African Adventures – day 1

So, after spending the night in a guest house in Kigali, we set off at 9 for the drive to Bwindi – first several hours through Rwanda on well surfaced roads, then into Uganda and far from anywhere.

 

Kigali is a bizarre African city, with swish buildings, neat main roads, no begging and a strong police presence. Off the main roads, the tracks are rutted and made of red earth, and they are heaving with people and noise and motorbikes. It feels as if all that is human has been swept off the main roads. Within about 40 minutes, our car started to loose power on the hills and black smoke started to billow out of the exhaust. We pulled into a garage to try and sort it out. A huddle of mechanics and hangers-on stood about and debated what might be happening. The car had only been serviced the day before. It turns out that the oil, which should have been changed, had probably only just been topped up. Topped up to overflowing, and flooding the engine, such that it was no longer combusting as it should. After an hour of negotiation, draining off the oil, refilling, we were on the way again, out of the capital, past small tea plantations, hills of small-holdings, and evidence of terrible soil erosion at every river bed and hill-side.

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car trouble

 

We got to the border at lunchtime. There is quite a substantial no-man’s-land at the border with a trail of trucks looking desolate as they wait for their papers to be processed. We had to exit Rwanda (one stamp), and enter Uganda (another stamp.) And the car had to give up its temporary export to Rwanda (two offices, two stamps), and be signed into Uganda again (two offices, two stamps). Altogether an hour of paperwork and stamps, but all very sedate and peaceful and we were through.

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Plastic pleasures in Kabale

We stopped in Kabale inside Uganda. It is the largest town in the district. We did some shopping for luxuries like cheese, got some chipatis and samosas for lunch, and stopped at the bank. Then the journey was really under way. We turned off the tarmac, and into the countryside. The road was narrow and made of stoney, beaten earth, with some fairly steep drops at the side. I can see why the car needed its shock-absorbers changed after only a few thousand miles. We were amongst hills scattered with small-holdings with banana and plantain trees, small crops of tea, and people with pigs and goats on the paths. Onwards for several hours up and up into the hills. Eventually, we could see where the cultivated area stopped and the national park began. Our route took us along the eastern edge of the Bwindi Impenetrable Forest.

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off the tarmac

Bwindi amazing fact number 1 ; this forest has the highest number of different tree species per unit area of anywhere in the planet.

 

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the countryside and the edge of the forest

It was beautiful, full of forest noise, of frogs, grasshoppers, monkeys calling, birds singing. The trees were gracious and spread over valleys and ravines giving beautiful vistas with canopies of trees in the foreground, and forest in the background. We saw black and white Colobus monkeys playing close by. The road had a few moments when I was glad it wasn’t me driving, where the rains had caused the mud to slip onto the path and the passable area between the hillside and the road edge was a little bit narrow. Apparently the Uganda Wildlife Authority maintains the road because they know this is a route taken by tourists. It does make me wonder what other roads are like. We emerged from the forest into cultivated land just towards the golden hour of the evening, when the light was glancing off the roofs of the small houses. It looked tranquil, and quite idyllic until you you noticed the state of people’s clothes, the fact that so many of the children were obviously stunted and had pot bellies because of poor nutrition.

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the forest

The sun set quickly, and we made the final miles in the dark.
We arrived in our village, Buhoma (the village where Bwindi Hospital lies), where there were brightly lit small kiosks down the main street. We drove past the hospital and to our accommodation in the staff quarters next door.

From somewhere, we still found the energy to greet our neighbours and new colleagues and to take sight of our small but perfectly adequate new house, then to eat and stumble into bed.

A day of rest and sorting the house tomorrow, then work starts.

Up, up and away

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I am at 11260 meters up in the sky, travelling at a speed that would be 535 mph on the ground, looking out of the window at Heraklion in Crete (- I know because there is a google map – ) flying is exhilarating. I love seeing the environment spread out beneath me like a real-time geography lesson, there’s snow on the Alps, the Rhone really does flow out from the mountains to the sea, and the Croatian coast is, well, really dramatic. I find it amazing that humans have engineered a massive hulk of metal, and filled it with people, and baggage, and dressed it with fancy gadgets to make it comfortable, and that this can lift off the ground and carry us through the sky. If someone had told this to my grandmother when she was a child, she would have thought this was a crazy dream. Human beings are so ingenious.

 

Being up in the air feels like time-out-of-time. For the past 6 months, my life has been woven with lists of to-do’s, a chunk of my mind always forward planning, always aiming for the utmost efficiency of time and organisation. And now we are on our way. For today, there is nothing to plan and nothing to schedule. It is a huge relief. My body can feel it. Last night was the first night in weeks that I slept through without waking in the early hours with tasks on the mind.

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The girls have been wonderful travellers so far. Things have been easy because we haven’t had to rush. There’s been time at the airport to dawdle, and to work out how the escalators work, or to ask questions about the security checks, to go to the loo umpteen times and to eat malteesers. We stopped in Brussels overnight and ate expensive dinner very late in a hotel. The girls giggled for hours after the lights were out. And today’s flight has been smooth so far. The girls who are rationed to  one Disney film a year are binging on movies and airline snacks and relishing the fact that no normal rules apply, just for today!

 

Now I must stop so I can look out of the window. I can see the cost of Lybia (or maybe just into Egypt?) endless sand crossed by pipelines and dotted with the shadows of the clouds below us.

 

By the time we arrive in Kigali it will be dark. What will it feel like arriving in an African night with all my family? I remember when I first arrived in Cameroon when I was 18, we were landing at dawn, in a major city, and it was dark, no street lights, no neon, and it was hot, as if I had stepped too close to the plane’s engines… what an impact that had for me then. What will the girls make of it – the smells, the dark, the heat? I’m hoping that our online visas will be turned into real ones without too much of a challenge, and that Zishan (the British GP whose time in Bwindi is finishing) will really be waiting at the airport to meet us. Let’s see what awaits.

 

 

 

Getting ready…

In five week’s time, and save for disasters, I will be with my family, somewhere in the skies above Europe, heading towards Uganda.  I am about to spend the next several months there, working as a doctor in a hospital in the remote, rural South West corner of that country, close to the border with Congo and with Rwanda. I am going with Brian, my ever-supportive husband, and my two wonderful daughters, Miss A who is 7, and Little Roo who is 4.

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My fellow travellers in a more familiar environment

Five weeks – quite a long time to get ready? It really doesn’t feel like that. Between now and then there are still so many things left to sort out, from antimalarials to mail-forwarding to work meetings to birthday parties. Oh yes, and a new opthalmoscope, and reading books for the children who won’t be in school for a year, and where will I buy shampoo – do we need to bring enough for 10 months? And then there is a house to de-clutter before our tennant arrives …..

Somewhere amongst all this busyness I am trying to reflect on what it is we are about to embark upon.

Here are the facts:

I am a GP Partner (that means I am responsible for a general practice surgery as a business as well as for the patients.) I have been given the most generous opportunity by my colleagues – they are allowing me time away, up to a year away, to do something that feels like it matters. That thing for me, is to be with my family, working in Africa. I have worked in Southern and Eastern/Central Africa before, but never with children. Brian has too, but before the girls and I were part of his life. For both of us, the experiences were formative. We want to be open to being changed again, and for our girls to have that opportunity too.

We will be living at, and I will be working in Bwindi Community Hospital. The hospital was established only 15 years ago as an outreach clinic to meet the needs of a disadvantaged community who had been displaced in that area after the opening of the national Park, the Bwindi Impenetrable Forest. The services expanded, and now there is a fully established, and very well regarded hospital which has been innovative in many of the services it offers. The hospital is part of a network of hospitals run by the Uganda Protestant Medical Board. There is an equivalent Catholic hopistals board,  and a Muslim medical board that supplement the State provision of health services. All of these are not-for-profit and need to generate income to run their services. The income comes from private donors, NGOs, the state, and there is a tiny contribution from user fees. BCH has been at the forefront of creative solutions to funding services. The hospital has developed a health insurance scheme that allows even the poorest families to access services even if they are expensive, and so enable people to take up preventative services as well as ones aimed at curing disease.

I will be working in the Adult In Patient ward for three days a week, and I will be involved in Quality Improvment projects for another three days.

We will all live on the hospital site. Brian is going to home-school the girls,  and put energy into being part of the community.  We will all take as much advantage as possible of the fact that we will be living on the edge of one of the most biologically diverse areas of the world, the forest home to half of the world’s population of mountain gorillas.

Here are the feelings:

There is excitement, of course, but at this stage, the dominant feeling is actually one of doubt. Here are some of them.

How can a GP like me, settled into the ways of primary care in the UK, make any sort of meaningful contribution in a setting so unfamiliar to me,  when I will be there for such a short time?

After 15 years in General Practice, will I still be able to deal with people who are seriously unwell? Will I be of any use putting in a cannula, setting up a drip, putting in a chest drain, doing a lumbar puncture? I did all these things when I was younger, but will I remember how? Will my fingers remember the technical stuff? Will my presence on the ward be useful?

Do I have the stamina to see people die so frequently and in ways that would be unthinkable back in the UK? How will I respond?

How can I understand what will be useful for the services in terms of quality improvment, and find a way to make a difference?

Will I be able to spend the time with my family that we will all need? After all, part of the point of the whole undertaking is to spend more time together than we do when we are in our busy lives at home. Will I really be able to stop working all evening (or is that just me) ?!

Will I be thrown off course by things that previously I took in my stride, like bad roads and dodgy public transport?

Will the children find the newness of it all too much of a challenge? Will they settle?

Will Brian and the girls have enough to do each day so as not to resent the whole project?

Is it really fair for me to leave my colleague to manage the practice without me and carry the responsibility for so long whilst I swan off indulging my whims in this way?

Is it right to leave our extended family?

So many questions, and so many doubts. We can only trust that the answers will show themselves with time.