I arrived at Entebbe Airport on Saturday night June 7, 2014 after about 26 hours of flights and stopovers. Was picked up by David and Joseph and immediately taken to a party at the home of Dr. Sarah Nkonge to celebrate the work we had been doing together, the Rotary of Makindye and me. Thus began my journey in Africa. The following is from a few days later when we traveled to the Lwengo District.
I didn’t sleep much last night and got through some of the toss and turn hours by reviewing my suitcase contents…why did I pack Catwalk Sleek hair spray? Maybe for my visit to the King of Tororo…but more about that another time. We left Kampala for a 3 hour drive out to Lwengo; of course it takes well over an hour just to get out of Kampala, the city of no public transportation or beltways so all roads lead to massive “jams.” Our driver Joseph is amazing (the best, except maybe for Mahindra who drove me from Kathmandu to Hetauda for 8 hours over hairpin turns up very steep, narrow mountain roads with no guard rails.) Sarah, David and a reporter from a local TV station and I all loaded in the four wheel drive Ford. Sometimes beautiful landscape of rolling green mountains and then the villages of rusted tin sheeting and concrete blocks, the ubiquitous charcoal smell and piles of mostly plastic garbage, rotting foods and road kill. A strange occasional battered phone booth, odd because almost everyone seems to have a flip phone and there are ads for “mobile money” everywhere. Always the sad lost discarded flip flops. Traffic of cars, mini buses, bicycles, motorcycles piled with people, bananas, mountains of plastic containers; on one, a man and a women; on another, a man, a woman, a baby and a goat; on one several boxes of condoms that spilled out in a trail along the side of the road precipitating, among those in our car, several hilarious adaptations of and responses to, “why did the chicken cross the road?” which during all drives was prominent as many chickens actually crossed the road right in front of our wheels. Women walking with massive bundles of sticks, huge plastic jugs of water or gasoline, and bowls of cassavas on their heads, and babies scarfed onto their backs, the little baby feet peeking out on both sides of his or her mother’s breasts. Children playing in the gravel alongside the roadway and a few elderly people crawling. All this takes place at dizzying speeds in a dangerous dance of near misses, and every moment that someone isn’t killed is a miracle, proving that Uganda is actually overflowing with miracles.
We arrived at a Girls School, a collection of large low buildings and toward the back of the “campus” was a large barn with a dirt floor and about 50 women and their children waiting for our presentation and distribution of the birthing kits. The women are beautiful and the children adorable. They were all obviously dressed in their best colorful clothes, some very worn but still bright and bespangled with sequins, decorated with embroidery. The clinic director introduced me in Luganda, one of the several languages in Uganda that vary from district to district. She said I was bringing the kits from Australia, short cut for I am from the United States and I got the kits donated from the Birthing Kit Foundation in Australia. I told them I was so pleased and honored to be there, that I had been all around the world but they were the most beautiful women and then I went through the contents of the kits. The little piece of soap, a pair of latex gloves, black plastic sheet for the birth area, 4 cord ties, and the one clean wrapped razor blade “Please don’t use this for anything but cutting the umbilical cord,” I pleaded, knowing that some research had indicated that the blades were sometimes used prior to the birth for any number of household tasks like cleaning fish.
I marveled that the babies and children actually looked quite well and healthy and were very playful and engaging. When I commented to a few of the mothers later they told me that it is the healthiest babies that survive, the ones that are “right sized;” the others that are too small die at birth or shortly thereafter, the ones that are too big die with their mothers since they often can’t be delivered at a hospital that can perform C sections. Other children that aren’t really strong die in the first year of malnutrition, malaria, dehydration or accidents…so it is the healthiest, most resilient that are with them. Tragic Darwinism.
The women so were appreciative of the kits, but said they needed more than one pair of gloves, because they sometimes tear, and more pads for the bleeding after birth. I said I would try. Someone delivered bottles of soda. Fantas all around.
Then we went over to the Girls’ School to distribute sanitary pads and soap during the student lunch break, which I was told would be chips and soda. There were about 50 girls in red uniforms. This was outside on a hill and the breezy atmosphere was an opportunity to have a good time with them. The girls all spoke English, so I could speak with them without a translator. I talked to them about staying in school, staying strong and being sisters. Having babies when they were really ready and in a good relationship. I found myself saying the same things I had said to kids in the Bronx: Your body is your own. If someone hurts or touches you, tell an adult you trust. I had an almost imperceptible heart pang thinking of my work at the Child Advocacy Center in the past. They sang a song for me and we all danced and I taught them to kick like the Rockettes. Then we gave out the sanitary pads and soap which was like giving out party favors on someone’s birthday.
The women had talked to me about how bad a local clinic was and that was why they would rather have their babies at home, so before we drove back to Kampala I asked to visit the clinic. We drove to the clinic and on first sight I could see why. It was literally a hole in the wall shack attached to other shacks. The crumbling concrete steps alone spoke volumes about how difficult it would be to give birth there. The clinic director showed me around and said she had been trying to get more support from the Ugandan government so she could improve the facility. She also has to charge 15,000 Ugandan Shillings for a delivery, the equivalent of about $6 US, and some women just can’t afford to pay. There was a small room of deteriorating concrete for the exams, the labor room with a damaged table and stirrups, and a room with 4 little beds side by side for recovery. The women can stay for 6 hours after the birth to recover before they have to leave. I asked if (since there was a long drive back to Kampala) I could use the bathroom and was shown a rocky path to a shack beyond a stubbly field. Let’s just say it was much more rocky than path. The toilet inside the shack was a squat hole. Now I have used many squat toilets and they can be quite nice, tiled, clean and you get a good stretch workout in your quads while peeing. This one was covered with excrement and urine and dirt and full of insects. Mosquitoes and flies and any number of unidentified winged things buzzed around my head. A caterpillar that could have morphed into an exotic butterfly or something that would rip my leg off humped past my foot as I stepped onto the two bricks on either side of the hole. I did a quick flashback of all the meds I had taken: Hep A, Hep B, Polio booster, Yellow Fever, Typhoid capsules with live bacteria, Cipro in my bag and antibacterial wipes at the ready. The women who gave birth there and the staff who delivered the babies did not quite have these advantages.
The four hour ride back to Kampala was quiet. I perused a local newspaper: Article “Uganda Fails to Achieve the Millennium Goals and Reduce Maternal Mortality.” 17 women and 106 babies die every day during childbirth. That is a maternal mortality rate of 370 per 100,000. Most “economically developed” countries have a rate of between 5 and 10 per 100,000. The United States has a rate of 26 per 100,000 which has been increasing.
As the Ugandan landscape sped by my window, I needed a little “normal” and slipped in my earbuds, turned on my Ipod and slid the power bar. It was on Shuffle, which i call Random. Paul Simon’s most tender, sad, wrenching lyrics: In a phone booth in some local bar and grill, rehearsing what I’ll say my coin returns. How the heart approaches what it yearns.
privatelifeinpublichealth 
