Posted by: anandinafrica | August 4, 2013

Rounding Out

A long-lost friend recently got back in touch with me, which is always a pleasure. He mentioned how he didn’t know if I was still in Africa since I never put a final blog post about my return to the US. He’s not the first to have said this, so I thought it would be appropriate to finally round out this blog, although much delayed. The previous post was my last from Uganda. Afterwards, we returned to Washington D.C.  where we presented our summer projects at a GHFP research forum in the Ronald Reagan Building (it was interrupted by chaos when, no joke, an earthquake hit D.C. and we all had to evacuate into the streets). All in all, I think back on that whole summer experience fondly. I’ll have unexpected reminders of it all the time, and I carry all the lessons I learned with me today and forward. Thanks to technology, I’m still in touch with some of my Ugandan friends and colleagues along with those from my previous stay in Tanzania.

WordPress has developed a cool feature where you can see all the stats of who’s visiting the blog, from where, and which posts are the most popular. Since they rolled out the feature, the blog has had visitors from 149 different countries! This includes places as unexpected as Azerbaijan, Suriname, and Mongolia. There are still some white spaces (see map) in Central Asia and Central America, and Central Africa from where I haven’t had visitors, but that also includes some countries where internet censorship blocks all WordPress blogs. So far, I’ve had more than 40,000 hits! The top ten countries that visitors hail from are as follows:   1. United States 2. United Kingdom 3. India 4. Canada 5. Tanzania 6. Australia 7. Germany 8. Kenya 9. South Africa 10. Uganda


Blog visitors from all over!

I’ve gotten all kinds of inquiries and comments regarding global health/public health/med school/East Africa/tourism/ugali/etc from people who stumbled across the blog. A few people have requested some of the pictures for use in their documentaries. One person even used a picture I took from Zambia as the cover a book he published. If any of you have any questions at all about anything related to this blog (or not), please feel free to contact me. Thank you, my friends. Asante sana marafiki yangu.

Posted by: anandinafrica | August 20, 2011

Birth and Death

Birth and death are natural processes of life, but both have become an unexpectedly regular part of the workday in Kampala. For example, last week I saw my first natural live birth which was unbelievable. But literally seconds after the baby was born, I heard another mother wailing at the top of her lungs from outside the open window of the labor ward. “It’s coming from the pediatric ward,” Paul said. “Someone’s lost her child.” He said it matter-of-factly and continued with his business, as did the nurses. In a country where more than one out of ten children never makes it to a fifth birthday, my shock was just their everyday.

Healthy baby boy delivered at Mengo, seconds old

And it’s not only children who lose their lives early. The New York Times ran a story just a couple weeks back on maternal mortality in Uganda. The article focused on a locally elected female politician who bled to death in her hospital bed trying to give birth after no one heeded her calls for help… for 12 hours. It is easy to point fingers but the problems are much bigger than simply neglect on behalf of the health staff. Health has not been the priority of the government, and that was made clear when they spent half a billion dollars purchasing fighter jets this spring. Additionally, the article mentions that the government is investing less and less into the health sector. International aid is to serve as a supplement, but the government has used it as a replacement.

Maybe this is why twins and the bearer of twins are given such high respect in Ugandan culture – double the life in a country where each life has far fewer guarantees of survival. In fact, once a couple has twins, the name of the parent changes. The woman is addressed as “nalongo” (the mother of twins) and the man becomes “ssalongo” (the father of twins). The Ugandan media actually had nicknamed President George W. Bush ssalongo since he has twin daughters.

Twins and their parents are given much respect

A brother of one of the hospital workers was admitted to our intensive HIV/AIDS treatment room, suffering from an HIV-related opportunistic infection known as PJP. He also had late stage liver disease. But neither the patient nor his family could afford money for further tests, and even if those costs were covered, there was not enough to pay for any type of medication or admission to the wards. “Sometimes you just have to tell the family to pray,” one of the doctors said matter-of-factly. Two weeks later, the man passed away. One week after that, the hospital worker had a baby girl of his own. “We lost one, and we gained one,” he said with a smile.

“What happens when you get old in the US?” the same co-worker asked me while we were on home-based outreach in the community. He didn’t let me answer before he went on to describe the apparently dreary fate of the elderly in Uganda. They have no income and social security is not well in place. Apparently people go to their NSSF account only to find that their savings fund have been used up by the government. People earn so little as it is which makes it difficult to save, especially sums that are to last for several years. It is considered shameful if the parent moves in with his or her children, especially with a daughter who is married. It is expected that your grandchild takes care of you, so if you don’t have any grandchildren it can be problematic, and many die having fallen through the holes of an already weak safety net. When I asked someone else in our car how they were going to prepare for old age, he laughed and said, “You just pray not to grow old.”

Birth and death are universal, but somehow it’s as if they’re a bigger part of life here. Maybe I’m just noticing it more since it’s so common. After all, Uganda has the second highest total fertility rate in the world with each woman averaging more than six children. At the same time, the life expectancy has barely cracked fifty years. Some of my co-workers jokingly lament – “I’ve only got 10 years left!” Despite the nature of their work and the nature of life in Uganda, everyone can let loose. Each day, tea and lunch at the hospital are almost exclusively set aside as times to be silly (and eat). The rooms fill with laughter, hand holding, high-fives, and hugging. Looking around, you wouldn’t know that we worked in an HIV/AIDS department within a Ugandan hospital, but it’s a great way for everyone to handle all of the emotional weight that comes with this work.

Posted by: anandinafrica | August 13, 2011

I’m Muganda

The current Kabaka, King Ronald Mutesi

“I’m Muganda,” a co-worker told me on my first day of work, beaming with pride. “I’m Anand. Nice to meet you,” I replied. I, of course, thought that Muganda was her name until I found out that Muganda is what you call a member of the Baganda tribe in the Buganda kingdom. Like many countries in sub-Saharan Africa, politics and allegiances often fall along tribal lines in Uganda. This is in interesting contrast to Tanzania, where its first president, Julius Nyerere, promoted socialism for the first 20 years of the country’s existence. He abolished tribalism and then unified the country by making Swahili the national language. Such was not the case in Uganda, and that seems to be more typical of a country in this region.

The largest tribe, the Baganda, dominate Kampala and the central region of the country. They are probably the proudest and most vocal of the tribes, paying their respects to the Buganda King, known as the Kabaka. His picture is all over the place – necklaces, keychains, barber shop walls, and inside taxi cabs. The Buganda kingdom was prosperous and well-governed until Milton Obote, Uganda’s second (and fourth) president, attacked the Kabaka’s palace and sent him into exile in the UK where he was subsequently poisoned and died. It wasn’t until the 1990s when the Kabaka’s son, Ronald Mutebi, came back to restore the monarchy, although his position is now largely ceremonious. In somewhat of a reversal of Coming to America, Mutebi, who had been raised in the UK, came back to undergo the traditional coronation ceremony of the Baganda.

The Kabaka was overthrown, the palace overtaken, and a prison was built on the grounds by Amin

But the Baganda are not the most powerful tribe – that distinction apparently goes without argument to the Banyankole of western Uganda. It is the tribe of the current president, Museveni. Then there are the Busogas, the Acholis, the Bakenye, the Batooro, and about a dozen others. There is also a north-south divide in Uganda, where the southern tribes are clearly better off than their less-educated, poorer northern brothers. Both Obote and Amin were from the north, so obviously that did not bode well for the north’s political reputation. Uganda is far from a homogeneous population. The languages are both Bantu-based and Nilotic. Because they vary so much, English is used as a unifying language and Swahili is used within the military and police forces. There is a very visible Somali community in Kampala. The Somalis are mostly refugees who crossed through Kenya, where apparently immigration law is harsher, and settled down in a more permissive Uganda. A portion of our patients at Mengo are Somali, but communication is difficult since the Ugandans do not speak Somali, and the Somalis usually don’t speak English or Luganda. The July 2010 bombings in Kampala by Al-Shabaab, a Somali based militant group, struck fear into Ugandans and unfortunately created a negative perception against the large locally-based Somali population. It’s hard to tell whether that sentiment is subsiding or not. The Somalis are concentrated in a part of the city called Kisenyi, also known as “Little Mogadishu.”

The Buganda Kingdom

There are smaller numbers of Rwandans and Congolese, and they speak Swahili and French. Their populations are logically larger near Uganda’s borders, but they have a presence in Kampala, as well. The South Sudanese are probably the most visible, simply because they tower over their Ugandan counterparts. I know that Dutch people are apparently the tallest in the world, but I think they face some stiff competition. On the other end of the height spectrum, there is a community of pygmies near the western borders of Uganda. Everything seems to fall along tribal lines, and even in a big city like Kampala where one would imagine such distinctions disappear, that’s not necessarily the case. I can definitely see why it’s important for some people to maintain tribal identity, as each group has different traditions and distinct cultures to take pride in, but then at the same time, unity and equity seem to suffer.

Posted by: anandinafrica | August 11, 2011

Miracle Workers

I’ve seen some pretty incredible things during my time in Uganda, but the most impressive has been watching the health workers here at Mengo Hospital. Frankly, they’re miracle workers. Given the resources that are available, the staff somehow manages more than 4,000 HIV/AIDS patients in addition to a couple thousand TB patients. They have extraordinary skills and superb teamwork –that includes the physicians, nurses, assistants, volunteers, managers, technicians, data keepers, and administrators.

A few members of the Mengo Dream Team

Dr. Paul and Dr. Vincent lightheartedly make remarks to me on a daily basis comparing what they do to how things “would be done in developed countries.” It’s true – the conditions are not completely ideal. The hospital sincerely tries its best to provide treatment at no cost, but some charges become unavoidable. Then the treatment or test all of a sudden is not feasible for the patients. Towards the end of the quarter, donor-allocated medications for HIV or TB or even antibiotics may have run out. When x-rays are needed, the machines can be broken. When blood transfusions are required for the severely anemic, the blood bank may not have any stores remaining. All the required instrumentation is not always available for surgery. But everyone tries their best and does absolutely everything they can given the circumstances.


In fact, I’ve found the physicians here to be so versatile. Sometimes in the US, it feels that all the specialties and super-specialties preclude physicians from gaining knowledge of other fields. But here, the doctors can at any moment serve as the primary care giver, the radiologist, the dermatologist, the ENT, the pathologist, the surgeon, the pharmacist, and the ER physician. There are only an estimated 2000 doctors in Uganda, so sometimes they have no choice but to task-shift and take on other roles. They will read scans, do skin biopsies, administer chemotherapy, and deliver babies – both naturally and via Caesarean. Every Friday is circumcision day so we usually operate on 8-10 patients, including infants, adolescents, and adults (circumcision has been proven to significantly reduce HIV transmission, so many health centers are rolling out low-cost or no-cost circumcisions).

Saturday support groups

There are frustrations on all ends. The doctors work long hours, they’re paid little, and their job is emotionally and physically taxing. There are also risks, especially when working with HIV-infected blood. One of the doctors was pricked while doing an operation and had to take HIV post-exposure prophylaxis, which ended up giving him the side effect of Stevens-Johnson Syndrome that has scarred his body. For the patients, HIV drug adherence can be difficult, often complicated by some secondary infection, further complicated by their personal living situations. The prevalence of concurrent relationships (referred to as ‘side dishes’), multiple wives, discordant couples, and positive children can certainly make things challenging. As a result, the health workers also have to function as social workers and counselors for the patients, although there are great counselors on staff, as well. Every Saturday, a specific support group is held at the clinic – for children, for serodiscordants, etc. There are also HIV+ volunteers who do home visits and community-based DOTS to improve HIV and TB adherence. The clinic may not have everything, but what the staff is able to do is simply inspirational.

Posted by: anandinafrica | August 7, 2011

Summer Reads

In our free time and during the weekends, we either travel around Uganda or simply relax in Kampala. I’ve also been able to do some reading in that downtime, so I thought I would share a few of the good books I’ve finished here –

Kampala Cake Festival

No One Had a Tongue to Speak (Utpal Sandesara and Tom Wooten) – My cousin co-wrote this book! Shout out to Utpal : ) With a forward by the renowned Dr. Paul Farmer of Partners in Health, this book unravels the history behind one of India’s deadliest floods in Morbi, Gujarat. Through the stories of a select number of families and individuals, the authors show how lives were changed when the Macchu II Dam burst, unleashing its wrath on Morbi and the surrounding villages. The book details how improper engineering, inadequate notice and response, and politics played into the disaster. It’s extremely well researched, as Utpal and Tom carried out hundreds of interviews of survivors uncovering the details of the ill-fated event, and wonderfully retells the story of the forgotten flood.

Ugandan dances at Ndere Center

This is a Soul (Marilyn Berger) -Dr. Rick Hodes went from the comforts of suburbia to some of the most difficult situations in Africa. For the last couple decades, Hodes has made Addis Ababa, Ethiopia his residence, working closely with Mother Teresa’s clinic. The book chronicles the challenges of working in those circumstances but more so delves into the lives of the boys and girls he rescues off the street and adopts as his own children.  For those with specific medical interests, Hodes largely works with patients who suffer from spine disfigurement due to TB and arranges for them to have spine surgery. This is a story of sacrifice, persistence, and more than anything, passion.

The Teeth May Smile but the Heart Does Not Forget (Andrew Rice) – Everyone who travels to Uganda should definitely read this book. It’s a fascinating work even for those who are not traveling there. It is the story of Duncan Laki, a Ugandan living in suburban New Jersey, who decides that he needs to find out what happened to his father, Eliphaz. His father was a village chief who disappeared as did so many others under Idi Amin’s reign of terror. The book details Duncan’s quest as one clue intriguingly leads to another in discovering the elder Laki’s fate and bringing those responsible from Amin’s time to justice for the first time in Uganda’s history. The neatest thing about the book’s organization is that it ties the events of what happened to Duncan’s father with the overall history of Uganda from prehistoric times through colonialism to independence.

Boating on Lake Victoria

National Antiretroviral Treatment Guidelines for Adults, Adolescents, and Children – June 2009 (Ministry of Health, Uganda) – Ok, obviously this is not “casual reading” but it’s a must for anyone working in HIV/AIDS care and treatment. Each country tends to have its own guidelines, but regardless they are written in line with CDC and WHO recommendations and modified given the resources and circumstances of each nation. This is what I used as a basis for a background into testing, ART initiation, PMTCT, and opportunistic infections associated with HIV/AIDS.

Tide of Fortune (Manubhai Madhvani) – This book is great for anyone with an interest in studies of the Indian diaspora, specifically in Africa. Madhvani goes back to telling the story of his courageous forefathers who arrived by boat to Mombasa, Kenya in the 1800s and made their way to the interior of Uganda. The Madhvani name is synonymous with business empire here in Uganda, but the author goes into detail about how that empire was created, how it fell with the Indian expulsion under Idi Amin, and how it was resurrected. It details the family’s history and provides kernels of wisdom on successful business enterprise. A special thanks to Mr. Ronnie Madhvani for gifting this book to me.

Weekend outings

The Challenge for Africa (Wangari Mathai) – I actually read this last year, but I wanted to mention it anyways because I thought it was so fantastic. Mathai, a Kenyan, won the Nobel Peace Prize in 2004 for her work in the Green Belt Movement, environmentalism, and conservation. She gives her very informed and honest opinions on why the problems which exist in Africa exist, and what is the best way forward in tackling them. The issues she addresses include corruption, environmental degradation, religion, tribalism, loss of indigenous culture, leadership, health, development, and reliance on Western aid. For those who don’t have any background in Africa and even for those who do, this is an incredibly insightful book.

Posted by: anandinafrica | August 3, 2011

Alphabet Soup

USAID's GHFP implemented by PHI

Over the last couple of years, I’ve begun to realize the crucial role acronyms and initials play in global health and medicine. The entire language sometimes just looks and sounds like alphabet soup, but it’s something I’ve been adapting to. For example, when talking about HIV/AIDS-related areas (Human Immunodeficiency Virus/Aquired Immune Deficiency Syndrome), you’ll no doubt come across PMTCT (Prevention of Mother to Child Transmission), VCT (Volunteer Testing and Counseling), PLWHA (People Living With HIV/AIDS), ANC (Antenatal Clinic), GBV (Gender-Based Violence), OVC (Orphans and Vulnerable Children) and ARVs (Antiretrovirals), among many, many others.  Then, there are the more medically oriented terms, such as the possible OIs (Opportunistic Infections) that can affect people living with HIV/AIDS: PJP (Pneumocystis Jiroveci Pneumonia), SJS (Stevens-Johnson Syndrome), IRIS (Immune Reconstitution Inflammatory Syndrome), and CCM (Cryptococcal Meningitis).

Here in Kampala, the presence of foreign assistance agencies and humanitarian groups presents another whole stack of letters: DFID (Department For International Development – UK), DANIDA (Danish International Development Agency – Denmark), GIZ (Gesellschaft für Internationale Zusammenarbeit – Germany), PEPFAR (President’s Emergency Plan For AIDS Relief), IRCU (Inter-Religious Council of Uganda), PSI (Population Services International), and FHI (Family Health International).

Oh, the letters

When our supervisor from Washington D.C. came to visit a few weeks ago, she showed that she was a pro in this language, spewing letters left and right while we all stared at her blankly. She would speak about FSOs (Foreign Service Officers), HTLs (Health Team Leaders), MDs (Mission Directors), PCVs (Peace Corps Volunteers), and who knows what else. But even she admitted to not knowing all the terms – she recently went to a conference where everyone was throwing around the term FFATA. Apparently, it stands for the Federal Funding Accountability and Transparency Act.

And of course, I’m here working for USAID’s (United States Agency for International Development’s) GHFP (Global Health Fellows Program) implemented by PHI (Public Health Institute) in partnership with HSPH (Harvard School of Public Health), MSI (Management Systems International), and TUSPHTM (Tulane University School of Public Health and Tropical Medicine).

Posted by: anandinafrica | August 1, 2011

(Second) Homecoming

Rooftop overlooking Dar es Salaam city center

I remember the anticipation and excitement I had when I was flying into Chicago from Tanzania last August – I had been gone an entire year from America. I could hardly contain myself when I saw the city’s clean, gridded urban planning, the abundance of grassy parks, and the dark summer waters of Lake Michigan from the plane. But last week, I went from Uganda back to Tanzania for the first time since I left. I had similar sentiments as I drew near to Dar es Salaam’s Indian Ocean coast, its swathes of palm trees, white sands, and its nearby islands. Chicago is where the heart is, but I’ve come to realize that Tanzania is my second home.  When I finally took my first breath of Dar air, I was enveloped in the unmistakable humidity and heat that characterizes the city, but somehow I didn’t even mind.

Coconuts sold on the streets

I stayed in city center, and all the things that are typical of Dar came rushing back to me on all sides. It took just a quick walk around the streets to see all the women walking around in colorful traditional kangas, the wazees with their decorative Muslim hats and thick beards, the roasted chicken and nyama choma stands that grilled until the wee hours of the night, the maandazi sellers on the side of the roads, and of course the dalla-dalla buses blasting Bongo-Flava with their conductors shouting all corners of the city – Posta, Masaki, Mwenge, Kariakoo, Buguruni, Mbezi. Dar es Salaam is a true mixture of cultures and people from around the rim of the Indian Ocean as well as the interior of Africa. As the sun set, the muezzins from mosques across the city simultaneously send their calls to prayer, as they have for centuries since Arab traders introduced the faith.  And while English is commonplace in Uganda, I was once again immersed in pure Tanzanian Swahili. I’d forgotten about the pole-pole pace of the place, but I had no problem adopting it, buying coconuts and sipping their water while slowy strolling around.

Indian Ocean Coast of Dar es Salaam

First and foremost, I wanted to see my MPH classmates with whom I spent the majority of my year in Tanzania. There were 21 of us in total, 19 in Tanzania, and only a handful who remained in Dar es Salaam while the rest were scattered across the country. I was able to meet up with a good number of the ones who remained in Dar, and it was fantastic – lots of yelling, smiling, and Tanzanian 3-sided hugs.  They even called up all of the other classmates who are in different regions of the country so I could speak with them on the phone. It basically felt like one of those movies where at the end it tells you what all the main characters are doing since the story ended. And holy cow, my classmates are doing some extraordinary things. Basically everyone received a promotion after obtaining their MPH. Some are country managers of international NGOs, health directors, Ministry of Health officials, District Medical Officers, and more. I sadly missed our graduation ceremony which was this past December, but apparently Tanzania’s president, Jakaya Kikwete was the guest of honor and earned an honorary degree in public health, so everyone was joking that he was basically our classmate.

MPH reunions with Aisa and Irene

I saw my professors, who were quite surprised but pleased to see me. They all wanted to make sure that my MPH skills were being put to use, and I assured them that they certainly were with my current internship in Kampala. The Muhimbili campus was as I remembered, but unusually busy with people flying around because the US Secretary of Health and Human Services, Kathleen Sebelius, happened to be visiting the campus and hospital later that afternoon.

Catching up with old friends

Of course, the trip wouldn’t be complete without visiting my scholarship sponsors, Rotary. I went to a club meeting. Usually, one Rotarian introduces me as a guest, but the president said, “We all know you, so you’re everyone’s guest. Welcome back.” I even met my Rotary host family from last year. I didn’t get a chance to tell everyone I was coming beforehand for a visit, so first they’d be shocked and excited when I called, thinking I was calling from the US. This would then be followed by further excitement which would progress to shouts when I told them I was in Dar. I saw several families, neighbors, and friends, including some international friends who had returned for the summer. We drove along the oceanfront, spent the nights on familiar rooftops, and ate at our favorite places. I literally had breakfast, lunch, and dinner with someone every day I was there.

Colonial buildings of Dar

Dar es Salaam is Arabic for “Haven of Peace” but that certainly isn’t always the case in this city of 3 million. I forgot about the bureaucracy, which was more than evident as I tried to obtain my transcript from my university. It involved getting a dozen signatures from different departments, my undergrad diplomas, and my birth certificate. While the nights were cooler as this is ‘winter’ in Dar, the heat during the day was far from comfortable. The city is significantly more expensive than Kampala. Additionally, the government is rationing electricity to Dar es Salaam almost every single day, cutting it for 15 hour stretches. But at the end of the day, I can’t deny my fondness for the city – after all, I was drawn back without hesitation. I’ve already counted my blessings on being able to come here not once, but twice thanks to Rotary and GHFP. I’m not sure if I’ll be able to return again, but everyone told me “Karibu tena tee-zed” – welcome again to TZ. As they say in Swahili, mungu akipenda – if God wills it.

Posted by: anandinafrica | July 30, 2011

1972 Indian Expulsion

Nakasero Hindu Temple, downtown Kampala

In my early childhood, I had a babysitter named Shantaben Patel, an Indian grandmother who would come over every day to take care of me as my parents worked fulltime. It wasn’t until I grew older that I learned that Shantaben was originally from Africa, a refugee from President Idi Amin’s Uganda. She lived in Kitgum, a small town near the border of South Sudan, before escaping with her family. Hers was one of the tens of thousands of Indian families who migrated to Africa en masse from the late 1800s onwards when a craze for East Africa (Kenya, Uganda, and Tanganyika colonies) enveloped Indians searching for greener pastures on the other side of the ocean. Once settled, the Indians quickly became the merchant class, eventually controlling large proportions of the local economies.

When Amin took power via coup in 1971, he was a welcome change from the increasingly autocratic, corrupt second president, Milton Obote. But, it was only a matter of months before Amin began to imprison and kill those who were a direct threat to him, including those in his cabinet as well as civil servants. Eventually, regular citizens who aroused any suspicion were imprisoned or done away with. Almost exactly 39 years ago, Amin claimed to have a dream in which he was told to grab the nation’s wealth for natives. “No country can tolerate the economy of a nation being so much in the hands of non-citizens,” he stated. He proceeded to give Indians 90 days to leave everything behind, pack one suitcase, and leave the country.

Old Sikh temple, downtown Kampala

Because Uganda was a British colony prior to independence, most Indians held UK citizenship. But a few days later, he said that he wanted all Indians out, regardless of whether they held UK or Ugandan passports. The underlying motives of policy were not unprecedented. Many native Ugandans felt that the Indians had too much of a stronghold on the Ugandan economy which prevented any locals from taking on advanced business positions. They controlled almost all of the cotton gins, sugar cane plantations, tea estates, and factories along with the majority of small businesses. Making up around just 1% of the population, the Indians contributed to a quarter of all tax revenues and an even larger proportion of the national GDP. At the time, this policy was heralded as one of Amin’s most popular, since anti-Indian sentiment ran high. However, the effects of the expulsion were almost immediate as the economy collapsed. Regular foods and goods sold in Indian shops were no longer available and now had to be smuggled in across borders. Amin redistributed Indian properties and businesses to his cronies, which were then essentially mismanaged to disrepair.

Ugandan Indian refugees land at Heathrow, 1972 David Hurn/Magnum

Some say that the estimated 73,000 Ugandan Indians (or Asians, as they were referred to in line with colonial British terminology) who were expelled in 1972 were the lucky ones. Up to 300,000 native Ugandans lost their lives under the regime of Idi Amin. While displacement is traumatic, many rationalize that the Indians at least escaped Amin’s rule and were granted asylum and citizenship in more developed nations, namely the UK and Canada. The Ugandan situation caused Indians in neighboring African nations to also panic and consequently flee – historians label these mass flights as the “Asian exodus”.  Many of the Indians you find in the UK and Canada will tell you that they have come “via East Africa.”

The hints of the Indian past are seen all over Uganda. Many of the buildings from the pre-Amin days are still standing. They are built in the typical Indian bungalow/ apartment style, with the name of the owner and the date engraved at the top. Today, they serve just as the façade to Ugandan businesses. Indian food is everywhere. Indian Hindu, Jain, Muslim, and Sikh places of worship from the pre-Amin days are still standing. Used as office space, abandoned, or turned into bars during his regime, they are now back in use.

Indians have once again returned, Kampala

I’ve met some who left, like Shantaben, who have never come back. While I was in Tanzania last week, I met a Ugandan Indian who had resettled in the UK. She has never stepped foot back in Kampala. “I had very, very fond memories of growing up there… of that land… I don’t want those to ever be replaced.” Stories like hers are commonplace. Far less common are those of Indian families who stayed behind in Uganda or returned post-Amin. There is a family who lives in the same neighborhood as me here in Kampala who never left. “You could count on two hands the families who had stayed behind in Kampala.” They faced harassment in the beginning, but then things slowly improved.

When Museveni, the current president, took power in 1986, he invited the expelled Indians back to Uganda, offering back some of their possessions and providing incentives to reboot the economy. But naturally, a very small number of families and individuals returned. And in the 15 years that had passed, many had settled down and restarted their lives in the West. Still, the Indian presence is once again strong in Uganda. However, probably 90% of families are immigrants straight from India and are not part of the historical Asian population.  The anti-Asian sentiment has managed to creep back as I have discovered in conversations with locals and immigrants alike. History isn’t likely to repeat itself, but it’s no doubt a delicate dynamic that needs to be addressed.

Posted by: anandinafrica | July 28, 2011

Fearful and Fearless

Preventing mother to child transmission

About a month ago, I shadowed Jacob  in the outpatient department where he was doing HIV testing and counseling with individuals and couples. The very first session I saw involved a couple who had been referred for testing after the wife had fallen sick. After completing the pre-test counseling, the HIV rapid tests were ready for reading. They were presented to the patients in a way so that they had ownership over their results. The husband saw that he was positive, and 30 seconds later, his wife was given the same results. The man looked stunned, and the woman put her head in her hands. A long silence ensued until the man slowly made eye contact with us and asked, “So what do we do now?” We answered his questions, attempted to put them at ease, and listened. We told him about meds and a referral to the HIV clinic, while his wife continued to stare off at the ground.

In one morning, we did 49 rapid tests and counseling

HIV testing is still something that is met with apprehension, not just in Uganda, but in all settings. I’ve talked to a number of health professionals in the hospital who themselves are afraid of going in for testing. After that first experience with Jacob, it’s become much clearer why that fear exists. The threat is so real. It makes sense logically that people should just get tested so that they find out their status and then get treated accordingly if necessary. But when you put it in the social structure and cultural context of HIV testing in Uganda, the underlying reasons for the fear no longer seem unwarranted … the stigma from the community… the different gender expectations…the potential of families falling apart… marriages breaking up.

I worked in the hospital’s PMTCT (Prevention of Mother to Child Transmission) clinic for a good chunk of time this past month with pregnant mothers and occasionally, their spouses who had accompanied them. The goal at PMTCT is to find out the status of the mothers, and regardless of the mothers’ status, ensure that the baby is negative.  I did both finger prick rapid tests and one-on-one/group pre-test counseling where we talked about HIV transmission, specifically mother-to-child. We talked about risk-taking behaviors, prevention, and treatment options for positive mothers. We always emphasized the importance of sharing that one has been tested and to encourage brothers, sisters, and friends to come and get tested. After all, it is free, as is treatment.

PMTCT counseling sessions

Women often express concern about their husband’s whereabouts, especially those that work far away from home. Many have also felt powerless in negotiating the use of condoms. As a result, Mengo has “Men’s Access Day” every last Friday of the month where men can come in and have specific testing, counseling, and education alongside dozens of other men. When the patients say that they are ready to see the results, the atmosphere usually changes. Sometimes they become nervous, sometimes they hold my hand, sometimes they anxiously laugh, sometimes they’ll turn stone-faced. Most of the clients are negative, and I can see the relief wash over them. However, it’s difficult to gauge what the results mean to them. Was this a wakeup call, or was this a free ticket to more risk-taking behavior?

Testing and sorting rapid tests

The issues that arise stem from the fact that HIV is not what it was ten years ago. In Africa, where the ARVs were either unavailable or wildly expensive, being HIV+ was essentially a death sentence. Now with the Global Fund, PEPFAR, and other donors stepping in to provide essential medications, HIV is just another chronic, manageable disease like diabetes. A recent study showed that those with HIV who are taking ARVs have the same life expectancy as the average HIV negative Ugandan. I’ve heard from so many people that Ugandans are far less scared of HIV than they were a decade ago. On the one hand, this means that people are more willing to get tested and treated compared to the past, although it’s a slow growth curve. On the other hand, it means that people are becoming less concerned about engaging in HIV risk-taking behaviors. In the 1980s, the HIV rate in Uganda was near 25% In the 90s, it dropped to 15%, and it recently came to an all time low around 6%. However, that rate is spiking up again for the first time in decades. This dynamic of being fearless and fearful when it comes to HIV testing has continued to have an effect on health-seeking behavior and thus the HIV positivity and treatment rates.

Posted by: anandinafrica | July 19, 2011

New Neighbors

Special South Sudan section in the Ugandan paper

Uganda just got a new neighbor along its northern border – at least in terms of name. Just a few days after America celebrated its 235th birthday, South Sudan became the newest nation on the planet on 7/9/2011. Sudan, which was the largest country on the African continent, officially broke into two parts. The long-oppressed, historically black Christian south became independent from the largely Arab Muslim north. We were contemplating heading to Juba, the capital city of the new nation, for independence day celebrations but there were a few too many question marks for us to take the 15 hour bus ride northwards. Instead, Jacob and I watched the jubilation live from home on Al-Jazeera, which was still pretty exciting. Ugandans consider the South Sudanese as brothers. The languages and tribes of South Sudan extend to the Ugandan side of the border, as well. Hundreds of thousands of Ugandans do business there, especially in Juba, so it made sense that Ugandans were just as excited about the official secession.

#9 Luol Deng (bottom left), a native of South Sudan, warming up at a Bulls game I went to in April

One of my favorite Chicago Bulls players, Luol Deng, was born in South Sudan and is amember of its largest tribe, the Dinka. Like many others, he fled the region with his family as a refugee during a civil war which plagued the country for the last 3 decades. In January of this year, South Sudan had its referendum vote on whether or not it should remain a part of Sudan. Luol was instrumental in getting the vote out in South Sudanese diaspora communities, including Chicago, which served as one of the eight official American voting centers. The January results showed that 99% voted in favor of independence, which was made official on July ninth. Luol returned for the historic event and even ran a basketball camp for Juba youth while he was there. However, it’s not all a rosy picture. The nation has some of the lowest human development indicators on the continent, and there are still security threats from the North and disputes regarding control of oil. When Eritrea broke away from Ethiopia in the 90s, it was only a matter of a few years before a border dispute led to a deadly war, so anything can happen. Omar Bashir, the president of Sudan, wished South Sudan prosperity and stability, which is a start. It’s too early to say what direction the nation will go just 2 weeks after independence, but let’s cross our fingers and hope for the best.

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