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…yeah remember that? I never did end up watching Kony 2012, but I did drive by what used to be Joseph Kony’s home last week. I wonder if Ugandans know that high school and college students around the world were sporting “Kony 2012” paraphernalia in 2006.
 This way of compartmentalizing seems to align with my observation of Ugandan culture and personalities. Ugandans (yes, I’m generalizing) live very much in the present which can make it difficult to plan ahead (socially and professionally). Many of you can probably talk about a time where you were angry down to your core – I don’t find that Ugandans express their deep seeded frustrations or dwell on controversial topics. There’s this tendency to just move on from arguments and laugh about things, which can be frustrating or conducive depending on what your desired outcome is. Sure, there were riots surrounding the election, but many have come to accept Museveni’s rule and corruption as just how it will be. I was surprised to hear how many Ugandans truly believed that Besigye would have won in a fair election but figure that Museveni is old and will die eventually. Perhaps this attitude and lack of passionate anger is partially why this corruption has been able to endure for so long. My colleague who lived in Uganda during this time said that it was life-as-usual in the capital. They were vaguely aware of what was going on up north since it was absolutely unsafe to go anywhere near there, but they were not affected by it even though it’s only 4-5 hours away by car (though the roads are much better now so it probably took a bit longer). I’m trying to learn more about modern Uganda history so I'm currently reading The Teeth May Smile But the Heart Does Not Forget which follows a son's search for answers around his father’s sudden disappearance about 30 years ago. So far it's a really powerful read. On a more touristy note – I have to highly recommend the Iron Donkey Café in Gulu. They have a legit coffee machine, grilled cheese & tomato soup, wraps, and a killer quesadilla (granted my bar has been lowered). I would have never expected to find such a slice of home so far outside Kampala. Thanks Nicky for the suggestion!
...woah woah woah, back it up. First, you have to participate in an "introduction." Christine, the woman who cleans my apartment, invited me to her cousin's introduction. An introduction is a traditional pre-wedding ceremony where the man's family is formally introduced to the bride-to-be's family. This is also where the exchange of the dowry takes place. The introduction took place in Mukono, about 40 minutes outside Kampala. Different cultures within Uganda have slightly different types of introductions. The one I attended was Bugandan (of the Banganda people) which my colleague tells me is known to be more dramatic and eventful. The women are all dressed in traditional gomesis which are long silk dresses with pointy shoulders and a big bow. Some men wore long white tunics, kanzus, but others were in suits.
Unfortunately, I could only stay for the first hour, but I hear that these introduction ceremonies can go on for 7+ hours - there was a big meal, Christine said a chicken for each person(!!), and of course, lots of dancing.
"When I told Christine that in the United States, traditionally the bride and her family foot the bill for most of the wedding expenses she exclaimed, "how can that be?! The woman will give you children!!" The bride’s brother was also there and when we were ready, he walked in front of the caravan of cars and led us to the area where the ceremony / party would take place. I asked why we kept stopping, and Christine explained that the brother had to pretend that he was deciding if he wanted to invite us and lead us to the right place. The first car therefore has to play along and was also stopping on its own as retaliation. Once we got to the main area (I think outside the father of the bride’s house), we parked over to the side…Christine says they made us park “in the bush.” Everyone got in two lines, one for women and one for men as they prepared to ask permission to enter the area. Both families are represented by a spokesperson. The emcee on the bride’s side I assumed was her father, but my colleague says that he was probably hired and that people who chair these introduction ceremonies can make a lot of money.
I didn’t expect the introduction to be so theatrical. It was pretty funny as the spokesperson for the bride’s side essentially gets to berate the man and his family and they just have to keep saying “thank you for your comment, can I please respond,” or things like that. For example, in typical Ugandan fashion, we were about two hours late. The groom had sent a letter requesting permission to come and I guess he said we would be there at 1pm sharp. When questioned about this, the groom’s spokeperson blamed the roads, the rain (it didn’t rain that day…), and having to come from many villages. From what I could tell, the ceremony includes different representatives from the bride’s family (the girls in the video are the bride’s sisters) coming out, dancing a bit, saying a few words, and then her spokesperson asking the groom’s spokeperson if they’ve brought anything for them for their time and trouble. They then will hand over envelopes of money and continue on. Underlying all of this, the groom’s side is pretending to look for the bride among her sisters and the women in the audience. The bride was in the house and I don’t think she comes out until the end of the ceremony. The groom, sits towards the back and is represented by his spokesperson who you see in the video.
Election day is tomorrow and things have been getting crazy in Kampala, so I have retreated to nearby Kenya.
I am hanging out at Diani Beach for a few days and it's beautiful and so relaxing. There's nothing like falling asleep to the sound of crashing ocean waves. I'm getting some dives in and will try my hand at kite surfing before I head to Nairobi for the weekend. Updates and photos will come on the soon-to-appear Kenya page!  Another highlight of the Sipi trip was brewing our own coffee. While I’m not a coffee drinker, I was excited to see the local coffee production process and the end product was actually really good! I drank the whole cup, Zea would’ve been proud. :) We started in Mangusho’s garden where he grows coffee beans. They’re Arabica which means they have 2 beans per berry (is it a berry?) instead of 3 beans, which would be Robusta and apparently not as good. Once the plants grow in his garden, he replants the seedlings in little bags for each to grow on their own. They grow in the shade of banana trees which is perfect for them because it keeps them out of direct sunlight. The elevation at Sipi is also ideal for good coffee plants. Melissa may have to help jog my memory on this, but I think they then grow for another 9 months before they’re ready to be planted in the soil to grown into larger trees. Mangusho showed us a coffee tree that his grandfather planted years ago – he’s carrying on a family tradition. Legend goes that that was the first coffee tree in Sipi!
It takes 4 weeks to dry the beans, so we jumped over that part of the process. Once you have the dry beans, you need to remove the husk. While you can do this by hand, as you can imagine, that is very tedious and time consuming. So we used a wooden mortar and pestle. It’s important that the mortar is really deep so the beans don’t escape. Once our arms were too tired to continue, Mangusho took a plate and artfully separated the beans from the husks. We’re now ready to roast the beans! I had no idea that the difference between light, medium, and dark roast is simply how long you roast them for…so self-explanatory haha. At Mangusho’s suggestion, we decided on a medium roast. The beans crackle a little kind of like the early stages of cooking popcorn on the stove. It smelled great! Once they were ready, we let the beans cool on a banana leaf. Mangusho had us try the beans – they were pretty tasty. Definitely really flavorful. I feel like describing the taste of coffee is similar to describing the taste of wine, so I’ll continue to steer clear of both.
Ina, Melissa, and I took my car, yet to be named, on a little road trip to Sipi Falls in January. Without traffic and with good roads, it would probably be a 4 and a half hour drive. But, the 190 mile journey took us about 6 hours on the way there and 8 on the way back because we hit some bad traffic coming back to Kampala. We stopped at Mbale Resort Hotel for a late lunch on our way up. There’s a nice pool that you can eat by and the food was pretty good, and cheap by Kampala standards. The roads to Mbale are pretty nice (just need to keep an eye out for all the speed bumps) and it’s just the last 45 mins or so from Mbale to Sipi that are full of potholes. Crow’s Nest is a really popular budget option and has a great view of the falls. But Lacam Lodge, where we stayed, includes all meals (and they're great) so once you factor in food costs, at $25 a night, I would highly recommend it. We stayed in their dorms, but they also have nicer bandas that have their own bathrooms and outdoor seating area. You can also arrange all your activities through the lodge. Our amazing guide, Manugsho “Steve” Martin took us on a 4-5 hour hike of the three main falls in the area. I’ll let the photos speak for themselves. The following morning, we checked out Mangusho’s favorite waterfall before hitting the road and heading back to Kampala.  Mangusho (which means “elephant”) is half Kenyan and half Ugandan. His dad was a Masai warrior but unfortunately killed by poachers when Mangusho was young. Soon after, Manugsho, his mom and brothers moved back to Sipi, the home of his mom’s tribe, the Sabine.
Before he turned 18, Manugsho participated in the male circumcision ceremony which is a pivotal right of passage. In Kenya, this ritual is done in private with only males present, but in Uganda, the ceremony is a huge public gathering and celebration. Teenage males will spend the year prior to their circumcision building themselves a home close to their parents. Once they have “proven themselves” they will live on their own, but it’s important to still be closely their families. As a well educated son of a warrior, Mangusho was chosen to go first. During the ceremony, the males are not supposed to flinch or cry - their faces are even painted so it’s very obvious if they do. Those that don’t make it through the circumcision are publicly shunned (I think they’re actually given slashes on their arm so it’s visible to everyone) and likely will never have a family. We asked Mangusho what he would do if he had sons - would he circumsize them in the hospital or have them endure the same pain he went through? He said that for safety, he would prefer the hospital but because the male circumcision ceremony is such a big part of Sabine culture, he would want them to participate in the ritual. We loved learning about Mangusho’s life and would highly recommend him as a guide!! Sipi is beautiful and relaxing - perfect for a 3 day weekend getaway. With more time, I would have loved to climb Mt. Elgon which we could see in the distance. Wanale Ridge in Mbale is also supposed to be really great.  Family Planning register and some ARVs After a 1:45 AM wake-up call to watch the Superbowl, I spent the day at Buwama Health Center III.
I am working to support a National Technical Support Supervision where members of the MOH and other IPs are visiting about 100 facilities across the country. We have a 30+ page questionnaire that we go through at each site to understand to extent at which facilities are using nationally provided tools, supplies, and recommended patient flow / patient care processes. We then wrap up the visit by debriefing with the available facility staff and developing an action plan with owners and deadlines (#PMOmg). So far, I’ve been to five facilities and it’s been incredibly eye opening. It’s easy to back up pilot recommendations or national roll-out strategies with some data, but actually seeing how things are done (or not done) on the ground has provided invaluable context to the work I’m doing. The quantitative and (potentially more impactful) qualitative data we are collecting will be compiled and shared with DHOs (district health officers) nationally in the coming months. The first two facilities we went to were doing a great job. The staff was engaged, open to our suggestions, and seemed to be doing all they could to provide high quality care to the large volume of patients that arrived each day. While that was awesome to see, it almost discouraged me a bit about the strengthening work we are doing. It made me feel like without hiring a lot more staff and building more rooms to see patients, we’re grasping at straws hoping we get lucky that the infants or children we test are from the frequently cited unidentified HIV+ population. The third facility, which was pretty rural, was not performing at the same standards at all. Their in-charge seemed detached and unaware of all the problems in his facility. The majority patients they were able to identify were not being retained on ART treatment. My program manager tried to express the gravity of this situation by explaining that the poor healthcare and follow-up services would have a much greater impact on the surrounding villages than they may think. The CD4 cells of those who take 1st line ARVs and then stop after a few months or even a few years, will mutate and become resistant to the drugs. That means that if the patient starts the same treatment regimen again, the drugs will not be as successful in suppressing the virus. The next step would be to put the patient on 2nd line ARVs, but the side effects are much worse. There are 3rd line ARVs but they are not available in Uganda as PEPFAR does not support them. All that being said, having poor retention rates for those initiated on care, means that there are HIV+ people in the local community who are not virally suppressed and likely spreading HIV to other people. Those people are getting a mutated strain of HIV that is already resistant to treatment – so if and when they seek treatment, it will not be as successful. That discussion was disheartening and reenergizing at the same time. It showed me firsthand that there is so much work to be done. But, it also made me think about what challenges we’re addressing in our work which are mainly process based (testing at more entry points, following-up with patients via SMS / phone calls / home visits, etc.) versus some of the underlying systematic challenges. At the facility I just discussed, the core issue seemed to be the staff. My team told me that basically the in-charge was linked to a MP (member of parliament) which essentially made him (and his two sons he employed to work there) untouchable. Because the community is small and rural, it’s likely most other folks are closely connected as well rendering them untouchable and it’s hard to incentivize people from other areas to move there to work there. But what if we paid health care workers more? In most cases, they already work for close to nothing and meanwhile we are paying MOH staff to come to meetings. For example, last Friday CHAI hosted a meeting about a new testing algorithm that’s being proposed and every government official in attendance received transport reimbursement (even if coming from Kampala) as well as ~$40USD. Apparently, one of the more recent PEPFAR grants tried to ban the payment of per diems to MOH officials since…it’s their job…but that had to be removed as no one would show up to the important meetings. In the same meeting, someone made a comment about all the efforts around follow-up initiatives. He said that the way we are talking about follow-up assumes that forgetfulness is the reason why mothers are not coming back with their children for treatment. However, we are ignoring that many of these patients don’t live close to facilities and transport costs are high (and if the wait is long, they may have to go home without being seen that day). Perhaps we need to instead hire more VHTs (village health teams) to engage communities and bring treatment to the patient instead of vice versa. On a lighter note, at Buwama today, I saw the newest born baby I’ve ever seen! I remember growing up always visiting my new cousins a day or two after they’re born, but I was sitting in the maternity ward going through some registers when Brenda, one of my colleagues, and I heard a baby crying from the labor suite across the room from us! I had no idea anything was going on because apparently mothers are not allowed to make noise during labor. About 15-20 minutes later, the midwife slowly walked the new mother out and let her rest on a cot in the room. Then another woman brought out the baby for its first feeding! There was no privacy at all, not even curtains. We were sitting maybe 10 feet from her and the door of the room led outside so people were coming in and out frequently. Brenda says she’ll stay there for a night or two before she’s discharged to go home. She had a small suitcase with her with some blankets and clothing. It reminded me of this article another colleague shared last week. What a jarring juxtaposition at the inequity of services and resources mothers-to-be face across the world. As if that isn’t enough…mothers usually will come to the maternity ward when they are in labor…mode of transportation: BODA?!?! It looks like the NRM has been handing out 50,000 UGX notes (about $15 USD) as they've traveled around the country hosting rallies. Museveni, the incumbent, has been arriving to some rallies by helicopter which allows him to cut down on travel time a lot. He has a full entourage of yellow trucks with open beds and huge speaker systems and busses that are used to bring people from more remote areas. Apparently the man you see in the photo above, was beat up badly soon after that photo went viral since people knew he had so much cash on him.
Elections are on the 18th and I'm heading to Kenya for the week to escape the potential (and likely) craziness that will ensue. I'll spend a few days hanging out at Diani Beach before spending the weekend in Nairobi hanging out with Kristy and Hannah - can't wait! The 2016 Ugandan presidential elections are in just over two weeks and we’ve somehow timed our site visits perfectly with some presidential rallies happening in a few small towns in Central Uganda. After a long day at the field, we returned to our hotel to see a campaign handing out cold hard cash for votes.
How much do you think it costs to buy a vote? Let’s play! Price is right rules. Answer to come in my next post! Bonus points to those who want to comment about how much it costs to buy an American vote these days… In the meantime, I thought I’d share some other cost of living snippets of life so far here in Uganda. Rent: $100-500 per bedroom per month
Plastic soda bottle: 60 cents
Curious about other costs? Let me know! My general observations is that “stuff” isn’t as cheap as you might think, probably because most of it is imported. However, food and then time / labor costs are pretty low. An example of this is that taxis and private hires all charge only on distance and not time. Given the Kampala traffic, this was surprising to me. A short, cheap ride could last 5 minutes or 20 minutes depending on the time of day, but it’d cost you the same amount. The culture here is very relaxed when it comes to time. Meetings unapologetically start or end late…or just get cancelled after you’ve already arrived. We once told data collectors to come pick up their money and materials for field visits and then due to some bank delays made them wait around THREE hours before we starting handing things out. While I was anxious and embarrassed leaving them to sit around the office waiting, I don’t think we got one complaint or question about when things would get started. That was insane to me and I’ve realized I place such a high value on time – both my own but also respecting others’ time. This probably stems from all the hours I “wasted” sitting alone waiting at the Millbrae BART station…just kidding Mom.  I bought a car! It's a two-door 1997 Toyoto RAV4. Japanese cars are by far the most popular here and there are a lot of companies that import used cars from Japan. While this car is definitely old, because so many people here drive Toyotas, and RAV4s in particular, it's really easy for mechanics to work on them and replace parts where needed. A Ugandan friend helped me find a trustworthy car dealer and negotiated on my behalf in an attempt to avoid Muzungu prices. Before deciding to buy the car, I had Jon, a mechanic frequently used by a few CHAI staff check out the car so I knew what I was getting myself into. He said that while the car was definitely old and needed some routine maintenance, it would do the job. The car dealer agreed to fix a few things that Jon pointed out needed to get done right away (new front windshield, new spark plugs, new air filter, fixing the A/C, adjusting the drive belt, and a few other small fixes).  The purchasing process took a full weekend because I paid in cash and had to deal with daily ATM withdrawal limits. I've never paid millions of dollars (read: shillings) for anything before! Even with the conversion rate, this has been the biggest purchase of my life. And it's one that didn't allow for my usual few hours of internet research...yes, I spent more time thinking about buying a mop than this car... Expats come and go so often, that I'm not too worried about selling my car at cost when I leave Uganda. If I can keep it in good shape, I may even be able to make a small profit - we'll see!
I consulted a few of the CHAI drivers and other expats here before going through with everything to ensure that I understood what I needed - a sales agreement, receipts for everything (since I was going through a dealer), and the log book which changes hands with each owner. Because I don't have a work permit, I can't legally put property under my name. Since obtaining a work permit can take months, and in some cases, up to a year, I'm here on a "special pass" which is like a 3 month temporary work visa. So, like most of the other expats in the office, my car is registered under my coworker's TIN (tax identification number) Number. TIN Numbers (yes, that's repetitive) are used during any official transfer or registration of vehicles and/or land. After leaving my car with Jon for a few days to really make sure everything was good to go, we gave the car a real test by taking it up to Sipi. We survived the weekend journey safe and sound! I'm excited to have the freedom to get around the city more easily - having a car makes getting together with friends, doing groceries, and running errands SO much easier. While I'll still do my fair share of boda riding, come rainy season, I'll be really glad I have some wheels of my own. This blog has been a fun way for me to not only document my time here, but also stay engaged with all of you back home. So, thanks for reading! So far, I haven’t had any zero page view days which is a great incentive for me to keep writing and posting! According to the statistics that Weebly provides, I’m getting about 5-10 unique visitors each day. A few shout-out to my loyal readers out there…Mrs. Thompson wins for having my blog linked as its own icon on her iphone home screen and Mia comes out on top for most blog comments! I’ve started adding “categories” which are essentially tags for each of my posts. For those new to the blog, this can make it easier to sort through posts so you don’t have to read from the beginning. I’m looking forward to traveling more within Uganda and the region, so stay tuned for more “travel” posts and photos with my real camera. On the radar…Sipi Falls this weekend, Jinja and the Nile next weekend, and then a big trip to DRC / Rwanda / TBD with Katharine and Liz in March! See below for a map of Uganda. Emily and I were brushing up on our East African geography yesterday over Skype so I realized it might be helpful to share a map here as well! Entebbe is where the airport is - the drive to Kampala is anywhere from 1-4 hours which means you have to leave well in advance of any flights. Jinja is the big hot spot for kayaking and rafting - there's a big Nile River Festival this weekend so a lot of people are heading there for the weekend. Then, Sipi Falls, where I'm going this weekend is just northeast of Mbale. I recognize a lot of these other cities through the data analysis I've been doing, so it's nice to be able to get an understanding of where our work is being piloted / implemented as well!  |
AuthorI'm eager to learn about the world around me and find that travel (and food) is one of my favorite ways in which to do so. 
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