by Judy Steel
As I left Dennis was waiting, but this time he asked me to visit his mother who he said was very sick. When I arrived at her house it was so small and dark that I could barely see her lying in bed. Someone lit a tiny paraffin flame and told me she had suffered from malaria plus a loss of weight and severe coughing. I suspected a combination of tuberculosis and AIDS, so I gave her chloroquine tablets for the malaria.
As I left and weaved my way back through the tiny alleyways between the slums, little children shouted out to me and some men called out kisakye webale webale nnyo. Recheal translated it as ‘miracle grace from God, thank you very much for what you are doing’. Over the next few days, Edward gave me more pethidine to give Jeffrey some relief. When he died, three days later, I felt grateful his suffering had ended and that he had at least had two or three peaceful days in his final week.
After only a month in Uganda I realised I needed some time on my own. The days in the clinic were exhausting; not only the rush of people wanting help but also adjusting to the heat, language and cultural subtleties of Uganda. I missed Allan desperately and craved letters from home, as well as simple things like bread. In Uganda, bread is sweet and made with loads of sugar, though eventually I found a bakery that made bread with salt.
I was very tired at night, and coming home to a house constantly full of visitors and neighbouring orphans wasn’t helping me rest. One morning I answered a knock on the door at home to find a nurse from the clinic who had tracked me down and wanted 800,000 shillings (A$700) for sponsorship. Being asked for this type of assistance was to become a regular occurrence, but I learned quickly how to say no. Another time there was a robbery next door and we were awoken by screaming. Unfortunately it wasn’t unusual to hear screams in Kampala at night due to domestic violence, but in this case there had been six armed intruders and a man was stabbed.
The heavy tropical rains made things even more difficult. One morning after it rained, I made my way to the clinic through ankle-deep mud, remaining upright until the last minute. As I fell, my shoe stuck in the mud and my foot flew out and landed in a bog. The incident seemed to aggravate something in my knee and it would often bother me at night, despite applying heat rub. Edward arranged an X-ray of my knee which cleared it of any breaks but I began taking anti-inflammatory medication to ease the pain. I missed my life in Adelaide and was struggling to come to terms with the reason for my being in Uganda. What difference could I, a fifty-six-year-old retired nurse, possibly make? I was homesick for my man, my house, my family and friends and everything I had taken for granted for so long. I wondered if I was making a difference at all. In hindsight I realised this breaking point was the beginning of what was my apprenticeship in Uganda.
In an attempt to counter these feelings, I booked into the Sheraton Hotel for a night. I had no problem dealing with the luxury because one of the things I had learned at my brief training was the importance of going somewhere like this to take time out. Despite being right in the centre of the city, the hotel is surrounded by beautiful gardens and my room had a wonderful view, soft pillows, carpet and lights that stayed on (when you wanted them to). In addition to the hospitality there was the added attraction of a functioning business centre, so I immediately sent and received emails. Allan rang twice and it was wonderful to hear his voice and talk to him. Later I had calls from Peter, Fiona and David.
I wallowed in twenty-four hours of luxury, beginning with a haircut and head massage. Then I climbed into a huge hot bath and read my book while sipping on a glass of wine. The television in my room wasn’t working but I didn’t care, instead watching a stunning sunset and looking at my photo album which I had brought from home. In the evening I ate in the restaurant but found I couldn’t finish my steak; I suspect I was now unused to eating so much. At lunch on Sunday I discovered several other expatriates enjoying the buffet after church – it seems the Sheraton is a regular place for mini-retreats.
My return to the reality of Uganda came two days later when I visited a village church. Frank and Michele were involved there and were assisting the local pastor. They invited me to visit to see if I could instigate some treatment for the children who were all suffering from malnutrition, worms and chest infections. It was on the outer edge of Nakulabye, not far from a trading centre and marketplace along a potholed dirt road. The bins trailing one side of the road were overflowing with decaying rubbish, children searching through them for something to eat. The Wall of Fire Church was built out of rusty sheets of corrugated iron, plastic bags and papyrus reeds. Four people were living in the back of the church in desperate conditions: an 87-year-old woman and her 60-year-old daughter in one room and in another partitioned area was a small nine-year-old girl named Beth and her mother, Anna-Mary. The two older women suffered whenever it rained because both the roof and the walls leaked, so water ran through their room.
Before I left Adelaide I had been given some money by an Adelaide Rotary Club with the freedom to use it where I thought the need greatest. In my heart I couldn’t think of a more worthy recipient so I arranged for their room to be rebuilt, evicting six rats along the way. We had enough money left over to buy a single bed and mattress which the two women shared, and they were so excited they both hugged me. We also began working on a plan to help Beth get to school.
Beth had been to stay with Frank and Michele for a few days and when I got up one morning she had washed all the floors. I felt this little girl needed a chance to go to school. The Heywards were starting a sponsorship program supported by their church in Australia. In the years to come the organisation would set up formal sponsorship for hundreds of orphans, leading them to build their own church and school. I sent home an email to Allan suggesting we sponsor Beth and he agreed so we began by arranging for her to visit a dentist, which turned out to be something of a disaster as she screamed the house down and wouldn’t let the dentist near her. He was at least able to catch sight of her teeth, which needed fillings and three extractions. Afterwards the dentist began discussing fees until I explained her living conditions and that I had taken on the responsibility of her support, and he (bless him) said he would waive all fees. Her mother, Anna-Mary, brought her back the following week and Beth behaved and her teeth were fixed.
A few weeks later we drove over the most tortuous nonexistent roads to enrol Beth and a boy named Gerard (who was being sponsored by Frank and Michele) at school. They were so excited about starting the next day. I bought them a couple of extra reading and writing books and the teacher offered to give them extra tuition for a fee. It was so wonderful to see Beth’s face glued to the window of her classroom with a look of excitement and anticipation. My mind raced, thinking about what potential lay ahead for this nine-year-old. Would we be supporting her right through to university?
Over the next few weeks in the clinic, news of my work spread through Nakulabye. A cheeky little three-year-old named Thomas and his band of merry friends popped in and out crying, ‘Mama Jude loves me.’ Thomas lived next door to the clinic with his mother, who had a small street stall selling vegetables and dried fish, while his father had died from AIDS. Thomas decided that he loved me, and I certainly loved him. Thomas would sit on a stool and watch me work for hours on end, even as babies screamed during immunisations. Little children like him captured my heart, and it did my soul good to cuddle a healthy baby. After one visit to Jeffrey, I came into the clinic to see Thomas standing on the steps, declaring in a bossy voice, ‘Mama Jude is back and she loves me.’ His sidekick, Karlim, slipped in quietly to see me on his own. This day he was wearing a shirt and, I noticed with a smile, trousers that actually stayed up.
Chapter Six
DESPITE HAVING MUCH TO occupy myself with, I was still unsure what my future work in Africa would involve, if anything. I wasn’t prepared to commit myself to the clinic because I felt unclear about its role beyond immunisations and midwifery, worthwhile as these were. I worried both that the nurses were not being trained properly and about the ac
counting. The staff were not using aseptic techniques, the basic method of preventing contamination by using sterile equipment and fluids during nursing procedures. As far as I could tell, they could all have become HIV-positive because of a lack of basic medical education. It was a big decision to commit myself financially, physically and emotionally to something that I had so many questions about. The worries left me fearful, tired and feeling a little sorry for myself.
Eventually there was no choice but to speak candidly to Edward and Alice about my concerns. I had been in the city and we had arranged a meeting at the clinic. After catching three mini-buses and walking almost two kilometres to the meeting place, Alice told me things were busy and the meeting was off. I was feeling frustrated on my walk back to the taxi until I had a delightful encounter with an old lady. She was walking with difficulty, but still the conductor wouldn’t let her get onto the taxi because she was the equivalent of twenty cents short of the fare. I paid the fare and told him quite firmly to put her off at the right place. When we sat down together on the bus I nearly suffocated (the poor woman was extremely odorous) but we shared the biscuits I had in my bag and chatted, with others on the bus interpreting. By the time I got off everyone knew what I was doing, where I was from and the answer to the insistent question: where is your husband?
After being in Uganda for a month, my administrative skills were starting to be recognised. I was approached to meet medical officers and nurse educators at Kampala’s Mengo Hospital, established by the British medical missionaries Sir Albert and Katherine Cook in 1897 and the oldest in East Africa. Sir Albert’s vision was to create a maternity training school in Kampala and so he wrote training manuals in the Ugandan language, Luganda. Although English, and to a lesser degree Swahili, is widely used in Uganda, Luganda is the language of the slums and among the illiterate. Katherine was matron of both the hospital and, later, a nurses’ training college. Sir Albert later started the Mulago Hospital, to treat venereal diseases and sleeping disorders, and another school for training Ugandan medical officers. Katherine died in 1938 while Sir Albert passed away in Kampala in 1951. The Mengo Hospital continues to be run with the help of a small British charity, while the Mulago has grown into the largest teaching hospital in the region. It is now government owned and operated and includes institutes for heart, cancer, infectious diseases, burns and plastic surgery.
There is no access to Mengo if you don’t pay. While there has always been access for the poor to Mulago Hospital, this works in a vastly different way to anything I had ever known. Patients must take their own carer, bedding, bowls and food, and pay for medication. On my visit I was impressed with how Mengo was run and we effectively had a brain-storming session. I suggested the need for a course for village nurse aides who were trained in primary health care. We spoke about concentrating the care in the village and preventing illness from occurring rather than having to treat it.
The next day I met Lawrence Kaggwa, medical director of the Mulago Hospital. When I arrived at his office he had only five minutes scheduled. After I hastily told him my qualifications and experience, his manner changed and he offered many apologies and insisted we meet again in a week. As he left he arranged for a nurse to give me a guided tour of the hospital, considered the finest in Uganda.
It was shock time for Judy! Apart from the ward sister, I didn’t see a nurse in any ward. The postnatal ward was so crowded there were mums and babies sitting on the terrazzo floor; there weren’t even mattresses let alone beds. I visited accident and emergency to see how things functioned when I sent a mother from the clinic. It was overcrowded with long lines of patients waiting to be seen. It was a huge challenge to my previous training and experience in casualty at the Royal Adelaide Hospital. There was very little evidence of medical supplies and chaos seemed to rule everywhere. Toward the end of my tour I cuddled a precious little boy who had been brought to the hospital after being abandoned, tossed down a pit latrine. When he was rescued he had maggots in his ears. After I got home I sat down and reflected on the day, realising that I had to come to terms quickly with the sadness of this country and that there would be some things I could never change.
A week later I met Dr Kaggwa again, but this time for an hour. He was interested in my work and asked if I would write up something on caring for him to use in teaching his staff and to show to the Ministry of Health. I promised to do so when I returned to Australia. Caring was something I had taught my nurses in Australia and I was excited to think that he would want his staff to learn this because I certainly had not seen any evidence of it. The staff were few in number and it was obvious that they were removed from anyone who was in distress. It seemed that they didn’t know how to reach out and touch someone, empathy was nonexistent. I wanted to teach them the value of touching, of kindness and compassion. In reality, when I returned to Australia I wrote to Dr Kaggwa for more information before I put in the work writing up a paper, but he never replied.
The longer I was in Kampala, the more I ached for news from home. Days turned into weeks without any mail until finally I went to the post office to check if there was a reason nothing had been delivered. They took my details and promised to call, though they never did.
As I left the post office, a thief snatched my gold cross chain from around my neck in an instant. I sat down on a wall near the centre of the city and cried out of shock and fright. I wanted Allan and I wanted to go home and, briefly, I felt I had had enough of Uganda. Some passing people were very apologetic, including one lady named Sophia who stopped and talked. She was a nurse, on her way to working in a clinic that was just past mine, so we walked together. My feelings of self-pity were put into perspective as I looked around: nearby a leper sat, with damaged legs, no toes and only thumbs left on his hands. I forgave the robber and the next day five letters and a tape arrived in the post.
One day, Edward sent his driver, Abdu, and Alice to collect Michele and me. Edward had never held a driver’s license and so always had a driver working for him. Apparently Edward was concerned that my view of Kampala was of an enormous slum and he was determined to show me what else the capital had to offer. We drove to the museum and then the Bugandan Parliament. Uganda has a long history of inter-tribal animosity, and the Buganda tribe (to which Edward belongs) is the largest. All the different tribes have their hierarchy, but because the Bugandan tribe is based in the Kampala area, their Parliament sits in the capital. One example of the destruction caused by the tribal warfare was the king’s palace, which was in mid restoration after being bombed during the previous Obote regime.
Our last stop was the fabulous wildlife park at Entebbe, stocked with leopards, crocodiles and a majestic lion. We had a personal tour with Sam, one of the horticulturalists, who showed us how they were teaching children to save the planet Ugandan-style by growing herbal medicines. Sam told us that the monkeys here know what herbs to eat to cure themselves of malaria and worms and right on cue one performed for us, standing and beating his chest and bossing his women around.
On another day out with Edward I saw his commitment to helping others. After he and Abdu collected me in the morning, we drove 100 kilometres to a village not far from the shores of Lake Victoria. Alice and two nurses came along as well. All the local mums were waiting with their babies ready for immunisation along with some very sick people needing treatment. They had no doctor in the area although the clinic was managed by Agatha, a trained community nurse. Edward worked all day and then sat down with the mothers to educate them about HIV/AIDS, convulsions, nutrition and family planning.
I spent the day visiting people in their homes. One woman in her fifties had AIDS, as did another in her thirties who had eleven children. I was totally charmed by a seven-year-old deaf boy whose mother had Kaposi’s sarcoma (cancer of the blood vessels commonly associated with AIDS). The day ended with a visit to the shores of Lake Victoria where we bought Nile perch. We got enough for everyone and took mine home to Frank and Michele’s, where i
t was sliced into cutlets and pan fried until it was moist and succulent and then served with chips for supper.
Later that week Edward showed me more of his country, this time via a meeting with the Prime Minister of Buganda, Mulwanyamuli Semwogerere. Edward warned he would be making a donation and suggested I also make a small donation towards the forthcoming marriage of the King. I found the amount he suggested – 50,000 shillings or A$50, a small fortune to most Ugandans – hard to digest but ended up going along with it.
The Prime Minister was charming during our twenty-minute meeting. I told him of the increasing numbers of abandoned babies and the need for formula to feed them, as well as the greater numbers of people coming for advice about AIDS. The clinic was developing a reputation for treating patients kindly and with respect, and I mentioned to the Prime Minister that perhaps this was a good news story the papers could run about the clinic and the need for formula for babies. The next day I read my name in the paper for presenting the Prime Minister with 50,000 shillings towards the King’s wedding. The paper also reported I came from Austria – not quite the story I had in mind.
After the meeting I went with Edward to his home village of Najjanankumbi, where he was building his hospital. The village seemed typical of what I had seen in Kampala; in five square kilometres the population is 40,000, with people living in often desperate circumstances. Edward returned to his work in the hospital. Alice had come along with one of her nurses and accompanied by two local widows we visited the aged and abandoned women of the village and those dying from AIDS. Little did I realise that this was a precursor to what was to become my walking clinic in the future. We walked for three hours until my leg felt like it was going to fall off. I later discovered I had damaged cartilage in my knee.
