Done but not over

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Elizabeth and Ruby.JPGI expected to feel relieved, elated even, to be leaving Uganda. The work had been hard, the frustrations many, and all of us, Dad, Bob, and I, missed family and friends back in the U.S. It had been nearly ten months and we were ready to go home. So why were my eyes so wet as the plane lifted off into the night and the lights of Entebbe faded behind us? Uganda and her people have a piece of my heart and it told.
The last paper was graded, the grades averaged, and the final report made. Goodbyes were said, hugs exchanged, promises of emailing regularly made. The most immediate and obvious reflection came easily. All nations have some glory and some shame; I had learned better to embrace both the glory and shame of being a U.S. citizen. I had learned better to put the U.S.’s glory to work and to seek to remedy or mitigate some of her shame. I learned that being a child in Africa and being an adult with much responsibility are very different things. In communication with Joseph, Florence, and Jannat from Mbarara University of Science and Technology (MUST) in western Uganda, I consented to take on some advising of master’s in nursing theses. My stay in Uganda was done, my Fulbright assignment completed, but my work for Uganda is not over.
Ugandan Child.JPGThere is still much to puzzle over in the analysis of my experiences in Uganda. I expect it will take a long time to reflect on and I will likely not ever come to the end of it. But let us take another look at one critical issue. The blog entry, “If you put it that way,” reflected on the different ways one could think of resource-rich and resource-poor healthcare environments. It is difficult to think about the topic of this entry in more than one way; the temptation is to think that more money will solve all the problems of the resource-poor. But it is not so simple; there is perplexity in the problems and the solutions in both rich and challenged environments. One only has to consider the recent healthcare reform efforts in the U.S. to appreciate the complexity in what is possibly the richest healthcare environment on the planet.

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Safari 2

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Bob, Ruby, Carl at Equator.jpg
Bicycle with Matooke.jpg From March 15 through 18 we took our second safari, traveling west and south to Queen Elizabeth Game Park and then to the far southwest corner of Uganda where it meets Rwanda and Congo. The road between Kampala and Mityana was dirt and bone-jarring; it has been under construction for about seven years. From Mityana westward was a smooth, paved road, steadily climbing in elevation until we reached the lush tea and matooke plantations of Fort Portal. Beyond Fort Portal were the majestic Renzori Mountains, the Mountains of the Moon.

We descended into the Western Rift Valley south from Fort Portal, traveling with the Renzoris on our right and passing matooke-laden bicycles like this one. One could feel the heat increasing from the cool mountain air of Fort Portal to hot, dusty Kasese. Just south of Kasese, we stopped to take photos at the Equator and pass from the Northern to the Southern Hemisphere.

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Money Matters

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Kampala and larger Ugandan cities and towns are full of well-dressed folks busy with cell phones and other electronic devices. The streets buzz with vehicles, bodas, and the press of business. Yes, it is a developing country but “develop” is a dynamic word and Uganda is a dynamic country by what the eye can see. Happy hour billboards and slick-paged magazines like “The African Woman,” (http://www.africanwomanmagazine.net/) communicate universal issues of modern life: family, fashion, business, romance, work and leisure. There seems to be a certain cosmopolitan sameness to the world’s urban centers. Perhaps that is where we are all headed in the end: vast cities stratified by economically defined neighborhoods: the posh gated communities, the rows of industrial looking apartment complexes, and the slums.

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If you put it that way…

Dr. Ruby Dunlap’s Uganda Fulbright Blog

“Newtonian mechanics is satisfactory,” says Polkinghorne, “for largish objects moving at ten miles an hour, unsatisfactory for the same objects moving at a hundred thousand miles a second.” “Kuhn dismisses as an irrelevancy the well-known fact that Newtonian mechanics is the slow-moving limit of Einstein’s mechanics. Yet to physicists this relationship would seem to be important, for it explains why classical mechanics was so long an adequate theory and why it remains so for systems whose velocities are small compared with the velocity of light.” (One World The Interaction of Science and Theology, pp. 14,17)

Monkey in tree.jpg Probably Newtonian mechanics sufficed for explaining the movements of your vehicles on ice and snow this winter in the U.S. The reports about your winter have been remarkable, especially since, while the Equator crosses southern Uganda, the elevations are high enough to make it balmy most of the time. Some days have been downright chilly, a few hot in the afternoons. Mornings in paradise are almost always perfect mornings of comfortably cool freshness. And the look from our “tree house” apartment is always one of lush rain forest. Here is a photo from the family home in Ohio where I spent my teen years and one from where we are living now to show the difference this winter. We also see monkeys in the trees around our house, unlikely in either Ohio or Tennessee.
carson icecicle.jpg Buttons Backyard.jpg

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Tell it slant

Dr. Ruby Dunlap’s Uganda Fulbright Blog

Tell all the Truth but tell it slant—
Success in Circuit lies
Too bright for our infirm Delight
The Truth’s superb surprise
As Lightening to the Children eased
With explanation kind
The Truth must dazzle gradually
Or every man be blind—

Emily Dickinson’s (1830-1886) poetry is for me a gradual dazzle. This one came to mind as I’ve taken retrospective tours of the Ugandan nursing graduate students and my experiences with philosophy and theory over four weeks in January. Do and should nursing theories give priority to a received philosophy of science or a perceived philosophy of science? Which one fits best with a Christian worldview? What exactly is a worldview and what could be especially Christian about it? What are the logical parameters of differing worldviews? Is logic a valid criterion by which we should evaluate any worldview or theory and on what grounds do we recognize the validity of logic itself?

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And then they went home

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Ruby and Students.JPG This past Friday night, I dreamed I was a pizza box. My consciousness resided in part of the box lid; I felt the air move as my cardboard face fell downwards. Mefloquine can do that. I had forgotten to take it in the morning and rather than skip another dose as I inadvertently had the week before, I took it just before bedtime with consequences among those the inserts predict: vividly bizarre dreams.
Many of the expatriates here take no malaria prophylaxis at all and few Ugandans do. But malaria is endemic and dangerous; I helped a wobbly student walk to the front gate, get on a boda, and on to home a few weeks ago with a 3+ malaria raging in her system. Being stricken with recurrent bouts of malaria is what all Ugandans deal with as a matter of routine. It only takes one bite from one infected mosquito. Many sleep under mosquito nets; many do not. Dad refuses his mosquito net since it hampers him getting in and out of bed. I do not fuss since a fall and a broken bone are at least as risky for him as malaria and he is taking his malaria prophylaxis weekly.

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How silently, how silently, the wondrous Gift is given!

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Globe.jpg We hope you had a Merry Christmas and Happy New Year, family and friends!
We celebrated Christmas in Uganda this year, five of us. Daughter Amy and son-in-law, Chris, arrived mid-December and returned to the U.S. on January 2. Dad Wesselhoeft and we arrived here August 14. On Christmas Day, we will had been here 134 days. The day after Christmas, December 26, was exactly the halfway point for our stay here. We are missing so many things about our lives in the U.S. that we will be looking forward to May 11 when we expect to return.

The September semester was very busy for me and had lots of adjustments for all of us. January semester will be another busy one with classes every day of the week until the end of the month. Then there will be lots of paper grading as students email me assignments.
We did have a very fun visit to Uganda’s largest game reserve, Murchison Falls, last week. We saw awesome waterfalls and many animals. In the photo above are the five of us pointing to Uganda in central eastern Africa on a big globe in front of the Nile River at Murchison Falls.

Left to right, Carl Wesselhoeft, Chris Sutton, Amy Sutton, Ruby Dunlap, Bob Dunlap
See a more photos of that trip by clicking below.

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“I Don’t Want my Nurse to Quote Shakespeare”

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Nurses in Uganda, like nurses in the United States, are struggling with questions of professional identity and what or even whether a bachelor’s degree in nursing adds to the nurse enough to justify its additional expense, time, and academic labor. “I don’t want my nurse to quote Shakespeare,” said a non-nurse friend, “I just want her to give me my shot.” We were discussing whether nursing education should include humanities. I’ve forgotten the friend who said this; the comment has stuck in my memory, an iconic summary of all such questioning about what it means to be a nurse and what entails an appropriate education for such a profession.

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“I Would Teach for Free”

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Bishop Tucker Building.JPG “I would teach for free but they have to pay me to grade papers.” This comment from a teacher friend was naturalized long ago into my habitual outlook on things and without any difficulty whatsoever. I have been and continue to be grading, or “marking” as they call it here, papers, what seems like hundreds of them, weeks on end now. I know that “hundreds” is a hallucination of a paper-fevered brain but there have been and are being lots. Grading graduate nursing papers, all of which have been written by students for whom English is not their first language, has turned out to be not that different from grading nursing papers by students in the U.S. for whom English is their mother tongue. Having to grade the papers turns out to be our students’ revenge for us assigning so many of them.

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“We Tremble Not For Him”

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Cow Resting 2.jpg What did I expect the most trusted and skilled exorcist in the Mukono area to look like? Perhaps a fierce intensity out of the eyes? Perhaps either wildly careless or flamboyant clothing? In any case, his speech should be full of emotionally charged religious utterances, something befitting regular contact with the world of demons and evil spirits. That world, which few Westerners are likely to take seriously, the world relegated to a tiny minority of secretive devotees in the West, is taken very seriously in Uganda and by the vast majority of Ugandans. When it is taken that seriously by the locals, expatriates do well to attend seriously to it as well. Here is a not unusual bit in another of Uganda’s English newspapers, the 9 November, 2009, issue of The Daily Monitor:

Masaka man accused of witchcraft
Residents of Kijjomanyi Village in Kalungu Sub-county in Masaka District on Friday burnt the house of a 72 year old man and killed his goats, accusing him of bewitching them. The residents accused Mr. Felix Ssali of using spirits to kill 15 people between June and August. The district police chief, Mr. Moses Mwanga, said investigations are ongoing.

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Iganga Bob

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Peter,_Bob,_Moses_and_Iganga_mother.JPG The non-verbal expression, “eh,” is most consistently noticeable in North America among English speakers dwelling near and around the U.S.-Canadian border. It shares company with such verbal expressions as “you bet!” a response so characteristic of the area that when an agricultural expert from Minnesota answered a question with it recently, I couldn’t help but smile with memories of miles of northern forests and lakes riding in on the coattails of “you bet!”
My own southeastern United States, on the other hand, is known for the spoken elaboration of multiple syllables into words which are written with only one. One of my favorite examples was from a patient who asked me, “Can you give me a nerve pill—I’m fixin’ to have a spell.” I hadn’t realized before that moment how many syllables a southern woman could put into the word “spell.” Practice saying, “Spay–ee—ell” and you’ll get an approximation. Make sure you draw it out to communicate adequately the threatened onset of something most dire.

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Those Nurses

Dr. Ruby Dunlap’s Ugunda Fulbright Blog
Lily.JPG Along the stone retaining wall outside our apartment is a row of snowy white daylilies. That is, I call them daylilies because of their leaf, stem and bud shapes. If not actually a daylily, they must be close kin to the daylily tribe. The flowers start out as a daylily bloom, a suggestion of a white trumpet on a slender stalk. But then the Designer of this flower changed His mind. Instead of the expected trumpet shape, the flower turns into a loose fringe of white, the petals going abruptly from wide to narrow in a graceful drape. I do not know which gives me more pleasure, the recognition of a familiar plant type or an unexpected variation in that type. This daylily illustrates my conviction that our appreciation of diversity needs to be anchored in an appreciation of unity. Otherwise, diversity becomes mere difference and mere difference seems to me to degenerate easily into competitive hostility among differences.

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The Maid Escaped Mid-Term

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Ruby in Clinic.jpg As Dad and I walk down to the track most mornings around 6:30 AM for exercise, we meet many elementary school children in neat uniforms headed for school. They walk purposefully and soberly but their faces break out into smiles as we greet them. “Good morning,” Dad says, “God bless you. God loves you. Have a good day at school.” And they beam with pleasure, receiving the gift as Dad intended to give it.

We see children outside the campus headed for school in deep purple, bright pink, yellow, orange or green uniforms. The effect is of a moving flower garden. The imagination fast-forwards 5 years, 10 years, and one wonders what kind of man or woman each child will be father or mother of and what kind of world today’s fathers and mothers will leave tomorrow’s. I especially wondered this as I spent a day this week doing school physicals on 43 girls ages 13 to 20 at a secondary boarding school.

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Madame Janet visits Mityana

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Uganda’s premier English language newspaper, The New Vision, had this article with the headline, “MEDICAL STAFF ABANDON HOSPITAL IN MITYANA” in the 23 September issue, page 7.

Over 40 medical workers in Mityana Hospital on Monday morning abandoned work, leaving 400 patients unattended to.
The workers went to attend a court session where their four colleagues were charged with manslaughter following the death of a pregnant woman in labor.
Sources in the hospital said workers reportedly agreed not to return to work unless their colleagues were granted bail.
Nurses Jane Nanfuka, Agnes Namirembe, Joy Namutebi and Dorris Nalwanga allegedly refused to attend to Sylvia Nalubowa and her unborn baby last month.
The hospital administrator, Charles Luzira, said the medical workers were not on strike but were only showing solidarity to their colleagues and would return to the hospital after the court session.
The nurses were backed by officials from the national midwives and nurses association.
Chief magistrate Justine Atukwasa granted the accused bail of sh200,000 each which they paid. She then ordered them to return to court on October 6.

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I say “Mattress,” you say “Matt-er-ess.”

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Christine and Eva.JPG “Does the U.S. have a big problem with culture?” asked Eva, her small face full of concern. We had just finished reading and discussing Wellman’s chapter on “The Diverse Learning Needs of Students” in the 2009 Billings’ textbook on Teaching in Nursing. The “problem” in this chapter (pp. 21-22) is expressed partly as a catalogue of failures, failure to recruit sufficient minority nursing students and nursing faculty, failure to adequately support the minority student, etc. “Well, children in the U.S. go to similar schools,” I said, “and almost all of us speak the same language. We do have some cultural issues but I don’t think we have a ‘big problem’ with culture. What about Uganda?”

“Oh, all children in Uganda learn English from the beginning,” she said, taking her cue from me. “We don’t have a big problem with culture in Uganda.” (See photo of Eva, the young woman wearing the black sweater. Christine is busy at the computer in front of Eva who is speaking with Keren.)

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“When were you last de-wormed?”

Dr. Ruby Dunlap’s Uganda Fulbright Blog
While in Kampala on Saturday, I received a frantic text message from Bob: “Come home and look at my stomach.” He was indeed in a pitiable state with an intensely itching rash and welts erupting all over him within a few hours. He was having an obvious allergic reaction to something. We thought at first it might be the laundry detergent. Perhaps Amina hadn’t rinsed his clothing sufficiently? I gave him what I had: topical diphenhydramine and also topical cortisone I had purchased at a Mukono pharmacy on the way home. I also had him take Advil PM which has close to 40 mg of diphenhydramine per tablet. That made him sleep and calmed the itching for a little while. But the rash kept growing and I began to get suspicious of the doxycycline. Antibiotics are notorious for causing rashes like the one Bob was having. I instructed him not to take any more doxy and re-washed all of his clothing, rinsing everything until the water was perfectly clear.

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This Week in Kampala

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Kampala is a city of unknown millions who, from a distance and from a height, has a lush look to it with many red tiled roofs nestled among trees and rolling hills. Marabou storks are its biggest birds, tall, gaunt, bald-headed carnivorous birds that prefer their meat well-aged. When one sees many of them circling, a ballet of exquisite grace for one of the world’s ugliest birds, one can be sure of a butcher shop close by.

Getting into Kampala from Mukono is a laborious drive of around an hour if one is lucky, the vehicle lurching either to avoid or try to beat other occupants of the road to a coveted spot. Lurching, I might add, in a mix of oily black diesel fumes, red Ugandan dust, and the smell of garbage which litters the roadsides. I had to make this trip four times this week. I have decided the experience gives me sensory data with which the better to enter imaginatively into Dante’s Inferno.

The first trip was on Monday for groceries, a weekly hire of driver and vehicle which has become necessarily routine. The next two trips were for a two day meeting of a Duke University sponsored “partnership to improve the Ugandan health system.” Mike Smith, the chair of health sciences at UCU, had been invited and, in turn, invited Jean Chamberlain, a Canadian OB/GYN who has made it her personal life’s mission to reduce maternal mortality in Uganda, and Edward, the Ugandan physician who heads an undergraduate program in health administration which is funded by another Canadian organization. As it turned out, I was the only nurse invited to the group.

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First Class Maps

Dr. Ruby Dunlap’s Uganda Fulbright Blog
“Africans don’t like maps and they don’t use maps,” laughed my Ugandan colleague as he handed Mike Smith’s map to me. Mike wanted me to see the turns in the road, the towns and villages, and the geographical features of the country through which we were traveling from west to east as we headed to Sipi Falls.

“What do you do when you want to get somewhere?” I asked. “Do you just start out in the general direction?” But they laughed as though my question were hardly worth answering. Even without maps, Ugandans are a people on the move and they always seem to end up where they want to be. Ben, our Saturday afternoon speaker for the retreat, told us the chilling story of how Idi Amin had punched him in the face, causing the loss of his eye, and how he had followed the railroad track by foot to escape being murdered by Amin’s henchmen. It took him nine days to walk from Kampala to the Kenyan border to safety, the railroad mapping his path securely.

Ben, at the time the editor of one of Uganda’s English language newspapers, hadn’t caught a typographical error in the headlines. The headline was supposed to read, “Amin Raps Nyerere” or some such other African leader. Someone had inadvertently put an “e” after the “p” in “Raps” and Ben had not caught it before it went to press. Amin was not amused. “Ben is one of the few important people who survived the Amin years,” one of the Ugandans told me later.

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Sipi Falls Retreat

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Sipi Falls.JPG Members who could from UCU’s health sciences department spent the weekend in a retreat at Sipi Falls near the Kenya border. That I survived this experience is testament to a God in heaven. It all began innocently enough with Faith, one of those splendidly capable young women such as Belmont’s school of nursing has in Karen and Heather, telling me “we would do a little walking.” Faith had organized the whole thing, all the meals and the stay at the Crow’s Nest at Sipi Falls. Why that name didn’t make me suspicious I’ll never know.
We loaded up on the school of nursing bus: department head, physician Mike Smith who, besides myself, was the only other expatriate. Faith, Maureen, and Dorothy, department administrative coordinators. Jemimah, the chair of nursing.
Inside our bus.JPG Edward, a physician, who is the administrator of a MBA in healthcare. Francis, one of the instructors for their BS in community health, an important non-nursing health profession in developing countries. Clarissa and Selah (pronounced Sell-ah) from the MPH in maternal-infant health. Mike told me it’s actually an MPHL (MPHLeader) degree, open to anyone with a previous bachelor’s degree and very popular; it has UCU’s largest enrollment for a health profession. Tom was our driver. And finally, Grace and the other Faith, two of my MNS students and also faculty for the RN-BNS program. Here’s a photo of our first meal stop, lunch on Friday. I had beans and rice with greens, all delicious.

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Finding a Rhythm

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Had it been a philosophical chicken, it certainly would have appreciated Thomas Hobbes and his cynical view of things. From the moment it emerged from its shell, wet and tottering, until it was finally dispatched by someone to be eaten by me and mine, it had lived to eat brutishly and avoid being eaten nastily.

It had been marginally successful in its first ambition and finally unsuccessful in its last. Now, to add insult to injury, I was critically gazing at its scrawny, blue-tinged carcass and wondering why I had paid 12,000 Ugandan shillings for it, roughly about 6 USD.
Chicken, I had been told, is more expensive than beef in Uganda. My experience has validated that. A plump fryer-sized chicken in a Kampala grocery store costs about 16,000 shillings or 8 USD. A pound-sized package of minced (ground) lean beef costs about 1.50 USD. The chicken in my kitchen had been purchased, sight unseen, from someone Karen had said raised really extra good chickens. This must have been one of their bad-chicken days.

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Karen and Jemimah

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Karen, Jemimah and Ruby.JPG Karen Drake is a tall, strong woman whose primary home is now Minneapolis but who has spent most of her life on foreign missions of one kind or another. She lived with her parents in Japan until she was 17 years old, becoming fluent in all things Japanese.

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Justice

Dr. Ruby Dunlap’s Uganda Fulbright Blog
“Do not,” warned Ben, the security specialist at the U.S. embassy, “go toward a crowd of people. Move away as quickly as you can when a crowd starts to gather.” Uganda is among those countries distinguished by regular occurrences of mob justice within its borders.

A couple of U.S. college students in their study abroad semester at Uganda Christian University, perhaps motivated by curiosity mixed with the natural tendency to behave in ways opposite from what one has been told, went towards a crowd instead of away from it and witnessed the beating to death of a man by a mob.

The day after we arrived, the local paper had a story about a landlord who was first hacked and then burned to death by irate tenants who had heard he was thinking of selling his property. It happens here regularly enough, “mob justice,” a category of justice within this society. Litigation is rare among those Ugandans who have cheaper and more effective ways of retribution at their disposal.

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Taking Care of Business

Dr. Ruby Dunlap’s Uganda Fulbright Blog
The circulatory system of Kampala is an atherosclerotic mesh of streets most of which wind through the vast slums which, if reports are correct, characterize the cities of the so-called developing parts of this planet. There are sections of privileged residences and businesses behind fortresses of thickly spiked walls, gates and hired guards.
The U.S. embassy is one of these, a massive structure of multiple barriers and checks. Our embassy driver had never left his vehicle but hired nationals guarding the entrance still lifted the hood and ran a mirror underneath it to check for any discourtesies before allowing it to proceed through yet more checks and barriers when we arrived at the embassy around 9 am Wednesday morning.

We walked through a metal detector. I had to leave my three memory sticks and calculator at a front desk; no electronic devices of any kind are allowed to be carried into the embassy. After that, we had to leave our passports with a young Marine who sat behind thick glass at the final check. We were met by Dorothy, the Ugandan national who works as a cultural affairs attaché and who had facilitated the orientation for the Ugandan Fulbrighters in Washington in June.

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Water

Dr. Ruby Dunlap’s Uganda Fulbright Blog
“Monkeys live at the top of the hill,” university staff told us. “They are shy, not like baboons. At the top of the hill is your best chance of seeing them.” Camera in hand, I determined this morning to go photo-hunting for the resident monkeys. I tried several roads which went left and up but always dead-ended in someone’s driveway.
Finally, I came across a young man getting off his motorcycle in one of the driveways. Just beyond the driveway was a high gated area around several huge water tanks. “Good morning,” I said, “I’m Dr. Ruby Dunlap. I’m trying to find the way to the top of the hill.” (I wear the “Dr.” with egalitarian American lightness but Ugandans value titles as much as they value conservative attire and one potentially offends by being too casual with either.)

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One Chance Firsts

Dr. Ruby Dunlap’s Uganda Fulbright Blog
Our frontyard.JPG The hour of reckoning, the day of doom, must elicit a look on the human face which is among those things transcending place or time. We arrived at Uganda Christian University at the end of the first week of final exams and just before the beginning of the second week when pen to paper or mouse to screen stand in as prototypes for that Apocalyptic opening of books.

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