utrecht as per yesterday. Lonneke will come and tour here in about four and a half week. I am looking forward to meet her after 10 years.

As I see Nard immerse in Uganda culture I feel protective, as if you want to give a younger brother the best there is to be seen knowing that not all is beautiful or easy to understand. Besides crossing roads he is doing great. Being of surgical inclination I have nicknamed him Dr Vlimmen (A Dutch cult hero in a novel written about 80 years ago) and we share the same passion for birds. As I write this a hawk is circling around my house. Yellow beaked and looking for a rodent or large rodent I guess. Our favorite bird is the marabou, with its carnavalesque beak on top of a white boa and black feathers.

As Nard is both a dentist as well as a medical doctor in Fort Portal he is working in the dentistry and surgical department s. It is not easy to explain to a patient who has travelled 200 kilometer that the material required to fill his tooth has run out and that he will have to return another day. Yet here we do it and traveling 200 kilometer may take the whole day and several days’ salary.

The first night he was here I took him to 3 of my favorite pubs, clubs and restaurants. An Eritrean restaurant across the street, a huge pool bar (9 tables) annex bar/dancing and the classic of classics; Al’s Bar. In Al’s Bar you can feel time warped as the action starts at 0300 AM earliest and the music seldom goes beyond the end of the seventies. And what a collection of music the owner has. In the restaurant we met Nick one of my dear friends here and several other guys. A straight plunge into a sheesha and discussions of Ugandan culture versus Dutch culture. Nice to hear from the side.

Then almost straight to Fort Portal where we stay at Eveline’s house. As I wrote before she has started a church, a boarding primary school, a health clinic, a maternal health clinic, mobile health clinic and a project for pygmies.

I will ask Nard to write a blog entry for this blog as a guest writer. It is not possible for me to crawl into his shoes all I can see that experiencing the health care system in Uganda and mostly the Ugandans are having a major impact on Nard.
What I will say is that the gift he has taken to our fellow doctors and clinical officer training school, a medical library of about 500 medical textbooks on DVD is the best remedy for a knowledge craving brother and sisterhood of medicine.

Namaskar,

Ashis

UgandAshis 25 Surprise

2009-06-21T23:49:00.000-07:00

UgandAshis 25 Surprise

June 20, 2009

Kampala, Uganda

A young friend of mine had his farewell party before going to Italy to become a civil pilot. His party was at one of my favorite hang outs; Kyoto at Centenary Park. While on the dance floor I bumped into Samali Okoth. She is of Russian-Polish-Canadian-Ugandan descent and has spent time in Kenya-Canada and Uganda while growing up. We hit it off straight away and starting swapping our experiences as mixed blood people. Somali is 5 foot 9 and because she practiced body building on a very high level is massively and muscular in her built. She is so big most men are intimidated by her.

Her story about her first day in school in Canada I have to share. As she entered the classroom the teacher Mr. Dyke a world wise 50 year old told the class room that they had a special new classmate. SomaLEE Okoto, eight years old from East Africa. As he unrolled the map of Africa from 1946 with Rhodesia, Tanganyika still on it he asked her to point out Uganda. She found Lake Victoria and happily Mr. Dyke commented that the country being on the equator it must be very hot. He then continued to ask if she lived in a mud hut. The kids joined in with a barrage of questions the first one being if she had a pet lion.

Sincerely peeved by the mispronunciation of her name and the misconceptions of her country Samali she took up her place in the classroom and joined the mathematic class. As she made an error she raised her hand and asks Mr. Dyke for a rubber to rub out the mistake. Mr. Dyke became flush faced and told SomaLEE that in Vancouver the called the device an eraser. To the humor of the class she replied that in Kampala an eraser is to wipe the chalk of the blackboard.

In Uganda the same unbelieving ears as she pronounces her name to anyone Samali. The commonest answer is: “Are you sure?” followed by the same response when they hear her family name Okoth (both names are 100% Ugandan) but Samali has a very light skin. Surely confused the next question if she is sure she is sure. Or Madam you cannot be Ugandan. I just laughed and laughed how often have I been told I cannot be of Indian or of Dutch decent. Seen as a muzungu (white) in Africa and an outlier in Europe. Being of mixed descent is a mixed blessing.

Our night ended with a picnic in the garden after visiting the 24 hour market. It is then that she told me her family ran the first private hospital in Uganda, Nile Hospital in the 1980’s. Due to external circumstances the highly successful business was forced to shut down. And as a consequence she still has the remnants in apparatus (hospital beds, x ray machine, wheelchairs etcetera)

My friend Eveline’s clinic is expanding this week to a second building for mother and child care. The admissions in the first building (14 beds) are maximally occupied and we need beds, wheelchair, second x-ray machine etcetera. Life is full of surprises. Go clubbing and end up with part of the inventory for your new health clinic.

Namaskar,
Ashis

UgandAshis 24 Sprawling hills

2009-06-21T23:44:00.000-07:00

UgandAshis 24 Sprawling hills

June 18, 2009

Kampala, Uganda

I met an elderly shopkeeper yesterday and as we started talking about the Cranes and food we eventually came to talk about the neighborhood I live in right now. It is a in between of suburb, small village and continuation of Kampala city. We live about 5 minutes drive of the shore of Lake Victoria and that is why we have so many predator birds circling around. As we speak I can see two kites (hawks) on the look-out.

He was telling me how 15-20 years ago the hills we were looking at were dense rainforest with exotic flora and fauna. Ggaba then was a beach were some fisher men moored their boats. Now we can see the repetitive red tile roofs and red brick one storey houses. Nickelangelo, my architect friend would say that there is only one blue print on offer to construct houses in the whole of Uganda.

In the Netherlands out of jealousy we always joke how everything in Belgium happens 10 years later. Well all over Africa people are flocking to the smaller and bigger cities, yet in Uganda that trend is present but much delayed. In a population of 30 million Kampala is the biggest city with 1.65 million inhabitants followed by Kira with 205.000, Gulu 146.000, Jinja 132.000, Entebbe 115.000, Mbarara 102.00 and all others information is lacking or are below 100.000. If we add up all the numbers on http://en.wikipedia.org/wiki/List_of_cities_and_towns_in_Uganda then we can estimate only 10% lives in a city.
Living in Kampala and working in Fort Portal (46.000) gives a much skewed view of what Uganda is. I hope to be travelling more and more to North, East, West and South. Feeling traffic jams, industrial pollution, crowding of people, inner city crime, loose moral of big city inhabitants, unraveling of the social fabric and other big city problems are an issue for the majority of Ugandans is misreading the reality.

The average Ugandan digs, earns about a dollar a day, lives in a rural area with limited access to healthcare, primary education, has bad roads, lack of clean water. Despite to for once quote Winston Churchill ‘Uganda is the pearl of Africa’ problems are present today and with one of the youngest populations in the world deforestation, overgrazing, over use of agricultural land and emptied lakes devoid of fish are current problems bound to get worse.

It is not for a lack of highly educated, motivated, caring people in Uganda. The biggest gift Uganda brings to the world are the kind hearted people. Vision from the leaders in the country, opportunities for loans, integrity by all living and working here and a true open world market would help. The label for Africa as a lost continent is tedious, simpleminded and does not reflect on the talent and potential of the continent.

Namaskar,
Ashis

UgandAshis 23 Rwanda’s plans for computers for all primary school students by 2012

2009-06-21T23:30:00.000-07:00

UgandAshis 23 Rwanda’s plans for computers for all primary school students by 2012

June 17, 2009

Kampala, Uganda

Under the name One Laptop per Child has been launched by Global Center for Excellence in Laptops and Learning in collaboration with the Rwandese government. The plans sound great: all Rwandan primary school children to be supplied with XO laptop by 2012. The cost of the laptop is $100 a subsidized rate. Nicholas Negroponte’s plan to make computers available to all may take off in Rwanda.

Going back for an instant to Uganda when I meet students on the bus travelling up and down to Fort Portal half of them seem to be studying IT. It is a misconception that there are no qualified people to run software or computer hardware companies in East Africa. And at the same time access to internet is costly, low bandwidth and often just not working. I was smirking yesterday when I read a letter to the editor in my Daily Monitor newspaper describing the failing of a competing internet provider (MTN). All the writer could get was the MTN homepage and that for 5 days in a row. It was the letter I was about to write about my provider (UTL). Fortunately for me my connection has been up and running for two days.

The internet connection for Sub Saharan Africa has been depending on costly satellite connection. As we speak the cable that has been laid on the bottom of the ocean has reached Mombasa. So with a bit of luck there should be a normal bandwidth connection in 2010 or 2011 in Kampala. This cable is supposed to hook up most of East, Central, West and Southern Africa.

So with normal bandwidth access to the internet and all primary school kids in Rwanda computer savvy will the next Silicon Valley or Bangalore be in Kigali, Rwanda? Let us hope so. For all the Rwandese have been going through their economy is one of the fastest growing worldwide (not easy when your country is landlocked) It is only 15 years ago when the world watch on to yet another genocide.

An informed and well educated group of youngsters may be key to have Africa as the happening place now and the leading continent worldwide in 50 to 100 years. After all this continent has the resources, the people and when peace is the norm the golden opportunity to shine.

The XO laptop will be introduced in 17 countries in Africa. Let more of the African leaders give their future (the kids) an edge to compete with the world. The 2.2 million in Rwanda may have been given a powerful boost.

Namaskar,
Ashis

UgandAshis 22 Final examination

2009-06-17T08:02:00.000-07:00

UgandAshis 22 Final examination

June 13, 2009

Kampala, Uganda

The clinical officer doing his mock exam was clearly nervous. As I tried to ease his mind with easy questions he blanked. Given our patient we were reviewing was a very complex case. A young man, 28 years with skin lesions (Kaposi sarcoma), generalized body edema, difficulty breathing, extremely anemic and very weak.

Common causes for generalized edema are heart failure (anemia), kidney failure (nephrotic syndrome) and malnutrition (malabsorption). What you look at to determine anemia is palmar and conjunctival pallor, to access the heart I was asking our examination candidate to name some of the findings of our patients fingernails: they were spoon shaped (which you see in iron deficiency anemia, or koilonychias), had fungal infection (discoloration, thickening) and there were signs of cyanosis (blue discoloration of the finger nails)

Not only was the candidate getting quiet, our patient started gasping for breath. He had received 2 blood transfusions over the last 24 hours but was still not doing well at all. As I listened to his chest, felt his jugular artery I noticed he was having no heart beats. I started cardio pulmonary resuscitation as the entire room (about 20 patients) became quiet. Tried adrenaline and while I saw the young man’s father coming into the room with his hands raised to heaven I knew I had to stop.
Wailing broke out straight away as all family members rushed to the deceased. These are moments for which there are no words – just a feeling of deep sorrow. Questions what we could have done better for this individual patient. When examinations of 150 students take place by 8 teachers in 8 subjects it is hard to balance patient care and proper training.

Having contracted HIV and not being on treatment had lead our patient to decline rapidly. When he got admitted we did care for his eminent medical issues. Yet as many fellow people living with HIV/AIDS the presentation to a hospital is often when the patient is either in coma, severely malnourished or suffering from severe opportunistic infections.

As our deceased body was taken to the morgue by the family with 5 minutes the bed had filled up. Examinations continued. There is no doubt there are great needs for patients in Uganda. Besides infra structure medicine and equipment one of the most important is human resources. Trained, qualified and motivated health staff. Our young examination candidate just passed his exam.

Namaskar,

Ashis

UgandAshis 21. Follow your heart

2009-06-13T11:53:00.000-07:00

UgandAshis 21. Follow your heart

June 10, 2009

Fort Portal, Uganda

Dave Matthews sings that it is all out of his hands for now. He makes majestic music and here as I hear I disagree. Everything is in your hands. Follow your heart.
Today I examined 28 clinical officers for their clinical medical exams. Fifteen minutes of grilling of these future health workers in Uganda. Their final practice for the exams which is in a month and after these exams most already have a post somewhere in Uganda. Reviewing their skills has been a blessing.

After candidate 26 I temporary lost the plot and started to feel dehydrated. I hinted at the candidate that I may be more of a patient then the one he was presenting and that I required urgent rehydration. What would his regime be for me? As he looked at me puzzled I informed him that without an urgent pop my brain would disintegrate and I would collapse into a serious shock. One of his colleagues picked up the hint, pocketed a quick 700 shilling and left to get me a Mirinda.

But before I let the innocent clinical officer leave I requested for a blue Mirinda (which does not exist). Giddy and silly yet the patients and the clinical officers understood I was BS them. Three minutes later (and several serious question further) I got my soda pop.

Follow your heart; I came to Uganda after having been here for two months previous in my life. I had some friends yet knew non of them for more than two months. Something is telling me that I made the right choice. My working week is filling up rapidly and soon will be overfilled. I do what I like to do; teach clinical officers, I shall be teaching public health at a university, work in a medical ward (soon a pediatric ward as I review my current diagnostic and therapeutic skills), join a medical clinic, start PGHF (about to launch, prepare for a month tour of the USA, network and create opportunities for friends to come here and work.

Some say you dominated by circumstances or others in the choices in your life. I disagree as long as you follow your heart you create your destiny. Easy? No, yet not living in your true vision and mission in your life is so much harder.

So as some of my friends have taken their two young kids for a 9 months sailing trip of the BVI’s, Cuba and tens of islands more and others have emigrated to Canada. Was it easy for them? Perhaps not yet as I read their travel blogs or when I visit him in Calgary they have dared to live and have all the more fun for it. Walking the talk!

As the clinical officers march off to all parts of the country in a month’s time I wish them the courage to follow their hearts.

Namaskar,

Ashis

2009-06-13T11:48:00.000-07:00

UgandAshis 20. Credit crunch

Fort Portal, Uganda, June 9, 2009.

Credit crunch

Credit crunch is a daily event in Uganda. Here when you do not have money for school fees you visit a friend. When you cannot buy food your family will chip in. Extended families and friendship’s keep even the poorest of poor afloat. Uganda has been blessed by Mother Nature, its fertile soil, heavy rainfall and cheerful people can live off their lands. Digging as they call it here is the way to avoid credit crunch. As I see every day in my own garden, drop a seed and before you know it you have a tree or plant presenting you with the choicest and sweetest of fruits.
As I spend 3-4 days in Fort Portal every time the papaya tree has a fresh fruit my boys pretend it is their duty to eat the fruit. Stating the fruit is ripe and I was away they happily munch away. I aim for a papaya this weekend and have selected a juicy specimen to be consumed in fruit eaters delight.

The rural areas are a perfect place to shop for vegetables and fruits. Yearlong the prices are extremely low. Yet in the towns and cities the crunch can be felt. Sometimes the price of items reminds me of the bag of money you need to take in Europe or the USA to buy food. Here in a road side stall you can have a full meal for $ 1.5 dollars (no not a Mc Burger a proper meal with a nice variety of rice, beans, goat, papaya, cassava and sweet potato)

It is political season as the state of the nation was read out by the current president in power since 1986. A few months ago the government declared that the world wide credit crunch would have no effect on Uganda. It is true that we have no foreclosures of subprime mortgages here or banks requiring bags of gold to prop their carrion loving superfluous lifestyle. Yet NGO’s feel the crunch, donor money is rapidly drying up (could it have to do with the lack of seriousness in the government to address their consistent high scores in international corruption classification?) and as a consequence basic provision of ARV’s for people living with HIV/AIDS are under threat.

Yes to believe that endless economic growth is possible is a world view – one that was shattered in the Western world a while ago – yet here it can be stated that Uganda’s economical growth is record high and reaching for new heights. What is worse that in this country that is a true bread basket for the region and potentially for the world there is acute and chronic malnutrition. And that without a guerilla war in the country. Amartya Sen states that it is amazing to see famines happen in this time and age as they are so easy to anticipate.

Uganda may have severe famine issues very soon – yet the government boasts it will achieve record exports of agricultural product over the next years and massive oil field are about to be exploited.

My guard in the mean time sends his entire salary to his family in Arua, Northern Uganda. The price of their staple foods have doubled over the last week and are looking at another doubling. Amongst the reasons extensive droughts and lack of stored food reserves in the country. For president Museveni credit crunch does not exist for and for my guard it means that since he works for me he is broke as he needs to send all his money to support his family.

Namaskar,
Ashis

UgandAshis 19. Full moon

2009-06-13T09:36:00.000-07:00

UgandAshis 19. Full moon

Kampala, Uganda, June 7, 2009.

Full moon

Pale white
Steady light
Reflection bright
Travel mental kite

Limitless energy abundant
Key to self – locked?
Patterns patter
Alike a mad hatter
Opportunities make unblocked
Balanced coordinates concordant

Silver light embraced delight
Why o why dear Rahu
Must I repeat
Infinite defeat
Makes me cuckoo
Drop, stop, soar to height

In your reflection
I shower in clarity
Pure nudity
No more deflection

The karmic path blazes
Get along
Sing the inner song
Leave behind soma’s hazes

Focus on why
Do not deny
Destiny’s call
Self imposed wall
Crack maya’s veil
Stop the wail

Instead unleash hawk
To message
What needs be said

Feathers point the way
Full moon light the path

Namaskar,
Ashis

UgandAshis 18. WBS cooking show

2009-06-13T09:16:00.000-07:00

UgandAshis 18. WBS cooking show.

Kampala, Uganda, June 7, 2009.

WBS cooking show.

A while ago Reeta, a young Indian-Ugandan host of life style television show on the biggest Ugandan television network and I bumped into each other at a common friend’s place. Nickelangelo quickly grabbed the opportunity to boost about my excellent Indian cooking skills. Innocent me as the Sweish chef of the Muppet Show just nodded. One month later I received a phone call. Why had I not called her and when was I going to cook a proper dish for Reeta? I told Reeta that I spend my weeks in Fort Portal nowadays but that I happened to be free on Monday morning. Ok she said. Get ready to cook a meat dish for her TV show.

A nice way to be introduced to the Ugandan public: the singing and dancing chef. Quickly I consulted my mom and dad for one of our killer dishes, lamb. I spent the last days cleaning the kitchen, stocking up all the oils and spices I need for tomorrow. All that is left for tomorrow is fresh lamb and lemon.
Can I actually cook?

Well while being a student and I did that professionally for some time I did cook quite a lot however over the last 10 years my cooking skills have gotten a bit rusty. It is here in Uganda that I have started cooking again. And now my work is in Fort Portal so all my attempts remain for the weekend r for national Ugandan TV. As many things in life let me go and try, see if I can wing it.

I could also try an act as the Swedish cook of the Muppet Show or give a discourse on the wealth of health by eating well. The meal is supposed to be a meat based meal – many of the Gujarati’s here are vegetarian and some others do not eat onion and garlic. I was expressly requested to make a meat masterpiece.

A report will follow on the outcome of the televised onslaught. Will I get a cult following as the mad dancing and singing Indian cook? Will the meat burn? Shall I pull it off in front of the glaring and unforgiving camera? Can I find meat tomorrow? Will my gas stove function? Shall I be unmasked as a fraudster?
Whatever will happen – I will go down with laughter.
Enjoy the show!

A day after the recording and six days before the airing of the show – the film crew really liked the grub and despite my mediocre cooking pots – nothing burned! And they want to film me again cooking and or telling my life story as a physician or about spirituality. Perhaps I will become a fixed feature on the show. Let us await the response from people I know (and those I do not). Currently I am know as Salvador (a hero from a South American soap) perhaps now I become the doctoring cook.

Namaskar,
Ashis

UgandAshis 17. Chicken

2009-06-07T08:28:00.000-07:00

UgandAshis 17. Chicken.

Kampala, Uganda, June 7, 2009.

Chicken.

Eagles and hawk circle my house. It is as if they know I am planning to create a minor chicken farm in my back garden. Then we have snakes in the premise as well. Towards the front of the house is a small stretch of swamp land with mongoose, rats, cats and dogs all eyeing the potential of eating my future chicken. To assure my future feathered friends protection I need to construct a chicken ren, double the number of guards, get watch dogs for my chicken and I need to get smart chicken.
During my journeys around Uganda I have seen many a chicken waiting to be rescued and become part of my egg laying brigade however experts have informed me that rural chicken do not like the nightlife infested city neighborhood of Kansanga. I may have to find some party girls. The old dilemma arises again; do chicken lay eggs when there is no cock around? In my experience they do and I have heard the opposite. I just cannot introduce a cock – my friendly relationship with the neighbors may straight away change into a strained one.

For all of you experts on chicken out there. What type of chicken should I go for? The reason for me keeping them is to eat their eggs and see if I can rear a whole flock of prize chicken. Perhaps I can even enter competitions for Miss Chicken. We shall see.

Talking about chicken two of my Iranian friends are about to launch the best chicken restaurant in East Africa. To be called Chicken King they are now looking for another name as it has been registered already. Their terrace overviews one of the busiest streets and night club areas in Kampala called Kabalagala. Sheesa’s or waterpipe will be available and good lounge music. As I cannot indulge myself on my own chicken it is at their restaurant where I will be eating soon.

And what ever happened to bird influenza or even swine flu? On the radar and now it has fallen off again. For those of you who will be visiting Uganda a bird safari amongst other safaris is a must here as if I am not mistaken Uganda has more bird wildlife than any other country in Africa (perhaps in the world) but even here environmental nightmare, encroachment on wet lands, poaching and hunting is common so much so that the national bird of Uganda the crane has reduced from 100000 to 10000 birds over the last 40 years. If ever I get land here it will be a paradise for birds.

A friend told me a story of his youth when he was asked to buy some rice at the shop in his youth. As he walked towards the shop he heard a beautiful bird sing he listened and followed. Then another bird popped up. He kept on following the miraculous tunes and as he wandered home his heart was filled with joy. Such a sweet songs, such a wild colors, an elegance these birds bring to the world. His mom asked him on returning where was the rice. Oh, oh he replied on seeing and hearing nature’s splendor his original task had disappeared from his mind.

Namaskar,
Ashis

UgandAshis 16: Teaching

2009-06-07T08:05:00.000-07:00

UgandAshis 16. Teaching.

Kampala, Uganda, June 6, 2009.

Teaching.

Fort Portal, named after a pompous British administrator who never even visited the place lies on a nice elevation. It overlooks Rwenzori mountains and has lots of rain and matooke (plaintin). As there has been findings of oil it is likely the place will boom and bloom. And of old there is the tourism; an abundance of animals (gorilla, baboon, chimpanzee, leopard, lion, kob, spider monkey and a range of birds) and flora can be found. If I make time I can visit some of the wild life parks over the next weeks. I would love to see a gorilla in nature. Or spend a day listening to birds and monkeys.

Talking about monkeys; monkey king or mister monkey is the name the kids have given me here. As I call them monkeys so do they me. A lot of wild life conservation is being done in this area and it is necessary.

The hospital and the clinical officer medical school take up most of my time in Fort Portal. For example this week I did a 3 hour ward round with about 25 students followed by a preparation for their final examinations. We reviewed the clinical examination and looking at the clock it became clear we had been discussing for nearly three hours. Today I added another two hours of theory on diagnosis and treatment of common medical conditions in a hospital setting. To keep them awake I shower them with questions and do a jiggy (dombolo) once in a while.

At the end of the day I ran in to the principal of the clinical officer school. He had booked me for examining in the clinic around 30 (?) students in what is called long and short case. Then I bumped in to the course organizer of the public health school. Next week we meet on Tuesday to see how we can prepare the New Public Health in a bachelor’s course at the Half Moon Monkey Mountain University.

All in all enough there is enough to do for a while. And then I am meeting up with some other local NGO’s with international roots. One of the organization’s founder’s is becoming a close friend and fellow entrepreneur. She has set up a beautiful primary school with boarding facilities and is thinking of constructing buildings for a secondary school. As it is now many children leave around 04.00 am to reach school before 08.00 am and after school they walk back another 4 hours. In theory there is universal primary education, free schooling for all, at least primary level in practice a small contribution is asked for each trimester, as well as uniform money, books, note books and pen/pencil and lunch fees. Despite the total fee may be about $50 only for all expenses for many parents that is out of reach and children stay home until part of the harvest is sold.

In the end most people living in the rural areas have a very low income. Yesterday in the state of the nation President Museveni declared the average income to be $440 dollars a year. Many do not reach $35 a month or just more than a dollar a day. Oil has been found in Lake Albert region, quite a lot in fact. Straight away there is an issue as the government wishes to build a refinery and a oil pipe line through Kenya but have no funding to start the project. The explorers of the oilfields are smaller oil companies and do not have the cash either so they want to export the raw unprocessed oil. The final question will be if the average Ugandan benefits from the rich resources found in the country. Sad news is Uganda scored a third place in Transparancy International Corruption Index.

Namaskar,
Ashis

Ugandashis 15. Fort Portal - Clinical Officer School

2009-06-03T01:32:00.000-07:00

UgandAshis 15. Fort Portal – Clinical Officer School

Kampala, Uganda, June 3, 2009.

Fort Portal – Clinical Officer School
As you meander the overcrowded wards in the district hospital in Fort Portal you cannot avoid the ubiquitous red-green and blue labeled young clinical officers in training. The clinical officer plays an important role in the Ugandan healthcare system. Following some statistics to show you why:
Uganda has about 30 million people and trains about 150 doctors each year. Given the relative low salary of about 250-300 dollars per month many seek employment overseas. There is a local (rural-urban), regional (Uganda to South Africa/Cameroon) and global (Uganda to UK and USA) brain drain leading to about 75 of those doctors to leave the country. It is said there are 2000 doctors working in the whole of Uganda and about 4000 nurses (less sure about that one). This makes a whopping 1 doctor per 15000 people. Or as I just read the Netherlands trains 3000 doctors a year for a population of 17 million.

Here when you enter the district hospital we are supposed to have 40 doctors as this hospital is the referral center for 5 districts and about 1.5 million people. Reality is 10 doctors! Not bad for a 400 bed hospital where about 15 deliveries take place a day and 3 caesarean sections. As you can understand it is the clinical officers that clerk all admissions. When a case is complex the nurses and the clinical officers call for a doctor to give a consultation.

To make a living most doctors have private chambers. They receive patients there who can add to their meager income. The hospital in the afternoon will have only 1 or 2 doctors. The on call obstetrician and surgeon, sometimes a medical officer stays behind as well.

Back to the clinical officers; they get a three year theoretical and practical training. There are six schools in Uganda (3 private and 3 public). The school in Fort Portal alone churns out 123 exam candidates this year. Due to lack of funding, limited number of clinical instructors, old teaching materials and books studying is not easy for the students. There is an overhead projector for sheets but none for power point presentations.

Doing ward rounds with colleagues attracts flocks of white coats with red, green and blue labels. After seeing all patients in the early morning selected complex cases are discusses and examined with these students. Once I started doing this I was requested to meet the head of the school. This year’s group have their final examination coming up in a month’s time and can always use more clinical lecturing. If I could make them a mock exam, or better train them clinically that would be wonderful.

As I boarded the bus to Kampala I made a list of things I needed. Perhaps some of you can help. As I find many power point presentations online for clinical medicine nowadays does anyone know if there are mock exams for medical students on-line. Why reinvent the wheel when the work has been done already. The projector I am looking at is a friend’s who has borrowed to another friend who is in Gulu now.

I should be moving towards the bus now. Over the last few days I have been around Kampala to get a white coat, medical instruments, internet access, fixing my computer etcetera, etcetera. Let us hope for internet access from Fort Portal.

Namaskar,
Ashis

UgandAshis 14. Plans

2009-06-03T01:08:00.000-07:00

UgandAshis 14. Plans

Kampala, Uganda, June 3, 2009.

Plans

So it has been two months here now. Following a short overview for PGHF and myself so far. Found a house that functions as a guest house for all you visitors, as an office for all the future staff, as a storage facility and as my personal home. I got a working permit and registration as a doctor for the whole of the East African region. The multi entry visa stamp is in my passport. Found three different posts in Fort Portal; doctor in the wards, lecturer at a public health course and clinical instructor at a school for clinical officers. The registration of PGHF as a Ugandan not for profit is about to happen.

There are several organizations, local and international with which we are exploring how and when to collaborate. Given our network in Fort Portal it is likely we will start working there but I am planning to visit Gulu, Mbale as well (Northern and Western Uganda). As a medical organization one of the first things to do is to identify local smart partner-NGO’s that have a track record of quality work with innovative and creative approach. I have the impression we could have found some very strong partners in Fort Portal with similar mission and vision.

One of the earlier blogs I may have written about the young men I saw at Lake Albert who had a chronic and lethal disease called schistosomiasis or Bilharzia. You get it by entering the water that is infested with the vector, snails and the causative agent, a helminth (fluke or work). The medical post does not have the treatment for this disease. In fact treatment is only one tablet of a medicine called Praziquantal, but as people re-enter the water all the time, re-infection is very common. Prevention of the disease requires community mobilization, education, health promotion, change in sanitation behavior, building and maintenance of latrines, killing of the snails with chemicals.

Most people in Semlike region or Lake Albert region do not have access to medication or health staff. It is there where a mobile clinic that supports the local government health care system can be instrumental in a better health for all. The doctors in the hospital are happy to join as are clinical officers, nurses and lab technicians. Often lack of vehicles, gasoline, materials or bad roads hinders health and other programs.

My travel plans for 2009 are as follows:
1. Field visits to partner ngo’s in Mubende, Buvuma Islands, Fort Portal region, Mbale and Gulu
2. Visit to the USA for a month in October
3. Visit to India for 2 weeks in December/January

Visitors confirmed so far
1. A young Dutch doctor, future maxillo-facial surgeon
2. A young public health doctor from the USA

After exploration and registration the phase of grant/project proposal writing is about to take off.

Namaskar,

Ashis

UgandAshis 12. Fort Portal

2009-05-15T02:34:00.000-07:00

UgandAshis 12. Fort Portal.
May 11, 2009
Fort Portal, Uganda
Fort Portal.
A Saturday lazy weekend delay and by Monday I made it. Fort Portal, home of the Toro kingdom, lots of rain and a city in process of bursting on to the map. Oil has been found, gold as well, the tropical rainforest that comes from Congo is sent through Fort Portal. A university has started operating and construction sites are blazing – well Uganda style; pole pole –
My host is a Belgian-Ugandan pastor living in the USA and Uganda doing great work as building a school, health clinic, hospital, educating Batwa (pygmies) who have been forced out of their rain forest in Congo. It is very likely I will be visiting Congo soon. Another dream to come true and a friend found.
Today I visited the regional referral hospital for 4 (or 5) districts. The medical director is in Kampala for budget talks and his acting colleague shows me around the hospital site. Everywhere building is going on, new wards are being constructed and that means that the arrivals are stacked up in temporary shelters. It is not that the builders are unavailable, but the money from the Ministry of Health may be delayed.
I joined one of the 7 doctors (3 gynaecologists, 1 physician, 2 surgeons, 1 medical director) of the 441 bed hospital for the end of his ward round. Out of four new patients three were newly diagnosed with HIV/AIDS coming in with severe malnutrition, oral thrush, chronic cough and diarrhea, seizures or semi comatose. The HIV tests are available, so is the CD 4 count (indication of the severity of the viral destruction of the immune system’s T-cells) and the Joint Clinical Research Centre so anti retro viral treatment should be given to children, prisoners and vulnerable people. The reality is not so straight forward.
As an example: for 4 months this hospital has been without anti-tuberculosis drugs. That is quite devastating for patients living with a co-infection of HIV/AIDS and TB but also for those suffering from TB alone. TB also kills. As we finished the ward round we discussed the difference between Mulago (county tertiary referral centre) and this hospital. In Kampala at least at lot of diagnostics can be done but they have the same issues with access to drugs. But as the general public is more educated in Kampala when drugs are not available they go to a pharmacy to purchase the drugs themselves.
For a while I will try my hand at working in this hospital. Given the ideal location; view over the half moon mountains, proximity to Lake Albert and Congo there is a lot of potential for projects here. Also unlike Kampala and Northern Uganda there are very few NGO’s here and even Ugandan health workers flee the scene for greener, warmer pastures where more money can be earned.
Namaskar, Ashis

UgandAshis 11. Patience

2009-05-15T02:27:00.000-07:00

UgandAshis 11. Patience.

May 8, 2009

Kampala, Uganda

Patience.

With the sad departure of my beloved Mac I have fallen back on a true mini-computer. Even with a partition of the hard disk; Linux and Windows for my internet connection I rely on the Windows platform. And I recall why I moved away from Microsoft 5 years ago. Apple even when gimmicky, expensive, over-the-top, trendy, snooty and what more still has no issues of crashing programs, worms and virus intrusions.

As it is within 1 day I have managed to pick up a virus and need to reinstall Windows. It means that for about 10 days now I have had very limited Internet access. Which leads to the following point: has my life been rendered anyway by not being able to access my g-mail, twitter, yahoo and other accounts.

On the one hand yes, when you are blogging from Uganda it is not very helpful not to be able to upload content. Video’s are not easy at all and when you are left without any contact at all it is not always easy.

On the other hand no, face to face is the best interface. I can still write every day and just overflow the websites with my writing.

Talking about patience; it paid out to stay calm and relaxed as I can now practice medicine in Uganda and about 8 neighboring countries for the next two years. There is no reason to postpone a visit to Fort Portal now. The place I will be practicing in a district level. It is near the majestic Half Moon Mountains and also the basis of a peasant resistance movement in the 1980’s called the Ruwenzururu. It is not far from Congo and I am sure there is ample opportunity to dance some dombolo.

Patience then… mmm … I will board a bus Saturday and let you know about the developments. And for those of you planning to visit: King size bed number 2 is now in place.

Namaskar,

Ashis

UgandAshis 10. Hole in the road

2009-05-15T02:25:00.000-07:00

UgandAshis 10. Hole in the road.
May 5, 2009
Kampala, Uganda
Hole in the road.
Chinua Acheba, the Nigerian master writer wrote a story once about a hole in the road. A hole so big entire trucks would disappear in it. Employing an entire village to pull out the stranded vehicles nobody was trying to fix the hole in the road.
The road I take to my mansion is littered with smaller and bigger potholes. Some so big I am sure I have seen the snout of a hippotamus and on one occasion the wild snarl of a crocodile. Local kids do not believe me when I tell them to watch the water. I guess you cannot win them all.
A local builder found a great solution to his superfluous construction debris. Ditch it in the hole. And so we were hole-less for a whole one day. A bristling rain and new holes popped up straight away. This time I decided to make the best of it.
It has been a while since I swam and this Olympic Pool opportunity was not one to pass on. Within half an hour all the neighborhood kids had joined. A huge pool bash was going on. Hawkers joined at the rim of the pool and started selling sausages, ladies popped up with matooke and yams. The barbeque was on. Ghetto-blasters blared and the pool side party turned into a wicked rave.
As I open the newspaper, Daily Monitor: there it is: muzongo (foreigner) gives pool side rave – wild party as never seen before in Uganda. The Red Pepper opens with a front page photo of an ecstatic crowd partying to some groovy beats.
There is Uganda for you ; never miss an opportunity to party!
Namaskar,
Ashis

UgandAshis 9. Oh No

2009-05-15T02:21:00.000-07:00

UgandAshis 9. Oh no.
May 1, 2009
Kampala, Uganda
Oh no.
The house I am living currently is quite big for a sole person. However I am sure to have many visitors coming and it will also double as an office for PGHF. The garden has a huge wall around it and since 1 night I had a young sentry/cleaner named Emmanuel. Cheerful that my house is starting to look like a home I left to watch the Barcelona-Chelsea football match down in a local pub with a friend. Post match I stayed around for a while longer and when I returned home the funny feeling that I had when I left became a bad suspicion.
The upstairs door to my balcony was open. I was sure to have locked it. As I rushed into the living room my worst fear came true: laptop, red cross bag, digital photo camera, money, modem, two pairs of Merrell shoes, a loaf of bread, a carton of milk and a book all gone.
I miss my Macbook and my internet connection. The burglars stoutly had entered my neighbors gate, smashed the glass off the top brick, scaled the wall, climbed up to the balcony, forced open the door to the house, snuck down, nicked all my items, moved up again, climbed down the balcony, rescaled the wall and all without making a peep.
When the police came and did their forensic work they were sure it was an inside job, someone who had worked in the house before. I am awaiting results of the investigation.
To make sure that this does not happen in the future; I now have a night time guard who is armed with bow and arrow, all the security lights are fixed around the compound, considering getting a dog (or two, an old dream of mine)
I hope the culprits get nabbed so no one else has to suffer their crimes. As far as my losses go, all is material and I have backups of my photos and my Mac Book. It feels like a nuisance and makes me more determined to make this mighty house my secure home.
As for the benefits : finally a dog! And I will learn to shoot bow and arrow properly through my night guard Sam and both Emmanuel and myself are unharmed, getting to know that your landlord is sincere and that your neighbors care (last night I ate tilapia at my neighbors).
Awaiting a new cam I may take some shots with my video to show you the house, garden, Emmanuel, Sam, bow and arrow. Bare with me until I have a renewed internet connection. In Uganda Labor Day is a public holiday like about 50 other days.
Namaskar,
Ashis

UgandAshis 2009 – 4. Home on the ranch

2009-04-27T05:41:00.000-07:00

UgandAshis 2009 – 4. Home on the ranch.

Kampala, Uganda
April 23, 2009.

Home

To call a place home is easy
Friends and family
Form the nurturing environment
From which one
Flies around
Now I can say to you.
Crash by
My mansion is yours
Mi casa es tu casa
The house is
Big enough to play hide-and-seek
Pluck jackfruit, papaya and banana’s
BBQ
Loiter on the veranda.
Enjoy the breeze
Gaze at moon and stars
Come, stay
Call it your home

Namaskar,
Ashis

UgandAshis - 3 The water bill

2009-04-23T11:41:00.000-07:00

UgandAshis 2009 – 3. The water bill.

Kampala, Uganda
April 23, 2009.

My friend, whom I shall call Adam received a water bill yesterday. Nothing out of the ordinary were it not for the fact that instead of the normal $50 fee (100.000 Ugandan shilling) it was $500. Also his water had been shut off. Adam is a very friendly and typical Ugandan in the sense that everything is happy go easy. Knowing he had a letter form the water company stating that for a week their had been a leak outside his house in a pipeline he left to get his water reinstalled.

Today however he lost his patience at the district office of the water board. In an ever escalating shouting match with the official he tried to point out the fact that the bill was not correct and that the water board should review the bill. The man behind the desk dug in his heels claiming the manager of the office was the only one who was able to make a change. ‘Why not go half-way sir?’ You may $250 and we re-install your water for an other $50 fee.

By now all about 100 people awaiting in the queue joined in and a true riot was developing. People were getting ready to storm the office. A 83-year old Acholi Northerner acted as a chief whip and spokes man. Blasting the officials for their lack of common sense, their inability to admit mistakes, or once a mistake is made to fix the problem.

As the general manager walked in it was clear he could do one thing. Adam’s bill was reduced to the normal monthly fee, a letter of apology was written and his water is reconnected. As he shook his shoulders leaving the water company he could hear the Acholi gentleman blast away at the official again. With a smile on his face he mumbled a prayer for the besieged office worker.

Namaskar,
Ashis

UgandAshis - The hawk has landed.

2009-04-19T18:23:00.000-07:00

UgandAshis 2009 – 2. The hawk has landed.

Kampala, Uganda
April 18, 2009.

The hawk represents the messenger in the Lakota tradition. (http://www.animaltotem.com/hawk.html for more information) . I am a bird lover and I like this feathered friend a lot. It is with great joy to see them anywhere. If you like birds Uganda is a paradise. A good place to nest therefore as here I can develop my ornithological skills. Bird watch and make photos from dusk to dawn could be a full time job.

It is after a period of 10 years on a tour of nations in several continents that I have picked Africa and Uganda in specific to set up shop. A base from where to blog, vlog, write, dance, cook and invite friends from all over the world to visit in my then constructed little palace on lake Victoria.

Amongst the things to do: nurture the newly fledgling Phoenix Global Humanitarian Foundation Africa, teach Public Health at local Universities, work in a hospital, receive and guide visitors around Uganda, build a network of grass root organizations, fundraise, become a platform on web 2.0 and to look at news ways of doing humanitarian work. Ways that aim to make myself replaced by a local staff member as soon as possible, to make projects thrivable, sustainable as per local demand, local analysis, local solutions and international knowledge and skill transfer.

Here I feel the calm to write a daily blog, some poetry and work on the second book after Utmost. For a period in my life I had an urge to travel. I still do but from a solid home base. Uganda will give me all the tools required.

In the mean time let us go back to the hawk. Two Cooper hawk feathers made their way to me. Next visit to the USA I shall ask my possum friend to help me out again to bead two feather holders as I have done for my red tailed hawk feather. Besides being examples of nature’s brilliant beauty they protect me, guide me and lead me to focus on why I am in Africa.

Land, build a nest, fly and be a messenger for the radiant bliss that is Africa.

Namaskar,
Ashis

UgandAshis - Viva la vida

2009-04-19T18:22:00.000-07:00

UgandAshis 2009 – 1. Viva la vida.

Kampala, Uganda
April 17, 2009

In Hindu mythology there is a figure called Ganesha. He is a mighty scholar who is the child of Parvati and Shiva. Yesterday when I visited the mandir (Hindu temple) I offered a flower to him. He is known as the remover of obstacles and the gatekeeper. It is in this same mandir when Idi Amin, dictator of the seventies in Uganda told all Asians to leave Uganda that 79 families took refuge. The mandir today, built in 1954 still stands tall in the heart of Kampala. Over the last 2 decades many families have returned and a diaspora of Eastern African Asians has formed as well, mainly in the USA, UK and Canada.
A snippet of the fascinating history of Uganda over the next blogs I am hoping to write about the history, the people, the mythology, the nature, the health care system, the stories, the dreams, the hopes, the injustice, the bliss, the joy and the children of Uganda.
Everyday merits a story. From the boda boda driver (motorbike driver) to the preacher, the salesman to the doctor, the cook to the police officer all share their stories with me freely. In common there is one thing a joy of living.
It is a pleasure to live in a country that despite immense pressure on people, stress, depression hardly exists. The resilience I talk and write a lot about my friends the Zaghawa you find here as well. As you do the humor and the dignity.
When you are making plans life happens to you. The plan for now is to stay here for 5 years and set up Phoenix Global Humanitarian Foundation Africa with Kampala, Uganda as a head office. You will be able to follow the ups and downs from this blog.
This blog will be made available in different formats; through twitter, facebook, blogger and as a list serve (www.ashis.org). Feel free to share, post questions, comments. Once my Internet issues are soundly resolved I shall also go back to vlogging. Currently through 12 seconds and twitter I have posted 5 posts (ashisbrahma).
For today there remain two plans;
1. Shave a huge part of the beard
2. Viva la vida

The second is a given, let us see if I can accomplish #1 as well.

Namaskar,
Ashis

[Ugandashis] UgandAshis 4: It is what it is!

2008-11-14T00:43:00.001-08:00

UgandAshis 4: It is what it is.
Kampala, Uganda, November 13, 2008
It is what it is
"How much to Protea, near the Golf course?"
"Five thousand shilling sebu!"
"Make it 4 and it is a deal"
"Deal!"
"There is one question you must answer ok… Do you like matooke (banana dish)?"
The boda-boda driver (moped driver) looks at me startled.
"Yes I do, it is my favorite food"
"O so if you could choose between matooke, rice, poosho, sweet potato, yam, Irish potato and cassava you would eat it first"
"Yes I would sebo (sir)"
"Ok so tell how is it that after eating matooke I am hungry after 2 hours"
"Well matooke is 95% water, that is why we eat it with yam or potato sebo"
"Wanji (ok) so that is why I should not only eat matooke, thank you sebo"
As our boda is swerving through the hills of Kampala I continue my friendly banter.
"So my friend I hear boda-boda drivers are like rock stars, how many girlfriends do you have?"
"Sebo I really have only one!"
"Good man, how come?"
"Well I lost my 5 closest friends to HIV/AIDS and I love my life to much"
HIV/AIDS is well known entity in many Ugandans lives.
"By the way sebo, if you crash the boda into a car and kill me the first thing I will do when I am dead is kill you"
"Sebo how is that possible dead is dead!"
"Trust me on that one"
I have safely arrived on my destination, time to upload videos, respond to e-mails. "Thank you for you safe delivery Mr. boda boda."

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Posted By Ashis to Ugandashis on 11/14/2008 12:42:00 AM

[Ugandashis] UgandAshis 3: The Buvuma Islands

2008-11-12T06:37:00.001-08:00

UgandAshis 3: The Buvuma Islands.
Kampala, October 29, 2008.
Willy looks slightly terrified. It is his first time on the water in a boat. And we picked a mighty lake named Lake Victoria as an introduction. As the boat starts bumping and grinding he asks why we are sliding. I tell him there are speed bumps in the water as to reduce the pace of the boats on the water. Julius our host for the weekend almost rolls of the boat with laughter. It has to be said however the next two times we board the boat wearing lifejackets Willy is like an old school sailor.
Lake Victoria has many islands. The island group we are visiting is called the Buvuma island group. It has about 52 inhabited islands, of which the largest is Buvuma. The lake is teeming with birds, crocodiles, Nile perch and it is said hippotamus. For centuries people living on the islands have been neglected for many reason. First there is the fear of many Ugandans of water, secondly many criminals found shelter on the islands, thirdly some of the islands take over 8 hours to reach by motorized boat, fifthly as mentioned crocodiles and hippo's do not make a safe journey.
The island we are sleeping is called and has about 1500 inhabitants in three camps. Since 1 year a secondary school has been opened and there has been a primary school for quite some time. An organization called Shepherd's Heart is working hard to uplift the quality of life of the islanders. Projects ranging from agriculture (digging), clean water (McGuire purifiers), education (school), health care (small clinic and lab) and mission (Christian). The local population and the Mission people warmly receive us. We talk about their work and progress. They have been digging land around their newly constructed houses and face dangers as roving goats and mischievous monkeys. Last weekend a troop of primates destroyed the eggplants. They know exactly when fruit or vegetables are edible and wait until the humans turn their backs to strike. The goats are less delicate. They come and chump away until the dogs, or the diggers chase them.
Not only are there monkeys on the island as we depart I see a water snake and I am told on neighboring islands there are pythons that have eaten goats and dogs. And then there is the waterbuck. It is hard to believe that the island only has a circumference of 6 kilometer.
Termites build hills up to a meter and a half. The students are asked to help remove them. One girl stands out as she chops away with a hoe until the entire mount is gone. Too bad she could not find the queen. The highlight of my visit was my inauguration as a Scout. A circle was formed and with a left handed greeting I was inaugurated. Hoping to be prepared the rest of my life.
The islands rock and lots of work to do there.

Namaskar, Ashis

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Posted By Ashis to Ugandashis on 11/12/2008 06:03:00 AM

Homecoming

2008-10-14T07:55:00.000-07:00

UgandAshis 1: Homecoming
Monday, October 13, 2008.
“ How does a frog move? ” Hop-hop… Twelve kids squatting and hopping. “ And how does a snake go? “ Slither-slither… Slide, slide. Arms and legs move side to side. Here I am at a very special occasion. It is a meeting to decide the bride price according to the Ugandan traditions. I am back in Uganda after 5 years and this time it is possible to dance with the kids.
In 2003 I had been working for Doctors Without Borders in Lira in the Northern part of Uganda. The Lord Resistance Army (LRA), a motley group of child soldiers, sex slaves under the lead of a self proclaimed Christ, Joseph Kony was terrorizing the entire province. Burning of houses, capturing of children, killing, raping, maiming and amputating limbs of civilians was common then. It was the time when a documentary appeared about the children leaving their villages at the end of the afternoon to sleep on the porches of shops in the bigger cities of the province; Lira, Kitgum and Pader. Hundreds of thousands of people could not till their land for fear of being attacked by the LRA. Despite the fact that the area is a fertile one acute hunger and malnutrition of children and adults was rampant. It was a stressful time as the outskirts of Lira were attacked while I was there. In the short month I was in Uganda I helped starting to set up a therapeutic feeding center next to the hospital in Lira.
Even in that short month I came to feel the kindness and easygoing ways of the Ugandans. And in the few short days I am back now I feel it again. Joseph, Dr Dickson, Liz, Willy, Anne, Tyson and everyone I meet treats me as if I am part of the family and have been for years. That feeling of homecoming is pure bliss. It makes it easy to be.
The equator runs through Uganda and it makes it an interesting geographic and social launching pad for the Phoenix Global Humanitarian Foundation. As many countries in Africa there is corruption, social injustice and at the same time there is hope to tackle and address the HIV epidemic and to develop the country economically.
This year I have been traveling in Chad, Gabon, France, India, the USA, Cuba, Mexico, Colombia, the Netherlands and now Uganda. A deep yearning for a home has been surfacing. It may sound strange but in three days in Uganda it may all come together. As a choice of a place to stay and have as a base it looks super. Let us see if over the next 6 weeks this feeling gets stronger. If so I will act on it.
Kids are beautiful all over the world. Yesterday it was so much fun to dance with the small ones. Children are gifts to the world. They are the reason to act and improve our actions in the World. The reason to find a solution for the fuel, food, financial, banking, capitalistic, emotional, and military crises the world is currently facing. Let all our inner child’s unite and let there be a dancing party world wide.
Namaskar, Ashis

Ashis pointing.

2008-05-12T16:34:00.001-07:00

Ashis pointing.:

Ashis on i-ACT Darfur

2008-04-04T14:48:00.000-07:00

Ashis on 60 Minutes

2008-04-04T14:08:00.001-07:00

Watch the video on the CBS News Website

It hardly seems possible, but after four years the genocide in Darfur continues. The government in Sudan has launched a new offensive, maybe trying to finish what it started three years ago. As correspondent Scott Pelley reports, more than 300,000 people are dead and more than two million are refugees in the Sahara.

To understand what is happening in Darfur, 60 Minutes came upon on the story of a boy named Jacob. We know him only because his name is on schoolbooks found in the ashes of his home. Jacob's village was wiped out. Our team saw his books in a museum. We didn't know whether Jacob was alive or whether we could find him. But we decided to try. Our search turned into a remarkable journey into a place we were forbidden to travel looking for a boy swept up in the 21st century's first genocide.

There were more children in the clinic. Ashis Brahma is the camp doctor. One doctor for 25,000 people.

"We have very simple drugs here but I'm doing funky medicine, voodoo medicine or bush medicine," Dr. Brahma explains. "I'm doing what we can here with the medicines we have without equipment."

Our team met a starving child framed like a picture against that vibrant culture that used to be with little certainty of a future. Dr. Brahma was hopeful for this girl, suffering with meningitis, but she died in just a few hours.

"What is it that you think people don't understand about what's going on here now?" Pelley asks Dr. Brahma.

"This is bad. They go to the villages, and they burn one village after the other, then when the people come out they catch the women and gangbang, they rape them not one guy, no 10, 15 then they carve up the men and throw them in the drinking water to make sure that this place will never ever be used again. And you're telling me the people in America don't know this or don't want to know this. Maybe its too much to know but that's what's happening right now and its happening all over again," Dr. Brahma says. "I'm sorry to say I'm going to sit here with you in two years time and I'm gonna tell you the same sad story. People will say, 'Ich habe nicht gewusst,' which is German for 'I didn't know.'"

Ashis on 24 Hours for Darfur

2008-04-04T14:01:00.001-07:00

Ashis at the Free Hugs Campaign

2008-04-04T13:21:00.000-07:00