The End!

3 out of us for us are now safely back home: Sarah, Lyanne and myself. Alix has now been reunited with her husband in Casablanca is off to new adventures for a couple of weeks.

It will be interesting as the summer months go by to reflect on what has changed for us after this experience of practicing midwifery in Uganda. How have we changed within? How have the way we practice midwifery changed or will change? It is impossible to go through such an experience and stay the same, nor would I want to. Certainly all of us now feel more confident about practicing many skills, and dealing with emergencies. There is a renewed commitment to women's health, reproductive choice, and the 'art' of midwifery. I hope there is more mindfulness, more appreciation for what we have, and more compassion.

There are also aspects to going back to work in Canada that I anticipate will be challenging. Dealing with the overabundance of supplies which leads to so much waste will be difficult.  Consider that in a 24 hour period, approximately 30 birthing women will fill up 3 small garbage pails while in Canada,  one birth will fill one laundry bag and one garbage bag! I also foresee that another challenge will be to maintain sterility in the way that is expected in Canada. Finally, after seeing women be in labor for days, DAYS, without any pain medication, I believe it will take somewhat of an effort at times to continue to be present to a woman who is finding it difficult to cope while she has been waiting a 1/2 hour or an hour for an epidural. I may dislike to admit that, but it is true. So to sum up, what will be most challenging will be to keep births in Africa in their context and keep births in Canada in theirs.

Thank you to all of you who have read our blog and have written us with your kind words and encouragement. It was much appreciated.

Carolyn

And then there was one

Today is my last day in Uganda. Lyanne and Sarah flew out on Friday morning and Carolyn left early this morning. Tomorrow I fly to Casablanca to meet my hubby. What does one do with her last few hours in such a remarkable country? Well, she does laundry, on-line check-in, seeks out some waxing services (I have some serious hair growth after two months which seems fitting here in Uganda but unfit for someplace as glamorous and Casablanca) and then I will go to the Wildlife Rehabilitation Centre to see the few animals who evaded us on safari (hyenas, mongoose, and the giant shoebill bird).

There is so much to catch you all up on. Carolyn and I had a very rejuvenating last few days. On Thursday morning we took a matatu to Kampala then to Luwero town on our way to volunteer at Shanti Uganda. Getting there was an adventure as we didn't yet have an address or phone number- we guessed that it was in Luwero town (since Luwero is a district). When we arrived in Luwero town we set about asking boda  boda (motorcycle taxi) drivers if they had heard of the place while we searched for an internet connection. After 10min we found someone who new the place.  I wanted them to tell a car taxi how to get there but they didn't want to give up the fare so for the first time we gave in and got on the boda bodas with our 40lb backpacks on our backs and our daypacks on our fronts and Carolyn's drum resting on the handlebars. Off we set riding on a motorcycle down dirt roads in the village- what a thrill! The boda boda driver was true to his word and delivered us safely.  The only hitch was that Carolyn was in a skirt which she had to hike up to her thighs to ride the motorcycle which resulted in her scandalizing a quarter of the village.


Upon our arrival we were given the tour. There first structure is a waiting room, prenatal exam room and a 5 bed postpartum dorm room in a cob house painted a sunny yellow with recycled glass bottle windows.  The next building has two birth rooms with lovely double beds, shelves for birth equiptment and a shared bathroom with a sink, western toilet and a small but deep tub. There is also a small lab in this building where instruments are boiled daily, supplies are stored and bloodwork is done. They can test for pregnancy, malaria, HIV and blood group. They gave us a tour of their demonstration gardens planted with food crops (corn, watermelon, pumpkin, gooseberry) and medicinal birth plants (aloe for heartburn, hibiscus for anemia). Finally there is a large open air banda (a round building made of mud with a thatch roof) and it is here that the teen girls group meets, prenatal mothers do yoga and HIV+ women meet weekly to make beads and sew bags.

We taught the two midwives about shoulder dystocia and they taught us baby massage which we had both heard of but had never seen before. We then had the pleasure of meeting with the HIV+ womens group to colour signs to welcome the new director Sadi, who is arriving next week. After colouring the women changed into their pants and we got in a circle to do yoga. This was a RIOT! The most fun yoga class ever. A volunteer led the class and the local women are welcome to jump in and suggest a pose. Their favourite poses involve animal sounds- cat and cow was hilarious. They especially loved it when Carolyn taught them lion and they got to roar!

Yoga with the women from Shanti Uganda's income generating group

Carolyn demonstrating rebozzo techniques at Shanti Uganda

Unfortunately you will note I didn't mention accomodation on site so it was back on the boda boda with all our luggage and into town for a night of very stimulation conversation with Kristen (Shanti Uganda site director), her sister, a volunteer and a man from Free Trade Vancouver who was researching the sustainability of Shanti's products.

The next day we taught the midwives about hip squeezes, counter pressure and rebozzo techniques and they taught us a prenatal yoga sequence. We reviewed shoulder dystocia with them and made posters about shoulder dystocia management and the hip squeeze/rebozzo techniques so they could teach the other midwives. It was so lovely to see such a compassionate and holistic example of birth at the end of our trip.

Thursday night we went back into Kampala. We stayed at a great hostel, Tuhende, where we met a woman travelling from the Netherlands who joined us for dinner at an Indian restaraunt. While there two chaps from UBC also joined us (small world) and then Jennifer, Prossy's daughter came along after dinner. Again- wonderful stimulating conversations!

Friday morning we had breakfast with our friend from the Netherlands and a new friend from New Zealand and we all traveled together to Entebbe. We spent the afternoon by the pool and had a wonderful last dinner together (with creme brullee and martinis).

Posted by Alix

Home!

I got home safely, and am visiting family in Ontario. Fortunately, I got home in plenty of time to get to my cousin's wedding -- congratulations to Natalie and Kabez!

Sarah and I parted ways at Heathrow, because she flew into Vancouver, but I heard from her this morning and she arrived safely as well. Alix and Carolyn are still in Uganda for another couple of days.

Thanks, everyone, for following along with our adventures, and I look forward to reconnecting with you now that I'm back in Canada! We have updated some previous posts with new photographs, so take a quick scan through if you're interested!

Posted by Lyanne

We're leaving together...

This morning, Sarah and I managed to successfully navigate the Ugandan public transit system, and we've now arrived at the airport guest house in Entebbe.

Our last day in Mbale was very touching. We went to one birth (Sarah caught, and did a beautiful job) and we dropped off all of our leftover medical supplies; they were gratefully received. We also went by Family Planning, to say goodbye to our friend Grace. We gave her a head lamp as a gift; midwives here do cervical cancer screening by visual inspection, and her lamp hasn't worked properly for months, so she was very excited to have a new hands-free model!

We had ordered a cake for the Sisters on the ward as a thank-you gift, and prepared special gifts for each of the sisters who had supervised us these last two weeks. Little did we realize that in Uganda, a cake is A Big Deal. The student clinicians had suggested that we write "To love and serve" on the cake -- that seemed nice enough, so we agreed. It turns out these words are the last line of the Ugandan Nurses' anthem, and Sister Rose, the head of the labour suite, sang us the anthem when she saw the cake. We had a lot of fun taking group photos, and at the end of the day we gathered to cut the cake. First there were speeches, thank-yous, and prayers, and four of us held the knife together for the first cut, wedding-style. The sisters all had incredibly kind words for us, and we were both a little sniffly as we stepped out the door for the last time.

Sisters Rose and Rosemary with their cake

Later that evening, Sister Irene, a midwife we've worked with quite a bit this week, dropped by our dorms, with gifts for us and for Angela. Once again, we were incredibly touched, as we know that midwives here are not wealthy. We also had a lovely visit with her, and it was lovely to get to know her a bit better.

Our lovely farewell cake

In the evening, we had planned a farewell gathering with the student clinicians, and yet another cake. This is when we learned the four rules of cake:
1. You don't pray before cake.
2. You don't wash hands before cake.
3. You don't grab, you "pick" (dainty fingers!)
4. You don't "leave the bones" (this seems to mean that you eat everything)

Picking, not grabbing

Before getting into the cake, we all sat at a table together, and every student said a farewell speech, with the two of us speaking last. It was very sweet, and very touching. Both Sarah and I were very happy to have made friends in Mbale, but I don't think we realized how much they enjoyed our excursions, or how much they felt they'd benefitted from our teaching sessions. Once again, the cake-cutting was very elaborate; five of us made the first cut together, and then all of the clinicians took turns posing for the camera while cutting the cake. The group did an excellent job making the giant sheet cake disappear, and we couldn't have imagined a better way to spend our last night in Mbale. Not only that, our noisy dorm-mates had left Mbale earlier that day, so we were treated to silent surroundings when we headed to bed.

The whole group of us

One of the student clinicians, Denis, accompanied us on the bus as far as Kampala, and then took us to his sister's house for lunch. He had assumed we would take a boda-boda from the bus stop; we were both a little relieved when he decided we had too much luggage, and found us a safe taxi instead. His sister's house is beautiful, and lunch was delicious, but the television in the living room seems to be constantly on "E!" network. Sarah and I found that the celebrity gossip and vapid TV shows were a little much after not watching any TV for nearly two months. We were sad to have yet another goodbye today, but we're looking forward to a series of reunions when we get back home!

Our last day!

We are finally finished! Today was our last day at the hospital. When we arrived there was a mother who sounded like she was in very active labour. Her chart said she had been 6cm at 7am but when I checked her at 10:15am she was only 3cm...not even in active labour yet. Carolyn and I decided since there were many beds free we would keep her in the delivery room in case the birth was precipitous- you always wonder when a mother who has given birth before is labouring so hard at only 3cm. Her labour became so active I stood beside her and held her hand until 10:55am when I saw the head and called Carolyn. The delivery was the perfect normal birth- baby well (though only 36 weeks) and mom well, perineum intact! Carolyn spent the rest of the morning teaching the new batch of students that arrived on the ward the other day- she taught them how to use the partogram and manage a postpartum hemorrhage and I taught them how to chart a delivery note and manage a shoulder dystocia. I finally pinned down the doctor to interview for my MVA research- I have 14 interviews now. 

Traditionally UBC students have left little goodies as a thank you to the staff. This year we made each staff person a goodie bag with a black pen (There are never enough here), a few cookies, instant coffee and a few chocolates. They  were warmly received. 

We have gone into Masaka town to celebrate by picking up the clothes we have ordered at the tailor (with amazing African fabric), to use the internet, and drink a few shandies before going back to the hotel to meet Prossy for dinner.

As we reflect upon our experience, there are many things that come to mind. As per Carolyn's post near the beginning of our time here, it is so clear how much WE have learnt and received from being here.  Our confidence in dealing with obstetrical emergencies has grown exponentially, our confidence in making sound management decision has increased as well. We have seen and learnt what it is like to practice in an extremely low-resource and rural setting. After being here we can clearly identify which resources are essential (oxytocin, gloves, saline and giving sets, something to tie the cord, something to cut the cord, a needle driver) and things that are not (a billion blue pads, clamps, warm compresses, superfluous catheter supplies etc).

We wish we could give the mothers who allowed us to receive their babies more than the hats and blankets, though they were gratefully received. And perhaps we did, so many of them thanked us profusely and told us that they had had a good birth experience. 

We have reflected on our favourite births. Alix remembers the woman who she feels she was able to provide really excellent emotional support to as this woman spoke English well.  This woman reached down to touch her baby's head while pushing and asked to see the placenta (a rare occurrence here). Alix was also so happy when she caught a supremely vigorous baby who cried on the perineum before his legs were delivered. Carolyn remembers fondly a birth that happened recently. The mother at first kept calling her 'muzungu', but Prossy told her to call her Caro, and thereafter, it was "Sister Caro, Sister Caro". She told Carolyn that she had had a really good birth experience which was so touching. 

Tomorrow morning we are going to take the bus to Kampala and then Luwero to visit Shanti Uganda's birth centre. Shanti Uganda is a Vancouver based non-profit founded by a group of yoga teachers.  Many of you know I sold Shanti Uganda jewelry made by HIV+ mothers in a income generating group as a fundraiser for my Uganda trip.

Picking up clothes from the tailor

International Relations

So I am going to attempt to write a post that has as little as possible to do with birth.

I feel Lyanne and I have been very lucky in Mbale, in that we have managed to make some local friends here. Of all the things I was expecting to find in Uganda, a social life was not one of them. However, especially since our return to Mbale, we have spent some part of almost every day with our new friends. Most of these friends are student clinicians, a ‘core’ group consisting of Denis, Paul, Francis, Deogratias, Castro and Kevin, and others who join us more occasionally.

As mentioned by Lyanne in a previous post, Friday night was spent seeing how they prepare a typical dinner. It turns out, dinner is cooked in their bedrooms, on a single burner set on a small wooden frame which gets electricity via two bare wires stuck into the electrical outlet (Kevin was very careful to make sure the outlet was turned off, and to use a pen…yes, a pen… to ground the current as he placed the wires). I later found out that Denis’ mother died when he was younger from electrocuting herself using a similar apparatus.

Lyanne, Francis and Denis

Denis cooking our feast

The final product - delicious!

Friday nights the clinicians always spend out at a club (Friday night is free for students) and so Lyanne and I decided to accompany them. Dancing with Africans is entirely humbling and entirely invigorating all at once – us white folk just do not know how to dance.

Sunday we attended Catholic mass, and later brought a few of the clinicians to the pool we frequent on the weekends. While the pool fee is the equivalent of $2 for the whole day, it is still significantly out of price range for most of our friends, and so we were only too happy to treat them. We had asked them all before they arrived whether they knew how to swim, and they had all assured us that they did – a blatant lie as Lyanne and I soon found out! Thankfully the pool is only shoulder deep, and the two hours spent attempting to teach these five grown men how to do something, anything graceful in the water were entirely hilarious.

Attempting to teach Francis to float

Tonight we had the honour of being invited out to dinner by Dr. Paddy. Although I try not to pick favourites, I find Dr. Paddy’s compassion for labouring women and outright glee at every healthy baby he delivers so refreshing, especially in a country where compassion in a health care provider is not exactly encouraged (Lyanne and I get laughed at for rubbing women’s backs during labour). Dr. Paddy is currently completing his internship year at Mbale Hospital. He took us out to our favourite Indian restaurant, and we got to pick his brain about his experiences over the past year, and also about his upcoming training in neurosurgery in another nearby hospital. We’ve been so grateful for Dr. Paddy’s warm welcome of our presence on the ward. I’m sure the OB/GYN wards will be very sad to see him leave in August, but I know he will do incredible things with his future training.

Dr Paddy

Tomorrow night is our last in Mbale. Thursday we make our way to Entebbe, where we fly out from early Friday morning. Tomorrow is the day we will give what is left of our supplies to the hospital and say our goodbyes to the labour ward staff. In the evening we are having a goodbye celebration with the student clinicians. We have purchased an exorbitantly priced strawberry cake for the occasion, and expect to share it with twenty or so people.

And so our day of departure approaches, and I find myself incredibly sad to be leaving. While the experience has been intense in so many ways, it has also been very affirming for me.  If I can love being a midwife so much in these circumstances, I must really have chosen the right career. Days are long and exhausting, and sometimes devastating, but there has never been a moment when I questioned whether this is what I want to do with my life.

Posted by Sarah

PS Dear Mom, please do not be alarmed that we have no female friends here. This merely reflects the 10:1 ratio of men to women working in the hospital (in our age range anyways).

Our last few days

On Sunday Prossy took us to her village, 5 miles outside of Masaka.  Incidentally, this is the closest village to Masaka. The people of this village must walk to the hospital, but their commute is far less than many other labouring women. We first went to visit Prossy's foster family. She was warmly greeted by her 90 year old jaja (grandmother) and her uncle. They welcomed us into their home and gave us pop and showed us photos of their family- Catholics who are closely related to one of the Uganda martyrs.

Prossy and her Jaja and Uncle

We then walked to visit the Good Samaritan School for the Deaf.  This boarding school houses and educates 98 deaf children from all over central Uganda. Most of the children come from poor families and only 5 pay tuition. The government provides only $80 of funding every other year. The rest is fundraised. Children sleep in bunkbeds two per mattress and their green uniforms are splitting at the seams.Despite this they are all fluent in sign language, can read and write and do math.

Good Samaritan School for the Deaf

Yesterday we spent on the antenatal (prenatal) ward. We observed a group HIV pre-test counselling session (albeit in Lugandan) and then we proceeded to draw blood from all 55 women who attended the session. This was great practice as between us we had only done venipuncture 4 times since we learned the skill in second year. We then learned how the point of care testing for HIV and syphillis is performed. 3/55 women tested positive for HIV, none for syphillis. Somehow, being witness to these pending diagnoses was more upsetting than working with someone who already knows their HIV+ status. We reconfirmed the 3 positives using a second kind of test- they were all true positives. The ramifications of this are huge- it is likely that these women will realize upon diagnoses that their husbands have cheated and infected them. When (if) they tell their husbands they will likely blame them and may beat them. If they already have children and this was their first test they will worry about their children's status and the status of the unborn.

Point of care HIV testing

Children at HIV Cares playing with donated dolls while their parents wait for treatment

We also got to see how a malaria blood smear is done and visualized the malaria parasites under the microscope.

Today started out very slow and boring. We had no power, no running water and no IV fluid for the majority of the day so it was probably just as well that it was slow. We did each attend a birth and Carolyn resuscitated the third baby that was born. One really scary happening was that a mom brought her baby from the nursery into labour and delivery after realizing its cord tie (a glove collar) had come undone and the baby was bleeding. This is very scary because babies only have about 400ml of blood. Thankfully Carolyn quickly retied and Prossy ran to provide an IV.

Tomorrow is our last day on the wards!

Sleepless in Mbale

Sorry about the radio silence from Mbale. We had a crazy day Thursday, and it's taken a while to process it. Time for a mega-update!

Our British dorm-mates have an unfortunate habit of coming home at 11:00 pm and drinking in the hallways of the dorm until 1:00 am. After eight days of early mornings after involuntary late nights, we are both very, very tired as we head into our last few days.

Thursday

Thursday was intense. Between us, we caught six babies, including one (Sarah's catch) who took a veeerrrrry long time to crown. That's not the intense part, though.

When we arrived on the ward, Lyanne was asked to assess a woman who had just arrived. She did, and that was all fine; meanwhile in the next bed (which is immediately beside the first bed, no divider or anything between the beds) a woman was labouring hard and growing distressed. This is not an uncommon sight on the labour ward. As Lyanne was heading out to chart her assessment on the first lady, the second lady's attendant mentioned that the woman was "having trouble seeing." Vision changes, in the maternity world, are closely associated with high blood pressure and a disease called "pre-eclampsia," which, if left untreated, can lead to seizures and is the second most common cause of pregnancy-related maternal deaths worldwide.

Anyway, at this point Lyanne got the woman to lie on her side, and quickly took her blood pressure. 166/120, aka really very high. The shocking thing was that this woman had been in the ward for 12 hours already at this point, and no one had taken her blood pressure in all that time. There was also a nurse from Mississippi on the ward that day, and she quickly set up an IV, while Lyanne tracked down her Ugandan-midwife-supervisor to ensure that the woman was treated with the appropriate medications. Unfortunately, at this point we couldn't hear the fetal heart; the baby had died. Once the woman was resting, Lyanne stepped out to do two quick catches, and Sarah took care of a woman having her first baby (the verrrrry slow one mentioned earlier); when we got back on the scene, the woman had birthed her stillbirth, and was just birthing the placenta (a Ugandan midwife, one of our supervisors, was caring for her). After the placenta came out, there was a rush of blood clots -- the woman had clearly had a concealed placental abruption (when the placenta separates before the baby is out, causing bleeding). The high blood pressure might have caused the abruption, and likely the abruption was the reason the baby didn't survive. It quickly became clear that the woman was hemorrhaging. The midwife set up a second IV, the American midwife put pressure on the uterus, Sarah gave medications and put in a catheter, and Lyanne took vital signs and kept the IV bags running. The midwife ordered blood for transfusion, but the blood bank didn't have any of the right blood type. The woman's blood pressure was plummeting, the bleeding wasn't stopping, and she started having seizures. The doctors arrived a few moments later; unfortunately everyone's best efforts just weren't enough. The woman passed away shortly afterward.

It was probably a good thing that we were kept busy for the rest of the day, catching babies on the ward, and going into the operating room to receive and resuscitate babies after two cesareans.

One of the cesareans was a bit crazy as well. The anesthetist decided to do spinal anesthetic; typically women here have cesareans under general anesthetic (in this case, Ketamine). A spinal is the same idea as an epidural; freezing around the spinal nerves. In theory, this is much more localized. If the woman lies flat on her back, however, there's a danger that the anesthetic will rise too high along the spinal cord, and rather than just affecting the nerves of the abdomen, it can affect the nerves that control breathing. This is exactly what happened. The anesthetist put in the anesthetic (after the oh-so-reassuring comment, "This must be the right place"), the woman laid down on her back, there was no way to angle her body at all, and after a few minutes, the woman stopped breathing and lost consciousness. Fortunately (?) the anesthetist seemed almost to expect that this would happen, and he moved quickly to ventilate the woman's lungs, so she was fine, and regained consciousness shortly after the surgery.

Unfortunately, the baby did not do so well. The baby would respond very well to receiving air from the bag-and-mask, and would start breathing on her own, but then would rapidly deteriorate whenever we stopped ventilating her lungs. She was also very blue in colour, and had an asymmetric chest; all of this suggested a heart problem. In Canada, this baby would have been put on a respirator, had some diagnostic tests, and then had surgery; baby would probably have been fine. Here, however, there was nothing that could be done. After consulting with the doctor, when we had been breathing for the baby for about an hour, we had to make the difficult decision to stop the resuscitation and to let the baby die.

Friday

There's a strange phenomenon here in Mbale. It seems whenever there's a really intense, busy day, the next day is very quiet. Friday was no exception. After the intensity of Thursday, we were shocked to come to work to find only one woman labouring. Sarah caught her baby. Another woman transferred in, and Lyanne assisted the doctor with the delivery; Lyanne's grandmother will no doubt be pleased to know that there's now another baby "Lillian" in Uganda. When that woman left, we experienced something we've not seen before -- the delivery ward was completely empty. Eight empty beds, and no one waiting on the bench in the lobby. Over the next few hours, a few women trickled in for assessments, but most of them were in early labour, so they went back outside. After two hours on an empty ward, we headed home.

Friday night, our student clinician friends cooked us dinner -- rice and beans. We met them at their dorm, and one of them brought a one-burner hotplate into the room. Fortunately, the power stayed on until five minutes after the rice was ready. It meant eating by candlelight,  but the food was delicious, and several of the students from nearby rooms joined us for the meal. We photo-documented the experience, but unfortunately we can't get the photos from Sarah's camera onto Lyanne's computer.

The Weekend

The weekend was lovely and relaxing. Perhaps the most newsworthy event -- Sunday morning, our friends took us to mass at the local Catholic church. Neither of us has much experience with Catholic services, but I think we managed to not do anything too embarrassing. The music was amazing -- no printed hymns, so all of the songs were repetitive with simple lyrics, but everyone in the packed church was singing, clapping, and moving to the music.

Monday

The most exciting thing today -- Lyanne caught a baby that came out face-first! This is not something that happens often; face presentation is relatively rare, and often these births end in cesarean, because the diameter of the face is much wider than the diameter of the top of the head, so these babies often have trouble fitting through the pelvis. The mom was incredibly strong, and it was really amazing to see.

The midwives here were all very sweet when they were reminded that this is our last week on the ward. One joked that she would have to tie a rope to our feet so that we couldn't go back to Canada. Clearly there are often international visitors in the hospital (we've seen several during our brief time here) but the midwives have been very welcoming, and they were happy that we came with some competance and a willingness to work hard. We might not miss the intensity of working here, but we will certainly miss the people.

Posted by Lyanne and Sarah

The ATM has captured my card

We have decided to post with some of our favourite Ugandan uses of words and turns of phrase, as well as some of our language errors.

"The ATM has captured my card."

"The matoke refuses to leave the spoon."

Matoke is mashed plantain- a staple here.

"Alix, why have you soiled yourself?"

This is what they say when you accidentally get blood on yourself.

"I have failed to deliver this mother."

When the mother's labour is not progressing. 

"They made us go to bible study in college, Imagine!"

"You are most welcome."
A common greeting when arriving somewhere new.

"Do you like peanut butter?" response "Uh ugh"
(really nasally, said the way my 4 year old niece does)

"The woman who went for c-section had a ruptured uterus." response, "eiiiiiiii"

"Those people will have some IV cannulas."

"Could you get us some toilet paper rolls please?" response from hotel receptionist, "Yes please."

Here, someone says please not when making a request, but when granting one. 

"Is this where we catch the the costa to Kampala?" response eyebrow raise

Here, an eyebrow raise means yes- they are not making a suggestative gesture....unless they have long dreadlocks and seem to be familiar with western culture, in which case...

"That evening the wind blew up, the sky grew dark and it what? It rained."

Ugandans love to pose a question and then answer it themselves.

"In Canada, elementary and secondary school are free." response, "Sure?"

"How are youuuuuuuuu?" response "Fine" 

Carolyn and Alix had a Lugandan lesson in Vancouver. At that time they were taught that endaggala means medicine. After 6 weeks here Prossy finally informed us that endaggala actually means banana leaves...daggala is medicine. 

During our Lugandan lesson we also learnt that ebizza means contraction. However, in Lubisu (which is spoken in Mbale) ebizza means pubic hair. Imagine! We say, "To ebizza, to sindica. Ebizza-sindica." (no pubic hair, no pushing, pubic hair-push).

Woot, woot!

Yesterday Alix and I had a really good day working on the ward. We were supposed to work on antenatal, but when we arrived in the morning Prossy told us that there were 4 women who were 8 to 9cm and would deliver soon, so we quickly grabbed our supplies and headed to the delivery room.
It was a day of feeling really competent. I managed to get two IVs in successfully without any assistance at all (I often need someone to at least connect the IV because the cannulas are heavy and I am always afraid of losing it if I let go). These two IVs have also been after several successful IVs and this has been a tremendous feeling as I had decided that IVs were the bane of my existence :)
I also made a good management decision regarding one of the births, properly assessing what was wrong, and what was needed, which was reaffirmed by the OB when I spoke with him.
Alix did an amazing job suturing a 2nd degree tear without assistance. It was a work of art and looked perfect, and all in an acceptable about of time.
She also perfectly handled a shoulder dystocia and was gentle enough that the woman had no tears.
It was great to have such a positive day as it rejuvenated us and has made us be able to look at our final 3 days of work with some equanimity.

Tomorrow we are going with Prossy to visit her family in one of the villages, so it should be a good day.

Where is the key?

Yesterday Carolyn and I caught 1 baby each at the end of the day and then went for beans and rice for dinner at the Banana Chick Hunger Care Centre (sounds simple but it is such a pleasure the odd time we get beans). The lady from the grocery store we shop at treated us each to a banana for dessert. Carolyn has patiently taught Alix how to play whist and crib and we enjoy playing cards and drinking a beer on the patio of the Zebra in the evenings.

This morning all the moms were for CS but one, mom #1. The obstetric Operating Room was in use for general surgery all morning- an Ear/Nose/Throat doctor had been in surgery for several hours removing a foreign object lodged in a young boy's throat. One of the women waiting for c-section was in labour with her second baby. She had quite a bit of bleeding for 6cm and a bandal's ring was starting to form (separation of the upper and lower segments of the uterus- a warning sign of uterine rupture). Wisely Prossy advocated for her to be the first c-section noting pending rupture. She was right- by the time the c-section was done the uterus had ruptured along the scar from a previous c-section. The baby thankfully survived but the woman needed complicated surgery because her uterus had also adhered to her bladder with scar tissue. 

Another woman today had a blood pressure of 240/160- more than twice the healthy blood pressure. For some reason she hadn't received any blood pressure medication yesterday and was only being induced today. To make matters worse they are out of Magnesium Sulphate, a medication used to prevent seizures in women with pre-eclampsia. For a woman to buy her own costs 90,000 UShl ($35) -more than anyone delivering in a public hospital could afford. I hope she will be ok.

Carolyn caught baby #1- a very cute and healthy little girl and mom's perineum was intact- yay! Next a woman came in from home- she had been pushing for 4 hours and her baby's head was swollen with a blister and her vulva was swollen with a blister. The fetal heart was very fast. I didn't expect her to deliver but when I was assessing mom #3 she did. Baby #2 was born with a heart rate of 40, not breathing. Carolyn quickly began bagging the baby and then moved to chest compressions. She was about to give up when it moved its leg so she continued. Prossy told us to move to the nursery (where she could start an IV on the baby) so Carolyn and I walked carrying the baby down the hall while I listened to the heart and Carolyn bagged it- but the key to the nursery was missing so we had to stand in the hall holding the baby in a bloody blanket in between us while waiting for the key to be found. The baby never did breathe on its own and after 20 minutes we ceased our efforts and gave the news to the mom.

While we were resuscitating baby #2- mom #3 delivered in the first stage room. She had given birth to 5 previous babiess and had only been 5cm with mild contractions half an hour before. 10 min earlier when I had checked her blood pressure she still appeared to be in early labour...the is why we have a saying, "never turn your back on a multip!"

Tonight the administration has invited Carolyn and I and the group of Danish nursing students who are here to dinner to give them feedback on how they could improve. We are flattered that our humble student opinion is valued and look forward to the social time. Tomorrow we will do our mandatory shift in the antenatal ward.  We are braced to see up to 100 patients in only 8 hours!!!

Strength and Resiliency

On Monday, Lyanne and I arrived on the ward in Mbale for the first time in almost three weeks. At rounds we had heard that there were many women awaiting cesarean (seven, as it turned out - in a ward with eight beds, that's pretty significant). Five of these were emergency cesareans (as previously stated, ‘emergency’ means a woman will wait at least two hours, often much more, before going into theatre). Throughout the morning, EVERY SINGLE ONE of the women waiting for emergency cesarean section delivered vaginally, three in very quick succession (there was 15 minutes at most between each birth). Three of these babies did not require any amount of resuscitation whatsoever. Unfortunately, the remaining two babies had died in-utero (one mother had a prolapsed cord, the other a placental abruption).


Yesterday, Lyanne and I assessed a primagravida first thing when we arrived on the ward. She was 9 cm dilated, and had been very slow to progress throughout her labour. The doctor on call came in and assessed this woman an hour or two later, and determined that when her membranes ruptured, she would deliver - he did not suggest an oxytocin augment. (Perhaps I should mention that it is rare for health care providers to artificially rupture membranes here - there are no amni-hooks. When they want a woman's membranes to rupture, they get them up and walking around). Things got a bit busy on the ward, and it was several hours later before I returned to reassess this woman yet again. Her cervical dilatation was the same, and her membranes remained intact. I managed to rupture them myself, which revealed thick meconium stained fluid (for those not in the know, this can often indicate fetal distress). Throughout the day, the baby's heartrate had remained in the normal range, though we were listening only every few hours. At this point I needed to consult again, and so waited an hour for the doctor to arrive. Minutes after his arrival, Lyanne and I noticed this woman was pushing and that we could see the head coming. Lyanne did a beautiful job catching the baby, and this lovely little boy came into the world as healthy as you could wish, no resuscitation required.


So all of this makes me think - in Canada, our lady yesterday would likely have had an oxytocin augmentation, an epidural, possibly a cesarean section. Every one of the ladies for cesarean on Monday would have made it to theatre. Perhaps the babies that did not survive on Monday would have survived in Canada; it's impossible to know. I think most people would agree that doing six cesareans to save two babies is reasonable. However, I can’t help but feel we are giving women’s strength and babies’ resiliency too little credit. Birth works, so well, so much of the time, even if it doesn’t go according to our expected timeline.




Posted by Sarah

I like boots. They make my feet feel safe.

Hello from Masaka!

As with Lyanne and Sarah, we returned 'home' on Saturday, though unfortunately we wouldn't call it a pleasant trip. We got onto the bus to go to Kampala without mishap but getting in and out of Kampala is always a disaster and so it took us an hour once we arrived in Kampala to get to bus station, and another hour once we actually left the bus station, to get out of Kampala, to Masaka. Buses schedules around here are non existent, basically buses leave when they are full so we also had to spend an hour on the bus refusing water, pop, bracelets, cellphone holders, loaves of bread and meat on a stick. In any case we finally made it to Masaka in one piece 7 hours after leaving Jinja. The joys of 3rd world travelling! We should mention that we did get quite the kick from the person sitting in front of Carolyn who kept nodding off. Finally Carolyn had to put her hand in front of her own head to prevent getting headbutted which provided a nice cushion on which this man to put his head.

The wheels on the bus go round and round...

Our two days of work in Masaka have been uneventful. Carolyn's shoes got baptized by a load of meconium stained amniotic fluid at the one delivery of the day. Thankfully she was able to borrow Prossy's boots, which lead her to remark that she liked boots because they made her feet feel safe. Unfortunately this delivery was another macerated stillbirth. Today was slightly busier with two deliveries and several assessments; however overall we hope that it will pick up a bit.

6 days left of work and then it will be time to head back home.

Things we have accomplished so far this week

- We have figured out two more uses for a sterile glove package (What is that now? 25 possible uses? More?)

- Lyanne did bimanual compression of a uterus without getting blood on her clothing or her arms

- We have caught another four babies (two each)

- We have resuscitated two babies after cesarean section

- Sarah started an IV under pressure with no trouble at all

- We found our way to the Indian restaurant all by ourselves (okay, Sarah found the way, Lyanne followed)

The internet has been fairly unreliable in Mbale since we got back, so our updates will likely be less frequent. Alix and Carolyn no longer have access to a laptop, so their updates will likely be even less frequent.

"It's almost like coming home..."

After wishing our fearless instructors a fond farewell, our intrepid foursome spent one final night in Kampala, and then left for Jinja, bright and early, for one final day of adventures before returning to our respective placement sites.

We enjoyed a beautiful day by the pool, a delicious dinner, and a fabulous night of DIY karaoke (singing along to music from our computer) and a rousing game of zilch. Our plan for a late-night swim was foiled, alas, by a disembodied voice that came out of the shadows to warn us that the pool had just been treated with some heavy-duty chemicals, so we had to settle for a final morning swim instead. Our fellow guests at the resort this time was a group of about 25 female missionaries from the Southern U.S., so the stay was a little less quiet than before. Still, it made for good people-watching.

The four of us went together to the matatoo park. Matatoos are kind of a cross between a bus and a taxi -- large vans that follow set routes and pick up/drop off people at set points along the route, but the fare depends on the distance travelled and there is no set schedule. Lyanne and Sarah managed to find their way onto the matatoo headed to Mbale, and we have arrived safely after a fairly pleasant drive.

Seasoned travellers that we are, we've been pilfering saving the little bars of soap and extra rolls of toilet paper from the hotels where we've been staying these last few weeks, so we arrived at our dormitory well-armed. We're staying in the same building, but different rooms, just to maximise our potential for trying to open someone else's door. Mbale feels lovely and familiar after all our travelling, and when we headed to the supermarket to pick up some food for tomorrow's breakfast, we ran into the Ugandan midwife who is our main supervisor for our last two weeks, which made us feel a little more like we've returned to our Ugandan home-base. It's certainly strange to be navigating the city without Angela, and speedbumps have been added to the road near where we're staying, which has thrown off our whole system for crossing the road. Fortunately our favourite Rolex vendor was working tonight (no samosas for sale today, unfortunately) so we picked up a tasty, if greasy, dinner and we're settling in for a quiet night. Our plan is to spend Sunday by the pool once again to shake off any remaining Lower Mulago stress -- neither of us is particularly the "lounge by the pool" type normally, but we're both finding that spending a day swimming and reading is the perfect way to unwind from the craziness of the work here.

Monday we head back on the wards!

Posted by Lyanne and Sarah

Shaking our ''sitting facilities'' to Jinja

We are finally finished in Kampala. We did our 4th half day in Mulago hospital today. Only Sarah caught a baby today. Another group of Ugandan students caught a dead baby with a mouth full of teeth and a brain but no skull to cover it (anencephaly)...One woman has been waiting for 3 days to go to the operating room to get a vaginal tear sutured- it was too deep to do on the ward. She had no food- Alix gave her a granola bar and Angela (one of our instructors) bought some formula for her baby since she had no milk... Oh and yesterday a breech baby's head got stuck and it died.

Alix went in the operating room for 4 ceseareans in case any babies needed resuscitation. Cathy and Lyanne had noticed that one mom was bleeding more than she should have been prior to delivery and suspected a low lying placenta. They had pointed her out to the doctor and it was a good thing- that mom went straight to c-section and sure enough the placenta had been low lying. The baby needed only 4 puffs of air but was well enough to go to postpartum with mom. The second woman had been diagnosed as postdates, breech with polyhydramnios (too much amniotic fluid)- turns out the baby was head down, large and stillborn. It smelled worse than anything Alix had ever smelled even though it was dead less than 24 hours- it was covered in tiny blisters and Alix wondered if it had died from syphillis. The third baby came out screaming and robust. The fourth baby was supposedly coming face first and labour was therefore obstructed, but when the doctor pulled it out it was actually breech. They thought it was term but really it was only about 34 weeks and needed 4 min of resuscitation.

Needless to say we are not sad to be leaving. Though on a positive note, the Ugandan students at this hospital have been great to work with. Keen to learn, aware of what they don't know, and friendly, working alongside them was a positive experience. Carolyn today enjoyed mentoring one of the students who completed her first birth and another who wanted to learn how to use the partogram.

Last night we took our instructors out for dinner to a great Indian restaraunt and then we went to see a wonderful performance of traditional music and dance. We were so glad to finally get to hear some live music- it's a shame that there isn't more of the marvelous local drumming to be had. At the end we got up and shook our booties (or as the emcee put it our "sitting facilities") on stage with the dancers. Tonight the instructors took us out for dinner at the Indian place. They leave for Entebbe tonight and fly out tomorrow. We will miss their support, guidance and company greatly.

Tomorrow we will be heading back to the amazing resort on Lake Victoria in Jinga, source of the Nile, to spend Canada Day together drinking banana gin by the pool and eating delicious 'Ryan's chips' with avocado- these are fries smothered in some ketchup/chili sauce mixture with red onion and green pepper. Yum!  We have a Canadian flag t-shirt and tie that we were planning on giving away but perhaps we'll wear them with our swimsuits first. It will probably be our most patriotic Canada Day ever.


Lyanne delivering a placenta




Us with the inspiring Dr. Mirembe, renowned Uganda researcher of maternal mortality and champion of midwives.



Human (read female) suffering

Today was one of the hardest days for me so far here in Uganda. The four of us, as mentioned before are in Kampala; we have been spending our time in 'lower Mulago' the high-risk ward. Basically what this seems to mean is that approximately half of the women are waiting for c-section. Put another way, what this means is a large group of women are out of their minds in pain, moaning and screaming, terrified that they are going to die or that there baby will die. It is a cacaphony of suffering, and suffering with no end in sight.  This is not like in Canada or like any other developed country where waiting for a c-section means maybe an hour. If you are lucky, it will maybe take you 4 hours but realistically, you might be waiting for day or longer. There is also no such thing as an epidural for a long obtructed labor. Imagine being at the very limits of what you think you can handle, and yet you have to go on, and you have no idea, none, of how much longer you will have to continue experiencing the worst pain that you have had in your life. 
As a careprovider it is a helplessness that is so profound. You get so drawn in to the suffering around you. It is so draining. Today, there are no inspiring moments, just anger and sadness that this ward is only a sliver of what most women in the world experience. Actually I take that back, the strength of these women is even beyond compression. It is amazing what one can survive when you have to.

Carolyn

The last 4 days of safari and the first day in Kampala

We left fort portal and drove down to Queen Elizabeth National Park for Wednesday/Thursday nights. We stayed at the simba camp= simba is swahili for lion. The rooms were great but the food was expensive- one night they tried to serve us potato curry with roast potatoes as the vegetarian option!  It was here that we discovered the local banana gin called Warugi- or ugi for short. Tastes just the same but costs $0.55/shot. With a little tonic water or bitter lemon we were set. 

 

On Wednesday afternoon we decided to add an evening game drive to the itinerary. This cost an extra $35 each for park entry and gas but was worth it because we saw two lions- a young male and a female lying down about 10 feet from our car. Wow! They are beautiful. We also saw elephants (up close) and warthogs and many antelope. On Thursday morning our game drive was quieter but we glimpsed a leopard-incredible! Thursday afternoon we went on a boat ride on the Channel that connects Lake Albert to Lake Edward. We saw many hippos, numberous birds including the saddle beaked crane, we saw a crocodile who had tried to eat a python but the python's fang pierced the croc's lip making swallowing impossible- so he swam dragging the dead python with him. We also saw a fish eagle catch a Nile perch. Take that National Geographic!

 

On Friday morning we drove to Lake Mburo. On the was in we were thrilled to see a harem of zebras! Once inside we went for yet another boat ride with many fish eagles and hippos. We got too close to one hippo and had to race away as it lunged up out of the water to attack our boat. We saw how the local fisherman fish- they use floating papyrus reeds weighted with rocks to suspend the nets. We ate dinner at the open air canteen by the lake and we had a great view of hippos and warthogs. The next morning we left at 6:30am for a brilliant game walk and learned that the most dangerous animal is the buffalo who does not like to be surprised. We saw a new breed of antelope called a Topi. That afternoon we went on a game drive and Sarah spotted a mongoose (I missed it) and we saw a new breed of antelope- the Elan.

 

We are now in Kampala. Today we went to Mulago hospital and began with rounds. We heard about the extremely high volume of cases (sometimes labour admissions numbered 120 in 24 hours), the many successes but also a few tragic stories of deaths due to anaesthetists not showing up for their shifts, refusing to anesthetize a patient who was too sick only to have them die anyways, a broken oxygen set up and lighting in one of the ORs.  Several ruptured ectopic pregnancies were delayed in getting surgery because the gynecology OR was being used for cesearean sections. We heard about a woman who had had a failed abortion at 20 weeks at a local clinic- they tried 5 times to remove the products of conception- perforated her uterus and let her go septic before finally referring her... I have great admiration for the hospital staff and the great volume of women they serve despite shortages of staff and a lack of functional equiptment. Did I mention there was a grave shortage of sutures?

 

After rounds the BC team hit the  high risk ward today in full force- good things- in only 3.5 hours we caught 6 babies between us. Carolyn 1, Sarah 1, Lyanne 2, Alix 1, Cathy 1. Mickey and Angela helping all. All were happy endings but 1- Alix's catch was a macerated still birth.  We left work in hopes of finding the fabric market but our driver took us to a craft market instead- no worries- the gals happily dove in.  Delicious samosa and rolex for dinner tonight- best $0.50 dinner ever.

 

Posted by Alix

Things We Learned on Safari

Hello!

We haven’t had internet access for several days – I hope you haven’t all been hitting “refresh” every 5 minutes in the hopes of an update!

The rest of our safari we spent at Queen Elizabeth Park, and Lake Mburo. Many more hippos (including one very angry one), impalas, lions, more elephants, crested cranes, a saddle-bill (bird), a very shy leopard, and many, many zebras. We also all ended up falling a little bit in love with the warthogs.

We were back on the ward today, all together in Lower Mulago’s high risk labour ward. To wrap up our safari story, we figured we would share a list of things we learned on safari. So!

Things We Learned on Safari

* Kampala, the capital city of Uganda, was originally called “Ka-impala,” meaning “here there are impalas.” Impalas used to live there, but moved south thanks to climate change and human development. The colonial Brits decided to shorten the name (maybe it sounded too Klingon?)

* A group of zebras is a 'harem,' a group of hippos is a 'school,' and a group of vultures is a 'committee.'

* Buy your own avocados from roadside fruit stands, and bring them into the restaurants. The chef will turn them into guacamole for free, and avocados are (literally) 200x more expensive if ordered from the menu.

* ”Pumba” is Swahili for “warthog.” “Simba” is Swahili for “lion.” We don’t know for sure, but have a pretty strong suspicion that “Timon” is Swahili for “meercat.”

* Never give a monkey a roll of toilet paper.

* Carolyn is the fasted reader.

* Check the price on the menu before you order tea.

* “It’s okay” or “I’m okay” means “yes” in Uganda, not “no.”

* Never cross a hippo.

* Never cross a buffalo.

* Never cross Alix if she has access to a moldy frying pan.

* Do not pack a half-empty (i.e. open) container of jik (bleach) in the same bag as your clothes.

* Do not eat too much fruit if you’re going to be driving from Murchison Falls to Fort Portal.

* When the guide closes his car window, it might be a good idea to also close yours, especially if you’re about to be passed by a large truck on a dry, dusty road.

* In addition to “White person,” “muzungu” can also mean “wealthy person,” especially if referring to someone who receives money from white people.

* Do not try to do a safari game drive in a Corolla on dirt roads after a night of rain.

* Sit on the left on the boat rides.

* Stand further back on the squat toilet than you think you need to.

* Check for wasps nests before you say your hotel room/banda is fine.

* If the souvenir shop is painted like a zebra, there are probably cheaper prices elsewhere.

* Never eat a banana in front of a warthog.

Posted by Lyanne, Sarah, Alix, and Carolyn.

Murchison Falls Boat Ride

Why did the elephant cross the what?

Lake Mburo Boat Ride

One foot in each hemisphere...




Breasts vs Icicles

Yesterday we slept in (well some of us did-others wake up at 7 no matter what) and then headed to the Toro Botanical gardens. We were lucky to have an herbalist as our guide who had a very impressive vocabularly of female reproductive anatomy words and a comfort discussing them. He showed us many of the local medicinal herbs for childbirth. There were plants to prevent a miscarraige when a woman has bleeding in early pregnancy, plants to ease labour pain for first time mothers, plants that treated syphilis and candida, plants that helped create a swift birth, helped with the delivery of the placenta, helped with fibroids, fallopian tube problems etc. Like us they prescribe fennel to increase milk supply and sage to dry up milk. On the wards we noticed that very few women tear during birth-despite their great strength when pushing, sometimes poor nutrition and their choice of birth position (often on their backs). When we asked the midwives about this they explained the women soaked their perineums in an herbal bath before labour to prevent tears but they didn't know which herbs are used. Today we learned that a plant called waruncha and potato runners and boiled briefly and then used in said herb bath.
We  saw many species of indigenous plants including several endangered species that are being cultivated. There were also herbs and spices, traditional dye plants and even a specimen of purple sticky punch! We spotted a black and white colobus monkey and at a pale purple/green tree fruit that looked like a mini eggplant, had the internal colour and texture of a tomato and tasted like a salmon berry-yum! Our guide Dominic came along and we got a kick out of the fact that he bought a stevia seedling which he then carried with him on our excusions for the rest of the day so it didn't wilt in the car.
After the gardens Dominic drove us to visit the Amabere caves and 3 crater lakes. The caves are made of limestone and contain both stalictites and stalamites. These are formed when water seeps through the porous limestone causing a chemical reaction that results in the release of C02 and drips of calcium carbonate that form rock icicles from above and spears from below that eventually meet in the middle forming columns. Ambabere means breasts...If you have ever seen a stalictite you would agree it bears more resemblance to an icicle than a breast, and Lyanne pointed out that stalagmites bear a strong resemblance to penises...but we know that men all over the world are breast crazed and so Amabere it is. The local myth is that there was a king Bukuku who had an extremely beautiful daughter Nyinamwiru. One version of the story holds that the king had heard a prophecy that Nyinamwiru would give birth to a boy who would kill him and take over as king. In the first version of the story the king cut out oneof Nyinamwiru's eyes and one breast-throwing the breast into the caves and creating the first stalactite. He was too late though- Nyinamwiru was already pregnant. She gave birth to a boy who Bakuku kidnapped and threw into the caves also. There he was found by a potter collecting clay. The potter fed was too poor to feed the baby and so fed the prince with the milk that dripped from the stalactites. Eventually the boy prince grew and killed his grandfather, fulfilling the prophecy.
Another version has it that Nyinamwiru had many unsuitable suitors. King Bukuku had his daughter's breasts cut off to deter suitors. This failed and so he banished her to the limestone caves. There she was impregnanted by the King Isaza and gave birth to a boy prince, Ndahura. Having no breasts she fed Ndahura, future king, with the limestone milk from the stalictites.
Then off to visit 3 crater lakes. The scenery was beautiful- grassy green volcanic hills, grazing cows and the Rwenzori mountains in the distance. One crater was reputed to have quick sand in it! Viewing the 3rd crater involved a short climb up a very steep hill- the first cardio any of us has had in 4 weeks. We were all panting by the time we reached the top and we were grateful today was slightly overcast and cool. The view was well worth it. On the way down we stopped by a tiny store in a mud hut for beer which we ate sitting on a bench in what appeared to be a 5'x5' goat pen...the goats were tied up outside. Dominic told us about sugar daddies, sugar mommas and the difficulties of divorce in Uganda. He confirmed that a marriage is not legally binding until children are produced (we thought Benon was joking) and if the your parents don't consent to your marraige the church won't marry you.
We finished our day at a wonderful pizza restaraunt run by an Italian expat. We had thin crust pizza with mozza, gouda, tomato, olives, pineapple, garlic & eggplant and shandies. It was scrumptious! And they had a Canadian flag hanging in the centre of the restaraunt to boot. Dominic rested his stevia plant in a windowsill while we ate. We found a wonderful craft shop after dinner and have now settled in to read for the night. All four of us are reading a fabulous series about witches that Sarah has gotten us hooked on- The Witches of Eileanan by Kate Forsyth.
Today we drive to Queen Elizabeth National Park for another game drive.

PS- we apparently double posted...

A beer stop after climbing up to view the crater lakes

Part 2: Fort Portal

Yesterday (Monday) we spent most of the day on the road, driving to Fort Portal. It was about 300 km, but it took most of the day, because most of the drive was on narrow, dirt roads, filled with potholes. The sun was hot, and the dust from the road blew in through the windows. As usual, we were sharing the road with many boda-bodas, and people cycling with more on the backs of their bikes than I'm comfortable squeezing into the trunk of my car. Incredible.

We made two stops along the way for food, and at both stops, we recognized the same tourists that we'd run into at Murcheson falls the day before -- clearly, there are specific "muzungu-friendly" restaurants that all of the tour guides end up using. Our guide/driver, Dominic (of www.assuredugandasafari.com) was joking that the reason the ride was so bumpy was that he was lonely driving with all four of us sleeping, so he picked out the best potholes to jolt us awake. :)

We also passed through a town called "Kyejojo," which translates, literally, as "It's elephants!" It seems local farmers were finding that an animal was destroying their fields at night, so the villagers stayed awake together one night to solve the mystery of the disappearing crops. As the name might suggest, the culprits turned out to be elephants, so the town was named in honour of the farmers' started exclamations when they first noticed the animals galumphing through their fields.

Fort Portal itself is clearly a relatively well-off town. The roads are well-paved, there is very little garbage in the streets, and even our "budget" hotel has comfortable beds, hot showers, and soap in the bathrooms. The town is surrounded by tea plantations, which probably goes most of the way to explaining the town's relative economic security.

Most people come to Fort Portal to see the chimpanzees, but our budget didn't permit us that particular excursion. Instead we spent the morning at the local botannical gardens. When the guide asked us what our particular plant-interests were, and we mentioned herbs involved with pregnancy and birth, he excitedly found one of the female gardeners who had worked as a birth attendant, and she told us all about several of the local plants. We also toured the arboretum, saw a few monkeys, and sniffed many of the wonderful-smelling herbs. Our Dominic ended up buying a stevia plant for his kids back home (like in Canada, stevia is used as a sweetener here) and he took great care of the plant for the rest of the day, moving it to the shade, watering it, even bringing it into the restaurant with us where we ate dinner because he was afraid his plant wouldn't be safe in the car. We've named the plant "Steve."

We spent the afternoon at some local caves and volcanic hills. The walk to the cave was muddy and slippery, but the caves were interesting enough, and we saw another waterfall. The local name for the caves translates to "breasts," because the stalactites apparently resemble breasts. The local legend is that a king removed his beautiful daughter's breasts and threw them in the cave, because he had heard that his grandson would steal his kingdom -- as most similar stories go, he was too late (she was already pregnant, and still very beautiful) and the breasts continued to grow in the cave, and fed her infant son when her father banished him to the caves as well. We also climbed up the volcanic hill, and were treated to a beautiful view of the surrounding area.

There's a song with a line "You never know 'til you reach the top if it was worth the uphill climb" but here, the opposite seems to be true. The uphill climbs, tiring though they may be, tend to end in spectacular views -- today the top of the 1093 metre hill also featured hundreds of beautiful, colourful butterflies. It's the downhill climbs that tend to end in less spectacular sights -- and the problem with that is that they are also the ones where you have to climb up on the way back!

We went to a local pizza restaurant for dinner. We haven't made much of a point of seeking out Western food here, but after a long day with minimal food since breakfast, pizza has never tasted so good! Fresh pineapple on the pizza was a particularly special treat!

We head for Queen Elizabeth Park tomorrow. If it's anything like Murcheson, we won't have internet access there, so we'll update whenever we can.

Posted by Lyanne, Sarah, Alix, and Carolyn

Part 1: Boomu women's co-op, Murchison Falls

Our vacation began 3 days ago and we have packed a lot in 3 days. We were picked up from Jinga by our tour guide and we spent the day driving to Masindi. On our way there we stopped at the rhino sanctuary where we saw...we know the suspence is killing you...rhinos. So awesome! An interesting fact is that when the mama rhino gives birth she rejects her previous baby and sends him or her to live with other rhinos. It just so happens that a mother just gave birth, though we weren't able to find her as she is too aggressive right now to be around humans. The sanctuary is not like a zoo. The rhinos are in the wild over a very, very large kilometrage and you have to go and find them. This is also the first time that we feel like tourists. It's almost like culture shock. We were appalled when we saw a woman with short shorts and a tank top. We know that we are tourists, but where we are working there are basically almost no other foreigners, plus we are working all day. After the rhino sanctuary we arrived in Mapingi and stayed at the  BOOMU women's cooperative. Basically it is a co op run by women for women. The work they are doing is amazing. They have a crafts store where 85% of the proceeds go back to the artist and 15% goes to the co op. They have a guesthouse, and a restaurant and provide workshops on basket weaving and food making. They also provide a guided walk around the villages where you stop at 3 different locations and learn about ancient hunting practices, birth practices, and ancient marriage practices. When we arrived we had dinner there and Edna the woman who runs the co op sat down with us and described the story of the co op as well as how it is for many of the local women. It is heartbreaking and unbelievably inspiring to hear about how much she has accomplished as well as the challenges they face. For example, they have bees and make honey, but have no money for jars. They don't have money for electricity so people often drive by not realizing that there is a guesthouse that they could stay in. The next morning we went to the basket weaving workshop which was very interesting and heard a horrific story about Edna having a sore tooth, went to the "dentist" who pulled out two rusty nails, decided that her tooth wasn't so bad so went back home. She then returned the next day because it hurt so much and was told to go home since she refused his services the first time. She returned again and had her tooth pulled with the two nails and she "almost cried"! Have we mentioned that women here are much stronger than woman in Canada? Afterwards we went for the guided walk and here are some of the more salients bits of info that we learnt:

1. Traditionally men hunted with double ended spears. They had 3 hunting methdods. They would dig a large pit for the animal to fall in, construct a huge net and chase the animals into the net or simply chase they animals towards men waiting for to spear it. The first man to spear the beast (usually a buffalo) gets to claim the hindquarter. However, if the beast does not die right away the hunter makes a deal with the beast. If the deast lies down to die the beast can claim the life of the first person to taste it's meat. In this case the first cursed bite is offered to a neighbour in the village rather than a family member.
2. During childbirth a woman will kneel holding onto the central post in her house and her sister-in-law will provide a hip squeeze while she pushes. After the birth the husband will bury the placenta outside the house, marking the spot with an arrow. He will also place a spear at the corner of the house so that passers by will know a baby has been born. Baby boys remain indoors for 3 days, girls 4. On the day of their emergence the old women from the village come and they are served millet and soughrum ground ceremoniously while the grinder sings a birth song.
3. In the past, when a man loved a woman he would approach her 3 times. Each time she would reject him. On the fourth time she would agree she loved him but insist that he marry her. The man would tell his father who would befriend her father. After the 6th or so meeting of the fathers, the boy's father would express his son's interest in marrying his friends daughter by saying he wanted one of the man's "hens". The father would deny that any of his daughters would want to marry and so the girls mother was called. The mother would call all her daughters before her and ask which wanted to marry the boy. After several inquiries the girl would admit her interest. Then an introduction would be planned. The girls family would visit the boys family and give the boy an envelope with money (a "cock") and list of things for the bride price. The boys family agrees to pay and he girls family goes home.  The whole community of the boy would contribute to the bride price (cows, goats, money, alcohol). On the wedding day the boys family would come to the girls with the bride price, new clothes for the bride and a floral necklace. Once the bride price is counted an approved they dance. Then they look for the bride. A row of younger girls is presented first and when the groom doesn't recognize any of them he must pay their transport home before assessing another row-same thing. Finally he pays a friend to bring a third line before him which contains his wife. He place the floral garland around her neck and they dance again. The woman is then asked if she accepts the man. If she does they feast and dance again. The mans family then goes home, the bride accompanied by 3 aunts who carry her the whole way. Upon their arrival the bride & groom together plant a handful of seeds and then hoe together. Three days later the aunties return and if the seeds have germinated the marriage will be fruitful. The woman is then gifted with 2 knives, 2 pots and plates and must cook a feast for everyone. After this the woman spends the next 3 weeks indoors.
4. Some tribes bury their dead in their house.
5. When a woman has twins and they die the twins are each placed in a pot, the lid is sealed and they are kept in the corner of the kitchen for 40 days. Each day their mom puts the cooking ashes on them. After 40 days the fathers family and mothers family walk to meet by a tree marking a halfway point- they throw small green tomatoes at each other, place the pots under a tree, exchange meals, eat and return home.

Afterwards we headed to Murchinson Falls which were beautiful and then made our way to our accomodations. We spent the night sweating like crazy and awoke to thunderstorms; however this was made up for by having a wonderful day of a game drive and boat trip down the Nile! The Nile! Our safari guide was terrific and managed to not get us stuck in the multitudes of ditches that were there unlike several other cars and their unfortunate inhabitants. So today we saw: giraffes, elephants, baboons, monkeys, bufallo, dozens of antelopes, hippos, crocodiles, warthogs, and many birds. So cool! All of them quite up close. We were amazed by the gallantry of the giraffes, the speed of the elephants, the wallowing of the hippos, and the playfulness and jumping ability of the antelopes. We were surprised to learn about how many male species of animals reject their male young in order to maintain dominance. We were all really adorable in our geediness and gleefulness. Oh Africa! Such a country of extremes.

Lyanne, Sarah, Carolyn, and Alix