Monday, December 20, 2010

John and Meredith's Last Weekend

For John and Meredith's last weekend in Uganda, we decided to take in some of the scenery on the Eastern side of the country. Here is Sipi Falls which lies in the foothills of Mt. Elgon near the border with Kenya.

Sipi is a series of three waterfalls. This is the falls located highest up in the hills, affectionately known as Number 3.

After a day at the falls, we ventured down to Tororo to visit Jacob and his family. The kids have grown up fast since the last time I saw them, and the littlest one I was meeting for the first time. From left to right: Branka (wants to be a pastoress), Matai (wearing the Museveni T-shirt, wants to be a teacher), Bernice (still undecided), and Grace(wants to be a pilot).

To get back to Kampala, we hitched a ride at 6 AM on the back of a pick-up truck driven by one of Jacob's friends. Our co-passenger was printer needing some repairs in the capital. A little chilly, but the views were great.

The best film crew to hit Uganda since The Last King of Scotland.

Sunday, December 19, 2010


On a bitter cold winter evening 4 years ago, I met Jacob in Minneapolis. We were both attending a party to welcome a human rights lawyer visiting from Zimbabwe. Jacob likes to tell the story a little different than me, adding something about my curious dance moves, but regardless of what may or may not haven been the impetus for our first conversation, we became fast friends. Jacob was attending the University of Minnesota for a Master's in human rights law, and at the time, I was interning at the human rights center in the university's law school. He was visiting from Eastern Uganda, where I was heading for the first time later that year. Shortly after our first encounter, he began slowly preparing me for his native culture and cuisine. Each week, we would meet up for lunch at an East African restaurant, Tam Tam ("Sweet Sweet" in Swahili), hidden near the seven-corners district of the university. What I remember most about our early friendship was his unbelievable stories.

When Jacob was in primary school, he had to perform manual labor around his village in order to pay for his school fees, including his entrance exam for secondary school (which is not free in Uganda). When his headmaster had pocketed the money instead of offering entrance exams to the students, a young Jacob Oboth-Oboth organized them in protest. He was punished as a rabble-rouser, unable to return to school until a later date when the headmaster finally decided to hold the exams. On the morning of his entrance test for secondary school, Jacob had to carry his own desk several kilometers and was confined to a tiny space while taking it. Despite it all, he still achieved one of the highest scores in his district, and through the generosity of a missionary family, he eventually got the education he had worked so hard to receive.

For the past several years, Jacob has been an attorney representing the Ugandan government in its Eastern districts. Today, however, he has given up his legal practice and is campaigning to be a member of parliament. The same disdain that he had for injustice as a child has lead him to choose a life in politics. And just as he struggled against corruption to have the opportunity to learn, he is now facing some of the most blatant fraudulence in his pursuit to be a leader for his community. His opponent, Dr. Otaala, is a high ranking minister in Museveni's cabinet, and well known for misappropriating funds. During the multiple poorly regulated primary elections for the ruling party, the National Resistance Movement (NRM), Jacob had received a court injunction to prevent certain districts from being included in the vote because Dr. Otaala's campaign had greatly inflated the voter registry. The NRM electoral commission defied the courts and permitted a very large amount of mythical votes to count towards the Minister, giving him the nomination.

Violence has also crept into the election. A couple of months ago, a university student from Jacob's campaign was photographing Dr. Otaala handing out money to potential voters as well as using government vehicles while conducting his rallies, which is illegal. Dr. Otaala saw the student taking pictures, seized him, and threw the camera away. He then withdrew a pistol from his coat, aimed it at the student, and just before he could fire it, his body guard grabbed his arm while two shots were fired into the air. A mob of Otaala's supporters then pounced on the student, injuring his kidneys and forcing him to spend a week in the hospital. This was all reported in the newspapers, criminal charges have been filed against the Minister, and yet he is still running his campaign as normal. The only explanation that I get for this kind of impunity, "He has lots of powerful friends after lots of years in government."

Despite losing the NRM nomination, Jacob has decided to run as an independent candidate. Last weekend, John, Meredith, and I visited him at his home in Tororo. Between his non-stop meetings, he found some time to update us on his campaign and even showed us the video footage from the day he signed his nomination papers. The streets of his home town were flooded with people shouting his slogan, "Me Ahongo" ("The Time is Now"). President Museveni, despite being NRM, has decided to give his support to both candidates. Jacob has also received a nickname, Nyaserere, which is a type of genetically modified cassava. As Jacob explains, "It's a new breed, that's easier for people to cook, it yields faster, and is weather resistant." Now on the side of his campaign posters, next to his portrait, there is the outline of a thin Nyaserere tree.

Thursday, December 16, 2010

A Radio through War and Peace

Waving her hand outside the car window towards a collection of hills near Lira town, Diana said, "That's where the rebels burned down a radio station."

After spending a day looking into complaint boxes, we decided to continue our examination of another major object becoming central to our film, the radio. During our time in Gulu, we witnessed how communities there were frequently using programs on the air to express their complaints. From the beginning of our work with the human rights commission, we had also learned how a local radio station in Lira had leaked the story about Esther being held captive in a private clinic for 3 months, which lead to both her release and the commission taking up her case. And while our HEPS tour guide Diana was calling our attention to the vague mounds buffering the city from the village, we knew there was a deep-rooted reason why so many from the North choose the radio to voice their right to health.

Like Lacor Hospital in Gulu, Radio-Wa ("Our Radio" in Lwo) was founded by a Comboni missionary. It started in 2000 during the middle of the war between Uganda's central government and the Lord's Resistance Army (LRA). From the beginning, the station held programs to promote peace and stability in the region. At the heart of its broadcasting were two programs titled Karibu ("welcome" in Swahili) and Dwog Pacu ("come back home" in Lwo). During Karibu, letters from family members would be read to child soldiers calling them home and imploring them to stop fighting. Family members could also phone-in during the program and dedicate songs to the lost children, who they hoped were listening. Dwog Pacu was a program where former rebel soldiers got the opportunity to make an appeal for peace and invite their friends back from the bush. Both of them were hosted by a DJ named Kakaba, who became a legend on the radio not only because of his humor but also because of his clandestine alarms broadcast to villages when rebel troops were approaching. He was a popular man with the military and informants loved to report to him. If he got word of the LRA heading towards a village, he would announce to them on the radio, "There is a lot of smoke in your area today." Villagers would relay the message to their neighbors, gather their children, and together they would flee.

In 2002, Radio-Wa was becoming too much of a nuisance for the LRA, and the rebel leader, Joseph Kony, ordered his soldiers to burn down the building with Kakaba in it.

Today, Radio-Wa is housed in a building next door to the Lira's catholic cathedral in center of town. When we entered the station's compound, we were cheerfully greeted by its new director, Alberto, a middle aged Spaniard. Alberto came to the station a few years ago just as the war in the North was ending, and before that, he had spent years working for development broadcasting programs in East Africa. Despite having lived so far from his home for so long, he still kept its memory alive and well in his office, evidenced by a large poster on the door of David Villa gracefully dribbling a soccer ball. As we sank in to the deep cushions of the armchairs lining his workspace, he was glad to share with us the tales of Kakaba and how the radio had risen from the ashes to continue its mission of peace after being shut down for 6 months and relocating to its new residence. Citing military intelligence reports that he acquired, Alberto also informed us that Radio-Wa's programs have been credited for the escape of over 1,500 abducted child soldiers. With the director's stories only feeding our eagerness to learn more about the station's early life, he arranged for us to take a tour of the radio's former ecclesial home nestled in Lira town's eastern hills.

The LRA's assault had left the station's original infrastructure completely destroyed; the red and beige stripes of the cathedral walls were coated black, though the edifice stood firm. Before leaving Alberto's office, he joked, "If they really wanted to destroy the radio they should have cut down its mast, but they only burnt its insides." These days, the enclosure has regained its rusty bands, but instead of a radio station, it now houses a rudimentary TV broadcasting organization, TV-Wa. Our guide for the grounds was Brenda, a young female host for the TV station's music video programs. She lead us along the clover shaped outline of the building, from its main entrance to the radio tower. Half-way between them, she stopped in a little cove and placed her hand on the outline of a doorway now filled in with cement, "This is where Kakaba escaped." By this point, we had heard numerous versions of how the radio DJ had eluded capture by the rebels. One story was that he was tipped off just as the insurgents were arriving. Another, divine providence had called him away for an appointment during his regular working hours. My favorite version, however, is that Kakaba was a very short man who slipped passed the rebels unnoticed because of his height. Either way, the legendary DJ lived up to his own legend, and survived the attack to continue calling the soldiers home. Sadly, Kakaba passed away last month, he was only 38 years old. His funeral was one of the largest Lira has ever seen. After being a voice for his people on the radio, he championed their demands in government, running unopposed because of his popularity. He outlasted the war, but rumor has it that he died from complications due to one of Radio-Wa's new primary foes in the time of peace, HIV/ AIDS.

Before we could finish our Radio-Wa safari, we ventured into the interior of the renovated church. In order to get to its current resident's recording studio, we walked along a dark corridor, lit only from the sun streaming in through the building's high windows. About 50 feet down the hallway, it forked. To the left, there was a hue of fluorescent light and the glow from TV monitors through a Plexiglas divider making up a dead-end a few yards away. Continuing straight ahead, however, the darkness increased like into a cave. A tall vaulted cavern could hardly be recognized, and black, fluttering shadows would occasionally make an arc halfway towards the floor and return back to the vague ceiling, bats. Hundreds of them. With a slight chuckle, the studio's technical assistant informed me that he normally should be able to access the station's generator through the short passageway ahead, but deeper into it, the bats dart down at such great numbers that he prefers to take the long way outside when the power goes off. The LRA attempted to burn the building down more than once, even after the TV station reoccupied it. But now, the staff worry only about their neighbors from the natural world.

Tough Surroundings

Early last week, we said our goodbyes in Gulu town and made our way about 100 miles southeast to the district of Lira. We were invited by HEPS-Uganda (The Coalition for Health Promotion and Social Development) to film their work in the field. As I described in a previous posting, HEPS has for the past few years conducted rural right to health training programs in villages throughout Lira as well as piloted anonymous complaint and compliment boxes in several local health facilities. Unlike formal, legal complaint systems, such as the Uganda Human Rights Commission, these tiny wooden boxes are providing a user friendly and time efficient tool for patients to voice their struggles.
Our first appointment in Lira was a visit to the District Health Officer (DHO). We showed our letters of support and were quickly granted permission to do our filming in the district's health centers. Before we could leave his office, however, we still had one question. "Have you seen any of the mysterious disease here?" John asked. Though we had relocated further away from the most affected areas, Lira still shared its northern border with one of the districts hit by the illness. Most of the media was echoing our friend Luca's contention that the disease, with symptoms similar to a viral hemorrhagic fever, was pneumonic plague. With increasing news reports that early tests were coming back positive for Yersinia Pestis, the CDC, WHO, and Uganda Ministry of Health finally came out with a statement that evidence was actually inconclusive, meaning they still didn't know what was killing people. The number had reached 38, but no new cases were being reported. During this time, I began receiving a long thread of emails from Yale physicians and faculty concerned for our team's safety. Between them and our friends in Gulu, we were constantly being updated by those involved on the ground and those in-charge back in the US. While some European and American institutions decided to have their students retreat to the capital, it was determined that no evacuation was necessary for us, especially since the mysterious malady was very responsive to antibiotics and the most feared diseases had been ruled out. The deputy DHO of Lira also informed us that no cases had been seen in his district, and that we should simply proceed with the normal precautions (i.e. avoid close contact with sick patients and use the Purell often). With that in mind, we proceeded with our tour of the district.

Our first stop was a health center in an area called Otuke, located 3 hours east by 4x4 from Lira's capital. Because of the region's great distance from the district's governing city, Otuke was recently granted permission to form its own district. Despite facing the challenges of establishing a new body of local government leaders, the budding district borders one of the most lawless territories in East Africa, Karamoja. The Karamajong people are probably most known for their armed cattle raids throughout North Eastern Uganda. The basis for this communal practice of thievery has been given several anthropological explanations. One is that the Karamajong believe they are the true owners of all cattle by divine right, and another is that the raids serve as a right of passage for young males who also acquire greater status by having a greater number of livestock. Since the fall of the Soviet Union, a large number of AK47s have also poured into Karamoja increasing the violent nature of the cattle raids.

When we asked the DHO of Otuke about the major challenges to health service delivery in his district, he responded, "The number one problem is insecurity, especially from the cattle raiders." 3 days before our visit, the raiders had passed close to the health center and stolen 80 cattle. A few weeks before that, they had passed through a nearby village and left one man dead. After that event, the district's polio vaccination program was shut down until the central government brought in armed guards to accompany medical staff. After hearing the DHO's plight, it felt a bit strange to ask him how well the complaint boxes were being implemented in his his health center.
He was happy, however, to tell us that the staff were still frequently consulting the boxes even while HEPS was no longer able to send one of their team members to oversee them. Despite living in tough surroundings, it seems from the HEPS complaint boxes that patients in Otuke are concerned most about the same problem as everywhere else in the country, no drugs in the health center.

Sunday, December 5, 2010

"Good News, It's Plague"

This past week, we began filming interviews with medical staff at the government-run Gulu Referral Hospital. While waiting to meet with the head of the hospital's community outreach program, we were hosted by his office-mate, a very congenial public health officer. He brought us across the hall, into another office, which appeared to function more as storage unit these days. We scavenged for places to sit, and he began asking lots of questions about our film and research projects, in particular he wanted to know the specifics of where we intend to work. "Will you be in Kitgum or Pader?"

"Not anymore," I replied, " since a few weeks ago, we decided to just keep it simple and limit ourselves to Lira and here."

"Good, that's very good because you may have heard about the strange disease there now. Been killing people. Since about two weeks ago. They get a fever, start coughing blood, and after a few days they die. 30 people so far. Government's keeping it very quiet. Until they know what it is." Then shaking his head, and with a little, soft laugh, "Or, until it's too late. Like always."

After processing his cautionary words, John, Meredith, and I immediately began darting our eyes back and forth between each other. We were just 7 kilometers from the hospital that battled the most famous Ebola outbreak ever, and now, we were being warned about some mysterious hemorrhagic fever threatening communities in the neighboring districts. We all started blurting out, "Is it Ebola? Is it Marburg? Lassa?" He simply reassured, "They don't know yet." Then his colleague arrived and greeted us one by one. The public health official got up from his chair, and walked around a desk to shake all of our hands one more time. As he was leaving, he said "It was nice to meet you. Good luck with your work."

We kept short our meeting with the community outreach leader, and scheduled an on-camera interview with him for the next morning. Then the three of us made our way out of the hospital grounds, which actually feel more like an army barracks than a health facility. It's surrounded by a chain linked fence capped with barbed wire and its front gates are patrolled by an armed guard in military attire. As we reached the outside world, we all professed our mutual anxieties from hearing about some deadly disease being hushed from public ears. Was this guy serious? Does this really happen, a government keeping a deadly outbreak secret?

Just as we were beginning to evaluate these questions, Akra arrived at the hospital gates with the car. We started driving back to the center of town when we spotted our Italian friend Luca at an intersection. He was trying to give directions to a boda boda driver for some arts and crafts store in the neighborhood. We offered him a lift and he gladly accepted. After he squeezed into the back seat, we promptly barraged the young pediatrician with questions about the rumored lethal illness. He quickly responded, "It's all true. We had two cases brought to our hospital this last week, both died. Nobody knows what it is." When we arrived at Luca's destination, we decided to join him for some souvenir shopping. While perusing shelves of minimally designed earthen clay pots, and surveying walls covered in brightly painted canvases depicting rhythmic scenes of village life, we prodded the Italian for any other details he could provide about the mysterious disease. He really didn't have much more to add, but promised to keep us posted on whatever he learns at the hospital. After we finished wading through the local wares, we dropped Luca off at another motorcycle taxi stage and returned to our hotel to log footage before our next appointment at a local radio station.

Two hours later, while I'm sifting through the morning's interviews for highlights, my cellphone begins to blare its obnoxious techno-ring. It's Luca. I answer. "My friend, good news! It's plague! Pneumonic plague!" A little unsure of what he was saying, I replied with a confused, "What?" "It's not Ebola, it's plague. Results came back. It's good news, at least we can treat this one." "I see. Great news. Thanks."

Shortly after getting the brief words of comfort from Luca, we had to leave for our next filming engagement. Our filming journey has helped uncover various informal and formal channels through which the local population is able to voice their right to better medical services. One of the more popular informal routes is the radio. When we asked the District Health Officer of Gulu how human rights empowers the community, he replied, "Go talk to the radio stations." He then explained how more and more people are calling into radio programs to complain about the poor state of medical services, and in turn, the health facilities are forced to respond to the shaming publicity. Just about every person that we've interviewed so far has referenced the radio as a main source of health rights education or tool for voicing grievances. For these reasons, we have begun exploring how radio stations serve as a practical alternative to the human rights commission when Ugandans are stranded from essential medical care.

For a long time, the radio has played a very important role in Acholiland. During the war years, parents would broadcast messages to their children, stolen at night by the LRA and forced into carrying out their gorilla military action. Often times, the LRA would force new abducted recruits into murdering other members of their community, and then tell the young ones that no one would accept them back in their villages after what they have done. Despite having spent most their days hiding in the country side, the LRA remained connected to Gulu town by the radio, especially at night when they would come in close to the city for raids and reconnaissance. So in the evenings, mothers and fathers would use the air waves to call their children home, telling them no matter what they've done, it's okay. As peace settled into the region, the radio then became a greater tool for the locals to learn about and voice their civil and political rights. Historically, most complaints have involved torture and abuse by soldiers, especially the loss of cattle to feed the military. But more and more, as resettlement is taking place, and the NGOs are pulling out, the economic and social rights, like health, are being asserted.

Mega Radio is a local station that has been around the longest. It has weekly programs devoted to human rights issues as well as health topics, and for our film, we interviewed a DJ, Steven, who is in charge of both. On top of being trained in broadcasting, Steven is also a doctor to-be, having just finished his pre-clinical years. In a well enunciated voice born for the radio, he provided us a lot of great sound bites for how his type of programs are a clear channel for rights to be expressed and heard. After our interview, we went into the studio with him to document his work. He warned us in advance, however, that the radio only broadcasts in Acholi. "The language of the people," he stressed. Despite his concern that we wouldn't understand anything he announced on the microphone, we were able to follow his first news report loud and clear. He began, "Pneumonic plague... Kitgum and Pader."

Fortunately, we head south tomorrow for at least a few weeks. Hopefully, this plague will end its course soon with no more casualties. At least, the whole town is aware of it now.

A Day in the Park

After an incredible week of work, we took a day off to go to Murchison Falls National Park. It's pretty amazing to live only two hours away from this wildlife wonderland. Photos courtesy of John.