Madagascar: First Impressions

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After living in rural Uganda for a few months, arriving in Tana (Antananarivo) can only be described as a beautiful, chaotic, polluted assault.

Madagascar is still a place people visit and travel with caution.  Following their independence in 1960 they have struggled with their economy following corrupt politics and a coup d’e’ta as recently as 2009.  In fact due to the recent elections it is harder to get a visa on arrival and I had to get a 60 day visa with the hope of extending it to 90 at the embassy in the next few weeks (fingers crossed).

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The population of Madagascar is around 25 million and the average GDP per capita is $450, making it the 8th poorest country in the world.  Poor sanitation and access to clean water continues to be a battle and dysentery is still the leading cause of death.  Madagascar has also had 2 outbreaks of the pneumonic and bubonic plague within the last 10 years.  Unsurprisingly, although still slightly off the tourist trail, Madagascar is a popular place for NGOs and there are multiple organisations, both grass roots and more global operations that operate from Tana.

Although politically Madagascar is more stable than recent years it is still inadvisable to travel around at night without a passport or without expecting to pay a police bride.  I will consider myself exceptionally lucky if I have not been robbed or pick-pocketed at the end of 3 months, having already witnessed it in my first two days.

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Yet despite this, I have already fallen a little bit in love with this amazing country.  Having been a former French colony their influences are everywhere.  Besides the obvious French language and chateaus on the hill, you can find baguettes on every corner, good coffee and old French cars on every street, painted cream and serving as ‘le petit taxi’.

The area I am staying in has markets the length of the street.  The quickest route to the hospital is through a tunnel of markets providing everything you can imagine, the strong smell of meat offering an alternative wake up call.

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Walking the streets of Tana you need to keep alert (definitely not my strong point), as open manholes and gaps in paving drop straight to the rubbish or sewage below.  The smells can be particularly strong at times and only just mask the fumes of the cars which due to the old, cheap models and poor quality of petrol are what I have found most difficult to adjust to.  (I should point out at this stage, that I live on perhaps one of the busiest streets in the city) As soon as you step out of your room, you are confronted by a lung full of emissions, along with the noises and endless calls that last until night, when the streets become unsettlingly deserted.

It is at these times when I miss the beautiful Ugandan hills and being woken by the cockadoodling of Allan and the beat of the school drums.

The rains, when they come, which is often in this season, are short but unrelenting.  Within 5 minutes you can be ankle deep in gushing water; it pools in the roads and streams of roofs in torrents.

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Every day stalls line both sides of the streets which makes navigating a route difficult but Thursday is particularly busy.  Markets upon markets flow through the heart of the city, rendering it virtually impossible to walk on pavements.  They offer everything from clothes to food and electricals.  Although hectic, I’ve already become accustomed at weaving my way through and marvelling at the scenes…

Broken down cars that won’t start.  Disabled people crawling down the street on their hands and knees.  Pousse-pousse being pulled by men through the streets, contributing to the winding queues of traffic.  Children following you like a shadow, then counting and pocketing someone else’s money.

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I am staying near the hospital at a centre recommended by the Dean of their Medical School and it is only a short taxi ride into the main city or a 30 minute walk.  I was taken aback by how hilly Tana is, although only a short walk it is a predominantly vertical one!  Madagascar is still an under-visited country and the tourists and workers that come here are generally European, predominantly French.

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Tana appears a city you need to discover for yourself.  The Lonely Planet is outdated and inaccurate and although the Bradt guide has greater depth it doesn’t appear to give perhaps the content that you would expect of most guidebooks for a capital city.  The only way to get to know the city is to find it for yourself or mix with true ex-patriots who understand its workings.

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In earnest, I was a little taken aback by Madagascar.  Having travelled to Egypt during the Arab Spring, the year of their revolution, you wouldn’t be surprised to learn that I’m travel first, research later.  But in truth, I can’t think of any country I’ve visited where I have been restricted after dark.  Perhaps it is this that makes me feel slightly uneasy, or the fact that limiting movement in the evenings I feel far more claustrophobic than I have ever felt travelling before.

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Tana is intriguing and daunting, beautiful yet crumbling.  A city of contradictions.  Of all the many places I have travelled, it is the place I feel most unease.  The place I am least likely to let my guard down.  Behind the characterful facade lies an ingrained poverty, one where the police are so underpaid they live off brides and corruption and many people cannot afford medical care or reach basic standards of education.

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The capital, Antananarivo has the potential to be one of the most beautiful cities.  It appears to have good infrastructure, built by the French with grand villas, roads and hospitals.  It is a city devoid of skyscrapers, with panoramic views that span over a plethora of architectural styles to the paddy fields and hills beyond.  In fact, for a country that has been one of the poorest in the world for many years, the capital appears incredibly developed and the health care system run effectively with the hospitals appearing in far better conditions than the ones I have been to in Uganda.  However, with the current political situation as it is I’m not sure the city is ready to embrace all that it has to offer.  Most of the beautiful villas appear crumbling and disused, with many reluctant to show wealth for fear of robbery, which is common.

I feel that Madagascar will be the country that surprises me the most out of the places I’ve visited and I’m curious to see what the next few months have in store… Here’s to Tana!

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Chair antics

IMG_2010A blonde, a Swede and a partially blind Ugandan attempt to make a chair…. it sounds like the start of a bad joke doesn’t it?

Well, this is reality.  I’ve commissioned a Swedish volunteer to help me make some adaptive seating for a disabled boy in the village and we have roped in the skills of a local carpenter who has lost the sight in one eye and has provided some rather questionable chairs to the lodge we reside in.  His name in Mandev, which isn’t actually his name at all, more a nickname which abbreviated in Ugandan, means man with a beard.  He is in his 70’s, has a 20 year old wife and lots of children that attend our school.

The initial idea was to make some supportive seating for a boy without sitting balance which may help reduce his tone and give him some comfort.  My initial sketches, although not great, were quickly adapted by Jan our Swedish volunteer into something completely different but looked like it may work.  Given that Sweden has a reputation for high class products and of course is home to the infamous IKEA, which if anything shows how well the Swedish can put together furniture, I decided to run with it.

Many people in Uganda still resort to witch doctors and are under the impression that if they have a disabled child then they have been cursed in some way.  This young boy was identified to me by a neighbour and his parents were more than happy for me to meet him.  Unable to sit independently or talk, he has the most beautiful smile and I instantly wanted to try and help in some way.  At 16, it is unlikely rehabilitation will make any huge differences, especially if no-one is able to carry on my work after I leave.

The best solution therefore was to make him a form of adaptive seating to help reduce his tone, improve his strength and hopefully improve his quality of life.

The question was how to do this.  Jan decided that Mandev was the best option and we handed over his above plans… inevitably what we got given was nothing like it.

Needing to then adapt the plans I had a little help from Jessie, another physiotherapist I had made contact with who works at a disabled school.  We began to change the design to ensure that at the very least, he had some more flexion at the hips to stop him from sliding out and falling onto the floor.

The other very obvious problem was that the chair was wonky (a common theme with Mandev’s chairs!).  Hardly surprising, considering he measures the legs from a different point each time and his tape measure is so old that it no longer has numbers on…

IMG_1791.JPGIn addition to the chair, I also asked him to make a table which we could fit on top as the boy has enough upper limb activity to feed himself.

Five attempts later, with some measuring help from another Swedish volunteer, Jutta, we finally had something that was beginning to look like it might actually work.  Lucky, as I’m not sure Mandev would have been able to handle it if I’d have sent him back again to make more changes.

On the way back from town I bought a mattress to provide the additional support the chair still lacked.  Coming back from town, sitting three on a motorbike, holding a pair of crutches and a mattress I realised how much I have become absorbed in Ugandan life.  It also cemented the fact that I have very little regard for health and safety.

IMG_1967The chair looked great, such a good effort and I began cutting up the mattress to provide the chair with more postural support.  That is, after a photo of the carpenter with his goods of course.  Also, it turns out Mandev’s real name is Nathan… suits him far better I think!

IMG_1974.JPGAs the mattress was thick and I only had a small, plastic pair of scissors I had to resort to a knife to cut it up.  Although not ideal, I appeared to do a fairly good job.

IMG_1994.JPGAfter some battling to get everything back together we finally had a chair that might actually do the job.  I was buzzing!

IMG_1997.JPGTried and tested by our very own Pats…

IMG_2007.JPGThe next problem was how to get it up the hill.  On a good day, without carrying a huge wooden chair, it takes about 30/ 40 minutes to reach their house.  After trying my sweetest persuasion techniques, I couldn’t entice anyone to carry it up for me, except for one of the cowboys who then got called away milking.

So, what else to do in Uganda other than call a boba boda?  I have seen everything from goats to bananas to coffins on motorbikes so I was pretty confident they would be able to help me with my chair.  Laurence called in some friends and within 10 minutes my chair was being loaded onto one of two motorbikes – the other to take us up the hill.

 

Bumping up small dirt tracks and through banana plantations, on a motorbike, is an unbeatable feeling.  We passed the local villagers attending a service outside the church and I smiled and waved at some of my patients and the people I have come to know over the last two months.  It is such a wonderful community and I have loved being a part of it.

When we arrived, the boy, P, was on the floor outside and smiled at the sight of us (his dogs were slightly less friendly and did their best to inflict fear).  On previous visits he has generally been outside but when I have turned up unexpected he has been lying on the floor, in a small hut and I believe this is where he usually stays.

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We lifted P up into our arms (for anyone bothered about manual handling – TIA) and carried him to the chair.  It was instant gratification for the last few days stresses and exertions.  He looked perfect.  Yes, the chair was probably only just adequate but he looked so much better and it was definitely worth the effort.

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His mother, who had seen us passing, had ran up the hill from the evening church service to meet us.  Her kind words and blessings making it all the sweeter.

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That smile!

I haven’t yet mentioned by this was actually my last evening at the lodge and it could not have been better.  Leaving behind something so small, that will make such a huge difference, there is no better way to end a trip!

The only issues were that I burnt myself on the motorbike exhaust (basic error – and one I have avoided for years!), giving myself a second degree burn.  Fail!

I also definitely paid too much for the boda (to add insult to injury) and he wasn’t dropping his price, so I had next to no money for food or water for the next 30 hours until my flight!  But, it was worth it all for the sense of accomplishment.

Thanks to all the amazing people that helped make this a reality.

To donate to my projects so I can keep providing help where it’s needed, visit my just giving page here.

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Mountain Gorillas

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The beautiful hills of Uganda are home to the famous mountain gorillas.  There are around 850 wild mountain gorillas left in the world, habituating forestry between the borders of Rwanda, Uganda and the Democratic Republic of Congo (DRC).

Awareness and conservation for these incredible animals was made famous in the 70’s and 80’s through much of Dian Fossey’s work, the pinnacle perhaps being her book ‘Gorillas in the Mist’, an account of her thirteen years living in the rain forest with them.

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Recently the cost of gorilla permits have gone up in all locations and Uganda is now cheaper than Rwanda to do the famous gorilla trek.  DRC remains the cheapest but after the recent murder of both rangers and tourists in the area (2018), is not recommended.

There are two areas within Uganda to see the gorillas, the famous Bwindi national park and the lesser known but equally as beautiful Mgahinga national park, in South Western Uganda.  This is where we did our gorilla tracking.

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Mgahinga national park is the smallest in Uganda, covering the northern slopes of three volcanoes and bordering two national parks in Rwanda and the DRC.  The setting is spectacular.  At the base of the volcano is the town of Kisoro, the closest border town to the DRC.

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It’s impossible to go to the border town and not see hundreds of refugees who are making their way into Uganda, a country with an open-doors policy to refugees.  Mainly children, they wait near the border until they are transported to UN run camps.  The poverty of some of these children is extreme and their health poor.  The little boy trying to rub his face against me definitely had either oral herpes or a severe bacterial infection but I loved how happy they were to meet a friendly stranger.

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To track the gorillas you need to set off early and we stayed right at the base of the national park.  The guesthouse had only just opened and it was beautiful.  Half way up the volcano, the views across the country were stunning.

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The next morning we set off early to walk the remaining distance from the guesthouse to the rangers huts where we met the others in our group.  The biggest advantage of choosing Mgahinga over Bwindi is the groups sizes are generally smaller.  Although they only give a limited number of permits a day you can still have a group size of up to 8.  At Mgahinga we were lucky enough to have just 4 in our group; another volunteer from my lodge, an Australian couple and myself.

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It was a fairly steep climb from when we set off.  The trackers leave at first light to where they left the gorillas the night before and begin their tracking.  By the time you set off with the rangers, generally the trackers have either located the gorillas or aren’t far away.  It can take any length of time but most commonly between 1-4 hours.

We were lucky that we only had just over two hours of trekking until we found them.  Although this is actually more than many, the walk is stunning and having spent the majority of the previous day travelling in the car, welcomed the exercise.  For anyone thinking this sounds a struggle, the first sightings of the gorillas is worth the effort.

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Nothing can really prepare you for the first encounter.  It is absolutely fantastic.  The sheer size and elegance of these animals renders you practically speechless.

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It shows how well habituated they are they walk right past you without even acknowledging your presence.  In order for tourists to be able to visit the gorilla families, they first need at least three years of habituation by the trackers.  This means that everyday for 3 years they are monitored, observed and slowly exposed to humans.  Allowing tourists to visit ensures that the revenue comes in to protect the forests and the gorillas from poaching and deforestation.  As mentioned earlier there are only 850 mountain gorillas left in the world and tourism is vital to maintain their species.  To cause the least disruption to their normal behaviour the group sizes and time spent with the animals is always limited, as well as prohibiting any consumption of food and drink.

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For anyone wanting a truly unique, once in a lifetime experience, this has to be it.  Tourism is still slow in Uganda and it is the most incredible country, rich in beauty and kindness, with so much on offer.  Tourism is important not just to protect these incredible animals but also those all over the country, including the incredible [Queen Elizabeth Park] and the captivating [chimpanzees].  If anyone is still looking for a reason to visit, the fascinating life of Dian Fossey (my namesake) would inspire even the least adventurous and last but not least, the Disney film Tarzan arguably has one of the most underrated soundtracks!

Ugandan Community Visits

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Community visits are an incredible way to see village life.  And to keep fit! To reach many of my patients houses I have to climb the hills on either side of the valley and wind my way through banana plantations.

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The houses themselves can differ greatly from being small, basic structures with a few rooms, built entirely from mud and wood, to slightly larger, solid brick houses.  Most houses have their own land for farming which means despite the area being poor, it is rare for people to go hungry, as generally crops are plentiful.

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Everyone in the community is friendly, if ever I get lost trying to find a patient (which is frequently!) I just have to ask and someone will either point me in the right direction or show me the way.  If I am with a patient, often other villagers will walk in and out and that is how I have come to gather a small community caseload, someone knows someone else that needs therapy.

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The first patient I met was suggested to me by one of the staff at the lodge.  He is 24 and since the age of 15 has struggled walking due to increased tone in his legs.  He has never had a medical diagnosis and as far as he and his mother are aware has no clear trigger before the onset of symptoms.  He is a fascinating case and as well as providing rehab, one I want to look into further.  I am hoping that before I leave we can get some medical tests completed and maybe have a clearer idea of what is causing his symptoms.  At the moment there are lots of differentials but it is important to rule out anything causing immunosuppression as if this were the case, in Uganda, he would be entitled to free healthcare.

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Whilst I was with this man a lady stopped by and recommended going to another house just up the hill.  When I arrived at the second house I met a gentleman struggling with arthritis and his son, completely immobile and without any speech.  He was sitting on the grass under the shade of a tree and unable to maintain independent sitting balance, yet despite this he was laughing and giggling appropriately as I moved his arms and legs.  Again, this child has no diagnosis but unlike my first patient, he has never been able to walk and therefore a definite diagnosis is less likely to change his treatment or long-term medical management.  Often children here if they are disabled are still kept hidden away as they are considered ‘cursed’.  Many people still rely on local witch-doctors for medical care and given that this boy is now sixteen years old, he is actually fairly healthy.  He has minimal contractures, is alert and engaging (even if unable to follow instructions/ commands) and has adapted to maintaining sitting balance by fixing with his right arm.

I’m currently in the process of getting an amazing Swedish volunteer and a local carpenter to help me make supportive seating for this boy which hopefully will help reduce his tone a little and allow him some comfort and relief.
Madrass=Mattress (Swedish code)

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The main difficulty with my community work here will be sustainability once I have left.  Many of my patients I can get to continue exercises independently and they know how to get in contact with our nurse at clinic if they have any trouble.  The harder patients will be the younger children, particularly those with neurological conditions.  Last Wednesday I met a little boy at baby clinic who is 6 months old, yet presents as a 2 month old.  He is the first child of a young mother and for the last week I have been going up to his home to visit him but I am concerned about when I leave; I also have far more concerns related to his breathing which I want to look into further this week.

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Luckily, since my arrival I have made contact with a physiotherapist who teaches at the University of Mbarara, the only University in Uganda teaching physiotherapy.  She has put me in contact with another physiotherapist based about 30 minutes from where I am who works at a school for disabled children and is looking at setting up a physiotherapy clinic alongside this.  I am aiming to meet with her next week and hopefully any of my paediatric patients with more complex or long term needs can be referred onto her to review after I have gone.

If you want to support my work, please follow the link to my just giving page.  Any additional money raised will be spent funding medical tests and imaging for patients that need it and will help pay for the adaptive seating we are making.

DONATE HERE

Right to an Education

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I strongly believe that every child deserves the right to an education.  Having been lucky enough to be University educated in the United Kingdom, it is something I value highly.

One thing I have learnt since being in Uganda, is that things don’t often work out as expected.  After all, this is Africa.  Yesterday, my plans to start health screening on the oldest nursery school children, were knocked on the head.  We needed to print more screening sheets but as the power was down, we were unable to.

On my way back to the lodge to sort the papers, I passed a small boy.  Bare foot and dressed in rags, talking to the staff outside the gate, they were trying to round up enough money for a bus fare.  It turns out the boy had been found earlier in the morning, sleeping in a ditch outside the lodge.  He had spent the night there.  Visibly in pain, he limped towards us.

His name was Paulo and he was 11 years old.  With nurse Rosen’s help, we established that his father had taken him to his sisters, where he was to work for an old lady as her cow boy.  He walked there and back each day and after working two months, reasonably asked for some money.  At this request, the old lady ‘chased him away’.  He went back to his sisters, who instead of helping him, made him start walking back home.

It had taken him 4 days to reach here and he lives near Mburo, another 3 hours drive away.  There was no way, with any conscience, that I could have just let him get on a bus when he could barely stand.   Instead, I picked him up and piggy backed him to the lodge where he could shower and change.

This was very emotional.

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Outside the showers

This photo captures the moment perfectly.  Sitting outside the staff showers, waiting.  It is heart-breaking, in this moment, to see a broken child.

He stripped off his rags, torn and dirty and dropped them on the floor.  Standing malnourished, naked and vulnerable, he just looked at me.  He was placing all of his faith in a complete stranger.  More than that, in a white stranger, whom he could only communicate with on a basic level.

I fetched a bar of soap from my room and my towel and ran the shower for him.  I have no idea if he has running water at home, although it is still rare in our region, so I doubt it.  Despite his fears and exhaustion, it was obvious the pleasure he took as soon as he stepped under the water.

Naked, swollen-bellied and eyes closed, a small smile danced across his lips.  Despite his ordeals, he stayed in the shower and scrubbed every area of his body with the feverishness of someone who has not washed in days and the conscientiousness of someone much older than his years, who knew to take full advantage of this opportunity.

Dripping, he stepped out of the shower and I wrapped him in a towel.  I’d set Rosen the task of trying to find some spare clothes from the donations that may fit him but after holding a recent market to make money for the school, we had no children’s or men’s clothes left.  We managed to find an old shirt and school jumper but no bottoms would fit his tiny frame.  Eventually, Tony found a smallish pair of shorts with a draw string waist, some of his own, that did the job perfectly.

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Stepping out of the store room Paolo looked like a completely different child and I showed him a photo of how he looked in his new clothes.  Lifting him up onto my back I grabbed a banana from the kitchen and a large bottle of water from the bar.

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We got back to the others and little Paulo was unrecognisable.  Sitting down under the shade of the registration tent, I took a look at his feet and his left ankle was acutely sprained.  Very tender and swollen he was now struggling to even stand, so I grabbed our only bandage from the clinic and strapped it as best I could.

We grabbed him a soda and some bread and set up a mattress for him to lie on in the shade.  He tried to stay awake to listen to our conversation but eventually drifted off into the most peaceful looking sleep.

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When he woke, he finished his food and drink and, well rested, I carried him back to the road to wait for the bus. Along with bus money, we packed a bag with his rags, some biscuits, a few pencils and a letter folded in his top pocket explaining how we found him and that a bright young boy like him should be in school and not working.  We explained that as a school, we are able to provide bursaries and hope that the family will contact us to let Paulo continue his education.

He is the sweetest boy.  I’m so glad we were able to take him in and show him kindness, even if just for the day.  However, it is heart-breaking to know that once he gets home, we have no way of knowing how he will be received or if his family will agree to let him continue school instead of working.

There are so many injustices in the world and it is so sad when it happens to young children.  I pray that the letter we sent with him will be enough to change his future.  If he were able to return, I would pay his school fees myself without hesitation to keep him here, safe and away from child labour.  It is so sad to be in this situation as, despite all that appears best for him, the only option, the right option, is to send him on his way and return to his parents.  I guess all I can do is hope that they get in contact with our director when he returns.

If you want to contribute to my overseas work, then please follow this link below to my crowdfunding page.

https://www.justgiving.com/crowdfunding/diana-whiteside

 

 

Thank you and please share.

Uganda Lodge

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Believe it or not it has taken over 2 hours to write the title.  I am fully submerged into Ugandan life and finding any spare time to blog is as hard as ever.  I’m finally getting out my laptop and I have an excitable 11-year-old next to me who won’t let my concentration drift even for a minute.  We have discussed the reason for a belly button; worked out basic mental arithmetic and pretended to talk without teeth.  Needless to say, it makes writing a little tricky; when school term starts in a fortnight it may become a little easier, but I’m not too convinced.

Life in Africa is exactly as expected, everything runs at a slower pace, on African time.  The nearest town to where I am staying is Ntungamo, in Western Uganda, near the Rwandan border.  The people of Uganda are friendly and inviting and as area I’m working in is fairly remote, it is still rare to come across white people which makes everyone is excited to see you!  They point, stare and wave shouting ‘Muzungu’: white person.

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Local house

Whilst staying in Africa I’m residing at a guesthouse adjacent to a school and when not working at the local hospital or health centre, free time is spent renovating the school before term starts and rounding up and playing with the local children whenever possible.

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Sunday Funday!

In addition to a school, the guesthouse I am attached to has a medical centre over the road and a development building which has brick making, sewing machines, shoe making and a barber to teach local trades.  Much of this is still under development and they are hoping to set up more vocational style work for children to go into, that are unable to study at secondary school due to academic or financial reasons.

The whole development was started by a single, remarkable man named Denis.  As a child he did not attend school, along with many other children in the area and the at the age of 13, became a child soldier.  Now he is older, he still works for the Ugandan army but has started up this entire project with the aim to ensure that every child in his neighbourhood can get an education and access to health care.

The money Denis makes through various projects and volunteer opportunities is all reinvested into the community with any money being contributed to the school’s development and bursaries for the local children that cannot afford it.  All the government schools in Uganda charge for attendance about 35 000/ term, this is approx. £7GBP.  As this is a private school the fees are a little higher, also offering the addition to board for children from further away, however as this is heavily subsidised by charitable donations it generally works out at a similar price to the government run schools.  Any families that cannot afford to pay cash are often allowed to pay in goods, for example beans or bananas and as long as it can be utilised by the school they are happy to accept it.

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School Classrooms
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Classroom
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Boys Dormitory

As mentioned, fees can be heavily subsidised, children at the school can be sponsored to attend and bursaries given to poorer households.  Yet despite this, some children still cannot afford to attend.  The area I am in is predominantly farming land and this also contributes to the main conditions seen at the health centre.

Due to the poverty there are limited water supplies and water is collected by children and families from water sources often polluted with animal waste, this gives rise to high incidences of typhoid and H-pylori.  On my first morning at the clinic, every child that attended had one of these conditions and it is generally related to poor water access and not boiling water before drinking.

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A local house made from mud and wood, they last about 50 years

Other conditions common at the clinic include malaria and mosquito born pathologies.  To reduce incidences of malaria in Uganda the government have issued free mosquito nets to families however, despite this they are seldom used.  Often when visiting homes mosquito nets are found unused, for storage or even on occasion as fishing nets.  This leads to large quantities of people catching malaria, however, as it can be fairly easily treated if caught early, the locals treat it in the same manner as catching a cold in the UK.

If you want to read more about the types of medical conditions I’ve seen then read my posts on [The Local Hospital] and Ugandan Community Visits.

Abbas’ Story

I met Abbas and his mother Lela on my first day in the camp.  This is his story.

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Abbas suffered a spinal cord injury after rebels opened fire on his car in 2016.

Abbas lived and worked near Ramadi, Iraq, with his mother, Lela.  Since the beginning of the Iraq war in 2003 Ramadi has been a centre of insurgency for many groups.  In May 2015 Ramadi was lost to ISIS and, according to the UN, it has seen the worst destruction of anywhere in Iraq. A city reduced to rubble.

When Abbas’ car was hit, it spun and crashed, killing all the other passengers and damaged his spinal cord at T11, paralysing him from the waist down.  After initial surgery in Iraq, Abbas had a metal rod implanted to fixate his spine.  After 6 months this began to rub and became very infected, leaving him with a hole in his back and as a result, the rod was then removed.   Abbas and his mother decided they needed to leave Iraq for their safety and for the medical care they could no longer receive, given the security situation at home.

In 2017 they began their journey to Europe, flying from Iraq to Turkey and making the rest of their journey by foot.  It took 10 hours to walk to the coast, stopping and starting often, with friends and strangers helping push his wheelchair.  In the forests of Turkey, Abbas had his wheelchair taken by the smugglers and sat for a day on the forest floor, before making the dangerous journey by boat across to the Greek Islands.

The boat journey lasted for seven hours and during this time Abbas was sat in one position, on a wooden board and unable to re-position himself due to his spinal-cord injury.  They arrived on the Greek Island of Samos on 16th September 2017 and were arrested on arrival.  There they were taken into custody and Abbas was left on the floor of a police cell for two days.  From here they were transferred to a refugee camp.  On arrival in the camp, after 4 days of sitting and being unable to change position, Abbas developed a grade 4 pressure sore on his right buttocks.  This is an extremely deep and painful sore which he is still struggling with today, a year later.

Abbas remained in Samos a month. He was provided with a new wheelchair and, although he received some medical help, he says the conditions were poor and impossible to manage for someone needing disabled access.  He reported it was so hilly that he could not get around and as a result was unable to access a bathroom for 15 days.  As Abbas was identified as a more vulnerable patient, he was transferred to the mainland, to the camp at Diavata, on 20th October 2017. This is where he remains today.

On arrival in Diavata he was hopeful he would receive some physiotherapy and further medical care.  However, he did not receive any therapy from the Greek health care system; the only rehabilitation input he received was from another volunteer Physiotherapist, Hannah, for a few weeks in July and after my arrival in September.  Despite the severity of his injury, the Greek surgeons do not want to operate on his pressure sore.  Instead, his mother Lela dresses it every two days and although she worries that she is not a nurse or medically trained, it says so much about their relationship, that it is as clean and in as good a condition as it is.

One of our volunteer doctors reviewed his pressure sore recently for me.  The wound itself has a 5cm sinus and they believe he needs debridement under anaesthetic and will likely need a long period for recovery.  Abbas is hopeful that soon he will have papers that allow him to seek asylum elsewhere in Europe, as he does not feel Greece is meeting his needs.  As soon as he is able to travel onwards, I will ensure a letter of recommendation travels with him, in the hope that the next country can attend to his care more appropriately.

When I began my work with him, Abbas had not left the camp since he arrived a year ago and seldom ventured outside of his container.  We have been having rehab three times a week to increase his muscle strength and wheelchair independence for when he is able to leave.  He is now able to get to and from the doctor’s office to collect his wound dressings independently and we are beginning to tackle curbs and steps.  The terrain is still difficult as it is very rocky but he is exceptionally motivated and amazingly strong, which makes my job easy.

Abbas’s main limitation to rehab and becoming more independent is his pressure sore.  Due to the severity and location he is not able to sit out for long periods and tends to sit out only for an hour or two per day.  This means that even though he is now strong enough to get about the camp, he is unable to attend any of the language classes put on as he cannot physically sit in his wheelchair for the required amount of time.  On his wheelchair he has a thin, foam cushion that he and his mother cut to size themselves and this offers nothing in the way of pressure relief for his sacrum.

He spends the rest of the day repositioning himself in bed but his mattress is equally poor.  It is the same thin foam, positioned on top of some cardboard, perhaps explaining why his wound is refusing to heal.

Although ultimately Abbas will require surgery, having a suitable pressure-relieving cushion to sit out on would completely change his day to day function.  He will be able to sit out more, get out more and maybe even attend language classes, in the hope that one day he will be able to make a home here in Europe.

Abbas and Lela have particularly touched me whilst I have been in Greece.  They have the most beautiful relationship, which is difficult to put into words, although this image captures a tiny glimpse of it.

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I want to be able to help them as much as possible whilst I am here and once they move on.  An appropriate wheelchair cushion will cost between £100-300. Although getting a mattress, too, would be preferable, it would be better to purchase that once they are settled in their new country, which hopefully won’t be too long now.

If this story affects anyone in the way that it does me, then please donate to my just giving page and we can purchase a cushion for his wheelchair.  For anyone wishing to help further, if you donate to my just giving page and comment ‘Abbas’, along with any other comments, I will ensure that 100% of the donations are passed onto him and Lela.  This is in the hope that when they finally get a new home, two years after fleeing Iraq, they will be able to purchase anything they need for Abbas’s ongoing care.

DONATE HERE

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