UgandAshis 52 The hawk swoops

UgandAshis 52

August 23, 2009

The hawk swoops

The balcony view of this house is great. Just in front of my house is a swamp and a half wild plot of land. It must be teeming with life as hawk, egrets and the ibis all vie to be present there. Just now I had a hunch a hawk had seen a snack. Indeed he landed and about two minutes later he/she took off with a 75 centimeter snake dangling from its claws. Must be a munchy feed for its youngsters.

Rainy season has really started and when it rains it pours down in buckets. It explains why this land is so green and has so many lakes, ponds, rivulets etcetera. Planned to start August 15th it started the 15th. Spot on time.

In the mean time my parents are arriving tonight. And tomorrow I shall surprise them with a barbeque for about 20 of my friends. Somali, Iranian, Baha’i, Ugandan, Congolese and Dutch will be eating side by side. As it is Ramadan the barbeque will start after sundown and not to late as three young girls will be running around. Like Lonneke and Nard I am sure my parents will love the country and the people and after so many years they will finally be able to go and do some proper safaris.

In either a Toyota super custom or a land cruiser we will be off on Tuesday where I take on a multitude of new tasks (next blog) and they will be hopping around from volcanic crater lake to chimpanzee park to botanical garden visiting my different employers, meeting my friends, seeing the patients, watching the bees hum and enjoy the view of Ruwenzori mountains.

The next week professor Ekke, Lynnea, Yogi, Bruno, Emmanuel, Ismail and my parents will be staying at the mansion. It is starting to become a real community. Around the corner is my favorite neighborhood restaurant where we will have Ethiopian coffee and enjerra with the crowd of people.

Our garden is delivering massive quantities of fruits and vegetable. Today we harvested a bunch of matooke (plantain), a jack fruit and saw that the tomatoes are getting there. The hamerkop (http://en.wikipedia.org/wiki/Hammerkop) agrees the strategy and just now flew off. It is time to plant some more trees in the garden and flowers. I am aiming to see the majestic sunbird (http://en.wikipedia.org/wiki/Sunbird) in and out of the garden. Just as in the garden in Fort Portal.
A message for all you birders out there. Uganda is the place to be twitching your heart out. Even those of us who are less inclined to our feathered friends Uganda is the place where you do become interested in ornithology. It is not for nothing Uganda has these phenomenal birds out there to be admired by all of us (http://en.wikipedia.org/wiki/Marabou & http://en.wikipedia.org/wiki/Grey_Crowned_Crane) Oops I am off my parents shall be landing in about 1 hour and 15 minutes. Stroopwafels are on the way!

Namaskar,

Ashis Brahma

UgandAshis 51 Coming and going

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

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

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

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

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

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