Transport in Uganda

Although maybe not untypical of Africa the public transport options in Uganda are quite different from the UK. In our past blogs we have referred to some of the difficulties and dangers but we hope you find the following photos interesting and amusing.
There has been no passenger trains in Uganda since 1997 so most  journeys are made by the roads which range from good stretches ( some funded by EU money) to pothole ridden obstacle courses. Uganda is a relatively small country. roughly 250 miles wide by 300 miles - the the same area as the UK (91,000 sq. miles) according to the Bradt guide.  Country-wide travel by coach/bus has its dangers. The Post Office buses are the recommended services but generally the  buses are referred to as ‘flying coffins’ and travel at night is not recommended.

In the remote areas pick-up can be the only available option but if you are not sitting inside the journey can be precarious.

The taxi service is provided by 14 seat minibuses (referred to as matatus in Kenya). Outside Kampala they are not so well regulated but within Kampala the maximum number of passengers varies little from the regulation number of 14. Although chaotic they do seem to be very effective in moving lots of people and you rarely have to wait more than 5 minutes for one. 

 A lot of taxis have religious slogans on the back windows but I don’t know if they are more successful at avoiding breakdowns and collisions.

The old taxi park in Kampala.

Outside town we believe they can be very overloaded and you may be sharing your seat with a goat. 

 
Inside Kampala the Boda Boda motorcycles provide a taxi service that can beat the traffic jams. In earlier blogs we have mentioned some of the many accidents we have heard about but for many it’s the most convenient way to get about. We have not had the need or the desire to use them so far. They do provide some amusing sights as there appears to be nothing that can’t be carried on a Boda Boda.



 
A three-piece suite.

Bags of charcoal

 












Chickens














An improvised windshield

Boda boda drivers take a rest.

Children come and go from nursery.

Bicycles are also a popular form of transport . They provide a taxi service and are also used to carry an amazing variety of loads.

Matooke - a staple food

Pineapples

 Kleeneeze!

 
 Bicycle repairs.

If you have no wheels you must carry your load. 

The skills in carrying a load on the head are amazing and taken to an extreme at the Ndere Traditional Dancing Centre in Kampala.













 
Rhona and I have not seen a baby buggy since we arrived. We expect this is because pavements are few and the pedestrian ways are generally rough tracks. 
So until they can walk babies are carried in a traditional way.

 I thank our recent visitors for permission to use some of their photos.

Kampala Erupts

Rhona - 25th March
Life in Kampala has been a bit tense since a week ago last Monday when there were riots at Makerere University following the death of two students. There was a strike on Monday and then there was trouble at a student hostel, which a security guard tried to resolve by shooting three people with one bullet, killing two.
The following day there were student riots, and then on Tuesday night the Kasubi Tombs, a World Heritage site, was razed to the ground by fire with more rioters stopping the fire service from entering.



 

 We were at the Tombs three weeks ago with Donald and David. It was a nice antidote to the bustle of the centre of the city but it is off our Kampala tour for our future guests. 


 
Fortunately we are on the southern outskirts and the troubles were all on the north. We were pretty safe and unaffected but some VSOers live on the north and had to stay at home until the situation died down. There are elections due in May 2011 so there may be more trouble to come.Today's news is of a further 2 student deaths.
However, we had a very nice evening on Friday with other VSoers in a boutique hotel on the north of the city and all was calm, apart from the sky which was lit up by lightning all night though there was no thunder or rain. The Emin Pasha was built by a safari company whose clients were not greatly enamoured by the big international hotels in the centre of Kampala and they certainly got this one right. It is very elegant with terraces to sit on and very nice music, very sophisticated and a great end to a busy week.
I have been spending time with the nurses and learning a bit more about the treatment of HIV/AIDS. I attended a group education session for clients who are starting antiretroviral therapy (ART). 

Clients who are HIV +ve but well are prescribed Septrin, an antibiotic which they take routinely once a day to reduce their chance of picking up opportunistic infections, to which they are susceptible. When the disease progresses to a certain level, they start on ART (for life) which involves taking heavy-duty tablets twice a day and they have to take them at exactly twelve-hour intervals to be effective. The medication makes people feel unwell, especially in the first few  months and particularly if they do not take food beforehand. Many people can only afford one meal a day and not always that. They have to come to the group education sessions along with their treatment supporter, a family member or friend who has agreed to help them to stick to their regime. The community health workers also visit them at home at least weekly to give them support. The session was very well done by one of the staff of the Adherence and Support Department who monitor and support people on ART and also those on TB treatment as well. In addition they look after pregnant women and their children up to the age of two years, who are enrolled into the PMTCT (Prevention of Mother To Child Transmission) programme.
I also attended the weekly meeting of the community health workers. They are all HIV+ve and clients of Reach Out  and each looks after a small number of families in their own community. They have a community leader who supervises them and they discuss clients and refer upwards if necessary. There is a strong religious element as well and they will often go and pray with clients who are very ill. It was interesting hearing about the problems they encounter in a country where there is absolutely no welfare state to provide a safety net for people in extremis. Clients of Reach Out are very fortunate that they are so well cared for and can be given food, although the World Food Agency have stopped their programme at Reach Out and food aid is decreasing generally. They also have community supporters who will look after clients who are very ill and have no family to care for. However, while our clients enjoy a Rolls Royce service, others in the same community who are not HIV +ve and those in other areas do not have access to even basic care, which does raise questions about equity of access to health care.

My VSO Placement

Bobby - 16th March 2010

This is probably the most boring blog so far (no photos but I thought some flowcharts might be helpful) but being 6 months through our 1 year placement I thought I should record a bit more about the work I am doing. I am enjoying my placement and feel very lucky that there is a substantial job to be done.

I am working for (as is Rhona) Reach Out Mbuya HIV and AIDS Initiative. It started in 2001 with less than 20 clients and now has around 3,000. Since its start over 7,000 clients have been registered. Mbuya is a parish on the east side of Kampala on the Port Bell Road. Our house is about 3km further out on the Port Bell Road which  makes travelling to work relatively easy.
Reach Out is required to make regular reports to the Ministry of Health and funders. As the organisation grew the reporting depended more and more on spreadsheets and at some point it was realised that there would be benefits from establishing a Health Management Information System (HMIS) which would capture data from day to  day and generate the analyses for the required internal and external reporting.
In February 2009 Reach Out engaged a consultant/contractor to provide the HMIS using an MS SQL Server database and Visual Basic front end for the data capture. The contract was for 2 months starting  February 2009. When I arrived on the scene at the end of September 2 data capture screens (out of around 20) were in use.  The consultant was claiming that the system was substantially complete but Reach Out had not tested or implemented most of what had been delivered. This was not surprising as I discovered the only database established was the one Reach Out was using to key the live data into  - there was no test system. The system had been described/specified as a number of modules e.g. pharmacy, laboratory, medical (including Follow Up records, TB register, PMTCT register), stores, so I set about identifying all the issues/bugs which required to be addressed. I spent the 3 months up to Christmas working with the consultant trying to get him to fix the problems and address some of the other issues.
I think the basic problem was the specification was very loose and the consultant didn’t seem to be keen to do much analyses so in many cases what was delivered did not meet the requirements and there was little detail on what they were.
I had no previous experience of MS SQL Server but, when I established the test system, I was delighted to discover how easy it was to take an MS Access database and convert it into a front end for the MS SQL Server database. Importing the MS Access tables worked a treat and MS Access ODBC links were easily established. Around 70,000 Follow Up  records had been entered and MS Access link tables allowed us to start checking and using the data for the reports at the end of December. (A number of staff at Reach Out have some knowledge of MS Access)
Reach Out are trying to capture all the historical records going back to the start in 2001. As the data capture was way behind schedule and the consultant was “slow” in delivering I suggested as an interim measure that I create an MS Access database to capture the TB Register data. When the consultant delivered the VB screens we could convert to using them.
Christmas came and went and I was getting concerned at the amount of time I was wasting checking each delivered offering from the consultant only to find that a substantial number of the outstanding issues were not addressed and had to be followed up in the next delivery.
In January we had a meeting with some of the IT staff from CDC, Reach Out’s main sponsor, and I was very interested to hear that they were encouraging the use of MS Access as a front end to MS SQL Server as it gave the (more competent) users the option to change the data capture and add new fields to meet changing needs without having to further engage the services of a consultant.
A short step from that was the realisation that the time I was wasting with the consultant would be better spent developing MS Access front ends to the HMIS database. So we have abandonned any further development of the VB modules and I am now developing the HMIS system. I am enjoying this although my lack of experience with MS SQL Server can be a bit of a constraint.
I have had concerns that I wasn’t passing on skills to the staff but it’s not too bad just now with a few keen to learn from me.
I have a clear idea what I want to achieve in the next 2 months so that the last 4 months will just be consolidating the procedures and training – if only. There are signs of the next phase of requirements emerging but I will have to try not to get to involved or else I will never get home.
What do you think? Is this really boring? Please comment.

More Safaris

 Rhona -

Our friends Donald and David from the UK have been here for twelve days and just left on Tuesday. It was great having them, and they packed a lot into their stay. Bobby was patrol leader and Donald youngest or “bim” scout of the Kingfisher patrol – I trust Donald was more deferential to his PL in 1964 than he is now! They arrived late at night so stayed in Entebbe and we drove down the following morning, delayed a little by torrential rain. However, the sun came out and we had a good tour of the botanic gardens with lots of birdwatching, then lunch in Gately Inn Entebbe (recommended) and then home to Kampala for walk through village and up the hill at the back of our house for an introduction to real African life and a good view over Kampala. On Sunday we had a trip into the centre of Kampala and the taxi park and market before escaping to the more peaceful Kasubi Tombs,

where the Kabaka kings are buried and their female descendants take turns to sleep even today.

On Monday they were off to Rwanda for gorilla trekking and returned latish on Thursday for a quick turnaround before we all set off to Lake Mburo for three days safari. On the road down we all had the opportunity to straddle the Equator.

Lake Mburo is very underrated, it has lots of wildlife, and is the only park in Uganda with zebras and impala, both of which were plentiful. There are no big cats, but we saw plenty of buffalo and 50 species of birds (Donald and Bobby were into making lists, maybe a throwback from the 1960s) - more photos at end of blog. We stayed in Mihingo Lodge which was very comfortable with fantastic food, which the owner attributes to the input of his Scottish mother-in-law.

 

Impala and Zebra at Lake Mburo

Yellow billed oxpeckers on a buffulo.

One of many Fish Eagles on the banks of Lake Mburo

 

 

[Note - Bobby is extremely jealous of Donald and David who saw this Shoebill on the way to Jinja last Monday] 

  

The only negative aspect of our trip was as usual, the roads. On the way down we had an accident in heavy rain when the minibus in front of us braked hard to avoid a  boda boda and we went into the back of the minibus. We were going very slowly at the point of impact and we, who were in a very sturdy Landcruiser with a driver, were unscathed, but three of the passengers in the minibus had minor injuries (two had concussion and one probable cracked ribs). They were on their way to Bwindi for gorilla trekking but neither they nor the minibus were fit to continue, and with the delays at the police station they would not have got there in daylight. They were a bunch of physicians and some medical students over from USA working in Mulago Hospital, the big and grim tertiary referral centre for Uganda, plus another American who is working for a few months and is a colleague of one our fellow VSO ers. They were getting more than their “fair share” or statistically anticipated of road traffic accidents; the weekend before they were on their way to Jinja and were involved in a much more serious accident, with one of their party sustaining a severe laceration to her leg down to the bone, and drivers of two of the three vehicles involved pinned down for hours.

 We are supposed to be in the dry season but the weather is unpredictable, often hot and sunny but with a fair smattering of rain, some long downpours and some cooler days and nights. There has been a mudslide in the east of Uganda, killing nearly 400 people, in a village where the population has doubled in the past two years. The mudslide is being blamed on intense cultivation of steep slopes and removal of trees and grass with subsequent loose soil which does not absorb the water. The average family has ten children but polygamy is common and fathers having 26 children is not uncommon. The only way to address the population explosion is to educate girls so that they get interesting jobs but education in these poor rural communities is very poor (typically not beyond P7), so it is a vicious circle. Most of our women colleagues in Reach Out have only few children, (they are the lucky ones who have qualifications) despite being Catholic, but upcountry it is very different.

We had a slightly guilt-ridden day on Wednesday, having decided to miss Reach Out’s quarterly spiritual retreat, which consists of spending all day in church, with breaks for morning tea and lunch. We went to one before and it was really just too much spirituality in one sitting, although many people do seem to get a lot out of it. There are two church services in the morning with very long sermons and a full mass in the afternoon. As Reach Out parties are memorable affairs with a good programme and lots of structured interactive activities which make use of our colleagues’ innate abilities on the singing and acting front, it is strange that the spiritual retreat consists of being talked at by a priest. Anyway, we got on with work of which there is plenty.

Between visitors

13th February, 2010

We are having a quiet weekend between guests - two have just gone and two more arrive next Friday. Trailfinders are having a surge of interest in Uganda as the hotspot destination for Scottish tourists.

We had a great time with Allison and Alison, who spent time in Bwindi Impenetrable Forest and saw the gorillas twice, once on the official trek and once later as they and the gorillas were walking along a path. 

 We had a good trip with them to Jinja, and had  a great boat ride when we saw lots of colourful birds which seemed to be lined up for us at very close range. (I acknowledge that the better photographs on this blog are attributed to AW)

 The source of the Nile marker where the river starts its 4,000 mile journey to the Med.

 Giant Kingfisher

 Open Bill Stork (I was looking for Rod Hull!)

 

We stayed in Gately on Nile, a very nice homely hotel, with very fancy pebble showers.

We had a visit to the Ndere Centre to see dancing from different areas in Uganda which is always interesting, some spectacular. A week ago yesterday we had a class in Ugandan dancing in the VSO banda with the instructor who ran some classes for us before Christmas. They experienced all Kampala weathers, hot and sunny on arrival and cooler and wet when they left. On the way back from Jinja we stopped at Mabira Forest for a forest walk with Hussein, the same guide we had previously. We asked for a 2 hour walk. After 1 hour the sky darkened and the sky opened. Its amazing how we stayed dry for the first 5minutes but the forest canopy could not hold back anymore and we got seriously soaked. 

They had a morning at Reach Out and experienced the yoga and spiritual reflection and also spent some time in the clinic seeing a variety of clients. 

Then we had the usual late night departure routine of a trip to the botanic gardens at Entebbe, dinner at Gately Inn Entebbe before taking them to the airport. We had a relaxed evening at Sophie Motel and then drove back to Kampala the next morning.

Last night we joined other volunteers at the weekly rendezvous for drinks and a meal. It is a good opportunity to catch  up  with the other volunteers although we have not managed along for a few weeks.  Work continues to be very busy for both of us. I have been helping people to prepare and submit abstracts for an International Aids Conference in Austria in July. It was very time-consuming, and not helped by a very slow and fragile internet connection which made each on-line submission and  conference scholarship application a very lengthy process. However, it’s another good learning experience and either Reach Out staff have to learn how to do these things themselves, especially the managers and supervisors, or be very selective about which abstracts are submitted. However, it is difficult because they are just so nice and such wonderful nurses, and some of the best and most articulate are also unlikely really to be able to write English well and get to grips with modern technology. Also there is the usual issue of African time which in this case was at odds with a deadline given by super-efficient Austrians. Anyway it would be great if  we could see off a delegation of Reach Out staff, in their lovely African traditional dresses, from Entebbe airport. The somewhat dour and sedate Viennese would be taken aback I suspect. I am now agitating to fill the research officer post which I took over when I arrived. I am having to do the routine work with studies, abstracts and ensuring that the many students and some external researchers who come to Reach Out to carry out research conform to research governance procedures which I have strengthened and revised as well as trying to move the organisation forward. The way forward is to collaborate with academic institutions both local and international and there are March deadlines for outline proposals for two possible sources of funding, the Leverhulme Trust and Nuffield Foundation which both have international programme grants, the Nuffield specifically for Africa.

Bobby is meantime living and breathing databases. He is now being helped by a very able member of staff who has been transferred from the Reach Out Centre at Kasaala which was established one year ago. He is happy there are now a few very able members of staff to whom he can transfer skills and attempy to make a sustainable impression on the organisation. Wow 5 months down and 7 to go - time is flying by.

A good life in Kampala

Wednesday 27th January.
Well, after the excitement of Christmas things have settled down and we are both hard at work for Reachout. We are feeling very settled in Uganda and a lot of our earlier fears have diminished. We find the Ugandans to be a gentle and friendly people although some of the behaviour on the roads seems out of character. We are more comfortable with the routine but there are constant reminders that life in Uganda is harsher than back home –a member of the Reachout staff died over the weekend after a boda boda accident last Friday.

Last Thursday I enjoyed a trip out into the country. Reach Out Mbuya has four bases where they run clinics. Three are relatively close on the east side of Kampala (Mbuya, Kinawataka, Banda). The  fourth, Kasaala, is about an hour and a half north of Kampala just beyond Luwero. I hadn’t been before but a visit was required to understand what data recording was in place. Kasaala appeared quite idyllic compared with the busle of the city. Kasaala village, I think, has a population of about 1000.

There is a bore hole water pump in front of the clinic. This was in constant use filling up the stack of yellow jerry cans. 

The land is lush and green and I became aware of the abundance of fruit and vegetables as the pickup was loaded for the journey home.

Last Friday evening we enjoyed the monthly gathering of Kampala volunteers. This time we met for a drink and a meal at the Centenary Park next to Garden City.

Our Sunday routine, when there are no other commitments, is to spend the morning at the gym and swimming pool at Kabira Country Club. Last Sunday we were a little more adventurous and we visited the Speke Resort on the shores of Lake Victoria for the first time. The centre was built for the CHOGM conference a few years back. Apart from extensive hotel and conference facilities, there is an Olympic size swimming pool and a modern gym. The setting is very attractive with the view out to the lake.

On Monday night we were at the Caledonian Society's Burns Supper which was very enjoyable. It started at 7.30 and was attended by around 80 people. We left at 12.30 although the dancing was not near finished. It was a first for me to pipe (or bow) in the haggis on my fiddle. Conveniently, for Kapalian  Burns Supper goers the 26th is a national holiday - NRM Liberation Day.
The last few days have been very hot with temparatures in the low thirties. On Friday we are looking forward to welcoming our next visitors and showing them how we live when they are not watching the gorillas.

Back to auld claes an' matooke

Sunday 10th January 2010

After a great Christmas break, we are back to focusing on what we came to do here. It was good seeing everyone at Reach Out again. Most had gone back to “the village” for Christmas. Everyone seems to have a village of origin, no-one admits to being from Kampala, but while most people still have some relatives there, with the move to urbanisation, there is a gradual loss of connection with their roots and it may be that the next generation will seen themselves as city born and bred with no relatives to visit up-country. Kampala is still quite quiet and the traffic in the morning is very light, it may be because the schools are on holiday until 2nd February. Reach Out cut down its services more over Christmas than before, although there were still clinics for the acutely ill and very sick clients. Surprisingly, the clinics have been quiet this week, the nurses think some people may have travelled to their villages for Christmas and not have the money to travel back.
Bobby is back to being busy working with the IT consultant and the Monitoring and Evaluation Team to get the new HMIS completed and has started generating reports from the considerable volume of data that has been entered over the last six months. He is enjoying exploring and learning about SQL Server while depending on his MS Access to provide users with a more familiar front end to the data.I have been working on analysing data for a study evaluating the effectiveness of an intervention for discordant couples (one HIV+ve the other –ve)  so that I can work with clinical staff to submit an abstract for a big HIV/AIDS conference in July in Vienna. I am also working with another member of staff on another abstract for the same conference about the Prevention of Transmission from Mother to Child Programme. It would be great if they can go. They are all very good and confident at talking and have a charm and grace that I can only admire but writing is more difficult.
My main goal is to set up a collaboration between Reach Out, a local university and a Scottish University, which would provide the long-tern academic support needed to allow Reach Out to take a lead in setting the research agenda. The staff are very keen to use and do research to be able to show the effectiveness of their nurse-led model of care and all the other aspects which makes Reach Out so special. From an academic perspective, Reach Out is very dynamic and ready for change and innovation.
We are also making the research governance more streamlined, and this is particularly important because of the constant stream of students, some local and other from overseas (overseas from Uganda!)  who want to come to Reach Out to carry out research for their dissertations. I am preparing guidance for prospective researchers which we will put on the website to make it easier for them to understand the process involved before they can have access to staff and clients.
We also now have weekly meetings of the Research Capacity Group, and overall there is a lot of research being done, mainly by using data which is collected routinely for the reports which donors require quarterly. With the new Health Management System which Bobby is helping to design and implement, extracting this data should be easier than before.  Given the problems we have had in extracting and interpreting routine data in two recent community nursing studies I think Bobby could maybe show NHS boards how to do things the Reach Out way when he comes back to Scotland.
At the end of the week three members of staff left and we had a very African send-off - they just do these things so nicely. 

One was a long-serving nurse, and the nurses are a great team who recently won a Best Practice Award, so it was a very emotional send-off for Lynn. Towards the end of the ceremony, we were each served a soda (Coke, Fanta etc are collectively referred to as soda here) and a brown paper bag with a vegetable samosa and a bun, to finish off the party in style.
We have had lots of e-mails over Christmas, which we have appreciated, and some have included photos of the snow at home. We realise that the UK is having the worst winter for 50 years and  that the cold spell is far more prolonged than usual. We also read that the UK is importing salt from Africa for the roads - we certainly don’t need it here except for our rehydration therapy. By way of contrast I decided on Friday morning to work outside to get some space to spread out some questionnaires which needed checking before the data was entered. I started out on the bench outside the office but soon became too hot and had to move under the shade of a  large tree in the compound. I did think about the photos and reports in the Scotsman online as I worked – and I know we will dream of this climate next winter. 
It also seems strange sitting on our verandah in the evening with a waragi (gin at £4 a bottle and very acceptable) and tonic watching the birds as the sun goes down and knowing that we will not be doing that next January.