More: https://picasaweb.google.com/sleely/Zanzibar?authuser=0&authkey=Gv1sRgCIzbt8ab-LWL0wE&feat=directlink

Photo Overview of Uganda

This selection of photos is from my whole time in Uganda:

https://picasaweb.google.com/sleely/UgandaTour?authuser=0&authkey=Gv1sRgCMS6nYnnqeK-Yg&feat=directlink

Shira & Mira in the field (photos at the end)

Patients slowly file along the dusty road, past the water pump, into the shade of a single huge tree in the middle of the health center. Rows of wooden benches are crowded into the tree’s shadow, and a scale for babies hangs from a branch. Some patients arrive riding unpainted bicycles or sitting on the padded, tassel-ringed passenger seats mounted over the rear wheels of bicycles or motorcycles, the women sitting side-saddle with infants in their arms or swathed to their backs. They are perhaps 90% women, most with a young child, wearing dresses that are a cacophony of mismatched color-swirled fabrics decorated with repeated patterns of teardrops, leaves, umbrellas. They sit tall and silent, packed so closely they are touching. Sometimes one hands her baby to the man or woman beside her for a few moments; I wonder if they've met before.

The shade-tree is the center of a compound housing a dozen buildings, each painted a pale, solid color with open windows and a concrete stoop. There are staff quarters and latrines for those who stay onsite, in-patient wards lined with twin beds for general patients, women, maternity and TB, a laboratory equipped with microscopes, freezers, and sometimes power, and clinics for out-patient treatment, ante-natal care, children, and HIV patients. The few staff who have arrived early sit in back offices preparing for the day’s work while the patient numbers slowly increase – five, fifteen, fifty.

Each patient carries a worn school-child’s exercise book, of various shapes and bindings. As they file in, each sets the exercise book on a table in front of the closest building, then takes a seat.  There is no clock, but the minutes tick by. No one asks questions or expresses impatience; there is no rush. One woman is lifted from the back of a motorcycle and laid on blankets on the ground; then everyone returns to their seats, quietly. A man shows his infant her own face in our car’s sideview mirror. A few set blankets in the shade of other buildings and trees, perhaps eating roasted corn wrapped in paper sold from the roadside just outside the health center. No one is drinking water, though the dusty heat is slowly increasing.

The scene is typical at 8am at remote health centers across the country. Around 9am volunteers and staff arrive at the tables and begin sifting through the notebooks is order, calling patients one by one to learn their purpose, take their weight, height and arm circumference, and send them to the appropriate clinician. Patients travel up to 30 or 40km to reach the clinic, leaving behind dependents, chores, and income generation for most of the day. These are government health facilities, and most services are free of charge, supported by international donations – for HIV, at least, primarily funded by the US.

Some of the sick patients are checked for HIV, using quick tests easily administered by a volunteer or nurse. In the US, anyone HIV-positive is treated with anti-retroviral therapy (ART), but in countries like Uganda the costs seem prohibitive. In the US, laboratories check the amount of virus in each patient’s blood, but again this is not feasible in Uganda. Patients are therefore tested to count a type of immune cell affected by the virus; if the count is below a threshold or if the patient is very ill, they are provided with ART; if the count is above the threshold they are given antibiotics to boost their immune system. Re-counts of immune cells are supposed to be repeated twice annually to monitor patient health and determine ART effectiveness.

Analyzers for checking immune cells (CD4) were traditionally designed for the first world – for research and organ transplants – and they require first-world infrastructure and skill. Blood has to be prepared and sometimes refrigerated; machines require uninterrupted power and temperature and humidity control. Lab technicians must be trained to prepare samples, as well as computer literate. In Uganda such infrastructure is available only in limited settings, and so patients or blood samples must be sent long distances to central laboratories for testing. Patients lack the means for distant transport, and so systems have developed whereby blood samples are collected on specified days from each health center, transported in cold storage on motorcycles to hospitals, and processed. Weeks or months later, result documentation reaches the health centers to be sorted into patient records, and on their next visit patients can then be provided with treatment if qualifying. In the meantime, though, some patients have returned to find no result available. Other patients have fallen ill or died. Some patients never return. Projects and policies have sprouted across the continent to address issues of blood collection and transport, testing, monitoring patients, tracking data, etc. One of my projects is development of a reliable national sample and results transport network.

Today, though, there is a rather new solution. One trend in diagnostic technology is toward portable battery-powered analyzers requiring no climate control and limited operating skill. Uganda is piloting such analyzers, and this is one of my projects. With this technology patients could potentially arrive one morning at the health center, discover they are HIV positive, be tested to determine whether they qualify for treatment, and receive counseling and medication before departing. Successful initiation of treatment is not only crucial to the health of one patient and the situation of their dependents, but recent studies have proven the long-held belief that appropriate ART treatment reduces virus transmission to others.

The new technology is so reliable and easy to use that the greatest challenges are with system integration – national policies, daily procedures, staffing levels and record-keeping have developed based on the limitations of conventional technology, but to take advantage of the benefits of the new technology trends, the system has to change. Traditionally HIV treatment was concentrated on specific weekdays to collect batches of samples to send for testing and to free staff for other tasks on other days. However, ill patients arrive daily and testing and treating them as they are discovered requires staff, records and facilities to be available to these patients every day. Results have to move from the analyzer operator to the clinician and patient within the facility, but this was previously not part of anyone’s job. These are small changes, but there are many of them, and they are crucial.

Designing and testing this system is my goal for the next few months, and a graduate student (Mira) has joined our team for the summer to focus on this project. Together we visited health centers to observe and understand their practices and culture, and now we are designing not only a system, but also the tools and training program to implement it nationally. Then we will try the system at a few centers, adapt our plans as we learn, and collect data to demonstrate that – hopefully – the system is effective. The intention is that this system is used at hundreds of sites across the nation – perhaps influencing system design in other nations – as increasing numbers of such technology are deployed across the developing world and more and more companies release competing products to the market.

Click here to see more photos at 2 health facilities

Photos Galore!

I'll write more about my work soon, but here's a pictoral introduction:

First, I moved into my long-term house with one housemate (who's rarely in town). Very comfy place - and there's a spare mattress waiting for you.

 More photos here (none of the bedroom...no good angle...you'll have to come yourself) https://picasaweb.google.com/sleely/HomeSweetKampala?authkey=Gv1sRgCLynnLjNqaShPA&feat=directlink

2) For work I sometimes go "up-country" and then we inevitably shop at roadside stands where everything is cheaper and fresh. Now it's mango season.

 Here is me being hot, sweaty, dusty, and tracking data with our team. One of my projects is a pilot study of a new technology at remote rural health centers, so we visited those centers to collect data and provide support.

More photos here: https://picasaweb.google.com/sleely/PilotStudy?authkey=Gv1sRgCKWDisuNte_qWQ&feat=directlink

 3) Another project is creation of a new laboratory for the special HIV tests required for most infants. Thursday was very exciting because the equipment arrived. The hired manual labor immediately went on strike for higher payments, but between some persuasive speeches and a little praying, we eventually got the machines off the truck and into the lab.

More photos here: https://picasaweb.google.com/sleely/NewEIDHIVLabUganda?authkey=Gv1sRgCOO5vJ2p0tXuXg&feat=directlink

Passover in Kampala

Pesach is one of my favorite holidays because it is one of the twice yearly family traditions (Thanksgiving being the other one) when my whole family gathered together. There was the big meal, good conversation, traditions and board games, surrounded by a few days of hiking, canoeing and fishing with the extended family. My mother led a large community seder with my extended family, who usually arrived late and loudly, seated at the head table. My grandfather led the family seder, at which he was allowed by my grandmother (again only twice-yearly, since he couldn't carry a tune) to sing. Traditionally the leader breaks a piece of matzah and hides half of it for the children to find, and he was a master at clever hiding despite never leaving the table. My mother prepared a traditional spread of food and everyone made their traditional contribution - one grandmother brought stuffed potatoes, the other a root of horseradish which she dug from her garden each year, placed on the table with dirt still clinging to the sides, and then took home and replaced in the earth to grow again for the next year. Wherever I have been in the world, I've tried to have a passover seder. At least one year in Switzerland, I was the only Jew at my seder - but we made the traditional foods and discussed the story with interest and enthusiasm.

This year I was grateful to be invited by new friends in Kampala to their seder. They hosted about 17 guests, most of them Jewish, and I got to bring my cousin Abby who happens to be working 6 weeks in Kampala while I'm here - what are the chances? It was a potluck and the best meal I've eaten in Africa. The set-up was beautiful, the people interesting. They distributed various different Haggadahs and we selected portions of each that seemed worthwhile (or funny). It being Africa, the power was out for the first couple hours and I think some of the plumbing as well. Due to the resulting mood lighting, the photos are not amazing, but I think they show that the set-up was definitely amazing:

My cottage at Maria's Place

(above is the main house - where Maria lives)

(below, inside my cottage)

 the yard in my compound

road to Maria's Place

Welcome back to the dream you had

Outside my cottage three young men are chatting, laughing, and listening to a radio talkshow while they handwash sheets in a huge plastic bin and hang them in the sun to dry. I lie in bed with my laptop on my knees, the mosquito net brushed aside. From far in the distance comes the sound of hammering and a power saw, with the occasional call of a rooster. I am back in Kampala, have walked back into what seems so starkly to have been a dream.

The flight from London was an hour longer, as we skirted Libyan airspace and flew over Sudan. The excessively fertile greenery spread beneath us as the plane approached Entebbe and the equatorial sun rose. My new coworker Evan was by chance on my flight – the second time we’ve landed together in Entebbe – and we rode the hour to Kampala together with the company’s driver Paul. I’d been torn about my decision to return to Uganda, but the greenery, smiles, perfect temperatures, and waiting friends reminded me of why I’d felt wrenched away when I left in February.

My new job is with the Clinton Health Access Initiative (CHAI), which focuses on HIV and malaria treatment and prevention across the developing world. There are global and country-specific initiatives, and my work will focus on HIV in Uganda. I’ll be supporting the Ministry of Health on projects related to laboratories and pediatrics. The team is primary young westerners – 5 focused on HIV and a few others on malaria. The staff are determined, enthusiastic, intelligent, and fun - a close community.

My original interest in coming to Ugandan with AJWS included exploring work in medical technology and strategy in the developing world; I thought it an ideal first step to come to the developing world and learn about the people, culture, and situation. AJWS had no NGO’s focused in my area of interest, but in my free time I tried to meet people in and explore the health sector. My one and only American friend worked for CHAI and was returning to the US for an MBA, and so before I left the country I applied to be her successor.

Returning to the US was strange – I haven’t lived in the US since 2007, and I “returned” to my parents’ cold, cavernous rental house in San Diego. My Ugandan clothes weren’t warm enough for the San Diego “winter” and my only friend was, ironically, a Ugandan, who kept me up-to-date on the national elections. I’d heard nothing from CHAI after my interviews but struggled to begin contacting my friends and colleagues about jobs in San Francisco until I was sure I wasn’t returning to Uganda. I visited Illinois for a week to sort all my childhood possessions before my parents sell the house – reviewing the concrete details of my life, especially letters and essays I wrote about my career interests, was a very moving experience. I then went to San Francisco to look for a job in the US, having heard nothing from Uganda except the frequent emails of old friends wondering when I’d return.

There must be a ShiraLee-targetted hippy energy vortex beneath San Francisco, because I was happy the moment I stepped off the plane. Every old friend I’d contacted offered me a place to stay and their excitement and free time, even after three years away. Every day I met colleagues and friends to chat about our lives, and many helped me with my job search. I was so excited to be there, to build my life in a city I love, to stay in one place long enough to take advantage of opportunities, to invest in people and communities. Even the daily rain couldn’t dampen my enthusiasm; every interaction reminded me of why this life is the one I love. Then I heard from Uganda – an offer for the job I'd wanted most, with CHAI - but if I wanted it I had to leave San Francisco immediately. I was torn, but I had promised myself that my priority would be finding a job that was interesting, challenging, in which I learned new things every day. This I would find at CHAI. And so I left for Uganda with slightly less enthusiasm than had originally overwhelmed me, and a promise to myself to return to San Francisco after the 8 month contract.

I flew through both San Diego and Switzerland to collect my business clothes and other necessary belongings. Even after the emotional rollercoaster of closing my life in Illinois and revisiting my life in San Francisco, I was unprepared to walk back into my Swiss life and find it still intact. The apartment was there, full of the furniture I’d selected, the decorations I’d designed, even the food I’d collected. Little details flooded back – the soap I’d been using the month before I left that smelled good but lathered poorly...Again, I felt I’d left in a hurry – it seems one cannot leave a place gradually – and, though I’d known life had continued without me, it was unreal to walk back into that life and see it there, as I’d left it, only a little evolved – a few new things here and there, road construction, my belongings in boxes in the bedroom, tulips poking up in the garden box, and some junk mail for me in the post. I opened all my boxes, collected anything I could use in Uganda, and repacked the boxes – over 3 days. Each day I met one old friend, but it was a last minute, rushed trip and most of my old colleagues didn’t know I was there. I felt like a secret intruder into my own history, but strangely comfortable; I had missed riding my bike to town and sleeping on my mattress, and the weather, ironically, was gorgeous.

And now I am back in Kampala, though not back to my old life. I live in an upscale, quiet neighborhood full of westerners rather than the loud, crowded, downtown intersection I left. Paul drives me to work each morning, so I don’t walk the dusty, chaotic streets or crowd into a public taxi. I joined the country club across the street and swim or visit the gym almost daily. The most expensive grocery stands beside my office, full of imported western goodies; I miss the market that used to sit across the street, but life is more comfortable. I’ve been training 10-12 hours a day to transition knowledge and contacts for my new job; it’s intense, exhausting, and fascinating. I visited a remote northern health center with a team to collect data to analyze a pilot of point-of-care HIV testing equipment; in a few days test machines should arrive for a new government lab to perform HIV testing of infants born to HIV+ mothers; and I’m helping the team setting up the lab and the transport network to reliably move samples and results between patients across the nation to and from the lab. My second day at work was a conference to standardize national investments in laboratory equipment, and Monday I’ll get to edit the final report of all the decisions. I'm spending Saturday morning relaxing in bed and writing to you. Come visit.

The most amazing nature in Uganda

Click HERE to view more photos

Virunga Volcanos

click here to view more photos

Along the road - typical Uganda

click here to view more photos

Kisumu, Kenya - our AJWS "family" thanksgiving

click here to view more photos

Jinja: The source of the Nile at Lake Victoria

click here for more photos of water and friends

A day in the life of…(part three: evening)

Food

Across the street from my apartment is a fruit and vegetable market. Sellers are sprawled across the dusty earth with piles of sweet potatoes, cassava, “Irish” and huge bunches of green plantains (mah-TOH-kay). Usually they are women, often seated with children. Small 3-walled, roofed stores sell eggs and some sweet white bread. Behind them, two rows of roofed stalls crowd a narrow corridor, laden with sweet pineapple, small spherical watermelons, green pumpkins, big and small bananas, green and black avocados, big purple eggplants and tiny green-yellow-white ones (shaped like eggs!), small and large mangos, carrots, green peppers, tomatoes, green beans, dried beans and peas, dark green leafy vegetables, and more. At one end are cages of live chickens, tables of fish, and counters of raw red meat.

Many of the sellers know me by now, and the prices are usually the same as those for locals. Three large eggplants for 25 cents, a bunch of small bananas for 50-75 cents depending on size and quality. I live on fruits and vegetables sautéed on my gas stove. Leaving the market through a swath of blankets covered with for-sale plastic dishes, flip-flops, belts, hairclips and 2^nd-hand clothes, I can cross the street to the grocery store to buy a box of packaged South African juice and a bag of milk.

Many sellers offer their wares in the streets; when I’m riding in a car I am offered, through the window, bunches of small red onions, passion fruits, peanuts or dry muffins from a bowl on someone’s head, and airtime for my phone. On the side of the road men use machetes to chop huge jackfruit, opening the rough green shell to expose fleshy, sweet yellow fruit that inspired the taste of juicy-fruit gum. Others chop sugarcane and sell chunks in plastic bags. Small stands sell greasy chapatti, or chapatti rolled around a fried egg, called a Rolex.

Transport

Often in the evenings I journey downtown to meet a friend. Beside the market sits a group of white taxi-vans. When one fills with passengers it departs, and the next opens its doors. If I walk too close, a group of young men – conductors – surround me and pressure me into the van, yelling like auctioneers at me and any other potential passengers about their destination and the prices. It took many weeks to understand their rapid shouts. Learning to say the common prices in the local language allowed me to ensure I was charged the same as others, and telling the conductor that one word in his language usually made the whole van laugh (somewhat uncomfortable for me but probably positive) and endeared me to the conductor so much that one invited me to his village on the spot.

In more crowded areas downtown groups of men sometimes block my path and hold my arm to physically pressure me into a van, which I despise. I am always a bit nervous in the vans due to bad experiences and lack of control. I never know how long we will wait before filling and departing. The vans are usually uncomfortable and stuffy. They are all Toyotas, stripped long ago of any excess padding; I think they’d make a stellar advertisement for the longevity and durability of Toyotas. They are packed with rows of seats, and the seats near the sliding door collapse to allow other passengers to enter; those are usually crooked and unpadded; not ideal for a long ride but refreshingly close to the windows. The front seat is perhaps most comfortable, but sitting close to the windshield without seatbelts in chaotic traffic is not exactly comforting, so I avoid it.

The conductors often misquote the price to whites – the skin tax, as they say – so I ask other passengers for the price if I don’t know it. The prices are fixed but sometimes fluctuate with rain or based on demand. If I don’t know how to recognize my destination I ask other passengers and the conductor, though often the conductor has failed to notify me or decided to drive past my destination and leave me elsewhere. Most challenging for me is that the vans frequently decide to use alternate routes to avoid traffic, often on bumpy unpaved side-roads in round-about directions that disorient me. I no longer know where we are or where to get off, and the conductors insist on my exiting where they recommend, without explanation, even if I am not sure where we are. I don’t deal well with the lack of control for myself.

On the plus side, a few conductors have given me spectacular advice and directions, and very often when I ask passengers for help, many people in the van chip in their advice and watch out for my interests. Once when a conductor was mistreating me everyone in the van started yelling at and lecturing him. Most touching is how often a fellow passenger exits with me and insists on walking with me all the way to my destination to ensure I reach it, even it if it is 20 minutes out of their way.

The alternatives to the public taxis include walking long distances along the bustling streets, constantly alert for vans pulling off the road, bicycles and motorcycles, and other pedestrians. I often choose this option, which perhaps explains why all my shoes are now dusty brown (somehow locals’ shoes are never dusty or muddy, even when they’ve just come in from walking in the rain, but when I ask how they achieve it people just laugh).

The final option is to hire a private car, like an American taxi. There is also a stand full of these cars near the market across from my house. When I enter the area, several men look up expectantly and proceed to usher me into their cars. I insist on first agreeing on a price, so they offer me heavily inflated tariffs. When I begin to bargain, they insist that there is a jam (although we both know there is always a traffic jam) and that fuel prices have gone up. When they refuse to come down to a reasonable price and I walk away from them, I am always surprised that they never call me back to offer what I know is an acceptable price.

One of my least favorite things in Kampala is having to make evening plans knowing I must face the stress of either a public taxi or a private one, though I am lucky to live where I have a choice. After 8 or 9pm it is best for me to use the private taxis. Most other people use motorcycles, but I am forbidden and have seen so many accidents I highly respect the rule. But the private cars are considered an expensive luxury by most people, and I have to settle somewhere between stressful bargaining and feeling overcharged.

At home

A couple times I’ve invited girlfriends to dinner, though inevitably the power goes out and we sit in the dark with candles (this rarely happens when I’m home alone). One friend was so kind as to wash our dishes in the dark, and I have a photo of another cooking on my gas stove wearing my headlamp. During one dinner party the water also stopped, and during another the gas in the stove ran out. Fortunately the gas station next door sent an attendant with gas to my place within a few minutes, and he gave some insight to my friends on the rising fuel prices.

Another of my regular evening activities is fitness. Given the stress of going out, I am very grateful for the fitness DVD’s my housemate brought when we lived together my first two months. I bought a floor mat because the floor is too hard for impact sports, and I turn the volume full blast on my computer and strain to hear the instructions over the honking traffic outside. I also have a tennis ball I use to massage my back. The 2 and 4 year old kids who live in the compound discovered my mat and ball one day and were completely befuddled as to why an adult would possess such extravagant toys. I told them the mat was for jumping, and after they bounced around for awhile we played catch with the ball and they have frequented my home ever since. I often look out my front door to see their inquisitive faces pressed to the glass, hoping to find me home. Their mothers insist I should never spend an evening alone, and urge me to join them for coffee in the evenings.

They buy raw coffee beans and roast them on a charcoal stove in the living room. They have a beautiful traditional clay container, shaped like a gourd, in which they put freshly ground coffee and water, with long, stringy plant fibers as a filter. They serve popcorn
with the coffee, and sometimes cake baked in a thick skillet on the stove, and they have a burning ember that smells good and fills the room with smoke. They serve the coffee in tiny cups and saucers, first filling each cup at least 1/3 full with sugar. They then fill the cups to the brim with hot coffee, then add hot milk while the liquid overflows into the saucers and on the tray. I don't know why they always pour until the liquid overflows. They told me never to go home and be lonely or bored; I must always come to see them instead. Once they fed me dinner (pancake-type bread with goats meat stew) and were so impressed that I knew how to eat it with my hands.

A day in the life of…(part two: afternoon)

I bring my own laptop with a USB-modem for internet; it looks like a flash drive and allows me to access the internet anywhere in Uganda. Once I even called Megan from a moving car, though the call dropped pretty quickly. While my computer slowly starts, I check the kitchen to see whether there is any cold purified water, or some boiled for tea. They always mix ground fresh ginger with the tea, though I prefer the rare cinnamon. Office doors are almost always kept closed, for noise and confidentiality. I share my office with one other person and have to venture out to interact with others, unless they wander in looking for her. We are also home to the office phone, which rings many times each day and attracts a stream of hopeful users, though it is too often lacking airtime so cannot be used.

I find the working hours lonely, as I must choose between accomplishing work at my desk or wandering to seek interaction; I prefer the work and interaction to be coupled, but scheduling team efforts here is a major challenge. Lunch is therefore a highlight. Many people send their orders through a motorcycle driver, who collects food at a local restaurant and delivers it for a small fee; others bring food from home, though there is no refrigerator to store food during the warm mornings, nor microwave to heat it. Many days I join the steady trickle of employees who walk a few blocks to eat at a woman’s neighborhood restaurant. The restaurant is perhaps six square meters, if that. There is one permanent wall and three partial wooden sides. Along one small rectangular wooden table is a bench that holds 3-4 people; along the back wall a 2^nd bench for 3 near (but not along) a second small table, and in the middle an extra stool. The proprietress stands in the corner surrounded by pots, bowls, and other containers, some on tables and stools and some on the ground. You choose your “sauce” (beans, beef, fresh fish, dried fish in sauce, groundnut sauce) and a combination of “food” (white or brown rice, boiled mashed plantains, “irish” (potatoes), sweet potatoes, yams, boiled pumpkin, a solid cream-of-wheat style pudding made from ground corn). She heaps enough starch onto one plate to feed me for 2-3 lunches, with a scant teaspoon of “greens” (a spinach-like boiled leaf) and a bowl of sauce. The whole thing costs about a dollar. Runners bring clean plates and silverware or fetch soda or fresh juice from surrounding shops. Customers continuously arrive with containers to take lunch back to their work places. The volume of customers fed over lunchtime is incredible, given the size of the shop, but there always seems to be plenty of food.

Lunch is not until 1:30 or 2pm, and many people take tea (with a snack) sometime between the beginning of the workday at 9am and lunch. When I return from work when the office closes at 5, the young man working at my compound expects me to take tea (with a snack) again. Tea is usually drunk with milk and sugar, and sometimes a spicy mixture of seasoning. Snacks seem often to include samosas and or fried pancakes, or perhaps fruit or a hardboiled egg.

A day in the life of…(part one: morning)

Notable snippets of daily life

Around 5am the call to prayer begins, usually seeping into my sleep as the voice of someone standing nearby talking a little too loudly. Slowly I remember it is the amplified muzeen, and I readjust my earplugs, put a pillow over my head, and hope very strongly to fall back asleep.

A couple hours later when my alarm vibrates there is yellow light pouring through my curtains and the sound of engines rumbling and people shouting in the roads. I crawl out from under my mosquito net, make the bed to prevent the constant dust from settling between my sheets, and flip the switch to turn on the hot water heater, which takes about 15 minutes to produce a showers’ worth.

Careful ironing of clothes is imperative here; wrinkles are heavily frowned upon. The iron has a plug from continental Europe though the outlets here are British; with the correct application of a pen-cap into part of the British socket, the EU plug can be inserted directly into the outlet without adapter. My iron remains plugged into the socket so I don’t have to perform this procedure daily. Every outlet has an on-and-off switch, so I flip the switch on and the iron begins to heat. It's hot enough that ironing makes me sweat, so it's convenient to do it before the shower while the water heats; the only danger is to awaken one morning without electricity, so it is imperative to have a back-up outfit that doesn't require ironing. 

It’s important to use the toilet before taking a shower. The shower is a large-diameter, good-pressure shower-head over the center of the bathroom, so once the shower is complete, the bathroom is covered with water. Stepping out of the bathroom with damp soles or flip-flops causes the water to mix immediately with the ubiquitous layer of dust to produce muddy footprints, so after the shower it’s something of an ordeal to go back inside the bathroom. The young man who works in the compound and cleans my apartment kindly requested that I schedule him no less than twice a week so the layer of dust doesn't build too thick and make his job more difficult; he was frustrated when I went on vacation for 2 weeks and the floor was slippery with dust; I wasn't too thrilled myself.

Somehow I found granola (sold in bags; never boxes) to eat with little bananas and milk (there is skim at one store, but it’s too far away, so I have whole milk, also in bags, or yogurt). The bags of milk last me a week and are difficult to keep from spilling; clearly I don't know the proper strategy.

As much as I hate doing dishes, it’s refreshing to discover, 90% of the mornings, that there is indeed running water in the kitchen sink for this purpose. Otherwise I have to carry pitchers of water from the bathroom sink, which is fed by a tank rather than directly from the tap and therefore provides a reserve of water that only ran low once in 2 months. Carrying pitchers, though, I always find myself feeling grateful that I have a tank at all. Same with having the non-electricity-based gas stove.

The metal gate inside my front door has space for a padlock only high above my head; reaching up to unlock it before unlocking the front door is the most frustrating part of the morning besides re-locking it when I leave (before relocking the front door behind me).

Leaving my house, I wish a good morning to the young man who cleans the balcony floors (every day), waters the plants, washes the sheets, and offers services washing clothes or as an errand boy. He’s also the guard at the front gate of the compound at night. The neighbors in my block of 12 apartments include two Eritrean mothers whose young children have finally begun talking to me, and I wish them a nice day if they are outside.

The small road outside my house is full of people, 95% men, sitting on any available object to have morning tea, washing cars, carrying supplies, building or dismantling old cars, unloading trucks, and watching me silently as I walk to work. A few always call hello to me and ask how I am. Work is a 20 minute walk down a paved road with wide swaths of dusty earth on either side, lined by a low row of concrete shops. There are always trucks in the road and mini-buses pulling off to collect passengers. Someone honks at me every few minutes, and sometimes I think I can tell the difference between honks to alert pedestrians they are in the way and those to catch my attention in case I’m willing to take a ride. Simultaneously, the motorcyclists call to me from every direction “Hello Sistah! My Friend! My size! You come we go! How are you? We go together! Honk!” All public transport solicitors seem under the impression that, though I’ve been walking down this road for many minutes surrounded by constant appeals to ride, I may just yet be convinced to hop on with them. Sometimes other people on the street call good morning to me, even falling into step with me to chat for a few meters about life, work, religion, culture. It’s warm enough that I usually wear a dress with short sleeves, but occasional foggy mornings are cool enough that locals appear in shawls or winter coats.

The most challenging part of the morning is crossing the street; the constant flow of zig-zagging motorcycles weaving on both sides of car lanes, speeding taxi-vans belching black exhaust, and private cars shoving their way around each other to crowd into the intersections are adequate chaos, but always coupled with a constant flow of ambling pedestrians squeezed onto rutted, dusty roadsides, rows of hopeful motorcycle-taxi drivers willing to approach potential customers on the bike within an inch of collision, and manual bicycles outifitted to carry passengers and freight.

Depending on the day, there may be a large crowd of people standing and sitting outside my office, watching me enter. A lottery is held Monday and Tuesday mornings (to prevent people from camping out to get the first slot), and there are always more clients than available appointments per week. The guards nod as I climb the stairs.  The doors are first unlocked at 9am, though as recognized staff I can reach my office earlier through side entrances and a maze of corridors. The office was built to hold about 22 staff and now holds over 60, and sharing is particularly a problem when lawyers and counselors have private sessions with clients about sensitive and confidential issues. I am on the second (and top) floor in the main building over the kitchen and somewhat sheltered from the racket the generator makes every time the city power goes out. After a couple months toting my own cushion to place on a wooden-slatted chair, someone rolled a nice desk chair into the office to use at my desk while I was away, and I haven’t questioned it’s origin since my return.

Thus begins a typical day in the life of Shira in Kampala...

Overview of my work

What am I doing here?

It is easy to write about nature; nature has no sensitivity to being caricatured on a public forum. And wondrous nature is indeed one of Uganda’s greatest treasures. Yet from this blog the most important, interesting, and impactful aspects of my experience in Uganda have largely been lacking – first, the people of my personal relationships, and, second, my work. Still wary of attempting accurate public descriptions of my friends and colleagues, I’ll begin with my work:

Every Monday and Tuesday morning, a large crowd of refugees gathers outside the gates of my office building. They represent diverse ages, genders, nationalities, languages, professions, experiences, family responsibilities, psychological trauma and hope, personal safety and security, levels of poverty, strategies for self improvement, and needs. They have come from many of the countries bordering Uganda, as well as several countries bordering those. Uganda provides a haven from the war or victimization of their homeland. It is also a dauntingly challenging new residence.

Uganda is a land-locked country surrounded on many sides by historical centers of conflict but enjoying relative stability for decades. Near and less-than-idyllic neighbors include the Democratic Republic of Congo, (South) Sudan, Somalia, Rwanda and Burundi, Ethiopia and Eritrea. Uganda’s own history is no fairytale; it’s most infamous scar being Idi Amin’s regime. One of the most common arguments I heard motivating good treatment of refugees was the knowledge that Ugandans may one day themselves be refugees, and the fact that many have experienced forced migration already in their lives. A long war in the north created numerous internally displaced persons, and my company is actively involved in determining how to balance western and traditional justice mechanisms to resolve lingering conflict, rebuild communities, and usher peace and economic development to these regions. Then, too, within Ugandan there are human rights abuses, unemployment, and tribal and ethnic tensions. The refugees and IDPs arrive in this challenging environment with limited knowledge of laws, often limited local language skills, lack of support and broken community structures, experiences of violence, abuse, losing loved ones, and usually rape. They have little bargaining power, few valuables or money, disrupted education and limited opportunity to make a living.

Multiple local and international organizations provide material assistance – food, shelter, clothing, money – though there is always need for more. More rare are the organizations which attempt to change the position of refugees in Uganda by pushing the government and UN for change; it is a politically risky maneuver, but every organization, no matter how idealistic its mandate, must be held accountable by someone.

In Uganda refugees may choose to live in a settlement camp, in which they are allotted sufficient resources to meet their daily needs by national and international aid organizations. Alternatively, they may elect to move to a location such as Kampala – the largest city – and take the gamble to employ their skills to build an independent life and seek greater opportunities than the largely stagnant camp life. If they leave the camp, they are no longer wards of the aid community and must care for themselves. Those gathered outside my company every Monday and Tuesday morning are primarily these urban refugees. Company delegations visit the camps for many weeks each year to provide services, but the work to which I am directly exposed focuses on these urban clients.

The primary mission of my organization is to provide legal aid to refugees, who cannot afford lawyers and are often ignorant of and vulnerable within the foreign legal system. They also provide psychological counseling, free English classes for adults to help them communicate and advocate for themselves, and referrals to organizations that provide material and medical aid. The organization trains police, immigration officers, and other influential stakeholders on refugee policies and rights. They push for existing policies to be respected and sometimes try to change or enact new laws. They research refugee and IDP situations for the purpose of advocating to improve rights, policies and laws for these populations.

What does this mean concretely? A few general examples of services sought by refugees include:

·   Before becoming official refugees, new entrants are called “asylum seekers” and must apply for refugee status from the Ugandan government in order to remain legally in the country and qualify for aid. Asylum seekers may need assistance navigating any delays or rejections, as well as help finding material assistance before (and after) achieving refugee status. As conflicts in the home country evolve, the populations’ status within the national or international policy may change, and they may be ushered home again – more or less legally.

·   While in their host country, refugees may have legal trouble with a landlord or employer, or with government or UN officials. They may be searching for separated family members, or be orphaned minors heading a household. They may face threats of continued conflicts transplanted from their country of origin, such as violence or abduction. They may struggle to access schools for themselves or their children for lack of records from their home country. The list is a long one.

·   Refugees may be victims, in their home or host country, of torture or sexual and gender-based violence (such as rape), and may have been exposed to HIV through these experiences; they may need counseling to move forward in their lives and care for their families, and such experiences put great tension on marriages. Try for a moment to imagine the effect on a marriage and family if a woman is raped and as a result becomes HIV positive and bears a child – What do she and the family feel about the child? What becomes of the marital relationship mentally and physically? How much support does she receive from her family, and they from a traumatized wife and mother? This is only one example.

·   For many, the holy grail of assistance is resettlement to the west, especially to the USA, UK or Canada, but this rare prize is available only to a select few, and most must find means to cope with their new lives in the host country.

If you are interested in more information, ask me for the company’s very informative website.

To return to the initial question – in which several of you have kindly conveyed interest – what am I doing here?

I wanted to work several months in Africa. I am interested in medical strategy and technology development in the 3^rd world, and I believed it a critical early step to spend time in the developing world; only in this way could I be exposed to the culture, the true state of affairs, and insights into which development organizations and strategies are actually effective. I decided to volunteer through the American Jewish World Service, which sends grants and professional volunteers to build capacity in small local grassroots NGOs throughout the developing world. I believe it is a fantastic organization and am very happy to provide more information about its activities and philosophies. At the time I applied, AJWS was sending volunteers to Nairobi, Kenya and Kampala, Uganda, as well as southeast Asia. When I mentioned the African locations to colleagues, Uganda seemed to be known to my parents’ generation as the land of Idi Amin; it hadn’t made major headlines since then. Yet everyone in my generation knew someone who had worked in Kampala and loved the city – the welcoming hospitality toward visitors, the relative safety and stability, the positive attitude toward white westerners. Kenya had a reputation as a more safe and stable country, but Nairobi has a decidedly more sinister side – the need to be home after 8pm, the aggressive interaction with locals, the armed robberies. If you want to know details of Nairobi life I’ll refer you to my co-volunteers’ fantastic blogs. Personally, I was going to Africa to interact with people, and in Kampala I already had a network of contacts – so I chose Kampala.

AJWS didn’t have any companies directly related to my interests, so with limited choices and mounting time pressure, I chose the company with the clearest strategy and organization; I wanted to work for a group who knew what they were trying to accomplish and had a method; I was attracted to the luxury of never doubting that my company was working to have an real impact.

During my 3 months volunteering, I had a variety of projects, and the way I came by those projects will make an interesting intercultural study for another blog entry. For now I will describe the primary work. Initially projectless, I was asked to assist in writing grant proposals. I then reviewed IDP policies with another volunteer to prepare an extensive briefing that my director could use to teach a brief course. I helped staff improve their excel knowledge to create budgets, an unofficial project for which advertisement spread rapidly by word of mouth through the office, prompting a barrage of requests and appointments that inspired one lady to comment that “Shira was going like hotcakes!”

The activity most interesting to me was advising teams on strategic planning. Each team was tasked to draft a 2-year strategic plan, often with limited strategic planning experience and training. For most drafts, the activities were well-planned and the team’s motivation clearly focused, but the objectives outlined in the plans weren’t very concrete or well aligned with activities, and there were limited means to measure impact of the activities or progress toward achieving the objectives. Measuring impact is very challenging in any situation, but especially when providing legal and psychological aid to a population who by definition remain in a challenging, vulnerable situation. And yet the teams were very receptive and enthusiastically attacked the challenge.

My biggest project related to the company’s client management system, in which data about every visit and every client had been stored for over a year but not yet analyzed. I studied the available data and interviewed staff to determine which statistics would be most useful for various purposes, such as designing interventions, advocacy, measuring impact of activities defined in the strategic plans, and grading staff performance. In cases where the existing system allowed extraction of this data, I created visuals of the information and used it to demonstrate to staff the system’s capabilities in order to gain more concrete information on the system’s potential applications. Many of the most useful statistics were not extractable with the existing programming and required a software specialist to adjust the system to allow the information to be searched and quantified. Much of my work was in compiling recommendations for improvements to the system for the future, with concrete examples of how each new tool would be used by staff. In addition, the system currently tracks only company clients, but many refugees visit the company each week and are referred to other organizations whose mandates better match the refugees’ needs. Information about these non-clients and statistics on referral locations are useful to the company but had to be counted manually for lack of a quantitative system. At the director’s suggestion, I taught myself a program to create an easy-to-use form in which information can be entered, which automatically saves the information in excel for easy counting.

I also had the opportunity to attend a 3-day training of immigration officers. I was encouraged to invite myself, and when I pushed for an opportunity to help I was assigned the job of taking notes. Taking notes for 8 hours a day for 3 days, sitting near the lecturer where everyone could watch me, was a big challenge – I have a problem sitting for long hours, and a problem with un-thinking boredom. Yet the information I learned from the training was fascinating and provided a background understanding for the organization’s work. I was also asked to give feedback on any improvements to the training, which was an interesting challenge. Most importantly, though, I interacted with the staff more personally and with the immigration officers.

Each evening, a group of officers left our hotel to have dinner together. They invited me and I was thrilled to accept. Several clearly had respected professional and personal relationships with my organization. They entertained me and the younger officers with endless stories of their experiences, primarily at airport border control. I had not laughed so hard in months, or even years. I made friendships that would last throughout my time in Uganda. My organization’s staff stayed at the hotel or visited their families in the area, so there was no question in my mind that I would join the officers each evening. Yet they were impressed and surprised that a foreign white visitor would split from the group to whom she was assigned and so eagerly join them for fun conversation. Perhaps my luckiest break was that the company car that was supposed to collect the staff broke down on its way to the training; I joined a few officers to drive the 4 hours home and cemented 2 of my closest friendships through the fascinating conversation that filled the kilometers. Throughout the rest of my months in Uganda, they were some of my closest friends. In addition to quality time and conversation, they provided more welcome hospitality than I ever dreamed to encounter, gave me insights into local culture, helped expose me to interesting places and events, found me a place to live, helped me navigate border crossings and documentation, and made me feel great appreciation and interest. Such personal connections are by far the most valuable aspect of my experience in Uganda, yet the most difficult to write about. Pages of blog entries could be devoted to describing my several friends and many acquaintances, to relating fantastically entertaining stories they shared with me, to describing cultural insights and personal experiences. Yet these are not things that belong to the public. This is my first blog and therefore the most public of my writing outside of rather dry scientific papers in specialized journals; I don’t follow blogs (and therefore feel a bit guilty to you who follow mine) – and so I make my own rules. If you are my friend and call to ask about my experience in Uganda, it will be overwhelmingly filled with personal stories of my amazing friends. They are the treasure of my experience.