Kampala, Uganda
Monday, February 8
Sitting at the Sheraton in Kampala drinking coffee, relaxing in an environment filled with familiar things—much needed after our first day in Uganda (yesterday). Arrived late Saturday night—stepping off the plane, hit by the first blast of smoky, damp air that I associate with Africa—nervous, overwhelmed, excited. Plane filled with the usual suspects—the missionaries clutching the word of god in their nervous, white hands; the post-pubescent adventurers dressed in hippy dippy safari wear clutching the word of lonely planet in their excited young hands; the Ugandans dressed in their finest, clutching a million bags and the tiny hands of children. The drive to David’s in the darkness is an assault to the senses…..dust and darkness punctuated by the beaming lights of erratic taxis and the pulse of club music, the chaos of a Saturday night threatened by the bota-botas zooming in and out of traffic. I think—I am back. Do I want to be here? Do I want to revisit the place that propelled me from adolescence into adulthood in a matter of days? Do I want to revisit the place that nearly destroyed me 9 years ago? I am still unsure. What is it about this place that grabs me and pulls me into the currents of poverty—what is it about this place that makes me feel alive and incredibly lonely at the same time. What is it about this place that challenges every part of me—challenges me to think, to feel, to breathe in the inequalities inherent in life…..that forces me to recognize my privilege and reject or accept it on a minute to minute basis. My identity is tied to this foreign, uncomfortable place in a way that is difficult to describe. It is the place where I first experienced death and true despair and it is the place where I first felt truly alive.
This should be an interesting trip. It marks the end of a journey that has lasted over 14 years. I have visited this place, this country at every critical point in my life’s journey from adolescence into adulthood and it has shaped me through the wonder, the guilt, the confusion, the horror, the anger, and the joy that it inspires inside of me. Can I say that I love it here? I cannot. But I can say that this place changes me every time I come.
We are spending the first 2 weeks working at the Infectious Disease Institue in Kampala. We are staying (for now) at the Makerere University Guest House and are in the company of at least six other American medical students. On our first day, we trekked down the road to the hospital—the other students walking confidently in their ridiculously white short white medical coats through the sea of Kampala city life—weaving through the crowds of people, trying to avoid inhaling the dust and exhaust, the garbage and sewage. Almost marching in single file, pretending that we are inconspicuous, that we belong somehow. Pretending we are doctors. But pretending is futile here—I learned that long ago.
We enter the IDI, unsure of where we are going and who we are supposed to meet. We are almost immediately taken to the IDI clinic, where at least 80 patients are waiting on benches on either side of a long hallway. None of the patients are talking to each other—they all sit staring. It is strangely quiet for a cavernous hallway filled with so many people. It is a place of serious business.
IDI, Kampala
February 10, 2010
Kuwaala Health Center (Health Center #3)
Fell on my way to the hospital today and finished the intense trek to the IDI with blood running down my hand—thoughts of tetanus running through my mind. The sight of my own blood mixed with the tension I feel weaving through the rush hour morning traffic led to an exhausting morning. Hopped into van heading to Kuwaala Health Center, one of the IDI-KCC clinic sites. The IDI-KCC is a capacity building partnership between the IDI and the Kampala City Council designed to improve access and tracking ART treatment in the community. At this point in time, the IDI-KCC partnership at Kawaala and 6 other government health sites provides free ART treatment to 2,000 patients and is currently funded by the Global Fund, PEPFAR, and the Ugandan Ministry of Health. The partnership was supposed to end at the end of March 2010, with the hopes that the Ministry of Health would be able to fully support the ART program. The partnership has failed to build enough capacity to continue without emergency funding through the Center for Disease Control. According to the young physician I was paired with for the day, the Ministry of Health has claimed that the IDI pays the IDI physicians that staff the clinics at an unfeasible rate. At this point, the Ministry of Health will not distribute ART treatment to patients without the availability of a 3-month supply of ART drugs. Currently, there are hundreds of patients who are on waiting lists for free treatment.
We pulled up at the clinic and I was slightly surprised to see at least 100 patients sitting on benches waiting for us to arrive. The crowd looked much like the crowd waiting at the IDI clinic at Mulago—however, there were at least 8 physicians staffing the IDI clinic on a daily basis and today there is only one. We set up space in a consultation room, the physician and I sitting on one side of a desk and the patients on the other, separated by a huge stack of colorful paper charts. Our first patient was a 29 year-old woman who presented in tears. She told us her story—she lost her husband three months ago and was ostracized by his clan secondary to her HIV status. Her care was transferred from other part of the country to the Kawaale clinic, but she was having difficulty accessing her much-needed ART treatment. The physician looked at her with pity—there was not much he could do for her. The encounter lasted less than five minutes, followed by at least 60 more patients with various physical and psychosocial complaints. The interviews were conducted in Lugandan, the local language, making it nearly impossible to understand what was being verbally communicated. The clinic morning ended with a cold chapatti, a warm orange soda, and a lot of questions about the feasibility of delivering ART treatment in a clinic like Kawaale without the massive influx of foreign money.
Globe Napper 