If days were suitcases, those first ones in Kampala were stuffed with the paraphernalia of summer fun and bursting at the seams. We worked hard. We played sport every day. We went out every night. I didn’t know how it was possible to fit it all in. Yet it was a strange time of paradox: drama and tragedy were daily wake-up calls that life was a struggle for many we rubbed shoulders with. Uganda was a country striving to recover from Amin’s depravity; its people still reeling from the violence, many still desperately poor.
For the first month, I was working full-time as Doc Gibbons’ locum. It was a steep learning curve, getting to grips with the tropical medicine and many complications of AIDS. In my surgeries, half my patients were Europeans and half Ugandans. I had naively expected all my European patients to be of similar ilk to back home. Not so. Some were used to very strange customs. One morning surgery a Swiss lady came in demanding that I scrape her tonsils and give them a good clean. She wasn’t happy when I explained this was an unfamiliar practice and in my opinion unnecessary, given they looked like a fine pair of tonsils.
But for the most part, I understood the Ex-Pat patients and rapport was easy. This was not always the case with my Ugandan patients. HIV was rampant at the time. I was learning quickly the different ways it presented, but usually this involved weight loss and concurrent infections: classically thrush in the mouth, a low tolerance to malaria and sometimes TB as well. The destructive power of this virus loomed large, and I felt such sympathy for its victims. These poor patients probably knew their fate, but we went through the charade of investigations and then an agonizing wait of a week for the results. The first time I had to tell a patient that she was HIV positive is imprinted on my mind. She was a girl in her early twenties, softly spoken with big eyes. Her eyes were expressionless, impossible to read. Empathy was difficult. I broke the news as kindly as I could. There was zero reaction. Not even a flinch. I went over the management several times, so that it sunk in. Still I got nothing back. She left the room and I sat in my large consulting office looking out of the window at the daily deluge in the courtyard, feeling inadequate. The chasm of cultural divide tore wide and deep that day. I referred AIDs patients to a specialist clinic run by Ugandans, where there was a counselling service and I desperately hoped they could help her better than I had.
I saw a lot of patients with malaria. Managing my first ever patient with symptoms of malaria was nerve-wracking. It was Day One at the surgery and I was dreading this moment. She was a 6 year old child with a fever and headache and obviously unwell. I explained to the parents that I had to take blood, which was a straightforward procedure. The tricky part was an on-the-spot test in my laboratory. Since my fated visit last week, The Lab had been a malevolent presence in my thoughts, which until that moment I had managed to ignore. I made a pretty good blood smear using the Romanowsky stain just as Doc Gibbons had shown me; placed it under my microscope and brought it into focus. I realised I had been holding my breath until that moment, when staring up at me and filling me with relief were lots of classic purple ring-shapes inside the red blood cells. These are the stained malaria parasites. This was good news for me and for the little girl. It meant I had a firm diagnosis and therefore could go on to treat her with quinine, a truly unpleasant drug, but effective and the only one available to me. She would be fine. The difficulty comes when the blood smear is unclear. This happened many times subsequently and the decision on whether to treat with quinine has to be taken on the clinical picture. The worry is then whether you have missed some other cause of the fever. These are the patients you go home and worry about.
I also had my fair share of stool samples, which always liven up an otherwise routine clinic. I wasn’t good at interpreting them in the beginning, as I simply wasn’t experienced enough to recognise the various bugs. Invariably the samples were triple wrapped in plastic bags, and the patients mortified. With my first such sample, I prepared the slide and dived in for a peek. This time I was very definitely holding my breath. As you can imagine, having your nose three centimetres from infected faeces is a bad moment in time. I came up for air and thought to myself “Absolutely clueless. No idea. Looks like a pile of poo”. I took the opportunity to traipse across Miss Kabego’s bleak waiting room and introduce myself to Dick, Doc Gibbon’s partner, and plead for help.
Dick Stockley was the classic bearded missionary doctor, sandals and all. To begin with, he struck me as reserved and his height didn’t help: six-foot-something of wariness in a white lab coat. We peered professionally at the sample together and he introduced me to the machinations of a microscopic stool sample, pointing out normal fibres and fat globules. He even found a few amoebic cysts, which was lucky for me, though maybe not for the patient. Ten minutes later, his guard had fallen away and the wicked humour for which he is renowned emerged as he scribbled diagrams of Shigella, Giardia and the scarily squiggly Strongiloides. “Trust me, Kate. The first time you see a Strongiloides down the microscope you will leap off your stool. It’s like watching a manic sea-snake squirming in a soup of runny poo.” And thus started a solid friendship, which was forged through a good few highs and lows both professionally and socially.
Dick and his pretty nurse wife, Rosie, had come to Uganda in the early 1980’s as Christian missionary medics. Not ones to settle for the cushy life of Kampala with its running water and occasional electricity, they set out to a remote region in the north of the country. Kidepo is inhabited by the cattle-raiding and violent Karamajong tribe. Dick and Rosie were the first white people that many of these tribes had ever seen and it was an incredibly brave venture. They lived a very simple life in a mud hut on the outskirts of a village. Rosie learnt how to grow vegetables and kill chickens. Initially, the villagers were distrustful of their new neighbours, but as time went on and the tribes learnt of the clinic and experienced treatment firsthand, their curiosity outgrew suspicion. Nevertheless, communication was difficult as the couple didn’t speak Karamajong, so other bonding techniques were needed. The worst of these came one night, when they were invited to sit around the fire for some kind of ceremony. To a background of rhythmic drumming, a spear with a hollow centre was inserted into the jugular vein of a cow and a cup of thick warm blood drawn down. This was then mixed with warm milk and presented to Dick to drink. This doctor, fresh from Cornwall, downed the lot without a moment’s hesitation and from that moment on, the Karamajong accepted him and Rosie as part of their village; in true Dick-style he had won them over. Even so, practising medicine out there would have been an enormous challenge. Dick must have felt out of his depth on many occasions and struggled with decisions on a daily basis.
This shaped the doctor he became and over the years that we worked together, there were times when I was stumped and his legendary ingenuity saved the day. One of these was rather sobering. It was 8 months into the job and Kampala was gripped with the breaking news of a mass genocide on its doorstep in Rwanda. I was the duty doctor when the call came in. It was a terrible line, but the caller explained he was in a remote area on the border with Rwanda. Apparently, there were literally thousands of Tutsi and Hutu bodies floating down the river across the border and being washed up. This Aid worker was distraught at the state and sheer numbers of them; he was asking my advice on how to dispose of the bodies and whether they would need to be identified. Again, my Buckinghamshire training let me down: time to consult our friendly bush doctor. Dick’s advice, true to character was “Leave them out for the vultures. They’ll be picked clean in two days”. I returned to the caller and paraphrased carefully.
Meanwhile, after the frenzy of preparations and the excitement of my arrival, Rick had returned to work and was bored. Now his boss was back from leave, he missed his job as acting General Manager. However, the experience had given him an overview of the business and he realised some restructuring was needed. He decided to sack Henry, one of the investment executives, who was incompetent and difficult; and started interviewing for his replacement. The best candidate on paper for this position was a 33 year old woman called Milly. Word got around the office and the next day, one of the executives, Martin, took a delegation to the GM imploring him not to recruit her, because “ women, they are lazy and do not work hard”. I would love to have been a fly on the wall to see how he handled that one! Milly regrettably didn’t show up for the interview, but I secretly hope she went on to greater things than Martin.
Not only was there sexism in the workplace, there was absenteeism aplenty. In the following two weeks, Rick lost 50% man-days to employees attending funerals, mostly for relatives who had died from AIDS. Both HIV and AIDS were taboo words. It was referred to, if at all, as ‘that illness’. When condolences were offered, the most frequent response would be “It happens”. This brought home the passive, fatalistic view that a lot of Ugandans had during those years. After the new recruit was hired, Rick offered him and all the other employees a full medical with an HIV test. Not one person took up this offer. Fear was rife.
One of the absentees was Rick’s driver, the charismatic Vincent, who we were growing to respect as a crucial member of the team. In fact we joked that he actually ran the business, such was his strength of character. This time his absence was not because of illness. He had been evicted from his rented house, along with his wife and 4 children and had taken the day off to settle them into his half-built house out in the rural area. The following Monday, Vincent came into the office looking 10 years older. He looked utterly desolate. He explained that his 14 year old daughter had been killed in a hit and run accident that Saturday. Rick was at an absolute loss for words, finding it impossible to imagine what Vincent was going through. He handed over the Landcruiser and some cash, so Vincent could go and make the funeral arrangements, and the following day the office closed down so they could all attend the funeral. It was a 200km drive south of Kampala. Rick and his European colleague, Heinz, were concerned about going as they knew they would attract attention and obviously did not want to detract from the ceremony. However, Vincent had made it very clear he wanted them there. The plan was to meet Ben, the junior less dependable driver at a junction on the road, so he could show Rick and his carload the route into Vincent’s remote village. However, Ben was no-where to be seen, so they had to track through the banana and cassava plantations following car tyre tracks in the dust, barefoot children running alongside the car shouting “Mzungu, Mzungu!” (“White person, white person!”). Finally, they came to a clearing with several mud huts.
A crowd of a hundred or so Africans were quietly gathered around a mud house set slightly apart from the others. Rick and his colleagues were greeted by the village chief, who took them into the house to pay their respects. A small wooden coffin lay on a table in the centre of the main room. As Rick’s eyes adjusted to the low light, he realised the coffin had a glass lid and that Vincent’s beautiful daughter was laid out for people to see. The atmosphere in that dark African room was silent and still with the heaviness of mourning hearts, and Rick was filled with a deep sadness that he had never felt before.
They were led back out, blinking in the sunlight, to a bench under a large mango tree. When everyone was assembled, a pink plastic platter was brought out, piled high with matoke and stewed goat. Matoke is the Ugandan staple dish and is made from the mashed pulp of a local green banana, which is a bland savoury stodge and weighs heavily on your stomach. All eyes rested on the two white men, as a bowl of water and towel were held for them to wash their hands before eating from the communal dish with their fingers. Rick was told later that had he politely refused the food, this would have insulted Vincent’s family by insinuating they were unclean.
The ceremony was held in Luganda, Vincent’s tribal language, in the plantation behind his house. To a background of low murmuring singing, a moving scene unfolded as father and uncles carried out her coffin. As they lowered her into a concrete grave dug amongst the cassavas, the anguished wailing of the women started. It seemed the most fitting accompaniment. After the grave was filled with concrete and the villagers began to disperse, Rick offered his sincere condolences to Vincent and his wife and left them to their grieving. They looked completely bombed out.
Life was unbelievably hard for many Ugandans like Vincent. They lived in one of the poorest countries in the world with the average person earning under a dollar a day. Yet they bore this hardship with fortitude. I witnessed many tragedies like this, and differences in attitude, like the sexism in Rick’s office. These were jarring moments: their life was raw; my life was fun. That cultural chasm again. Yet, those glimpses taught me something of their different world. These flashes of understanding awoke something in me – it was exciting to feel closer to their world, more connected – and I longed to know more.
The following week, we stepped back onto the expat Merry-go-round. Rick had a work trip to Tanzania, which gave me time alone to prepare for our first dinner party. Entertaining is a large part of expatriate life – it plugs the gap left by absent family and friends – and is a kind of speed dating which helps concrete your friendships. Rick’s 29th birthday gave us the perfect excuse to play host. It was a bit daunting as all our friends seemed to be cordon bleu chefs and I most certainly am not. Food is often black, wobbly or stringy once I am done with it.
Not to be deterred I made plans for my feast. Shopping for a dinner party was no mean feat: there were no large supermarkets, not even small ones. Meat and bread were bought from one end of town and fruit and vegetables from another. Cream was invariably off, so you bought 4 cartons as a lucky dip. The butcher displayed fresh meat hanging from hooks, absolutely covered with flies. Most westerners wouldn’t feed this to their dog, yet to many Ugandans this beef was a luxury. The meat I bought was frozen and kept in deep chest freezers. However, because the power was so unpredictable, most of the meat had defrosted and refrozen countless times. (No wonder I had so much practice in my lab with the stool samples).
Driving through Kampala was like something out of an Indiana Jones film: men steered wobbly wheelbarrows which veered unpredictably; crowds spilled out of bright roadside stalls; clapped out cars flouted every rule in the Highway code; chickens, goats and sheep appeared oblivious to the hooting, spewing, impatient vehicles.
It was on one of these pioneering shopping missions that I ended up down a blind alley with two Policemen-plus-AK47s in my car, wondering what my future held. I had ignored a blinking amber traffic light (the only one in the country), so the opportunistic officers had pulled me over, clambered into my little car and directed me down this quiet backstreet. I was now being apprehended in the local way: extortion. Regrettably for me, I was an amateur at this game. I had no idea of the rules or more importantly how to win by getting out alive. A farcical dialogue ensued:
“This is a bad driving offence, Madam. I will have to issue you a ticket”
“Okaaaay”. Winging it. No idea what he wants from me.
“Can you help me with this situation, Madam?”
“Erm.” Stares at him for some clue. “Not sure. Can I?”
“You will need to go down to the station to pay the fine.”
That wasn’t helpful. What on earth is my next move?
“OH! Um. Can I pay it now instead?”
Big toothey grin. Hit the Jackpot!
There was a worrying moment when I reached to get my handbag and the strap got tangled in the sling of his rifle. An alarming tug of war nearly lost me my get-out-of-jail-free card, and life. By now I was completely flustered, sweat soaking my cotton blouse, and desperate to get shot of the coppers. When I opened my purse, I wasn’t sure whether I had won or lost. To our collective dismay, I had a solitary 1000 Ugandan Shilling note (50 pence). A pittance. They looked at me suspiciously, appraising the state of play. Realising I was a hopeless case and not worth any more of their precious bribe-extracting time, they pocketed the note and bungled out of the car. I slammed it into reverse and drove resolutely home, shaking, to get my double cream refrigerated before it all went off beyond repair.
Getting the dinner party invitations out would be the easy part, one would think. The snag was that we didn’t actually have an address. Most residents had this problem. We lived up an anonymous dirt track off another dirt track, which was a fork off (you’ve guessed it) another dirt track. We all got very good at drawing little diagrams on paper napkins and cigarette boxes, which we all then lost and ended up following someone who knew. I had to engineer bumping into the guests in the prior week to hand them my little drawings, where the essential landmarks for turning into our road were a cow and a pile of manure.
The day before the dinner party I went to the colourful Nakasero market to stock up on fresh groceries. As soon as I pulled up in my little red Toyota at the lively marketplace, I was surrounded by “basket boys” vying for my attention and trade. The new Mzungu in town had been spotted and she was up for grabs.
“Madam, my name is Jodfrey – you take me as your basket boy”
“I’ll get you good prices, Madam, you take me”
“Let me hold your basket. You remember me for next time, Madam!”
In the quickest recruitment of my life, I picked Jodfrey for his beaming smile and sheer pushiness, and he was mine for the duration of my time in Kampala.
Jodfrey’s job as basket boy was to hold my basket, believe it or not, and fend off all the other kids trying to get a piece of me. He led me through the market, no doubt to his relatives’ stores and then supposedly bartered on my behalf for the best prices. I savvied up quickly and stepped in with a harder deal at the end. The market was a huge expanse of cleared dirt, every inch of which was filled with colour, produce, people, animals and noise. It was divided into different sections selling literally everything you could possibly think of. The first section had fresh groceries, highly polished and arranged in piles, tended by chattering African women in bright sarongs. Behind this, other sections sold bicycle parts, live chickens, frilly underwear, toilet bowls, wigs, mattresses…you name it.
I stuck to the fresh produce and left exhausted, tipping Jodfrey and promising he was mine forever. And he was. We had some good times together in Nakasero market. I was terribly sad to hear that after I left Kampala he died of AIDS. He was 15 years old.
At home, it was action stations. A heavily pregnant Mauda and I unloaded all the shopping and set to work in the kitchen preparing and marinading the food. She was now getting very rotund and I was worried she might just pop, but she insisted on working and wouldn’t hear of putting her feet up. She was excited to be hosting our first dinner party. I went looking for Fabian to ask if he would put some festive bamboo flares out in the garden before sunset. I popped my head round the bathroom door, to find him IN the bath, fully clothed with his trouser legs rolled up.
“Fabian! What on earth are you doing?”
“Me, Madam?” He wasn’t the brightest spark. “I am washing the tablecloths”
“But you’re IN the bath!”
“Yes, Madam. That is so.” I was slowly getting the hang of these African conversations.
“The washing machine. It is not good”
So Fabian, the dear soul, had taken it upon himself to trample the laundry in the bath every day, and had forgotten to mention that the washing machine had never actually worked. I suspected he preferred this method of washing, but I made a mental note to get it fixed anyway. This took another 6 months, which suited Fabian just fine.
Back in the kitchen, Mauda and I were working away whipping the slightly off cream and chopping the vegetables, when a scuttling in the corner of the room caught my eye. For a heavily pregnant woman, Mauda launched across that floor with grace and stamped on it. A crunching sound coincided with my squeal of disgust as I saw she had annihilated an enormous cockroach with her bare foot. (If anyone wants to know, they are yellow and slimy on the inside.).
Rick walked in at that moment having just flown in from Tanzania. It had been a hair-raising landing: as they came into land, the lights went out over the entire Entebbe peninsular including the landing strip. The pilot had to pull sharply out of the descent at the last minute and circle until the lights came back on. All a bit disconcerting. We went to bed unsettled.
Rick’s birthday arrived at last, and there were just the finishing touches to attend to. I wandered out into the garden to ask him to get some diesel for the generator, should we have a blackout. He was busy testing our night-guard, James, on his archery skills. They weren’t coming up to scratch by the looks of it, so poor James was set some extra-curricular training sessions. He actually looked happy that Rick was taking such an interest in him – most employers had fairly low expectations of their night-guard. Staying awake was a ten-out-of-ten. I did worry that in a combat situation, James’s bow and arrow may be found wanting, especially after what I had just witnessed.
We had a lovely birthday tea with the staff, and Rick unwrapped all his presents. The piece de resistance was an Alsatian puppy, called Jack, who did literally spring out of a cardboard box and surprise him. He was an instant hit with the staff, though Rick wasn’t sure. He isn’t really a dog lover, but I am and my argument was that we needed a guard dog (and I was short of present ideas). So what with James the dodgy archer and Jack the adorable puppy, we were armed for action and ready to take on the world.
The guests arrived and we had a wonderful evening, though the power went off and the generator stopped working. Luckily I had planned a fondue, thinking at least I couldn’t burn the food, so all was well and the candles just added to the atmosphere of merriment. No-one commented on the off cream either, so I triumphed in the cooking department and Rick declared the whole evening a success.
The following week, Mauda had taken to dusting everything in sight despite the enormity of her pregnant belly. I did wonder whether this was a sign that the baby was due and begged her to get some rest. She wouldn’t hear of it, and continued dusting the plants as she had run out of anything else to dust. I was in awe of her. Pregnant women in England experienced relative indulgence: ante-natal classes, breathing and birthing plans; long discussions with the Obstetrician about due dates, Caesarian Sections, and who gets to cut the cord. She seemed so naturally in tune with her body and its little passenger that it made a mockery of the fuss and coddling that occurs in developed countries. This was her fifth pregnancy and it was all in a day’s work for her. I wanted to be like her when I was pregnant and vowed that I would give birth as naturally as possible when my turn came. (Erm, yes. About that…).
Sure enough that afternoon, Mauda went into labour whilst doing a second round of the picture frames, and even then she didn’t seem to be in that much of a rush. I didn’t want to appear overly motherly but shouldn’t we be taking her to the hospital NOW? She left quietly, explaining that she and Fabian had it covered and that I was not to worry.
Two hours later, we were going through the evening ritual of closing all the doors and windows to keep out the mosquitos, when Jack started barking. Surely they weren’t back so soon? In walked Fabian and a beaming Mauda with a big bundle of blankets in her arms. She WALKED in. Not hobbled or limped, she just walked in. Her cheeks glowed, her brow was shiny and her hair was quite covered in sweat. She could have just done an aerobics class.
“Mauda! You’re back! Already? What happened? Are you both Ok? Oh goodness! What a beautiful, beautiful baby!”
“His name is Ronald, after our Kabaka (King)”. Both of them were bursting with pride. Life doesn’t get more satisfying than this moment in time.
It was an unbelievable tale, the best story of childbirth I have ever heard. Despite my offer of a lift, the labouring Mauda took her overnight bag and her husband and hailed a matatu bound for the hospital. Matatus are public mini buses, typically packed tight with people, live chickens and suitcases. Apparently, about twenty minutes into the journey, she realised that the baby was coming fast and there was no time to get to the hospital, so they got off the mini bus onto a busy street full of pedestrians heading home for the day. Totally unperturbed, Mauda, who was wearing her long bright traditional dress, asked Fabian to turn the other way while she squatted on the grass verge. The African women are prepared and always carry a clean razor blade and a piece of cotton when nearing their due date. She delivered her baby onto the grass verge, cut the umbilical cord with the razor blade, having first tied it off with the cotton thread. She went on to deliver the placenta, disposing of it in the ditch, then hopped back on the next bus with delighted husband and came home! She explained that this was no worse than conditions at the hospital, where there was no running water and the usual mayhem of a busy underfunded, government hospital.
She was back at work 5 days later with her beautiful baby Ronald tied to her back, happily dusting those picture frames and stamping on the odd cockroach. Despite much drama and hardship in their lives, the Ugandans had seen far worse and not so long ago. They got on with their lives as best they could, rarely moaning, and were thankful for the pleasures that came their way. I had a lot to learn from them.
Next time! We meet an orphan who will change our lives; Rick lands a whopper; and gunshots next door get some of us hitting the deck…