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