One world

“Mzungu” is a well-known but little-used term to describe white people here in Africa.

The people who have referred to me as a Mzungu the most are the children.

Walking down a back path of the hospital here, a little girl of about three was walking in my direction. The moment she noticed me, she broke out into a broad smile and started yelling “Hi Mzungu! Hi Mzungu!” as if I was the most extraordinary thing she had ever seen.

As she passed me, she reached up and gave me a high five and great big giggle.   It may seem like a tiny, insignificant human interaction, but for me, it was an awesome moment.  I was smitten.

That little girl will never remember me, but I will remember her. I didn’t need to take a picture of her or the moment itself – some things are precious precisely because they are recorded only in your memory.

When you see the kids here and meet their parents, it makes you realize how very small this world truly is.   And it emboldens me to wish the term “third world” extinguished from our lexicon.   If that’s asking too much, let’s at least not teach the term to our own children.

I am certainly no expert on human development or psychology, but from where I sit, I don’t see a bunch of kids here who would identify themselves as inhabitants of some so-called third world.   Sure, they have unique challenges and I’m not naïve – most of these kids will struggle to eke out a living.   But surely we can try not to denigrate them further by referring to their home as some place so remote that they couldn’t possibly be like our children at home.

What I see here are little kids laughing and playing and going to school.   And parents who worry about them and their future.   What is so other-worldly about that?

These people, they love like us, laugh like us, dream like us, bleed like us, and are prone to the same human fallibilities as us.

At the very least, let’s acknowledge that we’re all in this together.

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Henry Ddungu and I are the same age and while he is a successful doctor and a PhD candidate, we have lived very different lives.

He has three children, as I do, but his are ten years older than mine.   I teased him a bit about becoming a father so much younger than me. He is a remarkably friendly guy, always quick to share a smile and a good joke, but his response was quite serious.

Peter, he told me, back in the early 90’s when we were young, if you wanted to have children, you had to do it when you were young.   He was 21 when he first became a father because most of his friends, and four of his brothers all died before they were 27.

They all died from HIV.

Today, Henry takes care of an entire village of family members, many of them the children of his dead brothers.   With his skills and experience, he could practice medicine anywhere but he chooses to stay in Uganda.

“My family, they need me.   My people, they need me,” he says without any sense of ego. It is just a fact of life for Henry.

Henry is now the deputy director of the Uganda Cancer Institute and is determined to make a difference.   Later this week, the President of the Republic will pay him a visit to thank him for the work he is doing.

Henry is non-plussed about the pomp and circumstance that will come with that visit.

“I just want to do my best to see that whole families, and entire generations, never get wiped out by a disease again in my country.”

“This is why I stay.”

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Robert doesn’t know his birth day.

Both his parents were killed in Uganda’s civil war and he has no other family.   He was adopted as a young boy and did well in school.

Today he is one of only four kidney doctors in a country of 35 million people.

While communicable diseases such as malaria and HIV remain the most common cause of death here in Uganda, the prevalence of chronic diseases like hypertension and diabetes is on the rise.   These conditions often lead to kidney disease and the need for dialysis.   And in a place where kidney transplants are not an option, dialysis is a life sentence.

One of the many challenges in a resource-limited setting is that those in charge of health budgets have to make difficult decisions; ones that many of us in the west would find unpalatable. Faced with investing in high need areas such as public and maternal health, or those that have a relatively small number of cases like chronic kidney disease, the government here (and in most places like this) choose the former over the latter.   Every time.

Through a sheer sense of will and some obvious negotiating talents, Robert has built the dialysis unit here from four stations to 28.   He and his colleagues now provide dialysis for nearly 100 patients each week.   Each of them generally come for two sessions per week and must pay $30 each time.   The money goes directly to cover the cost of the supplies.

I asked Robert what happens if a patient can’t pay.

“They die.”

Still thinking about his response hours later, I am unable to reconcile it with anything I hold dear.   At first I was shocked, and then I was angry, and now my emotions oscillate between resignation, sadness, and a weird sense of rationalization.   For if it wasn’t for our support of Robert and his commitment and perseverance, even more people would die.  I have told myself this a dozen times already today.

But I can’t shake the sad reality that where you live so often determines if you live.

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Walking through the maternity ward at Mulago hospital provides a stark reminder of just how far this country has come and how far it has to go.   When I was here last, it was one of the world’s busiest birthing centres with 30,000 babies born every year. Today, I’m told that number is over 35,000.

That is 100 births every day.

To put that in perspective, staff at St. Joseph’s in Hamilton deliver 3,600 babies per year and at one of the largest in the country, BC Women’s Hospital, they deliver approximately 7,000 per year.

Mulago is a big place but it’s not that big. Consequently, competition for beds after delivery is scarce and the majority of mothers and babies spend their first night together on the floor.   Thin mattresses are laid down, covered in a plastic tarp and then with a blanket brought in from home.   Mom and baby swaddle together and grandmothers bring in food and water.

This tableau is simultaneously heartbreaking and deeply moving.

Like new mothers everywhere, they are visibly exhausted. It is also clear that for the most part, they are happy. They are alive and so is their baby. In a country with a maternal mortality rate this is forty times higher than in Canada, living through childbirth is not taken for granted.

Luckily for these women, Sarah Nakubulwa is looking out for them.

Sarah came to Canada ten years ago as medical resident sponsored by the St. Joseph’s International Outreach Program and McMaster University.   In that time, she learned new skills, developed a sense of what is possible and went home determined to make a difference.

Now a senior physician and PhD candidate, she remembers coming back from Canada and attending the daily patient meetings.

“At least three times a week, we would deliver a baby, admit the mother to the recovery ward and show up the next morning and she would be dead,” she says.

“I knew these deaths were all virtually preventable and I knew from my training in Canada that we just needed to take a fresh approach, establish some new protocols, and that we could solve this problem.   I didn’t want another mother to die unnecessarily.”

She and her colleagues developed and implemented a so-called High Dependency Unit and worked collaboratively to identify the women most at risk, remove them from the general ward and monitor them every thirty minutes in the 24 hours after delivery.

In the first three months following implementation, not a single mother died in childbirth at Mulago hospital.  Not one.

Five years later, mothers still die here but the number is down to 1 every other week and sometimes, only one per month.   Still one too many, but so much better than three a week.

Since Sarah started this program, at least 650 children didn’t go home from Mulago motherless.

I ask her what success will look like ten years from now, not sure what to expect.  Her response shows her humility and humanity:

“I really hope every mother here will have a bed.”

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Sense of place

Travelling to a new country has its own rewards.   Seeing the sights for the first time.   Smelling the unique scent of a place or tasting the food of a new locale all build memories and add a sense of newness to our memory banks.

But coming back to a place, for me anyway, has an element of accomplishment and connectedness that is far more rewarding.   Having a sense of place really matters.

For the next two weeks, I have the privilege to work my way across Uganda for the second time in a few years.   We have just arrived and already, I have a level of comfort and connectivity with the place and its people that I cherish as much as the work upon which we are about to embark.

I will spend my time with the dozens of physicians that have trained through the International Outreach Program and our unique partnership with McMaster University.   It will be an opportunity for me to bear witness first hand to the impact these remarkable people are making on a country that desperately needs them.

And despite the opportunities that await them in other countries, these smart, young physicians are all committed to Uganda.  Their participation in our program, through additional training in Canada, doesn’t want to make them flee what is back home.  It emboldens them to change it.  For their people.

Place matters.

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What’s it like to travel seven hours through one of the poorest countries on earth?

It’s exhausting. Physically and emotionally.

Physically in my case yesterday because the road we traveled has to be one of the worst anywhere on the planet. Of the 7-hour trip, the last three are spent on what I can only describe as a bumpy garden path wide enough for two cars (barely) over terrain that has never been graded. There’s no worn-down flat part because this ‘road’ is made out of rocks (small boulders actually) and three times, we had to cross a river without a bridge. When the rains come, the road is impassable. And this is the only access from Port-au-Prince to La Pointe where we are staying. To dull the monotony of the return trip, I’ve convinced my host to let me drive home.

But the real drain is on your emotions. I found myself tired last night. Tired of seeing people live in miserable conditions. Tired of seeing little babies struggling for life due to malnutrition; one of whom surely died through the night. Tired of hearing doctors telling me stories that would make you cry. Tired that the world, despite uncountable efforts, seems so damn incapable of ridding us of this scourge. Of poverty.

And then the guilt sets in. I get to go home. I will eat tonight. I will sleep safely. And then…how dare I let myself get tired from just seeing their poverty. They’re the ones who have to live it.

The guilt is crushing. And it’s a useless emotion because in the end, it’s selfish.

The balance comes from, all of all things, the wisdom of the tacky serenity prayer you see on bumper stickers: know what you can change and what you cannot. Our work cannot rid this land of poverty, nor can it solve the crisis that is public-health here. We can however, help a little hospital work a little better. Patients there will get care that is a bit more timely, a bit more effective, and a bit more clean today than they would have a year ago. There’s a little baby boy that (hopefully) had his first birthday last week because two of our volunteers saved his life minutes after he was born last October.

I held that baby last year. I wish I could see him today. Maybe he’d give me the hope I crave.

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Looking for it, instead of at it…

Six weeks ago we shipped a container full of medical supplies, birthing beds, and 300 feet of plastic pipe to hook up the water system at the hospital. Worst-case, it takes 4 weeks to get a container to Port-au-Prince. We left ourselves a lot of wiggle room. Or so we thought.

Alas, nothing in Haiti is predictable. With the change in government last week, we got caught in transition (and translation) and as of this morning our container had not cleared customs. Only a senior government official can do this and despite our best efforts, we couldn’t find this elusive character.

We hoped to get here and start the week by looking at our supplies. Instead, we’ve spent the last two days looking for them. We’re only here for five days and I was worried we wouldn’t meet our goals so we made a decision to stop waiting on others. We had bought supplies locally many times so we figured we could do so again, even if 300 feet of piping was a tall order. We had already expanded the scope of our water project the day before, so we were going to need to buy more anyway. Why stand around waiting for some official to grant us our goods. Action beats waiting any day.

As I mentioned in the post this morning, our goal is to provide clean water to the maternity ward by the end of the week. The only way that can happen is if we start today. And so we went to work. You can see below that the reference to the “Haiti Home Depot” is based on fact, although I suspect this is not a licensed franchise.

The Haitians are nothing if not enterprising.

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