First of all I should set the scene, forgive me if this is old news to some of you. I'm currently living in a town called Mbarara, 4 hours west of Kampala, in Uganda. I have a 2-year posting with Hospice Africa Uganda at Mobile Hospice Mbarara as the medical consultant overseeing the clinical team. The hospice here has been going for 9 years or so & has a staff of about 20, 6 of whom make up the clinical team (3 nurses, 2 clinical officers and a junior doctor). We currently have about 370 patients on our books, with HIV and/or cancer diagnoses. We see patients at their homes (if they live within a 20km radius), here at the hospice or at the local hospital. And once a fortnight we go further afield to see patients in the outlying districts.
Work is a huge challenge for numerous reasons: Most of the patients only speak Runyankore (a Bantu tribal language) so I need a translator which has its own communication difficulties. It takes a while to learn about the cultural differences, why people have the attitudes that they do towards health & western medicine, what you can & can't expect from patients, their families, the local communities and colleagues, what will & won't work etc. The facilities and resources here aren't quite what I'm used to - it's very difficult to get even a blood test or an x-ray done let alone a biopsy or scan - patients cannot afford investigations, labs run out of reagents or their equipment breaks down or there's no electricity, and there's no 'quality control' so the results are often unreliable or plain ridiculous. As a result many of our patients don't have a firm diagnosis, which may seem crazy but to a large extent it's irrelevant if there's no accessible or affordable treatment anyway - palliation really is the name of the game. It's not nearly as doom-and-gloom as it may seem though; due to incredibly strong religious convictions and wonderful family support networks the patients generally come to terms with their illnesses and accept their fate uncomplainingly, frequently showing such humbling strength, courage, spirit and faith that I'm lost for words.
My working day starts at 8.30 with a rousing hymn, morning prayers and announcements from any member of staff who wishes to communicate something to us all. We have a lot of meetings - staff meetings, clinical team meetings, management meetings, educational meetings, clinical supervision meetings... Ugandan's love their meetings it seems. To be honest not a lot happens until everyone has had 'morning tea' (tea made with large quantities of warm milk, often accompanied by a chapatti or sponge cake) as this constitutes breakfast for most people. Then, depending on the workload and the day of the week, I go out on visits, do a ward-round at the hospital, review patients at the hospice or do admin work. Lunch is a very big deal here; it’s the main meal of the day for most people at hospice so everything stops. There’s no such thing as a working-lunch or a lunchtime meeting. For a minimal sum I get a hot meal every day – matoke (mashed plantain), g-nut paste (funny pink ground nut paste), some form of meat stew (goat or beef I hope), avocado & sometimes beans, sweet potato, posho (nasty millet stuff) cassava, rice or irish (potatoes) – so not exactly going light on the carbs. Rounded off with pineapple or banana usually.
I live on a compound for university staff, opposite the main hospital & the university. It’s a bit like how I imagine a Butlin’s holiday camp to be – we’re all in small bungalows/chalets/flats and no-one ever has enough cutlery. We have a tennis court, some grass, banana & papaya trees, a few harmless snakes, lots of marabou stalks & a security guard. There are a few long-termers, here for a year or two or longer, mostly with NGOs. Then there’s the more transient population of medical elective or research students who come for a month or two.
Somehow the evenings just fill themselves; aerobics twice a week at the local night-club (I cannot describe the wonder of this class to you, you’d need to come & experience it for yourself I’m afraid, I believe it alone would be worth the trip though). And language lessons twice a week, the less said about that the better; let’s just say that I’m not exactly a natural. Evening meals are often a communal affair, we all migrate to the flat with the most chairs and you bring what food you have or what’s going off & needs eating. Often you supply your own cutlery, drinks & crockery too.
Week-ends are also quite sociable – trips to Kampala for a few days of Western indulgence, shopping & proper coffee. A visit to one of the nearby national parks to spot hippos, zebra or chimps. Or just chilling in Mbarara; going for a walk or bike ride, shopping at the market, going out for a curry & a beer, visiting the local ‘country club’ (swimming pool), catching up on work and emailing if the electricity permits.
As you’ve gathered by now, life’s pretty simple out here. The pace is slow, sometimes out of necessity (bad roads that seriously limit your speed or power-cuts that mean you can do very little except go out for a meal) and sometimes because that’s just the way things are. Some days it drives you mad & some days you go with the flow and feel grateful that you’re not part of any western rat-race.
The Ugandan people that I’ve come across thus far are wonderfully warm, friendly, honest & helpful. The majority of them are devout Christians which has taken some getting used to. They’re generally quite animated, fun-loving and seem to laugh a lot. Even though I rarely understand a word they’re saying at work I love sitting & listening, waiting for them all to burst into peals of laughter any minute. The locals tend to stare a lot & call you ‘fat’ (a compliment, or so they try to convince me) or just shout ‘mzungu’ at you for no apparent reason – on a good day I smile and on a bad day I have to stop myself from shouting back ‘black person!’ or some other sarcastic remark.
Being British it doesn’t seem right to write so much without a single mention of the weather. Nobody seems to know any more when the rainy & dry seasons are because they’ve become unpredictable over recent years. The wet months are supposed to be Sept/Oct & Mar/Apr, give or take, but you can get rain during the dry months, & even during the rainy season the downpour is only for an hour or so, not like the endless days & nights of rain in Sheffield. The days vary from sunny & hot to cloudy & mild. No hat, scarf & gloves weather but I do wear my hoodie in the evenings quite often.
Things I love about this place; cheap & tasty avocado, pineapple, banana & papaya, having scooters for short distance taxi-rides, beautiful countryside, the climate, being only an hour or two’s drive from elephants, hippos & lions, the local people & my colleagues, having my own 4WD, cycling to work, appreciating the simple things in life and really appreciating the luxuries & treats.
Things I don’t like so much; only getting electricity after 7 pm, always standing out in a crowd no matter what I’m doing or not doing, seeing the suffering & poverty that people endure and not having the medications or resources to help them, the long-winded meetings that achieve very little, posho, cassava & jack-fruit, Ugandan tea (it appears they export all of the good stuff).
So that’s pretty much it for the introduction, I will update shortly…
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