Travel #2: Orientation, orientetation, orientation....

 Breakfast is a feast of beauty. Not because the food is exquisite –I don’t know many people who get giddy with excitement at the thought of toast- neither is that a comment on the visual appearance of my fellow medical elective students (I choose not to make a comment either way when it comes to Ben and James); but it’s in reference to the view. My uphill stroll that takes me to the guest house –and takes the wind out of me, I’m embarrassed to add- ends with a view across the valley to the foothills in the distance. A stunning display of rich shades of green and brown reaching skywards, peppered by trees and small houses. It makes the climb worthwhile in a way that the brown slabs masquerading as toast don’t. The view at nightfall is even more dramatic as the sun begins to hide itself behind the horizon making the areas not covered in cloud light up with the colours of fire. We’ve yet to see the full display due to the pillars of cloud that obscure it, but I suppose I have another 7 weeks of dinners to witness that. The view on the way to chapel at 8:30 – which is attended by all the staff and students of the nursing and midwifery school- is equally arresting, a lack of tree cover giving you a panorama as you descend. The kasesse foothills are an impressive work of the creator and his nifty tectonics.

 Since I dispatched my last blog a few things have happened (which is fortunate otherwise this would be a short or excruciatingly dull read…you may be the judge as to whether this is still the case). I left the AIM guesthouse on the outskirts of Kampala early Saturday morning. Hitching a ride with an American couple missionaries who were just about to leave the mission field and were heading down to mbarara to pick up their possessions to return to the states. They were making the journey (providentially enough) on the same day I needed to go. We made the trip through the back streets of Kampala to avoid the inevitable grid-lock in the city centre and soon managed to drive beyond the city limits, which gets more and more ram-shackled the further you leave. Urban migration with the phantom promise of work and prosperity that the capital represents to those in the country side leads many to make the journey on the last of their finances and discover having arrived at the mirage they cannot leave. It’s estimated by the WHO that the ‘homeless’ in Kampala are set to double in number over the next decade with estimates reaching into the millions. I met some rural workers on my travels pursuing this dream across the country hoping for construction work, I couldn’t bring myself to try and dissuade them but instead wished them luck. Maybe they will be some of the lucky ones. Maybe.

We stopped for lunch in a town called Musaka (but no, they didn’t serve any musaka, or have an awareness of what it was) I had my first taste of Ugandan food on Ugandan soil. Metoki (spelt something like that and made of mashed plantain), potatoes (confusingly called Irishes) sweet potatoes (noticing a carb theme here? I reckon that Hulme hall had its Carbs, carbs with a side of carbs diet inspired by Uganda) chicken stew, baby egg plants (I thought they were peas and eagerly took a mouthful….turns out they have all the sweetness of lemons and the charm of road-kill) and beans in sauce (I’m going to have to get used to beans, they occur so much in my diet now I’m surprised not to find them on my toast in the morning). We casually dined with such light topics as infant baptism and communion and the ‘new perspective’ on Paul. (It makes more sense if you realise that the missionary in question also teaches seminary classes and is returning to the US to be a pastor). We arrived in Mbarara later that afternoon and I said my farewell to my Yankecano friends and met the Joel the regional co-ordinator for the region (he has a wonderfully alliterative –not illiterate, that’s something different- family Joel and Joy with their children, Dara and Dane).

 I continued to ride the orientation express (which ironically when combined with a slice of sleep deprivation proves to be very disorientating), completing my second day of three consecutive days of travel and orientation getting more narrow in it’s scope each time. First Uganda, then the region, then the hospital. I was then taken to the house of Seb, a British short termer working in schools out here. As soon as I arrived I was on the move again ( I say straight away…… there is always time for a cup of tea) to head into town for my last taste of western style food at a local restaurant with the other single missionaries (does this ring of SBS tactics to anyone). It was a good evening, two yanks, two brits and an ozzie enjoying fish (from either lake Victoria or George, I believe) and chips. I was also take to see the latest attraction in the town,  a multistory supermarket that boasted the only escalator I the west of Uganda (that had the young girls riding it so terrified that they had to jump the last foot to avoid being dragged under) and a furniture department with one singularly hideous number a round leather bead that had speakers and a stereo build into its headboard and glittery studs in its mattress. Classy.

 The following day was not preceded by a sound nights sleep due to the neighbours sound system and the local wild dogs on heat taking it in turns to compete for the title of ‘most irritatingly loud noise’ in the ‘late night’ category. With another refreshing 5 hours slumber ‘rejuvenating’ me I was taken to the taxi rank to take my next step on the journey to Kegando. I say taxi rank, but ‘rank’ suggests troops orderly lined up so smacks as a bit inappropriate description. The white vans congregate in an ad hoc clustering underneath signs to their destination. The Mbarara taxi station was tiny in comparison to the one I visited two days previously in Kampala. The Kampala station looked like a watering hole for a species of white four-wheeled beasts who gathered in the clearing as big as two football pitches in amongst the ‘forest’ of Kampala’s buildings.

 I didn’t leave the taxi station straight away, they have to fill up to capacity first. This process –rather confusingly- involved driving out the other side of Mbrara to pick up further punters. Before turning 180 degrees and heading back to the station, switching driver and setting off towards the open roads that led to Kegando.

  The countryside rapidly changed around me. The buildings of Mbarara gave way to country side that was soon littered by banana plantations, these were soon joined by the tea planations that hatched the hill-side with orderly, light green lines. Seated in the passenger seat of the minibus I had a privileged view of the country outside. At approximately the half way mark we entered national park territory, first the dense dusky-green forests of *(&)(*&& (find the name later) reserve, which bordered onto the planes of the Victoria national park. Animal sightings started becoming common place; I saw hawks wheeling overhead, storks (I think that was what they were) strutted awkwardly around, and a solitary bull elephant greeted me into the park.

 I was accompanied by a friendly driver called Solli (or something like that) and a mother with a babe in arms who sat up front with me (was our insurance voided by that?...is insurance something they do out here). We got talking and managed to surprise eachother with our cultural norms. She was 41 and the child she cradled was her 13^th, the driver had 6 of his own and his dad was 1 of 36 children (he reassured me that his granddad had 3 wives…but even so that’s a rapid infant turn-over rate from all of them). They were surprised to find I was only one of three and felt it was even more absurd that the norm in the UK was more like 2 children.

 I was dropped off at a crossroad in Kikorongo before being picked up by Helen Shepherd (33% of team Shepherd, with whom I co-led bible studies at Holy Trinity Platt. The other two being Paul and Esmi….that said I don’t remember Esmi pulling her wait in terms of preparing studies) and the other two Medical elective students.

 After a brief and comfortable journey –comparatively- I was at the termination of my travels. Kegando hospital. The site is split in two by the road we drove up on; downhill lies the hospital equipped with two medical wards of approx. 16 beds each, a Paediatric ward (including neonates), a surgical ward, and obstetrics and gynaecology. The site also features a leprosy ward (which is currently uninhabited) and a vesicovaginal fistula ward (for women being treated for labour trauma complications). There are also a cluster of outpatient clinics. Out front and centre- almost as a statement of intent- is the chapel. On the uphill side of the road lies the accommodation complex, including my current lodgings, the clay house. The other international residents include The Shepherds (a family of three, not woolly mammal farmers), Chris (Paediatric and all round brain-box doctor extraordinaire, I am given to believe), Ben and James the other med students, The Three Norwegian nurses (Ida, Synna and Ingrid) a German Orthopedic surgeon and out Maltese nurse and professional enthusiast Rita. The site also contains the halls for the nursing and midwifery school and the accommodation for the hospital Dr’s and administrators.

 My first afternoon in Kegando took us to the Queens Pavilion to get a stunning 360 degree panoramic of the Victoria national park and the lakes that are found at its edges. We accompanied Helen, Esme and Helen’s parents and sister (the Reids) who are currently paying the Sheps a visit. During our time at the pavilion, a warthog even turned up to pay its respects, but oddly fled when we started singing ‘when I was a young warthog’. Strange. From the looks of the national park we won’t have a choice but come back for a proper tour of the place.

 I’m now at the end of my second day of ward work. The first day I was accompanied by the Essex born James who’s a product of UCL. I did my best to be of some help, whilst trying to rap my mind around a system where malaria and typhoid are in the differential for almost any symptom and a lot of our diagnostic technique is treating the usual suspects and watching for improvement. Throw drugs at the problem and see what sticks (this may be a slight overstatement). The second day was supposed to be like the first, but our good friend Mr Traveller’s Diarrhoea decided to promote me from assistant to junior doctor, so I tackled the ward without James who was alternating between bed and his porcelain throne. I wasn’t without support, there was a more senior Dr on the ward, but he stayed all of 30 mins to do a ward round, when it had taken my 45mins to see my first few patients. After that he practically evaporated, not to be seen for the rest of the day. Fortunately I’ve been blessed with mostly discharges and stable patients, so I wasn’t terrified entirely out of my mind today. The step up in responsibility is a bit of a shock to the system however.

 Taking histories from patients is an interesting ordeal for two reasons, one the patients often don’t speak English so I need a translator (normally one of the first year student nurses) and secondly the usual bank of questions that I use for histories get blank stares from the students. For instant hurt (as used in the common phrase ‘where does it hurt’) has to be replaced with ‘pain’ and often ‘very painful’ has to be substituted by ‘pain-pain’. This is going to be a challenge, and possibly starts to explain why my ward rounds last a little longer than my Ugandan colleague’s.

 That roughly brings us up to date. Back to being called Dr….that still hasn’t got normal yet.

Prayer points, (for those that pray):

·         That God would grant me the knowledge and understanding to carry out my role on the wards (I’ve been reading Daniel 1+2 where it’s made clear that these things are from the Lord)

·         For health and the rapid recovery of James, the Norwegians have also all had some issues along similar lines.

·         For Paul’s return Journey to Kegando

·         For relationships with the nurses and doctors, and opportunities for discipleship and growth

·         For patience with the limitations in communication and the occasional obstructive nature of some of the staff. The ability to object graciously. To be firm but loving.

·         That I’d be able to pick up the basics of the language. (It’s great to see people’s faces light up when you great them in their mother tongue)

Travel #1: The Gamble/The Providence

So I took a gamble. 24^th January the day of my flights to Uganda. The dates of my Medical School exemption finals results: also the 24^th January.  What time do you ask? Results were due to be published at 12 midday GMT and my flight was billeted to take to the sky at 11.45am. Chances of the medical school publishing results early enough to get them before my Journey? The bookies had them down as being as good as those for twilight BDP2 winning ‘best picture’ at the Oscars and Nick Griffin being voted GQs man of the year.  (For those not getting the pop-culture references not an ice cubes chance in hell). The looming  knowledge that my results were sitting comfortably somewhere in a cyber space spreadsheet explains the knot that my stomach tied itself into on repeat occasions during in the flight when I let my mind wander to the topic. I had taken a gamble of sorts; I would go to Uganda resting on the 94% pass rate (with the dismissive ‘I am not part of the 6%...am I?....’ ringing around in my head) hoping that a failure wouldn’t begin a sequence of events that culminated in cutting my planned 2 months in Africa short. The back-up plan….there was no back-up plan (ask Dan Bauhahn or read ‘1 Englishman 3 states ‘ for a good overview of my staggering planning skills).

 The sword of Damocles* hung over my head as I travelled the underground to Heathrow (figuratively, this wasn’t some new transport for London initiative) where I had to sum up all the courage I could to overcome waves of pitiless commuters who packed out the Piccadilly line trains to bursting. Finally I learned their warrior ways and wrestled a place for myself and my baggage. The BA check in desk clerk proved yet another trial to overcome. A formidable South African woman who scolded me like a child caught pinching their sister (not a reference to personal history in any way, probably) for the crime of asking her to print my ticket rather than using a self check in machine. ‘I was holding up the rest of the passengers’ and was, ‘not to do it again’ I looked back apologetically at the two people who had just arrived behind me, who constituted what could –with a degree of imagination- be called a queue. They looked back, in response to my morose gaze their eye’s conveyed in the message ‘why are you looking at me? Shouldn’t you be checking in?’.

 I lingered around the airport for two hours – why do they insist on you being so early?- and discovered through various texts that there was no hint of exam results before boarding the 11:45 to Entebbe airport.

 The flight was a pleasant 9hr trip over Europe, the Mediterranean and down the West of Africa. I was accompanied by an elderly couple who made very little attempt at establishing any form of verbal communication and instead sat sullen alongside me. The wife was to my Lleft and spent most of the time gazing po-faced at all of the in-flight comedy selections. Jutting out a disapproving lower lip and not cracking a smile once; however much Sheldon cooper et al, the team of ‘the office’ and ‘two broke girls’ tried to draw at least a twitch of her facial muscles from her (although I must agree with her on the last one of the three).

 As my chatty companion worked her way through the list I took the chance to catch up on some film that I failed to see in 2012. This also served the purpose of making the flight that bit more cost effective by watching as many films as possible you offset the plane ticket price.  Other tips and tricks include: Watch the films with subtitles in double time = double the films; claim your neighbors un-eaten bread rolls; always say ‘yes’ when offered a drink (worked example: get a coffee, even if you already have a cup of tea) and keep the cups to pawn them at a later date. (I may have done all or none of these thing)

 That evening I watched the amnesiac double bill total recall (ironically a completely forgettable film) and the Bourne Legacy (technically contains no real amnesia, but the series is well known for it. Not a bad film).

 I stepped out onto the tarmac of the airstrip to take my first breath of warm earthy scented Ugandan air at about midnight. I was picked up by a ‘Special’ (a taxi, here ‘taxis’ are minibuses with seats for about 12 people, but apparently space for more once your outside of the sight of the police officials) driven from the Entebbe airport to Kampalla. Entebbe is a spit of land that reaches into Lake Victoria (all the lakes here about seem to be named after British royals, it must be particularly flattering to have a large body of water named after you by some explorer muttering ‘you know what this lake looks like? our queen, and so it will be named’). The hour was already late by then and the lack of street lighting meant that the roads were near pitch-black but for the glare (and we’re talking un-dipped-fog-light glare) of other traffic. Rules are limited on these roads and seem to extend to : stay on the road and don’t actually hit any of the cars coming in the opposite direction that you pull out in front of when you are overtaking. I remember having the reassuring thoughts ‘at least I’m at peace with God through Christ,’ which is always a good review of road safety.

 The staff/guesthouse keepers/masters of the house (he didn’t get the les mis reference when I used it however…maybe because he’s American) are wonderful here and the husband of the family was up to let me in at 1am. At which I half listened to his run down of the working of Breakfast before seizing a computer to find out my finals results. With baited breath I scanned the list and found my numbers (way to make us feel like inmates med school) and my scores.

 …..A Pass….waves of relief washed over me. I clicked away from the page. The tide of relief went out and left the wet sands of self doubt (tell me if I’m taking this analogy too far), I had to get the table back up to make sure. I still didn’t fully believe it until I checked again the next day.

Friday has been a day of greeting the other resident missionary families, orientation with the AIM short-term mission team who I came out here with and finally a tour around Kampala.

 Kampala is a sprawling city, home to about 1.7 million souls, and a wonderful confusion of sights and sounds, not to mention smells. My guide was Rhona a Ugandan employee of AIM who gave me a lesson in getting around the capital. I think I muttered my grattitude for salvation by faith alone a few more times that day as with a grin plastered across my face we navigated the roads of the capital on the back of ‘Buda-budas’ (nothing to do with the plump eastern mystic, I’m reliably informed) which are motorbike taxis (sorry mum). Threading the traffic on the bikes, was eye-of the needle stuff and crossing roads on foot was like playing ‘Frogger’….except with slightly more at stake. The whole thing was made that bit more exhilarating by the large warm droplets of summer rain that began to pound us, causing us to flee the open air.

 We had a dinner in an inner-city mall foodcourt. The word court in the name is quite fitting. As you sat down waiters from all the fast-food joints descend like culinary suitors vying for your hand (and you can guarantee they are only in the relationship for the money). Six men surrounded our table quickly covering our table in a makeshift tablecloth of laminated menus and demanded that we choose them. As you should in such situations, I panicked and chose the dish that I recognized. So my first meal in Uganda was the well known traditional dish of…er…beef fajitas. They were nice. Rhona told me her testimony as we ate and rain continued to douse  the golf course our table looked out over. It is an amazing tale, that I don’t feel that I have the right to publish here. Either way the LORD has acted tremendously in her life and her church are a great example of the body caring and discipling.  

 We returned after a further tour of the city and I’ve hung out with missionaries and their families up here in the guesthouse for the rest of the day. They are at once amazing and ordinary. Ordinary in the sense that they are no super Christians with mad-bible skills that none of us could aspire to be (and I don’t mean any of that as a criticism) but amazing in that they have responded ‘yes’ to the call to go to the hard places and amazing because of the work of a Majestic God in their lives and through their actions.

 They have almost all retreated to bed – sun has been down for a while- and I should do likewise. I’ve got a journey to Mbrara and then on to Kegando. Fortunately I’ve lucked (read: providenced) out and I’m getting taken by a missionary family for the first stage of the journey which should make it quicker, safer and more comfortable. Bring on the next step.

Prayer Points: For those that pray.

·         For the Mother in one of the missionary families who is currently suffering through malaria. For healing and the quick working of the anti-malarials, and strength for her husband.

·         For rest for a Missionary family who are relaxing in Kenya for a 3 week holiday. They are probably some of the only missionaries in Southern Sudan, and this can sometimes be a heavy burden.

·         Continued travel and health mercies.

·         Praise for my results ( if you view me becoming a Dr as a good thing)

·         Prayer that God will use this time to deepen my dependence on him and grow me in many ways.

·         Prayer for the team of two other electivites already in Kegando

·         Paul shepherd as he goes for interviews in the UK

*This is my first attempt at using this mythic imagery so those better versed in classic literature by forgiving if I’ve completely screwed up an attempt to look cultured and flowery.