Post Conference Visit

One of our project sites has been chosen for the post conference visit of the TUGH Conference in Kampala. Staff and volunteers have been creating displays of our interactive teaching material to mount on walls and local women’s groups have been preparing Ankole millet baskets for sale--sun hats from reeds, bags from papyrus, and placemats from banana fibres. Entertainment has been organized including drumming, dramas, songs puppet shows using locally-made puppets as well as village tours of model homes.

We are in the rainy season now, so a canvas tarp has been erected outside the health center for the crafts. Our trainers have donned fancy hats and serve as interpreters and escorts. More than 70 people arrive from Kampala to stay overnight at the Lakeview Hotel in Mbarara. For the trip the following morning we have someone on the bus with a portable megaphone to provide an introduction to the project and area.

The day is sunny and glorious. We drive past the tea plantations in shimmering green and crater lakes where everyone wants to get out and take pictures. Our trainers, who are drawn from local health center staff, move around among the people explaining the various techniques. We have also involved some of the elective students who worked with the project during their holidays to assist. Several groups move out to see the villages, check the pit latrines and Tippy Taps, observe the drying racks in use and the kitchen gardens. The villagers are proud their homes have been selected and at the same time staggered to see so many white folks at one time.

The number of flash bulbs going off is daunting even for those of us used to it. For many of the visitors this is the real, the rural Africa they were hoping to see. For the puppet show, dancing and dramas the whole group is crowded, African-style into one small room, but everyone is tolerant and kids are poking their heads in through every window and door.

The whole thing has been planned by our volunteers. After the ethnic dancing they soon have everyone up dancing. One of the volunteers pulls me to the front of the room and tells me to watch how the Ankole dancers, furiously wiggling their bottoms get the drummers to stop. I have seen it many times but never realized what I was watching, a ritualized approach and rebuff of the dancers to the drums until finally by increasing the frenzy of their dance they are able to silence the drums. It is as if the drummers are talking to them, “Are you sure you have had enough? “No, well try harder”

During one of the two dramas put on by the volunteers, a woman jerks erratically on the floor, simulating an epileptic fit and is ignored by the other players. She continues to jerk and writhe. A small child sitting at the front nearby the woman, collects a piece of cloth and unseen by the actors, gently places it over the woman. There is a poignant indrawing of breath from the audience at this touching display of mercy.

Well into the field visit, one of the medical students visiting is feeling unwell and admits to have been bitten on the hand two days earlier by a dog in Kampala while she was walking. Rabies immune globulin wasn’t available at the clinic she attended and the doctor told her to get it from another clinic. Several suggestions were provided. She decided to come on the Post Conference tour instead.

We have a gazillion physicians on the tour—well at least 20 --including infectious disease, microbiology, public health and internal medicine specialists, so there is plenty of free advice. However our field site is about 8 or 9 hours out of Kampala and those of us who work in the area think there is probably not any rabies immune globulin locally available. People requiring it are usually sent to Kampala or Kigali, Rwanda from here.

When we return to the regional hospital on Sunday, we sheepishly ask the internist, who has access to some inaccessible drugs, if he can assist. He is pretty sure there is none but agrees to go and check. He also contacts a local VSO doctor who has a couple of possible contacts in Kampala where rabies immune globulin might be available. Further questioning reveals that the bite was not provoked so the dog is unlikely to be rabid and the RIg is not indicated.

Numerous phone calls are made by many people in attempts to find RIg. Being Sunday doesn’t help. Several of the visiting specialists who were convinced they could locate some immune globulin because of their contact with local researchers or professors, have had to admit failure. Indeed it appears rabies immune globulin may not be available, not even in Kampala.

The RIg episode is a circus, a potentially serious one, with no one in control and too many experts. It reminds me that if you get seriously ill in a foreign country you need to have a good, local physician, no amount of “experts” is a substitute for one who knows the local system and how to connect with it.

For lunch the group is taken to a local safari lodge on the escarpment above Queen Elizabeth Park where we can see elephants as tiny dots moving across the plains. A tired but satisfied group returns to the hotel at the end of the day. Hosting the visit has made our staff and trainers more aware of how unique and exceptional the project is.

Photos: Trainers in hats; Explain to visitors; Puppet Show; drama