39 things I have learned in Uganda

My time in Uganda is coming to an end soon. On Tuesday, July 8th I will board a plane back to the United States. Although this list is probably not complete, and I tried to add a small amount of humor to it, here are some things I have learned during my seven months in Uganda

1. 9 times out of 10, when someone says “Do you like Irish?” they are referring to potatoes, not the people.
2. No matter what the real excuse is for being late, you can always blame your tardiness on “the Jam” (traffic).
   
3. After 6 months straight of wearing scrubs to work, my coworkers were impressed that I could actually dress “smart” (look nice).
   
4. Conversations are much more fun when you use any combination of about 10 different gasps or hums to show enthusiasm. (ask me for demonstrations).
5. When asking a yes or no question, the simple raising of the eyebrows can mean full agreement, while a small cough can mean disagreement.
6. Having a waiter or waitress ask “warm or cold?” after ordering a beer is totally normal.
7. Keep your electronics fully charged when you have power; you never know when it is going to go out.
8. In the lab, water might be considered “distilled” if it doesn’t have any visible particles floating in it.
9. If asked by a local, “Are you saved?” they are referring to your faith in Jesus Christ, not someone who has helped you. I once was asked by Derrick’s father-in-law if I was saved. Not knowing what he meant, I shrugged and said “Yeah.” He then asked who saved me, to which I shrugged again and said, “Derrick. He’s been a great help.” The shocked look on the old man’s face is something I will never forget.
10. “Let me come” means the same thing as “I will be right back.” This was really confusing the first few times I heard it as someone was walking away.
11. Ugandans are not too familiar with the red bumps of acne on white people’s face. Sometimes the first question when you meet someone is “Ahh, what happened to your face?”
12. If you need to talk to Derrick, you can usually find him in his office, but make sure you knock twice. Says Derrick, “I never answer the door on the first knock. If the person does not knock at least twice, they really don’t need to talk to me that bad.”
13. Drive on the left seems to be more of a suggestion than a law in Uganda.
14. Improvisation is key to almost everything. An example: No clamps needed; the thick band ripped off from the wrist of latex gloves is great for tying the umbilical cord of a newborn.
15. Being told “well done” for just showing up to work is a great way to start the day and a typical Ugandan greeting.
16. “Muzungu” is not a derogatory word; it simply means foreigner or white person. And kids love to get your attention when you are walking by shouting it at you.
17. Nearly all Ugandans I have met defend the life of all animals and insects, besides mosquitoes. Countless times I have been stopped from killing a cockroach by Derrick or my roommates, who go on to let it outside.
18.  In Kampala, locals consider it hot if the temperature is in the low 80’s and cold (bust out the winter jackets and hats) if the temperature is in the mid 60’s. This is about the magnitude of temperature fluctuations in Kampala.
19.  If you are not from New York or California a typical Ugandan does not know where your state is in the United States.
20. Contrary to one student’s belief, just because I am from the United States does not mean I know where to sell the skin of an anteater. Apparently he is under the assumption that there is a huge market in the USA.
21. “You’ve been lost” is a typical expression if you meet someone that you have not seen in a while.
22. Kampala is enormous compared to all other cities in Uganda... just use the taxi park size as a quick comparison. Can you tell which one is in Kampala and which one is in Kayunga, a smaller district where I worked with the House of Peace orphanage?
    
    
    
    
23. Ugandan walking pace = Caddy pace – normal pace. Most, but not all, are very slow walkers
24. There are few things that won’t fit on a boda boda (motorcycle). So far, I have seen an entire dining room set (large table +4 chair), a passenger +windshield, an entire family (dad, mom, 3 kids), 5 crates of soda, mattresses stacked 8 feet high….the list goes on and on!
    
25. When riding around town in a public taxi (matatu), often at least one person in the taxi will ask you if you know where you are going, and they will help make sure that you get off at the right stop and pay a fair price.
26. Ugandans are friendly people, and many will give a polite wave or smile when you pass them on the street. I am always happy to wave and smile back. But it seems that every white person I pass on the street makes a deliberate intention to not make eye contact with me. Still trying to figure out why that is.
27. Whenever a Ugandan does not know the… “what?”…the exact word they want to use, they don’t say “umm,” they say “what?” And depending on the pause ….“what?” …. the pause length and the…"the what?” the situation, I am often confused if someone is…what?...quizzing me or just continuing the sentence.
28. It is totally normal to be sold concentrated hydrochloric acid like this, which was poured out of a larger bottle with similar markings. This was $4 by the way.
    
29. Wear sunscreen and sunglasses if you climb to the peak of the Rwenzori mountains. Our faces looked like this and it burned when I opened my eyes for 3 days.
    
    
    
30. There are many Ugandans starting great organizations, such as Befriender Uganda, an organization that seeks to raise awareness and remove the stigma associated with Suicide and mental health. I attended an awareness walk with this organization, which consisted of a band, many signs, and people walking around the crowded streets of Kampala.
31. You can usually predict the restaurant meal price from the bathroom amenities...lowest price is a tank of water with bar soap, middle price is a sink with liquid soap, and you are at a classy place if the bathroom is complete with a sink, soap, and paper towels.
32. Everyone has a team the are supporting for the World Cup: From left to right, Scofield with Germany, me with Ethiopia aka just wanting to fit in, Elias with Netherlands, and Charlie with Brazil 
    
33. If you are buying a movie, make sure it is in English. You can get movies that are dubbed over by a guy who translates into Lugandan. The same guy narrates nearly all movies. When asking my roommates and Derrick why they buy some movies in Luganda format, as they all speak good English, they replied that the man narrating "adds things to the movie that isn't their normally that makes it better."
34. If someone starts a sentence with, "I have heard that in the United States...." chances are what they have heard is inaccurate.
35. You will get asked "Yes, boss, we go?" by boda boda (motorcycle) drivers no matter what you are doing when in public. Many times I have been running, with headphones in, and asked if I needed a ride. Only slightly demoralising, as if to say "Enough suffering, It looks like you need a ride."
36. If you are eating a meal, and get a bone stuck in your throat, it is common knowledge that the best way to get the bone out is to go get the pot that the meat was cooked in, put it on your head, and run in the direction that the animal originally came from. And all this time I thought the heimlich maneuver  was the best way to get stuff out of your throat....
37. It might just be the strong European presence in Uganda, but it seems like way more people smoke cigarettes here than in the USA.
38. It is a great sign of respect to be given a Buganda name from a coworker. Irene, a midwife at Mulago gave me the name Kalule, which made me her brother.
    
39. Nothing makes you feel more welcome in a foreign place than great friends.
    
    
    
    
    
    
    
    
    
    

A day on the labor ward of Mulago Hospital

I tried to compress six months of learning into one day. Some days are slow, but some days are like this:

I said goodbye to Derrick in the hematology lab and headed up to the ward. Along the walkway that overlooked the courtyard 3 floors below, I noticed people sleeping and washing clothes in the early morning. Most likely family of patients, some getting fresh air from the normally stuffy wards, others washing the patient’s clothes and bedding. The patient’s attendants are crucial to ensuring a patient gets proper food, bedding, clothes, and bathing while they are in the hospital. These tasks fall on the family members, as most nurses and physicians have over 40 or 50 patients to attend to. Tree after tree was eye level with me, until I glanced down at the two stumps of the trees that used to be in the corner of the courtyard near the walkway. These stumps always gave me a bit of an uneasy feeling, as Derrick told me that they had been cut down because too many people were using them for cover as they jumped from a high level of the walkway to commit suicide. Something, I unfortunately witnessed just a few weeks ago. Derrick says they jump because they are stricken with grief, whether it is an unexpected HIV or cancer diagnosis, or one of their family members recently passed, it is very apparent Uganda, as with many developing countries struggle greatly with mental health issues.

I continued to walk. “Yes, good morning, sir. Yes, how are you? Fine, fine, thank you. Good day, too.”

I have met many local students, interns, and residents during my time in Mulago, and I recognized someone nearly everywhere I went. I got to ward 3C and turned to go up the stairs, smiling at the 30 or so people that were waiting outside of the ward. More family and attendants of patients. Only a certain number of people were allowed into the wards at a time. Some smiled back, some just glared. They all noticed my long, white coat stocked with gloves, syringes, and blood tubes ready to collect samples for the day.

I headed up the stairs, past security at the door, and started down the long hallway. Straight ahead of me was the labor suite.

I greeted the in-charge nurse as I passed. “Good morning, sister, how are you today? Yes, yes, I am fine. Well done, too. Thank you.”

I reached the end of the hallway and looked right to glance at admissions. About fifteen pregnant women sat on a bench against the wall, awaiting triage, to determine if they entered the labor suite or were sent to antenatal care. At the admissions desk, I gave a “good morning wave” to Eve, one of the friendliest and hardest working midwives I have met at Mulago. Dang, I thought. Eve is on admissions today. I always liked when she was on the labor suite. She is always very helpful and working hard.

I looked left to wear there were women sitting on mattresses on the ground. Most were sleeping, nursing their babies, taking tea, etc. These women delivered yesterday or last night and were awaiting discharge. Women are kept at Mulago “overnight” after delivering, but what is meant by overnight depends on when a women delivers. If she delivers at 9am, she is discharged at 8am the next day. If she delivers at 10pm, she also are discharged at 8am the next day. I have been told that even if she delivers at 3am she is discharged at 8am. The constant need for space requires high patient turnover.

I continued into the labor suite, and I passed through the familiar “rubber ducky” sheets that hung in front of the entrance to block others from looking in. I quickly became used to the familiar smell of bleach mixed with blood that hit me every time I passed through the curtain. I swiftly circled the room, looking to see if anyone delivered very recently. I noticed all the beds were full with patients, as was the bench at the nurses desk, and a few women on the floor. Today is going to be a busy day, I thought, as I noticed one women in the back that just delivered and the placenta was still there. I walked up to her and said, “Mamma, ozade omwanaki?”

“Omwalla,” she replied.

 Ahh, a girl. Not of interest to me, as I was just collecting blood samples from boys (As a reminder, I am collecting the blood from the umbilical cord from male newborns to study G6PD deficiency). I said congratulations to the new mother, smiled, and walked to the nurses desk.

Here I noticed Joy, one of the oldest midwives who worked on labor and delivery. Joy saw me, smiled, and walked over to me and said very slowly, “Wasuzotya no Paul-o.”

“Bulungi, Joy. Wasuzotya no Joy.”

“Bulungi, Paul-o. Jabalayko”

“Kale, nawe jebaleko.”

“Kale, Paul-o.”

An exchange of “good mornings” and “well done’s” that I had gotten very accustomed to during me time here. Joy always made an effort to greet me in Lugandan, and as most Ugandans do, she adds an “O” to the end of my name. She sometimes greets me with the Buganda tribe name the midwives have given, “Kalule Paul.”

As the midwives attended to the immediate needs of the patients, I waited for morning rounds to start with the doctors. On the labor ward today was a resident and an intern from Uganda, as well as an OB/GYN resident from the University of California-San Francisco. This was the fourth resident that I had met from UCSF, and they were always very nice and helpful. As rounds went on, I listened as the doctors discussed the progress of the patients. I had begun to take for granted how much I had learned about labor and delivery, and medicine in general, during my time here. Able to follow along with the discussion, I mentioned I had a blood tube, and I could send to get the woman’s complete blood count (CBC) test. This particular woman had a fever and had other risk factors that made her a higher risk patient, and a CBC is a great first test to help doctors understand what the possible source of the problem could be. I gave the doctor one of the many tubes I had in my coat, he drew the blood and filled out the paperwork, and I told him I should have the results in a few minutes.

“A few minutes? Yeah, right,” he told me, as this would usually take at least 2 hours.

I smiled and said, “The perks of working in the hematology department. I know the staff and can run the machines. I will have this in 5-10 minutes.”

He gratefully thanked me as I went to run the test and returned 10 minutes later with the results.

By this time the team had moved on to another patient. This woman was young, 14 years old. She looked terrified, lying naked on the bed with a team of Ugandan and Muzungu (white) doctors around her. During my time in Uganda, I have probably learned more in the labor ward than any other place. More than in the lab, and more than talking with other people in the community. And after 6 months of working here, I still cannot imagine what is going through that young woman’s mind as she looked up at us, the group standing over her. When doctors are making their assessment, they speak and write their notes in English. Usually, all women are told throughout the whole labor process is where to go, were to sit, and to wait. Some doctors spend more time explaining what is going on, but many don’t. Women are constantly crying for help, asking for something to help with the pain (there is no pain medication on the ward), or asking to go to theater (for a c-section). To all of these I am left to only try to console the woman, as I cannot check her progress, give her pain meds, or move her to the theater. I just tell her that she just needs more time, a response that often leaves her discouraged.

As I was wondering this though, I heard Irene calling me.

“Paul! Paul…..prep the resuscitation area!”

Unfortunately, this was also something I was familiar with. I hurried to the corner of the labor suite, stepping over patients on the floor and a puddle of blood along the way, to where there was a small table, tubing for oxygen, and resuscitation bags and masks. I put on gloves and hooked up tubing to the resuscitation bag, attached a clean mask, and turned on the oxygen. Irene rushed the baby over and laid it gently on the table. This baby was pale, not breathing, and not moving.

Throughout my time on the labor suite, the midwives seemed to come to the conclusion that I was one of the better people on the ward at resuscitating babies. There are a lot of things to think about during the process, from making sure there is a good seal on the mouth, to giving consistent, controlled breaths. It is a high stress situation, but it is extremely necessary to remain calm. If you get stressed and start to panic, the breaths that you give through the bag will be too pressurized, causing air to escape through a pressure release valve and not go into the lungs. I have seen many babies die because of inadequate resuscitation skills, such as not giving good breaths or mistaking the gasping reflex for breathing, causing the care providor to stop giving forced breaths and proceeding to hook the baby up to nasal oxygen. Over my time here, I have been taught proper techniques by both foreign and Ugandan physicians, and since I am a constant foreigner on the ward, I have been able to pass these skills down to other students. For many months on the ward, I had refused to do anything “procedural,” such as starting IVs, delivering babies, or helping with resuscitation. I am very aware of what I am able to do, and I always try to think of the best thing for the patient before agreeing to “help.”

There is little supervision on the ward, and doctors and midwives are quick to shift responsibilities to foreign students. As a foreigner, local staff will ask you if you are able do a vaginal exam, start an IV, delivery a baby, repair a vaginal tear or episiotomy, etc. If you were to agree, you are often not supervised, unless you ask for supervision. This places a great ethical responsibility on visiting medical students to not practice over their training level when on the wards of Mulago. I have seen many visiting medical students get very close to the “ethical line” on the labor ward by stretching their limitations, but I have also seen a great number be very aware of their limitations. As I have said before but will repeat again, I am not yet a medical student. Because of this, I have been very cautious about what I do while I am on the ward. For the first few months I set the line at getting supplies, weighing and wrapping healthy babies, and cleaning. I was constantly turning down offers from midwives to deliver babies and start IV lines. It was only recently, after many, many times observing the starting of an IV did I agree to do it with proper supervision. I still will not deliver babies. I started helping with resuscitations after I had spent time working with some doctors from the United Kingdom, and they explained the process and things to look for. They eased me into helping, under their supervision. While working with them, I learned what to do, but I still wouldn’t do it alone; I left it to the midwives. That was until I witnessed midwives giving improper care when the UK doctors were not around.

“The breaths aren’t going in.”

“The mask isn’t properly sealed”

“That baby still needs to be bagged; you can’t just leave it on oxygen; he’s not breathing.”

Often but in a place between continuing to help the baby or attending to another mother, resources were stretched thin. Reminder after reminder, until I just needed to demonstrate.

“Like this. You see how the chin is tilted back and by fingers make a ‘C’ around the mask? Do you see the chest rising? What is the heart rate? 120. So does that me we need to give chest compressions? No, that’s right, we don’t…only if the heart rate is under 60. We just keep bagging like this: slow and controlled with a good seal.”

At any rate, I help with resuscitations when staff support is low and I am available. As Irene placed the baby on the table, I checked the normal signs: heart rate, color, and tone. The tone and color were not good (no reflexes and bluish), and the heart rate was 80 beats per minute. Anything below 60 beats per minute would require chest compressions as well as breaths. As I tilted the baby’s head back to open the airway, I ensured a good seal around the mouth. I started giving breaths as I instructed another student to monitor the heart rate. As I saw the chest rising, the heart rate started to pick up to 120 beats per minute, which is desired for a newborn. Over the next 5-10 minutes of giving breaths, the baby’s color started to improve from bluish to pink, and the heart rate stayed around 120. I talked through what I was doing so that the student was learning, too.

The baby coughed up a little mucous, which I cleared with a bulb sucker, and then he started to cry weakly. I patted his back to encourage more crying. The student helping me looked up and smiled. We monitored the baby for another 5-10 minutes as we hooked up nasal oxygen, also making sure he properly wrapped to keep him warm. This baby would need to be transferred to special care for additional monitoring, but he was breathing and his signs were good. The student and I labeled and weighed the baby as the midwife filled out the special care form.

I wish this was the case for all the resuscitations I see, but it is not. I relatively large amount babies need resuscitation assistance when they are born, and many do not make it. This is due to the large amount of women who are experience prolonged or obstructed labor, causing a higher amount of fetal distress. Women coming from far away may experience more difficulties due to delayed medical care. Most frequently these babies will have a good heart rate after giving breaths, but will not start breathing on their own. Standard protocol at Mulago is 30 minutes of bagging before you are told to stop. It is an extremely hard feeling to watch a midwife or physician (or myself) stop bagging a baby with a good heart rate, only to have the heart rate slow, and then stop. Knowing that things would be different in the United States with proper respiration equipment makes it harder still.

As this baby was transferred to special care, I checked the room for women close to delivering. The rest of the day went relatively normally for a busy day. I collected samples and helped where I was instructed.

As I was about to head back down to the hematology lab at 4:30, I checked with the doctor who was making afternoon rounds. By this time, the ward had quieted down a little bit, and I had collected 5 samples, which is a relatively good day. The resident was examining a patient, and I just wanted to check to see if I should wait for her to deliver before I headed down to the lab. The doctor was working with an intern, and the intern and I stood opposite the doctor around the bed.

“How far along is she, doctor?”

“Just 5 centimeters,” he said, as he took off his gloves and I was simultaneously hit with liquid in my face. The doctor carelessly took off his gloves, snapping the latex a bit too much, and as a result, I got several small drops of the blood and meconium from the vaginal exam on my face.

I froze immediately, almost like I had just been shot. “What’s her status?”

The intern seemed confused. “Her what?”

“WHAT is her STATUS?”

The intern flipped to the cover of the patient's file, which read TRR. My stomach sank. TRR stood for tested, results given, reactive. This women was HIV positive.

My first thought was water; I need water. I rushed to the employee break room. (All the other sinks on the floor were broken). I thoroughly washed my face, and returned to talk to the physician. I was extremely upset to say the least. After the initial discussion of how he should never snap his gloves when taking them off, we talked about where the drops landed. I said I felt several over my face, some close to my eyes. I told him I didn’t think any got in my eyes, but I wasn’t 100% sure. Through the eyes is really the only risk for an exposure to the face. The doctor assured me that I would “probably be fine,” which is actually very true. Even if a drop of blood entered my eye, infection rate of HIV is extremely low, well below 1%. I don’t even know if any got into me. You can’t get HIV through the skin, only through cuts, open wounds, and mucus membranes.

This experience for sure ended my day on the ward. I headed down to the hematology lab to talk to Derrick, as the physician’s mild reassurance was not enough to comfort me. In the lab, Derrick explained to me that unless I felt it get into my eye there was “virtually no way I could be infected.”

With his reassurance, I decided I was fine. I finished my lab work and headed home, still in a moderate daze. It was hard to put on a smile for the usual neighbor kids that greeted me along the way.

I must have recreated the scenario over 50 times that night in my head. “Did it get into my eye? Did it get into one of my pimples? Did it get into my mouth?” I replied to all these questions in my mind, “No, I would have felt it…..wouldn’t I?”

I didn’t sleep well that night, and when I woke the next morning, I knew that I had made my decision. I had to take the anti-retroviral drug post exposure prophylaxis (PEP) treatment. This was something that I wasn’t looking forward to, but well worth the cost of putting my mind at ease. PEP is free to all workers of Mulago, and is nearly 100% effective at preventing an HIV infection if taken within 72 hours of an exposure. The initial reason for my hesitation was that I had heard the side effects of the drugs are really bad: overwhelming fatigue, nausea, headache, night terrors. Not things that I would not to put up with for 28 days (length of time you need to take the drug) if I wasn’t even sure if I was exposed in the first place.

When I got to the lab, Derrick tried to assure me again, “Paul, the chances that you could get it based on what you told me is less than 1 in a 1,000,000.”

To which I replied, “People win the lottery all the time. To me, the side effects are worth it for me to have my peace of mind.”

So Derrick worked with me that morning to get the drugs from Mulago (which was quite the process). I can say that I probably was not directly exposed, but I did not want to take any chances. I have been on the PEP for about 3 weeks now, and the side effects are actually negligible. The drug I am on (atripla) is one of the better drugs on the market, and was recently upgraded (from combavir) to be stocked in Mulago.

So to my friends and family out their reading this, rest assured that I am fine. Just wanted to share what a “day in the life” might entail. It has been a long time since I posted my last blog, but I have been learning a lot and staying busy. Outside of the hospital, my other main accomplishment is climbing to the peak of the Rwenzori Mountains in late April. This was by far the physically hardest, yet coolest thing that I have ever done. The Rwenzori mountains are the highest mountains in Uganda, and the third highest peak in Africa. It might not get the big name recognition like Mount Kilimanjaro, but I would trade the surreal feeling of being the only group on the mountain, following a scenic river the entire way up, needing gum boots for 2 of the days to hike through a bog/swamp, and crampons, pick axes, and ropes/harness to make sure we didn’t fall of the snow covered glacier for height every time! (selected pictures below).

I leave Uganda in two weeks on July 8th. My time in the lab is going smooth, and I am going to finish my lab tasks on schedule early next week. I am getting excited to come home and see my friends and family (especially Kara! J ).

"Hey Paul, What is Uganda like??"

What do you eat?

Do you live in a hut?

They have 3G Internet??

Rightfully so, many people have asked me to describe my time in Uganda by asking the simple question, “What is it like in Uganda?” A simple question with a very complicated answer, I often am unable to make a coherent conclusion about what Uganda is “like.” Most often, I just say, “Uganda is different than the United States. That is not necessarily a good thing or a bad thing, but it is just different.” I then describe what I am doing in Uganda (working in research at a hospital), and how that is an example of how it is different.

But after living in Uganda for about 4 months now, I can see that much like any other country in the world, describing what Uganda is “like” depends on who you are, where you live, how much money you have, and how you decide to spend your money. I think that after understanding the diversity among these components in a certain place will you be able to understand what Uganda, or any other country, is “like.” Imagine trying to describe to someone who has never been to America, what America is “like.” Where would you begin? I have lived in the United States my entire life and still struggle with this question when asked by a Ugandan what America is “like.” I have only lived in Uganda for 4 months, so my understanding of these aspects is still a bit superficial, but I will try my best.

Let me first start with location. I live in Kampala, which is by far the biggest city in Uganda. It attracts the most tourists, foreign investors, and aid workers. The streets are always very crowded with motorcycles (Boda Bodas), public taxis (matatus), personal cars, and semi-trucks. Traffic in Kampala is a very big problem. Kampala is where you will see the one of the greatest disparities in regards to the available amenities for people with and without a lot of money. For the affluent, living in Kampala is sort of like living in the USA, with a few modifications. Shopping malls and department stores are abundant. Recently a multi-million dollar mall opened up just a 10-minute walk from my house. The Acacia mall boasts gourmet cafés, high-end boutiques, and many specialty stores.

Restaurant options in Kampala are diverse, with many options for eating Chinese, Mexican, American, Indian, Ethiopian, Italian, Greek, and, of course, Ugandan. Prices for specialty meals typically range from 15,000-35,000 UGs ($6-14 USD) but can go as high as 50,000-75,000 UGs ($20-30 USD) at some of the nicer hotels. The higher end restaurants also have excellent outside seating venues with comfy furniture. The night-life is active, with some of the higher end restaurants turning into bars on nights and weekends. Beers are typically 4000-6000 UGs ($1.60-$2.40), and you can even enjoy premium cocktails at the Camel Club for 20,000-30,000 ($8-12) per drink.

However, if you are like the vast majority of people in Kampala, you will never go to any of the places that I just mentioned. The poor majority never go to the malls, department stores, or bars. They shop in the local markets, buying the basics: rice, beans, Matoke (plantains) vegetables, flour, eggs, fruit, etc. I’ve been told that for what one meal costs in a fancy restaurant, an entire family shopping in the market could eat for a week. I buy a local lunch everyday at the hospital, and it usually contains matoke, beans, rice, sweet potato, and ground nut (G nut) sauce. A very full meal, and it only costs around $2. This is the price after the canteen cooking it ensure they have made a profit!

The markets are busy, bustling, and a bit dirty. The vendors all sell similar things, and are all trying to make enough to survive. This is the working and lower class of Kampala. In the market you can buy some cheap, ready made foods, like Rolex (egg omelet with tomato, onion, and cabbage, rolled in a chapatti) Kikomando (beans and cut up chapatti), and samosas. Each of these things can be made into a fine dinner, and I usually get by on 3-4 dinners a week on them. Each costs between 0.40 and 0.80 per “meal.”

Just 10 minutes from the grand Acacia Mall is Komwokya slum, one of the many ghetto’s of Kampala. Slums are usually located at the bottom of a valley or hill, and you know when you are overlooking one. The houses are so densely packed that the entire area looks like one giant, rusted, metal roof. Here you will find houses made of mud, metal, wood, and rarely concrete. Some have power, while most do not. The majority of houses in a slum do not have running water. Most people here will walk to a central water source for the neighborhood with large jugs, gathering enough water for the day. Whereas the wealthy have large houses, running water, a generator for when the power goes out, and a concrete wall surrounding the property topped with a barbed wire fence, the poor have a shack, which might have one room that an entire family sleeps in. There is also a small middle class that is between these two distinctions. The middle class is where I would place Derrick and his family. Derrick lives in a house, but it is not a large house. He has no walls around his yard that keep intruders out, but he does have running water and electricity. His two sons share a room with the house girl who helps Prisca, and Derrick and his wife share another room. He has a small living room, kitchen, and bathroom. His doors lock at night and when he is gone. He is not extremely poor, nor rich. Derrick would say that is poor but he still has a lot to give.

Living outside of Kampala is much different than living in Kampala. Every one of the outside towns is dwarfed in comparison to Kampala. Everything is smaller. I have only been to a few other “large” cities, but from what I have seen the distinctions are clear.  The luxuries of upscale Kampala, such as the malls, restaurants, and department stores, are nowhere to be found. They still have a few nicer restaurants, but nothing compared to Kampala. The local scene is a bit more… eh… authentic. Less of the things that Westerners seek for comfort.

Living in “the village” is another thing entirely.  Often living with very limited access to power and running water, the village is  really the stereotypical simple life that some people think of the when they think I am living in Uganda. No matter how much money you have in the village, there are really no options for you to spend it even if you wanted to. You would always find yourself moving closer to Kampala. I have spent very little time in “the village,” but Derrick’s wife Prisca keeps saying that she wants to bring me out west to her village where her parents live. Pretty much my only descriptions of the village life come from what Derrick has told me and from what I have seen while passing from town to town.

            All of these places are much different from each other and have different things to offer. Again, I live in Kampala, so I have the options available to pick and choose what types of venues I go to. I try to do my best to support the local businesses by shopping in smaller stores, shacks, and the market.  I also enjoy eating from the nicer restaurants to escape the inherent chaos associated with the market. One thing is certain, though, wherever go, I cannot escape looking like a Muzungu (foreigner). Whether it is trying to speak broken Lugandan and haggle in the market, or  trotting into a nice restaurant with other foreighners, I am a muzungu in Uganda.

            What Uganda is “like” for me as a muzungu is much different than what it is like for a Ugandan. Although there are tons of white people walking around Kampala, they are always a bit of a curiosity. Well, a curiosity for some, a target for others, I am curiosity to the random people who walk up to me, ask me what I am doing and where I am from. I am also a curiosity to kids. I would realistically say that nearly every child under the age of 5 who sees me walking on the street, specifically, off of a main street, will yell “MUZUNGU! MUZUNGU BYE! BYE MUZUNGU!” and wave at me until I am out of site. For example, everyday on my walk to Mulago Hospital, I walk through a lower income area of houses that is set up for families and workers of Mulago. This isn’t as dense as a slum, but the houses are similar. I feel very safe walking through this neighborhood, and all usually great me with a smile. There is a group of kids that hang around a certain house every morning and evening that seem to be waiting for me to come home. As soon as I turn the corner and one of them spots me from about 50 meters away, they start chanting…. “Muzungu, Muzungu, MUZUNGU!!!....” Sometimes they just do the wave and muzungu call. Other times, one will start a full on sprint towards me and warp his arms around my legs and give me a big hug, spurring a colossal group hug with about 10 kids in the middle of a muddy street. “Welcome back!” “How are you?” “Muzungu byeeeee!” they all say. All I can do is smile, tell them thank you, and that I will see them tomorrow. All want a high five or a handshake. Derrick says they just want to touch my white skin—a curiosity to them.

In Mulago, I am the Muzungu musawo (doctor). Let the record show that I am indeed no doctor, but I do walk around with a white coat. I am a researcher. And I do very little for the mothers in labor, but many, many times I have been thanked for my assistance.

“What did I do, Derrick?”

“You talked to them. You are a Muzungu and you talked to them. It doesn’t matter that you are not a doctor. They think you helped. They will tell everyone that a Muzungu musawo helped them.”

I am not sure when Derrick is exaggerating or telling the truth, but I can tell that some of these women really are grateful for me just being present. Whether they think they are getting better care or special treatment, if it helps them get through the agony of childbirth with no pain medication I would do anything to help. I will talk more about muzungus in Mulago and the hospital in general in a later post.

            Outside of Mulago, I can be a target to others: usually a money target. Things immediately become more expensive for me if I am in the market or trying to haggle for something. Derrick says that most people just see my skin and see dollar signs. Which, to tell the truth, is probably about right given the amount of white people in Uganda and how much money we have compared to the people we are buying things from. I do not mind being charged more for things. If paying 5 cents more for a banana or 1 dollar more for a taxi helps the person out, I really would just rather pay the extra money. Some, however, think that being charged more is unfair. They also think that me agreeing to pay more is horrible for Ugandan economics. Maybe they are right, but it just doesn't' bother me. Everything here is still much cheaper, even when I am paying "more" than in America.

            Generally, I think Uganda is similar to the United States in that the truly poor population does not have nearly enough and the truly wealthy have way to much. In Uganda, this gap might be wider, and have a smaller middle class, but the principles of disparity are there, and our countries are suffering for it.

So, What is Uganda “like”? I hope I helped answer your question. Uganda is unique for me because I live in Kampala. Uganda is unique for me because I am white. Uganda is unique for me because I work in a hospital doing research. I hope to experience more of Uganda before I leave, and I hope that my extremely superficial description helped you understand what the day-to-day Uganda life is like for me!