Town, apartment, and hospital

I deliberately stayed in town one weekend to be able to see Mbarara and to take a few pictures around the place. Documenting stuff for the blog is particularly good in that it makes me take the pictures, and I have a record for myself as well.

Home and food:

I live in a cinder block/concrete two bedroom house. The other bedroom is occupied by my Ugandan roommate, one of three astrophysicists in Uganda. Very nice man. We have a living room, dining room, and kitchen. The bathroom has two toilets separated by a partial wall. One of the toilets has a bath in it as well. The sink (just one) is separate, so potentially three people could use the bathroom simultaneously.

The kitchen has a strange stove with two electric elements and two gas burners. Only the electric elements work. The fridge is not good at all; weak. Anything that really needs to stay cold I need to freeze. For that reason, I buy milk in little 500 ml (slightly over a pint) containers so that I use it up before it can spoil.  Milk by the way, is sold in plastic/paper containers that are sealed. Sterilization is achieved, I believe, with radiation.

Food is, well, not so great. None of the restaurants here are anything to crow about, so I cook for myself. There is a limited array of vegetables (tomatoes, onions, potatoes, sometimes eggplant, sometimes green peppers and I end up making various egg, pasta, and rice concoctions. The Ugandan rice is actually quite tasty. Pasta comes from Egypt.

Water is sometimes sporadic. It has a pretty high particulate content. I put it through a particulate filter, and then I put it through my trusty First Need microbiological filter. (The First Need could get rid of particles too, but this way I don’t shorten the life of the filter.) Electricity is also sporadic. It’s generally on, but occasionally isn’t.

As you can see below, I sleep under a mosquito net.  Pictures are below.

 

Kitchen

My bedroom

Living Room

Town

I walked into town this morning. It is an absolute madhouse. The primary means of transportation is the boda boda. This is a motorcycle with an engine displacement usually between 100-200cc. The driver drives, and the passenger sits on the back. Women in dresses ride side-saddle. Some people hold onto the driver. Some people hold onto a handle that is behind them. Some people don’t hold onto anything. Some people, including me, don’t ride them.  Anyway, they are everywhere. Almost all the motorbikes you see in the pictures that follow are not for personal use, they are boda bodas.  The streets are lined with shops and stalls. The side streets have little stalls and shops as well. I must say that I felt sufficiently different and uncomfortable that I didn’t venture down the side streets, just stayed on the main drag.  I don’t know if any of you get solicited by Finca, the microfinance NGO, but I have a picture of their Mbarara office below.

This is the town center. The bull is the "famous" Mbarara cow statue, commemorating the famous Ankole cattle in the region.

Yup, Finca really does more than just solicit funds.

Typical street scene

What a great picture. Asleep on your wheelbarrow.

View into residential areas

This is actually quite typical. Folks will ride their bikes to where they need to pick up whatever, and then walk their bike back, piled full of bananas, milk cans, whatever.

Costs vary widely. A 500 ml bottle of Tusker beer (4.2%, not terribly high), is 3000 Ugandan shillings, slightly under 1 USD. The exchange rate is approximately 1 USD = 3300 Ugx. I can buy two small eggplants, 4 tomatoes, and 4 purple onions for about 2000 Ugx. However, breakfast cereal made in Kenya under British license is about 15000 Ugx, which is quite a bit. Toilet paper is about 1300 Ugx per roll. An albuterol inhaler made in India is 45000 Ugx.  A CT scan of the chest is about 200000 Ugx.

Hospital and University

The hospital and university are a sprawl of primarily one story buildings, many dating from the colonial era. There is some newer construction as well. For a person from a resource rich environment, it is very jarring to walk around. The hospital provides sinks for patients and families to do laundry, and every morning the lawns are covered with drying sheets and clothing. Wards are long, narrow affairs with no privacy, and they tend to smell. Handwashing is very difficult to achieve, and everyone carries alcohol gel. Attendants (family) either sleep on the floor next to the patient or outside. People here were not nearly as interested in posing for pictures as they were in Bhutan, so I shot a couple of quick pix of a part of the emergency room and the female medical ward with my tablet, so it looked like I was looking something up.  Sorry, everyone.

What’s really interesting to me and somewhat puzzling is all the global development stuff here. Mbarara and environs are funky enough to be decidely classed as resource poor, but ultimately it’s actually pretty safe and sane here. A bunch of universities and hospitals in the U.S. have partnered with the hospital here; Mass General even maintains a “guest house” here and they send residents here. University of Virginia sends their internal medicine resident with a global health concentration here one a year. All kinds of HIV related initiatives are here, funded by private sources and WHO. Everyone’s nipping and chipping off little pieces of the problems here and it’s not clear to me that systemically things change. Certainly, there is a boost in AIDS care—patients get medications because the US and others pay for it. There’s a TB program, and all kinds of meds, but there is no program for directly observed therapy. Some folks come here clearly thinking they have “the answer” but that usually fizzles out pretty quickly. There’s also people who come here with an academic agenda. Collect research data, punch your global development overseas ticket, and go home and write about it. Whether this has any direct benefit for local people is not clear, nor is it the purpose of the visit. To be honest, I worry about that. So, it feels hit or miss. All these people just churning away, but does it really improve life. I don’t know.

The local docs are very smart. I mean, very smart. The residents know far more about physical diagnosis than I do, to the point that it is embarrassing sometimes. They are not taught good critical thinking and presentation skills, but they catch on very, very fast.  Working with the residents has been wonderful. We really have learned a lot from each other.

Anyway, enough sociopolitical and economic philosophizing. Here are pictures of the hospital.

Typical morning scene outside the wards. Laundry drying, and you can just barely make out a group of ladies sitting and chatting at about 2-3 o'clock.

I love this. Everything is free, except for the stuff that isn't. Unfortunately, the stuff that isn't is the good stuff.

View of  a portion of the ED

View down middle of female medical ward.