Catching the Bus.

Before we left sunny Manchester, we were asked to sign a form saying that (amongst other things) we wouldn’t use public transport in Uganda. It was a mixture of curiosity, cost and basically not having any other option that led us to Kampala bus station last Sunday morning.

When we arrived; it wasn’t the perceived poor safety record that was worrying me. My bowels hadn’t produced anything solid in several days and I knew for a fact that the bus would not have any emergency lavatory facilities. The thought of a public transport gastro-intestinal catastrophe played heavily on my mind. We’d been warned that the bus would be busy/full so we arrived in plenty of time. The bus was due to leave at 11am – so we arrived at 10.15. We were pleased to be shown directly on to the bus and found two seats near the back. We paid our 20,000 Ugandan Shillings (about a fiver) each and made ourselves comfortable.

The grandly named ‘Gulu Express’ is a battered blue coach from the early nineteen eighties. Covered in scrapes and rust, it does not inspire confidence. The window adjacent to us had been broken and expertly put back together with selotape. It is the size of a regular coach but instead of the regular 4-per aisle, they have crammed in an extra 5^th seat. We had seven people in our row, including two children and no seatbelts. At 11am the bus was full and ready to go. At 11.30am, the bus was even fuller and pulling out of Kampala bus station.

As we pulled away the most noticeable thing was the lean. We knew the road was uneven, but it genuinely appeared as if they’d put a load of massive tyres on one side and tiny tyres on the other. From my vantage point, I could see nothing. No view forwards, backwards and only a slight view of the passing city through the broken window to the side. I spent the first few minutes trying not to slide off my seat. Every bump came as a surprise and my bowels felt heavy

At 11.45am we stopped at a roundabout. At 12.45 we had circum-navigated said roundabout and were able to start making some progress. The roundabout wasn’t especially large but it was complete chaos. Thousands of mopeds and bicycles, often carrying impossibly large cargo (wardrobes, car bonnets, 12ft pipes) dodge around each other, making it almost impossible to move a larger vehicle. Traffic policemen sleep idly close by on the grass. They carry large machine guns which is probably why no one attempts to wake them up.

At about 13.30 we arrived at the edge of Kampala, and I was actually quite enjoying our adventure. At the first police stop, a man had asked to hide behind my seat. I’m not sure if he wasn’t supposed to be on the bus or if he wasn’t supposed to be out of jail, but no-one else seemed to mind, so neither did I. I’d plugged Mattea into Glee on the ipod, and I don’t think she noticed

I glanced around the bus trying to figure what infectious diseases I might catch. Whilst I can’t deny that the bus was a sweaty mass of humanity, it struck me how normal this was for everyone else. These people were normal Ugandan folk (rich enough to afford a bus fare) who were travelling for work or to visit family. None of them seem worried about the rattling noises from the engine or the occasional grinding noise as we slipped off the tarmac to allow another vehicle to pass.

Similarly, no-one else was gazing out of the window and the passing villages, wandering about the tiny huts and the cramped living conditions. They didn’t seem too bothered about the crumbling market stalls selling almost nothing, or the wandering goats/children/cattle who hang out the edge of the road. It looks awful, but actually it’s not poverty or that sad, it’s just life in Uganda. The tiny hut is home and the ramshackle shack is work, and that’s ok. It’s different from Manchester, but it’s ok.

My favourite part of the bus ride were the food stops. About every three quarters of hour, we’d pull off the road and stop. Within seconds we’d be swamped by people trying to flog us stuff through the window. Corn on the cob, bottles of Fanta, pineapples, even live chickens! My favourite is the ubiquitous ‘meat on a stick’. A couple of bits of unidentified flesh burnt onto a random sharp stick, poked through the window whilst someone shouts ‘Mzungo’ at me. I’m not sure what it is (probably goat roadkill), but at 10p a stick, I’m not convinced that my bowels would have thanked me.

After 6 hours and 270km, we arrived safely into Gulu bus station at about 5pm. I stank, but my underwear was intact and so was the bus. I probably won’t get on it again, but I had developed a fondness of the ‘Gulu express’. Like so many things in Africa, and in particular in the hospital, it’s a bit rubbish, but it’s what they’ve got – and it sort of works.

The hospital continues to frustrate. We have settled well and are working hard, but the inability to do even the most basic things is baffling. The lack of awareness or acknowledgement of the death or suffering is difficult to watch, but life is definitely cheaper here. We’re having to learn that. We hope that the locals have noticed that we have higher ambitions and expectations and hope that they want to join us in making it a bit less rubbish.

Many thanks to those that have e-mailed. Apologise for the lack of writing recently. Mattea was briefly ill with an unspecified vomiting/fever but gladly she has fully recovered. We have also spent an amazing week in Zanzibar celebrating John & Angela’s wedding. Add into that the lack of reliable electricity and/or internet and blogging/e-mailing has proven more difficult than we hoped. We hope to do better.

Please do keep in touch

Dave & Mattea xx

Impressions

The People – Incredibly welcoming, generous and friendly. When we walk down the street, we’re struck by how cheerful people are. It’s clearly a very close knit community, lots of people bumping into old friends, shaking hands, always with a smile. On our way from Kampala, our driver thought he’d splashed a pedestrian when he drove through a pot hole. So he pulled over to check he was ok and apologise, turns out the man hadn’t even gotten wet!

The Pace – Slow! But then, when a nurse only earns £75month, £50 of which goes on rent and most of the remainder on food, what’s the rush. There’s not much else to do except make things last. And to add to the above point, one of the nurses from Manchester who has been working in Gulu for the past 6 months had a leaving party last night. Despite the relative poverty with which people live here, she got generous gifts from a number of the nurses on her ward, all beautifully wrapped.

The Food – Well, it depends if you like boiled goat, dried fish and LOTS of carbs. No, I’m being unfair. It’s ok, perhaps a little less interesting than the choice we have back home, but when the electricity goes off every other day for between an hour and 2 days, anything that needs to be refrigerated is kind of out of the question.

Meal Times – Amusing. Dave and I have been to a couple of people’s houses for lunch. On both occasions, this began with a prayer, followed by a hand washing ceremony, and then the TV was switched onto soap! The first time this was a Philippino soap, the second time it was a Spanish soap – both horrendously dubbed with American voices, and even one random very British voice. Although it seemed a little strange to us that you would have guests for a meal and insist on watching the equivalent of neighbours, we actually really enjoyed it and so thought not much more about it. Until, when we were out for dinner last night at the leaving party (comprising all the staff from the surgical ward, including the chief exec of the hospital), we spotted a TV in the corner of the wooden hut at the restaurant. I actually joked with Dave before the meal that it must be for watching soaps whilst eating. I spoke too soon. No sooner had grace been said, the dubbed Spanish soap crackled onto the TV. Unfortunately, the reception wasn’t very good because there was a tropical storm raging and so after 5 minutes of moving the aerial around, the TV was switched off and scanty conversation ensued.

The Hospital – A HUGE challenge. From talking to the nurse from Manchester, it sounds like the surgical ward is significantly better organised than the medical ward, which is so far from what we know as a hospital in the UK. For those of you who don’t know, in the UK, the nurses do regular observations on all patients such as blood pressure, heart rate, respiratory rate etc. This enables them to identify patients who are unwell or deteriorating. They can then either implement a treatment themselves or request a review by a doctor. This is not done on the medical ward. So, other than walking up and down the ward trying to identify any sick-looking patients by eye, which encompasses most of the patients, there’s no way to prioritise who you see first when you arrive on the ward. It also means that our review of patients always begins with doing the routine observations ourselves. This is particularly frustrating when you can’t get an accurate blood pressure reading because the cuff is too big for almost every patient’s arm (we have the opposite problem in the UK as you might imagine). We had our first death this week, a girl in her 20s with HIV. We don’t know the exact cause of her death but we do know she had a haemoglobin level of a quarter of what it should have been (and in fact, it was a nurse who took the blood and asked for an urgent haemoglobin check once she spotted that the girl looked unwell). She died whilst she was having a blood transfusion. It’s really sad to think that maybe her life could have been saved on that occasion if she’d been identified as being the most unwell patient and therefore the priority to be reviewed that day.  There are many other frustrations and difficulties, including the lack of investigations, drugs, and doctors (apparently there are no doctors on Thursdays and Fridays because the ward doctors are at clinic and thus the ward is run by well-meaning medical students).

Anyway, lots to think about. And things are no doubt on the up. In fact, US Aid are currently building a brand new laboratory for the hospital – a much needed commodity that will no doubt save many lives.