Mama Jude: An Australian Nurse’s Extraordinary Other Life In Africa

by Judy Steel

  Ronald’s commitment to helping others came from his own family experiences. His father was killed in the Obote bush war and his mother died of AIDS. Ronald was harsh on himself for not having been there to help his mother, and this guilt manifested itself into a career caring for others with HIV/AIDS. His grandmother still lived outside Kampala but, because he could rarely get to see her, he found taking care of old people on the walking clinic reminded him of her. He was paying for the education his two younger siblings and helping his older sister through university. During one busy day he remarked that soon we will need to have UACO open five days a week. There certainly was the need, and he wasn’t the only one who wanted it to happen.

  Chapter Twenty-One

  AFTER A WEEK IN UGANDA I was formally welcomed back with a ceremony at the clinic. Wearing my blue African dress, I arrived at the hospital compound to find more than 200 people crammed onto the clinic verandah. Immediately there was shouting and cheering, and then each group presented songs, dances and poems.

  First three little Congolese refugee girls recited a poem about war and sang a song, and then four boys sang and danced. The HIV/AIDS group nearly undid me with their wonderful singing and dancing. The leader, Pauline, is so beautiful and danced as gracefully as a gazelle. She knelt before me and sang and my eyes filled with tears. Then came the widows group and I really couldn’t stop the tears. In no time they had me and the others up and dancing, and then they got Edward up too. I had never seen him dance before.

  Iva, Sandy and Viv were welcomed too. Living all together at the hostel had been great. At the end of long days we would often just make toast with Vegemite and heat a cup of soup for supper, both because it was easy and because, in the two years I had been away, prices had shot up for accommodation, food and fuel. Edward and Rose were generous hosts. Each day Rose would make lunch for all four of us and Edward refused to take any payment, saying his culture did not allow it. Eventually I managed to get him to accept some money for fuel by telling him that UACO in Australia insisted.

  It wasn’t all work and we had a day trip to Jinja. The girls were snapping away with their cameras as we passed through tea and sugar plantations. Iva was particularly interested, given her work with the New South Wales Department of Primary Industries. She wrote up notes and became a kind of foreign correspondent for the department, sending back reports on how things were done in Uganda.

  Iva was great company, very down-to-earth and practical, and I found we thought alike on many things. Like her parents, Iva loved people and would sit and listen intently to their stories, whether inspiring or heartbreaking. She wanted to help people and to see how they progressed. Although she only had a first aid certificate, she quickly absorbed the work of the clinic. Being a farmer’s daughter, she was also particularly interested in the loan schemes that had resulted in small farms and agricultural projects. It became clear – to me if not Iva – that this wasn’t a one-off interest.

  It was obvious after meeting with the loan recipients that we needed to revise the rules. In my absence a committee of widows had been formed but no-one took responsibility for the money in an organised way so I suggested that we change the committee to include Bukenya and two HIV/AIDS victims, so that everyone had a voice in all decision-making. We decided anyone applying for a loan must prove they were local residents so the money helped the community, and later the rules were modified so that a person had to be registered with UACO for one year before applying for a loan, to stop those trying to get money without being committed to the community. And it was agreed small loans would be available for the poorest of the poor as a stepping stone to borrowing more.

  Things became a little tense when concerns were voiced that Bosco and Aisha had outstanding loans. It was a difficult situation because I wanted to instil a discipline about repaying loans and not make UACO a welfare agency, but also to show compassion for these people. I told the group how I had taken the story of Aisha’s café around Australia and inspired people to help. Through no fault of their own they had lost the café, and now both Aisha and Bosco were depressed and malnourished. Then I told them that after discussing it with Edward, Persis and the committee in Australia, I was wiping off the debt and they went ballistic, the air filling with ‘Hallelujah’ and ‘Praise the Lord’.

  The situation with Bosco was entirely different to the one faced with Ritah. She had the resources to pay back her loan but didn’t and often disappeared for weeks on end. When I spoke with her about the two cases she accepted what had happened.

  Persis and I gave Bosco the good news. In addition to clearing his debt we offered him a grant to get started again, and his face lit up like the sun. Bosco wanted to use the materials left from the first café to rebuild on a new site, but he was too weak to even nail the wood together so he started coming to the physiotherapy department to develop strength in his torso. It was then that I found that along with his multiple fractures at the time of his accident, he had broken his collarbone and it had healed badly and was subsequently weak.

  Once they had their café up and running again, Aisha bought fish and sold it along with tea at her new premises. Soon she was making enough profit to pay her bills and look after the family. The difference in Bosco and Aisha’s attitude was wonderful. They had a purpose again.

  The HIV/AIDS group took out a micro-loan to begin a craft business, making woven mats, food containers, paper beads, crocheted baby rugs and handbags. They sold them at roadside stalls and community meetings where they also spread the antiAIDS message, and they found ready buyers in Iva, Sandy and Viv. There were now sixty registered members of the HIV/AIDS group. They had many ideas and requests, including a bigger place to meet because the container was far too small for their growing numbers, and t-shirts to wear when they went into the community so others would recognise where they have come from. Many of the original members had died and five were now too sick to come to the clinic so were included in the walking clinic.

  Life in Uganda was as difficult as ever for those with HIV/AIDS. Discrimination and denial remained high, especially in marriages and the workplace. Employees with AIDS were immediately sacked, and poverty and hunger were rife among sufferers. This of course created a vicious cycle, as without a strong diet the body weakens and gives way to the opportunistic infections which eventually lead to death.

  A huge improvement could be made if the Ugandan Government supplied us with ARV (anti-retroviral) drugs that are commonly available to AIDS patients in the West. The drugs are not a cure but they strengthen the immune system when diet, hygiene and other basics are not a given, so conditions like tuberculosis, pneumonia and diarrhoea can be fought off. With this treatment, patients are able to live a relatively normal life, which is critical for families where an HIV-positive person is working.

  Over the years I had visited Africa, the drugs had become available but while ARV drugs are free in Uganda, patients have to find the money for travel to major hospitals and large HIV/AIDS clinics, and even then the drugs may have run out when they arrive. If we at UACO could become a centre for distribution of the drugs the sufferer could be treated locally. I learnt though that in order to become a provider of ARV drugs we would need a special machine for the blood tests, which must be done prior to dispensing. The cost of the machine was roughly $55,000, well beyond our means.

  While many of the HIV/AIDS group were successfully managing their loans, I soon had to tackle an awkward case when I discovered that the largest outstanding debt belonged to Ronnie, the previous leader of the youth group. He had been allowed to borrow far too much and wasn’t able to make the repayments, but when we met to discuss his predicament he promised to make monthly repayments until he paid off what he owed. I believed him.

  This sort of administrative work was increasing as gradually UACO moved from its infancy into an established institution. Although I went on walking clinics and visited the clinic, most of my time was spent going through reports and spreadsheets.
Not everything needed to be put into the newsletters we put together for distribution back home, but the Australian supporters who had trusted us with money needed to know where it was being spent and with what effect.

  One walking clinic was delayed by torrential rain. When we set off we were slipping and sliding under our umbrellas, trying to stay upright. We weren’t always successful. I ended up on my backside quickly followed by Jane, one of the widows, and we dissolved into fits of laughter. By the time I got home I had to soak my shoes in a bowl of water and scrub them to get the mud out.

  Despite the weather, we had many wonderful visits with old friends. The blind jaja Sisi was so happy we were there – she said she could tell it was me by my voice and the feel of my skin. We stopped in at youth group leader Paul’s house, which he shared with his mother. His father died from gunshot wounds when Paul was three months old and his siblings were all dead from AIDS. There were about ten grandchildren, all of whom Paul and his mama were trying to educate. Paul had recently graduated from university with a degree in education, but like so many Ugandans with tertiary qualifications, as yet he had no job.

  I was finding the walking clinics hard work physically. While parts of my body no longer wanted to go up and down steep hills the other part of me loved this side of UACO. It was so important to go deep into the villages looking for young mothers and babies needing immunisation. There was also a simple joy of village life. At every step something is happening. All the tiny shops are trading and food stall owners plying their wares. I was well known by now and the locals called out to me by either of the names that I have become known as ‘Oliotya Nambatya’ or Oliotya Mama Jude’. Translated it means ‘Good morning how are you’.

  Word was spreading of the work UACO was doing, and one day I walked into Edward’s office to find two Catholic nuns from a maternity clinic a hundred kilometres away. They had heard about the Zonta birthing kits, of which Edward gave them 200, then they posed for a delightful photo for the Zonta Club. Edward clearly explained to them that the kits were not to be sold and that they would need to report back to him on their use. Over the next few weeks the rest of the kits were distributed, and Edward put up a map on his office wall marking all the places they were being used.

  After weeks of anticipation, the secret of the new facility at the hospital was revealed. I was taken to the hospital where, in true Ugandan style, a crowd had gathered, including representatives from the youths and widows. After speeches were made, Edward invited me to remove some paper off the wall revealing a sign underneath:

  JUDY STEEL REHABILITATION CENTRE (PHYSIOTHERAPY)

  I was speechless.

  Edward had renovated and rebuilt the facility beautifully. There was an office, waiting room, tilt bed for postural drainage, ultrasound room, large exercise room, equipment room and two very large toilet rooms with sinks. Lubega took centre stage, taking nearly three hours to tell us in minute detail about every piece of equipment. He kept repeating, ‘There is nothing like it in all of Uganda.’

  Waiting out the front before the opening, I realised that the little boy with cerebral palsy who had needed the wheelchair was before me. He was growing well and his mother was obviously giving him the best care she possibly could. She sat next to me inside and while I stroked the little boy’s face he smiled at me, and I was a little misty eyed when I realised the difference that was being made to the lives of this child and his mother.

  To complete her Ugandan education, one morning I took Viv to the Florence Nightingale Clinic at Nakulabye to walk through the slums with me. In the brief time we were there I found Thomas and his mama; he was very quiet and as usual he needed a good scrub. When we returned home Viv was a little quieter than normal. Although we had been working in tough conditions in Najjanankumbi, things were worse in Nakulabye where the population was larger and the facilities at the Florence Nightingale Clinic more basic.

  About a week later, Beth and her mother, Anna-Mary, came to Edward’s hospital. Anna-Mary had had constant malaria which required medication via injection from time to time. Beth said she was having trouble at school but that her grades were fair. In truth her grades were terrible and she wasn’t learning. Despite going to school, each night she would return to live in a one-room house with anything up to seven people there. Without a table to sit at or electricity to light the room she had no chance to study. It was very sobering because she had grown very tall and pretty but thin because of a lack of food.

  Work at the UACO clinic continued and hundreds of mothers came to learn, with family planning top of the list. Ignorance of medical conditions was one thing, but so many women had no idea about their own bodies. One little mama came in with her six-week-old daughter. Just eighteen, she lived with her aunt but had a man who ‘looked after’ her. She had never heard about family planning and I told her she was too young to have another baby straightaway. She was grateful and came back for more information. Thankfully, others were getting the message. A Congolese refugee we knew as Mama Thomas had three children under five and, although she didn’t speak English, she made me understand clearly that she was not having any more babies.

  Edward was very worried about two teenage orphans. They were members of the youth group and beautiful dancers in the drama group, but Edward feared that they would be in real danger where they were living. He wanted to bring them to live in the hospital – there were some rooms in the old part where he housed young ones and supplied them with food and pocket money. In return, they cleaned the hospital before going to school. If they showed promise he trained them to be nursing assistants or helpers around the hospital. Iva stepped in and agreed to help the two girls through secondary school by paying their school fees.

  I was sorry to see my three Aussie friends go. They had been great company and each evening we would gather in my room to discuss the day. They all left at different times, Sandy tried first but as she boarded the plane at Entebbe she started vomiting and eventually caught a taxi back to the hostel. We nursed her for several days, Edward arriving in the dark one night on a boda-boda to administer intravenous antibiotics. Viv left after two weeks for Zambia and Iva left last of all. She was the same age as Fiona and we had become great friends. In my heart I knew she would return to Africa.

  Underpinning all of UACO’s operation was Bukenya. In addition to being a fine accountant, he is a wonderful person who radiates love. He is a Muslim and his father had three wives but doesn’t take any care of them or his children. Bukenya lived alone because his mother and some of his brothers lived in the country while a sister was going to university. Bukenya was only twenty-six years old but paid all their school and university fees.

  Despite all his work, I still found auditing UACO a draining experience. The toughest part was finding a quiet space and a block of time when no-one was around – a bit like finding hen’s teeth in Uganda. Often when I did find some spare time to start work, the power would go off and take computer access with it. One time I thought I’d found a nice quiet moment at the hostel until a group of girls arrived back from a school break and started screaming with delight as they caught up with each other. Soon after came the booming sound of dance music …

  The UACO clinic was functioning within budget but the cost of drugs staggered me. The first time I looked at the receipts I thought we were covering the cost of the entire hospital, but that was just what basic medicines cost in this country. Edward buys in bulk to get the best price, but the growth of UACO was reflected in the ever-expanding pharmaceutical bill. During a conversation about the cost of things, Edward said he gets stressed when I am there because the community presumes that he gets paid millions by UACO. After that, whenever I spoke to groups of people I would go through the structure of UACO and emphasise who was paid and who wasn’t, emphasising that Edward was a volunteer. This was a relief to him.

  The generator was another major cost but was an essential for both the hospital and clinic given the constant power outages.
It cost roughly $20 to run it for ten hours using twelve litres of diesel, and servicing it was an added expense. Although mostly reliable, it was still unpredictable. One day a power surge from the regular power supply blew up Edward’s fax machine and only the surge arrestor stopped the computer suffering a similar fate.

  My financial concerns about Ronnie had been sorted out, but the youth group continued to provide me with headaches. I was disappointed during our first meeting on this trip when they just wanted more, more and more. They asked for new uniforms, football boots, footballs, volleyballs, gardening tools and at least one wheelbarrow. Their only suggestions for self-improvement seemed to involve me buying them things. They had written a report of their activities explaining how they had been busy with community service, but I couldn’t see any examples of it. The water well next to the hospital clearly hadn’t been cleaned for a long time and there was a lot of rubbish around their piggery. We held another meeting during which I expressed my concerns, making it clear that I didn’t want to be told things that were not true.

  Then it was time to show, not tell. I took three young men from the group with me on a walking clinic and, at the end of it, Paul confessed he had had his eyes opened. We found one young mother without a husband. She was living with her very old grandmother, six children and one baby. As usual, the parents were all dead of AIDS and the mother had ended up with the responsibility of caring for them. I took the opportunity to teach my young friends that the birth of the young baby was the result of unsafe sex and the mother will in all probability have or get AIDS. The baby had only had one of his scheduled immunisations, but by the time we left she knew all about the correct immunisations for her baby, how to protect herself and where to come for information about family planning.