Link Letter from Simon Challand in Uganda
South Rwenzori Diocese
In Sickness and in Health
One of the things I have discovered during my time in Uganda is that being a White Male Doctor gives me an unusual status which is exaggerated by being the only member of the species left in the district. A WMD is reputed to have extraordinary powers - if you are sick he can heal you, sometimes just by touch, if it is broken he can fix it, if you are broke he can finance you, and if it is a problem he can solve it. His greeting is worth 10,000 Ush. If all this were true I should be a happy and doubtless rich man, but sadly it is an illusion. The problem with such illusions is that there is a danger of believing them yourself after a while and also that your legendary, if not mythical status, isolates you from those around. (Of course small factors like language, culture and education also play their part). This situation can be dramatically reversed when illness exposes your true feeble nature.
A short while back I had my worst attack of malaria. I am getting very good at making the diagnosis, it begins with a pain between the eyes and very soon I am flat out. On this particular occasion I had just arrived at Nyabugando Health Centre, near to the Congo border and about 60km from Kasese - no sooner had I greeted the staff than I had to beat a retreat to my bed at the house of my friend Ezera where I stay on these trips. Ezera is a giant among the Kakonjo, partly because of his height and the size of his hands, which seem to envelope mine when we shake, but also the size and warmth of his personality. I deteriorated quite rapidly and by evening I was very weak and suffering attacks of sweating, dizziness and vomiting; not exactly a bundle of laughs.
Everyone was very supportive - the staff from the health centre made periodic visits to monitor my progress and express sympathy. "Bolho bolho" - "sorry". Eriphaz, the Diocese AIDS supervisor who had travelled out and shared the bedroom with me got up repeatedly during the night, every time I was sick, to see that I was all right. However it was Ezera who took on the job of nursing the sick doctor. He brought me food and drink and gently encouraged me to take some, he supported me as I hobbled to the latrine and held me while I threw up on the way back. After a night of vomiting and sweating I was feeling rough and Ezera suggested I bathe. This is done in the little bamboo outhouse by splashing cold water from a bucket over yourself. I really wanted to be left alone especially as movement made me violently dizzy, but Ezera insisted that I would be better for it so I let him help me over. I sat inside on a low wooden stool and Ezera covered me in water and soap and his big hands lathered me up. I felt as helpless as a child but Ezera made a great Dad.
That was the turning point of the illness. I did indeed feel better for having been bathed and I was soon lying out on a mattress in the shade of the coffee trees well on my way to recovery. It was an important experience for us all. My friends and workers saw me at my most vulnerable and treated me with love and compassion. Although in many ways I live and work alone, I now know that I am surrounded by my Christian brothers and sisters and they have seen that I am as frail as them. Yet again I find myself deeply indebted to Ezera, a man who has nothing of material value to give me but who has opened his home and his family to me and who now, with gentle strength, has nursed me back to health.
Waters of Life?
"Its like pushing water uphill" so said Adrian, with his head in his hands when I asked him how work was - but then he is the general manager of KCCL, an international outfit with six contractors employing maybe 1,000 workers and a budget of $100 million and they are nearly six months behind schedule. Why did his words resonate so strongly with me?
St Pauls is struggling and I dont know why. It seems to have everything going for it - good premises, well qualified staff, adequate drugs, but people just arent using it. Some of it seems to go back a long way to the "good old days" of IRDP, when it was over staffed, over managed, and seemed to lay golden eggs for the diocese. Maybe - I was not there then. The Integrated Rural Development Programme was a Norwegian church funded development project combining health, water, agriculture, forestry and credit schemes and seems to have achieved legendary status. It has certainly left its mark - it build large well constructed health units across the district, it piped clean water from the mountains to areas around Kasese town and it still works to encourage reforestation and soil conservation. The problem, as with a lot of development work in Africa is "sustainability", what do you do when the donor money runs out, and in an area where death waits on your doorstep in the guise of AIDS or rebels? It is hard to plan for tomorrow.
Another part of the problem at St Pauls seems to be relationships - between senior management in the diocese and the clinical staff - between the "In Charge" and the nurses - between the cathedral, the diocese offices and the health centre, all of which rub shoulders a little uneasily on the same compound. I am sure I am part of the problem as well. I am an outsider, a stranger, I do not know my staff as well as I would like, I do not always understand why they do the things they do, what their priorities are, why they have suddenly disappeared to yet another funeral (in a hot climate without refrigeration, you do not wait long to bury the dead) or why they are fighting amongst themselves. I know that there are many barriers I have not broken through.
I believe relationships are at the heart of the Kingdom of God, enshrined in the commandments to love God and to love our neighbour, but how hard that is sometimes! How do you express that love when you are trying to lead a team, to provide health care for the sick, to run an efficient business, to pay salaries, but we do not seem to pull in the same direction. Patients die, staff squabble, work is left undone and the kingdom seems to evade us. How hard it must have been for Jesus as the disciples misunderstood him, doubted him, bickered, grasped at worldly power and then deserted him.
How can we further the Kingdom at St Pauls? By prayer, although too often it seems to have become an institutionalised ritual, but maybe praying with the patients will bring healing to us as well. By meeting together and talking through the difficulties - Ugandans like meetings, it seems you can not pass the time of day without first drawing up an agenda. By sharing meals, that ancient custom of fellowship. By playing together, when the groundsman finally gets round to levelling the volley ball court.
Only when we truly discover the Kingdom within us and among us and maybe only when we leave the security of the health centre and go out into the community, only then will we be able to reveal the Christ who brings healing to the body, mind and soul. May be then the water will flow down hill again.
A little later Adrian brought up the subject of the psychological welfare of his expatriate workers and suggested I might start a drop-in clinic. As he walked away he turned to me and said, "I just want to come and see you and have a good cry".
Gorillas and Guerrillas
Most people will have heard of the recent killing of six white tourists in Bwindi National Park, home to the endangered mountain gorilla, by Hutu rebels from Rwanda. The attention of the western media was focused on this part of Uganda because of this incident for three days. This was a tragedy for those people and their families, but I want to remind you to look beyond the headlines and remember that this sort of tragedy is happening to ordinary Ugandans each day in west and north Uganda. It is also a tragedy for the country as a whole because tourism is the second biggest foreign exchange earner after coffee, and this industry and therefore the whole economy, is going to be very badly affected for a long time.
Kids, pups and bunnies
A woman in Uganda has a 1 in 10 chance of dying from causes related to pregnancy. In the UK it is one of 5,100. Pregnancy related illness is one of the biggest burdens on the health of the people of Uganda, when a woman dies the whole community suffers. The problem is neatly summarised as:
Two important ways of dealing with this problem are to improve female literacy and to provide contraceptive services. The Government has recently introduced UPE, Universal Primary Education which should, in the long term, produce women who can read and make informed choices. South Rwenzori Diocese in partnership with the governments of Uganda and the USA have started a Family Health Programme, the main component of which is contraceptive services. We have a small operating theatre at St Pauls where I insert contraceptive implants and soon we hope to start doing permanent surgical contraception. The contraceptive implant "Norplant" is inserted under the skin by a simple operation and lasts for five years. Many women are realising this gives them the opportunity to do things other than raise children, like run a little shop, keep chickens or pigs to generate income or further her education. It also means they are more likely to afford school fees for the children they already have. The most important benefit is that for every year a woman avoids pregnancy is a year added to her life. At the moment the work is hampered by the lack of an operating theatre table and lights; can anyone out there help, please?
In the same vein and to be sure I practice what I preach, I have just given my dogs a contraceptive injection. To improve nutrition and make money many people are starting to keep rabbits. I have just obtained a pair from my friend Brent, who has left for the fig city. Robert has built a hutch, check they are male and female, and now we hope they will breed like, well errrr.. rabbits.
P.S. since writing, Ezera and his family have been forced to leave the large brick house they were living in and move into a two room mud house away from the family home, while Ezera builds a new home for the family.
WANTED - Doctor or Fool
The SRD Health Trust is a forward thinking, dynamic institution preparing to take the Christians of Uganda into the 21st century. It is seeking a qualified health professional to manage its first class Primary Health programme for a period of six months from mid February to mid August 2000.
The successful applicant will be:
Applicants should apply in writing to Dr. Simon Challand, enclosing your CV, names of referees, a note from your mother and 1kg. of chocolate.
Seriously folks, although I fulfil all the above criteria(!) there are not many like me but if you have a decent head on your shoulders, some experience in the medical world and a huge sense of humour you might be the one to baby-sit St Pauls health centre during my leave. Interested or know someone who might be? Drop me a line or email and I will send a more accurate job description.