One Friday morning, I poked my head into Dr. I's office. He was about to head out and asked if I wanted to join him. Once a week, the pediatricians take turns to round at the Baylor Pediatric HIV/AIDS Center near the hospital. Today was his, and I gladly came along.
Walking down the hill from the in-patient pediatric wards, we pass roomfuls of crying babies and mothers waiting outside for their children, hand-washing and drying bedsheets on the grass. Stepping over the crowd, we make our way to a open-air brick building with wood paneled accents. We enter a bustling lobby, and Dr. I greets the receptionist at the desk to the right. Wait, receptionist? I look again. Yes, there she was, smiling behind a flat screen monitor, typing appointments on the computer. This was not the Mulago I was used to. Behind them, families rested on polished wood benches while waiting for their appointments. On the left, the adults watched television while on the right, a teacher was leading the children in a game. I turn to Dr. I and smile. This was a slice of heaven on earth.
The Baylor Center is supported in part by Bristol Myers Squibb, and the benefits of corporate funding are very apparent. First and most important, all treatment and care are free. Each case begins with ample counseling and social work, which is unimaginable for any of the adult AIDS patients. The children's families must be deemed competent and responsible before any long-term drug therapy is given. Once the family is approved, the counselors try to increase adherence, which is tantamount. Each month there is a follow-up visit, in which an attending physician treats the patient in the privacy of an examination room! Truly simple comforts in the West, but a complete luxury in Africa.
Throughout the hospital, local art adorns the walls. Electronic medical records are being rolled out, and an entire upstairs floor houses administration and finance. I had never seen such officers in the rest of the hospital. They even feed the patients! Two times a day, the Center canteen distributes a food pack for each family. When they leave at the end of the day, there is a take-home gift which includes some food for the road and family members at home. As such, adherence is phenomenally high.
After seeing a few patients with Dr. I, I had to leave, but I felt relieved. Though outside the AIDS epidemic rages on, in here there was a bit of a respite. In the quiet, air-conditioned space, I could feel hope. Everything was going to be all right.
Monday, August 3, 2009
Tuesday, July 21, 2009
Pediatrics
Dr. I is a gentle and unassuming man with a penchant for elegant patterned ties, which he wraps around his spectacles when they are not in use. He presides over one of four pediatric wards at Mulago Hospital, each of which rotate in turn as they try their best to admit the hundreds of extremely sick children who arrive at the acute pediatrics unit every day.
The children range in age from newborns to young teenagers, and they fill up the waiting room, resting on their mothers' laps. Frequent crying punctuates the air, as a child suffering from sickle cell anemia struggles in pain. Sickle cell anemia is a genetic condition that occurs when some or all of the red blood cells produced are abnormally shaped and can easily form the shape of a sickle. These blood cells cannot move properly through the circulatory system and easily form clots in the smallest blood vessels, triggering the painful crises that the children are experiencing. Even more troubling is the anemia, or lack of red blood cells, that occurs when the spleen filters out these defective cells.
A rare moment of silence in the waiting room belies the dangerous condition that many of the children are facing. Without a sufficient number of red blood cells, the anemic body cannot bring enough oxygen to the tissues throughout the body, and severe illness and death is imminent.
The on-call responsibilities are taken by Dr. I's ward today, and he scans the waiting room area, triaging the patients to find the sickest ones. It's a simple test: he pulls down the eyelids to see the color of the conjuctiva lining the inside of the eyelid. If you look at your own in the mirror, it is probably a shade of pink or red, depending on how long you have been staring at the computer screen. In the sickest children, the color is a blank white. The same test is done for the tongue and palms of the hands. Similar results are found.
The mothers are instructed to bring their children inside, and Dr. I begins writing the patient's charts. A cursory diagnosis is given, for the first priority is for the patient to receive blood. More detailed treatment options can be discussed later. So Dr. I begins to jot down the patient's history. Other than the genetic sickle-cell anemia, the other common cause of anemia is infectious-pediatric malaria.
Malaria is a disease caused by tiny protozoal parasites. After a nighttime bite from an infected Anopheles mosquito, the parasites enter the blood stream, invade the liver, and spread to red blood cells. The parasites multiply within the blood cells and rupture their hosts when their numbers are sufficiently high.
The patients in the acute care ward arrive only after prolonged waiting and even transfers from other hospitals, so their conditions are often very severe. High fever, anemia, and a marked increase in size of both the liver and spleen can be seen. To confirm a diagnosis, however, a blood smear must be done. Without a lancet, the laboratory technician finger-pricks hundreds of children a day, and smears the blood on a glass slide. A blue field stain and red malarial parasite stain is added, and the slide is viewed under an oil-microscope.
The P. falciparum species of parasites are endemic to Sub-Saharan Africa, and are easily seen. Infected red blood cells present with an ominous red dot, and malaria parasites swimming freely in the blood can be easily spotted. Based on the number of parasites seen in each microscope field, a diagnosis is given: no malaria parasites seen, +, ++, +++, or ++++. Many of the children present with +++ or ++++ malaria.
After the diagnosis is confirmed, the children are moved to the emergency treatment room, where there are cannulated. A plastic cannula tube is inserted into the veins on the back of the hand, but not without much screaming and crying. The plastic screw top is removed and a small sample of blood is drawn to determine the blood type. Four drops of blood are placed on a white tile, and four different antibodies are dropped on each blood spot: anti-A, anti-B, anti-AB, and anti-Rh factor. Swirling the tile around reveals clotting in the anti-A, anti-AB, and anti-Rh spots. The child has A+ blood.
Blood shortages at Mulago are a constant worry. Some of my colleagues witnessed a child who did not receive a transfusion in time and passed away on the table. Each bag of blood is precious and contains life. Gingerly, Dr. I removes a bag of blood from the refrigerator and brings it to the child's mother, asking her to warm it under her arms. The child is transfused, a dose of quinine is given to kill the malaria parasites, and one life is saved for today.
The children range in age from newborns to young teenagers, and they fill up the waiting room, resting on their mothers' laps. Frequent crying punctuates the air, as a child suffering from sickle cell anemia struggles in pain. Sickle cell anemia is a genetic condition that occurs when some or all of the red blood cells produced are abnormally shaped and can easily form the shape of a sickle. These blood cells cannot move properly through the circulatory system and easily form clots in the smallest blood vessels, triggering the painful crises that the children are experiencing. Even more troubling is the anemia, or lack of red blood cells, that occurs when the spleen filters out these defective cells.
A rare moment of silence in the waiting room belies the dangerous condition that many of the children are facing. Without a sufficient number of red blood cells, the anemic body cannot bring enough oxygen to the tissues throughout the body, and severe illness and death is imminent.
The on-call responsibilities are taken by Dr. I's ward today, and he scans the waiting room area, triaging the patients to find the sickest ones. It's a simple test: he pulls down the eyelids to see the color of the conjuctiva lining the inside of the eyelid. If you look at your own in the mirror, it is probably a shade of pink or red, depending on how long you have been staring at the computer screen. In the sickest children, the color is a blank white. The same test is done for the tongue and palms of the hands. Similar results are found.
The mothers are instructed to bring their children inside, and Dr. I begins writing the patient's charts. A cursory diagnosis is given, for the first priority is for the patient to receive blood. More detailed treatment options can be discussed later. So Dr. I begins to jot down the patient's history. Other than the genetic sickle-cell anemia, the other common cause of anemia is infectious-pediatric malaria.
Malaria is a disease caused by tiny protozoal parasites. After a nighttime bite from an infected Anopheles mosquito, the parasites enter the blood stream, invade the liver, and spread to red blood cells. The parasites multiply within the blood cells and rupture their hosts when their numbers are sufficiently high.
The patients in the acute care ward arrive only after prolonged waiting and even transfers from other hospitals, so their conditions are often very severe. High fever, anemia, and a marked increase in size of both the liver and spleen can be seen. To confirm a diagnosis, however, a blood smear must be done. Without a lancet, the laboratory technician finger-pricks hundreds of children a day, and smears the blood on a glass slide. A blue field stain and red malarial parasite stain is added, and the slide is viewed under an oil-microscope.
The P. falciparum species of parasites are endemic to Sub-Saharan Africa, and are easily seen. Infected red blood cells present with an ominous red dot, and malaria parasites swimming freely in the blood can be easily spotted. Based on the number of parasites seen in each microscope field, a diagnosis is given: no malaria parasites seen, +, ++, +++, or ++++. Many of the children present with +++ or ++++ malaria.
After the diagnosis is confirmed, the children are moved to the emergency treatment room, where there are cannulated. A plastic cannula tube is inserted into the veins on the back of the hand, but not without much screaming and crying. The plastic screw top is removed and a small sample of blood is drawn to determine the blood type. Four drops of blood are placed on a white tile, and four different antibodies are dropped on each blood spot: anti-A, anti-B, anti-AB, and anti-Rh factor. Swirling the tile around reveals clotting in the anti-A, anti-AB, and anti-Rh spots. The child has A+ blood.
Blood shortages at Mulago are a constant worry. Some of my colleagues witnessed a child who did not receive a transfusion in time and passed away on the table. Each bag of blood is precious and contains life. Gingerly, Dr. I removes a bag of blood from the refrigerator and brings it to the child's mother, asking her to warm it under her arms. The child is transfused, a dose of quinine is given to kill the malaria parasites, and one life is saved for today.
Sunday, July 5, 2009
Benevolent Dictator
If you are familiar with the film, The Last King of Scotland, you will have heard of Idi Amin, the ruthless dictator-president of Uganda in the 1970s. Amin seized control of the country in a military coup, beginning almost a decade of tumultuous rule. Political rivals were purged, disobedient military officers were executed, and intellectuals were killed. The Ugandan economy was turned upside down as the merchant class Asian Indians were exiled from the country, taking their entrepreneurial abilities and capital with them. Amin was a brutal ruler who left a legacy of blood and destruction.
Or did he? If you talk to present day Kampalans, you will find a very different opinion of the man. In contrast to the negative view of Amin shared by Westerners, many Ugandans I have spoken to find Amin to have been quite a good leader. Amin was a patriot, they say, who was not without his flaws, but loved his country and did his very best for it. My colleagues and professors who have lived through Amin’s time speak of private secondary schools which only allowed entrance to white or Asian Indians, government agencies headed by those with British heritage, a commercial center with only two African-owned business, and entire hospital floors at Mulago Hospital, where I work, reserved for VIPs – Europeans and Asians. Amin ended all of these practices, they say, and Africanized the country. The schools were open to all, businesses were given (forcibly) to African owners, and an African nation was truly given to Africans. For what was independence, if Uganda was still to live under de facto colonialism?
Sure, there were costs of this transition, as the Uganda replacements were not always as competent or ready to accept the responsibilities of their new posts. But, as Amin said, to learn to swim, one must be prepared to take a few gulps of water before the skill is mastered. Perhaps the African businessmen were not as efficient as the Asian Indians, but at least Uganda is run by Ugandans, a fact that may not be as evident in neighboring Tanzania and Kenya.
My colleagues’ views are not without merit. If I had grown up in what I viewed to be such an unfair environment, it would only be natural to feel resentment toward the European and Asian outsiders who were benefitting from the country’s resources, while local Ugandans suffered. Seen from this point of view, Amin’s populist policies can be judged as not only understandable, but even just.
The younger generation I spoke to, however, emphasized a more negative view of the dictator. Amin was a rash man, they said, who acted on impulse. He would wake up one day, claim to have a dream which called him to exile all the Asians, and then pronounce a law requiring them to leave within ninety days. Many of these Asians were Ugandans by birth, having been in the country for generations. They had nowhere left to go, and the results were devastating. Many ended up committing suicide. Other, more dubious stories abound, such as Amin telling the national football team not to return from Kenya after their World Cup qualifier loss, or face execution, and ordering a brutal murder of his own wife.
There are many views of the man in Uganda, all of them quite strong. Amin’s legacy is quite a complicated one, which surprised me very much, as I expected a strong hatred toward such a brutal dictator. But the public’s views did remind me of another leader who commands a complex legacy, whom I often talked about with my friends while in China. Speaking to the local people about their own history reminds me that human events seldom occurs in black and white, and the Western view is not always the objective view I assume it to be.
Or did he? If you talk to present day Kampalans, you will find a very different opinion of the man. In contrast to the negative view of Amin shared by Westerners, many Ugandans I have spoken to find Amin to have been quite a good leader. Amin was a patriot, they say, who was not without his flaws, but loved his country and did his very best for it. My colleagues and professors who have lived through Amin’s time speak of private secondary schools which only allowed entrance to white or Asian Indians, government agencies headed by those with British heritage, a commercial center with only two African-owned business, and entire hospital floors at Mulago Hospital, where I work, reserved for VIPs – Europeans and Asians. Amin ended all of these practices, they say, and Africanized the country. The schools were open to all, businesses were given (forcibly) to African owners, and an African nation was truly given to Africans. For what was independence, if Uganda was still to live under de facto colonialism?
Sure, there were costs of this transition, as the Uganda replacements were not always as competent or ready to accept the responsibilities of their new posts. But, as Amin said, to learn to swim, one must be prepared to take a few gulps of water before the skill is mastered. Perhaps the African businessmen were not as efficient as the Asian Indians, but at least Uganda is run by Ugandans, a fact that may not be as evident in neighboring Tanzania and Kenya.
My colleagues’ views are not without merit. If I had grown up in what I viewed to be such an unfair environment, it would only be natural to feel resentment toward the European and Asian outsiders who were benefitting from the country’s resources, while local Ugandans suffered. Seen from this point of view, Amin’s populist policies can be judged as not only understandable, but even just.
The younger generation I spoke to, however, emphasized a more negative view of the dictator. Amin was a rash man, they said, who acted on impulse. He would wake up one day, claim to have a dream which called him to exile all the Asians, and then pronounce a law requiring them to leave within ninety days. Many of these Asians were Ugandans by birth, having been in the country for generations. They had nowhere left to go, and the results were devastating. Many ended up committing suicide. Other, more dubious stories abound, such as Amin telling the national football team not to return from Kenya after their World Cup qualifier loss, or face execution, and ordering a brutal murder of his own wife.
There are many views of the man in Uganda, all of them quite strong. Amin’s legacy is quite a complicated one, which surprised me very much, as I expected a strong hatred toward such a brutal dictator. But the public’s views did remind me of another leader who commands a complex legacy, whom I often talked about with my friends while in China. Speaking to the local people about their own history reminds me that human events seldom occurs in black and white, and the Western view is not always the objective view I assume it to be.
A Day in the Life
Ward 4A is the Infectious Diseases in-patient ward. As you enter, you pass through a long corridor that looks like every other wing in the hospital, with a nurses’ office, doctor’s office, tea room, pharmacy, and laboratory. At the other end of the hallway, you come into an atrium which separates the men’s wing on the left with the women’s wing on the right.
Immediately after stepping into the atrium, you realize that this is not a normal wing of the hospital. Patients are packed into the wards like sardines, with some spreading some sheets on the floor in between beds and using it as a make-shift space due to the overcrowding. Tuberculosis patients are placed in the open-air atrium, so as to isolate them from the other patients. The efforts are probably futile, however, the area is so cramped that nearby guests and attendants readily breathe in the bacterium-filled air.
As you walk into the women’s clinic, the first thing you notice is the silence. There are no cries, just silent, raspy breathing. As the intern doctor, you walk to the first bed and introduce the patient. Because HIV/AIDS is still a stigmatized disease, the patient is introduced as “seropositive” so that the surrounding patients cannot hear. Not that it makes a very big difference, as 90% of the patients on the ward are seropositive. In the US and Europe, we begin treating HIV/AIDS patients with antiretroviral therapy at a CD4 count of 350 or lower. The Ugandan standard is 250 because of lack of resources, but in the ID ward, patients present with counts of 50, 20, 4, and even 2. This would be considered late-stage disease in the West and a rarity to see, but patients are arriving at Mulago with little or no treatment, and a low CD4 count is the norm, rather than exception.
HIV/AIDS weakens the immune system, and it is the opportunistic infections (OIs) which inflict the most damage. Almost every patient is suffering from multiple OIs. On one female patient you can see candidiasis on the base of her tongue and roof of her mouth, presenting as a white carpet-like growth. Another has a large, baseball-sized wart growing on her forehead, possibly caused by herpes. Of course, many have tuberculosis, mostly pulmonary, but also presenting in various other parts of the body. But for many, the infections can’t be seen or heard, and are infecting the central nervous system.
Meningitis is the most common OI seen in the ward. The covering of the brain, the meninges, becomes inflamed due to viral or bacterial infection. For most individuals without AIDS, the immune system does a tremendous job of protecting against invaders which can cause meningitis. But for those weakened by AIDS, any household bacteria or fungi can invade, and the symptoms are sudden and severe – blinding headache, fever, seizures, altered mental status, and impending death. Even the best available antibiotics in the West are not particularly efficacious against the common meningitis-causing pathogens in AIDS patients, and as a physician in Uganda, you do not have access to many drugs. Antibiotics and anti-fungals are administered and lumbar punctures (spinal taps) are given, but many of the patients do not have a very good chance at survival. Even if they recover somewhat and are discharged, the relapse rate is extremely high and survival rates grim.
But you are an overworked young physician and do not have time to ponder these spiritual and philosophical issues. You move on to the next patient, trying to manage the massive room full of dying patients, hoping to save a few and prolong or at least make more comfortable the lives of the rest in your ward, with what little you have. Half the time there is no anesthetic available on the ward, and you have to perform the lumbar punctures without it. There are barely enough clean gloves and needles for you to draw all the necessary blood from the seropositive patients, some of whom are combative and increase the chances of you accidentally sticking yourself with the needle, something which has already happened a few times in your career.
Your thoughts are interrupted by a loud, howling scream. You rush over to the men’s ward. A gentleman is lying on the floor on a makeshift mattress, with drool and vomit on his right shoulder. His eyeballs are turned upwards in his sockets, and he is screaming at the top of his lungs. His body shakes uncontrollably, and his hands claw into the air. The screaming turns into moans, final cries for help. As you approach him to see what is wrong, his body snaps toward you. You jump back just and time and call for the senior health officer. The patient has late stage rabies and has completely turned deranged. You watch as the senior officer dons gloves and sedates the patient. Before you arrive for rounds tomorrow, he will have passed away. Remembering the moanings and cries, you realize that it is probably for the best, and say a quick prayer before tackling the next roomful of patients desperately needing care.
Immediately after stepping into the atrium, you realize that this is not a normal wing of the hospital. Patients are packed into the wards like sardines, with some spreading some sheets on the floor in between beds and using it as a make-shift space due to the overcrowding. Tuberculosis patients are placed in the open-air atrium, so as to isolate them from the other patients. The efforts are probably futile, however, the area is so cramped that nearby guests and attendants readily breathe in the bacterium-filled air.
As you walk into the women’s clinic, the first thing you notice is the silence. There are no cries, just silent, raspy breathing. As the intern doctor, you walk to the first bed and introduce the patient. Because HIV/AIDS is still a stigmatized disease, the patient is introduced as “seropositive” so that the surrounding patients cannot hear. Not that it makes a very big difference, as 90% of the patients on the ward are seropositive. In the US and Europe, we begin treating HIV/AIDS patients with antiretroviral therapy at a CD4 count of 350 or lower. The Ugandan standard is 250 because of lack of resources, but in the ID ward, patients present with counts of 50, 20, 4, and even 2. This would be considered late-stage disease in the West and a rarity to see, but patients are arriving at Mulago with little or no treatment, and a low CD4 count is the norm, rather than exception.
HIV/AIDS weakens the immune system, and it is the opportunistic infections (OIs) which inflict the most damage. Almost every patient is suffering from multiple OIs. On one female patient you can see candidiasis on the base of her tongue and roof of her mouth, presenting as a white carpet-like growth. Another has a large, baseball-sized wart growing on her forehead, possibly caused by herpes. Of course, many have tuberculosis, mostly pulmonary, but also presenting in various other parts of the body. But for many, the infections can’t be seen or heard, and are infecting the central nervous system.
Meningitis is the most common OI seen in the ward. The covering of the brain, the meninges, becomes inflamed due to viral or bacterial infection. For most individuals without AIDS, the immune system does a tremendous job of protecting against invaders which can cause meningitis. But for those weakened by AIDS, any household bacteria or fungi can invade, and the symptoms are sudden and severe – blinding headache, fever, seizures, altered mental status, and impending death. Even the best available antibiotics in the West are not particularly efficacious against the common meningitis-causing pathogens in AIDS patients, and as a physician in Uganda, you do not have access to many drugs. Antibiotics and anti-fungals are administered and lumbar punctures (spinal taps) are given, but many of the patients do not have a very good chance at survival. Even if they recover somewhat and are discharged, the relapse rate is extremely high and survival rates grim.
But you are an overworked young physician and do not have time to ponder these spiritual and philosophical issues. You move on to the next patient, trying to manage the massive room full of dying patients, hoping to save a few and prolong or at least make more comfortable the lives of the rest in your ward, with what little you have. Half the time there is no anesthetic available on the ward, and you have to perform the lumbar punctures without it. There are barely enough clean gloves and needles for you to draw all the necessary blood from the seropositive patients, some of whom are combative and increase the chances of you accidentally sticking yourself with the needle, something which has already happened a few times in your career.
Your thoughts are interrupted by a loud, howling scream. You rush over to the men’s ward. A gentleman is lying on the floor on a makeshift mattress, with drool and vomit on his right shoulder. His eyeballs are turned upwards in his sockets, and he is screaming at the top of his lungs. His body shakes uncontrollably, and his hands claw into the air. The screaming turns into moans, final cries for help. As you approach him to see what is wrong, his body snaps toward you. You jump back just and time and call for the senior health officer. The patient has late stage rabies and has completely turned deranged. You watch as the senior officer dons gloves and sedates the patient. Before you arrive for rounds tomorrow, he will have passed away. Remembering the moanings and cries, you realize that it is probably for the best, and say a quick prayer before tackling the next roomful of patients desperately needing care.
Monday, June 29, 2009
Murchison Falls National Park
Day 1
Murchison Falls National Park is the largest in Uganda, formed in 1952 from part of the Bunyoro Game Reserve, which was created in response to a sleeping-sickness epidemic from the tsetse flies in the early 20th century. Situated in northwest Uganda, Murchison has not escaped the volatility in the region, and has been the target of attacks in the past by the Lord’s Resistance Army. In recent years the violence has decreased markedly, and the animal supply in the region has recovered greatly from pre-Idin Amin levels.
So as Lindsay is leaving Uganda a bit earlier than expected, we joined with some of our British friends, also rotating at Mulago Hospital, and went on a three day safari this weekend.
The first day was mostly transport, as we drove north past Masindi and toward the Park. Paved roads gave way to pitted dirt paths, which were easily handled by our driver and the 4X4 10 passenger safari van, but made for quite a bumpy ride for those who sat in the back rows.
Five hours’ of traveling was worth it, however, as we walked to the top of the falls and watched the Victoria Nile dump its contents into a 7 meter wide space in the rocks, carving its way through the center of the park. The water in Lake Victoria drives the falls, and you can feel the immense strength of the water as it crashes through the gorge. From there, the water flows through a delta before joining Lake Albert, after which it becomes the Albert Nile on its way north toward Egypt.
Day 2
We were supposed to stay at the Red Chili Rest Camp, where all the backpackers from the US, Europe, and Australia congregate. But the travel agency informed us at the last moment that the camp had filled up, and so we were upgraded to Sambiya River Lodge, about an hour’s drive south from Paraa through the jungle on the only bumpy dirt road in the south of Murchison Falls National Park.
The accommodations were simple but sufficient-two beds were placed in each thatch roof banya, though we could see corrugated sheets reinforcing the roof below it. The facility was powered by electric generator, and the lights went out at 10:29 PM, a minute earlier than threatened.
My roommate Sam and I crawled out of our mosquito nets and bed at 5 AM and trekked to the communal showers, powered by solar heaters. The water had lost much of its warmth from the day before, but was attractive enough for a frog to wish to share it with me.
After an early breakfast, we caught Baker’s van and drove fiercely toward Paraa to catch the first ferry at 7 AM. We arrived just as the sun was rising over the horizon, which we could see over the Nile, as hippopotamuses wailed from the riverbank.
From Paraa, most game drives head to the west, where the Victoria and Albert Niles create a fertile delta region, perfect for game viewing. And we did see plenty of game. Herds of giraffe walked together, sometimes numbering as many as thirty or forty, moving in unison, similar to the CGI-dinosaurs in Jurassic Park. Water buffalo herds grazed in the savannah, alongside antelope, hartebeest, and the Ugandan national animal, the kob. Similar looking to the hartebeest, the kob is a deer-like animal with two graceful horns, and a favorite prey of the lion. We were fortunate enough to see one female lion stalking a band of kob before we headed back to the river launch area.
As we waited for our afternoon boat launch to the base of the falls, Natalie from the UK spotted a pack of elephants on the north side of the river. In the distance, the massive creatures had congregated near the Nile for a drink, and you could feel the power and grace in their movement from across the water. Business was slow, and two delta boat launch drivers offered us a free trip across the river for a closer view. As the boat drifted quietly toward the marsh on the riverbank, you could spot birds hiding in the reeds – kingfisher, heron, and bills gliding near the hippos. We drifted a bit too close to one school, and the dominant male and his female companions became agitated, standing up from their sleep and bellowing to protect their young. We quickly picked up speed and avoided the potentially deadly animals.
The day ended with the boat launch to the base of the falls, but I was a bit tired and nodded off for a few of the nearly four hours on the boat. We did spot a number of large crocodiles, who rested along the river by opening their jaws as large as possible – for a stretch, as our guides explained. And of course, we did indulge in our favorite brew, Nile Special, for some “Nile on the Nile.”
Day 3
Today was the final day. Having spent the night swapping cross-Atlantic games and celebrating the life of the great Michael Jackson (we had heard a day later than most of you folk in the US), we packed up and left for our final destination, the Ziwa Rhinoceros Sanctuary, run by a local NGO dedicated to repopulating the national parks in the area, including Murchison, with the white rhino that used to roam freely in Africa at numbers approaching 1 million, but have been hunted to extinction in many areas.
We drove into the bush, past baboons and monkeys, and continued the journey on foot, following our guide to a pair of grazing female rhinos, the second-largest land animals after the elephant. Corey and Billie were pregnant and expected to give birth in October, but the sanctuary was already celebrating – only a few days earlier, the first rhino born in captivity in Uganda since its extinction had occurred. So far, mother and baby were safe. Once the rangers could get close enough to determine the gender of the baby, they would name it. If a male, the proposed name is Obama.
Murchison Falls National Park is the largest in Uganda, formed in 1952 from part of the Bunyoro Game Reserve, which was created in response to a sleeping-sickness epidemic from the tsetse flies in the early 20th century. Situated in northwest Uganda, Murchison has not escaped the volatility in the region, and has been the target of attacks in the past by the Lord’s Resistance Army. In recent years the violence has decreased markedly, and the animal supply in the region has recovered greatly from pre-Idin Amin levels.
So as Lindsay is leaving Uganda a bit earlier than expected, we joined with some of our British friends, also rotating at Mulago Hospital, and went on a three day safari this weekend.
The first day was mostly transport, as we drove north past Masindi and toward the Park. Paved roads gave way to pitted dirt paths, which were easily handled by our driver and the 4X4 10 passenger safari van, but made for quite a bumpy ride for those who sat in the back rows.
Five hours’ of traveling was worth it, however, as we walked to the top of the falls and watched the Victoria Nile dump its contents into a 7 meter wide space in the rocks, carving its way through the center of the park. The water in Lake Victoria drives the falls, and you can feel the immense strength of the water as it crashes through the gorge. From there, the water flows through a delta before joining Lake Albert, after which it becomes the Albert Nile on its way north toward Egypt.
Day 2
We were supposed to stay at the Red Chili Rest Camp, where all the backpackers from the US, Europe, and Australia congregate. But the travel agency informed us at the last moment that the camp had filled up, and so we were upgraded to Sambiya River Lodge, about an hour’s drive south from Paraa through the jungle on the only bumpy dirt road in the south of Murchison Falls National Park.
The accommodations were simple but sufficient-two beds were placed in each thatch roof banya, though we could see corrugated sheets reinforcing the roof below it. The facility was powered by electric generator, and the lights went out at 10:29 PM, a minute earlier than threatened.
My roommate Sam and I crawled out of our mosquito nets and bed at 5 AM and trekked to the communal showers, powered by solar heaters. The water had lost much of its warmth from the day before, but was attractive enough for a frog to wish to share it with me.
After an early breakfast, we caught Baker’s van and drove fiercely toward Paraa to catch the first ferry at 7 AM. We arrived just as the sun was rising over the horizon, which we could see over the Nile, as hippopotamuses wailed from the riverbank.
From Paraa, most game drives head to the west, where the Victoria and Albert Niles create a fertile delta region, perfect for game viewing. And we did see plenty of game. Herds of giraffe walked together, sometimes numbering as many as thirty or forty, moving in unison, similar to the CGI-dinosaurs in Jurassic Park. Water buffalo herds grazed in the savannah, alongside antelope, hartebeest, and the Ugandan national animal, the kob. Similar looking to the hartebeest, the kob is a deer-like animal with two graceful horns, and a favorite prey of the lion. We were fortunate enough to see one female lion stalking a band of kob before we headed back to the river launch area.
As we waited for our afternoon boat launch to the base of the falls, Natalie from the UK spotted a pack of elephants on the north side of the river. In the distance, the massive creatures had congregated near the Nile for a drink, and you could feel the power and grace in their movement from across the water. Business was slow, and two delta boat launch drivers offered us a free trip across the river for a closer view. As the boat drifted quietly toward the marsh on the riverbank, you could spot birds hiding in the reeds – kingfisher, heron, and bills gliding near the hippos. We drifted a bit too close to one school, and the dominant male and his female companions became agitated, standing up from their sleep and bellowing to protect their young. We quickly picked up speed and avoided the potentially deadly animals.
The day ended with the boat launch to the base of the falls, but I was a bit tired and nodded off for a few of the nearly four hours on the boat. We did spot a number of large crocodiles, who rested along the river by opening their jaws as large as possible – for a stretch, as our guides explained. And of course, we did indulge in our favorite brew, Nile Special, for some “Nile on the Nile.”
Day 3
Today was the final day. Having spent the night swapping cross-Atlantic games and celebrating the life of the great Michael Jackson (we had heard a day later than most of you folk in the US), we packed up and left for our final destination, the Ziwa Rhinoceros Sanctuary, run by a local NGO dedicated to repopulating the national parks in the area, including Murchison, with the white rhino that used to roam freely in Africa at numbers approaching 1 million, but have been hunted to extinction in many areas.
We drove into the bush, past baboons and monkeys, and continued the journey on foot, following our guide to a pair of grazing female rhinos, the second-largest land animals after the elephant. Corey and Billie were pregnant and expected to give birth in October, but the sanctuary was already celebrating – only a few days earlier, the first rhino born in captivity in Uganda since its extinction had occurred. So far, mother and baby were safe. Once the rangers could get close enough to determine the gender of the baby, they would name it. If a male, the proposed name is Obama.
Monday, June 22, 2009
Losing My Religion
We were leaving for a family vacation the next day, and I hurriedly grabbed a beach book for the trip. Characteristically, I gravitated toward the non-fiction section and found the most interesting summer thriller I could find – Losing My Religion by LA Times writer, William Lobdell.
It’s quite a fascinating read (really!), in which Lobdell describes his journey from a typical atheist West Coast journalist to born-again Christian, and back. It’s not your typical Friday-night church testimony. The back cover lists accolades from voices as diverse as Richard Dawkins and the editor of Christianity Today. His story is equally varied in experience, but always amazingly honest.
Lobdell’s journey to faith is not an atypical one, with a friend bringing him to a men’s retreat in the mountains of Southern California in the midst of a quarterlife crisis, as he faced the foes of depression, a broken marriage, and a dead-end career.
The love, generosity, and compassion of the godly men and women he met encouraged him to seek the Truth in the Bible, and he found it. He ate it, digested it, and breathed it. Or so he thought.
The early 2000s and the Catholic priest sexual abuse scandals fell squarely into his lap as religion columnist for the Times, and Lobdell delved into his role as an investigative journalist, hoping to find redemption, even in this seemingly horrible story.
But the more Lobdell looked at the sinfulness of man, the more seeds of doubt began to take root in his faith. Over a long and arduous ten-year period, Lobdell finally realized that was immune to his beliefs, to deadened by the sinfulness he had seen in the Church to remain a Christian.
Lobdell’s story is as incisive as it is truthful. It is a wake-up call to all those who profess to be people of faith. We are, as often cited, both Christ’s best and worst advertisers. But I think Lobdell does make an important mistake.
When he came to faith, Lobdell saw the brokenness around him. When he changed his vision and averted his gaze upwards, to God, his entire perspective changed. Over time, however, he began to look around him again. It is not wrong to do so, but he forgot to do so while keeping one focused on God. The sinfulness of man – and of myself – is enough to make atheists of us all. I have seen so more sin in me in my actions in the past week than I could care to admit and still proclaim to be a follower of Christ.
But herein lies the beauty of the Gospel. We are not judged by our performance or graded by our works. No, as the fundamental truth, which I fundamentally forget (and deep down, sometimes just cannot accept), is that we are not judged, but that God’s love and mercy have triumphed over judgment. And so, Mr. Lobdell and the rest of us need not despair. Though the walk may be difficult and our partners may fail us, God never will.
African Hospitality
“The people are so nice there,” was my professor’s first remark about Ugandans. Of course, I thought. Every developing country I’ve been to has proven evidence of that. Or just every place outside of the East and West Coasts of the US, even. I wasn’t expecting much of a difference upon arriving at Entebbe Airport, as I walked off the glass and steel jetway (a pleasant surprise) and into the obligatory swine flu checkpoint.
“Please sit down, sir,” the nurse invited me in a sing-song voice. My thoughts turned to the worst – a possible quarantine, which my sister actually is right now undergoing in Beijing. “You can fill out this health questionnaire,” she suggested, and provided me with a pen. And waited, patiently. This was not the customs and border officer demeanor I had expected. Where was their tough-guy personality? What if my body was harboring millions of illicit microbes to bring into the country? “Where are you from?” she asked, interrupting my worried thoughts. “America, what a nice place. Welcome to Uganda, I hope you have a blessed time here,” she responded, in measured, kind tones.
As I was ushered past immigration and customs and into the calm, friendly arrival hall, I knew I was no longer in China. This was not a country of extreme changes, speeding along at the speed of Social Darwinism. No, this country ran in African time, which runs a good two hours slower than Korean time and three hours slower than Chinese time.
You can sense the pace of the country around you all the time. It is not a pace of laziness, but of quiet content. What is the need of hurrying rudely along when the destination itself is unclear and even unworthy?
In the words of our co-workers, Dr. Olive the physician, Simon the counselor, Aeyisha the nurse, and Haruna the driver, “Please, take a seat. Smile, and welcome to Africa.”
Wednesday, June 17, 2009
Medichine in Africa
Medichine is taking a break from Asia and has followed the Chinese businessmen, politicians, and oil traders to Africa.
I touched down in Entebbe on the shores of Lake Victoria on Tuesday evening and have spent the past two days setting up shop in the Muyenga district of Kampala. Our apartment is perfect -- we have a large common room with a TV that plays American and East African hip-hop, walls furnished with African handicrafts, a djembe, and bamboo furniture. A patio looks out onto the gated parking area, and in the near distance you can see a magnificent hill rising up to the north and a lush valley to the east.
My housemates are Liz and Lindsay, both medical school classmates of mine. Liz is a Christian ska groupie with hair dyed a deep reddish black, and Lindsay is from Chicago, but moved to New Jersey because of the "diversity", in her own words.
We were greeted yesterday by our driver, Haruna, a fit gentleman with three young children. Moreen is our housekeeper. She's twenty-five, hip, educated, and witty. We are quite happy to have met them. Simon is the tuberculosis attending physician who is one of the research project administrators on the Uganda side and has just returned from advanced pulmonary training at Yale.
All the people I've met so far have been phenomenally nice and compassionate. Not just the locals, but the expatriates and foreigners on my flight from Amsterdam were quite the joyful bunch. Many, if not all, were missionaries on short or long-term journeys to ministry positions in East Africa. While my trip is ostensibly for research purposes, I can't help but be reminded of my constant mission, to be a bold and passionate witness for my faith at all times.
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