It's a hard knock life in class 5

Thursday, July 31 2008

I realize that the last time I wrote was Sunday. It's been a really long week. We went to 3 schools, got about 68 blood samples, AND WENT WHITE WATER RAFTING DOWN THE WHITE NILE! Yes, that exciting (if you heard it like a used car salesman would say it). So, as hard as it is, I will start from Monday...

Monday was all about Good Times. Yes, the sitcom. You see, Good Times Primary School in Mpererwe, named themselves after that sitcom. They also happened to have so many parents show up for testing day, which was much cooler than the whole sitcom thing. We got 19 blood samples there. Not bad.

However, we were pretty impressed with Valley St. Mary's Primary School in Namere, too. I am actually pretty partial to this school because the headmaster, Julius, rocks. I'm pretty sure that the following biographical sketch is correct.... Julius is an orphan who really felt strongly about his musical talent and improving the life of other orphans in Uganda. So he got a group of musical orphans together who now give health education through song and dance. I get to see them on Monday but won't post the video because I don't have the bandwidth. Sorry.

Anyway, Uganda is at the beginning of the rainy season. There is no summer or winter here, just rainy and dry. So, as we were walking to VSMPS, the sky looked foreboding. As we walked in the door a few drips fell; 5 minutes later it was a full-on deluge. Parents still came. Probably not as many as would have come if the sun were out, but still, WOW. Everybody was wet, including one of our students who took a bodaboda and ran in the rain to get there. I think there is a picture of Henry with Lauren's shawl on him... Lauren's friends, Ruth and Anna, were visiting so they got to play with the kids at this school. Our favorite: Timothy. I have about 10 pics of him. Everytime I walk by the hospital and he sees me, he runs to hold my hand.

That night had it's own challenges. You see, the power went out just as I was making hashbrowns. Have no fear, I ate them... right after I cooked them on my new sigir (little coal stove I bought for $3.75. Problem was, I thought I may have made the whole thing non-kosher by taking coals from the family stove. Called the rabbi(s), no answer. Texted my brother, no answer. Called my mom, no answer. Meanwhile, Lauren, Rith and Anna were waiting on pins and needles for the answer so that I could explain whyI was having such a problem with cooking potatoes. Called a friend, no answer. Called another friend, Gila, who rocked before, but now rocks so much harder. She got the question, my calling card number, and my cellphone number within the 2 minutes I had left in airtime. She then called back with an answer after calling Yehuda Rother at Camp Stone (I can't and will never try to get away from that place). KOSHER! Nice; I ate them with a vengence.

Wednesday was N-U-T-S! Lauren, Ruth and Anna wanted to go to Jinja. I realized that I haven't really left Kampala, ever. So, Anna and I went white water rafting and Lauren and Ruth went biking. Both were adventures. I'm going to talk about mine because I was there, it's much easier.

It all started with an early morning bodaboda ride from Mpererwe to Wandegeya, then Wandegeya to the Lugogo Mall where we were picked up in a bus. We drove to the Red Chilli, a backpacker place, and met a huge bunch of Israelis who were very suprised to find a religious, Hebrew-speaking Jew in their midst. We drove about 3 hours to Jinja, though its only about 60 miles away and had breakfast at the lodge. I ate pineapple, good pineapple. We then took an open truck about 5km away to the head of the nile. No biggy here, just a big dam and smooth water... little did we know...

So we came to the launching site, chose groups of 7 (Anna and I ended up with "team mulalu," crazy in English) and took off. Paolo, our guide was on the Ugandan kayak team and can, without a doubt, beat you up. We had a few grade 1s and 2s just to warm up. He also had us swim through a grade 2 to "get a better feel for your life jackets, you'll use them for real very soon." And we did on our first class 5. Lauren and Ruth were able to take some pictures while we did it because they biked really fast to see us almost succeed. And almost we did. We ran though the first half pretty well. However, the second half flipped our raft front over back landing us all in the water. It was awesome!

After a few rapids, we had about half an hour of smooth water so we went for a swim. I talked with a Scottish MD about the kinds of ways we would pay for the trip. He payed a little more because a paddle whacked his nose on the first rapid. We also had a small lunch; they ate pineapple and glucose crackers. I had pineapple...and a Zone bar (thanks Weinbachs). Then we tackled "silverback," a rapid with a huge smooth drop (ie the water wasn't white, about a 20 foot drop) and a MASSIVE standing wave. We "surfed" the top of the wave and made it over.

The rest of the trip was as psychotic, flipping a bunch, trying to convince others we saw hippos and crocs, and avoiding certain death by walking around a class 6 rapid instead of running through it. There were some pretty scary times, like when you think you're about to reach surface but it never seems to come, or when someone grabs your leg after you see them get shoved under by the boat right after a class 5 rapid and you can't find them to pull them up until about 10 seconds later... yea, it was scary. But completely awesome.

The way back was in the same truck, but this time a 25km ride to camp... we rafted for 30km. On the way back the trip was made absolutely perfect when I saw at least 4 schools with the name of the company running our trip on their signs. The company gives back to the community. We chose the right company.

We got back to a BBQ with 2 free beers each, I ate couscous and lentils and had a beer. Couldn't manage to finish the first one, let alone start the second. And it was evening and it was morning, Day 4.

Today was hard. I got little sleep last night, because it felt like I was still in the rapids. It's hard to get rid of that much adrenaline. I still managed to get up early enough to prepare for Grace Primary School. We got a call about 30min before we were supposed to be there because so many parents showed up. I counted almost 40 parents. Unfortunately, about 20 left becuase their children were not the right age, but people kept on coming! We got over 25 samples at Grace. Today was a very successful day.

(sorry, after trying for about 45 minutes, not enough bandwidth to send pics. I will try again tomorrow.)

Testing, testing, test of…. faith?

Sunday, July 27 2008

So lets talk about Thursday. I woke up early to go to town to photocopy all of the documents for the school visit that was planned for 2PM. I arrived in Wandegeya at 9am, sat down with the printer and began printing the documents from my USB drive. We sent the first two documents to get copied. An hour and a half later, we finally finished printing out 10 documents. That is about 9 minutes/document…?! And we checked on the progress of copying the documents, only 20 packets of 9 pages were complete…in an hour and a half. TIA (that is Africa). You see, I had asked them to print on both sides of the page so as to save paper and to make the documents lighter for me to carry… little did I know that they were feeding the papers printed on one side BY HAND to print them on the other side. I had a small turret’s attack (I’m sorry if that is insulting to anyone).

I explained to the woman that we have to move faster because I had to leave Wandegeya by 11AM and told them to print one sided pages, sorry earth. I also recruited 2 more machines from a neighboring store. I got out by 11:30. Now because I had to be at St. Stephen’s Hospital at noon, and matatus take about an hour to get there, I got a bodaboda for the 12km journey. That in itself was an adventure.

12:03, arrived at St. Stephen’s. 3000USh spent ($1.80). Nice to know that even with such a weak dollar I still feel like I’m not spending NYC prices.

We got to the school on time and were greeted by at least 100 children all smiling and eager to see a mzungu go into their school. We waited for the headmistress to come, it was a standoff of cultures…we tried crossing the line by saying what little Luganda we knew, all we got were big toothy smiles, it was totally worth it.

We set everything up for blood testing and interviews on a shady stage in the middle of the playground. 25 kids, 3 parents. Unfortunately, one of the parents died and was being buried that afternoon so all of the other parents went to the funeral. The headmistress was embarrassed, we really tried to explain that it’s ok and that we’ll do what we can. We told her that though parents gave her permission, we need the parents to be around for the interview. All of a sudden the 3 parents who were there had 8 children aged 6-7 each. Hmmm. Possible, but not at all probable. So, one woman actually did have 4 because she ran the school orphanage. It seems that it’s quite normal for each school to have it’s own orphanage.

After a long introduction, consenting process, and blood tests, we got the kids’ results. I was really holding my breath as each result came with a high-pitched beep from the machine. NO CHILDREN WITH HIGH LEAD!!! We did, however, find 3 children (out of the 8 we tested) who were borderline anemic, and they will be getting free follow-up at St. Stephen’s. The day was a success.

We tried to get home early to prepare for the next day.

Friday: Mpererwe Church of Uganda Primary School.

This was our school. Right near the house, we went to their church and explained everything, we did the focus group in their auditorium. Only 1 parent showed up on time. We stayed from 8am to 1:30PM and waited for children who were sent home to go fetch their parents to return. All in all, 11 completed the study. A little disappointing, but still a good learning experience.

Talking about learning experience... As we were waiting for some of the parents to arrive, I was deciding with Lauren not to go to Mblae for Shabbat. So someone asked about why I can't just leave later and we had the "I'm Jewish" discussion. This one did not go as well as the others. For about 20 minutes, I was being told how many lies I believe in and how I'm going to go to hell for believing them. Ouch.

Truth is, I have no problem having these discussions with people as long as we don't accuse or denounce the other. I prefer more of a religious exchange than an outright disputation. She had never met a Jew before and thought I was SDA (short for seventh day adventist). She then told me how next time we meet she is going to bring her bible to prove me wrong. It's funny. I didn't know how to respond. I was thinking that maybe I should have a better look at the end of the the Old Testament so that I have a lot more to say. We never stressed all that in school. Something to think about.

Back to the school: Here we found 4 children with elevated lead levels, but nothing dramatic. Interestingly, 2 of them were twins exposed to the same environment. I am beginning to think that those children with high lead levels only have them because of their specific environments, not necessarily the dump. Lauren and I talked about it, either way we have done our job, we have a good study, and we got a $10,000 machine donated for 18 months. I truly hope that we get to report that all the children have low lead levels. After the session, I went home and made some cheddar mac and cheese for me and Lauren. Great comfort food after a long day.

Shabbat was nice and relaxing even though someone took the tape off of the refrigerator light button. Basically, I waited for the sound of the fridge opening and pounced on the opportunity. Always exciting here.

Really, there is nothing much to report for now. I’m relaxing today and making sure that we are prepared for tomorrow when we go to Grace Primary School. I have some pictures and hope they show up.

Consenting the parents at Kiteezi Learning Center

Getting Assent from the children, the candy helped a lot

Not a single kid cried when getting their blood drawn, notice all the kids looking on in the background.

Morning assembly at Mpererwe Church of Uganda Primary School, we addressed the whole school. When you ask these kids how they are doing, they respond in unison "we are eager, disciplined, and very smart." Or something like that.

Teacher Alice keeping the kids busy while we take some of their blood.

Our phlebotomist (sp?) and MD turned lab tech.

Getting the notes down in Mpererwe CU. Today we did the letter A.

Culture with a Corporal C

Tuesday, July 22, 2008

I think that many of the differences that I see between Johannesburg and Kampala are related to the type of interactions I have with the environment. In Joburg, I was with family all the time. It was a welcome break from being in Uganda and basically being on your own all day. Now that I’m back, however, I am clashing with the culture on a more basic level.

Today 2 students from Makerere and I went to 3 different schools around the Kiteezi landfill to ask permission to recruit students from them. It was so nice to hear the students learning in sing-song, really it was something out of a movie. I hate that I don’t have a camera… hopefully I will fix that tomorrow. The children greeted us to their school in unison. And then we went to the field, among little children playing, with the deputy of the school to discuss the project.

The meeting went very well. We discussed all aspects of the study and what help we needed from the school. At the end, he asked us to do ourselves and other researchers a favor. He said that other people come into the schools, take samples and then nothing. Nobody contacted them to inform them what the results were, nobody took the research any further. He said (something like) “don’t just take our children’s’ blood and write a book about it in America, help us make a difference.” Wise words. They reminded me of a professor at Mount Sinai who at first blew up at me when he found out that we were going into schools to analyze blood for lead levels. He thought that we weren’t going to provide treatment or education, just go in there with some skewers, stick some kids and run. Some people have a lot of distrust for researchers because they have been used by them in the past. Just an aside, this happened in America not so long ago… check out the Tuskegee Study on Wikipedia.

We assured him that we have no intention of leaving them high and dry, and he agreed to look over the forms and call us in a day or two. As he was walking us out, however, the visit turned very sour, for me anyway.

As the little Muganda children with bags on their back were walking, holding hands, back to their homes, I saw six boys are lying face down on the ground, their teacher above them. One of them was already crying, protecting his bottom by lying on his side. It took me a few seconds, but I realized that the teacher had a cane in his hand. I prayed that he didn’t hit the children in front of me, I don’t know what I would have done. I almost stopped him to begin with. The Makerere students were chuckling embarrassedly because, as they told me, they were in that position before. Students in Uganda can get up to 3 hits of a cane for any reason. Henry told me that at his school they hit him for getting below average marks; he’s been studying as hard as possible ever since. Teachers are allowed to give 3 lashes per student per day, the headmistress/master can give 5, and parents have no limit.

I wanted to say that it was barbaric and cruel; only savages hit their children. I wanted to judge them with my American values. Instead, I, an American medical student who learned that any evidence of abuse is required to be reported to the authorities, witnessed abuse and walked away. Abuse, you should just be aware is not reportable in Uganda…that’s what I was told by the medical students (I’m not sure if that is a legal or practical opinion). I haven’t had any lashes ever. Besides, that abuse is legally sanctioned. I don’t know if I did the right thing and I feel like I did not. I hope the teacher is now telling his wife how hard his day was because he had to cane six children.

I’m not sure what hospital (in America) I was in, but once I saw a woman slap her child very hard; not the kind of slap that people give to stop their children from doing something wrong. This slap was out of anger. I made sure that we caught eyes, and in my full ID tag regalia, I gave her a very stern look. She blanched immediately and apologized to her child. I could have taken it further, but didn’t out of embarrassment for me and the woman. I think this will be one of my biggest challenges as a doctor; learning when to be nice and understand where the people are coming from, and when to report them to the authorities.

I don’t know if I did the right thing.

I can’t end there. It’s too dramatic.

For the past two evenings I have been greeted at the Luboga’s by two amazing species of bird. One had a head that looked like it had been hit on both sides by a frying pan. Seriously, the head was almost 8 inches tall. The other was an extremely skinny light blue bird that stood about 3 feet tall.

That didn’t work. I’m going to make some comfort food…Black eyed peas. There isn’t any kosher French fries or barbequed/fried chicken here.

Back in the Saddle

It's interesting to go somewhere, leave it and then return. Prospectives change. I came back to Uganda knowing what to expect... funny story, about 10 minutes before entering the house, the electricity went out. 10 minutes later, the water stopped running. Thanks to my trip to South Africa, I have fresh pita which was dinner and will be lunch today. Seriously though, I find that coming back to Uganda is like coming back to what is normal for me, it was nice to be back in my own room surrounded by all my familiar clutter. I slept like a baby.

Everyone in the neighborhood also recognized me. I got a bunch of "culicayo," "welcome home" from the bodaboda guys in Mpererwe, from some of the shopkeeps on the road to the Luboga's house, and especially from the Lubogas. They said that they have to start fighting for their rights to me. Then when I showed Dr. Rev. Luboga that he made the front page of The Jewish State, he exclaimed "YOU TOOK ME INTERNATIONAL!" He loved it!

Faith, Dr. Luboga's neice, really took on the advocate's role last night. She made sure that there were fruit cut up and rady for me, she kept on sneaking me bananas, and made sure that nobody asked me to do anything besides relax. After stuffing my face with tons of fruit and pita, I excused myself and took off to hit the sack. I slept for 11 hours, 10-9. I guess a fast day (Sunday) will do that to you.

Now that I'm back in the Makerere School of Medicine Library, I feel like I'm back at the helm. There is much to do. Our first school visit is on Thursday, and Lauren lined up 2 more after that. All of the red tape has been shredded, and now there will be blood (reference to a movie by the same name, but probably a bit inappropriate here). I am very excited to start the testing. In retrospect, it's amazing how much we had to go through to get to this point. I feel like now that we can finally work with teh schools there will be much less work to do (not really though).

Talking about work... It's time I get back to it.

Note about pictures... there will be none until I get my camera fixed or buy a new one. Please send your donations to Danny Asher care of Nancy Asher...... (Not a real appeal for money, but if you want, be my guest)

Guilty!

I'm sorry. It's been so busy here in South Africa that I have not updated in almost a week. I had one very disappointed reader contct me and I had to act.

THis week has been absolutely nuts! I've been hanging out with the kids (Paul and Chev Bacher's kids), babysitting, cooking...it's wonderful to have more than a little stove. There was a bris on Thursday, lion park on Sunday, cool African market on Thursday too. It's been so nice being busy with other things here, but I can't wait to get back. Lauren has been working so hard!

Worst part: My camera broke yesterday. It's a summer of so many firsts so it fits that I shouldn't be able to capture it with my camera. I think I'm going to buy one in Uganda.

Amazing news: I have the front page of The Jewish State, a NJ newspaper, on July 18th. I share it with a great friend, Avi Hoffman, so this one is a keeper. Somebosy save me a copy! www.thejewishstate.net. Most of the article is very accurate, I know it's hard to interview and remember things perfectly, but Jason Cohen did an amazing job. They even put a link to the blog! Hopefully people will read and send money... we still need some for the project. AHEM!

I know I said it before, but it rocks to be with family, especially when my sister (in law) gave birth to Channa Asher, picture below.
Anyway, after a wonderful 10 days with my family and I have so many stories to tell and pictures to post, but Shabbos is in about an hour (its the winter here) and Zahara, 2 years old, is standing on the stove... i gotta go.

Have a wonderful weekend!

Lazy in SA

Sunday, July 14, 2008

Family is paramount. Even the kind of family that is not specifically related to you, but you still go through the trouble of explaining how you are related through marriage. I do that because my family in South Africa rocks. I am really living it up here; big bed, tons of food, and the best showers in the universe. Seriously, I feel like I am in a steaming hot downpour. They have one of those shower heads that is probably illegal in the US because it’s a foot or more in diameter and just deluges water in perfectly-sized drops.

I’ve been doing a lot here in SA besides improving my hygiene. Today we went to a game reserve and I pet lion cubs…yes, I’m a tourist. We also hang out on the trampoline, yes, TRAMPOLINE in their yard. I can almost do a back flip…will post the latest attempt. Shabbat was wonderful and full of all types of great conversation (and sushi). And, throughout it all, I have been comparing South Africa to Uganda.

South Africa is a mix of third and first world aspects that have not yet come to terms with each other. We drove down a 6 lane highway and saw huge shantytowns on the hillsides. It’s hard to explain, but there are sections of town that look like Manhattan and others that look like Kampala. Here you can really feel the tension between the “haves” and the “have nots.” There is also a lot of (violent) crime here, probably because of a lot of that tension. In Uganda, I don’t feel that tension. There is a large history of pain and separation here; I went to the Africa Museum on Friday and had a disjointed history lesson. Seriously, skip it.

Left uncompleted…

Snaps (like pictures in Luganda)

This is a sex free school zone
Rev. Dr. Luboga at the focus group

Mount Sinai's lesser known branch in Entebbe

Chameleon on St. Stephen's Hospital's road
Sunrise in Mpererwe

Sunrise in the Luboga's yard

Lake Victoria at dusk

Tastes like babies?

Just a quick update from South Africa:

1. I just ate meat for the first time in 3.5 weeks... twice.

2 MY SISTER IN LAW HAD A BABY GIRL! Mom and baby are healthy. Baby was 6lbs5ounces (ish).

It's great to be with family!

Lake Victoria Luxury

Wednesday, July 09, 2008

Today I went back to the Ministry of Health, but I had a problem. I didn’t remember the name or location of the person/people whom I spoke to last time I was there. So, naturally, I smiled a lot, pretended to accidentally open the wrong door, and walked around the entire building faking epiphanies when I reached the end of a hallway and did not recognize anyone in the offices in that hall. Eventually, I found Christine who was so helpful to me. She was, of course, all business until the very last second of our meeting. “Are you a believer in Jesus?” (completely out of the blue, no religious discussion before this at all!)

I answered quite candidly, “No, I’m Jewish.”

“You’re JEWISH? One of the chosen people?!”

Immediately she started crying to me and told me about how much her church prays for the Jews and for peace in Israel. She hugged and blessed me with the priestly blessing of the old testament among other blessings for about 5 minutes, still crying. I was a bit shocked. After all that impersonal service and telling me that looking at our proposal would take at least another week, a complete breakdown of any boundaries. She then asked me to bless her. So, I blessed her with the same blessings of the old testament, but in Hebrew. She really liked that. I know because she thanked me… and because at 5:30PM I got a call from the Asst. Director of Health who approved of our study. My friend Mike decided that he is going to play the religion card here too, but he’s an atheist, I doubt he’ll have as much luck. I know I’ve said this before, but people are really religious and religiously motivated here in Uganda.

This is going to be a treat. I went to a hotel tonight. You see, going to Entebbe, staying in a hotel, and then getting a free shuttle to the airport in the morning is just about the same as praying that your private hire taxi shows up on time in Kampala. I am paying $55 for the night in a hotel where I can hear Lake Victoria’s waves crashing on the shore, and I have hot water in my shower. LUXURY! I just took my first hot shower of the summer. It’s nice to be spoiled like this. Though, I did miss eating dinner and relaxing with the Lubogas.

Before my shower, I went for a walk to the beach. There were bugs everywhere. I took some pictures and will attempt posting them (writing this one in advance). There were also no muzungus around at all. Just me. So, naturally, I hung out with the security guards and talked about the differences between American and Ugandan culture. (for some reason, every single dog in town is barking and howling now). They get paid 150,000 shillings a month…about $95. We talked about religion, that always seems to come up here, and kidded about starting a business importing obutunda, passion fruit. Passion fruit at 1000USh for 15, in the US they are about $4 each; that’s a 100 fold difference in price and you can get passion fruit much cheaper in bulk. They made me promise that if I started a company importing obutunda and omuyembe (mangoes, also really cheap here), they could work for me for American wages.

On my way back to the motel from the beach, I had a bit of a scare. It’s about a 4 block walk, but instead of paying about 33 cents for a ride on a bodaboda, I decide to walk; the streets were empty and dark. I thought it was an economical decision. Of course, I see someone across the street sitting on the curb who gets up just as I pass by. My prejudice precedes me. I figure, like a good New Yorker, that I’m about to be mugged while carrying my passport, all my money, and my ticket for tomorrow’s flight. So, I turn around and ask him where I can get a bodaboda even though I saw them about a block away. He pointed, but then asked me where I was going. I said Sophie’s Motel. He offered to walk with me. I think I wet my pants. I immediately introduced myself and asked for his name, Emmanuel. I then drove the conversation towards religion, figured that I could get lucky twice, and also spoke about my research “helping the poor children of Kampala.” I put that in quotes because it’s what I said, not because it was a lie. Naturally, he was a real sweetheart who had just finished his shift at the big hotel nearby and had to walk home. I felt stupid and smart at the same time and will probably react the same way if it should happen again.

Tomorrow, I’m off to South Africa; don’t worry, the blog will continue and I will still be working on research for Uganda. You see, Dr. Angela Mathee, in Johannesburg,did similar research and has been helping us all along. I want to get a good night’s sleep for the meeting, so I’m off to bed. It’s 10:20PM..

Rights and not so rights

Tuesday, July 8, 2008

So yesterday was a day full of accomplishment. We got up very early, a huge accomplishment if you know me, and wrote a flurry of emails to different people around the world for some more information about study materials. Specifically, we might be able to get a machine called a Niton XLp 3 which analyzes soil for lead, marks it's gps location, connects to a laptop via bluetooth, and constructs a grid of all the samples...basically half the work. I might be able to get one in South Africa when I go visit my family on Thursday... don't worry, the blog will continue (I know you're all relieved).

After the emails, we rushed back to St. Stephen's Hospital and took the MU medical students out to lunch (7 people ate big meals, it cost about $4) and then walked over to St. Stephen's Primary School, which happens to be next to St. Stephen's Church... all affiliated. There we had a focus group. I don't know what everyone knows about focus groups so here comes the long winded explanation; nerds can skip to the next paragraph. A focus group is a quarum of people from different walks of life put together in a room to represent a community or target audience. They answer questions intended for the community and basically help researchers flesh out good questions from bad ones, important information from the not so important, etc.

So this focus group helped us go through all of the information in the study documents and discuss it’s cultural applicability and clarity. I am going to go through the issues from least to most interesting (to me).

1. Risks and Inconveniences

In this section of the consent document we discuss the possible negative outcomes that could happen to study participants; perhaps getting the venous sample could cause an infection, bruise, or some pain, or maybe getting identified with a high lead level could be stigmatizing to the child. However, the focus group said that when muzungus talk about risks they mean small things, but when Mugandas talk about risks, they mean broken bones, death, and blowing something up. They said that they don’t want to be told about risks when there are none. They said instead we should write “This might happen to you.” Like I said, least interesting first.

2. Privacy

I know that many of you have either heard of or perhaps signed a HIPPA document explaining that all of your health information is safe and that nobody besides those treating you will know any of your private information. Well, the largest section on the consent form, mostly because it was made in the USA, was the privacy section. People in the focus group laughed at this section. They explained that they all lived in the same community and everyone takes care of everyone else, why should other people not know? How can they help if they don’t know something is wrong? People have no privacy here.

But now that I think of it, they are wrong. People do have privacy and know that it matters. You see, when someone signs up for an HIV test, nobody else finds out about it. And I don’t know how ready everyone is to share that information. Though, when we visited a lab at a hospital which will remain anonymous, they showed up the monthly record of HIV test results. Maybe they thought that because we were medical students, it was alright to show us other peoples’ results.

3. Rights

“We don’t have rights.” Was that clear? When we were discussing the fact that signing the consent form does not make them sign away their legal rights, they said they had no rights. When I pressed them for more information, they said that there were actually legal rights, but in order to get them you have to be well connected and rich. So basically, regular people, those without any major connections or wealth, in Uganda recognize that they have no attainable rights… and they don’t have the resources to fight for them.

At MSSM we had an exercise during the last 2 weeks of medical school where we discussed rights. We were asked what rights we believe that we have. We listed things like the right to vote, fair trial, privacy, legal protection and action, etc. Everything good Americans know they have in their arsenal. When we discussed what people in the third world believed should be rights, we found out that they were more focused on the right to food, healthcare, and other basics. We take those things for granted. We don’t really think about those things as rights as much as we see them as things that are available (to most, if not all).

Blessings

It's been a busy few days. Anu is really helping us revamp our study in order to get good and very useful data. Instead of simply taking samples from schools used in a previous study, we are going to see if we can get blood smaples from children in schools along the stream that passes through the dump site and continues on into town (I hope). Obviously it's tough to think that I have already been here for about 3 weeks and we haven't got a single sample to show for it. Which is fine, I think. I guess it's just important that we are getting through the red tape and that we recognize that simple getting blood samples to do a prevalence and education study will be a great accomplishment.

On top of that, my ticket to South Africa did not exist until this morning... even though I bought it in early June. Apparently getting a reservation confirmation number doesn't mean much at all. It's good to be in science, it makes you really anal. Luckily, everything worked out. I went to the South African AIrlines office today and they laughed because this happens all the time. When I showed them the email I received about a month ago, thay saw my desktop, a picture of my neice, Noa. They asked me how many children I had and I explained... Then the blessings started rolling. For a while. Like 10 minutes. It was awesome.

Living Jewish is a very religious country is really good. When it comes down to it, many of our interpersonal beliefs are similar. There are, of course, differences, but when anyone says Gd bless you, you should always answer amen. I think one of my brothers-from-another-mother, David Osband told me that. No matter what, accept the blessings. And boy are there blessings here.

On Shabbat I was doing my regular chilling. Wearing a white shirt and light khaki pants, I was reading a book in the sun when Jeffery Luboga's, Dr. L's son, fiance called to me. She had come to the house to clean Jeffery's room and do his laundry (I want a wife), and we struck up a conversation. She thought I was a seventh day adventist, but I explained I am Jewish. We had a great converstaion about Jerusalem and how important Gd is in our lives. It's cool to be able to share Gd with someone else. Someone who is completely different from anyone you've ever met before. It's important for us to recognize our similarities with other people from around the world. And then maybe all of us can take it a step further and reach out a hand to help them. Whoa, am I getting preachy. Enough of that...

Last night was a typical Kampala trip. After arguing with a matatu conducter about how much we should pay to go to the bottom of the hill of Mpererwe, normally its 200, but he saw 4 mzungus (that's the correct spelling) and thought he could ask for 500, we went to the local internet cafe...if you could call it that. I was downloading email at about 500 bytes per second. I can write faster than that. So we buy only 40 minutes because we have 2 emails to send. Right after signing into my gmail account, the power goes out. The lighting that we were admiring from a distance all night suddenly decided to get closer. It was crowded, the ground was muddy, the only light we had was from our flashlights, the bodabodas, and some matatus who finally decided it was dark enough to turn on their lights (only a few), and the ground was super muddy. But still, nothing slowed down. The only reaction to the power going out was an "aaw" from us mzungus. So after running the gaunlet (read: crossing the street), we made it into a "supermarket" and got out of the area ASAP.

On Thursday(I have to write more) I met a young man named Joseph who loves across the street from the Lubogas. He sold me a few paintings, I'm a sucker, and he returned on Friday to sell some to Lauren. She wasn't home, but we spoke for more than an hour while we watched the sun go down (I had already prayed mincha, the afternoon services). I learned a lot of Luganda from him and a lot about the plight of the young Ugandan man. I don't think it's appropriate for me to share with you all that he shared with me, HIPPA... But I can tell you that he is working himself to peices trying to raise money so that he can attend Makerere University in August. It costs about 500,000 shillings a semester... about $312, so it's $614 for the year. When he asked me how much I pay for school, I told him about $50,000. He was dumfounded. He said that I should take out the loans and move to Uganda and live like a king. Hmmmm.

The hardest part of being so far away from everyone is FOMO. I know some of you know the term, but for those who don't, FOMO stands for Fear Of Missing Out. It's what keeps you kids awake when they know you are having people over among other things. I have a lot that I am missing out on. My neice is going to become a big sister and grow 3 months older. I really just thought about making my trip end a bit earlier.

The further away from everything you know, the faster things seem to change.

Whoa!

So lets talk about how much I love bureaucracy.

Great, next topic. Today I was grilled for about 1/2 an hour by the Ministry of Health, loop number three. I think I did pretty well, but the best part is that his assistants were super friendly and eager to help. They were so excited to see someone doing this research. Everybody seems to be aware of the dump in Mpererwe, but not a lot of studies have been done on it's effect on anything but the environment. Nobody knows if this translates into problems for the children.

I was reflecting on the study, and I think the best part is our 2nd visit to the schools, when we give a health education day. That is the most important thing we can do. Hopefully, the information will spread and fewer people will have a problem with lead.

Anu, Dr. Natasha Anandaraja from the Mount Sinai School of Medicine Global Health office came last night to Uganda! Very exciting that MSSM is so devoted to our project. She seems to think that we have a real handle on the project and with the situation... little does she know... Anyway, she is staying at Betty's house, right down the block. Betty went to Oxford and got a degree in Horticulture, she now owns 2 garden supply businesses and has the most beautiful garden I have ever seen. She grows all of her own food, too! I wish I could do the same.

I was thinking a bit about the "recycling" system they have here in Uganda. If you want to drink a bottle of coke (no cans here), you have to drink it at the stand and return the bottle or pay for the bottle as well as for the coke. Also, if you want to buy a 1L bottle of coke, you have to bring a bottle in it's place. Maybe we have too much money in America and things are just too disposable. Glass is non-porous, why not just rinse it out with some soapy water and reuse it right then and there? I think this might go back to my rant on progress. If Uganda succeeds in becoming a wealthy nation, will they stop this "recycling system?" Will they start disposing over everything like we do? Also, is it worth not succeeding to maintain the status quo? Will somebody do a literature review? I don't have a lot of time.

Bug story: So I've seen jumping spiders, huge cockaroaches, a scorpion, and a bunch of ants... Last night, however, I saw the worst bug; the bug you can't manage to catch and is now somewhere in your room. NOT COOL. I was baking the laffa (yes I bake it on my own), this week its so much better. Softer and it rose more too.

Lastly, I think this is the first week without my friends the Weinbachs in Hillside. Hillside misses you!

OK it's 4:10PM and Shabbat is coming fast. Have a wonderful weekend.

Cool pic of the malaria lifecycle in mosaic (from Makerere Uni)

APPROVAL!

I can't talk very much now, but I wanted to report that we have IRB approval!

-Danny

Finally some pictures!

I tried posting the pictures in order, but don't feel like spending too much time on that. I think everyone would rather that just posted more pictures.

Do you ever wonder where your straws end up?

The cows in the dump drinking untreated water... these cows belong to someone who can not afford to get water for his cows and because of that, his family will pay by eating all the chemicals and contaminants

Lauren, the med students, and out tour guide at the water treatment plant

Yam farm, on the bottom you can see the barbed wire fence of the dump. We are trying to get some of these yams and test them for contamination.

My birthday feast in progress, thank you Lauren.

Shabbat setup, those are the laffa I was telling you aboutOur backyard, crazy birds all the time

View from the back of a matatu or shared taxi... everyone is gathered around a TV watching a soccer game

Dr. Luboga's Bday party

Mpererwe dump with the St. Stephen's ambulance

I always use protection in bed

more about the dump...

So there were a number of things I have yet to report about the dump. Like how I saw cattle drinking from untreated water. Or how there was a yam farm just beyond the barbed-wire fence. How about how the sludge that is separated from the water is dried in the sun and then used as fetilizer by people in the local communities (that's bad by the way). We have a lot of work to do here. I think it starts with reporting to NEMA (you remember NEMA, right?). More to come.

The B word

Tuesday, July 01, 2008

I mean Bureaucracy of course. People, people… let’s try to keep it clean. So we got a letter of support from the Director of Education at the Ministry of Education and Sports, but they have some friendly suggestions. They are: The Ministry of Health, The Kampala Clerk’s office, and advance notice to the schools. Makes sense, right? No. Because if we wait for both of those offices, we will not have time to give advance notice to schools. Hmmmm. I think we opened Pandora’s Box. On that note, one of my favorite websites is Pandora.com on which you can listen to all types of music without commercials.

This morning Lauren made me banana pancakes. AMAZING! I was hovering around her like a hawk, I felt like the Kosher Police…which I was. So the pancakes were amazing, then we made baked ziti for lunch (not baked), and tonight we are making stir fry. Now I am sitting at a café drinking freshly squeezed juice and eating fresh cut watermelon; oh the good life. Did I mention that we now have running water? I forgot the best part!!! So, travelling Jewish in a foreign land is complicated as many of you know. But it’s especially complicated when people want to give you stuff for your birthday… we were going to bake a cake from scratch and double wrap it to bake in the Luboga’s oven…if you don’t understand that, find someone wearing a yarmulke and ask them. BUT, instead we found ICE CREAM! Gd bless Shoprite of South Africa. So for my birthday cake, which is a real luxury, I am having cookies and cream ice cream with a Shabbat candle on top (thanks Mom).

I hope to write about progress in our research soon… but for now, suffice it to say we are working hard on getting things together so that we can work harder. We’re even hiring research assistants at the Makerere medical and dental schools. Hahahahaha (evil laugh)! I love the perks of being a PI (principle investigator)!

So. Now I would like to respond to some of the comments I’ve been getting. A caller from Hillside, New Jersey asker me to describe the people and culture here. I was also asked constantly to post photos. Thanks for asking. Pictures are a little hard to manage. You see, internet is really slow here and my SD drive in my computer is not working with the card that I have... I will try to fix it and will try to post pictures, but for now I can't post a thing. People in Kampala are really friendly and helpful. Everyone greets you with an "Olyotya", "Hi, How are you?" so if you just say hello to someone they will answer "fine, and you?". Everyone hear recognizes that you are a mesungo and probably have a lot more money than they have, but very few try to rip you off (except some cab drivers), there is a sense of what is fair and they keep to it. Otherwise, when walking around Kamapala, especially at night, there are tens and possible hundreds of little children begging for money. We were told by Faith, our host sister, that their parents teach them to beg and check if you have money. If you show any money you are cased and might be pickpocketed later. The best way to deal with it is to walk away. Which hurts. Here are obviously poor children who aren't going to school and only being taught how to beg and I , a "rich mesungo" walks away. I feel like handing out food. On that note, there is not much to report about the food here except that the fruit is AMAZING. I feel like anywhere but the US the fruit tastes like it should. More culture... I am going to a drum factory soon... should be great.

No internet, no water….no electricity?!?!

Monday, June 30, 2008

So, that’s not completely true (the title). I had water for this morning, but it was gone by the time we came back for dinner. The electricity went out for a little while, but came back on the same day… No, I’m still not complaining. I had my hot sponge-bath (the water smelled a little like burning, but no, I’m not complaining.

In other news, Lauren and I went to the Mpererwe dump today, tooks lots of pictures which I am still unable to upload due to internets speeds that rival a sloth moving in slow motion. There were tons of birds eating the trash and just hanging about, but more importantly, there were tons of people. People were sifting through trash to find useful items, planting their vegetables, and working in the water treatment plant. Yea, you read that right, people were planting fruit and vegetables in the dump that is leaching tons of horrible chemicals into the land and water. Three words for you: COMMUNITY HEALTH EDUCATION! I know the pictures will make things clearer so I am going to go to a café with really fast connection speeds and make sure to get them up tomorrow.

The COBES students, medical and public health students from Makerere University, were with us at the dump and they too had never seen it. They remarked about how dirty the “treated” water was, how disgusting it was that a cow was drinking from the untreated water, and were even scared of breathing in lead. So basically, we did what all medical school professors do; we simply told them about a problem affecting the development of children (lead, you know that’s what I’m studying here), and now everyone is sick with lead poisoning… I still think I have some disease that I can’t pronounce or remember, but I learned about it in physiology. I think I might start lecturing to medical students and then providing them with the cure (not covered by insurance) to their psychosomatic ailments. I’ll call it beer.

We also heard back from the Ministry of Education and Sports… they are excited with and interested in our study and they have some good ideas for us. No, I’m not dumb, just really optimistic. Their could be thinking “wow, what a great way to make the government spend tons of money on a dump instead of something more positive.” But they could also be thinking “what cool people, gee, I think we should give them a grant and start a kosher restaurant for Danny.” Hey, you never know.

So tomorrow is my birthday. I thought about that for a while today. I haven’t spent a birthday at home with the family in 7 years. Family, my birthday will be celebrated with a BBQ upon my return…please? I am craving meat, chicken, hot dogs (don’t be fooled, they don’t count as meat), pizza, and fresh vegetables. Yup, still not eating fresh vegetables though on Sunday I still got hit with some pretty intense…nevermind.

On that note…I think I hear the water cistern filling up again which can only mean one of three things; 1 it’s raining outside, 2 there is a croc in the cistern, or 3 WE HAVE WATER! Wow, now that I smell like burnt tea (water is heated on a wooden stove and is put in the same containers we serve tea out of…no I’m not complaining) we have water. I will complain about showers. One of these days I will not have to wonder if taking a washcloth to a filthy body and then rinsing it into clean water makes the clean water dirty, too dirty to use to wash the rest of your body. Half my tan is dust I simply can not remove.

It’s late, goodnight. I’m off to flush the toilet.

It’s filling back up… tomorrow is going to be a great day.