First Impressions of Uganda

[Tapped out on my iPhone. Pls excuse errors. – SPH]

How does one describe six days in the poorest district in Uganda? Surrounded by poverty; accompanied by indefatigable do-gooders; enveloped by heat and humidity; denied electricity and running water; surprised by the ignorance; stumped by the cultural and social differences; and without constant inter connectivity, I would describe it as indescribable.

We arrived in Bududa, a village in easternmost Uganda, after many hours on the long dusty road from Mbale, the nearest city. We stayed at the guest house affiliated with Bududa Vocational Institute.
The guesthouse is a mud brick building with a central living room/dining room giving off to four cramped bedrooms and a kitchen. Behind the kitchen there is a courtyard running the length of the house. Behind that there are four more even smaller rooms, one of which has a commode bench positioned over the “deep drop.” Each bed room is equipped with a bed, nails and hooks for clothes, a few shelves and a jerry can of water for sponge baths. The mosquito net hangs motionless. Every noise is amplified by the metal doors and tin roof. There is dust everywhere. The heat and humidity are stifling in the mid afternoon.

And yet, this house is filled with mirth and not with fools. Donors and dignitaries have collected here for a few days to celebrate the new buildings of the BVI. 12-19 people have crowded into this space and have enjoyed the camaraderie of the committed and the goat stew of the house cook. We drank wine and beer. We lived with endless dirt, dust and dung, without complaint.

I followed the medical care of an eleven year old with a puncture wound of the right fore foot resulting in major soft tissue swelling and infection. No X-Ray-to evaluate for a foreign body-was available because the generator had no fuel. This was the result of graft in Kampale. No IV antibiotics were prescribed for 48 hours for unclear reasons because she arrived at the local hospital (a government facility with salaried physicians) with our cash in her hands. By the time she had the needed I&D 72 hours had passed. The pre-op check list included a final cash payment to the surgeon before scrubbing. This salaried physician should have done it without extortion. She received instructions to keep the dressing and packing clean and dry. When I visited her the next day it was soiled and wet. We started over.

I also evaluated an 18 year old with swelling behind the right eye. A recent CT had revealed extensive inflammation and modest bony destruction of the sinuses and right orbit. She had showed some improvement with prednisone. No tissue diagnosis was available. No one understood the implications of a vasculitis diagnosis (Wegener’s granulomatosis?). No one knew that advanced immunomodulation therapy exists but will never be available to her.

Dirt, dung and dust permeate everything and must be overlooked. It is hard to reconcile the extraordinary advances (economic, intellectual, social, commercial, technological, etc.) of other societies with the stagnation that exists here, near the birthplace of Homo sapiens, the cradle of humanity. It is also legitimate to question, in an existential sense, the value or benefit of “progress.”

I suppose that visitors to Africa fall into two categories. There are Those who photograph some animals on safari then sigh with disgust, throw up their hands and turn and run. And, there are those who look at this endless morass of poverty, overpopulation, illness and illiteracy and then roll up their sleeves. Our hostess in Bududa was of the latter persuasion. She was a dynamo.

In the US a powerful justice system contains graft and corruption while the “free marketers” in the health care system gauge consumers to make excess profits. In Uganda graft and corruption are rampant and funds allocated to government hospitals are diverted before they are received, hence no fuel to run the generator. Despite the graft and corruption that permeates the Ugandan society and government (at the lowest levels this is based on economic need born of abject poverty) it is deeply refreshing to see non-profit workers delivering health care and education without trying to game the system for personal profit. Barbara Wybar and FIMRC http://fimrc.org (the local private medical clinic) are inspirational.

More later about FIMRC.