You are Most Welcome

The first morning I woke up in Kampala I was greeted by the sounds of a busy city street outside my hotel window. There were boda bodas (moto taxis) buzzing by, as well as cars and pedestrians going to and fro. I had only slept for a few hours the night after my arrival, but I had a busy day ahead to take care of administrative matters so that I would be ready to head out into the field with my colleagues the next day. After a nice breakfast made of fresh pineapple and mango, fresh-squeezed passion fruit juice, scrambled eggs and coffee, I headed with my STOP colleague, Scott, to the United Nations Department of Safety and Security (UNDSS) office to be outfitted with my official United Nations (UN) badge. Then we went over to the World Health Organization (WHO) offices to receive a security briefing on Uganda. In addition to the information presented on potential security risks in the area, I also received a hand-held alarm with a string attached, which I could pull in case of emergency. I was informed that these alarms are provided for female staff only.

A boda boda in Kampala.

 

After the briefing, we went over to the UNICEF offices where I was to meet my in-country supervisor, Sheeba. She is the lead coordinator for immunization services at the UNICEF Uganda office. Sheeba maintains a very busy schedule but I was able to catch her for a few minutes to receive a brief introduction to the office and receive some quick guidance on what our objective would be as Communications Consultants during the field visit that week. We were instructed to take this trip as an opportunity to observe a specific district in the country, take note of the current immunization situation, and gather ideas of how we could focus our work throughout the next couple of months.

The next morning a fellow STOP consultant, Joseph, who has been working as a Field Consultant in Uganda for the past year, picked up Scott and me with his driver, Amos. We embarked on our long 7-hour journey from the capital to the northwestern region of Arua. The roads were very rough and rugged, and of course it was sweltering hot. Despite the hot and bumpy ride, I was able to observe many interesting sights along the way. When we passed through town markets, there were people bustling about selling fruit, bread, and chickens, women walking with baskets full of goods on their heads, bicyclists balancing large bundles of reeds and other items, and children scampering about, often stopping to stare at the muzungu (white people) in our vehicle.

A local market center on the way out of Kampala

Even beyond the town centers, there were various men, women and children trekking alongside the road, carrying various types of goods and women carrying babies on their backs. It was an adorable and peculiar sight to see a woman walking with two tiny feet poking out from either side of her body. Then as we passed by, I could see a baby cradled across her back with the legs splayed on either side of the mother’s body. I noted how the women here in Uganda carry their babies differently than the women in southern Mexico, who often have their babies hanging diagonally in a cocoon across the mother’s back. We were also very lucky to come upon a safari of wild animals during the stretch of the trip through the national Uganda park reserve. We spotted exotic birds, hippos, monkeys, and even elephants roaming through the grass, only a few meters from our vehicle. It was miraculous! This was not like watching animals at the zoo; these were majestic wild animals roaming freely.

Stopping to feed bananas to the monkeys on the way to Arua.

Wild elephants in the Uganda national park reserve.

The long day trip to Arua went smoothly, except for the flat tire we experienced at one of the military check points. Fortunately, we had a spare tire that Amos was able to change on the side of the road. The sun was beating down on us and poor Amos was completely drenched in sweat after changing the tire. A few hours later, we finally arrived to the Arua district, in the region of Arua. Like Mary and Joseph looking for a place to stay at the inn, we went from hotel to hotel searching for accommodations that night. By the fourth hotel, we finally found a place with available rooms, one double for Scott and Joseph and one single for me. Many of the local hotels had only 7 to 10 rooms, and we speculated that they were full with refugees from Sudan, fleeing the current struggles for safe haven in Uganda.

My hotel room on our first night in Arua, complete with mosquito net.

The next day was Friday, and we took advantage of the opportunity to meet with leaders at the Regional Health Office in Arua. We met with the regional Health Officer and the regional Surveillance Focal Person. Our goal was to inform them of our presence in their region, explain our mission as WHO/UNICEF STOP consultants, and describe our intended efforts to support their work in communicable disease surveillance and routine immunization, with a focus on polio, measles, neonatal tetanus, and adverse events. We were received very positively and instructed that of the 8 districts in the region, we should focus our work on the districts of Arua and Adjumani because those districts are the most densely populated and host large refugee communities, which are known to have some of the lowest immunization coverage rates.

Meeting at the regional health office in Arua.

With the support and recommendation of the regional health officials, we then headed to the neighboring district of Adjumani. While the distance between the two districts is not great, the rough roads extended our trip to almost 4 hours. Once we finally arrived in Adjumani later that afternoon, we met with the District Health Official (DHO) to have a similar discussion as what we had at the district, as well as to ask some questions to quickly assess what is currently being done for communications and social mobilization around immunizations. We learned that there are roughly 60,000 refugees in the district, both in camps and integrated into the community, and that they have the lowest immunization coverage rates in the region. In addition, they are currently experiencing a meningitis outbreak with confirmed cases in two different counties. After a very productive conversation with the DHO, we agreed to meet the next day with a community health leader at the only hospital in the district to make a plan for various site visits during the upcoming week.

Woman carrying chickens on her head and a baby on her back
on our way from Arua to the Adjumani district. 

The ferry to get across the Nile River to the Adjumani district. 

Me on the Nile River ferry to the Adjumani district.

The District Health Office in Adjumani. 

The next day, Saturday, we headed out in the morning for the district hospital. The community health leader we went to meet with, a nurse, was busy seeing patients when we arrived, so we toured around the hospital which was constructed as an open outdoor structure with a courtyard in the middle. The various sections of the hospital had open waiting areas where people were gathered waiting to be seen. There were various posters on the walls encouraging people to get tested for HIV, avoid getting infected with malaria while pregnant by sleeping under treated bed nets, and family planning options such as IUDs, which were referred to as “coils.” We even encountered a laboratory with a plaque on the wall recognizing the “American people” for their support through the U.S. Centers for Disease Control and Prevention. Once the nurse was free, we sat down with her to discuss our plan for the next week to visit various district health centers, local schools, and two refugee camps. After completing our plans, we headed on to find our next place to stay for the rest of the weekend in Adjumani.

Sign outside the lab at the Adjumani District Hospital. 

All in all, my experience so far has been very positive. During my first few days in Uganda, I have found the people here to be very kind, soft-spoken, mild-mannered, and courteous. From the district health officials to the local merchants, I have felt warmly welcomed by all. Many of the Ugandans I have met have greeted me and kindly stated, “You are most welcome, madam."

A Whole New World

The journey from Los Angeles, California to Entebbe, Uganda was a long one. I left LA at 1:50 pm on Monday, February 17th, and then arrived to Amsterdam 10 hours later the following day. From there I ran through the airport past life-sized blue and white teacups and a kettle formed into tables and sitting spaces to arrive at the departure gate for my next flight. I left Amsterdam at 1:00 am PST on February 18th and arrived to the airport in Entebbe 10 hours later that day. From the time I took the shuttle to LAX on the 17th to the time I arrived in Uganda on the 18th, I had been traveling for 26 hours straight.

A view of the Netherlands during landing in Amsterdam.

I must make a brief note about my travels on the KLM Royal Dutch Airlines. First, I realized that there is this whole culture of Dutch people that I have only seen glimpses of in the U.S. in the form of tourist traps (e.g. Helen, GA) with little shops selling mini tea sets and tiny wooden clogs. But, I came to see that these are actually real people with life-sized cups and shoes who speak multiple languages and take great pride in treating you with courtesy and good customer service. When I entered the airplane in LA, I was greeted by attractive flight attendants in matching royal blue suits. Some wore pant suits and others wore skirt suits with panty hose and pumps. I couldn’t remember the last time I saw a flight attendant wearing panty hose in the U.S. Then, as I proceeded to my seat past these nice-looking flight attendants, I passed a staircase to a second level. Wait—a staircase? Yes, that’s what I said.

 

The airplane was humongous. Surprisingly, however, those 10 hours passed rather quickly. Between dozing off for several minutes at a time and waking to watch Captain Phillips on my personal TV and read my Immunization Essentials booklet, the time seemed to fly right on by (no pun intended). In addition, we were served not one but two meals by these blue suit-clad women, along with several snacks and multiple beverage offerings. My flight from Amsterdam to Entebbe was similar, except for there was only one rather than two levels on the airplane. And on this flight I had the misfortune of being seated in the center row of seats next to some oafy-looking European guy who was all but sleeping on me by the end of the 10 hour flight. Not to mention his snoring and constant coughing all over the place.

 

Anyhow, my arrival to Uganda was very smooth. It was an amazing feeling when I realized that I had planted my feet on a whole new continent for the very first time. I began to feel nostalgic of a similar sensation I experienced when, after so much yearning and planning, I finally had the joy of stepping onto Mexican soil in my new home where I lived at the time in Ensenada. In my jet-lagged, sleep-deprived, and disoriented stupor, I rejoiced silently within. I made it! Finally, I am out of North America!
 

 

Fortunately my fellow STOP colleague and the hotel driver had arrived punctually to the airport and were already waiting for me when I landed. I went through customs quickly with my Ugandan visa already in hand, pulled my two bags off the conveyor belt, and then purchased a new cell phone for local use—a Nokia phone no less. Talk about nostalgic. When I arrived to Entebbe it was late at night, and outside it was already dark and cooled off. My colleague invited me to sit in the front seat of the car, and so I made my way to the right-hand side of the vehicle, only to realize that there was a steering wheel there! Ah, yes, in Uganda they drive on the left side of the road and the driver sits on the right. I felt certain that this was just the first of many more cultural snafus to come.

 

The drive from Entebbe to the capital city of Kampala was about one hour. After zooming along the two lane highway that connects the two cities and dodging dozens of pedestrians, motorcycle riders, and boda bodas (moto taxis), we finally arrived to the Golf Course Hotel where I was to stay for the night. I was so relieved to finally be in the same room with a bed. But I was only going to have a few hours to rest, because my colleague informed me of a busy day ahead, starting at 9:00 am the next morning. After showering and unpacking some of my things, I collapsed onto my firm hotel bed, with the A/C running that seemed to produce no cold air, and rested for the first time on African soil.

The Horn of Africa

It all started back where it originally began--at CDC in Atlanta. Once again the call of duty required that I leave the acquired comfort of my Southern California home to respond to a greater and more compelling mission. And once again I found myself wondering how it happened, and why me? As in, there were so many others to choose from--how was I so fortunate to get the call? 

I will be forever grateful to A.J. Williams (the microbiologist at CDC who recruited me) for appreciating my type A personality and relentless zeal for figuring out how to get people to do what I need for them to do while having absolutely no authority whatsoever. And the whole interview took place from an abandoned office that I snuck in to after politely excusing myself from an asthma briefing meeting. Well, you know how well I do with interviews from unusual and awkward settings (let's recall the slam dunk interview I gave in 2011 to Catholic Relief Services for an International Development Fellowship position while stuck in the back of a car filled with family on the way to a winery over Thanksgiving). Then after several weeks of waiting, I finally got the email to inform me that I would join the ranks of a talented and diverse team of Stop the Transmission of Polio (STOP) consultants as a Communications Specialist on STOP team 43.

Everything became a whirlwind of airport shenanigans and multiple flights back and forth across the country after that. In January I finally made my way to Atlanta, the home of Coca Cola, the Braves, and CDC, of course. For two and a half weeks I was to be trained by experts from CDC, the World Health Organization (WHO), and UNICEF on all things polio, from acute flaccid paralysis surveillance to stool collection kits (one of which was jokingly "dropped" on me, just 'cause A.J. thought it'd be a funny demonstration). I was in for a crash course. On the first day of training I emerged from my hotel room to find a lobby filled with loudly talking men. Mostly Indian and African men, to be exact. It was the first time in my public health history that I was vastly outnumbered by my opposite sex counterparts. Apparently I was the first of only a small handful of STOP women to arrive to the lobby to catch the shuttle over to CDC. But soon two of my fellow PHPS Fellows, Amina and Ada, came down to join me. 

Week 2 of STOP training at CDC headquarters in Atlanta, GA

Once the training started, I came to discover a few things. First, the large group of men who made up the STOP 43 team were actually quite kind and friendly. Second, the training was like a mini UN with people from all over the world including India, the Middle East, Africa, Latin America and the U.S. Third, and most importantly, there is an endless dictionary of polio jargon and acronyms that are tossed around like ping pong balls. I could hardly figure out what one stood for before the next one was thrown out. And one of these infamous terms was "the Horn of Africa." At first I disregarded this foreign phrase, but then I came to hear it so many times that I began to wonder what it meant. Was it like the "boot" of Italy? Well, it turns out I wasn't too far off. If you look at a map of Africa, you can see that the northeastern part of the continent is actually shaped like a rhino horn. So there it is--I'm heading into the horn. 

At first I had been assigned to work at UNICEF in Kenya, but just one week before my scheduled departure, plans changed and I was re-assigned to Uganda. Despite my disappointment at having to wait another two weeks to head to Africa, I'm glad to have a few extra days to add to my travel stockpile, get my affairs in order here in LA, and enjoy the luxuries of hot showers, potable tap water, and my own bed. In the meantime, I am poised and ready to embark on this journey. I'm thankful for the opportunity to serve, and I pray for God's blessings upon us all as we deploy for this great mission.

Paska, one of my colleagues from Uganda, and me