Wednesday, August 24, 2011

It takes the youth

It takes a village, as Hillary Clinton and many others have claimed, to raise and educate children. Let me turn this around a little: It takes the youth to educate us on the global village we inhabit. This may sound hackneyed, but if you had watched our students in the closing days of our program in Gulu you would also share my renewed sense of interculturalism and internationalism, indeed of volunteerism.

I do not want to play down the profound significance of the lectures we heard for one week at the Institute for Peace and Strategic Studies at Gulu University from an impressive array of war survivors, peace-builders, religious leaders, community workers, and humanitarian, human rights, and development experts. Nor would I wish to diminish the richness of the students’ internship experiences in their various host institutions in Gulu Town, whether the local hospital, arts center, government office, education or development NGO, interreligious, sports, or cultural organization. Nor would it be right to underestimate the impact of our excursions into local communities in the region to learn how they were trying to recover from the effects of war and eke out a living for their families.

But it was also under the roof of our downtown hotel, Hotel Kakanyero, that lives were being transformed. Through the friendships that our students forged with the staff in the hotel--whether they worked in the restaurant, the reception, or the laundry--the hotel became a home. Life stories were shared, jokes were exchanged, and before long, when the day’s work was done, there were social outings to local coffee shops, restaurants, and Internet cafés. The young people even joined forces at a popular quiz and social night at a nearby hostelry to constitute the Hotel Kakanyero team! These human interactions, occasioned by a building, reminded me of that wonderful novel about a Cairo apartment building, The Yacoubian Building, by Alaa Al Aswany.

But it was not all about sociality. Our GSSAP students had learned enough from their new friends about their hardships as well as their hopes. They knew that some of them had been abducted and served as child soldiers during the war, that some were war orphans, that others had unpaid medical bills, and that several could not afford to complete their schooling. In next to no time, the students had raised money to purchase shoes, backpacks, and a bicycle, and donated funds to help start a poultry project, pay school fees and medical bills for at least four of the staff. There was also help with email addresses and Facebook accounts, and gifts of clothes and even beloved IPods. The significance of the Mark Twain quote, posted at the TAKS Art Centre that we frequented, “the best way to cheer yourself up is to try to cheer somebody else up” was really driven home.

On the final day of departure, there were hugs, tears, and endless photo opportunities. The students were moved by the gifts they received in turn from their Ugandan friends. But it was the letter was pushed into my hand from one of the waiters (with apologies for the spelling) that arguably had the greatest effect: “Your students could make me smile the whole day and night in the course of my duties. I will never have such friends again till they come back to Uganda.” Indeed we will, thanks to GSSAP.

Tuesday, August 16, 2011

Infected with smiles: my happy ending

My internship in Gulu ended with a bang.

On Friday, Aug. 5, 2011, the TAKS Art Centre hosted the first ever Poet's Night Out, and I had the privilege of watching the success of a dear friend.

During my two weeks working at TAKS, I helped a local young poet named Joseph.

Joseph appeared at the center on my first day and explained his dream for a monthly open-mic night.

He wanted to provide local poets and musicians with a channel to the Gulu community, giving them the exposure and encouragement they need to continue expressing themselves through words and song.

Over the course of the next two weeks, I watched as Joseph's organization savvy brought a variety of characters to the center.

These young artists injected TAKS with vitality and me with inspiration. The Poet's Night Out represented the essential purpose of the TAKS Centre: providing the community with a space for creativity and expression.

The event was a huge success.
The line-up featured poets, break dancers, storytellers and musicians from all different backgrounds, heading completely different directions but meeting for one brief moment at a crossroads.

The Ugandan youth I encountered at TAKS through my work with Joseph have an infectious energy that slapped me across the face.

The jolt was just what I needed, and I discovered something powerful and precious in these young artists: hope.

The name "TAKS" stands for "Through Art Keep Smiling," and my internship there left me grinning so much my cheeks are sore.

Poet's Night Out at the TAKS Art Centre, Gulu

Saturday, August 13, 2011

Putting the "Charm" Back in Charming

I was lucky enough to spend a day with a vendor of local herbs and charms in the Gulu Market. This video provides some examples of the various items available:

Tuesday, August 9, 2011

8:30 AM at my Internship

Our trip is winding down, and even though I am excited to come back, I am beginning to realize how much I will miss the town of Gulu. I will particularly miss the Acholi Religious Leaders Peace Initiative (ARLPI), where I did my internship. ARLPI is an interfaith organization based in the Acholi Sub-region of Northern Uganda that is made up of people from the Muslim, Catholic, Anglican, Orthodox, and Seventh-Day Adventist traditions, as well as the National Fellowship of Church of Born-again churches. Founded during the middle of the recently-ended civil war in Northern Uganda in 1997, ARLPI has aimed from its inception to promote peace and development through communal dialogue.

In my two short weeks there I was able to experience a lot, but I think that what I will miss most about ARLPI are the morning devotions. Every morning during my internship, I would get up at 7:00, shower, have breakfast, and then walk four blocks to the ARLPI office, generally arriving there around 8. After dropping my stuff at Cooper's office (he's the other American intern, there 'til December, and I had a spare desk in his office while I was at ARLPI), I would wander into the boardroom and sit down to wait for the devotions to start.

I think morning devotions are technically supposed to begin at 8:00, but in practice they never start until 8:30, because most people don't arrive at the boardroom until then. First there is singing ("Good morning Jesus, good morning Lord..."). Then the preacher of the day reads a passage from scripture and gives an interpretation. After the floor opens to anyone else who would like to add their interpretatuon, someone gives a closing prayer, announcement are made, and the workday starts.

What impressed me most about morning devotions was their participatory nature. Everyone at ARLPI gets the chance to lead devotions: the program coordinator, project leaders, office assistants, interns. And everyone gets the chance to comment on what the preacher of the day says. But perhaps most impressively, both Christians and Muslims get the opportunity to preach. To be sure, there are many more Christians than Muslims at ARLPI, and when one of the Muslims lead devotions, the Qur'an is not used. But coming from a state in the U.S. where the building of a mosque can insight hostility, it was a striking experience for me to hear one of the Christian members of ARLPI wish the Muslim community at ARLPI well at the beginning of Ramadan. The Christians at ARLPI would be praying for the Muslims during the season of fasting, he added.

To me, these morning devotions encapsulate ARLPI's philosophy: just as everyone gets the chance to speak at devotions, so does ARLPI encourage peaceful dialogues in which all parties get the chance to speak.

Morning devotions will be one of the many things that I will miss about being in Gulu and Northern Uganda. I am sad to be leaving.

Sunday, August 7, 2011

Experiencing Surgery in Uganda

Medicine in Africa: a cringe-inducing sentiment, evoking images of Ebola, malaria, malnutrition and overall misery. Upon telling people that I was going to the surgery ward, they winced and wished me luck. However, after spending two weeks in the surgery ward at the Gulu Regional Referral Hospital, all my initial expectations were blown away. While there certainly are some gruesome aspects and grave illnesses, the surgery ward is compassionate and optimistic.

Due to the lack of supplies, low funding and large volume of patients with severe conditions, I expected bedraggled and terse staff. Conversely, I was warmly welcomed into the hospital by some of the most compassionate and patient doctors, medical officers, and nurses I have ever met. They willingly explained their actions and decision making process when examining patients or performing surgery, allowing me to truly experience medicine. Moreover, they strive to deliver the highest level of care possible, and are delighted when a tibia is re-aligned perfectly, an infected wound finally turns around, and peoples' suffering slowly ebbs away. At the Gulu Regional Referral Hospital, in the surgery ward at least, the staff genuinely loves the process of healing others.

The level of care and sophistication of services floored me. I was told anesthesia was unavailable- "going under" is risky business in North America, never mind Africa. The doctors graciously permitted me to observe "theatre," and the experience was astounding and enlightening. Patients walk into the operating theatre if they are able, observing all the tools that will be used for their procedure. There is indeed anesthesia- Lidocaine is preferred for local anesthesia, spinal blocks for surgery below the waist, and general anesthesia if there is no alternative (eg. for a splenectomy). The surgical instruments are mostly manual, although enough machines (pulse oximiter, oxygen machine) require electricity to make the frequent power outages a serious problem. Improvisations must be made, but largely supplies are available. The surgeons know what they are doing, minimize bleeding and infection, and overall do an excellent job.

While the hospital is free, transport, food and time off work are not, so people put off hospitalization as long as possible. This means that fractures can be a few weeks old, severe burns infected, wounds exacerbated by flesh eating disease. While this complicates treatment significantly, the doctors still do their best to promote optimal recovery. Not everyone makes it, but the death rate is below 2% in the surgery ward and there is a constant effort to improve.

Ultimately I emerged with a completely different perspective than I approached medicine abroad with. The medical system is not in crisis, but in progress, and it still needs a lot of support. I will never forget the kindness of the patients and personnel at the hospital, generously helping me to learn and understand their medicine.

Monday, August 1, 2011

Time is Relative

Ugandan time is different from American time. Dr. Hepner described the attitude here well when she said to me, “In Africa, you are never late as long as you get there.”

American time runs a race, while Ugan

dan time takes a stroll in the park.

It took me a full week of work at the TAKS Art Center to appreciate how easygoing the people of Gulu are.

As a nervous American girl, I made certain to arrive at work fifteen minutes early each day.

At home in the U.S., this is expected. But at TAKS, the staff think I’m insane when I come so early.

The more time I spend here, the more mellow I become. Ugandans have an amazing ability to absorb my stress and leave happiness behind.

The laid-back approach to life rubs off on me like glitter, and I return to the hotel each day from work scintillating.

I want to bottle up this sparkle and take it back with me to ease the overwhelming pressures of academic life.

TAKS has been without power for the past month, but you wouldn’t notice if you paid it a visit. The center operates as though nothing is wrong: they have no choice.

The sweet staff are the most optimistic group of people I have ever had the pleasure to

work with.

David Odwar, the founder of TAKS, is a brilliant ceramicist casually referred to as “Big Boss” by the staff. His pots are incredible, but his genius shows when he brainstorms.

If you present David with a problem, big or small, the deafening sound of his neurons clicking and whirring almost drowns out his voice as he thinks aloud, spitting out solutions faster than a mathematical genius doing multiplication tables.

Stella is the soft-spoken receptionist whose voice sounds sweet and slow like honey dripping from a spoon. She is a skilled jewelry-maker and is patiently teaching me how to roll paper beads.

Pascal runs the art gallery and has the most infectious smile I have ever seen. This small but charming song-writer knows eleven languages and leaves a big impression with his music.

Amos in the computer department has a face shaped like a heart and a heart the size

of Jupiter. He remains smiling even though the lack of power at the center has cost him money and work.

Bubbly Joyce, the artist in charge of the kitchen, is a crate of dynamite. This dazzling dancer sings Christmas songs year-round.

Stephen, the goofy day guard, chatters like an excited squirrel and tells funny stories all day long.

William is the stoic gardener who says little but smiles and waves when I get there every morning.

I still arrive at work early each day, but the habit no longer stems from fear of being fired. I c

ome early because I desperately want to maximize my time at TAKS that is flying by far too fast.

The TAKS Art Centre where I worked my internship provides the community of Gulu with art, internet access, encouragement and space; it is a well-equipped creative haven for artists of all sorts.
Joyce at the TAKS Center smiles as she makes a beaded curtain for the kitchen.

Recycled paper beads made by local women are sold at the TAKS Center art gallery.

Traditional dancers welcome the return of the Acholi paramount chief.

A crowd of children lead the parade as the paramount chief arrived at Ker Kwaro Acholi.

The Gulu rugby team played hard and defeated Lira on Saturday.

Hard Work and Dedication

My Internship


One of my favorite parts of the GSSAP experience so far has been having the opportunity to learn about the daily lives of Northern Ugandans. Getting the chance to enter a person’s home and share food with them has taught me an incredible amount about the lives and struggles of Ugandans in rural areas. I have been afforded the opportunity to visit homes and communities because of my internship with Julia, one of the doctoral students with the program. I have been helping Julia with her research on the healthcare systems in Uganda, and the trips out to the villages have been full of adventure. Especially when it comes to mealtimes. My first real experience with traditional food out in the field was in Lalogi village. I was with Julia’s team at a health center interviewing patients and it was time for a lunch break. So I went down the street into the village with two of the translators, Morris and Jennifer, to pick up some roasted maize for the group. The three of us waited for the corn to be ready and then munched on a piece as we walked back towards the health center. Jennifer left to take the corn back to the rest of the group and Morris asked me if I was still hungry. I said I was so he took me across the street to a small building where a group of women were sitting and chatting outside. He spoke to them for a moment in Luo and then said to me that there was some fish inside that we could eat. Jennifer walked up and joined us inside the dark building and bowls of food were bought out shortly. While I was not sure exactly what I would be eating, I was not expecting an entire fish to be sitting in a bowl of soup in front of me. Jennifer and Morris laughed at my expression and asked if I had eaten with my hands before. While I was thinking, “Oh no, this is going to get messy”, I replied that I had eaten with my hands before but it was my first experience with an entire fish. Morris explained that there was posho (a bread made of ground corn that closely resembles grits) and cassava to scoop up the soup with and that I should start by inserting a couple fingers into the gut of the fish and tearing it in half. I hesitantly started to rip and Morris laughed again (he was already half done with his fish) and told me that I needed to get in there. I was picking out bones, doing my best to avoid the head, and getting a little bit of meat when Jennifer and Morris started laughing hysterically. I looked up to see what was going on and found that they were both looking right at me. I immediately asked what I had done that was so amusing and in between fits of laughter Jennifer managed to say that I ate like a child. Morris started laughing even harder as I looked down at my hands, both of which were covered in bits of food. Once they had calmed down a bit Jennifer explained that only babies who were two or three years old ate like I did. Morris explained that I ate like a rat. I stared laughing at that point and replied that, because I had never learned to eat this kind of traditional food, in this situation I may as well be a child. I was a bit embarrassed, but I felt much better when Morris told me that I would make a great anthropologist because I was willing to try anything. Despite the compliment, it’s safe to say that the next day at lunchtime I ate the bean stew and millet bread with only one hand.

Saturday, July 30, 2011

For the Benefit of Whom?

“Have you ever seen this type of infection before?” was the question asked by the doctor working in the pediatric ward of the hospital.

Believing he was talking to the medical student who was also working in the pediatric ward, I ignored him and went about my business. The doctor then asked again, “Have you ever seen this type of infection before?” I looked up to realize that, to my surprise, he was talking to me. I walked over to the child whom he was examining to see the infection. The doctor spoke to the seven-year-old girl in Luo, the local language spoken in Gulu Town, to tell her to open her mouth so that I could look. Inside, her mouth and tongue were covered with raised, white growths.

The doctor who had asked me about the patient was the same doctor that had been coming twice a day, once in the morning and once before lunch, to check on the patients in the Acute Pediatric Ward. The doctor that normally oversees the pediatric ward had been on strike all week, leaving patients to be quickly diagnosed by inexperienced medical students or by doctors practicing outside of their specialities. Ironically, the strike’s goal is to bring awareness to the community regarding the lack of resources in public hospitals and health clinics across Uganda.

After working at my internship for a week, I understand the pediatric doctor’s frustration. In the specific ward in which I am interning, there is only one nurse and one doctor. This can cause the work load to become overwhelming, especially on days where the number of patients exceeds the number of beds. Besides the lack of personnel , the lack of diagnosing equipment, such as chemical test and cultures, makes diagnosis difficult. To compound the problem, once diagnosed, the chances of the hospital having the medicine for treatment are slim. Speaking from an ethical standpoint and on-the-ground experience, instead of benefiting the patients and healthcare workers, the strike hinders the hospital’s efforts to aid the people.

Turning to the doctor, I replied, “It looks like oral thrush caused by a candida species.” I had diagnosed the patient.

Friday, July 29, 2011

To Teach a Woman to Fish

“There’s your ride.” Dr. Trish pointed from the balcony of Hotel Kakanyero toward the large, white, off-road vehicle.  The vehicle was the standard Non-Governmental Organization issue, noticeable from afar and newer than the few vehicles seen around Gulu Town.

Gray clouds were slowly rolling in, and dust from the dirt road flew as boda bodas, a sort of motorbike taxi, sprinted past. “Hi Ketty.  We need to get a few things, then we’ll be right back.” 

Ketty is a Team Leader with the Justice and Reconciliation Project’s (JRP) Gender Justice Program; she works intimately with formerly abducted women who’ve escaped from the Bush, often with children that will suffer social stigmatization.  Today she was going to take us into the field with her to talk to local, rural women and give them the donations we’d collected for their community.

“From up?” Ketty questioned.

Hilary, a fellow GSSAP student chimed in, “Yes, and get Dr. Hackett.”  Moments later, with four bags brimming with clothing, school supplies, and balls, Hilary, Adrianne, Dr. Hackett and myself piled into the SUV.  I was tucked into the posterior compartment where four seats faced each other, two on each side.  Donations were heaped on the seats across from me and next to me while a quiet, young woman sat in the remaining seat.  Patrick, another team member of JRP who was driving, moved to secure our door, “Apwoyo (ah-foy-o), my name is Patrick,” he said with a smile as he reached out a hand.  I took it firmly, returning his grin, “Apwoyo, Jaymelee, but they call me Lakisa Jane.”  Unlike the soft-spoken Ugandans, I had replied loudly, to ensure I was heard over the busy street.  His face lit up even more, “ah Lakisa,” he repeated before moving to take the wheel to begin our journey. 

My backseat partner was Sarah, whom we later learned was one of Joseph Kony’s many wives.  After escaping with some of her children from the Bush on foot, she began volunteering and working with other women who had been forcibly taken as LRA wives.  She remained quiet. 

Between Ketty’s warm conversation and stunning scenery the forty-five minute ride passed quickly.  Rolling grasslands, spattered with fields of corn or beans, continued as far as the eye could see.  Tall palm trees rose like sentinels stationed throughout the countryside, and in the distance beautiful hills marked fertile hunting grounds.  Cool air snaked through the open windows as we were jostled along the bumpy, eroded, red-dirt roads. Most travel on the path was done via footing (walking), bicycle, or boda boda.  Countless women walked, often carrying babies secured to their backs by blankets knotted tightly across their chests.  With items carefully balanced on their heads, sometimes padded by a coiled scarf, they transported logs, jerry cans, and produce.  In addition to them, we passed heavily loaded bicycles that frequently featured a man pedaling with a woman sitting on the rack holding a child or other goods.  In a similar fashion, motorbikes bounced along, often with multiple passengers and significant baggage.

The smell of licorice and chocolate filled the air, depending on which sweets were being passed around the vehicle, and gray clouds grew darker before we finally pulled into the district headquarters.  Along with the rest of our group, I was bustled into the District Chief’s Office (an appointed position), and I was surprised by the state of things.
Appearing new, the cream-colored building stood in staggering contrast to a small cluster of round houses, or huts, that stood to its west, and a gray, dismal health center that neighbored to the east.  Similarly, the office walls were brightly painted, and nice furniture filled the room.  To follow was a bit of pomp and circumstance as we were asked to sit and introduce ourselves.  As our group leader, Ketty explained the purpose of our visit and asked if we might use the community hall to hold a meeting with the women of the area.  After some expected politicking and displays of power assertion that occurs when one is the visitor, the Chief said only half-jokingly that perhaps our group could donate money to him, to make his office nicer with more computers.  The sad irony is that often in these rural communities computers are not even considered an option because they do not have any source of power to operate them, nor the education. 

Unfortunately our experience with him is not an uncommon encounter in areas overwhelmed with NGO presence.  A culture of dependency in post-conflict reconstruction becomes the established norm, and both individuals and communities begin to assume that outsiders only exist to provide monetary support.  Rather than working toward empowerment and self-improvement, people begin to think within the confines of a welfare state; people forget that “teaching a man to fish” is even an option. 

We were led to a sizable, empty hall, filled with plastic lawn chairs and flooded with natural light from the windows that lined the walls.  Slowly women trickled in, and after about fifteen people arrived, we started the meeting.  While I had expected only a meet-and-greet of the briefest nature, we experienced much more.

After some difficulty in explaining that we were there not as sponsors, but as students, the group began to share some of the challenges they face in their day-to-day lives.  In accordance with various reports read and lectures heard, women explained that they faced several primary and cyclical problems in this new time of “peace”:

  1. Abducted at a young age, they had limited education, and could not read or write.
  2. They returned with children from the Bush, whom new husbands refused to support.
  3. In order for their children to receive an education, the mothers had to support them.
  4. The mothers had to support them with limited educations and no vocational skill training.
In order to begin tackling their problems surrounding economic livelihood, the women had begun a community microfinancing project.  Essentially, every week, individuals pool their money which can then be lent out to group members with an interest rate of 10%.  Ideally these funds would be used as capital for launching new businesses; regrettably, they could not pool enough money to create a sustainable business. 

Moreover, their new, non-LRA husbands often were drunkards, or had other wives and children to support, creating competition for resources within one family.  Their circumstances were stymied by a lack of resources and a largely unsupportive male community.  Was there someone in the community who could tutor others in reading and writing for a small fee?  Could women band together in communities in lieu of increasing their burdens through marriage?  Why hadn’t NGO’s sent teachers or vocational skill trainers instead of erecting new administrative buildings?  Could the work that JRP is doing partner with my internship organization (War Affected Children Association) since it is trying to address similar problems of sustainable livelihoods? 

We also asked the ladies for their opinions on the appropriate mechanisms for justice and community healing.  The responses were insightful and honest as rain pummeled the roof of the town hall.  The more I heard them talk, these women who escaped the LRA, some who escaped the hands of Joseph Kony himself, the more I believed that the primary question should not be, as many lecturers suggested, of creating sustainable peace, but rather of creating sustainable change.  Clearly when given opportunity and tools these women can succeed, or else they would not have been in that meeting hall today. 

As the adage teaches us, they do not need more fish, they need to learn how to fish and have the tools to do so. 

Tuesday, July 26, 2011

On Texts and Texting

Walking and driving around Gulu town, it is generally the people and vehicles that command attention. But I like to keep an eye out for the signboards and slogans that grow more vibrant and diverse each time I visit—one indicator that Gulu is really picking back up after the war. There is a strong oral component to traditional African cultures, but with the advent of modern forms of education and mass communication, written texts have assumed greater importance. Even with the mobile phone revolution, texting trumps calling as it nearly always works and costs far less. Incidentally, it seems that the best way to get your store painted is to advertise national products. The phone companies dominate the store-painting scene. You could opt for Warid’s pink and white color scheme (“We care”) or the striking red of Airtel. Blue buildings are either Uganda Telecom (“It’s all about U”) or pharmacies advertising cold and flu medicine. There is the longstanding yellow of the oversubscribed MTN or the orange of, yes, Orange, the company that boldly declares that “Choice changes with Orange.” The market pitch of Nile Special (a beer some of us are partial to) declares “You’ve earned it.” That looks rather out of place in the context of Gulu, where livelihood is more the watchword than leisure. Senator Beer is described as the “true taste of our land”—tea and coffee are surely stronger candidates for this accolade. Opposite our hotel is the slogan for cooking oil that reads: “Buy Fortune, Build Uganda.” I will refrain from commenting here where Uganda’s fortune currently lies, beyond its people and agricultural potential that is.

A couple of us attended the morning service at the rapidly growing Watoto (a Pentecostal/”born-again”) Church last Sunday. No-one appeared to be texting during the service you may be interested to know. Rather, all eyes were on the large, computer-mediated images that communicated the number of “celebration points” or branches of the church, its mission statement, and then the words of the various songs that were sung with great gusto by the mainly young, upwardly mobile and English-speaking congregation. There was a point in the sermon when congregants were exhorted to open their Bibles at the texts for the day. The lively preacher jokingly remarked that he hoped that they had not brought the King James Version of the Bible as “they would only be able to understand one word out of three.” Since he was wearing jeans and advocating a more modern, upbeat Christianity I suppose that I was not surprised at his choice. But I immediately thought of the many churches I had frequented around Africa, whether mission-related or independent, where the KJV reigned supreme. Only that text was held to have the requisite sacred power because of the historic beauty of the language. As an educator, I preach that words do matter, and while I enjoy a clever slogan, I sincerely hope that Africa’s oral richness does not get swamped by the powerful forces of late capitalism.

Sunday, July 24, 2011

Oh...and I have AIDS

I have been doing health related research in Uganda since 2006, but every day I go out into the field I learn something new. In Gulu District, I have been traveling to rural villages to talk to community members about their access, obstacles, and solutions to healthcare. I have also been traveling to various medical facilities to talk to patients about their healthcare experiences and to observe patient/provider interactions.

Recently I was observing such an interaction. The patient was an older woman who was complaining of stomach pain, chest pain and general weakness. She, like nearly every other patient that day, was prescribed amoxicillin and acetaminophen after a consultation with a nurse that lasted less than 4 minutes. She wasn’t prescribed these drugs because they were the best ones to take for her ailment - her ailment wasn’t even tested or diagnosed – she was prescribed these drugs because these were the only drugs available due to rampant drug, supply, and staff shortages.

Perhaps hypertension was the cause of her chest pain – but there are no anti-hypertensives available. Perhaps it is indigestion – but antacids are not there. Perhaps the pain is due to tuberculosis – but the lab tech is too busy to run TB tests that day. Maybe it was malaria – but even if antimalarials are available, women are often told they are too old to be taking medication and they should save these drugs for children.

As the woman was leaving I stopped her to ask if she was satisfied with the services she received that day. She said she guessed so, but she didn’t think the medicine was going to work because it was the same thing she was prescribed last time and saw no improvement. I then asked her if there was anything else she would have liked to ask or tell the doctor. She then launched into detail: “I’ve had a persistent cough that has lasted for over a year. Sometimes I cough up blood. I think I have TB, but I can’t go to the hospital because it is too far, too expensive, and I have young children and my husband won’t care for them if I’m not there. Oh…and I have AIDS.”

I asked her why she did not mention this to the nurse and she said, “She didn’t ask.” Then she gathered her things and left for her long walk home. My translator explained that women in Northern Uganda are often raised to be quiet and submissive, which greatly discourages them from asserting themselves – even at the doctor’s office. I asked my translator, “Since when is AIDS an afterthought?! How is that something she forgot to mention?!” He gave me sympathetic smile, but said nothing more. When HIV/AIDS seems as common as the cold but still carries a heavy social stigma, anti-retrovirals are not in regular supply, and no one cares to ask anyway, I suppose it’s just not worth a mention.