Link Letter from Simon Challand in Uganda
South Rwenzori Diocese
Bwambale lay unconscious on a urine soaked sheet breathing noisily, his small body dwarfed by the mattress, as a plastic tube dripped quinine slowly into his blood.
He was three and a half years old but looked about two. His arms were thin and his belly distended: his eyelids, palms and nails were white, the tell tale signs of anaemia. Around his bed were his family, his mother breast feeding a hungry two year old, his fatherís second wife and her three children sat quietly on a adjacent bed. He needed referral to hospital for a blood transfusion but his family could afford neither the transport nor the hospital fees. Bwambale was "badly off" as they say: he was suffering from a combination of malnutrition, anaemia and now cerebral malaria. More than that he had the misfortune to be born in the wrong place at the wrong time. Africa in the midst of violence.
Like many others in Kasese, his family had been displaced from their home in the mountains - but these people were more unlucky than most, the father was suspected of being a collaborator with the ADF rebels, and was in prison, maybe the safest place because mob lynching is still common. His family had been moved for their own protection but the only place that could be found for them was a dry barren area on the plains near the prison and they were without seeds or garden tools and so unable to grow any food. Deprived of their home, their land and any means of providing themselves with food or income, malnutrition was inevitable. As Bakonjo people from the high, steep slopes of the Rwenzori Mountains where there are few mosquitoes, they were unused to malaria; They lacked the resistance that their lowland cousins obtained through repeated exposure to mosquitoes.
There are an estimated 20,000 Internally Displaced People (IDPs) in Kasese, invisible refugees in their own district. You do not see rows of white tents as on the borders with Kosovo: these people live with relatives, friends, in empty houses and even in the abandoned squash court in Kilembe.
They are only really seen when the Red Cross come to distribute food, but this is always only in limited areas. This benefits most - but misses those located away from the majority - like Bwambale and his family. Now, following some mysterious directive from Geneva, even the Red Cross have curtailed their activities. Most of the rebel activity recently has been in the two districts north of Kasese, people joke that the "Kasese wing" of the ADF are getting into trouble for being lazy compared to their Muslim brothers nearby. This is displacing more people from the neighbouring districts into Kasese and it is still not safe for the IDPs in Kasese to go home.
What hope is there for people like this? The Church is called to feed the hungry, welcome the stranger, and care for the sick, and South Rwenzori Diocese struggles to meet these needs through its network of health centres, distribution of food when funding allows, and through the hospitality of many Christians who open their homes to those in need. The Rwensande Archdeaconry Community Development Programme (which has been active in the north of the district for many years) is to start a programme aimed specifically at displaced people.
In partnership with the mission organisation ĎEmmanuel Internationalí, and the Canadian government, it will work to improve the nutritional status of those most at risk: pregnant and breast feeding women, malnourished children under five, orphans, the elderly and the disabled. It will also improve the level of health knowledge in the community, agricultural techniques, literacy and self reliance. They have asked me to be their medical advisor as an extension of the work I already do with the team.
As well as meeting peopleís needs for today, the Church must also point to the future. This morningís sermon was based on the words of the prophet Isaiah:
Sadly it is too late for Bwambale. When I arrived the next day his bed was empty and the sound of women wailing could be heard in the distance.
In Britain power is being devolved from Westminster to the people of Scotland, Wales and Northern Ireland. A similar process is occurring here and "decentralisation" is the buzz word. Power is being passed down form the parliament in Kampala to the district authorities and in health it goes further, to the Health Sub-Districts of which Kasese has four. Since 1986 when President Museveni came to power, there has been a very organised system of local councils from district level (LC5) to village level (LC1) which ensures grass root representation, and this probably has its roots in the African tribal hierarchy. As part of this system and process each health unit has a locally elected management committee responsible for the overall functioning of the unit. It always includes at least one representative from the church, one from the community and one from the staff.
The bishop has decided that South Rwenzori Diocese should also decentralise and as part of that process a further three health units are now jointly managed by the church and local government.
St Paulís Health Centre remains isolated, having always been managed (or not, as the case maybe) by the diocese office which is adjacent to it. We are exploring a closer partnership with the Town Council and we have now elected a management committee and held our first meeting. At this meeting we examined the problem of debtors, most of whom are departments of the church. How we shall recover the money is another issue as all these departments are themselves chronically broke. Still life goes on!
Make Haste Slowly
A mere four and a half months after buying the ball and the net, the staff at St Paulís Health Centre, the cathedral and the diocese offices, who all share the same compound, had their first game of volley ball. Next time I shall plant Neem trees and use them as posts, maybe it will be quicker?
Win some - lose some
Three million shillings (£1,500) from the government for each unit to buy drugs.
Four million shillings (£2,000) from the AIDS programme when the Co-operative bank collapsed. One million shillings (£500) owed to me by the District for travel costs to do my supervision work.
KCCL (expats building a cobalt extraction plant) have given a motor cycle, a 125 cc Yamaha, taxed and licensed, to St Paulís Health Centre. Now I might get to ride at last! My little CMS bike has been "down" since I got it. Pihl (pronounced "Pihl"!) Danish construction contractors for KCCL lent us their plumber and electrician with instructions to "Ordi dordi dordi" (fix what needs fixing) with materials supplied from their warehouse, gratis. They also gave the diocese a computer. This fit of generosity might be related to the fact that I had treated and helped evacuate three of their rather sick workers. While I was not looking the electrician replaced the lights we had just fitted courtesy of KCCL. Bright idea!
One of the things I really enjoy doing is helping people to learn. I have just spent a great afternoon with the ladies of the Karusandara Womenís Development Group, who have banded together with the aim of encouraging female literacy (the most powerful tool in health) and empowering themselves. We were looking at sanitation, which must be a problem in the area because they were severely affected by the cholera outbreak last year. We discussed the "whys, whos and whats" of latrines and hygiene, most of which they were aware of, although the concept of the VIP (Ventilated Improved Pit) latrine was new to them. Then I unveiled the "Tippy Tap" which I had spent the previous evening making. It is a brilliant example of appropriate technology, using an empty plastic cooking oil container, an empty tin, a bit of string, a bit of soap, and a candle and nail as tools (no sticky-back plastic in sight). When finished it is filled with water and hung from a tree beside your latrine: pulling the top causes a stream of water to flow and stop automatically (like those push taps in the public loos) so as to conserve water and the soap hangs from string beside it with a little cover to stop it dissolving in the rain...