Running on Grace

While mashing a hard boiled egg into honey, I watched images of protesters and smoke gathering in corners of Cairo. As I wrapped my modified breakfast burrito’s bronzed filling into a chapati, Al Jazeera commentators speculated the American agenda in Egypt on the Acholi Ber’s 16 inch monitor. In the hotel’s reception area, which also serves as a parlor outfitted in white plastic patio furniture, the young cleaning girls sauntered in t-shirts handed out by the electoral commission to promote itself and highlight the scheduled dates for voting. Big men visiting Gulu on official business periodically revived their instant coffee with the twirl of a spoon along the edge of their mugs. With the expectation of little change on the horizon, the flickering photos of upheaval and tear gas passed through the morning somnolence as more than a dream of exotic politics.
After scraping the brown splintered shells to the periphery of my plate and stacking my coffee cup and its saucer in the middle, I headed outside to meet our replacement driver for the day. Akra and the 4x4 were mired again in a garage for some new necessary repairs, so we were in need of a special hire to take us an hour outside of town to the village home of Peter, one of the complainants that we are following for the film. After quick negotiations, the driver Samuel and I settled on a fair price. His vehicle was a weathered green Toyota sedan that was missing some interior door handles and rattled on startup. But despite its questionable condition, the car was equipped with one piece of essential hardware dangling from its rearview mirror, a rosary. Automobiles in Uganda don’t advance on the highways by petrol alone, rather they seem to perilously proceed by the power of a religious mantra, “There but for the grace of God go I.” Whether empowered by a drooping plastic Jesus nailed to the cross or a scarf of marbled Islamic prayer beads, the nation’s drivers gather comfort and courage to push forward in the face of the ever present ghosts of failed transport attempts that collect rust along the roads. While religious devotion helps to assure the successful exchange of goods and people throughout the country, its sphere of support is not limited to the upholstered world of motorists. In fact, it's hard to tell any story of this place without some thread of spirituality weaved into the backdrop. For this reason, I attended a Catholic mass with Joella last Sunday to look for a choir group that could help with a soundtrack for the film. Entering the church grounds, parishioners amassed at the doorway to the ecclesiastical edifice and formed brightly colored clusters around the dried grass in the dusty compound. After shimming our way through the crowd at the back of the building, my Texas teammate and I found enough space for two on a bench alongside the pews.
Leading the church service was an old Italian priest who bellowed out the Beatitudes from the Gospel of Matthew. In a raspy, heavily accented voice, the clergyman began, "Blessed are the poor in spirit, for the kingdom of heaven belongs to them," and ended,“Blessed are the peacemakers, for they will be called the children of God." During my adolescence in suburban Minnesota, I had heard these promises proclaimed from the pulpits of office building-like houses of worship. At the time, they offered a literary challenge to my youthfully interpreted world, where gratification seemed as essential as breathing and a constant war waged with my older brother over which music would be played in the bedroom. Here, however, the words, like the images of Cairo, were more real than surreal for those gathered indoors. As the priest questioned why members of parliament earn ungodly amounts of money while most in the crowd struggle to purchase sugar and salt, the scripture's offer for the kingdom of heaven seemed a comforting proposition. In a place where the capacity for conflict has not completely ceased, making and maintaining peace is as sacred a task for survival as cultivating the land being resettled. Listening to the Sermon on the Mount, I had a hard time determining if the words had the same empowering impact on the parishioners as Samuel's rosary did on his driving. Regardless of the scripture's motivational direction, Acholi land church leaders are not leaving everything to grace with this upcoming election. The government has mobilized extra troops and tear gas to the region, to which the clergymen have voiced their concerns in the media as well as organized rallies calling for nonviolent voting procedures.
While most expect Uganda's election this Friday to pass without mass upheaval like its fellow dictatorships in the Maghreb, faith and prayers are still being employed from all corners of society to navigate through the possible rough road ahead.

Looking for Health in a Health Center

"When I can't treat my patients because the dispensary doesn't have drugs, it's embarrassing. Even when they can't afford it, I tell them to go buy in the shops because I can't tell them do nothing."

During the two months before the winter break, our crew focused on establishing storylines that depicted how the Right to Health is being voiced in northern Uganda. Over the past few weeks, however, we decided to take a step back in the narrative and shift our attention towards conveying the condition of medical services in government health centers. We toured 3 different levels of care units whose coverage ranged from the district to the parish (about 5 villages). During our visits, we didn't stumble across anything surprising on the surface. Graphically, each center conjured the cliche of African medical staff attempting to work wonders in the midst of empty dispensaries and labs without reagents. Had our film team left the microphone off, we could have easily walked away from these clinical excursions simply preserving the prosaic portrait of the paralytic physician in rural Uganda. But the stories that we actually captured on camera were not motionless; rather, the clinical officers were restless, doing whatever they could to spite doing nothing.

Celestino, Gulu district's public health educator and a medical supervisor at a sub-county health center, reported that he sends more than 50% of his patients outside his facility to look for oral antibiotics. He explained that over the past year drug shortages have worsen as a result of the Ministry of Health reverting back to an old strategy of medication and supply distribution, the "push system." In this scheme, drugs are dispersed from the National Medical Store to health centers every other month based on estimates of what types of cases are expected to be seen during a given period. Health centers are not able to request for medications (the "pull system") or use emergency funds to purchase drugs when they run out. Besides drugs commonly being delivered in inadequate numbers, scheduled delivery dates are often skipped. All of this, plus a large lack funding to the health sector mixed with some corruption, creates the situation where Celestino is forced to send patients away from his facility with only a piece of paper in their hands.

In the US, it sounds completely reasonable that a patient go see a doctor, get a prescription, and then run to a pharmacy to buy the medication. Though common practice throughout Uganda as well, the act of asking a patient to purchase drugs at a private dispensary here often carries the weight of demanding an impoverished subsistence farmer to find funds that are likely nowhere to be found. Celestino tells us that he is embarrassed to be unable to fulfill his role in providing the Right to Health, but he does not stay silent about the problems nor neglect to inform his patients where they can find treatment for a price. He continually files reports to his superiors about the inadequate provisions in his health center, and even though it is rare for anything to be done. The clinical officer is also one of the many believers that patients who become aware of their rights will subsequently become empowered to demand for better services. On camera, he cited the multiple local committees that community members could in theory use to voice their complaints, but after the interview, he admitted to being a little uncertain of his suggestions and asked us what we thought patients ought to do to call for change. We replied that we don't know, but that's why we are making this movie, to learn how others are doing it.

Throughout my stay in Uganda, I have been reminded on multiple occasions that I come from a country where health care is not a right and that it's strange for me to have to come all the way to Uganda to find it. Standing on the steps of his health center, Celestino jogged my memory once again. "It is very hard for me to understand, America goes to tell other countries about protecting rights, but you don't even take care of the most fundamental right. People need health care to live, so if you don't provide it for them, then you don't protect the right to life. Your system is very strange to me."

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.