#fibertuganda

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Hello Uganda!

We arrived into Entebbe after dark.  Entebbe is the upmarket extension of Kampala, the capital of Uganda, which is home to lots of official headquarters.  We stayed in a guesthouse owned by a friendly English couple who have retired to Uganda, who eased our culture shock with their Britishness; they recounted tales of their experiences in Uganda, & imparted some of their wisdom as fellow Brits in Uganda.  We awoke to see Uganda in the daylight for the first time.  We’ve both been to Sub-Saharan Africa before, & you can’t mistake where you are, with the red dusty roads lined with mud huts & colourful hand painted signs, with a hustle & bustle, with people often wearing vibrantly coloured clothes & carrying impressively large loads on their heads.  However, one striking difference between Uganda & other countries, is how green it is.  Ugandans are also particularly friendly, & as we walked along the streets we were greeted with lots of shouts of, “mzungo” & “how – are - you?”, particularly from the children.  There is the odd child, who are usually very young, who simply runs away screaming when they see us.  We’ve been told that Ugandan children are sometimes threatened with getting fed to a mzungo if they are naughty, a bit like we might get threatened with a lump of coal from Santa, & so that might explain the reaction.  We had always thought mzungo simply meant, “white person”, but it turns out the official definition in Swahili is, “someone who wanders without purpose, lost or dizzy” -which sounds about right!  However on asking the locals, they defined it as, “person of different colour/ superior/ rich”.  The stock response to “how are you”, is, “I – am – fine”, & they look a bit confused if you give them any other answer, I guess it’s the same as we are taught in school French that the only answer to “ca va?” is “ca va bien”.  At first we wondered why everyone was asking us how we were, but we’ve now figured out that this is the direct translation of the greeting in Rukiga, the local language in Kisiizi.  We eased our culture shock further by spending our first day hanging out in various café’s, bars & restaurants, overlooking the beautiful Lake Victoria.

That evening we were joined by another British couple who were incidentally flying into Entebbe the day after us also volunteer in Kisiizi; Gordon is also a doctor, & his wife Sophie is a primary teacher who will be volunteering in the primary school attached to the hospital -& the poor things haven’t spent more than a few hours apart from us since!

The next day we all ventured into the hectic Ugandan capital of Kampala, to apply for registration with the Ugandan Medical Council, & to get Ugandan SIM cards so we could get back in touch with the world.   The traffic in Kampala is busy & chaotic, it is overrun with small motorbikes, called “boda-boda’s”.  They carry impressive numbers of people, the most people we’ve seen on one so far is five, & equally impressively large loads, we saw a double mattress being carried which left a trail of swerving traffic & ducking pedestrians in it’s wake.  They weave in & out of traffic, squeezing into seemingly impossibly small spaces; we’re not surprised to hear there is a ward in Kampala’s hospital dedicated to victims of boda-boda accidents, & for the less lucky, there are an average of five deaths per day in Kampala alone.  We enjoyed our last evening in civilization by going out for a lovely dinner & drinks in Entebbe.

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What have we let ourselves in for?

The journey from Entebbe to Kisiizi took us twelve hours; we enjoyed looking out of the car windows admiring the luscious green scenery & the beautifully rustic Ugandan villages, in between napping, as we travelled increasingly remotely, & the roads became increasingly windy & bumpy.  We stopped off at the equator on the way to take the obligatory photos, & marvel at the water swirling different directions down the plughole on the different sides of the equator.  With Uganda being on the equator sun light hours are reliably between 7am & 7pm, & it rises & sets quickly within a few minutes.

Kisiizi is a small rural town in South West Uganda that has grown up around the hospital.  The hospital was built here in 1958 because there is a waterfall that provides hydro-electricity & a water supply.  The sound of the waterfall can be heard out across most of Kisiizi.  It sits in a beautiful green valley lined with forests, plantations, crops & mud huts.  There is an amazing array of exotic looking birds who sing from morning till night, particularly first thing in the morning, so we’re now getting used to being woken up by birdsong.  We have a particular favourite who has a call that sounds a bit like a computer game.  And when the goats join in & the cockerels are cock-a-doodle-doo’ing, there can be quite a racket.   To accompany the birdsong, there is a large drum that sits in the hospital grounds that beats out across Kisiizi several times a day, the first time being at 6.30am in order to waken everyone for the days work ahead.

Kisiizi has recently started trying to establish itself as a tourist destination, & they have built a Visitors Centre, a zip-line over the waterfall & a lagoon for kayaking.  Kisiizi has a dark past, it used to be the site for throwing girls, with their hands & feet bound, off the top of the waterfall & to their death, as punishment for becoming pregnant out of wedlock.  There is now a moving statue that was made by a local artist in memorial of this close to the waterfall.  The money made through tourism is then used to pay for healthcare in Kisiizi Hospital for those patients that cannot afford it.

The majority of the population around Kisiizi are subsistence farmers, & the local people can often be seen hoeing & carrying heavy loads of water & goods. 

English is the official language of Uganda, but there are over 50 different local dialects spoken throughout Uganda.  Most professional & national communications are in English, for example most communication between healthcare professionals in the hospital is in English, however many of the patients don’t speak English.  We are trying to learn a bit of Rugika, but we’re really struggling to remember & pronounce the words, they are just so different to English, it’s not like learning another Latin based language.  The language barrier makes working in psychiatry particularly challenging.      

The Ugandans love a carb, & a lot of meals here contain two, or even three carbs, some of their favourite, being Irish, their name for potatoes, & matoke, which is like a savoury banana.  There is also an amazing selection of delicious fruit & vegetables here, which make the fruit & vegetables at home seam bland in comparison; we seam to have sacrificed taste, for size & regularity.  Our new favourite snack is cutting open a passion fruit & then scooping out & eating the insides with a spoon.

Kisiizi has an amazing sense of community, with everyone looking out for each other, which is something that is sadly often lacking at home, although we also get the impression it is your typical small town which likes to gossip.  We have received the most warmest welcome, & been made to feel instantly at home.  

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We’re off to Uganda!

As a psychiatrist I’ve always had an interest in global mental health, as culture plays such an important role in mental health.  It's long been an ambition of mine to volunteer abroad as a psychiatrist.  I was particularly drawn to Sub-Saharan Africa; I love the culture, & there are several challenges in delivering mental health services, in particular the low-income of these countries, & the stigma of mental illness.  And conveniently my husband Rob, as a GP, also had similar ambitions to volunteer abroad, which meant this was an adventure we could share together.

So, we set about trying to find somewhere suitable to volunteer.  Due to the limited mental health services in Sub-Saharan Africa relative to general health services, we decided that we would first find a suitable mental health service for me to volunteer in, & then we would find a general health service close by for Rob.  After lots of failed attempts, we actually found Kisiizi Hospital, where we have ended up volunteering, through my brother Tim; he attended a course, at which there was a lecture on global psychiatry, & the speaker was a psychiatrist who has a link to this hospital, which unusually has a psychiatric department.  So, we organised that I would volunteer in the psychiatry department, & Rob in the medical & paediatrics departments, in Kisiizi Hospital.

We’ve had a hectic few weeks before setting off for Uganda, whilst we moved out of our flat, made our final preparations & said our goodbyes to friends & family.  We felt a sense of relief as we finally landed in Uganda after we’ve been planning our trip for so long.

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Business trip to Bwindi

We had been told that another Ugandan hospital, Bwindi Hospital, has a particularly good community mental health service, & so we decided to spend a week with them, to see if we could learn anything that we could take back to Kisiizi Hospital.  We stayed in Bwindi Hospital guest house, where we spent time with volunteers at Bwndi Hospital, & compared our experiences of being volunteers, overall we were glad that we’re volunteering in Kisiizi Hospital.  

Bwindi is also one of the gateways to the Impenetrable forest, which is home to the famous mountain gorillas.  It costs a whopping $600 to go gorilla trekking (it’s an even more ridiculous $1500 in Rwanda), & this means that it receives a lot of high-end tourism.  We enjoyed some of the trappings of tourism that were there including restaurants, bars & gift shops, all of which Kisiizi lacks.  We didn't go gorilla trekking during this trip, as we plan to do it later in the Congo (it’s only $400 there, & we’re planning to go in the off season when it’s half price).  Instead we ventured just to the outskirts of Impenetrable forest to do a self-guided walk.  We trekked through dense jungle, with our eye peeled in the hope we would be lucky enough to catch a glimpse of the magnificent gorillas for free.  Unfortunately the gorillas did not oblige, but we were rewarded with a family of monkeys swinging through the trees.

Bwindi Hospital is a Church of Uganda Hospital, as is Kisiizi Hospital, & was founded by an American missionary doctor 14 years ago.  One of the reasons for founding a hospital here was to serve the local Batwa (Pygmy) community whose traditional hunter gatherer way of life has been destroyed, & they have struggled to integrate into modern Ugandan society, leading to multiple problems, including high rates of alcoholism.  Bwindi Hospital is similar to Kisiizi Hospital, but is at an earlier stage of development, & has a more ‘American’ feel; we particularly liked the colourful murals on all the walls.  It was interesting to compare the two hospitals.  The American founder happened to be visiting whilst we were there, who is one of those people who leaves you in awe of how much he has achieved in his life, but despite that is very humble & interested in other people.  He explained that one of the ways he raises money is by hanging out in the fancy hotels frequented by the rich tourists that visit the area, & dropping Bwindi Hospital into conversation.  They also provide tours of the hospital to tourists; I felt slightly uncomfortable when I saw a group of mzungos dressed in safari gear going around taking pictures with their long lenses.  But we understand that both of these ploys can sometimes leads to very generous donations.  

The mental health service in Bwindi is ran by Kuule, a psychiatric clinic officer who also has a qualification in community psychology, who has been visionary in developing the service there.  There is no psychiatric ward, & they try & manage patients with mental illness in the community as much as possible.  If they do need admitted, then they are admitted to a bed on the general ward, & managed by the mental health team.   The focus of the service is therefore on providing community mental health services, & they carry out lots of outreach clinics & home visits.  

I joined the Bwindi mental health team on a home visit, which they were carrying out because this patient had repeatedly not attended outpatient clinic appointments.  When we set out, little did I know that we were going to climb a mountain the size of a Munro in order to reach this patient’s home.  From the top of the mountain we enjoyed beautiful views over Uganda, & even into the Congo.  By the time we arrived I was very hot, sweaty & sunburnt, in my work clothes, by which time were covered in mud, having not gone to work that day prepared to do a hike!  But despite my disheveled appearance the patient & his family gave us the warmest of welcomes.  We were told that the patient & his family had been going through financial difficulties, & so had been unable to afford medication, & so his local village had decided to club together in order to pay for it, which just shows the amazing community spirit that exists here.  The home visit was a five hour round trip, & it made me appreciate the journeys that some of our patients have to make in order to attend appointments, & the challenges in delivering a mental health service in these areas.  

With the high rates of alcoholism, Bwindi Hospital is particularly good at managing alcohol misuse disorders, & run several AA groups, one of which I attended.   The meeting started with introductions in the usual AA style, "hello my name is..., & I'm an alcoholic".  Awkwardly all the other healthcare professionals attending were able to honestly say, "I've never tried alcohol", whereas we just skirted over our own relationships with alcohol! It was touching to see the members sharing experiences, & providing support to each other.

The Bwindi mental health service also runs an innovative farm project.  There is a half acre plot of land next to the hospital grounds on which patients recovering from alcohol problems can farm.  The idea is that they can channel the time & energy they would have previously used seeking out & using alcohol, into farming; they cultivate crops, & manage a herd of pigs & a chicken coup.  It also provides the patients with some structure to their day, a purpose in life, & helps rehabilitate them back into the community.  The plan is to replicate this project throughout the hospital’s catchment area, & to offer this opportunity to all patients suffering from mental illness.  On the day we arrived there was much excitement as the chickens had produced their first eggs, & the profits made being reinvested back into the project.

I plan to take back some of the good work I have seen being done in the Bwindi mental health service, to Kisiizi Hospital.  Robert has spent time in various departments in the hospital, in particular the outpatient department, where he works in Kisiizi Hospital, in order to see if there is anything he could also take back with him.

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Lake Bunyoni

We took a trip to the beautiful Lake Bunyoni for the weekend, with some of the other volunteers at Kisiizi Hospital.  We finished work at 5pm on Friday, & then took the two hour drive to the lake.  Our accommodation was on one of the many islands on the lake.  We arrived at the shores of the lake after dark on a wonderfully clear night, & then took a magical boat ride to our accommodation, under an amazing display of stars; we were able to see the milky way clearly, & spotted several shooting stars.  We stayed in a ‘geodome’, at Byoona Amagara eco-resort, which was a dome structure that was open to the lake side, meaning we could lie in bed & hear the birds even more clearly than normal, & admire the stunning views of the lake.  

The first day we rented a canoe, that was made from a hollowed out tree trunk, & eventually managed to paddle in a zig-zag line across to one of the other islands (steering proved challenging).  The other island had a rope swing that involved swinging from a high platform into the lake.  There were some initial nerves when we first climbed up onto the platform & realised just how far we were from the lake, but we all gave it a go in the end, & despite some near catastrophic jumps, we all survived to tell the tale. We also made good use of our new GroPro, making some cool videos of jumps, & capturing some of the fails.  

The next day we took a wildlife boat tour on the lake, & saw lots of exotic birds, & zebra, that inhabit one of the islands.  We also saw the island which was a lepor colony in the past, & 'punishment island', where unmarried pregnant women were left to die.  This was all topped off with great company, lots of good food & drink, & some epic games of charades.

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Making a home for ourselves in Uganda

Rob & I have been put up in a lovely wee house, called Wendy House, amongst the other volunteer’s houses, approximately a two minute walk from the hospital, which makes for a great communte.  The done thing for working people to do here is to hire a “house boy/ girl” to do your cooking & cleaning.  Initially I wasn’t sure about essentially having a servant, but my guilt was eased when it was explained to me that it is a good way of giving employment to a local person.  And so, jointly with our neighbours, Sophie & Gordon, we have hired the lovely Annet, who I think I will now struggle to live without when we return home.  Most of the hospital staff live within a similar proximity to the hospital as we do, & it seams that for many people here, their life is their work, I think in the long-term I quite like being able to leave my work behind when I finish.    

There’s a good group of volunteers out in Kisiizi at the moment, it’s really sociable & thankfully we all get on really well; it’s nice to have people to travel with, & to share experiences with, & sometimes just to be like, “isn’t it weird how they do this here?!”.  And we’ve spent many hours playing various games, of which Bananagrams & the card game, ‘farmer’s bridge’ are some of our favourites.  

The hospital runs a keep fit class that we’ve been going to, to keep in shape.  Before we first went we were expecting a nice gentle work out, but we got a bit of a shock when we found out they were doing a Joe Wick’s HIIT work out, which will keep us fit while we’re here.  We’ve also been doing some running, which has been pretty challenging, being in the bottom of a valley, basically any run you do involves a steep climb, & this is combined with the uneven roads, altitude (we’re at ~1700 metres above sea level), dust & the fumes makes breathing difficult!  However, the altitude does mean that the climate here is very pleasant for running …& just for living in general.  Although Uganda is the home of the men’s Olympic marathon champion, going for a run is not a “normal” thing to do here, so we get a lot of attention when we run, most of it well meaning, however, the friendliness of my response can be variable depending on how exhausted I’m feeling!  We have also had a few locals joining us for parts of our runs, usually wearing flip flops, & barely breaking a sweat as we struggle to keep up, so they obviously have good running genes.  We have signed up to do the Running the Rift half marathon in Uganda in November so we’d better get training.  There are also lots of beautiful walks around here, but similarly to the running they all involve a steep climb, but the views at the top make it worth it.  Every evening after work the locals meet on the school pitches to play various sports, including football, volleyball, netball, badminton & touch rugby.  Rob’s been getting involved in the football; they play with skins (no t-shirt) versus shirts, & from what I’m told teamwork is lacking, with everyone just chasing after the ball.  I’ve had a wee go at touch rugby.  I’ve also been teaching Rob some yoga, & he’s been getting pretty good at the old downward facing dog.

With the strong Christian faith of Kisiizi community, we’re told that any alcohol consumption is generally frowned upon, so we’re having to (largely) hold off for when we travel outside of Kisiizi, so we’re undergoing a bit of an enforced detox, which I’m feeling pretty good for.  

We have discovered that the Ugandan’s love of speeches extends beyond chapel.  We attended a leaving party for a member of staff at Kisiizi Hospital.  We weren’t sure what to expect before we went, but the night essentially consisted of all attendees giving speeches about their departing colleague, with the finale being a speech by the departee himself.  And we have to say they give a pretty good speech.  I think if I’m ever going to be cured of my phobia of public speaking, then this will be the time!  

You can get the bascis in Kisiizi, but we take a trip to the nearest town of Kabale, which is about one & a half hours drive away, about once a month, in order to do a supermarket shop.  The supermarkets are not what we’re used to at home, & are very cramped & chaotic in comparison, with only a limited, & often randon, selection.  The drive to Kabale is beautiful, & it’s nice to get away for a bit every now & then.  Rob was also delighted to discover both that there is a golf course in Kabale, & that he had a fellow golfer in Gordon, & so on our first vitist to Kabale, they enjoyed a round of golf whilst us girls enjoyed a nice cocktail in a bar with a beautiful view.  Although I think the game was only tolerated in the end, as apparently they’re not as particular as we are at home about keeping their greens trimmed, & they had negotiate the resident goats.  

There’s lots of beautiful brightly coloured, patterned material on sale here & skilled tailors who will make it into pretty much anything you want, you just draw them a picture & they will make it for you.  So far I’ve got a skirt & a dress made, & I’m planning what to get made next.

We were invited to dinner with the family of one of Sophie’s teacher friends, who lives about a half an hours drive from Kisiizi.  It started with a slightly hair rising taxi journey along a dirt track, in the pouring rain.  We paid slightly more for the taxi not to be ‘overloaded’, & so only 10 of us piled into one car, including 2 people in the driver’s seat.  There was almost no visibility, & the driver smelling strongly of alcohol, but with an apparent passion for speed.  There were a couple of near misses, but we were all relieved to make it to our destination in one piece.  And we were rewarded with the warmest welcome, & a delicious feast of traditional Ugandan food; it was really touching to see the effort that the family had gone to with the meal, & how much our visit meant to them.  

Two months in Robert was badly in need of a haircut, so with trepidation we ventured down to the little shack down the road, with the sign, “Hair salon & shoe repairs”.   Our friendly hairdresser, also called Robert, was as nervous as my Robert, as he set out cutting his strange “mzungo hair”, but there was not need to fear as he created a very nice short, back & sides that any trendy Finnieston barber would be proud of, & all for the equivalent of just 50p.

Robert celebrated his 32nd birthday in Uganda.  With only limited birthday present options, I was forced to get creative, & lucky Robert was the recipient of a random collection of handmade gifts from me.  I also asked a local lady to make a birthday cake for him, which was decorated with the lovely message, “happy day to you”.  Birthdays aren’t really a big deal here, in fact lots of our patients don’t even know their date of birthday or age, so they wouldn’t even know what they were celebrating, & when to do it.  We celebrated Robert’s birthday with a little party with some of our new friends in Kisiizi.    

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Ugandan names

We’ve been particularly taken with the Ugandan names.  Here they don’t seam to be confined to using existing names, but will use any word they fancy, often of a positive (or not so positive) attribute or the name of something they like.  Some of our favourites so far are Confidence, Innocent, Immaculate, Marvelous, Precious, Generous, Fortunate, Trust, Promise, Memory, Sincere, Brillient (note the spelling mistake), Melon & Small.  I had a patient who was aptly named Happy, who suffered with Bipolar, & was in fact a very happy man! Sophie teaches a poor child who has the pressure of being named Saviour, & another poor child who is doomed with the name Anxious.  In amongst these names are lots of very British names, including Allan, Brian, Clive (who pronounces his name cleave), Trevor, Harold, Vera, Dennis, Maureen, Doreen, Gladys & Agnus.  We were surprised to be told that both Robert & I have good Ugandan names.  However, the Ugandan spelling of my name is bizarrely Phionah.  And apparently there are no L’s & R’s in Rukiga, & so native speakers get confused between the two, which means Robert sometimes gets called Lobert!