On Campus at Makerere University

I made my first Ugandan friends outside of work by playing pickup basketball at the University of Makerere (the biggest and best in Uganda).  Women don’t play many sports here so they are always really surprised but welcoming.  When I tried to rent a tennis racquet, the owner replied accusingly “who taught you??"



This weekend, by sweet serendipity, we additionally discovered the outdoor pool at the University of Makerere, which cost 3,000 shillings to the Sheraton’s 25,000.  It’s beautiful with grass steps leading to the only slightly cloudy water.  The first bizarre thing was that they were burning trash right next to the pool gate, which is normal here but still smells horrible.  The second bizarre thing was that one end of the pool was being used for baptisms.  Adults and children in nice outfits were being tossed into the water by a plainclothes preacher.  There seemed to be very little ceremony, just a lot of splashing around.

After the baptisms were over, the only people at the pool were a very large, informal university men’s swim team.  They ended up being super friendly and let us join in relay races.  Most of them had only learned to swim in college.  I was doing pushups by the side of the pool when a guy joined me, and it turned into a pushup then plank contest.  By the time we were done, we’d gathered a crowd, and everyone was cheering.

Mzungu

Our driver’s 8-year old son was killed last week in a traffic accident.  There’s a phrase that Ugandans do everything slowly until they get behind the wheel of a car.  Sometimes the streets are so packed with cars and motorcycles overflowing onto the sidewalk that the mass of pedestrians can barely walk through the jam.  Uganda only has 8 cars per 1000 people, one of the lowest of any country (compare to the United States at 797 and San Marino at 1263).  The noteworthy part is that the list excludes motorcycles.  There’s endless numbers of ‘boda bodas,’ and they are more than willing to act as taxis which can weave through stopped traffic.  There’s also ‘matatus,’ which are vans that act as jam-packed public buses.  Just like in Nicaragua, these buses have big, colorful letters painted on the windshields; here they say things like "bismillah," "trustworthy," "Manchester U," or "God is willing always No. 3."   Cars drive on the left side of the street here, meaning I run into people on the stairs all the time.

Greetings are a huge part of the Ugandan culture.  Every morning, coworkers always say “wasuze otya, ssebo/nnyabo?” to each other, literally how did you spend your night, sir/madam?  My Ugandan friends will never start a conversation with me without first saying “Hello, how are you?”.  I’ve heard that this is so important in East Africa, because it’s a region of past ethnic strife, and greetings reaffirm every single morning that one’s relationship with the rest of the community is still strong.  When I walk in the busy streets of downtown Kampala, hundreds of people might say “hello, mzungu” in one hour (mzungu means white person).  I much prefer this culture of friendliness to the excessive catcalling of Nicaragua.  Still, it’s telling that usually only men are the ones to shout “mzungu,” and sometimes from the balconies of buildings, the other side of the street, or while trying to grab my arm.  Once I was walking on the road with a lot of schools right at dismissal hour, and I was mobbed by kids wanting to follow after the mzungu.  Street vendors will shout out “Sister! You’re welcome please!” meaning “come see my wares!”  Uganda English puts “please” and “ehh?” on the end of most things said.  They also talk extraordinarily quietly.  And to be understood when asking for tomatoes, you have to pronounce it the British way.

Some new phrases for me are:

• What are you called? What is your name?

• Where do you stay? Where do you live? Very different from where are you from?  Most Ugandans may live and work in one place, like Kampala, but they are from another, and that village or area is known as ‘the place they will be buried.’

• When are you going? When are you turning?  In context of asking someone’s birthday.

• When do you swallow? What time to do you take your pills? Learned through watching patients receive counseling on their antiretroviral drug treatment.

Lake Bunyonyi

Last Friday was a public holiday, so Thursday afternoon we took off on an 8 hour bus ride out of town.  The ride was marvelously painless.  Everyone had their own seat, and there was distant Afro-beat music to be heard at all times.  The street vendors at every stop immediately hopped aboard to sell snacks, and usually didn't leave until the bus is nearly full speed.  The countryside of Uganda is beautiful, some parts full of trees and other parts grasslands.  At one point I woke up to the whole bus full of smoke as we were passing by the site of a massive fire on the plain.

Lake Bunyonyi, meaning place of little birds, is in the south-western part of the country--but still far enough from the border to be safe.  It is one of the few lakes in Uganda without the bilharzia parasite (schistosomiasis), and is so deep that the exact depth is unknown.  We did tons of swimming, canoeing, hiking, and running.  As we passed by little islands in the canoe, kids would run out from the trees to the shore and try to get us to come play and swim with them.  We saw the amazing crested crane, the national bird of Uganda and prominent feature of the flag, up-close!  We slept each night in a safari tent overlooking the lake.

Infectious Disease Institute Internship

I arrived at the beginning of this month in Kampala, Uganda for a two month internship at the Infectious Disease Institute (IDI), affiliated with Mulago Hospital.  It's a free, urban, academic clinic that treats patients with HIV.  The clinic is much more organized than I was expecting, and it's almost entirely indoors, unlike the public clinics in Nicaragua.  IDI has a day reserved for HIV positive adolescents and a day for Most At Risk Persons, namely truck drivers, commercial sex workers, military personnel, taxi cab drivers, and men who have sex with men.  My job (along with three other Yale undergrads) is to conduct research assessing the effectiveness of the Sexual and Reproductive Health department.  As a doctor in that department told me, their goals are epitomized by every HIV negative baby born to an HIV positive mother.  The staff puts the mother on an antiretroviral drug regimen for life as soon as she gets pregnant.  They monitor her immune system throughout the pregnancy and that of the baby after delivery.  After one and a half years of confirmed HIV-free life, the baby can be discharged negative.

While spending time in the department, I was introduced to a patient bringing in her 6-month old baby for HIV testing.  The woman looked both young and old at the same time.  She said her baby was doing well, only that it was scared because it had never seen anyone like me before.  I later found out the woman was the grandmother (at age 47) and the mother of the baby had died of HIV.

I spent another morning shadowing a nurse seeing general HIV patients.  We saw a woman with a large lump on her breast that was almost surely breast cancer already spread to the lymph nodes.  The nurse was frustrated because patients often have to be prodded to admit there is something wrong with their health.  Another man came in with a scalp infection pointed out to him by the nurse, and he said he thought that was just the way his head was.  I really enjoyed the opportunity to see VIA (visual inspection by acetic acid), the resource-limited setting alternative to Pap smears for cervical cancer screening.  After we told one Muslim woman she was clear, she was so relieved she said "God is great!" before even getting out of the stirrups.  This woman originally came to IDI with an excruciating headache.  She had cryptococcal meningitis, an opportunistic infection because of the HIV she also didn't know she had.  The nurse said when people in the villages get cryptococcal meningitis, they die there.  They don't come to the hospital because they think the sudden-onset, fatal head pain is bad spirits.

IDI has recently begun implementing the new WHO guidelines of "test and treat."  Previously, only certain HIV positive groups were started on the expensive drugs that had to be continued for a lifetime.  This included pregnant women, those comorbid for other diseases, and those with an immune system suppressed beyond a sufficiently low cut-off.  The new guidelines now say there is enough money and available drugs to put everyone immediately on treatment for life as soon as they are diagnosed.  The nurse I was shadowing worried this would promote poor adherence by patients, and problems later on with drug resistance.

Multi-drug resistant tuberculosis, which I learned about in global health classes as one of the greatest looming threats, is really rare here because they have been so successful in controlling it in Kampala. The reasons are that those who get it are quarantined in a specific ward of the hospital, and those who get it die fast.  Everywhere else at IDI, the patients seem mostly healthy at a glance.  However, in the IDI ward specifically for those who also have TB, the patients were wasting away.  Many used walking sticks, and some couldn't even lift their bodies out of bed.  Nonetheless, the care they were receiving was excellent.  It was fascinating for me to see Kaposi's sarcoma and oral candidiasis, other opportunistic infections so rarely seen in the U.S.

Kampala, the city of 7 hills

The famous 小吃 (street snacks) of Taiwan

Leftover from last summer, but more to come from Kampala soon.  Ugandan food is great, but no competition yet for the lively, omnipresent night markets of Taiwan.  I was planning to return to China this summer, but my plans (and YMUN China conference) were cancelled due to certain government regulations against foreign NGOs.

We took a ferry to this island with street vendors and a sandcastle contest

芒果／八寶冰 Mango and eight treasure (8 different types of beans) flavored bings:
shaved ice with condensed milk and topping 10/10

芋頭冰 Taro bing (I'm kinda obsessed with taro and since I can only get it in Asia went a little overboard;
I will admit there are better bing flavors) 8/10

豆花 Tofu pudding with red beans 7/10

Pastry sold on street filled with taro (other favorite flavors were chocolate oreo, cream, red bean, matcha, sweet potato) 10/10