Link Letter from Simon Challand in Uganda
South Rwenzori Diocese
Eriphazi Bwambale is the HIV/AIDS and Community Supervisor for St Paul’s Health Centre and for the diocese. He is 29 years old, married, with four children. He lives in Kasese but like most Ugandans, he has a house and a plot of land near his home village at the north end of the district.
I am from Kabatunda parish in Rwensande Archdeaconry in the North of Kasese District, but I grew up in Bundabugio, a neighbouring district north of the Rwenzori mountains, five hours drive from Kasese. This was because of a conflict in Kasese between the ruling Batooro tribe and my tribe, the Bakonjo, who were fighting for independence. I returned to Kasese at the age of fifteen. My mother and father are still alive and I have three brothers and eight sisters.
Kabatunda has been affected by malaria and cholera epidemics recently. There are many people suffering from AIDS. The area has been terrorised by the ADF rebels who have killed people, destroyed property and driven many people down from the mountains. My family manages to stay only by sleeping in the bush at night for fear of the rebels.
From the age of six to fourteen I was in P1 (Primary) to P4 at Kisongo Primary School in Bundabugio. It took eight years to finish four years of schooling because of repeated sickness, in a place where there is little health care. P5 to P7 took another five years because my parents struggled to find the school fees for me to continue. After P7 I was a teacher in a primary school for one year. I did my senior schooling in Karabole, the next district, where I studied maths, English, geography, history, science, agriculture and RE. All my studies at senior level were in English.
At primary school I studied Rutooro, the language of the tribe who used to rule over us, but I have never had the chance to study my own language, Lukonjo.
In 1987, as I completed my studies, another war started: Yoweri Museveni and the National Resistance Army began the process of liberating Uganda from a series of corrupt and violent rulers. Much of the fighting was in Western Uganda and the war lasted until 1986 when Museveni defeated his enemies and became president. He was democratically elected by the people in 1996.
After Senior School I served in the church as a youth worker and received training as a Sunday school teacher, youth leader and Boys Brigade captain. I was then trained as a community health worker by Kagando hospital following which I enrolled for Nurse Aid training which took three years. During this time I was sent to Kampala for an HIV/AIDS counsellor’s course and then continued at Kagando for a further three years as an HIV/AIDS counsellor.
In 1995 I was asked by the diocese to join their Development Programme as HIV/AIDS counsellor and I worked partly in Kasese Town and partly in my home area. I visited church dispensaries doing counselling for people and giving AIDS awareness talks in churches, schools and in peoples homes. In August 1997, with the financial support of churches in the UK, I moved to be supervisor of the AIDS programme for the whole diocese and I now live in Kasese Town in a house I share with other staff from St Paul’s Health Centre.
There are many reasons. Partly it is due to ignorance about the disease. Some people believe AIDS is an ancient disease and that it is not spread by sexual intercourse. Some associate it with evil spirits and witchcraft. Some say it only affects young people who live in towns.
Poverty is also a factor as it forces some women to turn to prostitution to find money for their families. Bad traditions are also a problem. In our traditional culture a widow may be “inherited” by the brother of the deceased man. Some tribes in Uganda have a practice of sharing sexual partners. Traditional healers often use unsterile instruments. War has made things worse because of soldiers and rebels taking sexual partners for money or by force. We have had three wars in Kasese since 1979.
The Diocese AIDS Programme is educating people about HIV/AIDS. We are training and supporting counsellors, Community AIDS workers, and offering testing. We provide help for those already suffering from the disease. We encourage people to change their behaviour to reduce the spread of HIV. The message from the Church is “Love Faithfully”. Uganda’s AIDS programme is a success and slowly the numbers are decreasing.
PWAs are People with AIDS. They have tested HIV positive and have symptoms of the disease. I provide counselling to help them deal with the emotional problems caused by the stigma associated with the disease. The community often rejects them and they feel very isolated. As a counsellor I have to approach the problem so that they can learn to cope with the situation, encourage them to look after themselves so that they can live as healthy a life as possible. I give health education about hygiene, nutrition and the importance of seeking treatment if they fall sick. Where necessary I refer them for further medical help. As people who have exhausted their financial resources due to the disease I encourage them to develop simple projects to generate some income such as rabbit keeping, handicrafts and cultivating vegetables for sale. Those who are working I encourage to continue in their job for as long as possible. Some PWAs are courageous enough to admit in public that they have the disease and they are able to encourage others not to be afraid and come for testing if they are anxious or to “Live Positively” if they already have the virus.
My Christian faith gives me encouragement to do this difficult job. Counselling people can be very painful for both of us, but what I read in the Bible makes me firm and gives me courage to continue. A helpful verse is “Come to me, all you who are weary and burdened, and I will give you rest.” (Matthew 11:28)
They went up in the air like children's toys and came down, smashing on the ground like milk-bottles. The matatu, a sixteen seater mini-bus taxi, was overtaking a saloon car on the bend of an empty stretch of road outside Kasese (late on a Sunday afternoon) when they collided. Empty, that is, except for me in my Suzuki coming back from Kampala. Had I been two seconds earlier I, too, would have ended upside down on the tarmac. As it was, I was there to help people crawl from the wreckage of mangled vehicles and splintered glass, taking them limping and bleeding onto the grassy verge. Some begged for assistance, others groaned, a baby cried. That any of them could walk was a miracle - given the violence of the impact and the severity of the damage to the taxi and car.
Some were not so lucky, the driver of the car had been crushed and died immediately, a woman passenger in the taxi died at the roadside shortly after I had helped her out. It was not long before other vehicles arrived and people stopped to help. We turned the car over to get at a badly injured man, unconscious and trapped inside. Some arranged to transport people to hospital. In a country with no roadside phones and no 999 services it is DIY rescue. Some people stopped and stared, some just drove on - not everyone is a Good Samaritan it seems!
By the year 2020 (less than 21 years away) road traffic accidents are projected to be the second biggest burden of ill health in the developing world. The first person killed by a car was a pedestrian in 1898, since then motor vehicles have claimed 30 million lives. In 1990 traffic accidents were the ninth biggest cause of death of men aged 15-44. Africa is one of the most dangerous places. In countries such as the UK the death rate is around 5 per 100,000 vehicles a year. In Ghana it is 111 and in Ethiopia 192. The Red Cross estimates the cost in terms of lost years of work to be $53 billion a year in developing countries, equivalent to the entire international aid they receive.
To be Frank
A young man with a crutch came to my office this morning. Most people come to my office to ask for money so I did not welcome him with open arms. He asked me if I remembered him: a common question, and as usual I did not (hey, there are half a million potential patients in Kasese, but only one white doctor!). His name was Frank and he had been the man trapped in the wreckage of the car crash. It was now four months since the accident, he had broken an arm, a leg, lost an eye and still needed crutches. Like the one of ten lepers whom Jesus healed he had simply come back to thank me.
I did not know Sam that well. I knew enough to know he was a warm, friendly doctor still in his early 30s and trying hard to run a brand new hospital and the new health sub district that it served. Others spoke highly of him. Last Sunday he was returning from Kampala to Kasese having taken a sick colleague to a specialist centre there. As he descended the escarpment into the Rift Valley and the Queen Elizabeth Game Park he broke the golden rule: "Don't cross the park after dark". Sam was murdered by the ADF rebels.
Bugs (Millennial variety)
Or why Kasese is the best place to be on the morning of 1 January 2000. Are you ready for Y2K? It is short for "Year 2000" and refers to the predicted crash of computers around the world because they have been programmed to record the year of a date as only the last two digits. 1999 is "99" in the computer but 2000 will be 00 which the computer will think is 1900 and the electronic world will come crashing down around our heads. Or so they say! What will happen here?
Lets take a guess:
The dogs have bred like rabbits and, much to my relief, have finally had 'the snip'. But what a snip! The operating theatre was the vet's living room, the operating table was a couple of benches stacked up, the light was provided by the sun through the front door. The whole neighbourhood came to watch and when it was all over we all had lunch in the same room! The rabbit breeding programme has not been so successful. Of the ten little ones, only two have survived, and the big New Zealand white female seemed to be infertile and is destined for the cooking pot. Yumm, Yumm!
Ugandan English - Lesson 29: Understatement
How is the patient?