Into the Pearl

2013-2014
Writer: Chris Grillo
Editor: Chris Grillo
Producer: Mike Esposito
Photographer: Chris Grillo

Chris Grillo was a good friend of John Kelly's at Colgate University. In 2014, Chris traveled to Kabale, Uganda to visit the JCK Clinic and assist with the first rounds of mental health outreach to the community. Below are selected journal posts from his travels.

Bwindi Community Hospital, JCK Clinic Starts Outreach in Kabale

Jan. 22:Made arrangements to visit Bwindi Community Hospital and arrived in the afternoon. As with almost every trip here, it's a process. Had to arrange a public-means pickup at 7am, then return for the trip at 9am. After a 6 hour journey (to travel a distance of about 70 miles), I arrived at Kanyantorogo. From there I was to take a boda to Bwindi but as luck would have it, Dr. Scott Kellermann was passing through with his family (his grandkids, wife and her friend from home) and picked me up. A boon because I wasn't really in the mood to argue against the "mzungu price" set by the available drivers, more than double the usual price. Of course, I'm happy to pay a little extra, but on principle I try not to get gouged, especially in Kabale because I'm going to be living there and frequenting all shops and services for many months. As would be expected, Scott and his family were really lovely. Had a nice conversation on the very rocky ride to the hospital. Jan 23 to 28:At 8am we had a short service and staff meeting to start the day at the BCH (this is a Church of Uganda - Anglican hospital). Scott and his wife began in 2001 with a open-air tent doing medical missionary work with the Batwa, displaced by the designation of Bwindi Impenetrable Forest as a national park. The clinic grew into a 112-bed hospital serving a population in a large part of SW Uganda. Really tremendous success, though not without attendant difficulties. I'll elaborate below. I wound up spending several extra days at the hospital, meeting with various staff as well as Scott a few more times. Obtained a variety of perspectives on the work we are doing, mostly encouraging. One administrator in particular was very enthusiastic about exporting the JCK Clinic outreach model to the BCH, and even partnering in both personnel and financial terms. Scott and I had several lengthy, challenging conversations. Particularly regarding the special difficulties of applying western medical models to African culture, especially among the most traditional, poorly educated and impoverished rural villagers. Not only do they have limited access to modern healthcare services but traditional taboos regarding illnesses, whether physical or psychological, as well as the use of traditional medicine and healers, complicate the application of these services. To say nothing of adverse effects on the health and human rights of the sufferer. For example, in some cases victims have been chained to a tree, while the healer performs rituals which may include cutting the skin on the arms and inserting materials subcutaneously. On a number of occasions I myself have seen strange scars on the chests of Ugandans; reliable sources including Scott confirm that in these cases incisions are made on the skin for the purposes of drawing out evil energies. To further emphasize just how strongly-rooted traditional beliefs in witchcraft remain, I note that human sacrifice is still regularly practiced and in fact at an increasing rate. At least one child dies per week in Uganda. The country even has an Anti-Human Sacrifice Police Task Force. Here are a few articles on the subject:BBC, 2010BBC, 2011Humane Africa, 2013 On a less macabre level, several western medical professionals indicated that, frustrating as it may be to us mzungus, even educated Ugandans (including medical personnel) may not understand or take seriously pervasive but less visible conditions like depression, to say nothing of anxiety-related illnesses such as OCD. Though I grant that it's anecdotal evidence, numerous Ugandans I've interviewed have uniformly dismissed and even laughed at the notion of long-term sadness, crying, etc. Scott also really tested my knowledge of African politics, history, healthcare, the economics of development, etc. By my own admission, my knowledge is still quite limited, though I'm reading and conversing daily to bring myself up to speed. In the few days I was in Bwindi, I was able to read two books from the BCH/Kellermann Guest House's excellent library (sadly, far better than any public library I've encountered yet), including "Shake Hands with the Devil," a powerful and profoundly frustrating firsthand account of the Rwandan Genocide by the Force Commander of the United Nations Assistance Mission for Rwanda (UNAMIR). Worth noting that he is the highest-ranking military officer yet to publicly describe his experiences with PTSD. My goal before I left for Africa was to cover a mental health, development or African studies-related book every few days until I'm reasonably knowledgeable, even to Scott's high standards, of my Ugandan/African and healthcare contexts. Encouraged by Scott's high penetrating insights and questions, I'll try to maintain that improve on that, maybe every 2-3 days. Also, Scott described his and the BCH's ongoing struggles to maintain and expand their facilities and services. As impressive as the organization is, it is not yet truly self-sustaining. Much of their operating budget still comes from private donations, wealthy tourists, and Scott's private income and frequent speaking engagements. The hospital is situated right outside the gate of the major and expensive tourist gorilla park. I hate to give away the game, but visiting western medical staff are sent to the lodges nightly to subtly "work" the guests and encourage them to visit the hospital in the hopes of a donation. I accompanied them on a few such visits. Less than 8% of funding comes from the government and, surprisingly, even BCH has difficulty securing grants. All this will be helpful to the JCK Clinic; Scott had very pointed advice and instructions regarding the strategies we should pursue, and what we can expect as the Foundation secures non-profit status and begins submitting requests for grant money. Scott is a real veteran, with strong beliefs regarding Western intervention in African society. He's dedicated himself to his patients, living among them for years, even building a home. It was tremendously enlightening to engage him in critical examination of the subject but also to get the "facts of life" from him. Yet in the course of explaining/defending Dr. Kelly's model for mental health outreach, I would like to think I softened his views of the JCK Clinic's long-term prospects.  I've stayed in touch with Scott since leaving Bwindi. He's thanked me for visiting and for raising challenging questions about mobile health delivery in Uganda, and encouraged me to report the results of JCK Clinic's work to him and BCH, in the hopes of fostering future collaboration. Webare munonga, Dr. Scott.

Though I grant that it's anecdotal evidence, numerous Ugandans I've interviewed have uniformly dismissed and even laughed at the notion of long-term sadness, crying, etc.

Feb. 4: First day of outreach to two parishes on the shores of Lake Bunyonyi! The day started at 8am. We drove to the lake and hired a boat to take us to the remote villages. After a short delay, as Cetinary and Felex negotiated down the "mzungu price" (white man price) we were being asked to pay, we were underway. I suggested that, in the future, Centinary drop me off out of sight of the dock before driving up and selecting a boat; I could continue on foot a few minutes later. Luckily, they were able to plead humanitarian mission. Everyone enjoyed the boat ride. First village visit! There was a small audience at our first village, limited by funeral services. Apparently there were 2 deaths recently, and all villagers are required, on pain of a fine, to attend services. The ties (or fines) that bind? However, the staff was able to see a small group of patients and make preliminary diagnoses. Met a small malnourished boy. Could clearly see his wispy blond hair, where strong black curls should be. Also quite small for his age. Centinary didn't think there was any mental illness, per se. Seems to be an intelligent boy who socializes well. The trouble apparently was that he's a very selective eater, refuses to eat much other than matoke (steamed cooking banana) and potatoes, and is very deficient in protein. Unfortunately, like many poor villagers, there is little available variety in the family's diet, and so few options for trying another nutrient-rich food source that he might accept. Immediately thought of our enormous Western groceries with an infinite variety of healthy, and unhealthy, food sources. I was frustrated and saddened to ask what foods were available, only to learn that they can only afford meat once per year, I think at Christmas; the boy refuses beans; and the family depends on selling their eggs. Centinary and I brainstormed ways to provide him better nutrition in the short-term until we could follow up on him. I suggested that perhaps the family could finely chop and mash the beans, and mix with the mashed matoke and potatoes, maybe also spare 1 egg per day for the boy? Here's hoping they have some success before our next visit. In the meantime, I'm going to look into things like fortified peanut butters. Perhaps we could arrange a supply for the villages we visit to keep on hand for emergencies? Perhaps JCK Clinic could keep a supply to carry on our rounds? Does anyone have suggestions? I welcome them.  I’m really surprised at the number of epilepsy patients we encountered on this and subsequent visits. I wonder what the pathology is. Centinary suggested that the natural birthing methods employed by most villager mothers (squatting) results in the babies falling from the womb onto the ground, often resulting in head injuries.  The first visit, though small, was in my opinion very successful. A number of the patients had never been diagnosed, let alone received medical treatment, for their conditions. This in itself really validates the clinic's mission. Really very encouraging. Also, I enjoy tremendously learning about these medical conditions and getting first-hand training and education from Centinary and the staff. Now, if only I could follow along with the conversations in Rukiga. Ran into a large group of woman with children sitting in the covered entrance to the health facility. They are there for a family planning lecture and birth control implantation (or removal) procedures. Medical treatment is done en masse in rural villages like these, since medical professionals are not resident full-time but rather visit periodically. Very large audience at the second visit. Centinary and Felex seemed to be excellent and very comfortable speakers. Lots of interaction with the audience, who seemed very engaged in the topic. Again, I wish I could follow up with everyone, but hopefully in a few months I'll have picked up something of the Rukiga language. A very large group of patients diagnosed today. As before, a large percentage of them had never been treated before. A number of individuals with epilepsy, one experiencing psychosis, one who actually had been previously diagnosed with depression (and I thought no Ugandan took this seriously), and one with schizophrenia. Since this is a warts-and-all approach to a blog (where's the value in white-washing things?), I'll admit that I was unnerved in dealing with schizophrenia, at least for a time. I've not really had exposure to some of the more "serious" mental illnesses before. Perhaps like most people, I turned a protective blind eye to these sufferers. Anyway, the schizophrenic approached me as I sat with Centinary and Felex beneath the trees shown above, while they delivered the talk. As I greeted him, he gripped my hand and never let go for 15 minutes, repetitively muttering to me in panicked, whispered Rukiga. He seemed desperate to have my attention, if I looked away he tugged me back. His eyes showed, I guess, some combination of fear and sadness. I wasn't sure what to do. In spite of my best intentions, I felt a bit of intense discomfort. But after a few minutes, I was able to calm him a bit. I gently encouraged him to sit down beside me and continued to hold and pat his hand as his muttering subsided. Turns out he's not much of a danger to anyone (and statistically the mentally ill are far more likely to be victims than perpetrators). We later had another brief bit of trouble with him, as he wanted to leave with us, but were able to turn him back to the village to his mother. Again, I'm a bit ashamed of my initial internal reaction to this patient. I know from my own struggles with OCD and depression the debilitating effects of unhealthy thought patterns. So I feel I should have had more empathy. Yet maybe that just underscores the need for organizations like Dr. Kelly's. With roughly 25% of the world population experiencing a mental disorder at some point in their lives, perhaps it is a civic duty to increase outreach. With exposure, education and treatment, we might preserve the humanity of the most troubled among us. Feb. 7 to 12:  Return to Kampala. The clinic's portable ultrasound became inoperable. I went to the capital to attempt a repair of the device. Unfortunately, the device could not be repaired there. The culprit is the very poor electricity infrastructure here in Uganda, which necessitates the use of high quality current stabilizers and surge protectors. I'll have to return to the U.S. with it in July, or Dr. Kelly will have to pick it up when he visits in October.   Despite that setback, I was able to have a good time in Kampala, meeting old and making new friends. Reunited with a fellow mzungu volunteer from Kabale, a Slovenian theater director named Jaka. In his time in Kabale, he worked on a production with and in support of the Batwa Pygmies. Good guy, hoping to visit him in Slovenia when I'm finished here. Attended a concert at the National Theater with the Slovenian folks, for an organization called "The Nile Project." It brings together musicians from the 11 Nile River countries, performing a mix of modern and traditional songs and instruments. A lot of great performers and interesting materials. Should've been unplugged, though, if it's loud for me, must have been deafening for the others. Feb. 12: Kampala to Kabale. Met Luise, German fashion model and documentary filmmaker, on the bus from Kampala. Took her to visit the JCK Clinic on arrival in Kabale. Unfortunately, there wasn't room for her to accompany us on our outreach trip the next day, had hoped she could document some of our work. Feb. 13: Second Outreach! Brought a greater supply of medicine to the villages, so we were able to provide immediate treatment to some sufferers of epilepsy, for example. I enjoy the improvements we've made and will continue to make as we refine the JCK Clinic's healthcare delivery model.  A range of diagnoses today: depression, HIV-induced psychosis, schizophrenia, psychosis, epilepsy. Many patients had not received treatment previously. More validation for the work the Clinic's performing. As usual, many patients visit traditional healers. There's a larger issue here, one the staff and I will continue to discuss as we improve the model: how to deal with the strong beliefs in traditional healing/witchcraft? With the obvious exception of the human sacrifices I discussed above, I think the utilization or at least acknowledgment of traditional healers in the healthcare model is absolutely necessary to successfully educate and treat rural Ugandans. I need to do more research on the traditional/modern medicine partnership. Many interesting studies have already been done, with some encouraging results: NCBI, 2004. OK, you're nearly fully updated. I'll try to make smaller but more frequent posts of 2-4 times per month. Frankly, the last few weeks have been difficult for a variety of reasons. Family and personal troubles, culture shock, so on. The constant power cuts don't help. May try a different tack the next few posts; many things on my mind concerning conditions in this country.

Met a small malnourished boy. Could clearly see his wispy blond hair, where strong black curls should be.

JCK Clinic Outreach Continues, Adventure Break!, Kampala, Personal Thoughts and Observations

Feb. 20:School Address. We began the day by visiting Centinary's old school, Bufundi College Kacereere, and gave a mental health education talk to the students. I finally got a chance to give my first at-length public address, as I was able to speak to the students in English (albeit slowly); I spoke about prevention and early intervention techniques. We also met with the Headmaster for a few minutes to discuss our work and the possibility of helping the school obtain computers (well, there's more to that, which I'll discuss in a future post). 1st Village Visit. Relatively quiet affair. I was able to speak a few half-sentences in Rukiga, so a small improvement. 2nd Village Visit. This took place in Felex's home village. Quite a large audience and patient population today. What was especially notable, however, was a woman suffering from a long episode of psychosis, as her medicine had run out. It was difficult to see her bound and restrained, surrounded by a crowd of gawkers. A lot of mixed feelings about her bonds, also whether it was ethical to record her but I asked permission from her family. I asked Centinary if we could transport her, in our vehicle, to the Kabale Referral Hospital at day's end, as I didn't like the prospect of leaving her in the village to await treatment indefinitely. It was a somewhat difficult 1.5 hour car ride; you can imagine 4 people in the back of a small car, one writhing, spitting and trying to strip her clothes. Especially, as I think I wrote previously, these kinds of patients seem to take a special and intense interest in me as a white person. After arriving at the hospital, we delivered her to the women's ward and assisted the psychiatrist in sedating her. (I found it disconcerting that it fell to Centinary, Felex, the woman's husband, and me to restrain the woman while the psychiatrist injected her. There seemed to be no other support staff in the mental health department.) Rather a difficult experience to be part of: to hold down, through her urine-soaked clothes, a disturbed woman as the doctor tried to treat her. I was somewhat disappointed in myself in that I felt a bit worried as the doctor drew blood and injected the sedative, afraid that while resisting us the patient might be seriously injured. Is this just "too much" empathy or a sensitivity which will improve with time and experience? I just think I should have felt more neutral internally. Well, we will see what comes with time. Feb. 25: Adventure Break. By this point I was fed up by a number of things (I'll elaborate at the close) and really wanted to get away from everyone and everything. So I just decided to make my way to Jinja / Bujagali, the "adrenaline capital" of East Africa. Took the 7am bus to Kampala, then another coaster bus to Jinja. Total trip time about 11 hours to go maybe 480 km? I have to laugh at the 5 hr suggested travel time it would take in Europe/US. Feb. 26: Whitewater Rafting, on THE NILE! Immediately upon arrival, signed up with a group for full-day of Grade 5 rafting, on the Nile! Befriended a rafting guide from Montana visiting Uganda on vacation, whose professional experience has been limited so far to Grade 3&4 rapids. Said he, with a sigh: "Amazing, this is your first Grade 5 experience, and it's going to be on The Nile." Yes indeed, my friend! Incredibly fun day: warm waters made getting soaked a pleasure; huge variety of rapids; long stretches of swimming in the Nile between rapids; pineapple-and-biscuit lunch on the raft while floating downriver; buffet dinner and unlimited beers at the finish; such a fun group that I switched campsites and headed to Bujagali with them that evening. Good decision. Feb. 27: Relaxing at Nile Explorers Campsite @ Bujagali. Bujagali, just 15 minutes from Jinja, was the original whitewater capital before the Owen Falls Dam was built, thereafter submerging Bujagali Falls, creating "Lake Bujagali", the reservoir, eliminating some big rapids and necessitating the shifting of whitewater starting points. It's still important, however, with the addition of horseback riding, ATV riding, bungee jumping, etc. Most importantly, though, the Nile Explorer's campsite is incredible, beautiful sunset views. Very professional rolex-makers (chapati bread with omelette rolled up inside) and other local vendor shacks right outside the doors to the camp—most of us never even bought food from the western kitchen inside. A bunch of us spent a bit of the day on a huge rope swing, plus there was a great slide down the hill. Cleaned up using creatively designed open-sided showers on the lakeside with a great view of the sunset. Feb. 28: Whitewater Kayaking! Full day kayaking with an instructor. Really great guy, competed in Uganda Nationals, and hopes to compete at the Olympics. I have a bit of kayaking experiencing, but all lakes and streams. They're not supposed to work on rolling in rapids on the 1st day with this company, but I was able to convince him to bend the rules a bit (anything can be done in Africa). Great to practice rolling in the rapids, far different than my flat water experience. Haven't quite perfected rolling in all conditions in Grade 3. I intend to return to Jinja before trip's end, or maybe jaunt over to Kenya, to master it and move up to the Grade 4 and 5 rapids. Definitely feel this will be my new favorite sport.   March 1: Bujagali to Mbale. Visited Kilombera Weaving factory on the road from Bujagali to Jinja. High quality handmade fabrics and items made from same.  Finally found some suitable gifts for the Grillo women. [Teaser to Kris, Kim and Mom: expect certain colorful items to add to your collection from Israel...] Always love to see complicated manually-powered machines. Stopped in Jinja to see the "Source of the Nile” March 2:  Mbale. Read about this tiny community of Ugandan Jews, the Abayudaya, on the outskirts of Mbale. Unsure if they're recognized by the Rabbinates of Israel but fascinating nonetheless, they seemed quite legitimate when I visited. Bit of a trip to see this in Africa. March 3: Abseiling and hiking! Started the day by rappelling down the 100 meter high main falls pictured above. Spectacular descent right next to the falls, could feel the mist. Great combination of hot day and cool breeze. Unfortunately my camera was with the crew at top, so I can't give you a perspective of hanging in mid-air next to the falls, and also turning round to see the massive valley stretching out in the distance. After abseiling/rappelling, spent a few hours hiking to the rest of the Sipi Falls. Great weather, hike and views. March 4: Kapkwai / Mt. Elgon National Park Exploration Center & Sisyi Falls. Expensive mistake here today. Had a brisk 5km hike, completed in 1 hr 10 min., but it was definitely not worth the price of national park admission and required guide fee, no monkeys, no birds, no butterflies, and the hike wasn't very challenging. Still, the ranger was pleasant and he got a kick out of my request to push the pace (gotta be ready for the Rwenzori Mtns. Margherita Peak climb).  He was very happy with our completion time, though sorry we didn't see any wildlife. But "saved" the day with a cheap visit to the apropos Garden of Eden campsite on the road between Sipi and Mbale. Most beautiful waterfall I've seen and there's even a pool at its base deep enough for swimming. Another great place for a couple. March 5: Nyero Rock Art in Kumi (in the Teso lands). I knew I forgot something! I was about to return to Kampala from Mbale when I remembered I hadn't seen these prehistoric paintings. No chance I'm going to miss seeing an archaeological site! So I made a day trip back out of Mbale to the town of Ngero.  March 7: Return to Kampala. Visited the Uganda National Association of the Deaf to learn a bit more about their activities and to see if they could help the Vocational Training Centre I wrote about previously. March 8: Visited the Kasubi Tombs World Heritage Site in Kampala. These are the tombs of the Kabakas, the kings of the Buganda people. The very largest tomb (formerly a palace, which Speke visited on his way to discovering the source of the Nile) for the kings, dating from the 1800s, unfortunately was burned a few years ago. They are rebuilding and claim the site will be finished this year. Would love to visit again once completed. Very interesting grass and wood constructions.  March 9: Orphanage visit. Befriended a group of English and German medical students at my hostel, Kampala Backpackers. They invited me to spend the next day with them at this orphanage on the outskirts of Kampala. Beautiful setting and the buildings are of a high quality. By all appearances, it will be a good residence for these children, who were so happy and sweet. They climbed all over us from the outset, and we spent much of the day just holding them. March 11: Visit to Bwaise, one of Kampala's worst slums. This was a bit of an ethical conundrum for me. Early in my stay, I had a conversation with a good friend of mine, another volunteer, who had remarked that conditions "aren't so bad here, that their lives are simpler, they have fewer material goods, but their lives are not necessarily of a lower quality." There is some truth to that (and we in the West could lead simpler lives, to our own benefit, I think) but my own view is that if we travel just a little off the beaten path, we will see unacceptable conditions. And honestly, here, one need not travel so very far off the tourist path. When I see scabbed, filthy, nearly naked children running barefoot among the detritus on the streets; people rooting through the trash heaps for items of value; infants malnourished because they only have a few food groups to choose from, too much of which consists of bread and sugar-based products; orphans huddled together sniffing gas or glue on street corners in large towns with adults standing around as though nothing were amiss; there is clearly something wrong. I don't pretend to know even a small part of what life is like for people in the developing world, and I hope I don't seem like someone who has answers and the ability to help. But I think it's dangerous to be willfully ignorant so I want to, where possible, see what conditions are really like. That itself leads to another question that often comes to mind: is it ethical for me to go around looking at people living in these conditions, as if I were visiting a zoo?  Because there's probably nothing that I can do for them. What right do I have to walk through their neighborhoods, with the security of knowing I'll return to a comfortable environment after a few hours?  But in the end I thought it'd be less objectionable if I tried to be as respectful as possible, asking permission to take these very few pictures, and at least depart with a better appreciation of the facts of life.  I think it's better that the wider world see and be aware. And maybe it'll inspire someone to help? I was struck by the number of propositions I received from prostitutes who were simply standing at the doors of what seemed to be their homes, some with children inside or nearby.  As noted above, I'll write a bit about the reasons for wanting a break from everything and get some action. I'd been preoccupied with a number of thoughts for the last month. First, I've been bothered by all of the double-standards. On the one hand, I benefit from the preferential treatment and, speaking loosely, "safety" I'm afforded by the mere fact of being a white male (I'm sure being a woman here is different experience, which I'll think and research on and write about at a later time). To clarify, in certain sense white expats are "safer" even in situations like mugging--as long as you give up money, they'll live, as they want money but also are afraid of US/EU intervention. Yet a local may be killed here, in his own hometown, for fear of recognition. And in fact, this happened to a MTN (a telecom service provider) employee who was not only robbed but also killed nearby my hostel a few weeks ago. As there are no suspects and likely never will be, no one can state whys and wherefores with certainty, but it seems sensible that it was a combination of resistance and recognition.  To extend this a little further, I'm a little troubled by the precautions Centinary feels he must take while I'm with the clinic, particularly, that he must travel in daylight, home well before dark. The logic is thus: a white man visits the clinic on a regular basis --> therefore there is $$ in the clinic --> therefore the local staff of the clinic must have $$ --> rob the local staff, which is less risky than robbing the white man. While this is a relatively safe place, I do feel a bit concerned that I might in fact bring this kind of unfavorable attention to the staff.  On the other hand, it is true that just by being white I am a target for crime, or at least hustling, in a way locals aren't. Yet on the whole I feel quite safe here provided I don't take excessive risks like moving around in certain places well after dark, etc.  Another disturbing reminder of unique realities on the ground: not long after the MTN man was killed, a young girl was abducted near my first accommodation in Kabale and found dead, but they're not sure if it was for sexual purposes or child sacrifice. This kind of sacrifice is performed by a witch-doctor for the purpose of making the client wealthy.  This actually happens--google child sacrifice in Uganda.  Additionally, a few British social workers I met in Kampala noted they were involved that day with a pair of infants found sealed in plastic bags and abandoned in the sewers. Luckily good Samaritans were mercifully close-by and heard their cries.  How many others have not been found in time, I wonder? And why the hell don't these people have just enough humanity in them to deposit the unwanted children at a hospital, a school, a temple, etc.? The social workers were really traumatized by the experiences, and it affected me also. A matter of less import: surprising number of LT volunteers have such an lackadaisical attitude (hey, it's Africa, anything goes) which I find disgusting or at least disconcerting. I'm currently still dealing with political crap with some of my friends, a crew of European volunteers, because they know I don't approve of several of their number who are openly unfaithful to their partners or spouses. (Glad I wasn't here--being in Jinja at the time--to see one poor woman visit her boyfriend and befriend his lover.) So many travelers do likewise to their spouses/partners. In fact, one woman I got on well with thought it would be OK for us to be together, because she was planning on ending her relationship with her boyfriend "soon, anyway". Sorry, unacceptable. As to the others, I've not made it my business, but I've said I'm uncomfortable with it and don't want to discuss it, as most of them seem to enjoy. The whole "whatever happens in Africa stays in Africa mentality" frankly pisses me off.  Fidelity--at the core of which I suppose are loyalty and honesty--is critically important to me. I'm continuously surprised at the ability of people to rationalize away their baser behavior. [I want to be careful here not to pretend I'm a saint. I've many serious flaws, strong and quick anger, serious self-doubt, unhealthy obsessive/compulsive thought patterns, and I'm sure many other failings my family, friends and ex-girlfriends could enumerate. At least I'm honest about myself and my flaws, even as I try and often fail to improve, and also where others stand with me.] Further, the sexual culture here is, how to say, more intense.  Sort of a merry-go-round, expats and locals alike. So many of my Ugandan friends confess to me openly that they have 2-3 lovers but would have more if they had more money, they don't test/get tested regularly and don't use condoms when they can get away with it (or are encouraged not to). From the many interviews I've had, male and female infidelity is quite prevalent.  And, depressingly though not entirely surprisingly, the incidence of HIV/AIDS is actually increasing here, in spite of the fantastic, effective US-designed and -funded prevention and treatment programs in place; one of the reasons, some doctors and nurses report to me, is the rationale that, "hey, it can be treated." Once again, the ability of human to use their powers of reason to sanction stupidity. On the expat side, using UK as an ex., when one considers that between 15% (for UK-born heterosexuals) to nearly 50% (total UK heterosexual population) of new AIDS/HIV cases among British citizens are contracted abroad, this is still a clear public health issue. Health Protection Agency, 2012 Now, it's certainly none of my concern, and I don't care as far as it goes, but the naivety and carelessness of it fairly shocks me, especially since many of the expats are quite well-educated. Yet some of the volunteers are surprised when harsh reality hits.  Today, in fact, one volunteer returned home to Europe a couple months early, because a local he trusted ran off with money from a bicycle sale. (What do you expect, entrusting $500 in a place where a public school teacher earns barely $100 per month, and even gov't. employees can go weeks without pay?) Another notorious long-term expat was strung along for months, purchased apartment, vehicle, etc. for her boyfriend here, only to find the relationship had always been an illusion. So many other examples of expats hustled. This is not to cast Ugandans in a bad light, only to serve as a warning to expats to tread lightly and think carefully. I recall Dr. Kellermann's reminisces about his early days, "getting taken for so many rides" in his time in Uganda, for which he couldn't blame them. "It's our fault, not theirs." We are rich outsiders vacationing comfortably among some of the world's most impoverished people; if they can fleece naive fools for a few dollars--dollars of far more value to them than a loss to us--is the crime so great? I'd like to go on a tangent about the implications of African dependency on Western aid, including a conversation I had on the subject with a educated Ugandan, a regional director of a prominent U.S. NGO, but I'll save it for another short post. I'll close on a more positive note.  Yes, there are facts of life here which weigh on me: living conditions which depress me, behavior which I disapprove of, so on. Yet I try to look to bright spots like the bright, cheery school in the midst of the slums pictured above, and remember the sweet laughing faces of the orphans, who don't yet know of race and class.  I think of the good work being done at vital institutions like these, and the genuine kindness of the volunteers here (yes, even those whose actions I don't always agree with).  There is cause to hope that we can teach this next generation to improve on our own and, by degrees, better the angels of our nature. Yet again it was a pain to work on this media-intensive blog here in rural infrastructure-poor Uganda. So I won't make any more promises about upcoming posts.  Maybe just check in weekly if you're interested.  I hope you're all doing well.

Yes, there are facts of life here which weigh on me: living conditions which depress me, behavior which I disapprove of, so on. Yet I try to look to bright spots...

Denouement

This is it, folks. Time to conclude matters. By the way, I notice I have a ton of visitors from Ukraine viewing this site, the most after USA, having recently surpassed Germany/France. Have no idea why but anyway my thoughts are with the Ukrainian people suffering under the machinations of Vladimir Putin. September 14: Beautiful autumn day here in New York, New York. It appears, sadly, that my 8-month summer is now at an end. Amazing how time has flown since my return, I actually flew back into NYC in July. Since then, I've occupied myself by visiting family and friends; finding new work; dating; studying languages intensively; and planning for my next move. Ideally, I'll be living in Western Europe until I go to (and maybe during) graduate school. It'll take some time to work out the particulars, but I decided about a year ago that I wanted to find a way to live in Europe, after a brief, powerful relationship made me consider new possibilities I had never considered before. Though that person has very painfully left my life, life continues, the possibilities remain, and we'll see what comes. June 21: Appreciation Dinner. I invited Centinary and Felex's families to dinner at a nice hotel on the hilltop in Kabale, to show my appreciation for taking me into their lives for 6 months. I chose this place, Cepha's Inn, because it has decent Indian food, which none of them had ever tasted. Also, the prices are such that they couldn't afford to eat here on their own, so it was a luxury for them. Really glad I was able to give them a taste of it. Traditional Grillo Family Dinner. Menu: Pasta n'ebihimba (Italian & Rukiga), otherwise known as: Pasta e Fagioli (Italian) or Pasta and Beans. After dinner at Cepha's, I rushed back to my hostel to make dinner for my friends, other volunteers and locals. Jesca and Winnie, the managers, have become my good friends and let me use the kitchen to cook this meal.   I enjoy cooking for my loved ones and had always planned to make meals for my friends and "family" here, but never got around to it. I needed to do it at least once, to give everyone a taste of my own family and cultural experience. So I finally made the time for it. Took a bit of hunting at the market and "supermarkets" to find the right ingredients, or close approximations. Because it's not quite exact and uses some Ugandan substitute ingredients, I decided to call it "Pasta n’ebihimba”, portmanteau of Italian and Ruyankoke-Rukiga words.  It's a 3-4 hour process, but thanks to Jesca & Winnie's help in boiling the beans all day (which is the longest part of the process) while I was out, I was able to put together the meal pretty quickly after returning from my earlier dinner. It's a great meal very suitable to Ugandan palate, because it's almost entirely vegetarian with the exception of the pièce de résistance, the strips of chopped bacon thrown in for flavor. Only a small amount of meat, 4 strips for a normal meal (tripled for this meal, though), so little that you hardly even see it when eating, but it's essential. And Ugandans love pork, so it's the perfect ingredient.  Was nervous about how it'd turn out, as I had to substitute some ingredients and triple the size of my family recipe. But my friends kept peeking over the kitchen half-door saying the food smelled amazing and demanding that I serve them immediately. So, I knew the meal turned out all right. People from Kabale Backpackers, from Edirisa Hostel, local passersby, and even the bank security guard across the street (with his assault rifle at hand) wandered in off the street to eat.  Just a great family experience. The only thing missing was my family's “moppine." It's a kitchen towel that is shared communally at the dinner table. My family usually didn't have individual napkins or tissues at the table. Instead, we would "pass the moppine" (provided no one was sick, etc.). Always amusing to us when friends joined us at the table, who were not used to sharing. Perhaps you may say it's uncivilized; I would say it's intimate.  June 22: Farewell Party from the staff at John C. Kelly Clinic. Felex planned this very thoughtful and well-organized farewell party for me (there was even a program!). Everyone made speeches, including me, which I hadn't expected. It really touched my heart. Tongue-in-cheek aside: added bonus that even Dr. Kelly hasn't gotten a formal farewell party from the staff yet. You'll have to wait until your next trip, Dr. Kelly! Haha Aside to my animals rights activist friends: I hope this doesn't offend you. I am very much against animal cruelty myself, but I also don't believe in complete vegetarianism. I think if animals can be raised happily and then slaughtered painlessly, then it's the best of all possible worlds.  Of course I don't claim to be an ecologist, but my ecology-related classes in college lead me to think that the most sustainable use of our food ecosystems is to grow food and/or raise livestock and fish in accordance with the nature of a particular environment and in moderation.  To be more clear, some environments, like tundras, deserts, and rock mountain areas, are just not conducive to farming, but may be well-suited to grazing animals. Rather than trying to force agriculture into these areas, or leave them wastelands because food can't be grown, why not utilize them to raise animals as has been done for thousands of years? Remember also that many species of these domestic animals would not even exist without herders and farmers, most of them would probably die out if mankind switched entirely to vegetarianism and didn't keep them as pets.  I don't have a definite answer to the criticism that killing any sentient animal is murder and therefore immoral, because I do have my own ethical problems with it. At the same time, I don't know that animals should have the same rights as human beings, in all respects. All I can say for sure is that I think the higher moral principle is to prepare food for the human population as sustainability, locally, and naturally as possible. That means limited growth of human population, of course. But it also means harvesting our resources as efficiently and sustainably as possible. Again, if we can make sure that animals are living as naturally and happily as possible, and are killed painlessly, perhaps that's the best route to take. I invite people to write to me to discuss or debate this topic. I'm now eating mostly vegetables and trying to get my meat from organic free-range farms and avoiding the American industrial-farming system, but I don't think I'd give up meat entirely.  But I do have a lot of ethical questions, so happy to consider different perspectives. Kampala for nearly the last time. Visit to the Kampala School for the Physically Handicapped. Kind of brings the trip full-circle. You might remember that I visited this school when it wasn't in session in January. I visited a last time but now the school's open. Here are a few pictures of the campus. Actually that's one of the problems Jonah and I discussed (see below). This school is actually amazingly well-supplied, to the point where they have to give donations away b/c they have too much. That's great, but the flip side is that there are hundreds of schools that have nearly nothing, because donors focus their attentions on places like this. The problem is this: this is a well-known school in Kampala, and gets a lot of foreign attention and donations, and leaves these donors with the mistaken impression that conditions are similarly good else where in Uganda. Yet those hundreds of other schools are unknown and receive little help.  What the government and NGOs must do is redirect the attentions of donors and donations to the hundreds of very poorly-served schools throughout the country.  Jonah and I ended up walking and talking through Kampala after he got out of school. Really interesting conversation of the kind I love to have with my educated European friends. Found ourselves nearly on the other side of the city after a couple hours of talking.  Everything from German, U.S., African politics, to environment, to development issues in Africa and Asia, and problems with aid programs through our respective governments. Really smart kid, wish him good luck in uni. Another point: I've met so many interesting people only to have them pass out of my life again. In this case, I didn't get Jonah's contact info and didn't get a chance to see him again, so probably won't locate him again. Happened so often here. Alas! June 29:Last one. Last thoughts. This is a tough one. How to sum up my time here? I could go on for pages and pages on what this country, its people and my friends and family here have meant to me. On the effect my experiences have had on me. Maybe for once I'll keep it brief. I came to Uganda for all sorts of reasons. I wish I could say it was entirely philanthropic but that was only part of the truth. It was primarily a sort of "quarter-life-crisis" rooted in deep frustrations with my personal and professional lives. The "tipping point" was the loss of a relationship which meant everything to me, perhaps because I'd been mired in depressive stagnation, often unable to get out of bed, let alone have a healthy relationship or career, or even to see a future.  Coming to Africa meant finally "curing" and proving myself, and perhaps to salvage everything I'd lost. There are many things I didn't achieve here: I didn't complete all the work I started (like this blog, which I had intended to be weekly or twice-monthly and include much more detail), or start some of the work I intended; I've had strained relationships and didn't win back the person I'd hoped to; and I still don't have a definitive idea of my future, although I intend to continue traveling for a while. But there are so many things I have achieved: I've helped the John Kelly Clinic to expand operations; assisted the staff in helping hundreds of the sick and mentally ill; learned much of the culture and even a bit of the languages of East Africa; befriended many wonderful people, local and foreign, who have a place for me in their homes if I should ever visit.  I have a better perspective on life and mental illness. While I still haven't decided on a new career, I have an idea of what I'd like to do (and what I'd like not to do). After giving up everything to come to Africa, I panicked for a while. Why did I do this? What will come of it? But I've found that sometimes it's OK to make the mistake of chasing a dream, however misguided, because you may find yourself anyway. Dr. Kelly and the Board invited me to become a member of the Advisory Board of the JCK Foundation USA, so I will continue to be involved with the work of the Clinic. I hope to return to Uganda someday to continue to expand operations throughout the country, and someday the developing world!  __Goodbye, everyone. Thank you for sharing this journey with me. Best wishes for your health and happiness. To my family and very closest friends, and even those who've passed from my life: I love you very much, and I'll always be there for you if you need someone. __Amid the concrete and steel and din of New York City, I hear and see visions of East Africa. The calls of elephants and the songs of weaverbirds come to my ear. Red-dusted air chokes my hair and clothes. The thrum of African drummers ring out across the lake waters and through the terraced hills. In the ageless distance, the plains of Karamoja shimmer and sway with the heat of the midday sun. And down from the snow-capped Rwenzoris come the chants of a chorus, bidding me "Oruzinduko rurungi. Ogaruke omuka!" (Safe journey. Come home soon!)