The Nseny headmaster called me while I was in a meeting with the leprosy specialist in his office. “We are here,” he said. Yesterday, during my trek into the Rwenzoris I met many people in villages and mountain schools and I told them about the free eye clinic that is taking place at Kagando. I saw a young girl with molluscum (viral warty infection) and a lesion at the lid margin causing inflammation in her eye. She had come all the way to the eye clinic to be reviewed for surgical removal of the warts and treatment. I watched her become sedated with ketamine and each mole popped, scooped out, and snipped. Done! And all for free. This is the great thing about medical camps: this girl will go back to her village without the painful viral lesion causing inflammation in her eye and without having spent any money.
I climbed up into the mountains wanting to move, breathe fresh cool air, and look over the peaks toward Sudan and the beautiful Queen Elizabeth vista stretching out below. I headed straight up (the path is almost vertical) toward the entrance to the Rwenzori forest. Along the way, children delighted me with smiles and shouts of joy. I am going to have such a difficult time back in America where kids by comparison suffer from tremendous indifference. Way up in the peaks, right at the entrance to the Rwenzori forest there is a small school of 19 pupils. I met the school teacher when I peeped into a classroom I was passing. He urged me to come inside and greet the class. After class had ended I said I wanted to enter the enchanted Rwenzori forest before I turned around to go back to Kagando Hospital. He accompanied me. On the way he told me that the forest is filled with the “poor man’s” medicine. He said they scrape the bark off pine trees, boil it, and drink the tea to treat malaria.
When we emerged from the forest a teenage boy caught my eye. In fact, it was his eye that caught mine because it was blue and grossly enlarged. I remembered that this week is surgical eye camp at Kagando so all examinations and procedures are performed free of charge by an internationally renown ophthalmologist. The school teacher, Paul was his name, translated as I asked the boy questions about his history. He told me he was born with the murky, large blue left eye but that his right eye was degenerating. Slowly people emerged out of the woodwork complaining of different eye conditions: iritis (red and inflamed sclera), glaucoma (intraocular pressure on optic disc), night blindness, age-related hyperopia. I explained that I am not a doctor and I don’t know how to treat any of the conditions I saw but if everyone who had eye complaints walked down the mountain to Kagando tomorrow, they could be seen by Dr. Keith. The school teacher was elated and said these three will come together and more as well.
I said goodbye to the eye people and made my way down the twisted paths leading to Kagando. I felt happy and embraced even though I walked alone. These mountains are full of such loving people and even in the briefest of interactions this comes across powerfully. I think I will come and live in this part of the world for that reason.
I suddenly felt a warm squishy hand in mine as I walked up the dirt road leading to the Catholic parish on the hill. An image of Sumit flashed into my mind: I remembered marching proudly around the hospital compound in India with his little hand clasped in mine. I remembered how he used to say “pyano” screwing up his face, jutting his fingers out in the air and wiggling them whenever he saw me. I remembered the smile that used to spread across his steroid-bloated full moon face when I would said “yes, piano”. Then I remembered with a shock of pain that Sumit has died. These memories flashed before my eyes in the few seconds it took me turn my head and find the body to which the little hand belonged. It was a young boy, shaved head, big round tummy, floppy arms, and the characteristic eyes of syndrome. I looked into these big round eyes– little globes that at first glance appeared dull but upon closer inspection I could see a world of expression.
He tugged my hand in his chubby floppy one over to his chest right above his heart. “waboucheri” I said. “it is OK” he replied in a small gruff voice. We walked on. I felt compelled to sing the song that I used to sing with Sumit when we walked: “Chanda mama durikee, pooh apa gya orikee, apa kya thali mae, moonakededo pyalimae”. My young friend looked ahead with determination as I sang. In this moment I felt closest to Sumit since his death. Tears came to my eyes because I was really feeling, which is something that has been difficult for me to do so far from the places where these tragedies have unfolded. What is your name, I asked. “It’s OK,” he said. I tried something else. I pointed to my chest and said: “Bira Daniela” (“Bira” means second born daughter in Lukonzo). “Wambali Joel,” he said seriously. We walked on in silence for some time. He offered me a gift of the last Mandasi crumb (he had been eating this pastry and wanted me to have the last bite). I took it, not wanting to eat the soggy little morsel but knowing I had to. After I had finished it and thanked Wambali, I to surprise him with something, so I whistled my special bird wobble call. It had the effect I was hoping for: Wambali looked around wildly, searching the sky, trees, and cassava plantations lining the road. I did it again. This time he located it and looked straight up into my face. He smiled. Such a sweet, kind smile.
That afternoon Wambali took me to his village and introduced me to his teachers, neighbors, and relatives. He led me door-to-door by the hand. Everyone smiled warmly and greeted us in Lukonzo. Having learned basic greetings in Lukonzo, I was happy to share these with Wambali’s community, especially seeing their surprise and excitement. Wambali pointed to a short stool outside his house, indicating for me to sit down. I sat and greeted his mother, offering her the banana that I had been carrying in my free hand. Wambali’s mother, who spoke some English explained to me that she had 7 children. I asked her if Wambali could come along with me up the hill to Nsenyi school at the catholic parish.
When Wambali and I arrived we could hear drums beating and children singing in unison. We quickened our pace, excited to find out what was going on. There was a ring of school children dressed in their Sunday best, dancing to the rhythm of drums beat by an older man, presumably a school teacher. They were singing songs of praise in a mixture of English and Lukonzo. When they noticed me and Wambali standing and staring, they invited us to join them and watch the performance. “You are most welcome,” the head master exclaimed. Wambali had been wearing my sunglasses and I got the impression that the other children didn’t notice he was special. Mostly the school kids were ogling at me. But then when Wambali took off his glasses and spoke in his little gruff voice I noticed a change in how the other children looked at him. At first they recoiled, then giggled, then completely, fully, and lovingly embraced him. I wondered how many syndrome babies are born in these rural communities and how often the children survive and integrate into the community.
Wambali beamed as he watched the school children dance and sing. When it was over Wambali stood up and requested (what the head master translated as) a “specific song of worship but whose name Wambali could not remember”. The school kids obliged by singing another devotional song and the Ugandan National Anthem. After the concert was finished I gave the head master my mobile number and he promised that his students would come down to Kagando hospital to give a performance for the patients.
Wambali put the sun glasses back on his face, stood up, and led me out of the throngs of children back to the main road. This is where we had to part ways. I would go up the mountain and he would go down to his village.
Marina, a fellow volunteer at Kagando, and I walked down the dark hill to the chapel. We were going to choir. There were some nursing students jamming on keyboard, electric guitar, and percussion. Many others sat on benches chatting animatedly. I was excited to finally be participating in choir (I had only observed from the back of the church). Diana, the reverend’s hip daughter who studies film and media in Kampala, was our leader. She taught us a 4-part song. I sat with altos whose voices were rich, deep, and loud. I tried to do the same and my larynx ached and sometimes no sound would come out so I would have to drink some water. It felt so powerful to sing in unison with the Ugandan nursing students. I could hear my own voice and the group voice with all parts at the very same time. This duality made me think of the balance we have to strike in all aspects of life: in the workplace, family, school— navigating between the individual, the ego, self-consciousness and appreciating the whole, the surrounding community, the environment— this is the perennial struggle that is easily resolved in a choir, but not so easily resolved outside of music. That might be the most powerful insight that music offers: the simultaneous appreciation of the self and the whole.
What if our hospitals could be more like music. What if our government, voting public, families, and individual citizens could be like music? I think in music this balance is easy because listening to the orchestra improves the soloist, and vise versa and this can be fine-tuned based on auditory information. However, how can you tweak and adjust the balance between citizen and nation if you have no means for fine-tuning? I think the solution might be in defining the relationship between the citizen and the nation. The citizen gets benefits from society and thus makes a contract to follow rules set by society. On the other hand, society is built up by citizens and conforms to the shape the citizens make. So can we then strive to make our country a healthier more unified shape? A form that is actually conducive to the survival of every individual piece of the whole? Because right now the shape biases certain members of society. (I change the metaphor): This bias does not create a healthy organism. When there is more blood supply to one area, another tissue is compromised and dies. When this tissue dies the whole body is taxed and there is a dangerous risk of sepsis whereby the whole organism could die. So it is unhealthy and dangerous to build a society within which certain people are neglected. We should stop this nonsense.
I spent the day in the surgical theater. First the patient whose arm had been destroyed in a truck accident needed debridement (where necrotic tissue is excised). His muscle tissue looked surprisingly healthy after two days in bandages. Contrarily, the smell was putrid from tissue fluid, blood, pus, and dying tissue. After debridement with scalpel and surgical toilet with normal saline his arm was immobilized in a plaster and he was referred to a more affordable hospital, Kilembe (we have to do that a lot here).
There was a C-section in the afternoon. As the blue baby was lifted from the gaping distended uterus I caught my breath, appreciating the significance of this moment: birth. The baby’s first cry and gurgling breath. The last drop of cord blood because now the tie between mother and son has been severed and they are two separate breathing patients. This kind of procedure is always intense because it involves two lives.
In the eye camp I felt as though a kitchen had converged with a classroom, nursery, and surgical theater. There were miniature autoclaves which whirred and hissed, their metal lids popping up off the basins of steaming surgical equipment. Babies from the neighboring theater and waiting room cried loudly. Ambient light from surgical lamps poured over the operating table. Nursing and medical students stood around listening to anatomical lectures. And finally, the surgeon peered through a magnifying scope into patient’s dilated pupils. I watched the surgeon remove murky cataract lenses and anterior capsules. I saw a conjunctival carcinoma tumor excision. I saw glaucoma treated by relieving intraocular pressure trabeculectomy (whereby a portion of the trabecular meshwork is removed so that fluid can drain out).
After seeing several cases, my feet, which have been becoming edemous from so much standing, were tired and I went to the break room. Surgical staff are really relaxed kinds of people (outside the theater). They joke and tell stories and have this ward-wide competition running: a race car video game competion on the break room computer. I pulled one of the dusty surgical volumes from the shelves where rats sometimes scamper. Outside a loud clap of thunder hit the sky and then torrential downpour rattled the tin gutters and awnings. I felt so cozy sitting on the bench surrounded by the surgical staff with my book spread out on the table and all of us warm and dry. Surgery is becoming more and more fascinating to me each day, each patient, each procedure, each surgical staff member I meet.
The storm cleared eventually and I crept out of the surgical hole— I call the theater this because it really sucks you in. As I walked up the hill to my accommodation I turned around and was met with the most visceral sunset I had ever seen. The sky had burst into flames. Dark smoky clouds hung over the Rwenzori mountains while a vibrant orb burnt a hole through the grey and turned every cloud in the eastern sky bright orange. I actually ran to fetch my camera, but unfortunately the combination of being slow and having a terrible lens means rubbish photographs.
In the afternoons patients and attendants leave the dingy wards for some equatorial sunshine on the grass. They lay their mats out and converse together or eat Matooke (boiled banana) as the toddlers waddle around between mats. The surgical ward patients are a family. They look out for each other’s children and share everything they possess. I was walking on the sidewalk between wards when I suddenly felt compelled to join the patients on the grass. They welcomed me to their mat with the kindest smiles and words in Lukonzo. The fishermen who spoke English said: “You are most welcome”. And I really was. We spent the afternoon talking about the fishing village, about their close encounters with hippos (which got them to surgical ward), about living with HIV (fishing villages show highest incidence of HIV), about their families, and my trip up into the Rwenzori mountains. I felt so comfortable and relaxed talking to the patients. They exuded such genuine warmth that I thought I would never leave the mat.
But darkness began to draw the corners of light in the sky behind the ring of mountains around the hospital and I said goodnight to my friends. The moon was full, golden yellow, and massive on the horizon. I had decided (against better judgement) to take a walk up over the hospital hill through the small villages tucked in the valley behind Kagando. Air was warm and thick with small bugs. The big moon cast yellow light on the ground as if it were an anemic sun. Children whooped and shouted in excitement as I passed their huts, glowing blatantly in the dark: “MUZUNGU!!!!!!” Some of them trailed behind me, their tiny bare feet pounding the dirt road in the darkness. I began to run so that I wouldn’t be stuck in the villages at night. The little feet behind me moved faster. Soon there were children flanking me on either side. I outstretched my arms as I ran and felt small fingers wrap around my hands. Running down the dirt road, hands in the hands of barefoot children, yellow moon in the sky, evening bugs chirping, I felt like this is it. This is being truly alive. When those little hands let mine go after a solid 5 minutes of keeping up I suddenly realized how safe I had felt in the throng of children. They were my protectors out in the villages at night. Now running on my own I felt exposed, vulnerable, and nervous. I ran faster. Swiftly ascending the monster hill that usually takes me ages to summit, I made my way back to the safety of the hospital. But when I got there i realized I had been safe the whole time. This place is my home. The villagers along the trail that I run everyday know me. They know I volunteer at the hospital and they look out for me. Even though I have not been here long, this is my home and I know I am coming back.
Today a man was crushed when the truck in which he was sitting flipped over. Amazingly he survived and arrived at the hospital with a shredded arm, deep lacerations to the scalp, and a severed left eyelid. He never lost consciousness and scored 15/15 on the Glasgow Coma Scale each time he was tested. I assisted in the debridement of his shredded arm. The muscles, fascia, fat, nerves, and bones were all exposed as if in an anatomical display. Except it wasn’t a museum. It was a living person’s arm. Bits of gravel, dirt, grass, and other road debris were lodged in the opened tissues. The ulnar nerve (which I have become so familiar with palpating leprosy patients’ ulnar nerves) was severed at the elbow. The orthopedic surgeon found the distal and proximal ends and tagged them so that once the wound is cleaner the two ends can be reconnected and maybe but not likely, the nerve will function again to some degree. The patient’s humerus had sustained a 3rd degree fracture and the joint capsule where the humerus and radius + ulnar articulate was exposed and filled with tiny bone fragments. I poured normal saline at high pressure into the wounds after necrotic tissue had been excised.