Hippos go "munch!" in the night...

Sorry for the long gap in posts!

After leaving an orthopaedic packed three days in Gulu, I drove with Dr. Kisige to Masindi where I was going to do my first tourist activity since arriving in Uganda!

In Masindi, a small town which serves as the fork between the Northeastern and Northwestern parts of the country, was fairly sleepy on a Saturday at noon. It was therefore easy to spot which van was the one I would be joining, the only one which unloaded a half dozen Mazungos for lunch. After finishing my meal with Dr. Kisige, I went to meet my group. I had managed to join a tour of Murchison Falls National Park which was being run out of a Kampala Hostel called Red Chilli Hideaway. My new group of seven consisted of Jeff and Nicki, an American-British couple who met in Croatia while traveling four years ago. They have spent the last three years working for the Abu Dabhi  Media Company in the UAE, and have just quit their jobs but will trek across East Africa before going home for Christmas. Hadar and Yoav are honeymooning in Uganda and Tanzania from Israel. Michael and Seb are two loners like myself, who nonetheless became good friends by the end of the trip, bonding in Russian.

The first day, Saturday, we "hiked" leisurely to the top of Murchison Falls. The Nile coming from Lake Victoria eventually narrows and splits into two waterfalls, Murchison and the local word for "freedom". Although not quite as impressive as Victoria Falls, you still get sufficiently doused in river water when standing at the closest lookouts to the falls. The cool shower is particularly welcome, as this part of the country hosts less and rain and rather constant 30 degree temperatures. A photograph of me at this point will come later courtesy of Jeff who had a waterproof camera. These photos do not do the falls justice, but imagine how the Nile here suddenly converges from 50m to 6m and drops down a rock face into a rift valley. It's quite intimidating from up close!

Proof I am actually in Uganda!

The "Freedom" Falls on the left, and Murchison on the right.

The Nile pouring into its 6m crevasse, from atop.

By supper time and before sunset, were back at the Red Chilli Rest Camp in Paraa on the south bank of the Nile. Cold showers were all we had, but were agreeably refreshing. I think had been spoiled up to now, but I was shocked at the price of food here. Had I known, I would have brought groceries! However, we had been warned that any food items MUST be removed from the tents and brought to the bar. The sneaky warthogs and baboons were well known for breaking into the safari tents in hunt of food. One warthog even walked its way into Nicki's tent while she was sorting fresh laundry!!

I didn't get one of these guys in the camp's garbage, but the ones in the savanna are nicer anyhow.

Although they mentioned hippos also come out to graze at night, they did not mention how close. My first night was disrupted by the heat, then by the heavy rains at 4 am, and then by loud snorting, huffing and munching sounds. Something was chomping on the grass alongside my tent at 445am. I was hoping it was a warthog, but as I lay perfectly still moving only my eyes, I saw a large shadow forming on the right side of my tent. The shadow covered the entire 5ft by 8 ft side of my tent as it took a few more steps forward. I had come to realise a hippo had decided on my plot of grass for its early morning meal. Afraid of disturbing it, I think I held my breath until it eventually walked away. I even turned my phone off so the alarm had no chance of going off and spooking it. It may have been only 10 minutes of grazing, but it felt like an hour.

A sly hippo - it had its eyes on me the whole time!

The next day on our game drive I learned that the hippos are nocturnal and come out to graze at night. They will walk up to 5km radii to find scrumptious grass. I guess my tent was within 5 km of the river bank. The second night, poor Nicki and Jeff had the same experience as me. Our tents were only 15m apart, but it seems I slept through round 2. Thankfully!

Sunday was a long day of trying to find the "Big 5" - Elephants, buffaloes, lions, leopards and rhinos.  Our three hour game drive was rather fruitless. The rains from the night before had slightly cooled the environment and so many of the animals stayed deep in the forest and the high grasslands. The rains also mangled the roads, making the entire drive like a game of vertical bumper cars. On top of that, we didn't see a single cat - just lion tracks in the mud! Luckily, I have seen them in a previous trip to Namibia and wasn't too heartbroken.  The rhinos were poached to extinction in the 60s, and I would be seeing them in a Sanctuary the next day as they prepare to reintroduce them in the wild. Buffaloes however were abundant. As were antelope, large fishing birds, and giraffes. We spent 45minutes tracking one elephant.When we eventually found him, we headed back for lunch.

Our 4x4 mini-bus which driver Moses managed to keep from getting bogged in the mud. The Germans has a similar vehicle, but got out to push at least twice.

This young lady posed like a model. Her right ear is tagged as she was injured and required veterinary care. She seemed to be walking fine today.

A large herd of buffalo in the background

A lone bachelor with his wee bird companion to eat the ticks of his back!

The afternoon consisted of a boat launch down the river to the base of the falls. The guide we had was great and the animals had finally come out to play! We saw at least 6 elephants, one of whom took a lengthy bath right next to us. Notice the water coming from his trunk and then his wet back on the next photo. This male was considered to be in his 30s or 40s. Most elephants can live to 80-100 years. The females remain with their young, while the males roam independently. We saw plenty more buffaloes, tons of hippos, some crocs who refused to be photographed, and more birds including brightly colored kingfishers, red-throated bee eaters, cranes and herons. The view of the falls from here was a quite at distance as the current still roars hundreds of meters away. On the way back we rode on top of the boat's roof for elevated, unobstructed views.

Bath time!

After the bath, our gentleman walks away flapping his ears - another way elephants cool themselves off.

Murchison at a distance

Nicki and I on top of the boat

The next morning we left Red Chilli to return to Kampala by way of the Ziwa Rhino Sanctuary.  As mentioned, since the rhinos were extinct donor funding has allowed for the 24/7 ranger-patrolled secure area to reintroduce rhinos to Uganda. Currently there are nine rhinos. There are two black rhino males from Kenya. There are 6 white rhinos, the more docile only grass eating type, made up of 1 male and three females and three babies all between 1 year and 14 months old. Two adults are from Kenya and two were donated from a zoo in Orlando, FL.  Each adult rhino has two rangers assigned to it 24/7 as well. The babies stay with the mom for years. They even feed on mom's milk until 2 or 3 years old. Once weaned, the females can carry again for another 16 month pregnancy. Once there are approximately 30 rhinos, they will attempt reintroducing them to Murchison Park. They are expecting 4 more rhinos to come from South Africa in the next few months.

So at this sanctuary, one drives out as close as possible to where the rhinos are, and then walk the rest of the way. Luckily rhinos are nocturnal and sleep most of the day. We came upon Bella and her son Augusto within 30minutes, the others were deep in the reserve. The mother and son were dozing lazily under shrubs. As they were calm, we were able to get as close as 10meters to them. It was surreal.

Bella dozing...

On that note, I too will go off for my nap! This week is business as the College of Surgeons of Eastern, Central and Southern Africa meets in Kampala. I will be hanging around to try and get a few more interviews. I am also trying to meet with a customs representative and some ministry of health workers this week too. I am staying with Dr. Sekimpi once again. His wife will have her baby possibly before I leave, which would be exciting! Friday I move back into a hotel as Nathan (finally!) arrives, concluding most of the business part of my trip and starting a little R&R as I muddle over the data I collected this past month.

Wishing you all the best and looking forward to seeing you in a few weeks!
Maryse
xox

Dr. Kisige's Gulu

My past four nights and 3 days in Gulu have been filled with complex, long-neglected orthopaedic cases, 30-degree operating rooms, election campaign rallies sung to the sound of World Cup-reminiscent vuvuzelas, and thunderstorms clanging for an hour or two a day which invariably cut the power to nearly the entire town for hours at a time.

That said, this might have been some of my favourite days so far.

Dr. Kisige is the head orthopaedic surgeon here. He purposefully started his practice here as he wanted to create a new department on his own terms. His experience, like mine, at Mulago taught him a lot about the do’s and don’ts of running an orthopaedic service. Gulu Regional Referral Hospital, where he works, is a 350 bed hospital with a growing orthopaedic department, and affiliation to the Gulu University medical school.

Dr. Kisige and his staff welcomed me warmly to their town and hospital. Wednesday was spent doing ward rounds and some interviews. Ward rounds was of the entire surgical ward. We visited each patient one by one as a team of medical students, interns, orthopaedic officers, nurses, surgeons and visiting doctor. It was sad to see how many patients delay coming to the hospital who are now faced with permanent complications. I don’t know how many cases of osteomyelitis of gangrene we saw that had been festering for years. It’s the opposite of home where it seems a clean cut barely needed a stitch necessitates an ER visit. There were also many burns, from babes to the elderly.

Dr. Kisige and his medical students on rounds with a patient in arm traction

A neglected open tibia fractures

An 18 months old with 2nd degree burns

Thursday I was in the operating room with Dr. Kisige. As per usual, the cases didn’t start until 10am. Our first patient was a 35 year old school teacher who was hit by a car while on a boda-boda last April. He was treated near home for his open segmental femur fracture in traction and then a hip-spica cast for 5 months. When healing hadn’t occurred they re-xrayed him and finally noticed his hip dislocation. By the time he reached Gulu, where the nearest orthopaedic surgeon was, it had been 8 months that he had been living with a broken, non-united femur and dislocated hip. We managed to fix the femur, but we couldn’t get the hip in. He will have to return for more surgery once the femur heals. Luckily being a teacher is a government job and it seems he is being paid on sick leave, but who knows how long that will last. Maybe because it is election time, he’ll get compensated until at least the elections in January.

Right segmental proximal femur fracture with right hip dislocation, the school teacher

Friday was clinic. It’s amazing the severity of the cases we saw. Lots of bone infections, even more neglected fractures and dislocations, I have certainly learned a lot the past few days. The saddest thing about yesterday was the story of this man and his three sons. In July, the boys had been riding on a boda-boda when they were hit by a car. The man who hit them was rich. He paid for them to be transferred to a hospital, as they were all severely injured. The family didn’t know they had been brought to a private hospital, Gulu Independent Hospital, where Dr. Kisige works on a consultation basis. After multiple surgeries and recovery, the bill was 2 million Ugandan Shillings, about 8700$. The father is unable to pay this of course, and the driver has denied responsibility as well. He has already apparently bribed the police to change the police report on the accident to absolve him of fault. Even if Dr. Kisige were to give his services for free, they are still left with a 14million dollar bill. Until they pay, these boys are bound to the hospital. They have spent a healthy 4 months there now. We are hoping they can appeal to the district commissioner for help, as it’s election time, maybe they will get some sympathy. But corruption in Uganda is high. There is little hope. It breaks my heart. Part of me wants to raise the money, but the other part says, if I do this now, when will the government ever realise how much crap goes on in their country.

The private hospital's OR. Despite newer construction and some amenities, they are still poorly stocked of instruments unless a patient buys and they order them in.

If only our hospitals promised to see us in 30 minutes!

There was a joke on the news last night, which I saw while at Dr. Kisige's for dinner (his wife, beautiful 6 year old daughter, Nambi Anne, and niece welcomed me with great warmth and yummy food!). A politician was saying how the Muzungo developed a machine for detecting corruption during elections. They used it in Nigeria and it caught 7000 people. They used it in Kenya and it caught 3500 people. They used it in Uganda, but someone stole the machine.

Somehow, despite the fictional nature of the story, this rings so true.

On that note, I leave Gulu today for my little trip with a few other backpackers to Murchison Falls. I will write you again soon with lots of wildlife and scenery pictures.

Happy American Thanksgiving.

Maryse

Bus ride in jpg format

After a long day of interviews and rounds yesterday, I couldn't have been less excited to hop back on a Gaagaa bus. The first part of today's trip to Gulu went by somewhat faster, as the on the 4-hour ride Karuma we stopped only three times before arriving. The problem was in Karuma. I waited two hours before my connecting bus to Gulu.

"Connecting bus" is an understatement. Basically, the company hires Toyota station wagons, all rear shocks conveniently absent, to make the one hour trip to Gulu on regular intervals throughout the day. Once a car is filled, they take off. "Filled" is also an understatement. Four people must be squeezed into both back seats, with one in the front, before leaving. That is 10 people per car. Luckily, the driver put me and my two backpacks in the front seat! I wish I could have taken a photo, but I felt bad enough that I had the best seat in the car.

While waiting in both Arua and Karuma, I snapped a few shots to give you an idea of my adventures.

Arua Gaagaa Station. The little white bench is where they searched our bags prior to boarding. They didn't even do this in Kampala.

Typical road side appearance. Multiple one-story buildings housing small convenience type stores, restaurants, or airtime shops. The little stand in from of the billboard is also the typical appearance of an airtime distributor. Although this one is yellow for the MTN company, they usually sell a few companies airtime cards and some snacks.

The race to feed the hungry mouths of travelers. In the background, meat-on-a-stick brushing against the bus. In the foreground, ladies roasting corn, meat and cassava.

Karuma apparently has the best roadside chicken. I couldn't bring myself to try, as the only chicken I saw and recognized were live ones with their legs bound, lying on the ground and panting from dehydration. Some people even brought the live chickens to the side of the bus to sell. In fact, one was in the car with us on the way to Gulu!

So far Gulu seems like a friendly enough town. Unfortunately the food in the hotel restaurant is not the best I have had in Uganda. I would love to explore the other restaurants, but nighttime walking in the Christmas season is a no-no for even the locals. Muggers and thieves are out in masses trying to scrounge funds for Christmas presents. Easter time is apparently the same. I guess it is stew, rice and cabbage salad for me for the next four days!

Have a yummy meal for me tonight everyone, I will be dreaming of it I am sure!
I am sure more hospital horror stories will be coming by Thursday night. Till then!
xoxo
Maryse

To Arua... Home of the sick and helpless

Yesterday I left Mulago Guest House for the last time. After a quick drive back from Masaka, I returned to Mulago for two nights before heading off up north. It was nice to see the UBC group again before they leave next weekend. We went out for dinner that night. We went to a Mexican restaurant run by an Australian in Uganda. At least my tacos were reasonable and the portions were American-style, such that I had enough leftovers for the next day's lunch. And thankfully, this time, we drove and so my purse was not stolen! Not that I took one with me after last time!

After a day of errands and booking my tour of Murchison Falls for the following weekend, I packed up to leave Sunday morning by bus to Arua. This bus ride rivaled only the one Freya and I took after being stranded in Taba (at the border of Israel) trying to return to Cairo.

Jackson had been super helpful and booked me a ticket for the bus he always takes back home to Arua, the Gaagaa bus. He suggested I take executive class for a slightly better experience. I arrived nice and early to the station Sunday morning, walking through a small crowd of locals who asked to touch my hair and reached out to touch my skin. 45 minutes later they called for the boarding of my bus. Of course, it could not go as smooth as that. It turned out Jackson booked me the 10pm bus, not the 10AM bus. Since the only executive bus of the day was 10pm, somehow Jackson and the clerk misunderstood each other. Not a huge deal as I was able to change it and get one of the last 5 seats on the bus. No refund of course for the price difference.

Waiting to put my bag under the bus was another story. Bag storage is not free. You must wait in a line, no, make that a hoard of  people, and beg for the attention of the ticket guy who looks at your bag(s) and decides how much you should pay to get your bag under the bus. After politely waiting with a few others for 20 minutes, they started the ignition and told people to hop on. In desperation, I approached one of the guys stowing the bags and gave him some money to put mine on in a hurry. He agreed. The only concern I had was that I would not get a receipt, but seeing as the driver saw me and my ticket as my bag went on, and that I was the only Muzungo for miles, my bag and I wouldn't be hard to forget!

The bus: Yes, a coach, but perhaps one from the '70s. The floor of the bus was just a metal sheet really, which met if I didn't move my feet around every once in a while, they would continue to vibrate even once I lifted them. The shocks at the back of the bus were gone. Had I still been in high school, sitting at the back of the bus so the bumps could throw me as high as possible would have been fun. But... seeing as I rode the Hemmingford bus for 5 years to and from school, this no longer appealed to me. Especially since the seats were not individual, but a bench, and my two bench mates were happily hogging most of the space.

The ride: The ride to Arua took 7 hours. I think it would have taken 5 and half, but it seems we had to stop in every little town on the way. We were either picking someone up, dropping them off, or stopping so the street food vendors could swarm us. Anytime we slowed down on the road side vendors flaunted their products at us through the bus windows. Passing by the windows were soft drinks in baskets on broomsticks, roadside-roasted pork on a stick which grazed the sides of the bus as they were passed up, water cans, bananas, cassava, or chappatis. Now I understand how these vendors make a living! People bought food nearly every time we stopped, and that was just our bus!

The way north to Arua comes with significant landscape changes. It is flat, with the occasional mountain here and there. The grass becomes yellow, though the trees are still wonderfully green. The Nile weaves under the highway here and there, gushing beautifully with white water over large boulders. No pictures unfortunately, as I had chosen an aisle seat to be the furthest away from the side of the bus in case of collision or rolling over. Paranoid indeed.

Sticky, sweaty and sore 7 hours later, we entered Arua. I saw the hospital on our way in to town. On arriving, I call Dr. Akusa, who was greeting me, to notify him I had arrived. He asked if I could meet him at the hospital. Although it couldn't have been much more than 1 or 2 km, I wasn't sure I wanted to walk. A boda-boda driver approached me for a ride. Only 1000 shillings he said (40cents). After asking him why he didn't have a helmet, and his responding I that I would tire before making it there in the 30 degree heat at 5pm, I agreed to a ride. I, however, made him promise to go slow and be as careful as possible. He complied. I think we drove at 20 or 30km/hour the whole way (the odometer was broken). "This is a nice speed I think, right Madam?" Yes, it sure was - we weren't even overtaking the cyclists! I got there safe and sound, and was certainly thankful I hadn't walked!

On meeting Dr. Akusa said he had been unable to book me a room for the next two nights. He said we could walk to a few and check them out. Dreading walking with my bags, the mayor of Arua saved us in the nick of time! As we were deep in discussion as to the rate I would be willing to pay for lodging, the mayor, Charles Asiki, walked by and said hi to Dr. Akusa. He promptly welcomed me and added his input to the hotel choices. He then offered to take me around with his driver so I could visit them all and choose! And so I hopped into a Toyota 4x4 with Dr. Akusa and the mayor of Arua to find a place to sleep. We eventually found one that wasn't fully booked or too expensive; Heritage Park was just right. I am still in slight shock that the mayor personally drove me around town, but I am sure thankful!

The orthopaedic ward - though this is only really a clinic as the inpatients go to the surgical ward

Chales Asiki (... on the right, in case in wasn't obvious)

Today was spent busily in Arua Regional Referral Hospital. After some issues getting permission to be there, someone finally granted me a seal approval and I could move around. We started with ward rounds. There is no orthopaedic surgeon here, so Dr. Akuda, a general surgeon, and his colleagues deal with all the surgical specialties. The ward was about 40% ortho nonetheless. But I saw things today I have never seen before and likely won't ever again.

A man with an untreated clubfoot that now looked more like a rugby ball on the end of his leg. Another man with a malignant fungating melanoma that was as large as a grapefruit coming out from between his second and third toes. It has metastasized as well. Then there was the slew of babies being treated for femur fractures in traction, stuck to bed frames. At home we treat these in casts and send them home. Here, they're bedridden for three weeks. The plague is also quite rampant in a nearby town, and many women are getting bad intestinal disease from it. The women are affected because the plague bacteria lives in little fleas in the woods, and it is the women who go in the bush to get food and firewood. There are not the facilities here to treat their disease with surgery, nor is there really the capacity to treat anything surgically including the 20 or patients admitted with fractures. It was quite disheartening.

Gallows traction for kids

On a lighter note, I conducted nearly ten interviews today.

On an even brighter note, I will leave you with the pictures of this monkey at Mulago who was showing off his belly, and the up close stork photo to show how ugly they really are. ugh....

Off to Gulu, by bus again, tomorrow! Till then!
Maryse
xoxox

Mmmm... Grasshopper Season!

I lied! You're getting another blog sooner than I predicted!

I am in Masaka this evening. I am staying in the nicest place yet, and somehow still paying less than I did for the Mulago Guest House! For about 23$ a night I have my own room, mozzie net, AC, satellite TV, carpeted, not a single bug (other than the grasshopper that somehow made it into my bag from the lake), a shower with curtain (1st shower curtain I have seen since I arrived!), and a full length mirror! There are even 52" flat screens in the restaurant! I kind of want to stay!

Hotel Brovad, Masaka

The give you an idea of the height of these Marabou storks...

Ankole cattle on the way to the hospital from the hotel.

So my stay at the Lake was not as relaxing as expected. It remained overcast the whole time and only for a few hours it was warm enough to be in short sleeves. The vervet monkeys woke me up quite early. It's apparently fun to run along tin roofs while people sleep beneath them! Also, my driver ended up staying there since it was out of the way. I felt somewhat pressed today to leave so he wouldn't be just waiting on me. I can't really get used to that idea. So I left midday. Oh well! At least on the ride there I got to see a dozen zebras, just hanging out with the Ankole cows, and a family of mongoose ( I even saw a few more today on my walk). And the impending storm this morning made for good pictures!

This morning's view

Last evening's view

What should have my lakeside workstation for today!

As I was leaving the lake today, one of the workers approached me with some local food. November, especially late November, is grasshopper season! One can buy them cooked or live on the side of the road easily. However, you can also fetch the kids to go catch some, or as I am told, put a bowl underneath a light outside. Once the grasshoppers crowd the light, throw a blanket over them. They all fall into the bowl. To cook them, first remove all legs and wings. Throw them into a piping hot pan, no oil needed, and cook for about thirty minutes until there are a nice yellow brown. I sampled one. It wasn't bad. Kind of like a french fry or a fried sardine. After she insisted I take a handful with me, I politely ate a second one and at that point my brain said "no more". Once in the car, I had a bite of chocolate to wash it down. Again, a mental need, as it really did taste just fine. As Nathan will tell you, eating anything whole with eyes still on it is difficult for me, but hey! it's a local delicacy so I ate it!

This is the grasshopper from my bag... not for eating as I killed it, but they are about 2-3 inches long and fly quite far!

On arriving in Masaka, I explored the area, walking to the hospital and around it. It was of typical structure, many one story buildings, but much nicer than the others it seems. Manicured laws, a gorgeous private ward that looks like a hotel, and lots of newly constructed buildings. I will see the inside of them tomorrow when I meet Dr. Semagala, the ortho surgeon here.

Before I head off for bed, one more funny and interesting characteristic about the Ugandans. Ugandans are the best "loaders" I have ever seen!
Whether they load bananas, sticks or 9 clay pots on their heads.... while walking or dancing!
or bananas, wheelbarrows, full size mirrors, doors, 10 ft poles, or a family of 4 plus luggage on a boda-boda....
or multiple sacs of charcoal falling out of trunk, a family of 6, and maybe a suitcase on the roof into one sedan...
or a half dozen cows and maize, two dozen pigs, infinite cases of bottles, all topped off with extra bananas or sacs tied to the siding of a large truck...
Ugandans can sure pack it on! And somehow things don't seem to fall off! (much...)

6 or so Ankole cows, brush, and bananas in one load! Yikes!

When I master the skill, I will be sure to pass it on. In the meantime, I'll stick to my backpack...

I also updated the map from the first blog with the areas I have been, and will probably be going to.
http://maps.google.com/maps/ms?ie=UTF&msa=0&msid=111798946089763601626.000492f91c30f37ac67da

Good night to everyone, and thanks so much to everyone who has written or commented. I love the communication!

Love,
Maryse

Western Uganda may be the most beautiful place I have ever seen!

The view from my guest house in Kilembe

I wish my photos could do even an element of justice to the scenery of Western Uganda. From Sunday evening until last night, I have been traveling along the Rwenzori Mountain range, exploring its valleys, plains, gorges and foothills. I have yet to see anywhere else so lush and so expansive. As the area is still relatively untouched by man, it is home to such exotic life, from flowers to animals, which some photos will show further on.

Nestled in pockets of this incredible environment are a few towns I have visited since Sunday. Fort Portal is the only English-named town in Uganda. It house 3 missionary private hospitals and a government regional referral hospital, called Buhinga. As there are no orthopaedic surgeons here, I met with one general surgeon, an orthopaedics resident in his final year, and a medical officer (a post-internship year obligatorily stationed upcountry). Sadly, orthopaedic care here can consist of little more than closed reductions, some casting and splinting, and the occasional debridement or pinning. As no orthopaedic specialist works here, they do not have any tools for even the general surgeons to manage basic fractures. Most people end up referred to Mbarara or Kampala.

The ortho resident here has voluntarily come back to his home town to provide orthopaedic care before starting his own practice. He ended up personally buying some basic tools (drills, a few pins etc) in order to provide at least some kind of care for patients. He will have to wait 2-3 more weeks before the government even considers his request for equipment. And as he tells me this, we are sitting in the nicest of ORs I have seen since arriving here. It is empty. There are not even enough doctors here to staff the OR on a daily basis, despite the pile up of patients on the ward. Where are the surgeons? Making a living in the private system or other endeavours. Government salaries for doctors here are not even enough to feed and family and put kids into school.

Fort Portal, across from Virika Hospital

The private protestant mission hospital. There are only medical officers working here. A specialist can be called in, if available.

After an hour of pounding rain, I met my driver for the rest of the trip, Fred. He is from Fort Portal also. We throw my bag into his car and begin the most beautiful road trip of my life. As we head southwest, we are driving along and eventually into, the Rwenzori Mountains. There is also an unnamed mountain range to the east, and in between them lie lakes. The largest one is Lake George.

Two hours later, we meander a two-lane road into the town of Kilembe. It is a gated town; a security guard mans a road block 24/7. The town is small and sits in the heart of a small valley, completely secluded from the rest of the world and, as I am told, the bad weather. In the 1950s and 60s, this was a copper mining town overrun by Muzungos. When the mines closed in the 1970s, the white people left, except for the occasional visiting doctor.  Kilembe is incredibly tiny and quaint. It has a gas station, a few local markets and a school. Somehow it also has a general hospital. Kilembe Mines Hospital, once the point of care for the miners, is a collection of tiny buildings on the foothill of one of the mountains. It includes the guest house where I was staying.

My guest house! Nestled under a half dozen mango trees!

Across the street from the hospital

This hospital is particularly interesting, and it probably the best run hospital I have been to in Uganda. It is considered a private not-for-profit hospital. This means it receives some money from the government, some from the catholic church, and a little from the patients. Although patients do have to pay a small sum for care, it is nothing compared to the costs of a private for-profit hospital. There is only one specialist doctor here, everyone else is a medical officer or allied health care worker, such as physiotherapists and orthopaedic officers (cast techs). The specialist is the only orthopaedic surgeon in the district, Dr. Wefula. He is also the hospital Superintendant. When he came here as a medical officer, they told him they would pay for his orthopaedic post-graduate training if he came back to work permanently. He did.

Dr. Wefula and I outside the "Major Theater"

Unlike any other doctor I have met so far, Dr. Wefula seems to enjoy his job. His team, as he is, is so motivated. Compared to the Kampala teaching hospital where length of stay for orthopaedic patients averaged 33 days, his average is 7-10 days. His wards are always full, but he operates 7 days a week, with his medical officers managing the obstetric and general surgery cases. He doesn't have a lot of equipment, but some was donated when he arrived, other things he has bought himself, and he receives a small supply from the government. As he said, "I don't have much, but I make it work with what I do have." Patients come here from all over the South and West of the country, and generally leave with a solid chance of full recovery.

Sample spread of local food. The hospital kitchen supplies lunch on OR days for the staff in their tea room. Far left in the pot are local sweet potatoes (they are whitish-yellow), in the leaves are Matoke (steamed plaintain, mashed), the second pot is rice, and the thermos pot, top-right, is a beef stew. The bottom left basket contains a meal of maize and cassava, the open pot is a bean-tomato stew, and the bottom right is an eggplant dish. Believe it or not, as locals tend to have only one big mean a day, everyone eats a lot of ALL of these dishes!!! It is delicious though!

I hated to have to leave so soon. The staff here were so welcoming. I hope to stop by in December when I come back this way. The next destination is Mbarara. To get there, the safest road is through Queen Elizabeth National Park. This is one of the most popular game parks here. The main road goes only through the periphery of the park, but sightings of animals are frequent, as you can see by the pictures below. Within 30minutes, I saw two elephants, 6 or so African Buffalo, two kinds of antelope, of which the Uganda Kob were in groups of hundreds (no pictures as there were far away), and a family baboons having a pow-wow on the road. I can't imagine what you see when you pay to go in!

A group of African Buffalo

Olive baboons. The little baby kept hiding from my camera!

Daddy Baboon

African elephant

The second elephant

 As we exited the park area, we started climbing along this gorge. Lakes and rivers were everywhere, but once we got to the top, suddenly you could see for miles to the south and west. It reminded me of that opening scene of the Disney Lion King movie where the lions are perched on a cliff and look over their kingdom. I could probably see into Tanzania one way, and the Congo, the other! Again, my camera died just before I could get a good picture of this view, but I promise - It was breathtaking!!!!

Richard (my drivers switched due to scheduling conflicts!) didn't know what the name of this tree is called, but it is deadly. It's hard to tell with this photo, but although the trunk looks like a normal tree, the branches are like a cactus. If you break the branches, out comes a milk that is apparently deadly to the touch!!! I will most definitely be staying away from those!

Lake George

A different lake...

And this is looking south from my Lion King perch. To the right, I could see about three lakes and the mountains behind.

The rest of the drive was equally beautiful, but I will spare you the details. I arrived to Mbarara after dark. I checked into the University Inn for my meeting tomorrow with Dr. Bitarho, the only orthopaedic surgeon in the city. This city, which I have yet to see, is supposed to be one of the most modern in Uganda. It has a University of Science and Technology, which includes a medical school. I am looking forward to my time here, though tonight (Thursday) I head off to a nearby lake for a day off tomorrow. This lake is one of the only bilharzia-free in the area and so I plan to swim, tan, and do some computer work outside! That said, you probably won't hear from me again until after my interviews in Masaka and I am back in Kampala.

Hope all is well at home,
Love,
Maryse