Making Progress

Peace Corps headquarters in Washington has issued a medical clearance for my return to Uganda!  The clearance was communicated to PC medical staff in Uganda and to the country desk in Washington, DC.  The next step is to find a suitable site for me.  I have no idea what the timing may be.  I will keep you posted.

How long? Not long.

I have not offered status updates in quite a while because there has been no progress. Although micrometers might be to gross a measure to record my progress it appears I am moving forward. I spoke with a PC staffer yesterday and she asked for additional information from my physician. As it appears their desire for information is unending I asked her what will happen after she gets that information. After several iterations of her answering questions I had not asked she finally said receipt of the requested information would complete my file and she would then approve me to my return to Uganda. Then the file would be turned over to the country desk. She would not comment on the process/procedures at the country desk and I did not ask her about steps subsequent to the country desk.

As a personal philosophy I believe that life presents us with challenges to help us grow. Life places us in situations that test us in our area of weakness. We pass the test by growing capacity in our area of weakness. We are repeatedly challenged with such situations until we are competent enough to move on to our next weakness. I assume I need to learn patience and forbearance. If I pass this test then I wonder what will be the next weakness for development.

I hope you are all doing fine. To my fellow volunteers I hope to see you soon. 

PS  My physician provided the requested infomration to me early this afternoon and I will send it to PC this afternoon. If only PC was as responsive.

1961 Chevrolet Belair

Things are looking up!  A few weeks ago, the consulting cardiologist that the Peace Corps selected to evaluate my condition completed his work.  In addition to his medical report of my condition he provided a letter to me and to my medical file that in part stated “…he (Howard) can return to Uganda as a Peace Corps volunteer without restriction.”  Of course, the consultant can only offer his medical opinion, the Peace Corps medical and administrative staffs are the decision makers as to my reinstatement.  However, the cardiologist’s endorsement was my first step in the process.  I have submitted an official request to the Peace Corps for reinstatement. 

On last Thursday, Peace Corps staff informed me they would begin evaluation of my medical qualifications for reinstatement during the week of June 10.  I am optimistic about returning to Uganda and I sense enthusiasm for my reinstatement.    Recently my cardiologist measured my blood pressure at 107/68 with a pulse of 58 versus the 150/90 recorded in South Africa.  I have been walking 20 miles every other day to try to maintain my weight.  I have had minimal success on weight loss but I do feel better after the walks.  About 12 days ago I had to stop walking because I developed bursitis in one ankle and exacerbated tendonitis in the other ankle.  The first car I ever owned was a 1961 Chevy Belair purchased in 1971.  I spent the next three years repairing it.  Sometimes I feel like my Chevy Belair.  Always something…

BACK IN THE USA

In October a fellow volunteer and I were walking to a luncheon meeting when I suddenly experienced chest pain and nausea.  It was a hot day and I assumed I had failed to remain well hydrated.  When we reached our destination I sat down, drank several glasses of water and within moments felt great.  I resolved to be more careful about hydration.

 

 Fast forward to February

It is 3:00 AM on a Monday; I am laying in the bed sweating and praying for even the slightest breeze.  Suddenly, chest pains.  I ask myself, “How much water did you drink on Sunday?”  I don’t answer.  Not because I don’t talk to myself, but because I have no idea how much I drank. 

At approximately 3:00 AM on the following Tuesday I am lying in bed and sweating.  Chest pains.  “How much water did you drink on Monday?”  This time I answer, “Three liters.”  Now I am worried. 

 

  

Fortunately, I was already scheduled to go to Kampala to have dental work done.  Prior to seeing the dentist I reported to the Chief Medical Officer (CMO) at Peace Corps and informed him of my symptoms.  The CMO ordered an ECG for later that afternoon and a blood test to check for heart muscle damage.  The next morning a consulting cardiologist read the ECG and I was admitted to the ICU at Nakasero Hospital in Kampala. 

Meanwhile the Peace Corps chartered an air ambulance to take me to a hospital with more advanced equipment.  In addition to a two person flight crew the ambulance was staffed by a British intensive care physician and an emergency room nurse practitioner.  By 7 AM the medical team was at the hospital to transport me to Pretoria, South Africa.  They had flown from Nairobi, Kenya to Entebbe, Uganda where they hired an ambulance to pick me up at the hospital. From Entebbe I was flown to Pretoria, South Africa and admitted into the ICU at Wilgers Hospital.  A day later they had a diagnosis and treatment began.   

I can do nothing but applaud the way the Peace Corps responded to my situation.  The response was sure, swift, and very professional.  I could not have asked for more.   

After discharge from the hospital I remained in Pretoria for several weeks, to ensure I was stable, and then sent back to the States.  Right now I am with my brother and his wife in Texas. I have been medically separated from the Peace Corps and therefore am no longer a volunteer.  However, I was told that if I reduce my risk factors for cardiovascular disease, if there is no recurrence of acute episodes over ~90 days, and my cardiologist in the US is supportive then I can ask to be reinstated to active service.  My request would need approval from the country director and both local and Washington based Peace Corps medical staff. 

I am committed to returning to Peace Corps service as soon as possible and I have reasons to be optimistic for a favorable outcome.  I fully expect to achieve the reduction in risk factors.  My blood pressure is already in the normal range (multiple confirmed and consecutive measurements with diastolic below 80 and systolic below 120).  With my recent weight loss I already have a good Body Mass Index (BMI) but now I am intentionally losing weight in pursuit of an even lower BMI.  My cholesterol is already low but I am now on meds to increase the level of ‘good fat’.  Since returning to the States I have embarked on a fitness program.  I walk 11 to 13 miles every other day and created a strength training program to build lean mass.  My original plan was to enroll in a health club but upon reflection I have decided to only do programs I can duplicate in Uganda.  So I have two knapsacks that I have loaded with bricks and cinder blocks and I use those for many of my exercises.  All other equipment I use is readily available in Uganda.

The clinical literature reports that my type of spasm is controllable with drug therapy over 90% of the time. Thus I am optimistic regarding recurrence of acute episodes.

On Monday I saw a US cardiologist.  He has ordered additional tests and I have to meet with an additional specialist but based on his feedback I am encouraged that a compelling case can be made to the Peace Corps as why I can safely be reinstated to volunteer status and return to Uganda.  My next appointments are on April 23 and 25.  Test results should be available soon thereafter.  I will report more at that time.  

Due to the way I departed Uganda my US cellphone remains in Uganda.  If you wish to reach me then send an email and I will call you or if you wish to call then call my Mobal number which is 01144 7738 803168, from the US or Canada.

Language Retest

In December, I started language lessons in preparation for my retest in January. (The retest date has been moved to March.)  My teacher is Lydia.  She is a primary school teacher and we meet each evening in a local Catholic primary school.  I feel we are making progress.  I have mastered the greetings, can understand prices expressed in the Lugandan language and can make small talk.  I should mention that greetings in Uganda are elaborate affairs that go on for several minutes and that require certain calls and responses.  My teacher has taken, what for me, is a novel approach.  She is teaching me to read and write the language simultaneously with learning to speak it.  Having to write the language has accelerated my learning.  It is also helping me train my ear to hear the language better.  That is increasing my comprehension.  I can actually write Lugandan better than I can speak it.  I intend to continue with a tutor throughout my tour of duty.   

 

School where I take my language lessons.

                                                     

View of classroom where I take my language lessons. (front)

                         

My tutor Lydia.

Some of you know that my retirement plans include annual bike trips in foreign countries.  My plan is to select a country through which I will bike, and then spend a year learning the language and reading the country’s history and culture before departing for a 30 to 60 day bicycle tour of the country.  (At the conclusion of each trip, I will take a weekend course at a culinary school in that country.)  Previously I had been concerned because I had never successfully mastered a language in the past.  The Peace Corps experience has taught me that I can learn a language and has helped identify the approaches that seem to work well for me.  

I have included pictures of the school grounds and the classroom where I have my lessons.  By US standards, the schools lack books, technology, and infrastructure.  A number of schools were forced to close because the schools lacked functioning pit latrines.  Imagine schools without toilets!  A Peace Corps colleague teaches at a nursing school.  The students have their first exposure to computers in nursing school where they learn how to turn it on, and navigate through Word and Excel.

Teachers earn very little in Uganda.  It is usually the last job one will take because the pay is so low.  For many Ugandans only complete unemployment is worst.  This year, to add insult to injury the teachers did not receive their pay in December or January and likely will not receive any pay before March.  A computer error removed nearly all teachers from the payroll system.  They now must complete and submit paperwork to be re-entered into the system and paid.  Ugandans celebrate Christmas much like Americans, with gift giving, toys for the kids and visits to home for family gatherings.  Thus, the lack of pay could not come at a worse time. 

Families are responsible to pay school fees each year.  I recently had a conversation with a young man about 20 to 25 years of age.  He is a ‘plant manager’ at a local dairy collection and cooling station.  (Uganda law requires milk be cooled shortly being drawn from the cow.)  Like many conversations I have here, he wanted money.  In his case, he wanted me to give him the money to pay school fees so he could complete what we would call high school.  He told me it would require UGS 1,200,000.  (~ $480 US)  Before I joined the Peace Corps, I decided I would limit my assistance to what I could do as a volunteer and would not become a funding source to fix people’s problems.  I declined to give him money.  I did brainstorm with him to identify strategies he might employ to complete his two years of schooling.  We did some simple calculations based on what he said he had already saved and projected how long it might take him to accumulate the funds necessary to finish school.  If his inputs were accurate, he can have enough money in two years, even if his income falls by half.  I shared some budgeting concepts and principles with him and provided specific steps to take in creating a budget.  I asked him to stay in contact and let me know how things progress.  We will see what happens. 

His reaction to the calculations for the projection was interesting.  He quickly grasped the calculations and understood what I was doing but it was as if he had never thought of doing such a thing.  His facial expression was one of both surprise and hope.  I hope he also had the feeling of having some measure of control over his life.  I will call him in two or three weeks to see what he has done and offer encouragement. 

This weekend I saw another illustration of how desperate some Ugandans are to pay school fees.  In the space of 24 hours, two female university students approached me about school fees.  In both cases, it was clear that sexual favors would be forthcoming if I contributed.  

A Day in Uganda

I often travel by taxi to a neighboring town ~40 kilometers away to shop.  The prices in Nakasongola are outrageous.  (One of the main reasons is the merchants travel to Luwero to purchase items for resale in Nakasongola.)  For example, I use a lot of bleach for cleaning floors, walls (the lizards leave droppings that sometimes adhere to the walls), dishes, and my bathing area, as well as laundry.  The largest size bleach commonly sold in Ugandan villages cost 5,500 Ugandan schillings (UGS) in Nakasongola and only 3,600 UGS in Luwero.  Although the   taxi trip costs 5,000 UGS each way, if I consolidate my needs and make one trip a week then it pays.  Recently I traveled to Luwero and the trip seemed to represent in microcosm many of the challenges and dilemmas faced by Uganda. 

The taxi pulled up to a stop and began to board passengers.  From inside the taxi I observed the following scene.  (I wish I could have taken a picture.)  A woman had a sleeping infant strapped to her back.  She was dressed in an evening dress.  Yes, I did say an evening dress.  In the villages, Ugandan women dress in long skirts or dresses that are well below the knee.  Indeed most commonly, the garment is at or just above the ankle.  Most often the clothing is purchased from vendors who sell second hand clothing sourced from the US and Europe.  Western evening dresses are just the ticket for Ugandan village women.  It is common to see a woman walking in an evening dress down a muddy and potholed street in one of the villages.  Get closer and you can see the ‘gown’ is tattered, with seams repaired in thread of a different color, missing decorations and perhaps hanging threads and the woman is dressed in flip-flops.  (To be fair on special occasions the women may be dressed in very stylish fashion with high heels and look like they belong in the pages of a fashion magazine.  I do not know how they prevent their heels slipping into the mud.)        

The woman was operating a small food stand.  A second and somewhat older child sat on the ground playing.  The woman was wielding a single bladed axe as she split a piece of wood to feed the ‘campfire’ she was using to cook the food she was selling.  She was selling beans with chapatti.  Chapatti is a kind of flatbread.  She was one of four chapatti vendors in a row on that side of the street and there were two others on the opposite side of the street and even more down the block.

A woman burdened with too many children.  Where was the husband or father of the children while this woman tried to do it all?  How can over six vendors of the same undifferentiated item in a village of <6,000 possibly each earn enough money to provide substantial support to a family?  With virtually no manufacturing sector, few extractible natural resources (except recently negotiated oil leases) how will this economy provide enough jobs for a population that is growing 3.58% per year?  (Uganda has the third highest population growth rate in the world.)

• The average Ugandan family has six children.  In private, women say there are too many children.  They are hesitant to make such a statement when men are present.  Women that insist on condom use are spurned and if she is a wife, she risks a   beating(s) by her husband.  A woman that uses the pill without the permission of her husband will be beaten or even abandoned.  Abandonment in Uganda means the wife must leave the marital home. 

Domestic and gender abuse is a big problem in Uganda.  Recently, I saw a man and woman fighting as I passed by in a taxi.  A small group had gathered to watch the fight and it was occurring in front of a residence.  I only saw one blow before the taxi passed but I did see the woman on the way to the ground.  A woman that fights back risks death.  Even in an abusive relationship, the woman may have no allies.  In the event she tries to leave the abusive husband, she may find her family insisting that she remain in the marriage.  Traditionally the groom pays the brides family a bride price to have their permission for marriage.  In the event the husband decides to give the woman back then the woman’s family must return the bride price.  If the family does not have the money to return the price and the husband is unwilling to compromise then the bride’s family will side with the husband and force the woman to stay in an abusive relationship. 

I boarded the taxi and sat in the back row next to a woman holding a baby in her arms.  The woman might have weighed 70 pounds.  She had patchy short hair and protruding eyes.  Her pallor was poor and I noticed skin peeling from her hands.  I am not a diagnostician but she looked like she had HIV/AIDS.  The baby had the orange hair commonly associated with malnutrition/starvation and was silent through the entire trip. 

• Uganda has the third highest rate of HIV/AIDS in the world and malnutrition is common.  The land is fertile and one can generally get carbohydrate calories, however protein and trace elements can be in short supply resulting in an increased incidence of goiter, short stature, and mental retardation.  Without the intervention of the US in providing antiretroviral drugs there would be a lot more AIDS related deaths in Uganda.  What happens if at some point the US Congress decides it can no longer afford to pay for the drugs because our taxes and deficits are too high? 

Taxis carry freight as well as passengers.  In this case, stored under the back row of seats were several 100 kg sacks of cassava flour.  Indeed my feet were propped on top of one of the sacks.  (Thank God, for the weight I have lost because the 270 pound-Howard would not have fit in the last row.)  Tied to the top of the taxi were about 30 live chickens.  The taxi was full and so the driver was moving with dispatch along the road.  He hit a bump in the road, propelling the rear of the taxi into the air, and catapulting one of the chickens out of its restraint and off the taxi.  The woman with AIDS was the only one that noticed the chicken leaving the vehicle.  She cried out to the driver to stop but her voice was too weak to be heard by anyone other than her other seatmate.  The seatmate yelled to the driver to stop and then the owner of the chicken joined in the chorus and the driver finally stopped and turned around to go back.  He reached the scene and there by the side of the road the chicken was grazing in the field.  The conductor dismounted from the vehicle and began to chase the chicken across the field.  Fortunately, he was a farm boy and knew how to catch a chicken.  The owner brought the chicken into the cabin with us and we were off again.  Everyone in the cabin had a funny quip to make about chickens and about the driver.  Even though I could not understand all that was said, the humor was obvious.

Taxis are licensed to carry 14 passengers plus a driver and a conductor.  Our   taxi was loaded with 16 passengers when it approached a police traffic stop.  The taxi slowed but the police officer was on his cell phone and waved the taxi through.  About 20 kilometers later, we approached another traffic stop.  He ordered the taxi to stop.  The driver immediately left the cab of the vehicle conversed with the officer and shortly later returned to the cab and took off.  From where I was sitting, I could not see what transpired but my Ugandan friends have opinions.  Corruption is a big problem in Uganda and charges of corruption are sometimes used as a political tool which makes it even more difficult to understand when it has actually occurred and when is it just political theater.  As a guest in this beautiful country, I have no opinion.

I arrived in Luwero, met a fellow volunteer, did my shopping, had a beer, and went to the tax park (a staging area for taxis) to board a taxi to Nakasongola.  A conductor asked me where I was going, I replied Nakasongola and he said board my taxi, as that is where we are going.  He even forced a passenger in the front seat to move over so I could sit in the front due to my height.  He also quoted the mizungu price of 5,000UGS.  The trip back was uneventful until the taxi stopped at a junction.  One road led to Nakasongola and the other to Saasira.  The driver and conductor decided they were going to Saasira and that I would have to get off and take a boda (motorcycle) to Nakasongola town.  Moreover, they demanded I pay the fare on the boda.  I demonstrated a little American anger and the driver decided he had had enough of this mizungu and made arrangements for an oncoming taxi to take me to Nakasongola for no additional charge to me. 

There it is, a day in Uganda.       

A former colleague sent the following link to me.  It is a video representation of human mortality over the last two hundred years.  I leave you to draw your own conclusions about its usefulness.  If you feel the conclusions are valid, how might they be used to advantage.  I am interested in your thoughts.  

http://freakonomics.blogs.nytimes.com/2010/12/07/ visualizing-mortality-history/