Moving forward

A photo of me holding Bright, the healthiest child in Uganda. Bright rarely smiles but chooses to show his affection in hugs and high 5's.

It’s been a couple weeks since my last posting and it is difficult to find where to begin. I guess I will start with our new volunteer Rotaract member Kristen Whitcomb who is assisting me in the assessment phase of the Rotary 3H grant! I picked her up at the airport in Entebbe on October 14^th at 7:30 am and took her on a whirlwind journey to begin her month and a half long stay here in Uganda. I began by taking her through the streets of Kampala to get some last minute items before heading back down to Bwindi (the dreaded 10 hour bus ride). Being with Kristen I began seeing Uganda and Kampala again for the first time to understand what she was experiencing so that I could explain this place that I am calling home for the next year. Just crossing the street in Uganda is a cultural experience. One can wait for 15 minutes without finding a break in the traffic or be forced to weave between a maze of matatu busses and jostle with motorcycles to find your way to the other side of the street. Walking down in the market area of Kampala I was stunned by the sheer volume of stuff being hawked. Small 10ft X 10ft cubby hole stores line the streets for as far as the eye could see. Second hand clothes, blankets, “rolex” watches, candies, jerry cans etc etc etc. Looking up I could see the market reached four stories high with trinkets and clothes of all shapes, sizes, and colors hanging from the exterior of the buildings swinging in the wind. It was just a solid wall of junk with nothing solid or stationary to focus on. Eventually we found all of the supplies we needed and headed back to the Backpackers hostel for a much needed rest.

Kristen and I woke early the next morning and caught the 6 am bus to Bwindi. Two breakdowns and 14 hours later we eventually arrived back at the guesthouse to BBQed steaks and peanut butter cookies prepared by the Danish med students Nadia and Karin and the IT expert Der (I guess its not all roughing it out here). I think Kristen was absolutely wiped out but I shall let her explain in her own words.

Kristen has quickly taken to the role of field/lab technician processing the bacteria samples and generating data that will drive project implementation. Her quiet and supportive demeanor has been a very welcome change from juggling the finances, testing, and project planning for the Rotary 3H grant (the 3 H’s stand for Hunger, Health, and Humanity all directly related to clean water). She has even begun setting up her own experiments for UV treatment of contaminated waters as a possible at home measure to ensure clean drinking water (see photo on right). Kristen has also wasted no time in getting acquainted with the multitudes of children here that sing at the top of their lungs "hello, how are you!" over and over again when they see a Mzungu. At this point I am thinking that a month and a half may not be long enough to have Kristen, I may have to keep her for the rest of the year!

To date we have collected fecal coliform data on 34 community drinking water sources including springs (protected and unprotected), surface water sources, gravity scheme sources (water piped from protected springs), and rainwater harvest sources. Thirteen of these sources were found to be under 10 cfu/100 ml. Sources greater than 10 cfu/100 ml is the contamination standard used by Life Water International. Our primary focus will be on those springs greater than 10 cfu/100ml. Obviously the most difficult situations are where there are no springs to protect and surface water is the only alternative.

Once again the major issue appears to be available land. Driving back from a weekend away at Lake Bunyonyi we spent 5 hours driving through the valleys and up over mountainous passes which characterize the region. During the entire drive there was not one strip of primary rainforest to see, not one native plant. The hillsides are all cultivated and the most common tree found is eucalyptus, which is an Australian native, used for building houses and other structures. The houses of the Mukiga (plural: Rukiga is singular) people here are spread out over every square foot of the land to be near to their crops. Unfortunately this often sets families and in some cases whole communities long distances from protected drinking water sources. The women and children in charge of fetching the water often resort to the nearest available sources that are often surface water sources that are always contaminated. The photo above is a child collecting 20 liters of water, equal to 40lbs!

Just one anecdote before I leave you for another couple weeks. As I stated earlier I visited Lake Bunyonyi this last weekend with the Danish med students Nadia and Karin for canoeing and relaxing (see photo below Karin to the left and Nadia to the right). The lake is a ten thousand year old lake and is the deepest lake in Uganda. It was created when a lava flow dammed a river and the river valley filled with water. On our return trip we hired, Patrick, a taxi driver to take us on the five hour journey back to Bwindi. The day was beautiful and there were no storms threatening to turn the roads into the muddy mess that can delay travel for days. Although a bit bumpy I thoroughly enjoyed driving through the lush green valleys and up over the mountain passes with stellar views.

Just 30 minutes outside of Bwindi I was confident that we would arrive at our destination without delay despite darkening clouds overhead… Just after we crossed the river we found that a ten ton truck had lost its brakes and drove up onto the embankment and turned over on its side blocking the entire road. Our driver, insistent on delivering us to our destination and heading back to his home that night decided he would drive across the nearby meadow, bypass the accident and get us back onto the road. The crux of our short detour was a steep ascent on slick muddy ground right before getting back onto the main road. The nearby onlookers viewing the accident were more than happy to assist us. As our driver approached the slope no less than 40 men and boys threw themselves against the back of our vehicle, rocking it up the incline and finally pushing the car up onto the road. It makes my heart ache to think that I didn’t have my camera with me to capture the moment. When we were back on the road it was time to settle up and I had a sinking feeling that the situation could get nasty. How do you pay a group of 40 people, I didn’t have any small bills on me better yet 40 of them? Is there any recourse if they ask for too much money? The group crowded around our driver arguing what the price should be. Thankfully the price that was demanded was 15,000 shillings which is about $10 however if they had demanded $100 I probably would have had to pay it. We left the scene of 40 men and boys cheering their good fortune at having landed such a prize. Nadia, Karin, and I could only smile in amazement at our good fortune and at the strength of Uganda which lies in its numbers.

Water water everywhere

Boda Boda driver riding through a flooded road

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10-14-08

I was caught in an incredible storm today. It was the first time that a hard rain persisted for several hours turning the roads into rivers of red brown water. Three med students and I were on our way to a local garden to get strawberries, basil, and some other hard to find fruit and veggies. Powerful gusts of wind began blowing and soon after drenching rainstorms accompanied by lightning strikes followed almost instantly by thunder. We took cover under a broad leafed tree but it was soon saturated with water and poured down through the leaves and drenched us. We held banana leaves over our heads in a feeble attempt to prevent the inevitable soaking. Finally we were as wet as we could possibly be and decided to make a run for it amid the lightning and rolling thunder to find a drier location. In the back of my mind was the local Batwa pygmie three weeks ago that was struck and killed by lighting and the newspaper article about how a strike killed 50 cattle in a neighboring district.

We finally found cover under an awning and waited for the worst of the rain to stop. When we returned to the guest house Der (the computer tech) told me that Dr Scott Kellerman was stuck across the Manyaga River at a fundraiser auction at the local church because of high water. I’ve never been one to miss high volumes of water so I quickly dried off and picked up my camera and ran down the road to see the flood waters. What I found was that the river had undercut one side of the bridge that linked the village of Mukono (where Scott’s fundraiser was) to the hospital and it had collapsed. People returning from the auction were trying to pick their way across the collapsed bridge with their families dressed in their nicest Sunday church-service clothes (see photos to the right). Boda Boda drivers were pushing their motorcycles up over the stones that were piled onto the collapsed bridge to assist crossing. I took turns taking photos and helping folks across the stones. Children descended upon the floodplain as the waters receded to catch mud fish (something like catfish) that were trapped in the grass and rocks. Just think, all of that clean water raining down every single day. So much potential! Quite a day!

One Thursday Paul and I visited Mukongoro, a settlement consisting of both Batwa Pygmies and local Mukiga people. This site was highlighted during my first visit in 2006 as having poor sanitation and no access to protected drinking water sources. Mukongoro resides in a narrow valley perched above the hospital just a couple kilometers from the Congo border. Villagers grow their crops in the wetland at the base of the valley and raise livestock of goats and pigs. Being that we are well into the rainy season here (September through December) there is water spilling every where over the footpaths and through the wetland though unfortunately non is potable and most is just a seasonal source of water. A local leader explained that during the dry season up to 150 families come down into the valley to collect water from a small fissure at the base of a bedrock outcropping. The water source during the rainy season was a muddy pool of water at the base of the wetland draining the area where the all of the houses are located.

We tested this source as well as the spring at the base of the bedrock. The testing kit determines the concentration of fecal bacteria in colony forming units (cfu) per 100 milliliters. A result of 20 to 100 cfu/100ml is considered high risk for fecal contamination. The rainy season source could only be estimated there were so many colonies. Estimates suggested that there were over 20,000 cfu/100ml in the source (the highest source recorded yet!). The dry season source was considerably cleaner (14 cfu/100ml) but lacks the necessary volume to provide for the number of families in the region. It seemed apparent to village members that contamination of their drinking water is an issue but the only alternative option for clean water is a 2 km walk up a steep grade of about 800 vertical feet. We realized that it would be highly unlikely to convince the village members that this is even an option at all. Currently we are looking into the potential for a large rainwater harvesting system. More later on this. In the meantime we will continue to test local water sources.

1st Outreach!

Strangler fig towering over a tea plantation

Our first outreach for the water and sanitation assessment began this week on a very positive note. The outreach coordinators at the BCHC, Rev Sam and Godfrey Abaganya invited the village health promoters to the hospital for a meeting on clean drinking water and sanitation. The village health promoters are village members assigned to track the health and well being of designated families in their community. Many traveled up to 4 miles on foot to attend the meeting. Our region of focus for the projects is the Mukono Parish, an area designated by the Anglican Church. This area includes approximately 12 villages although some are quite spread out. Villages are generally centered on trading centers but in some cases they are centered on churches or schools. Those attending the meeting were 22 health promoters that represent most of the villages in the parish as well as three members of the local sub-county government. As always prayer and introductions were the first items on the agenda. Reverend Sam facilitated the meeting introducing the topic of water and sanitation in the local Rukiga language. He translated for me intermittently and allowed me time for me to ask questions to the health promoters.

Rev. Sam effectively used story to make his point about the importance of community participation in the projects. His story was about a stork building a nest in a tree and refusing to ask for assistance from the ant people below. When the stork became caught in a storm shortly thereafter the nest was blown to pieces. The message of the story was that anyone from outside a community can build a project but without the local knowledge about where those projects should go and how they should be built the projects will fail. The story was very well received. Rev Sam used an effective mix of humor and serious discussion that held the attendees attention throughout the meeting that ended up lasting for 6 hours. After introductions the health promoters were asked to create a map of the parish describing protected and unprotected spring sources, villages, roads, and other key landmarks (churches, schools, crops…etc). To accomplish this they used plant stems to designate the roads and leaves for the rivers (see photo on the left). Sticks were bound together in the form of a cross to show churches and sticks planted in the ground marked protected springs, broken sticks were failed springs and so on. At that point the debate was on. Arguments broke out left and right about the placement of key landmarks and at one point I thought two traditional bath attendants were going to start wrestling to decide the placement of a spring. After an hour the maps were complete and we analyzed them and critiqued them together. Not only did the exercise give Paul and me a better idea of where the springs were located in the region and the layout of the villages but it promoted awareness about water sources and the importance of clean water. One goal of this project is to create a persistent voice in the region reinforcing the importance of clean water and hygiene to protect families from water borne illness.

On Saturday we went out for our first outreach to the village of Iraaro. Paul, Godfrey, Rev. Sam, Christine (one of the Ugandan outreach nurses), the driver, and I all packed into a Toyota pickup with an extra cab and navigated 10 km of incredibly rutted and rocky road. Noticing that I kept smacking my elbow against the window Christine stated “you are dancing” to which I replied “we are all dancing together” as we jounced and jostled our way to our destination. When I visited Iraaro two and a half years ago it was a village site with 98 homes and no protected water. This put it at the top of our list of sites needing protected water. To our great surprise we found that the local government, the district of Kanungu, had recently protected a new spring near the trading center that delivered an adequate supply of water (up to 20L/min). The average water usage for drinking and cooking is 5 liters per person per day and for bathing and washing clothes 20 liters per person per day. (How many liters do you use during a single shower?)

The new spring basin now provides clean water for up to 40 families. This means that 58 families are still without protected water. Most of these homes cling to steep slopes so that they can grow matoke (a type of banana), millet, cassava, beans, potatoes, and tea. Unfortunately this puts them in a position where they must collect surface water for drinking and cooking. In this area we tested the protected and unprotected springs as well as the surface water sources in the streams at the base of the slopes. The surface water sources were hundreds of times higher than the protected sources as we would expect. Protecting a spring source nearer to the other 58 homes will be a primary goal for the project.

As for the weekend I got a chance to get out and go to church on Sunday with a group of about 15 American students visiting from a program through the Uganda Christian University. We took great hike up two steep miles of beat up road past wide eyed children and their stunned parents. We climbed to a spot where we could look out over the lush green beauty of Southwestern Uganda. About halfway to our destination we stopped in the shade to catch our breath and realized that about 40 children had followed us up the path. They ranged from 3 to about 10 years old and stood in an amorphous group staring at the rare site of 20 Mzungus in their back yard. For some reason the UCU students decided it was time to perform a choreographed version of the Christian song “River of Life.” (see left) Cringing slightly at the exuberance at which the song was performed I gladly took snapshots of the children’s reactions. When the song finished the children stood there open mouthed and silent for about 5 seconds as if waiting to see if something else was going to happen and then all at once burst into raucous cheers and clapping (See photo on the right). The UCU students could only blush and smile and laugh. The children returned the favor belting out several songs and shaking their hips and hopping in the trademark Rukiga dance. It was a true delight. I'll leave with you a couple images of the future of Uganda.