by Judy Steel
One day on a walking clinic in Najjanankumbi I came across an example of how the disease has stripped out generations. A man named Anthony, who neighbours said was eighty-eight years old, was caring for six great-grandchildren aged between three and ten. I found the room they lived in almost unbelievable. It had no window and was only large enough to fit one single bed and a small child’s bed. The old man slept on the small bed and the six children squeezed themselves onto the other. During the day he carried twenty-litre cans of water for people in his neighbourhood to earn money to feed the children. The widows had formed a small group at the hospital so they could visit needy people in their community but they had no money to supply anything. With money from my church I purchased blankets to replace the one Anthony was using, which looked like a mechanic’s oily rag. We made arrangements with Edward at the hospital to keep posho and beans for Anthony to have access to.
Another time a very sick baby arrived at the Nakulabye clinic suffering from malaria and measles. The child was filthy because the mother thought her child shouldn’t be washed if he had measles, a common misunderstanding. In addition to treatment, mama got a lesson in basic hygiene and I was reminded again of why education is such an important part of improving health. It was difficult to explain the need for cleanliness in a place like Nakulabye, which was so filthy. Everywhere you walked were horrible smells, excreta, used condoms and plastic bags. It was not unusual to see a small child walking around with a razor blade in their hands because adults used them to cut their nails and then discarded them. I explained to mothers it was a good health investment to buy water (at this time of year, twenty litres cost five cents) and to wash their children and their clothes to prevent illness. Very few houses had tap water connected so water had to be bought for everything. In addition to basic hygiene, I stressed the importance of boiling their water before drinking it.
So many illnesses were symptoms of poverty, filth, overcrowding and malnutrition. Tuberculosis, for example, is one of the top ten killers in the developing world, with three million deaths and ten million new cases each year. The bugs that cause TB are inhaled and, while a healthy person is able to keep them under control, when the body’s immune system is weakened by HIV tuberculosis can spread to every organ in the body. Treatment involves a number of expensive drugs that need to be taken over six months.
Lifting people out of poverty is as much a health as a social or economic issue. At the clinic, more and more people approached looking for handouts. Women with babies would ask where I lived so they could come around and become friends. At times it was irritating, but I understood their need and thought I would do the same if the positions were reversed.
I still had money that my church had given to use within the community and I wanted to involve the women of Nakulabye in deciding how it could be used. I wanted them to tell me of their needs rather than me giving them my Australian point of view. Alice mobilised them into attending a meeting and we were encouraged when about fifty women arrived. This was the first time I seriously looked at a financial scheme. There was excitement about the possibility of using small loans for a community piggery or to open a restaurant. The women believed it would cost about A$1000 to set up either so I offered to follow it up with UGAFORD, a local organisation which offers small loans. After the meeting a group of drummers performed and someone tied a grass skirt around my waist. Soon over a hundred people were watching and they went bananas when I joined in the dancing. After catching my breath, a baby was placed in my arms – it was Grace, a newborn baby boy who had been abandoned on a doorstep and was being cared for by the woman who discovered him. I had taken a special interest in him and encouraged this lovely woman. She had a girl aged about six and had been wanting to get pregnant again without success. Little Grace turned out to be a gift for her.
Unfortunately UGAFORD turned out to be a dead end: the widows couldn’t even afford the transport to the their office each week to pay their instalments let alone the interest rate being charged. The next step seemed to be using some of the money raised in Australia to start the project. The widows firmed on the idea of opening a restaurant rather than a piggery; their theory was it would be quicker to establish and create a faster cash flow, as a restaurant in Uganda can be as simple as someone cooking and selling food next to a seat and table. There were about twenty women of various ages involved who seemed strong-willed and determined to succeed. They found a building in a good position in Nakulabye. It was a wonderful feeling being able to empower these women to try something positive. With the money they eventually opened this little shop which was part-restaurant, part-Ugandan-style delicatessen. I continued visiting them whenever I was in Nakulabye and the shop is still flourishing.
The widows weren’t the only group interested in bettering their prospects. When I was visiting a clinic down near Lake Victoria I met a group of youths (a title which seemed to apply to anyone under thirty-five) to see where I could help. These young people were all unemployed and desperate for a project where they could take on some responsibility and get a little income. We met regularly and in the weeks that followed I donated A$40 to help them start a piggery at Nkumba, about 130 kilometres from Kampala. They bought a boar and two sows, which they named Judy and Matilda. On the day they proudly showed me the porkers, they followed with a song they had composed about helping the poor, starving, lonely and elderly. The young men had such beautiful voices.
After some thought, I came up with an idea for another youth group who came from Nakulabye, stemming from a mixture of wanting to help them have a better life but not wanting to be used as some sort of Australian financial hand-out service. I challenged them to raise the money to buy seventeen pairs of shin pads for their proposed football team. There were so many youths interested, we had enough for two teams. The next part of the challenge was that each team sponsor a child (I already had in mind Grace and Fred). Fred was the beautiful baby who I met on my second day at the clinic. His mama was dying of AIDS and although Fred had been diagnosed with AIDS he was still in relatively good health. If the youth group met the challenge I would cover the cost of their sporting uniforms. I worried that spending such a large amount of money on sporting gear was an indulgence, but it felt like an investment in the community. The group readily agreed to the conditions and committed to taking care of the little ones, visiting their mamas and helping in the children’s education.
I met up with Recheal, the clinic nurse who had worked so well alongside me on the last visit. We had a lunch of chicken and chips followed by ice-cream; she said it tasted funny and would have preferred Ugandan food. About to turn twenty-one, Recheal told me of her desire to be an enrolled nurse. As a nurse aide working with Alice she had only had minimal training in the very basics of community nursing.
Over time I had become very fond of Recheal and liked the way she handled the patients who came through the clinic. She was respectful with the mamas and gentle with the babies. I wanted to give her the opportunity to have a better education. After discussing it with Allan via email, we decided to sponsor her.
I arranged for her to enrol at a hospital run by the Church of Uganda at Kiwoko, a two-hour drive north of Kampala. The course took two years and cost about $1000 per year. Recheal cried tears of joy when I agreed to sponsor her training, and Edward committed to being her supervisor. He arranged for her to work at his hospital during her breaks for extra experience and also gave her a sharp lecture in front of a group of people about his expectations. He explained the opportunity she had been given and that she should set a good example, work hard and not get pregnant.
I visited Beth and her mother, Anna-Mary, at their house. They had moved out of the Wall of Fire church and had a tiny room made of mud bricks with a dirt floor, barely big enough for a single bed. The door was kept closed with a bent nail. About ten children suddenly appeared in the room and began singing the evangelical anthem ‘My Redeemer Lives’; Beth joined in with great animation and da
nce moves. I gave Anna-Mary money for a new dress, schoolbag and some food, and for the first time she didn’t ask me for anything else. Beth’s school books showed she was a good student and her English was improving. She was ecstatic when I gave her a big pink teddy bear.
Since my first visit, there were some improvements in the health of those we saw on walking clinics. The children had responded to having been de-wormed. In Uganda almost everyone has at least one worm or parasite living inside them that can cause harm, and kids can sometimes have more than ten. Many of these worms live inside the bowel and compete for food, but if the child is malnourished they can develop anaemia and swelling of the legs. They become tired and can’t study at school and are more likely to succumb to infections. Worms are a big reason why up to half the children under five are underweight and anaemic.
I had been thinking a lot about Edward’s suggestion that we develop something on his vacant land. I felt quite sure that my contribution to this country was going to continue although I wasn’t sure how. I did feel, however, that it was going to develop into community health care in one form or another. So after a lot of thinking I decided to accept Edward’s offer to use the vacant land next to his hospital. My essential idea was to create an AIDS refuge and outreach centre that would also allow referrals to and from Edward’s hospital. It could be a place for the elderly to visit and perhaps have a meal. Every walking clinic I went on people would come forward seeking help for relatives or friends with AIDS, so maybe this clinic could be somewhere those people could be brought for assessment and to arrange follow-up nursing care in their homes.
Edward and I visited the other facilities treating HIV/AIDS patients to get some ideas. The United Nations runs a worldwide response to the disease known as UNAIDS, and their operation in Uganda was still small but was soon to expand. The UK-based charity Mildmay also has a centre in Uganda. When Edward and I visited their operation in Kampala it was just two years old and we were stunned by the modern facilities. They offered training as well as palliative outpatient care, but none of this was free.
Visiting the various services gave us ideas but we still only had a plot of land within the grounds of the hospital. Edward was using all his spare cash to finish building his hospital and hadn’t begun trying to equip it. We discussed setting up an NGO so money could be raised in Australia to create a health care clinic at Busabala Road. I didn’t want it to end up like the Florence Nightingale Clinic.
After the success of the previous year’s t-shirt day, we decided to stage the event again at the Nakulabye clinic. This time I paid Tewo, baby William’s mother, to buy 130 t-shirts with donated money and we bought 150 bags of popcorn, sweets and cordial. Despite my high hopes, the day was a disaster. More than 200 children of all shapes and sizes appeared and quickly resembled a mob. They screamed, fought and punched each other and could not be controlled. They attacked the bags of popcorn and many were split, contents spilling onto the ground. In total frustration I put half of the t-shirts away and never even brought the sweets out. We decided to save them for when children were brought in for immunisations.
My sadness was added to by the sight of little Fred, brought in by his grandparents because his mother was too sick. After progressing so well last year he had regressed, and was now thin and not thriving. He had AIDS, a chest infection and was also teething. All I could do was give his grandparents some syrup to help with the latter and most minor of his complaints. I decided this would be my last day at the Florence Nightingale Clinic; it was so sad to leave on these terms, but I could no longer be involved. Nothing had improved at the clinic and like my first visit I found working there a constant frustration at poor standards and dishonesty. I realised that as long as I was there Alice would use the situation to her benefit. She had mobilised far too many children for the party and we had had a riot. Earlier Alice had suggested I build a new clinic for them when I suggested erecting a simple shelter for those waiting in line. I found a report had been written about the clinic’s success – none of which was true. Alice always needed more and I didn’t have it to give. Although I still had a week left in Uganda I decided not to go to the Florence Nightingale Clinic again.
In the final week there was an incident that seemed to reinforce my frustration and powerlessness at being unable to help. I was sitting in my hostel room after supper and as usual there were thousands of cars and trucks lumbering past on the busy road outside. Suddenly there was much noise outside the gates of the hostel. A young man had been hit by a car and soon hundreds of people gathered to see what had happened. There is no ambulance service in Uganda and eventually the police arrived and put the man onto a truck which was driven away to hospital. I felt bad that I hadn’t helped in some way, and although there was nothing I could really do, the feeling lingered.
As I was packing my bags and preparing to leave, I reflected that this visit had been nine weeks of love, rejection, frustration, tears and prayers all mixed together. But I now felt certain that the way to make a difference in Uganda was to build on Edward’s work at Najjanankumbi. My understanding of myself and my relationship with God had matured, and it seemed okay to fail and not be perfect.
In my final hours before flying out, Alice and I talked through the issues of the clinic. In spite of her many failings Alice is a devout Christian and she asked me to forgive her for lying, which I was happy to do. I told her that I loved her and wanted to continue being her friend but that I couldn’t work with the clinic again. My focus was now on a new project. Although I still didn’t know what it was going to be I knew that Edward would be involved and that he was the one I could trust. Together we could develop something for the benefit of his fellow Ugandans.
Chapter Eleven
EXHAUSTED AND STILL DISTRESSED by Robina’s death and the other harrowing things I’d experienced, I flew to England where Allan was waiting for me. It was a cold, bleak London day but it didn’t make any difference to me because we were together again. He was my rock to hold on to and provide comfort. We met up with Allan’s brother, John, and his wife, Rosemary, for a short holiday, flying to the Greek island of Rhodes to stay in the tiny village of Lindos, which we had previously visited. It was extremely hot but the evenings were superb, especially while eating at a rooftop taverna.
During the flight home I reflected on my visits to uganda over the past two years. I felt worn down and frustrated, so much so that I actually considered never returning. What sort of impact was I making anyway? Things were done so very differently. Over the following weeks I came to understand that I was looking at it the wrong way around: rather than searching for what I had changed in Uganda, the real issue was what Uganda had changed in me. I had been through an apprenticeship, and now I understood a little of the country and its people. I just wasn’t sure yet what I could do with this knowledge.
I didn’t have to wait long for the answer, and with it came a resurgence of energy. Shortly after returning to Adelaide I was contacted by the purchasing officer from my old workplace, Resthaven, asking if I would like some equipment for Uganda. They were rebuilding one of the nursing homes and the CEO, Richard Hearn, wondered if I could use the furniture and equipment that was going to be replaced. Allan and I went to have a look at it and immediately knew we had to have it for Edward’s hospital: he didn’t have the money to finish building it, let alone equip it. Gillies called him the Noah of Najjanankumbi because he had followed God’s brief to build something with no idea what it would be filled with or how.
We went to Westbourne Park Uniting Church for assistance, and the church council agreed to underwrite the cost of a six-metre shipping container to send the equipment to Kampala. As we started collecting from Resthaven, word spread and other hospitals (particularly the Repatriation General Hospital) heard what we were doing and offered surplus equipment. The donations ranged from beds and lockers to intravenous stands and pillows. Someone offered a rarely used autoclave steriliser, worth about $4000, which we accept
ed with delight and took to the supplier for an overhaul. When we returned to collect it, the manager told us they were concerned about the machine going to Africa as it was one of the best in the state, and if any part broke down it would become useless. With his next breath he offered to donate an extra machine to the project just in case.
So quickly did the amount of equipment grow that suddenly the six-metre container was not big enough and we needed a twelve-metre one. The first time I looked at the steel container I immediately realised its potential: after the equipment had been taken out, it could be converted into a clinic in the grounds of Edward’s hospital in Najjanankumbi. It wouldn’t take much to cut doors and windows in it, and it would be the perfect adjunct to the hospital services. The Kiwanis Club of Adelaide heard about the plan and offered to pay the $4000 required to buy the container. They also insisted on painting it, and a generous donor provided some special heat-reflective paint so that it would not get so hot inside.
