Wednesday, February 25, 2009

A Modern Man of Uganda

Ugandan women who give birth at Nysambya hospital are encouraged to have an attendant with them for the labour and delivery process. Usually this person is a mother, sister, aunt, or friend. There is no rule or policy that prevents the attendant from being a man, but from what I gather, this simply isn't "done." Husbands occasionally accompany their wives to the hospital, and I've even seen one or two skulk around outside of the unit, waiting for news from within.

Peter is a Ugandan man who works as the country director for an NGO dealing in rural development. He and his wife are expecting their first child in April and rarely have I seen a man so excited about becoming a father. This evening he told me that he wakes up at 5:30am so that he can make his wife breakfast. She has been tired lately and is still working long hours as the assistant manager of a bank. Peter asked me several questions about things he had read in his wife's "pregnancy book."

I mentioned to him that the absence of men from the delivery room is one of the most noticeable differences that I've observed on the labour ward. I explained that in Canada, it is often customary for the father of the baby to cut the umbilical cord at birth. Peter exclaimed, "That is what I want to do!" He had seen this in a movie and was happy to know that it really does happen. I was surprised, and the other men sitting with us at the table reacted with a combination of fear, disgust, and disbelief.

Peter went on to tell me that he has only missed 2 of his wife's many doctor's appointments and that he wished their doctor had a device that allowed him to hear the baby's heartbeat. (As I've mentioned previously, fetal dopplers do not exist around here).

I'm sorry that I won't be here when the big day comes in April. I hope that when it does, the doctor or midwife at the delivery will recognize Peter for the modern Ugandan man that he is, and give him a chance to cut the cord.

Monday, February 16, 2009


There are over thirty languages spoken in Uganda and many more dialects on top of that. The official language is English, but the most widely spoken is Luganda. It's the language of the Buganda tribe who are located predominantly in central Uganda.

Contrary to what I had read from several sources, very few people here speak Swahili. I came prepared with a small Swahili vocabulary under my belt and a pocket phrasebook, but quickly found that I had no use for them. Apparently, when Idi Amin was in power, he forced the Swahili language on people and attempted to make it the official language. As one of my colleagues explained, "Swahili brings back painful memories for many Ugandans."

So, I've tried to quickly acquire a bit of Luganda. The first work that I learned wasn't hello, goodbye, or thank you. It's the word that I've heard spoken more frequently and with more force than any other. "Sindicat!" The midwives and nurses would yell at women in the second stage of labour, "Sindicat!" I didn't have to ask for a translation that first afternoon on the labour ward. Sindicat means push.

Over dinner, I told some of the priests at CANLET about learning my first Luganda word. They found this hilarious. But in seriousness, one of them said, "When those women hear you saying that in their language, I know it gives them great strength to push." I'm not so sure about that, but I've certainly sensed a lot of surprise and appreciation for the little Luganda that I have learned and practiced thus far.

Sunday, February 15, 2009

On African Time

On Valentine's Day I attended a wedding in Kampala. The marrying couple were friends of some people here at CANLET. Fr. Noah, one of the priests in residence, was performing the ceremony so he insisted that I attend.

February 14th was the hottest day that I've spent in Uganda. It must have been 35 degrees. Fr. Noah wanted to be on time for the ceremony which started at 2pm. "Let us leave at 1:30," he said. This punctuality didn't surprise me. I've observed Ugandans to be quite punctual. Our morning meeting at the hospital usually starts at 8am sharp with no more latecomers than we tend to have at morning teaching rounds in Fredericton.

On the way to the church, Fr. Noach commented on the traffic, "It's a good thing that there is no jam today. I hate it when one of the couple arrives when the ceremony is already half over." I thought I had misunderstood.
"You mean that the wedding might start before either the bride or groom has arrived?"
"Yes, we have to keep things moving, because the church will be having weddings all day."
I tried to imagine the wedding ceremony going on with bride or groom conspicuously absent. This seemed like a policy that was instituted in harsh opposition to the practice of "African Time."

My experiences in Africa are full of examples of African time. Meetings start when everyone has arrived, buses leave whenever they are full, and pedestrians walk at a leisurely pace.

I was relieved to see that both the bride and groom were present when we arrived at Rubaga Cathedral. The beautiful domed structure had been built in the 1950s and was quite simple on the interior with small stained glass windows and a brick pillars. The wedding immediately preceding ours was finishing and the brides passed each other just inside the front doors.

Seated in the back row of the first section, I was surprised to see no more than 100 people in attendance. People had mentioned to me that most African weddings are large with several hundred guests. It wasn't until the end of the ceremony that I turned around and noticed that more than 75 percent of the guests had turned up late. The cathedral was nearly full! I realized then that African time was alive and well in Kampala.

The ceremony was performed in Luganda but it seemed pretty consistent with weddings at home. The bride wore white and the groomsmens' tuxedos matched the bridesmaids dresses. The church was decorated with a great deal of tulle and everything had a 1980's feel reminiscent of "The Wedding Singer."

The reception was held in a park near the centre of town. Strings of white lights and hung throughout the gardens and

The wedding party arrived about two hours behind schedule, so the speeches got underway quickly. Somehow, I had forgotten to expect many long speeches. When I was working in Rwanda and attended many conferences and ceremonies I got used to the number and length of speeches that went along with them. In addition to members of the wedding party, immediate and extended family, the bride and groom's employers gave their remarks.

Following speeches, there was a delicious buffet dinner and entertainment by traditional Ugandan dancers. As one of three white people in attendance at the reception, I knew I was in danger of being hauled onto the dance floor during the performance, so I tried not to make eye contact with any of the dancers.

There were more speeches before and after the cake was cut. My favorite part of the ceremony was when the bride and groom knelt before one and other in turn and fed each other cake. Then, they knelt before their parents and did the same.

By the time the dancing started it was already11:30. From start to finish, the wedding lasted twelve and a half hours. I enjoyed the whole thing immensely and now count it among one of my favorite Valentine's days.

Friday, February 13, 2009

A Humble Abode

Believe it or not, when I arrived in Uganda, I didn't have a place to stay. That is to say, I hadn't settled on a hostel or made any reservations. The Lonely Planet Guide had some places that sounded good, but I didn't have a sense of whether they would be close to the hospital.

As luck would have it, my taxi driver from the Entebbe airport was knowledgable about the Nysambya neighbourhood. He told me that none the places on my shortlist were within walking distance and when I asked him if he knew of a hostel that would be convenient for a girl working at the hospital, he said, "Of course!" And so, he brought me to the Cardinal Nsubuga Leadership Training Centre (CANLET). When I hopped out of the taxi, Walter, the gatekeeper greeted me warmly and showed me into the reception desk. The centre turned out to be CARITAS run joint used to house students, seminarians, priests, nuns, and the occassional traveller. There are many people who live here permaneantly and others who are here attending workshops.

Carol the manager, showed me a few rooms to choose from. After my second night, I realized that my choice of a roadfacing room had been a poor one. The noise of barking dogs and honking mototaxis was endless. So, I was happily moved into slightly smaller, quieter digs. My current room is lovely and includes 2 beds, a desk, and a basin for washing clothes (or feet). The bathrooms here are dorm style, with shower stalls and flush toilets. It's very basic. Some mornings there is hot water, most mornings there is only cold, occassionally there has been none.

There is an internet "cafe" attached to the hostel (at the moment I'm sitting in front of a computer, but writing this blog into my notebook as the electricity just went out without warning. The internet connection is reminicent of 1996. That's life here.

I feel lucky to have stumbled upon this place. Becuase I'm a longer term guest, they gave me a break on the rate (30,000 shillings or about $15 a night, including breakfast.) Breakfast consists of tea, bread, a hard boiled egg, and a slice of pineapple or banana. For dinner we usually have mashed banana, rice, and some sort of meat with sauce. The banana mash is growing on me and the rest is pretty tastey.

A small outdoor bar provides a spot to have a drink and hang out with the priests or other travellers. Most of the travellers have not been Muzungus although there have been a few. Cilas, a Sudanese refugee now living in Australia passed through a few days ago. He told me that it had been his first trip home to Sudan in ten years. Beatrice, a medical student from the Demogratic Repulic of the Congo was on her way back to school in St. Petersburg. She said that the road home had been dangerous, but she was well protected by the machine gun mounted on the roof of her vehicle.

The walk to work only takes about ten minutes in the morning. lus, there are several schools located along the way. My comings and goings provide much entertainment for the kids. "Muzungu! How are you!"It's a pretty fun way to start the day.

So, it's a humble abode, but all that I require. The built-in circle of friends is a terrific bonus.

Sunday, February 8, 2009


From open sewers to beautiful flowering hedges, mangy stray dogs that sleep on sidewalks and magnificent cranes that nest in the trees of the public parks, there is good and bad to Kampala.

There are also people in every direction: well dressed business people, school children in uniform, women with babies on their backs, beggars with limbs missing, boda boda (motorcycle taxi) drivers, and people selling everything from toothbrushes to bibles on the sidewalks. With a population of 1.2 million, you certainly feel the density and stress on the city's infrastructure. It's generally loud, dirty, and congested. Traffic jams are are constant sight and horns blare everywhere you go.

Many of these people greet me when they see me coming. Today I've heard the following:
"Muzungu!(white person) Muzungu! How are you?"
"Where are you going?"
"From which country are you from?"
"Give me 500!(shillings)"
"Give me 1000!"
"You look so cute."
However, they are generally friendly and helpful. I've asked several people for directions and they generally go out of their way to assist me. I'm constantly being approached by people asking if I will, "be their friend." They try to give me their cell phone number and want to know when I'll be calling them. Today on my way to the Internet cafe, a bicycle taxi driver asked me where I was going and when I said that I didn't need a lift he said, "I love you." I'm never sure how to take those kind of compliments.

I was stuck in a traffic jam while I rode in a taxi bus this week. We sat for 30minutes without moving. The exhaust fumes can be overpowering at times. Taxi buses are 14 passenger vans that run a type of public transportation system. There is a driver and a caller- "Nysambya! Nysambya!" they call as they drive from the centre of town towards my neighbourhood looking for more passengers. In Rwanda we called these buses, "Matatus" and in Tanzania they're called, "Dala Dalas." It costs about 25 cents to ride the bus from the downtown taxi park to my neighbourhood.

An alternate form of transportation is the bodaboda. These are a fast way to get around and they will take you directly to your destination as they are often able to weave through the traffic jams. It's fun and pretty thrilling, but with no helmet and riding side saddle on the back (because usually I'm wearing a skirt) I know it's more risk than I ought to be taking. I've limited myself to two rides so far.

Kampala is safe. There are plenty of visible police and security guards. The hostel where I stay has a guard on 24 hour duty. Some of the people I've met have cautioned me to be careful with my purse, money, passport etc, but they also mention that I shouldn't be worried. "Kampala is not like Nairobi," I've heard this several times. I haven't heard any stories from the hospital about patients coming in with trauma as a result of violence or shootings.

I often find myself comparing Kampala to Kigali and I have to say that there are things that I miss about the Rwandan capital, but the more I get to know my way around Kampala, the more I like it. There is even a movie theatre and I see that some of the Christmas blockbusters are opening this week.

Friday, February 6, 2009


I'm working with 12 interns at Nysambya hospital, four of whom are currently rotating through the department of Obstetrics. They all graduated from medical school last year and their level of training is somewhere around that of a final year medical student and a first year resident in Canada. They are on call one in four nights just like residents in Canada. The day after their call, they go home at 1pm (in Canada we get to leave at noon). I've sensed a certain coldness from some of these interns. I can imagine many possible reasons for it. I'm doing this elective on their turf and while I'm slightly senior to them in some respects, they have much more experience than me in others. Plus, they work one in four call, so they're bound to be grumpy.

Luckily, on my very first day, I was assigned to work on the labour ward with Godfrey. It was also his first day of rotation in Obstetrics. So, we helped each other out. He showed me how to use a fetoscope (insert photo of 19th century medical device here) and I told him how to treat deep vein thrombosis in pregnancy. I could tell Godfrey was solid. He was quick to ask me about my family and tell me about his. His father had three wives and about 15 children between them. He grew up living with his mother and three siblings. Most of the other 15 were much older than him.

On day 2, we were back in labour and delivery and it was busy. We made a pretty good team as Godfrey would take the histories (in various Ugandan languages) and I would perform the physical assessments. Godfrey was stressing all morning about the fact that it would be his first night on call. I don't blame him. The first night on call in a new rotation is stressful. At lunch, we were sitting in the interns meal room and chatting with some of the other interns. I learned that the goal of most of the interns was to move on to a postgrad program- preferably in Europe, Canada, or the US. Doctors at the hospital in their first year of practice make about $500 a month. In Fredericton, when I stay at the hospital for an overnight call, I make an extra $75. When these interns do call, they make about $15.

Godfrey's cell phone rang part-way through lunch. He stayed at the table while he spoke. When he hung up he said, "Oh! I've just lost my father." There was a general, "Ohhh. Sorry." From everyone around. He explained that this wasn't his biological father, but an uncle who had been the man who raised him. It was sudden and the cause of death wasn't clear. After about a minute of attention being paid to this news, everyone turned back to their own conversations.

Later that afternoon, Godfrey told me that someone would probably have switched call duties with him had he asked, but that it actually worked better this way because being post-call meant he would finish at 1pm and be able to make it back to his village in time for the burial at 4 O'clock.

These events reminded me of how easy come easy go life can be in this part of the world. One of the midwives mentioned to me that I shouldn't ask expectant mothers about whether they had names picked out for their babies. She said, "They don't like to count their chickens before they are hatched."

Tuesday, February 3, 2009

First Day

Had this been my bathrobe's first trip to Africa, my first day at the hospital probably would have resulted me packing my bags for home.

Residency involves switching rotations every couple of months. It's basically like starting a brand new job just as you've started to settle into your old one. So, after several years of this routine, I have pretty low expectations for a smooth transition on the first day. Things like not being sure what to wear, or where exactly you're supposed to show up are a given. Hearing your new supervisor respond, "Oh! Are you supposed to start today?" when you introduce yourself is also a common occurrence. However, today took things to a whole new level.

I arrived at the hospital at 8am. The hospital is a sprawling compound of buildings and shelters, including several hen houses and a goat stable. Many of the waiting "rooms" are open air rows of benches.

At the front gate, I asked where I could find my supervisor, "Dr. Pius" and was directed towards the antenatal clinic. The nurses there instructed me to, "sit and wait" which I did amongst 100 or so very pregnant women. After about an hour of waiting, the head nurse, Sister Alice called me in to confirm what I was doing there. Then, she started calling around to find Dr. Pius. After another hour or so, I was invited to join the nurses for tea and then started helping them with some of their prenatal assessments. Finally, Sister Alice found one of the other Ob/Gyn attendings and asked if he had seen Dr. Pius. He replied, "Dr. Pius? I believe he is out of the country."

It would have been somewhere around this time that I would have thought about packing my bags, had I not been trying my hardest to roll with the punches. As it turns out, the rest of the afternoon turned out ok. I met a few more of the attendings and many of the interns. I stuck around the Labour ward and delivered a couple of healthy babies. The midwives seem pretty happy to have me there, and and the other attending staff were very accommodating and interested in knowing about my objectives for the rotation.

All in all, I would say that it has been a pretty, par for the course kind of first day on the new rotation. I'm definately heading back for more tomorrow.

Sunday, February 1, 2009

Along the Way

I wanted to mention a few of the highlights from the four days of traveling, so here they are in list-form:

1. The special "baby flotation" device, provided by Emirates Airlines and featured in the in flight safety video. (Think car seat surrounded by an innertube.)

2. The delicious lemony berry smoothie that I purchased in Dubai. The guys at the ice cream shop were playing something called flying ice-cream, where one stands behind the counter and throws a scoop of ice cream to the guy on the other side of the counter who catches it in a waffle cone.

3. Mr. Nice (taxi driver)

4. The wooden rocking chairs at Logan Airport in Boston. These were lined up along a big East facing window just outside my departure gate and helped to relieve my travel rage.

5. The flight from New York to Dubai was made much more comfortable due to the fact that I was sitting beside an off duty Emirates employee. He told me that usually he would have been sitting in Business Class, but the flight was completely full except for one economy class seat. So, he arranged to have the vacant seat located right next to him which also meant, right next to me.

Here in Kampala

Yesterday I arrived in Kampala. The trip turned out to be a bit longer than I had expected and included unexpected stops in Boston, and Addis Ababa.

I was feeling pretty jet-lagged when I landed and the customs/visa experience at the airport was pure East Africa. But, the moment I was on the road from Entebbe to Kampala I could feel my energy returning. With such constant movement: moto-taxis, cars, goats and cows, little children, and women with babies on their backs, it's hard to know where to look. The sensory overload extends to the ears with music blaring from our my own taxi's radio, occasionally being overpowered by a passing taxi-bus, or the stereo speakers mounted out front of a barber shop. The smells are generally good and I've gotten used to breathing though my mouth when they're not. The weather is a beautiful 33 degrees today. It feels pretty hot, but I wouldn't dream of complaining. Last night it cooled down to below 20. I've been told that it has been raining lately, although it is supposed to be the dry season. Although, the rains here tend to come in hour long downpours followed by sun.

My taxi driver, Mr. Nice* was very helpful. I was thinking of staying at one of the hostels that were reviewed by the Lonely Planet, and asked him if any of them were near Nysambya hospital. He said no, and told me that he knew of one that was. So, he took me to CANLET, the Cardinal Nsubuga Leadership Training Centre. It's some sort of Catholic training centre, so I think many of the guests are priests and nuns. There is a restaurant and breakfast is included. Plus, it's very close to the hospital.

Nysambya is on the outskirts of the city. Luckily there is an Internet cafe attached to the hostel but unluckily it doesn't let me on to the blogger website. Hopefully I'll be able to find a convenient option soon.

Tomorrow I start work at the hospital. I'm not completely sure what to expect. One of the people from CANLET told me that a, "Lady Canadian Doctor" had been staying there recently and that she had been working at the hospital. I also noticed that the MSF compound is next door. Once I'm more settled in I might drop by and try to make friends.

*Stage names are popular among Ugandans who work in the tourism industry. Mr. Nice is also the name of a fairly well known East African hip hop artist. I asked him if he was related and he told me that his real name was Amal.