Five Years in Uganda

Kiwoko Hospital

Last month I posted an interview with an Australian named John about his teaching experience in Taiwan and Japan. This month he talks about his years in Uganda with his wife Keiko, a Japanese pediatrician. 

To provide a good sense of place, I added links to Youtube videos featuring walks in Kampala, the capital city, and the Kiwoko Hospital. John sent the pictures of his wife and himself. We spoke via Skype while he was in Japan and I was in the Philippines.

John and Keiko’s story

keiko and john

Shortly after we were married, my wife said that before we got too old she wanted to work in Africa. I was surprised, but then Keiko had a much wider perspective than most of her colleagues. She thought that since she’d been fortunate to come from a stable family, good education, happy life and good health, she should put something back. I said, “All right, if you want to go, I’ll go with you. I wouldn’t feel right if you were over there alone.” Actually, I had no idea how hard it would be or how much harder it would have been without her husband. Like most people I had a National Geographic image of Africa.

First we went to England, where she studied at the Liverpool School of Tropical Medicine. Like most Japanese doctors, she’d never seen a malaria patient. We knew we wanted to go to an English-speaking African country, but which one? In Britain she met a Ugandan studying medical administration at the same school.  He was in charge of a network of hospitals connected with the Church of Uganda, which was Anglican. His organization was the Ugandan Protestant Medical Bureau (UPMB). When we returned to Japan we kept in touch. Meanwhile, we connected with a little Japanese medical NGO based in Tokyo. They dealt with Asian countries and had never sent anyone to Africa. We checked each other out, they checked UPMB out, and eventually we were on our way. They paid Keiko’s salary in dollars, but it was less than a third of what it would have been in Japan. I had no income.

Keiko

We arrived in May 2000. Now, high-profile organizations like Save the Children or the Red Cross have support networks on the ground. They’ll set you up in housing, they take care of your visa applications and all the other support stuff. Our NGO naively assumed that since I was a native English speaker everything would simply fall into place. They didn’t anticipate how slow and corrupt things were. That was very stressful. You’d end up trusting and bribing the wrong people!

When Keiko applied for her Ugandan Medical License, we waited, thinking it wouldn’t take long because Uganda’s short of doctors, after all. But months went by, and we heard nothing from them. We were told, “These things go slowly in Africa, so be patient.” Eventually we heard that the application had been approved but was just sitting there waiting for a bribe. It took a phone call and a tongue-lashing by a friend of a friend who was high up in the local medical hierarchy. Then the license miraculously came through.

In the meantime we were in Kampala getting organized. We’d had to rent an apartment, but there was nothing like the range of options you find in rich countries. There was really low-level, African style accommodation or luxury accommodation and pretty much nothing in-between. We rented a furnished apartment in a building with an elevator—that’s a luxury in Uganda—and satellite TV. We could watch The Simpsons. Yay!

Without her license Keiko wasn’t allowed to treat patients yet, but she went to hospitals and observed, getting a sense of the routines and the rhythms and the do’s and don’ts. The medical culture was totally different from anything in her experience. If you’ve seen the television show ER, you know every accident victim automatically gets a whole bunch of tests, like CT scans. Uganda had something like 19th century medicine with a few extras like x-rays and such.

When she got her license we moved to Kiwoko Hospital, in Luweero District, about 80 kilometers from Kampala. It’s pronounced Chiwoko. The Bantu languages mix up the k- and the ch- sounds. So you have to buy a “chilo of bananas,” and street-preachers will yell that “the Chingdom of God is at hand.”

During the the war of the 1980s and early 90s, one dictator was fighting another, and the Luweero Triangle was the meat in the sandwich. It was particularly badly affected. (link) It was one of the poorest, most problematic areas in Uganda.

We were given basic housing with a concrete floor, no hot water and intermittent electricity, lots of lizards and insects, and there were bats in the roof. Every couple of months a guy came to smoke out all the bats. They’d disappear but soon come back. It was like an endless, pointless ritual.

Keiko was the only pediatrician in an area with two million people. HIV was so prevalent at that time—probably less now because of the ongoing education programs – it was always assumed that every patient, whether a newborn baby or an adult, was HIV positive until shown to be otherwise. The exposure to bodily fluids was a constant risk. Twice Keiko got pricked by a used naked needle that nurses carried around without covering it. So immediately she had to wash out the wound and get tested. Thankfully, both times she tested negative. But that kind of risk was always around. She had to work a ten-hour shift, but it was never ten hours. There was always a knock on the door at midnight with some emergency case.

It was a very religious hospital, which can seem strange when you come from a secular country like Japan. There were biblical quotes displayed around the wards, and the motto was “We treat, Jesus heals.” The head nurse was a big, overbearing woman who seemed less concerned about professional standards than with the length of the nurses’ skirts and their church attendance. She seemed to see herself as some kind of chaplain. As a head nurse she was pretty hopeless, but I guess she got the job by having the right family connections.

Religious organizations there view outsiders with suspicion, kind of like a 17th century attitude. There were two doctors living next door to us. They were very stand-offish, I think because they didn’t know what to make of Keiko. Was she Chinese? She was considered a “pagan,” the word Ugandans used without the slightest trace of irony. They didn’t know what to think of me either, since international marriages and even inter-tribal marriages, were so rare. After years they still seemed to think I was some kind of mutant Chinese.

In Uganda your religion is an integral part of your identity. Most of Africa’s like that. From the names you can tell what religion people are. Obviously if a man’s name is Mustafa or Abdullah, he’s Muslim, But if it’s William, Henry or George then he’s Protestant. If it’s Patrick, Joseph or John-Paul he’s Catholic. If a woman’s name is Mary or Monica she’s most likely Catholic. Joyce and Florence are Protestant names. When people asked me what my religion was and I told them I had no religion, it shocked them. It was as if I’d claimed I didn’t have a name.

Every month there was a meeting at the Church of Uganda in Luweero, about 20 kilometers from Kiwoko. The bishop would be there, plus people from UPMB and Kiwoko’s administrators —maybe ten, twelve people. A woman usually took the minutes. Once when she couldn’t make it, they asked me to do it. The bishop looked like a medieval pope. He had a triple chin. Before the meeting he sat there with sugary tea and huge chunks of bread, which he slathered with margarine. He asked which church I attended. I told him I didn’t attend any church.

“ Why is that?”

“I’m not a believer.”

“ So you don’t attend any church at all!?”

“ No, Your Grace, I do not. “

Then the atmosphere became very frosty. That was the only time I ever took the minutes. And the lunch that I was supposed to get never materialized.

You’re always brushing up against that kind of attitude. You know the old saying, “Before the missionaries came, the whites had the bible, and the blacks had the land. After the missionaries came, the blacks had the bible and the whites had the land.” Sectarianism is rampant. Once a Catholic priest came to the hospital to give the last sacrament to any Catholics who were dying and might need it. He was chased off the premises.

When we talked earlier you mentioned the doctor whose prescriptions were changed.

She was a British doctor, a pedriatric nutrition specialist on the faculty of the Liverpool School of Tropical Medicine. Keiko and I had dinner with her once. She told us that many years earlier she’d worked in Nigeria. She’s a devout Catholic, but she got a job in a hospital run by a Protestant organization. The other doctors weren’t very friendly, and she put it down to her being a white woman and lingering anti-colonial sentiments. Then she discovered that they were altering her prescriptions and diagnoses behind her back, which is illegal in any country. She complained to the administrator, who said he would do something about it. But nothing happened. Later she confronted him, “I thought you were going to do something about this.” He said, “I am. I’m praying for your conversion.”

I remember a big controversy about evangelicals’ from the US going to Africa and preaching against abortion and homosexuality.

They’re called gospel crusades, where the “s” should be written with dollar signs, Go$pel Cru$ade$. They can be found in most big sub-Saharan cities. They claim to cure AIDS with the laying on of hands. They appeal to gullible people who are not necessarily stupid, but inclined to believe that whatever comes from the western world, America especially, must be better than what’s available in Africa. A combination of religious fervor and a lack of knowledge make them really ripe for charlatans.

These American crusaders attract huge gatherings that fill a whole soccer stadium. You can imagine how much money they get. They don’t get to fly their private jets and ride around in luxury cars because of their charitable instincts. It’s all profit motive. In Africa people are willing to buy what they’re selling, which is false cures and false hope in the guise of religious practice. I’ve heard evangelical guys say they can make the lame walk and cure cancer and all kinds of things with the power of prayer. It’s a real crime, but you can’t speak out against it because lots of people adore that kind of thing. People don’t want to hear otherwise.

In the Philippines, particularly out in the provinces, there are still medicine men, shamans.

We had some of that in Kiwoko. The medicine man saw the hospital as competition. So he’d claim the hospital was where people went to die, a slaughterhouse for kids. Parents would delay taking them to the hospital because they were advised against taking them They’d wait until it was too late, and after they finally did the kid would die. Then the medicine man would say, “Well, I told you so.” Education is crucial to countering that attitude, but it hasn’t done so, particularly in the rural areas. The education gap between the urban and rural areas is worse than in western countries.

But getting back to your experience…

As a house husband I wasn’t just sitting around waiting for the missus to get home. Everything was a major inconvenience. Anything you could take care of with a phone call or handle online here in Japan, all of that had to be done in person. I had to go down to the city and pay the bills, which meant getting there early, waiting for ages in line and battling my way through the crowd to the cashier.

When our computer was stolen, the thieves saw it had a Japanese keyboard and dumped it. We finally found out it was held by the police. I had to go to Kampala to get it, which meant I had to battle my way through the bureaucracy and bribe a couple of cops to get to get the computer back. This kind of stuff consumed so much of my time.

In Uganda it was assumed that we’d have a servant, a house boy or a house girl. We tried for one week until the woman we hired tried to steal Keiko’s camera. We said, “We won’t report this, but you’re finished.” So I did the housework. I had to iron clothes, including socks and handkerchiefs, because there’s a local insect they call the mango fly even though it has nothing to do with mango fruit. When you had laundry the fly would lay its eggs on the wet clothes, and if you didn’t kill the eggs with heat by ironing them, the eggs would attach to your skin, and the insect would dig into your body so you had to pull it out with tweezers. (Link) This meant everything had to be ironed, although electricity was available sporadically.

Life there was especially hard for Keiko. She was making life and death decisions all the time and battling fatalistic attitudes, a lack of a sense of urgency about things like malaria. The malaria season came twice a year because there were two rainy seasons, and after each one there was lots of stagnant water, lots of anopheles mosquitoes. The people have lived with this for millenia, so they consider it a minor inconvenience, like we consider a cold. But for newborn babies whose immune systems have been badly compromised with HIV, malaria can be fatal. Doctoring was much more difficult than just straight-forward examinations and ordering test. There were a lot of losses. A lot of kids looked like they were going to make it, and then they succumbed at the last moment. So it was very hard on her.

After three years we had a nine-month break. We went back to Japan and also had a holiday in Australia. Keiko took a one-month training course on HIV management at a university in Johannesburg. A month in Johannesburg for us was very pleasant. Jo’burg is the New York of Africa.

When we returned for our last two years, the hospital was opening a Neonatal Intensive Care Unit for newborn babies and young babies, the NICU. It was built with American funds, so the ambassador came and opened it in a big ceremony. The unit was actually very well equipped, and some of the nurses had special training by British nurses at the nursing school attached to the hospital. Keiko was in charge of the NICU.

Later she developed ties with an organization in Kampala called Reach Out, which was specifically involved with HIV-positive patients who were incapacitated and unable to attend clinics. She worked out an arrangement with the hospital so she could work part–time with Reach Out and part-time at Kiwoko’s NICU. At that point we moved back to Kampala.  She’d drive to Kiwoko Hospital, spend a couple of nights there each week and then come back on Friday night. So that’s how we spent the last two years.

Kampala

The Reach Out organization was well managed by a fine man, an Italian priest who’d been there for 40 years. He’d seen everything. He’d lost count of how many times he’d had guns pointed at his head. He stayed put through the civil war and the Tanzanian invasion and through all the chaos. He had natural charisma plus administrative skills. He spoke Luganda, Ki-Swahili and impeccable English. But in late 2005 he had to return to Italy for cancer treatment. After that things started to spiral downwards. We were due to leave by then anyway.

In our last two years we had two major crises. One was a car accident on the Good Friday of 2005, when we were headed for a small resort in the western Ugandan highlands. On the road our front wheels locked, and we slammed into an embankment at the side of the highway. Both of us lost consciousness. When we came to we saw the car was pretty much a write-off. We managed to stop a truck. The driver got the police, who brought us in.

At first they were very friendly and sympathetic. As time passed we really wanted to get medical treatment, but they wouldn’t let us leave. Then the questions started to get belligerent and accusatory. They didn’t see us as victims of an accident, but as pigeons to be plucked. They took separate statements from each of us. Keiko said the cop who took hers was basically illiterate so she had to help him write the interview report.

Finally the police commander came, whatever his title was, the one entitled to the biggest bribe. Right away he accused us of reckless driving. “Oh, it will be bad for you.” To up the stakes he ordered us to be taken back to the scene of the accident. When we got there, an empty beer bottle had been placed in the car.  “Oh, look at this! You were drunk driving. Oh, this is very bad.”

We couldn’t phone anybody because no one was working on Good Friday and we were in a very remote rural area with a weak mobile phone network. I knew from experience I had to bribe the top cop, but there was a certain protocol involved. You couldn’t just pull out your wallet and ask how much. That would offend his honor. You had to use the magic words, “Can we discuss this privately?” When we went behind the wreck of the car, he said he wanted 60,000 shillings, which was I guess about $40 at the time. I gave it to him. Suddenly he became very helpful, ordered a cop to drive us back to the city with a police escort. We talked our way out of the police escort because that would eventually require another bribe (“for expenses”). An off-duty policeman drove us back to the city.

We went to a clinic which was closed for Easter and a clinic run by Indians which was open but whose x-ray equipment was broken. At a third clinic we got X-rays confirming that nothing was broken. It hurt us to breathe because of the seat belt hitting our sternums, but they were just bruised, not cracked. We got super painkillers and went home to bed. On Easter Monday, the day after the holiday, we had a whole day of dealing with the insurance company, but that next saga ended okay.

The second major incident was on an airplane. We had a one-hour Kenya Airways flight to Nairobi, Kenya followed by a flight to Abu Dhabi, where we were to pick up a night flight to Japan. On the plane, as we descended into Nairobi, I remember exchanging a worried look with the Indian businessman across the aisle. The descent was unusually steep. When the plane touched down it bounced and skidded off the runway. This caused an emergency evacuation. The chute deployed. Passengers rushed toward it. The flight attendants, who were supposed to direct the evacuation, soon disappeared. Since it had been raining heavily, the first of the passengers sliding down the chute got stuck in the mud at the bottom, and people sliding down next kept crashing into them. People were injured. But the entire flight crew had vanished.

Outside the plane it was freezing. Nairobi is about 1,600 meters up. So despite its location on the equator, it gets pretty cold at night. The rain pelted down. We huddled under the wings until someone said the plane might explode. “Ah, yeah!”  So we ran away. We stood in the rain and the dark, waiting, waiting. Someone said, “I’m walking to those lights over there. That must be the terminal.” The rest of us waited. A couple of hours passed. Maintenance trucks came to examine the plane, ignoring us. Finally a bus arrived and took us to the terminal. We were all soaking wet, cold, tired, hungry and scared. We were given hot cocoa and Kenya Airways tee-shirts by way of apology. Then the terminal closed, and we huddled on benches all night until it reopened in the morning.  Keiko and I had missed our flight, but eventually we were on our way.

Such things happens in that part of the world. No explanation, no apology, nothing. We still don’t know what caused the accident. I know that descent felt wrong, so it was probably pilot error.

When we left Uganda we were really glad to get back to Japan for good. You turn on the light switch, and the light comes on. Flush toilets. Oh, luxury! You don’t have to count your change whenever you buy anything. You don’t buy a kilo of rice and find a big stone inside. There’s no  thumb on the scale. We could relax again. That was it.

Keiko went back to Uganda briefly a couple of years later, but the people she knew at the hospital had left. At Reach Out the standards had deteriorated because of nepotism and all that. It was quite disappointing, but so it goes. Over there it’s one step forward, one step back. But there’s some room for optimism. We saw lots of people who were unimaginably poor, but illiteracy is decreasing. That’s encouraging. When you have an illiterate population it’s much harder to make changes, via elections, for example. But for both of us one five-year stint was enough.

So did the two of you come to the conclusion that it was worth it or not?

Oh, yeah. We learned a lot about things that we would never, ever have encountered or even imagined. We saw for ourselves the monstrous gap between people in that part of the world and people in developed countries. You know, most people in the world have nothing like the advantages we have. As a First-Worlder you know that whatever happens you’re a privileged person.

We were in some very rough situations in Uganda, but we knew that we could get on a plane and get out of there. The Ugandans couldn’t. We understood how people could be resentful or envious, but there were a lot of really good people. I’m thinking of some I knew who had nothing like the opportunities that I had. I felt like a pipsqueak in comparison because they had so much natural dignity and wisdom. So you get to see that side of things. You also learn about yourself, what your limits are.

Sometimes you surprise yourself—how things you considered dangerous before are now no big deal, like exposure to illness or the risk of crime. You learn to take those things in stride, and you learn how timid a lot of people are, especially in risk-averse countries like Japan. Here the idea of living dangerously is eating food one day past its use-by date or crossing the street while the light’s still amber.

When we told people we were in Africa, we’d hear, “Oh, wow, great! Tell us all about it. Did you see any lions, chimpanzees, rhinos?” Nope, we saw a lot of goats, rats, cockroaches. We weren’t there as tourists. We knew people who’d been there as tourists, and they said it was fantastic. Yeah, we’d think it was fantastic too if we were on safari, being waited on hand and foot by people with permanent smiles.

When you live there it’s a whole different experience. Even though we weren’t living as Africans, but above their socioeconomic level, we saw enough to comprehend how different it was, what people have to endure yet how they’re still able to get through life. And even enjoy life.

Videos

 A Sunday Walk thru Kampala (Link)

John says, “This brought back memories. Of course Kampala is not typical of UGA as a whole, any more than Buckingham Palace is typical of British housing. It’s the capital and the only big city, so most of the wealth and resources are concentrated there. –The Bata shoe shop around the 6-minute mark was where I was pickpocketed once. In that video the streets looked much less crowded than the norm, but if it was Sunday morning a lot of people would’ve been in the city’s churches, which were filled to overflowing when we were there.

Kiwoko hospital and Around (Link).

John says, “KH looks much the same. The Paediatric Ward during the malaria seasons would often be short of beds, so there might be two kids to a bed, and sometimes patients were laid out on blankets on the floor. So you ran the risk of stepping on sick babies if you didn’t watch your step. — Did you notice the NICU early in the video? It used to be a frequent source of frustration that visiting groups from donor countries would be taken through NICU as part of their general tour of the hospital. The patients are the youngest and most vulnerable babies and the environment has to be kept as sterile as circumstances would permit. And then a bunch of tourists would tramp through that ward in their muddy boots and sandals.– Those huts shown toward the end of the video looked like the residential area of the nursing school, but my memory might be paying tricks.

A reader writes:

The article… depicts the conditions here caused by ignorance, corruption and pretending to believe in a christian god-construct.

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