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.

Nyaserere

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.

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.

"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.

A Belated International Thanksgiving

The following is a joint post from the team:


Throughout the week of Thanksgiving, John and Meredith were on a mission to get us a turkey. Despite being thousands of miles from home, we weren't going to let one of our country's great traditions go uncelebrated. The turkey odyssey began at the chicken coup in the corner of the market. Rumor had it there were some turkeys located in a nearby village, and John got on the phone to inform our would-be holiday bird suppliers, "We want the biggest, baddest gobbler you got." Within 2o minutes, our potential feast arrived, legs tied and strapped to back of a boda boda. The bird was handed to the Sound Man in order to assess quality; he grasped its leathery legs and held the specimen upside-down, pretending to gauge the weight with an up-and-down bobbing motion. "Hmmm..." He tried not to appear overanxious for the purchase, but simultaneously he cringed with the unforeseen pangs of a weighty conscience. Previously, our bearded microphone manager was unaware of the plights of our feather friends. In an act of grace, John pardoned the bird.

After a film crew meeting, the triumvirate determined that Thanksgiving dinner must not be abandoned so easily. But a key question became apparent, "Once we get the bird, who is going to kill it?" Meredith had prepared numerous chickens during her stint in the Dominican Republic, but she thought her counterparts should have to have the experience as well. John was still faint at heart from the turkey encounter the other day... and Michael was a little timid to take up the task, especially after watching the video of Dewan's holiday preparations. It was determined that there was only one way to solve this dilemma - Gin Rummy - a three-night game; loser makes the kill. It was agreed. Meredith took the early lead with Aces galore (15 points each) and never looked back. In the end, it was Michael who had to face the gruesome task. After he returned from Kampala, we ventured deep into the countryside surrounding Gulu town, and picked up the largest turkey we that could find.

Thankfully for Michael, the Italians had agreed to help us host the dinner at Lacor. With in 20 minutes of purchasing our bird, we arrived at the hospital's guesthouse, where Brother Carlo was quick to do the dirty job that we had all tried so hard to avoid. Preparing the bird was an all day affair. While telling stories of how his mother used to do it back in Parma, Carlo and Michael plucked the turkey then covered it in butter, sage, and a collection of local spices. The Italian radiologist had also put together a stuffing made of ingredients that he could rustle up from around the hospital grounds, which included sweet potatoes, pumpkin, and pineapple. It was remarkable, and the staff had a hard time not stealing spoonfuls at any opportune moment.

The fancy chocolate chips sent across the world by Mrs. Otremba were put to use by John, Meredith, and Luca (our Italian pediatrician friend) in order to top off the feast with some delicious cookies. Between the turkey and the cookies, it was hard to say what was the biggest crowd-pleaser for our international guests.

We hope that Luca summarized the sentiments of the guests from Canada, Italy, Australia, Uganda, and the United States with his tongue-in-cheek praise, stating, "This was my best Thanksgiving dinner ever."

Filming with the UHRC in Lira

On Saturday morning we put our new magic letter to use. We first met up with staff from the Uganda Human Rights Commission (UHRC) at their regional office in Gulu. They thought it would be a good idea if we took the Commission's 4x4 as opposed to our Corolla for the long journey to meet right to health complainants in the neighboring districts. We didn't refuse the offer, and we're very glad that we didn't. It took several hours to reach our first interviewee, who lives deep in the bumpy country side of Lira, where the roads are far less forgiving than the ones nearby Gulu town. A decal on the SUV's rear side window is a reminder of the region's recent history of war. It's faded color is also curiously resonant with much of the population's own wish to hold on to their past. Brother Carlo at Lacor keeps telling me that nobody wants to talk about the war anymore; they just want to move on with their lives. While riding the bus back to Gulu on Friday night, I sat next to a college student who was sifting through notes that outlined the different modes of file transferring through the internet. As our bus began pulling out of Kampala, she pulled out a cone made out of newspaper filled with what looked like a bunch of miniature green french fries. She asked me, "Do you know what these are?" I had read that it was grasshopper season in the Central part of the country, and so I guessed. My co-passenger was happy to offer me a taste of the novel insect delight, and to be honest, like most fried foods, it was pretty good. All this to say, via the grasshopper, we struck up a conversation. She was a native of Gulu studying journalism at the local university, and when I mentioned to her how much I enjoyed living in the town, she jabbed, "You like it just because of Kony" (referring to Joseph Kony the head of the Lord Resistance Army). This was not the first time that I came in contact with a local conviction that whites only come to Acholiland to satisfy some curiosity about misery. While our bus was mired at a police checkpoint, I tried to assure her that it was the town's friendliness, like her grasshopper gift, that I greatly appreciated. Even though she didn't resist my explanation too much, I got the feeling that she accepted it with a bit of skepticism as we shifted the conversation to complaining about our insanely long and overheated roadside delay. Having experienced several conversations like this one since being in Gulu, I often find myself having to consider how much of a role the context of this community's recent conflict should play in our documentary film. I'm hopeful, however, that we can share their current stories of using human rights to achieve better medical services without having to drag in the past too much.

Our UHRC 4x4 rests sheltered from the sun while we conducted interviews with the first complainant we met that day. Besides competing with the wind, the roosters provide a constant noise that we are fortunate to overcome with our fancy lapel microphone. Maneuvering in sync with the shade has also become a routine task while filming in the villages, not only for lighting purposes, but also for the sake of keeping ourselves and the interviewees from getting scorched.

This is the home of the first complainant who met that day. Her name is Esther, and her case was picked up by the UHRC after someone from the regional office was notified about her situation by a local radio station. We sat underneath a tree just across from this two-room hut as she shared with us her story. An audience of her relatives and neighbors gathered around us, some requesting to have their pictures be taken with the camera, others just curious to see what the mzgunus were doing in the village.

Esther had no problem telling us her tragic tale, especially since it had already been broadcasted on one of the district radio stations. She required a hysterectomy but was unable to pay for the procedure after it was performed at a private health facility. The surgeon had kept her hostage at the hospital for over 3 months until it was leaked to the media what was happening to her. One of her sons was forced to do manual labor in order to help pay off some of the bills, but at a rate that would take years to achieve. Another son, a soldier in Somalia, was also unable to send back the full amount of money to pay her debt. When her story was released, the surgeon became furious and demanded she leave the premises. The unpaid $70 of her $170 tab was forgiven, but her medical records were withheld from her. Who leaked her account to the local press is still an unsolved mystery, one that we hope to pursue. The UHRC is also intent on retrieving her medical records, which without them she has been unable to receive appropriate followup care. She still suffers a great deal of pain in her abdomen since having the surgery, and responded to most of our questions while lying on her side, finding it too difficult to sit up right for too long.




Here are a couple of videos taken by Meredith that give a short picture of our afternoon in Lira. During the middle of the interview, a parade bicycles passed behind us. When we drove out of the village after our visit with Esther, we came to an intersection where a fleet of bicycles were parked outside of a small home. Our UHRC liaison noted, "There must be a wedding or a funeral." Interestingly, the nearest health center is over an hour way from Esther's home, and the only way she can get medical treatment, while hardly able to move from the pain in her stomach, is by riding on the back of one of these bicycles.

Boda-Boda

My name is Michael Dewan. I'm a classmate of Michael's, also spending time in Uganda doing research. He's asked me to share some of my thoughts on the topic of the Boda-Bodas:

Etymologically speaking, Boda Boda has an interesting history. This two-word term refers to the motorcycles you can find buzzing around the pothole-ridden streets of Uganda. They were originally bicycles used on the border between Uganda and Kenya as means by which boys and young men would illegally transport goods from one country to another. With the introduction of Asian-imported vehicles, these bikes were replaced by motorcycles which could carry far more goods, further and faster than their engine-less counterparts. For short, the locals began calling these vehicles “border-borders”. Because the English pronunciation of the letter “r” is more-or-less absent from Ugandan languages, this term became further simplified to “boda-boda”, more closely reflecting its phonetics. Bodas have now made their way from the rural border to becoming an integral part of commercial transport within Ugandans urban centers.

Boda-Bodas, and particularly their drivers, have been demonized as reckless, lawless creatures that have no consideration for their fellow roadway users. They are constantly weaving between cars, riding up on sidewalks, and jetting through traffic stops, seemingly immune to the ubiquitous traffic jams that develop in and around Kampala. In a recent meeting with the Sargeant Assistant Commissioner of Traffic, standing in full police uniform, he angrily proclaimed that boda riders were “uneducated, runaway criminals. Simply mad.” He seems to be representing the majority of Ugandan sentiment as a number of voices in the audience could be heard echoing this belief.

And honestly, I felt the same. I’ve ridden bodas countless times and each time I do I notice my arms getting sore from holding on to the metal backing for dear life. But more than anything, something tragic happened about two months ago that found me investing fully into this helmet policy. Moreover, it seemed to confirm my loathing for boda drivers. I found myself going to International Hospital Kampala to donate A positive blood to another mzungu – a 4^th year medical student at UMich. While we had never met, he worked within Mulago’s gates at the Joint Center for Clinical Research on his third Ugandan tour. A boda he was riding was struck from behind by a car and he suffered severe brain damage. After an initial scan, he was quickly transferred from Mulago to IHK where he received a hemicraniectomy to reduce his medically refractory increased intracranial pressure. He died 5 days later. And my hatred for bodas was sealed. Perhaps the most disturbing part of the whole story is his last blog post where he describes his excitement after purchasing a helmet for the many boda rides he will be taking. Again, I never met Suj, but from what I’ve heard and what I’ve read, he was golden: http://sujalparikh.blogspot.com/

I felt a lot of things in the wake of what happened: anger, fear, sorrow, to name a few. But without getting much into my emotional reaction, these events combined with my sentiment towards bodas made me realize that something should be done about all this. It’s crazy that every day hundreds of thousands of Ugandans are placing themselves on these machines without helmets. Fortunately, I’m not the only one who felt this way.

Earlier this week I found myself at a conference for the Global Helmet Vaccine Initiative, an initiative with the vision of putting a helmet on every boda driver and passenger in Uganda and the rest of the developing world. The conference brought individuals from all sectors together to discuss the problem of head trauma in boda boda riders and what might be done to curb it. The CDC and WHO are active members of the research efforts, while representatives from the FIA Foundation and Arive Alive – Uganda contribute from a general road safety perspective. Of course the Ugandan government is an active participant sending representatives from the Ministry of Works and Transport, the Ugandan Police Force, and other policy-making officials.

I quickly discovered that from the government and the police’s perspective, these boda riders were pests that needed to be eliminated. And then I met some of them. Thankfully the organizers of the event had the foresight to invite some of these riders – the very people we would be targeting our campaign toward. After sitting patiently listening to their profession be damned by many of the stakeholders present, the boda drivers were given the floor. And they began describing their lives – a side of the story we hadn’t given much thought to.

Yes it was true, they said, we aren’t well educated. Our parents couldn’t afford to send us to the schools that many of you were lucky enough to attend. So we came to Kampala from the villages looking for opportunity. And the prospect of making a couple dollars a day transporting busy travelers on a motorbike seemed ludicrous to pass up. Just like many of you sitting here, we have families to feed and children to send to school, and driving bodas is the best shot we’ve got. And yes, sometimes we don’t follow all the traffic laws, but sometimes we feel we don’t have a choice. Our clients – many whom are businessmen and professors and even doctors – demand more. They are late and they will not accept waiting in a traffic jam so they command us to speed between the rows of cars. So what are we to do? Say no? And risk losing a morning’s wages? And we’re not all opposed to wearing helmets. Yes, they’re hot, and yes sometimes it’s difficult to hear in them, but more than anything, helmets are expensive. When given the opportunity to spend 20,000 Ush on a helmet, or to send two of my children to primary school for a term, I’ll take my chances with a head injury.

And it was true. These people were…people. They were sons and fathers, husbands and breadwinners, just trying to survive.

Boda bodas are not going away anytime soon – nor should they. The Ugandan economy relies too much on their services – and too many people rely on this job to earn a living. But there is work to be done and if anything is going to be accomplished in the way of an effective helmet policy, it will take all parties involved treating each other like human beings.

We’ve already begun some of the work. More on this later…

HEPS, the Mortuary, and the Letter

On Tuesday, I took the bus down to Kampala for meetings with a right to health organization, called HEPS Uganda, as well as to pick up our infamous letter of support from the Ministry of Health. In the Lira District, where we hope to focus our documentary film, HEPS has implemented a novel approach to empower impoverished citizens to voice their needs for better medical services. The organization has introduced anonymous complaint boxes in government health facilities. The boxes are emptied every few months, at which time the NGO reviews the written concerns of patients with each individual health facility. Some of the more common complaints involve medical staff charging for services that are supposed to be free as well as mistreating patients while under their care. For vulnerable communities throughout Uganda, the little wooden repositories have provided a moderately successful forum to hold local health centers accountable for failing to provide adequate and appropriate services. In one district, hospital staff was arbitrarily charging female patients different prices for assistance during labor (often the price would be more for delivering a baby boy). Dozens of patients quietly protested this practice through the boxes, and HEPS then took up the case with the hospital and district health authorities who eventually put an end to the illegal scheme. Sometimes, however, the anonymous complaints only shift a problem to some other unsuspecting community. In another district, a handful of patients and their family members filled up little slips of paper with stories of a surgeon conducting operations while intoxicated. Their silent voices were heard; the district health office ended the doctor’s practice at the community hospital. But, these same hushed grievances also allowed the surgeon to be easily relocated to a health center in the neighboring district, where he is reported to be currently practicing with impunity. Sometimes too, hospitals and healthcare authorities will completely refuse to act on the issues raised by HEPS’s boxes. In these cases, the NGO doesn’t have much teeth other than to lobby for reform at the national level. I asked members of the organization if they encourage communities to file complaints through the human rights commission, and one of them responded, “No, we teach citizens about their rights so they can make demands at the level of the hospital, but we don’t want to raise their hopes and then have them be let down.” The staff had yet to hear of a successful right to health complaint filed through the commission. Hopefully, we’ll capture one on film.

When not in one of my meetings or running on errands around the capital, I tend to make the Yale office at Mulago a base camp for operations. On this visit, I was pleasantly surprised to find Michael Dewan doing the same thing. He happened to be in the capital attending a conference on how to enforce helmet use amongst boda boda drivers in Uganda. How he became interested in the topic, and came to attend the conference, is a long story that he plans to share on this blog. I’ll just say for now, he has discovered a lot of amazing details regarding the boda boda culture, and its curious relationship to Ugandan politics. As a result of his participation in the conference, Dewan has begun helping out with an injury prevention study run by the CDC. One of the study’s first questions is how many deaths secondary to boda boda accidents occur each year? Not a terribly difficult question to answer in theory, but hunting down the numbers from the various institutions responsible for keeping them is an audacious odyssey in and of itself. As part of this quest, Michael had scheduled a visit with the city mortuary, and I decided to tag along while waiting for my next meeting.

To get to the house of the dead, we took a circuitous route through new Mulago and down a back driveway to a nondescript brown building situated just outside the hospital’s side gate. Our guide was a young mortician, happy to help with the data crusade. Though the building bore no visible clues of the treasure that lay hidden within its walls, the harsh odor that greeted visitors 15 feet before its entrance left very little on the differential for what this place could be. With our heads quasi-bowed, in an attempt to minimize the necrotic air directly stimulating our olfactory bulbs, Michael and I followed the city’s plain clothed Charon through the morgue’s doorway. We then entered an atrium painted turquoise and decorated with stainless steal industrial-sized cabinets. Each metallic chest of drawers was 3 high by 3 across, like a tic-tac-toe board. From the front, they were reminiscent of some funky, modern Japanese hotel’s sleeping compartments that I saw once on the travel channel. Across the atrium, we entered a tiny office with a wooden table in the middle, which was bordered on two sides with a single chair each. A middle-aged police officer sat at one end, flipping through some papers, while our guide pointed to a large rectangular book in the center of the table and said, “Here.” At home, death moves from the body to a chart to a computer file. Here, if you’re lucky, it gets saved in a day planner. And even then, the cause often remains ambiguous on paper. Thus, as the mortician flipped through the registry’s pages, he noted to Dewan he would probably have to look through the police reports stored at individual stations around the city if he wanted to patch together an accurate number of annual boda boda related deaths. To give an example of how one of these reports looks, he turned to a faucet, now turned file bin, attached to the office’s back wall and pulled out a few flimsy white sheets of paper attached together. “You see, it says RTA, road traffic accident, but it doesn’t mention what kind. But, maybe they have the numbers at the stations.” The police officer in the room voiced agreement. Leaving the office, we got a brief tour of the rest of the facility, which was basically a large room with a handful of tables. On them, there were a number of RTA victims brought in that morning. We then observed an autopsy of a young woman who had succumbed to injuries received while riding on a bus that had flipped over on its side. The patient had died of a pulmonary embolism, which was facilitated by her multiple broken limbs. While a group of men draped in aprons were carrying out the whole procedure, the doctor was careful to record all the findings.

By the late afternoon on Thanksgiving day, I had a great reason to be thankful, we finally got the letter. The letter. It comes straight from the top of the Ministry of Health and clearly states that there are no objections to our research and film. After weeks of jumping through hoops, I sat outside the director general’s office, describing to his secretaries the various foods we eat on Turkey day, while he made the final edits to our green light papers. By the time I got them packed away safely in my bag, it was getting close to dark, which significantly increases the risk of experiencing a RTA during the 4 hour bus ride to Gulu. So, I decided to take the shorter ride out of town to Jinja for the evening, to celebrate the holiday with Dewan and some of his friends who have been volunteering as teachers there for over the past year. The meal was amazing, a real turkey that Michael purchased down the road. The ride back to Gulu the next day was another long adventure, and the letters have already begun their magic. We started filming in the Lira district with the Human Rights Commission today. But I’ll tell you more about that soon. Hope everyone had a wonderful Thanksgiving.

Ozuku and The King's African Rifles

As I mentioned earlier on the blog, we've made some new friends in Gulu town, including Ozuku the tailor. Yesterday, he invited us to his village home near Lacor hospital to meet his family and interview him about his life and health concerns. He also arranged a meeting for us with two of his friends who had served in the King's African Rifles (KAR). On our drive through the tall grass fields surrounding the city, Ozuku would point out sites where he was ambushed by the rebels and the Ugandan soldiers. He feared them both equally. We drove over a 15 foot long wooden bridge that had exploded by a rebel landmine 10 years ago. At the time, Ozuku was riding on a lorry overflowing with sugarcane, and the blast had thrown him onto the shore of a small creek. He joked, "If there wasn't so much sugarcane, it could have been much worse" (referring to the fact that he now only has a permanent limp on his right side). As our Corolla struggled through the massive craters in the dirt road, the tailor would gesture with his hand outside the window, pawing at the hills stretching green towards the south, while describing how he could spend days fleeing the unflinching soldiers from both sides of the war. He then would let out a loud chuckle, "They were such terrible times."

Despite it all, Ozuku still finds a way to make light of a very dark period. The first time he shared this story with us, he was busy hemming the puffy shoulders of a bright pink traditional dress under the awning of his shop in town. Like most store fronts throughout Uganda, his is painted with the colors and logo of a local cellphone company (red, black, and white in his case). Ozuku began with his classic laugh and shaking of the head, "One day, I acquired some beans and put them on a fire with only piece of wood burning. The bullets started, and we dodged the bullets until we ran into the bush. Now after returning home later that day, around 6, we found the beans were cooked just proper. I had put on just the right amount of wood. That was just another sign of God's support there." And again, he let out a booming chuckle, while we joined in this time.



The KAR were a special unit of soldiers created by the British from their East African colonies between the early and mid 20th century. The soldiers helped on military campaigns in Africa and abroad during both World Wars. Probably the most notable member of the KAR was Idi Amin. When Ozuku proposed to organize a meeting with two of his friends who had served in the KAR, we jumped at the opportunity to hear their stories. Before giving a little background about the video above, I will just touch on some of the highlights from our interviews with them. The men were both around 90 years old, a rarity of rarities in this part of the world. Having lived through WWII as soldiers serving in Burma, where they fought a relentless Japanese advancement, these men both noted that life in Northern Uganda was much more difficult than their military service. One of them noted, "WWII was a clean war, while war here is dirty." One of the men had lost 3 sons to the rebels. Both men also had numerous complaints regarding the lack of compensation for veterans, and one requested that we ask the Queen of England to provide money owed to them for their services protecting the empire over 50 years ago. They also were promised money from the current ruling government in Uganda, which they believe was "eaten" (a term commonly used to mean "taken" or "stolen") by the politicians. They provided us with their military credentials in hope that we could report their plight to anyone in power, and help secure some of the money that they've been promised. We brought them sugar, salt, soap, and tea for welcoming us into their homes.

Regarding the Flip video above (courtesy of Meredith): Just as in a medical interview, sometimes the most significant information comes out at the very end of it by simply asking, "Is there anything else you want to tell us?" This gentleman, in classic Ozuku fashion, began his response with a chuckle. What you see above is the start of a story where this elderly KAR vet describes taking 4 Japanese soldiers prisoner while fighting in Burma (Ozuku is the translator with a white beard and neon colored baseball cap). As the story continues, he reveals to us that his regiment of Ugandan soldiers were desperate to keep the Japanese at bay. So they decided to exploit the old rumor that Africans were cannibals. They killed one of the 4 prisoners, chopped them into pieces, and put the body parts into a pot. They showed this to the remaining 3 Japanese captives, who were subsequently released to tell their friends of the "madness" of the African troops. When we asked, "how did you choose which prisoner to kill?" He answered, "His own bad luck."

A Whirlwind Week

We headed back down to Kampala on Tuesday morning to pick up the newest member of our team, Meredith Camp, and to continue on our quest for the Excalibur of letters that will finally cut through all the red tape in one fell swoop. On the way back to the capital, Akra successfully navigated our Corolla through all the dusty traffic, trading centers, and potholes in record time. While our ride wasn't the most spacious, especially since we were joined by Luca, the Italian pediatrician from Lacor, our discomfort was probably nothing compared to what these soldiers felt bursting out of the back of a lorry.

After spending the past 2 1/2 years in the Dominican Republic, Meredith just finished the Peace Corps. in October. Before she could make New Haven her new home, however, she has decided to bring her skills of thriving on limitations to this side of the world for the next month. Despite her long travels, the only rest she got that day was in the backseat of the car as we raced around town for meetings and gathering paperwork. The big meeting of the day was with the Secretary of the Uganda Human Rights Commission (UHRC), who granted us permission to now interview all the potential characters for our film but still wants us to hold off on actually using the camera until somebody high up in the Ministry of Health (MOH)gives consent to the project. He explained that he's a bureaucrat, and though he thinks our project is "benign," he doesn't want to be held responsible if our film "paints the current government in a bad light." With the help of some of my friends, we were able to schedule a meeting at the MOH two days later, and the ultimate letter we've been hoping for seems to be within our grasp. We are hopeful to get it by early next week, which means I have another 4 hour trip to the capital coming up soon.

While we had a some time off in between meetings, we ventured to Jinja and enjoyed a day on the Nile river. Only an hour and a half drive from the capital, it's the perfect oasis from the nonstop hustle and bustle of Kampala.

We made record time on the way down from Gulu, and we also made record time on the way back. This trip, however, was the longest it's ever been. 2 hours into the ride, I noticed a little orange glow coming from behind the steering wheel. I turned to John, who was sitting next to me in the backseat, and asked "Do you think that is the check-engine light, or is something wrong with the battery?" To which John then asked Akra if he was worried about the illuminated warning sign shining underneath the broken speedometer. Akra simply replied, "No problem." So we thought to ourselves, if he's not worried, we're not worried. Well... even if worrying wouldn't have done us any good, our initial intuitions, that the car was indeed trying to scream for help, were correct. About 15 minutes after I noticed the new glow in the car, the car puttered to a stop on the side of the road. After we tried all kinds of creative pushing and pulling methods, and hypothesizing the significance of some fluid spots under the car, Akra hitched a ride to the nearest petrol station 3 km away to look for a mechanic.

When we left Kampala, it was close to 5pm and I was a little nervous about starting the journey so close to dark. Now, I was really regretting it. While our driver was gone, the rest of us tried to keep ourselves entertained by engaging the local livestock (until a bull became made some aggressive steps towards us, then we kept a safe distance across the road) and by trying to predict the eventual outcome for our evening. To make a long story short, Akra showed up 30 minutes later with several mechanics who disassembled the engine by flashlight and diagnosed a problem with the belt. We spent 3 hours in some small town while the car was being fixed, and $40 later we were back on the road. We reached Gulu by around 1 AM. As our hotel's doors were closed, we knocked numerous times and called the main desk phone, which we could hear blaring some loud obnoxious ring tone. I felt bad thinking that I was going to wake up the other guests. But, despite all these efforts, nobody came. Then a guard patrolling the outside noticed our fatigued groans, and came to our aid. He merely walked to an open window, and said in a modestly forceful voice, "Boy." Less than a minute later, a semi-conscious young man unlocked the glass doors and guided us to our room keys.

More Scenes from Gulu

Road construction began on market street this past week. While little shops close early in the evening, smoke collects over the road and kids return from school along lines carved into the dirt by a giant tractor.

After making strong progress at the beginning of the week, we ran into a bit of a snag by the end of it. To meet our possible film subjects, we need another letter from a desk higher up in the human rights commission, which we are now in the process of acquiring. So while we wait for yet another document of approval, we decided to spend our down time meeting other members of our new community. First, there is Leonard (or Ozuku, a nickname he received because of his well-groomed beard reminiscent of a Nigerian rebel of that name), the elderly tailor who has survived every war in Uganda since its birth. He has been teaching Acholi to John and me, and requested that we film him telling stories of his medical struggles, including a hip injury he received secondary to a landmine explosion 10 year ago. This weekend we are going to his village where he is also introducing us to a few surviving members of the King's African Rifles who fought in WWII. Next, there is Florence, a woman in her 30s who runs a crafts store next to Leonard's business. She is also happy to help us learn the local language, and sold John an adungu (a string instrument shaped like a miniature boat). Wile trying to find someone to help John tune his new instrument, we met Charles on the street, a boda driver by profession, who plays the adungu in the local catholic church. After treating him to a soda for his help, we now hope to recruit his musical talent for the film (a possible lead for you Savant).

Behind our hotel, the city clumps into small clusters of administrative buildings, NGO offices, and local businesses. On the left hand side in the far back of this photo is the Gulu regional hospital. Sadly it looks as if the building has suffered from the war as the much as any place or person. Echoing the hospital's broken windows and fractured walls, 12 health centers in the district closed this month because of a lack of medicines.

Across the street from our hotel is a school yard. Throughout the morning, its floods with children dressed in bright blue and yellow uniforms. Like any other piece of valuable property in the developing world, the grounds are walled off by brick and cement coated with shards of glittering glass.

Because we had no map of all the affordable hotels in Gulu when we first arrived, John and I had to be strategic in finding our accommodation. We would visit a guest house, request to see one of its top floor rooms with a balcony, then negotiate a price for the room. While conducting our negotiations, we would look out over the town for another nearby hotel that had the architecture for our price range, as well as a decent looking balcony. That's how we found the Acholi Ber, and I have to say we got pretty lucky with this one.

While I was busy one afternoon jumping through hoops for our letters of approval, John and Akra went for a little reconnaissance drive in the surrounding area. Though these puddles looked fairly innocent, they almost swallowed our Corolla. A crowd of local spectators gathered outside their grass roof huts as the soundman and the car's captain navigated the waters at a 45 degree angle. In celebration of their successful traverse, John got out of the car and juggled a soccer ball with some of the local boys. With high fives and the sound of laughter from the audience, they drove on.

Akra, busy at what he does best... From the rear view mirror dangles a large picture of the Kabaka (Bugandan King) and his wife. At the bottom of their photo is laminated a brightly colored map of the world cut out from some report that looks like it could be from the WHO, UN or some global NGO. Of the many colors representing the different states of states, in the middle of a sea of yellow that is sub-Saharan Africa, Uganda shines red, a color listed critical on the legend. I've spent hours in the front seat speculating what could be so lacking in this country compared to all its neighbors. Akra isn't sure where his dad acquired the map, and while driving in the villages, he often wedges the large photo-map ornament behind a sun visor so it doesn't obscure his view of all potholes.

The Germans, Marcus and Thomas, legends from the casualty ward. They spent the weekend with us in Gulu. We visited Lacor together on Saturday, and they shared stories on camera of their work in Mulago. They experienced a lot in their three months at the national referral hospital, and witnessed the extremes of its limited resources. They were the essential medical care that P. received, and lots of others.

Views from the Acholi Ber

Due to some scheduling conflicts, Binford and I were forced to look outside of Lacor for a place to stay while in Gulu. After checking out 4 different hotels, and their various balcony views, we negotiated a great price at the Acholi Ber. Our room is on the top (5th) floor of the hotel, and has pretty amazing views all around. This view is while looking west down market street.

Looking to the East, there is a collection of traditional homes at the dead end of our street.

In Gulu town, old and new live in a dense network of cement, brick, metal, mud, and grass .

While we're not enjoying the wonderful scenery from our hotel balcony, John and I have got two strong leads on stories for our documentary. One involves a woman who was imprisoned for 3 months in a hospital because she was unable pay for a necessary hysterectomy, and the other involves a woman denied access to anti-retroviral therapy while being jailed. The Human Rights Commission is organizing a time for us to meet with the complainants soon.