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Road Trip to Uganda

Weeks 7 and 8 saw us mostly out on the road, first a trip to Uganda with Dr. Mike Marks and then a 3 day weekend safari trip in the Masai Mara. I’ll write about our safari trip next time as there is far too much here already!

Dr. Mike Marks MBE is the former Medical Advisor for Direct Relief International (DRI) and has been closely involved with OGRA Foundation over the years. He was awarded an MBE in 2008 for his work towards establishing primary healthcare in Africa. Mike is passionate about sustainable healthcare solutions in Africa and was keen for us to experience some of the projects he has been involved with in Uganda. Our trip nearly didn’t happen due to the recent Uganda Ebola virus scare in July and the director of OGRA was hesitant to let us go. Fortunately the situation in Uganda got better with no new cases reported, so the trip was given the go ahead at the 11th hour. On reflection getting to spend so much quality time with Mike was absolutely priceless, he has so much experience of development and healthcare systems in Africa.

This was quite an epic journey (nearly 500 miles), two days drive in a 4×4 with three of us in the back (Joan, Doug and me) with Mike and Mishack, our driver, in the front. The trip didn’t get off to a good start as the car started to overheat not far out of Kisumu. Later on we found that the car needed regular stops for more water, due to a small hole in the radiator.

The last half of the journey in Kenya was slow due to the massive number of potholes and this is one of the main roads! However, we were able to cross into Uganda before lunchtime at the busy border town of Busia, $50 USD for a single entry tourist visa. Not long into Uganda and we spotted some baboons at the side of the road close to a police check-point. These were the first real native African wild life I’d seen.

Baboons

Baboons

Other than birds, up to this point the only free roaming animals I’d seen in Africa were domesticated animals: dogs, cattle, sheep, goats, pigs etc. As we drove thorough Uganda to Kampala I was struck by a few first impressions: the roads in Uganda were in much better condition; the towns we passed through were cleaner, with little of the roadside trash which seems to plague most of Kenya; the buildings appeared in better condition and the countryside was really very beautiful. The local currency makes you an instant millionaire as 1 million Ugandan Shillings equals about £250. So you end up carrying around huge bundles of cash to pay for small items.

En route to Kampala, we drove passed a huge rice plantation owned by Tilda, a familiar name back home, and we even had a brief stretch of road which was dual carriageway. We stopped at a service station on the outskirts of Jinja for lunch. Jinja sits at the northern tip of Lake Victoria, and is famous for being the source of the river Nile. In the afternoon we passed through the Mabira Forest, an ancient rain forest, which Mike told us, had been famously saved by the locals from deforestation. A sugar company (with government support) had wanted to cut down a third of the forest and use the land to expand their sugar cane plantation. A grass-roots campaign using SMS messaging persuaded the government to scrap the plans.

Lunch bill for 4 = 56,500 Uganda Shillings (about £14)

Late afternoon we arrived at the outskirts of Kampala, a huge city with all the traffic problems which come with capital cities. So the last few miles took ages. Mike knows his way around Africa and had booked us into a very small and comfortable hotel for our overnight stay in Kampala.

HIV billboard in Kampala

The second day started off fairly straightforward but took a bit of nose dive as the car nearly had a complete melt down; this was the radiator I mentioned earlier. Within a couple of hours it had gone from being full to empty. We had to buy a 20 litre jerry can and some water in a village and everyone kept a very close eye on the temperature gauge for the rest of the day. We were making good time until just after Ntungamo when we hit over 30 miles of new road construction. This project is funded by the European Union and will upgrade the road all the way to the border with Rwanda. This part of the journey was tedious beyond belief as the road calming measures used are sleeping policemen bumps positioned every 50 metres or so. Much more effective than the speed cameras we have back home, but not very comfortable when you are squashed into the back of a car and it’s 32 degrees outside. The final stretch of road works were part of the climb into the mountains and at one point several huge boulders were bouncing across the road ahead, having been disturbed by one of the road building excavators. Finally, we cleared all the road works and completed our journey into the beautiful mountain countryside around Kabale.

Countryside near Kabale

We were staying in a hotel just above the town of Kabale on the edge of Lake Bunyonyi – a true paradise and well worth the long journey. Lake Bunyonyi in many ways reminded me of the Lake District back home but without the same mountain backdrop (or the tourists!). All the roads up there were dirt roads and the place was as peaceful as it was beautiful. The tragedy for the local tourist industry, a valuable part of the economy, was that the summer season was ruined by the Ebola outbreak, which was in the similar sounding town of Kibaale, which is actually over 350 Km away! I’ve recently found out that Uganda was chosen by Lonely Planet as their Number 1 best travel destination for 2012. With a little more time (and $750 each) we could have gone on a trekking safari to see gorillas in the Bwindi Impenetrable National Park. The park is home to almost half of the mountain gorillas left in the world. The numbers of gorillas left are shockingly small and I hope that they are able to survive.

Lake Bunyonyi and the early morning mist

On Wednesday we went and spent most of the day at Rugarama Mission Hospital in Kabale. This is a hospital which Mike and Direct Relief International have helped to equip. Mike was really keen to see how the hospital was progressing, in particular their maternity facilities. We were met at the hospital by Michael the hospital administrator, who then showed us around. The hospital has facilities to support premature babies and we saw several tiny babies in incubators, wrapped in blankets and wearing woolly hats, one with a birth weight of 1.3 kg (~3 lbs). The youngest premature baby to survive at the hospital was a 26 week pregnancy.

2 babies at Rugarama

After visiting the wards we saw an area of the hospital grounds where family members stay on site so that they can care for and feed their family members who are in the wards. There was a large kitchen area for the family carers to cook food (over wood fires or on small charcoal burners). Just past this area was the new maternity unit, currently a single story building, with the option for a second floor to be added at a later date. While in the maternity unit I spotted this poster and was immediately reminded of my job back home.

Molecular Biology and Bioinformatics!!

With the equipment donated by DRI the unit is able to give good quality maternity care and provide operating procedures we all take for granted back home.  The hospital has ultrasound equipment, but is desperately in need of an X-ray machine. Interestingly we saw next to no IT equipment, even the accounts are still done the old fashion way in paper ledgers. As in Kenya, having a robust electrical supply is a big issue and in the ultrasound and dental wing we saw a battery backup system (charged off the mains) which is able to provide 6 hours of power. The hospital also has a large diesel generator, but the running costs (fuel) are high.

Circumcision poster for HIV

Circumcision is believed to reduce the risk of HIV infection. However, the effect can be the opposite as men then think that they are able to have unprotected sex without getting infected. See this wikipedia article for conflicting studies on this subject.

Our trip to Rugarama was very helpful, it was a really well run hospital, with passionate caring staff who were doing an amazing job with very little resources. When we left, Doug and I had one thing preying on our minds: Why do we need to install computer systems (at least the complicated type we are looking at in Kenya) in these kinds of healthcare settings when really basic medical equipment is missing? An X-ray machine to aid diagnosis for potential TB patients or an IT system for managing patient records? Until the basics are in place the answer seems pretty obvious to me.

On Thursday we went to see one of Uganda’s smallest and most remote medical centres on top of a remote mountain above Kabale.  The Kigazi Medical Centre is the brainchild of Jon, a born again Christian from England or “Jon Of God” as Mike likes to call him. Jon lives half time in Uganda and half time in England where he earns money to fund his projects for this community in Uganda. The medical centre is really basic, there is currently no electricity but solar will be installed in the future. Like most places we have seen in Africa they have rain water harvesting and large storage tanks for the collected water.

Kigazi Medical Centre

Next to the medical centre we saw the next phase under construction – a community hospital which will be able to offer basic maternity and care facilities for the community. While we there we decided to give the local builders a hand by moving bricks from the piles left by a delivery truck over to the brick layers. Building materials are available not far from the site. Bricks are made in home-made kilns dotted all over the countryside. Essentially these are piles of fresh clay bricks piled high, covered in straw and clay and then fired the old fashion way (like the Romans used to do it). On our way up to the site we passed armies of people mining rocks and sand out of the hillside by hand. I saw people sitting on huge piles of rocks armed with a hammer bashing away all day turning the large rocks into aggregate of the right grade for construction (such as hard core for the roads or to go into concrete mixing). Extremely hard labour and some of it being done by children.

Jon and I shift bricks

In the photo above Jon is the one to the right of me and is the driving force behind this project. He is totally driven, slightly mad and rather opinionated. Read his long biography and make up your own mind.

Come Saturday we had one day of relaxation before we made the trip back to Kisumu. We went on a boat trip out on Lake Bunyonyi with a local guide we’d met a few days earlier. The lake has 29 islands and we stopped off at Bushara Island, the second largest island for lunch. My favourite story was for Punishment Island where they used to drop off unmarried pregnant women. Then a local man, who could not afford “bride’s price”, would go and pick up the poor unfortunate woman and claim a “free” wife. “Bride price, also known as bride wealth, bride token, is an amount of money or property or wealth paid by the groom or his family to the parents of a woman upon the marriage of their daughter to the groom.” from Wikipedia. At the far southern tip of the lake we stopped and visited a small village which was gearing up for market day. The village was only a few miles from Rwanda. The market was not worth hanging around for and we had to buy the village chief a bottle of beer for the privilege of being there.

Punishment Island

While we were in Kabale, Mishack managed to get the hole in the radiator fixed for the princely sum of £30! Labour is cheap. As a result we managed a pretty uneventful journey home, however I will remember this trip for the rest of my life.