Settling In

Red Tailed Monkey hanging out near the guesthouse

It has been a long week of settling in here at the guest house as well as working out the first details for the assessment of water sources. My banda hut is still being constructed up near the park so I spent my first couple of nights here in the guest house. It’s a pretty sweet deal with meals prepared daily, a solar shower (that I have yet to catch a warm shower in), and toilet- all of the 1^st world amenities are accounted for. Scott realizing that I was pretty cramped for space with my testing kit, supplies for 800 tests, pressure cooker sterilizer, as well as my personal belongings offered to let me stay in the “mud hut” that is down below the guest house (see photo above). Walking through the guest house garden of pineapple plants and Matoke banana trees the mud hut is secluded from the hospital and nearby road by a wall of tropical vegetation. A nice big lawn with an outside gazebo for working makes it a great living area. The building itself is a spacious two room structure, kind of reminiscent of my cabin back home though when the sun hits the corrugated metal roof it really starts cooking inside (which I guess is also a little reminiscent of my cabin back in Nevada City). Of course Scott failed to mention the minor rat infestation until after I had moved in. I guess some of my down time will be dedicated to designing primitive rat traps. If anyone has a prototype for a trap, let me know please! The photo to the right is my gazeebo office and bird watching vantage point.

On the water project side of things Scott Kellermann has assembled a solid team that will be managing the Rotary 3H grant (among many many other projects) to reduce malnutrition and to improve water sources in the region. The malnutrition portion of the grant involves providing sustainable goat herds to several villages in the area. My focus will be primarily on providing sustainable water sources as well as sanitation to villages with the greatest need (I will do my best to stay away from the goats). My first task is to determine where the greatest need is. To get started Paul Mahwezi and I visited Godfrey Abaganya and Reverend Sam who are the outreach health officers for the BCHC. They have been coordinating community health projects and providing vaccines to the villages in the Mukono Parish (encompasses about 14-15 villages) for the last 4 years. Among other things they have been collecting specific information on the number of households with access to sanitation and to protected water. Using this data to guide our assessment Paul and I will begin at those villages with the poorest sanitation and access to clean water.

Godfrey and Reverend Sam have also designated “village health promoters” in the villages in the region. These are community members in charge of visiting designated households to follow up on if individuals are taking their medication and knowing the status of sick individuals. This type of community follow through will be absolutely necessary for sustaining the water and sanitation projects when they have been implemented. Boreholes, protected springs, and rain-water catchments that are built by the government or NGO’s for communities very often fail because the community is not involved in the projects and not educated on how to maintain their water sources. If people are asked why they have not maintained their clean water supply their answer is often that the ones who implemented the project are responsible for maintaining it. To avoid this situation we want to involve the community as much as possible in the implementation of the projects. The village health promoters should be a great way to facilitate this community involvement.

The first step of the grant is to complete an assessment of drinking water sources in the villages to determine where the projects should be implemented. To practice I just went out into the neighborhood with Paul to find some drinking water to test. My trusted bacterial testing kit gives a measure of fecal coliforms in water in a measure of colony forming units/100 milliliters. To get a result you filter water through a 45um membrane that collects fecal bacterial cells then the membrane is placed on a nutrient medium and incubated at 44oC for 18 hours. Each bacterial cell is then able to grow into a visible colony that can be counted. Of which the yellow colonies are fecal coliforms. The photo on the right is the result of a contaminated test from a local spring contaminated by a pit latrine. Each yellow glob is a colony of fecal coliforms.

Many of the people around the hospital are lucky enough to have access to a piped gravity fed water system that originates from large springs within the Bwindi National Park for a small monthly fee. One would expect this local area to be pretty well-off when it comes to access to clean water. Unfortunately the preliminary information we gathered and the data we collected this week paint a far more disturbing picture. The gravity water system and selected protected springs had the lowest counts of fecal bacteria and the surface water (streams) displayed heavy contamination. One protected spring, suspected of being contaminated by a pit latrine up gradient from the spring was heavily contaminated.

Talking with the local villagers Paul and I discovered that many families refuse to pay the 500 Ugandan Shillings per month (about 33 cents) for the gravity fed water and drink this contaminated water instead! Even more disturbing was the conversation we had with several girls from 5 to 9 years old that admitted to collecting water from the river for drinking. During the conversation I watched a herder guide his cattle into the river for watering. Not only is surface water contaminated by poor sanitation in the villages but cattle, goats, and pigs are another major source of fecal coliforms. This trip once again hammered home the point that education is the key here. No amount of money or implementation of clean water systems or new technologies mean a thing without the basic education that clean water is life. Children live and die by the choices that are made regarding water everyday. In many cases it is not the lack of access to clean water but the choice to not walk that extra distance to collect clean water or the choice to refuse to pay a fee for clean water. I’m going to look into outreach to the local schools and churches here to talk about these choices. The photo above is of children collecting water at a protected spring. Each jerry can weighs over 30 lbs!

Although some of these issues are pretty hard to stomach my spirits remain high. I’m really looking forward to heading out to the communities in the Mukono Parish to start figuring out where the projects should go. The rain forest here continues to amaze. Every time of day and night has a different collection of bird and insect calls. There is even a set of calls during the heavy downpours that occur daily. Red tailed monkeys are always looking into the guest house most certainly contemplating a mad dash into the house to raid the banana dish. It is such a rich and beautiful place to be and every day there is something new to see or hear or taste. I gave Jack Fruit a try just this weekend. A giant oblong fruit that weights about 30lbs with a rubbery flesh that I can best describe as a bubble gum flavored. I’ve heard rumor that it is related to the Durian Fruit of Southeast Asia but smells about a thousand times better! I look forward to sharing more experiences with you all as they occur. Hope you are all doing well. This photo to the right is me with my prize. Stay away from my Jack Fruit!

Beginnings

I have finally arrived at the Bwindi Community Health Center (BCHC) guest house in Southwestern Uganda after hours of flying and navigating my way through the chaos of Uganda’s capitol, Kampala. I arrived last Tuesday night at 8 pm after 18 hours of flying, with layovers in St Paul and Amsterdam. My first impression as I walked off the plane, onto the runway, was a blast of humid 70 degree air that washed over me. Kampala is just a 45 minute drive north of Lake Victoria which is the second largest freshwater lake in the world (can you name the first, think Siberia) as well as the source of the Nile River! The lake is so large it creates its own climate of dense humid warm air. I spent three days in Kampala gathering the last minute supplies necessary to carry out a water quality assessment of drinking water sources as well as personal items that I could not carry with me.

The chaotic streets of Kampala

Kampala is a sprawling city of nearly one and a half million people with 40 story skyscrapers intermixed with the poorest of the poor shanty towns. It is the fastest growing economy of any city in Africa were you have women and men walking around in fine business attire walking by beggars sitting on the street with deformed limbs. Gridlocked traffic at all hours of the day and a maze of unmarked roads make traveling by Boda Boda (motorcycle) the only feasible way to navigate the city and forces one to reorganize their imprinted rules of “1^st world” personal safety. I found navigating the markets and government offices of the capitol city to be an even greater challenge. Fortunately I was assisted by Paul Mahezi, a Ugandan, who was sent on the ten hour bus ride up from the BCHC. Dr. Scott Kellermann (see www.pygmies.net to learn more about this doctor) hired Paul to assist in the Batwa Community Projects (BCP) which is an off-shoot organization of the BCHC to improve the lives of the oft struggling Batwa Pygmies.

Paul will play the critical role of translator, procurement officer, and accountant for the water projects (not to mention keeping the Mzungu ‘aka white person’ out of trouble). I realized immediately how invaluable our partnership was going to be for the rest of the projects after the first couple of hours traveling around Kampala with him. Mzungu prices are always at least 5 times the cost that it would be for Ugandans and even by accompanying Paul to buy certain items he could not get the prices he would normally have found on his own. We spent Thursday day alone trying to figure out all of the necessary documents needed to obtain a year long work permit for myself. This entailed bus or boda boda rides as well as several miles of walking on foot to visit the internal affairs office for the application, Interpol to get a criminal report, the police academy to get the fingerprints for the criminal report, the Uganda Protestant Medical Bureau to get a cover letter…and so on. By 5 pm I was absolutely spent due to traveling in the heat and humidity, jet lag, and just the outright tedium of obtaining all of the necessary information to avoid costly return trips to Kampala.

Finally by Friday I was resigned to the fact that I would need a return trip to Kampala to complete the work permit and buy the rest of my supplies, so Paul and I decided to leave for Bwindi early Saturday morning. At 5 am we loaded all of my supplies onto the bus which was a large traveling pack, a large duffel bag, a bacterial water test kit, two large cardboard boxes, and my daypack. Among the items purchased in Kampala I had a two burner gas stove, gravity fed water filter, teapot, cooking pot, pressure cooker (for sterilizing the testing kit equiptment), a baby scale for the hospital, a heavy marble plaque for the hospital with the Bishops name on it, batteries, coffee not to mention all of the gear I brought from the states. It reminds me of the second chapter in the Barbara Kingsolver book the Poisonwood Bible, “The Things We Carried.” I felt like the family in that book bringing all of my stuff to a place where it may or may not have use. Over time I will most assuredly find out! The bus ride is an exhausting ten hour trip from smooth tarmac, to bone jarring potholed pavement, to a less punishing but incredibly dusty dirt road. Road weary and crusted in dust Paul and I reached the BCHC guest house under a tropical afternoon downpour. The guest house was just as I remembered when I first visited in April of 2006 (see the below photo). I received a warm welcome by Dr. Kellermann, Stephen “Blackie” Gonsolvez who works on the BCP, two med student from Denmark Karen and Nadia, Dir the hospital IT manager, as well as hospital administrators Richard and Levi. We had a traditional Batwa pygmie dinner of pasta with Bolognese sauce and soon after I was ready for bed.

I woke this morning to 15 different bird calls (I lost count at that point) and red-tailed monkeys racing along the roof of the guest house. Today is Sunday which is the slowest day of the week because everyone is at church. This is generally the day off for the staff of the hospital as well as everyone working at the guesthouse. This will most likely be my blog day. It feels great to be here and great to finally be on the ground working out the beginnings of the water projects. Next post I’m sure I will have more news on the assessment and preliminary phases of the project. I would just like to thank everyone who has supported me in this venture I hopefully I can interact with you through the blog. Special thanks to the Nevada City Rotary for writing the grant and to Rotact of Nevada County for the amazing support and fundraising for the projects. I look forward to hearing from you all. Until next time…Cheers!