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.

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. 

From the Government to the People

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.

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.

"You Punctuate Our Suffering"

The village of Lukodi lies about 17 kilometers north of Gulu Town. On May 19, 2004, LRA rebels stormed the village and slaughtered more than 100 men, women, and children while the government forces retreated. Today, a stark memorial stands in a clearing among the tall grasses and occasional shady trees. Only about 45 names are listed though many more died. Soon, the site will move to location nearby, where it will develop into a community center devoted to the memory of the victims and embodying the hope of the survivors and future generations.

We were invited to Lukodi by Vincent, a primary school teacher and member of the Community Reconciliation (CORE) Team. Residents and committee members walked with us to the memorial sites. They shared their stories and narrated the events of that tragic day. In soft and solemn tones they described the brutality and horror of the attacks, the bitter sorrow of displacement, the aftermath of the war, their ongoing struggles to recover from the trauma, and their efforts to cope with persistent impoverishment. They talked of peace and healing and hope for the future.

Standing before our group, the head teacher of the primary school eloquently expressed his appreciation that visitors had come to Lukodi. We were certainly not the first group of foreigners to pass through.

“You punctuate our suffering.” The phrase simply slipped from his lips amid other remarks, yet tore through my heart like a bullet and lodged in my brain. “You punctuate our suffering.” It was pregnant with meaning and complex moral implications. Our visit was a break in the everyday routines of the village. It provided the residents an opportunity to show us their place and speak of its history and their experiences. Perhaps it gave them an opportunity to make a connection that might lead to more tangible assistance in the present or future (provided we might remember them and return again, as several residents noted often does not happen, despite what visitors say).

But our visit also required them to relive their trauma, to lay it bare in front of a group of strangers, to drag the buried horrors back out into the daylight, as the villagers had been forced to do with the newly buried bodies of their murdered loved ones by the forensic investigators for the ICC. Our presence did not relieve any suffering. Nor did it intensify what few of us could hardly imagine enduring. We merely punctuated that which constitutes a central part of what it means to be from Lukodi.

Why did we go to Lukodi? To honor a polite invitation? To take pictures of schoolrooms and smiling children? To play a game of soccer with the youth? To visit a war memorial? To play witness to a drama of terror we as North Americans can scarcely grasp in terms of lived experience? How should we understand the head teacher’s words and what it means to northern Ugandans to have foreigners punctuate their suffering? I struggle with these questions and how to communicate the gravity of these lessons to the students, how to process them myself.

GSSAP is not about war tourism. We did not come to northern Uganda as voyeurs to the violence that has penetrated the lives and landscapes of this region and its residents. We did not come to save souls or heal wounds. We are not trying to give voices to the voiceless or agency to the disempowered. We are not here in the name of charity or pity. We do not wish to contribute to further dehumanization through patronizing good intentions.

GSSAP came to Gulu so that we can learn from Ugandans and others about the staggering complexity of the causes and manifestations and consequences of both conflict and peacebuilding. Our objective is to learn to think critically, to view the problems and possibilities as Ugandans view them, to engage our analytical minds and reflect sincerely upon – perhaps to interrogate mercilessly - the humanitarian and humanistic impulses that have led us to this point. We are here to form human connections, some fleeting, some durable and long-lasting. We try to remind ourselves continually that endeavors like this should not first be about us, although we MUST own these lessons ourselves and carry them forward in our lives. GSSAP is about seeing, creating, sustaining, challenging and transforming the relationships we form not only on the basis of common personhood but also the historical, political, and economic ones that link us in ways we often scarcely can grasp.

We are deeply indebted to the people of Lukodi and stand in solidarity with them, in common humanity and in painful humility for the chasm that exists between us, in spite of us, because of us.

References: Justice and Reconciliation Project. The Lukodi Massacre: 19th May 2004. JRP Field Note XIII, April 2011

A Meeting at Parliament

On the 11^th of July the GSSAP students were fortunate enough to meet with the Honorable Betty Amongi-Ongom. One of the most prominent topics focused on the governments Peace, Recovery and Development Plan (PRDP). This plan rises out of the recognition that the conflict has left the North politically and economically underdeveloped; and thus directs efforts toward institution reconstruction, education, peace building, and of course economic recovery. These overarching areas are themselves composed of myriad aspects. As part of the implementation at the local level, the government is working to support cultural and religious leaders to ensure that they have the capacity to mediate conflicts that may arise in their community, such as land disputes (which is currently one of the major issues affecting communities). With this information in mind, I inquired about the possibilities of women becoming cultural leaders and having a voice in the outcome of the dispute resolution, especially in what has historically been a rigid patriarchal system. This question itself requires a little extra information about the evolving negotiation of gender roles in Northern Uganda.

During the conflict with the LRA, portions of the population spent roughly ten years in camps as internally displaced persons (IDPs). During this time, gender roles were reversed as women became the breadwinners of the households. This renegotiation occurred because food distribution targeted women rather than men, as men could potentially have several wives (thus needing more food). This essentially equated to women gaining power that they had not been afforded in the past. Now, after the conflict is over and people have returned home, the women are understandably unwilling to relinquish it and revert back to more traditional systems; hence, my question about the prevalence of women becoming cultural and/or religious leaders.

The response we received was slightly surprising (at least to me). The answer was none, that only men are allowed into these positions. I immediately found myself questioning how effective this approach would be at social renegotiation if recently empowered women were not allowed increased capacity. However, it was then revealed to us that part of many donor contributions included an aspect of sensitizing cultural leaders to both the needs of women and the social benefits of including their opinions, especially concerning economic issues.

As we left parliament, I reflected on not only how informative the presentation had been but also on how naïve my expectations were; I was projecting my goals from my culture onto that of another. My perception had been that somehow a cultural system that had been in place for centuries had suddenly taken a sharp turn in another direction in a matter of a few years. Betty Amongi-Ongom’s discussion with us painted a realistic illustration of what the early appearance of change can look like, and she allowed me to gain a more reasonable understanding of the current situation, as it pertains to gender roles in Northern Uganda.