This is from last week’s Stroud News and Journal about my up-coming charity run aiming to raise money and awareness of the African Palliative Care Association.
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This article was written as part of The Guardian’s ‘Adventure Sports Series’.
Jinja, Uganda, is a town on the banks of the Nile that is gaining a reputation as the extreme sports capital of east Africa. This is, in part, thanks to the range of whitewater rapids on the nearby stretch of the river Nile.
You can read the whole article on the Guardian Travel site by clicking here >>>
To mark World Human Rights Day (10th December) I wrote this article for ehospice about the importance of integrating palliative care into international human rights mechanisms.
As we celebrate Human Rights Day we should take a moment to reflect on the millions of people around the world who are suffering from excruciating but ultimately preventable and manageable pain because states have not set up systems that meet and respect their basic right to health – their right to palliative care!
Palliative care is defined by the World Health Organisation as: “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
Human rights and palliative care are in many ways natural partners. Both are based around the dignity of the individual being applied universally and without discrimination. But they also overlap. Not only is palliative care a human right in itself, it also allows for the fulfilment of other rights.
Without good palliative care, people can become imprisoned in their own homes. Trapped by the burden of disease symptoms including pain making them incapable of accessing education, health, transport or other basic elements of life that most of us take for granted. These are elements of life that we all have a right to.
Read the full article here >>>
Palliation – literally, the removing of symptoms of life-limiting illnesses such as pain – has been brought sharply into focus in Africa due to the dual burden of an ageing population and an increased disease burden.
To give just one example, 70 per cent of people living with HIV worldwide live inside sub-Saharan Africa, a region which constitutes only 12 per cent of the global population.
Millions of these people in sub-Saharan Africa require palliative care to address the medical/physical, social psychological and spiritual challenges as a result of the life-limiting illnesses.
Despite the large demand, there is still little palliative care provision across much of Africa. Many countries do not have any element of palliative care: no hospices, no formal training for medical professionals, no or little integration of palliative care into national health systems and often little public awareness.
It is estimated that only 9 per cent of countries in Africa have palliative care integrated into mainstream health services.
One of the largest challenges facing pain relief efforts in Africa is the availability of, and access to, oral morphine. It is thought that Hospice Africa Uganda, a centre of excellence of palliative care in Uganda, can mix a three week supply for a patient for ‘less than a loaf of bread’.
Despite this, oral morphine is still not widely available to most Ugandans, let alone the rest of Africa.
Bernadette Basemera, a palliative care nurse based in Kampala, explains part of the problem:
“Morphine wrongly incites fear: Doctors wrongly fear patients becoming addicted, the police wrongly fear drug related crime, and members of the government fear falling short of international drug control frameworks.”
As a result of this fear, millions do not have access to morphine and suffer unnecessary preventable pain.
In recent years however, there have been signs that this might be a thing of the past. In the last two years alone four countries – Rwanda, Swaziland, Tanzania and Mozambique – have all adopted stand alone palliative care policies.
Although policy development does not immediately translate into oral morphine availability, a number of countries such as Kenya, Nigeria, Zambia, Namibia Ethiopia and a few others have improved access to oral morphine. Meanwhile Hospice Africa Uganda, in a partnership with the Ministry of Health of Uganda, continues to produce and distribute oral morphine whilst at the same time offering training courses to practitioners from all over Africa.
At the heart of these developments are passionate workers like Bernadette. Once again working late, Bernadette describes why she wants to work in palliative care, saying:
“Palliative care is the sort of care that you would hope you and everyone you care about receives. No one wants to think of a loved one suffering unnecessarily.”
Bernadette offers a simple motivation for her work in palliative care. This simple motivation, however, could benefit millions of Africans. Palliative care needs to be rolled out, and people like Bernadette might just be the way to make it happen.
I don’t think I shared the article on Hynd’s Blog at the time.
The title, “They come down from the hills and get us with dogs and guns“, might read to some as being as slightly over the top. The fact that I can promise it isn’t says a lot about life in Yanoun.
Anyway, have a read of the article and let me know what you think.
PS – you can also watch Emmet’s video about life in Yanoun.
I am on an elongated honeymoon with city in which I live, Kampala. A rational mind living in this city would see the congestion, the number of motorbike accidents, and the levels of petty theft, but the mind of a lover is anything but rational.
My mind sees green hills, standing pert overlooking the beating heart of the city centre. It sees the taxi buses that serve as the blood flow of the city, bringing life to each of its extremities. It sees the millions of people swarming through this landscape, each like an atom of the body, for a limited period, an inseparable part of this wider being – Kampala.
The irrationality of my mind was brought into focus a few days ago when I was walking back from work over one of Kampala’s hills. On this occasion the weather was close and heavy. It had been raining most of the day and it felt like there was more to come.
On this day, a thick mist was rising from the sodden ground and dancing in the air with the heavy low clouds. Walking through this was like entering a steam room as the thick air stuck to the inside of my lungs.
For most in Kampala, their thoughts in these few minutes were on finding shelter before once again the heavens opened. My mind though, was caught in that moment, enjoying it, literally breathing it in.
I stopped and stood, just for a few seconds, and watched the moisture lift from the ground and glide through the overhanging tree branches. Through the mist I caught glimpses of other houses and people making preparations for the inevitable downpour. But for those few seconds, it felt like I was alone in the city.
The air of Kampala was slipping into me, dissolving the distinction between the two of us, for a few seconds making us one.
Of course the sky then opened dropping heavy thunderous balls of rain. Every other resident was dry under shelter as I was striding through the streets with thick red mud clinging to my feet.
Somehow though, I didn’t mind, I still enjoyed it.
As with every honeymoon, I know this will all end. I know there will be a day where I will be walking the streets and feel my wallet slip from my pocket as the sun burns that bit harder onto the back of my neck and I will long for nothing more than the soft comforting embrace of the temperate valleys from which I am from.
But that day is not here yet and so, just like every other lover around the world, I will continue forwarded, blinkered by the beauty of all that sits around me appreciating it to its fullest.
The race to replace Cameron is well and truly on.
Cameron’s lack of popularity within his own party is well documented. The pertinent questions are now ‘who’ and ‘when’ – not ‘if’ he will be replaced.
So to start with the ‘who’ question. Ladbrokes offers us a reasonable overview (erring as always on low risk predictions):
Four names May, Hague, Boris and Hammond- only two credible though: Boris and May.
Let me explain why by starting with Boris.
Well, people respect Boris in a way they simply don’t the other serious contenders (May, Hague and Hammond). They also know who he is – recent polling by Lord Ashcroft showed 94% of people recognised Boris’ picture, and significantly 91% got his name right.
In contrast, Hammond was recognised by 23% of people and only 10% of people got his name right. Ouch.
I still maintain that Boris would be as much a disaster for his party as he would the country – but if the Tories want to run this experiment I am more than happy to pick up the popcorn and watch their implosion.
A straight Boris win then? Not quite. It boils down to the crucial ‘when’ question.
If Boris is to take over from Cameron before the next general election he needs to overcome three quite big challenges:
Tim Montgomerie (for whose opinion I have a certain amount of respect) insists this is all possible – I though, remain dubious.
If Boris is to become leader Cameron has to stay leader until after the next general election. This is in itself highly unlikely with everyone assuming Labour will win a (small) victory at the next elections.
So, if a leadership election is called before the next general election the Conservatives are left with three choices:
May is the only credible choice.
Predication A: If Cameron goes before the next election then May will take over and last only a few years as Conservative leader before she loses the next election and then the party slumps even further in the polls. This might then open the way up for Boris.
Prediction B: If Cameron hangs on in there, then Boris may well come through as the next leader and will last until just after the 2020 elections and leave behind him the chaos of a divided party, in-fighting and a catastrophic electoral defeat that makes the 2015 results look not too bad.
Either way – things are not looking good for the Conservatives. Their only hope? Labour continuing to flounder.
The people of Agoro in northern Uganda were some of the worst hit by the Ugandan civil war. As the village slowly recovers, Steve Hynd from the Mountain Club of Uganda visits Agoro to explore the surrounding mountains and what role tourism might have in the regions recovery.
The car pulls up next to two piles of red mud bricks. Behind are a handful of thatched mud huts that mark the edge of the village of Agoro. Ahead, beyond the mud bricks , is another collection of mud huts. The latter are UPDF army barracks. The pile of red mud bricks is the checkpoint into the barracks that cannot be passed until ‘clearance’ has been approved.
A smartly dressed soldier appears and waves the car through. The soldier introduces himself as Lieutenant Everest. Dressed in ironed khakis and polished leather boots Lt Everest stands tall with his chest puffed out. His appearance would have been archetypically military if it wasn’t for his curious grin and unashamed enthusiasm.
When the prospect of climbing the surrounding mountains is mentioned, the aptly named Lt Everest describes in some detail the security challenges. He talks about the landmines that line the border with South Sudan and claimed a UPDF soldier’s life in 2011 and countless other lives during the civil war. He also talks though about the ‘potential’ of armed conflict breaking out from over the border.
The village which is two hour’s drive north of Kitgum, the most northerly town in Uganda, has every reason to be on edge. Agoro has been devastated by 17 years of almost continuous civil and tribal conflicts. Many people have been killed or forced into fighting for rebel factions including Kony’s notorious Lord’s Resistance Army.
Human Rights Watch (HRW) have documented wide spread human rights violations including reports of cutting the lips and breasts off women who dared leave the internally displace people (IDP) camps. Agoro’s children were also hit particularly hard.
The Lord’s Resistance Army, notorious for its use of child soldiers, operated heavily in the area. One 12 year old child from Agoro told HRW how he was beaten until he agreed to kill a civilian. His experience is sadly not unique.
In light of this very recent history, Lt Everest’s opinion that armed guards were a necessity for any mountaineering expedition had to be taken seriously, despite the relative stability and peace of recent years.
Two soldiers, carrying nothing but dust covered AK-47s led the way through the fertile fields in plastic wellington boots with the local guide, Jeffery, following suit. As Jeffery walked he pointed with obvious pride the varied fruit and vegetables that flanked the small path that he was walking.
This pride stems from both the villages new 680 hectare irrigation system and, in contrast, the near starvation that many in the village faced just a few years previously. The International Rescue Committee described Agoro’s recent history saying:
“Most of Agoro’s residents had been driven from their homes into a makeshift camp that grew up around the local trading center. These displaced farmers, with little space or incentive to grow their own food, lived on relief rations provided by the United Nations.”
It is no surprise then when Jeffery takes pride in both being able to walk freely through the fields but also being able to reach up and pick some mangoes from near-by trees.
These agricultural fields sit in the bottom of a valley which is encircled by imposing mountain peaks, the highest of which on the Ugandan side of the border stands at over 2,800 meters.
As the agriculture gives way to uncultivated bamboo forest though, so the path soon disappears. The soldiers though march on insisting that they regularly walk these routes for ‘surveillance’. The pace of the walk drops only occasionally to drink some water or to stand for a nervous few seconds as everyone waits for a snake to slither off.
The higher up the ‘path’ goes, the less apparent the ‘path’ becomes. So, the last hour before summiting is spent scrambling through thick grass up improbably steep slopes. The soldiers who at the bottom seemed at best bemused about why anyone would want to go to the top of the mountain are now clearly enjoying themselves.
Standing on top of the peak the soldiers explain that we cannot go any further in case the South Sudanese soldiers see us. “It might cause problems” says the younger of the two soldiers as he pulls a cigarette out of his shirt pocket.
As he explains this though, he does not look up to the border of South Sudan but instead he looks out over the plains that stretch for miles out to the south. The plains are dotted by the volcanic mountains that hint at the potential for other walks in the area.
Just as the agriculture of the plains is booming in this formally ‘no go’ area of northern Uganda, the potential for tourism is also growing. The Ugandan Tourism Association has documented the so far mainly untapped tourism potential of northern Uganda. There is no reason to think that Agoro could not be at the heart of this tourism revival.
The village of Agoro has seen an unimaginably difficult couple of decades loosing men and women and children in a bloody conflict. This history requires visitors to be sensitive to such loss, but should not stop them from coming.
As we leave Agoro, we say good bye to Lt Everest and thank him for his help. We pull up at the pile of red bricks that mark the entrance to the army barracks and Lt Everest, now in civilian clothing, beams a smile at us and says, “Tell your friends to visit, they too can be our guests.”
Steve Hynd is a freelance journalist based in Kampala and is a member of the Mountain Club of Uganda.
This is an article that I wrote for the Africa edition of ehospice.
Mutagubya Bruno is the son of Lawrence Ssenyonde. Lawrence has cancer of the prostate and needs oral morphine to relieve his pain. Bruno recently talked to ehospice about what life is like caring for a family member in severe pain.
On the outskirts of Kampala, Mutagubya Bruno lives with his mother and father. A small alleyway leads to a neatly kept garden that is lined with palm trees and freshly hung clothes on a washing line. Bruno breaks the conversation he is having with his mother as a small delegation from Hospice Africa Uganda arrive through a side gate to their house.
In the living room, the three health care professionals sit in a line craning their necks to try and listen to Bruno’s father as he describes his pain. As Bruno’s father speaks, one of the nurses sorts through her case notes. She glances at the previous dosages of oral morphine Bruno’s father has received.
Throughout the conversation Bruno sits on the edge of a worn-out arm chair opposite his father looking on.
This article was written for Cotswold Outdoors Community Blog.
Mount Moroto stands at 3,082 meters above sea level in the Karamoja region in the north east of Uganda. Over the last few decades the region has witnessed war and conflict which has left its peaks predominantly unclimbed. Recently there has been a large-scale amnesty on guns and dip in the levels of violence. Steve Hynd from the Mountain Club of Uganda took this opportunity to see what the mountain has to offer.
The Foreign and Commonwealth Office (FCO) advise against all travel to Karamoja. They describe it is as:
“largely lawless. There are frequent road ambushes and tribal clashes. Small arms are widespread and there are regular deaths or injury from gunshot wounds”
As it turned out, guns were the least of our problems…
We were travelling in a convoy along a dirt road which locals had told us was impassable during the rainy season. It was Saturday 30th March – the rainy season was due to starts on the April 1st.
On the road, there were a couple of hairy moments; wheels spinning on steeply banked rivers edges, deep mud that resulted in everyone getting out and walking but it was, in a 4X4, passable.
Two and half hours and 45km after leaving Moroto town we arrived at the small mountain village of Tapach.
Tapach sits at the head of a valley tucked in underneath the imposing ridges that lead up to the peaks of Mt Moroto. The village boasts stunning views of the plains of Karamoja that stretch out away from mountain.
Living with some of the best views high on the side of the valley we found Friar Gerald – our only real contact in the village.
With a warm smile he greeted us while glancing at our mud covered cars before asking, “How was the road?” The only honest answer any of us could muster was, “passable”. He grinned a knowing grin and said, “It will be fine along as it doesn’t rain”.
As we waited for the ‘guides’ to come back from the fields where they worked, I asked the Friar a little bit about the valley and the region. We talked about the lasting legacy that the conflict had on the village.
On the drive in we had passed a number of UPDF army camps and I asked if they ever came to the village and the Friar responded saying,
“They keep themselves to themselves nowadays. I think that’s better for everyone”.
Clearly the memories of what happened in the region had not gone away. In 2007 Human Rights Watch described a government disarmament drive headed by the army in their report, “Get the Gun”. The report documented wide-spread use torture and a number of murders.
As the Friar said, perhaps it is best they keep themselves to themselves.
The guides soon arrived though and we started snaking our way up the hillside behind the monastery. The climb was tough going and this was extenuated by the 5 litres of water we were carrying as the guides were unsure as whether or not there was any water available on the mountain. The hot sun beat down on us as we huffed and puffed our way up the valley side.
The collecting storm clouds offered us only occasional shade.
Within an hour we were rewarded with panoramic views. In one direction there were the endless plains of Karamoja, on either side deep valleys with small hutted villages and in front of us the peaks of Mt Moroto.
By mid-afternoon we had climbed around 1,000 meters. High in the mountains the heavens opened in spectacular fashion. The intensity and consistency of the rain slowed our progress as we picked our way across rocky ridges and up steep muddy slopes.
About an hour before dark we stopped high on a ridge to pitch camp.
The guides collected wood and lit a fire, the rest of us erected our tents and prepared food. On the equator the sun sets in a blink of an eye. For a brief moment though the storm clouds were silhouetted in front of departing sun before darkness descended on us.
Trying to not think about the rain and the state of the road back to Moroto I closed my eyes and let sleep take me.
The next morning we awoke before light and set off in a slow drizzle for the summit leaving our tents pitched on the ridge. The short walk took us through thick forest that clung to the ridge top. We scrambled up steep scrub land making the final assent with anything but elegance. Just under two hours after leaving camp we stood on the summit of Mt Moroto.
Starring into the thick mist I wondered how many other had stood where I was now stood. The answer, of course, is ‘not many’.
We made our way down, packing the camp on the way, slipping and sliding in the now thick mud. We arrived back at to the village at about 4pm with a sense of achievement but also dread about what lay ahead on the now sodden road back to Moroto.
Phoning ahead we found out that friends who were driving a Toyota Rav4 had left the village at 11am and were, at 4pm, still not back to Moroto.
I’ll admit now that I was worried – would we get back to the Moroto before dark? Would we get back at all?
Driving back was in itself an adventure. On a couple of occasions water came over the bonnet of the car, and on countless occasions the ground clearance proved in to be insufficient. But, just over two hours later we arrived back to our rendez vous in Moroto – 10 minutes after those in the Rav4 who left at 11 that morning.
I tried really hard not to be smug.
The other car load that left Tapach after us didn’t arrive back until 11 that night, they told me the next day that they had to cut out the seatbelts to use as a towrope.
The whole weekend was a mini adventure. We were not sure what we would find when we left Kampala for this remote region. We had heard stories of guns, torture and of course incredible peaks. But what we found were warm welcoming locals who were slightly bemused as to why we wanted to climb Mt Moroto. The soldiers were courteous though and the locals delighted though that we were visiting.
Moroto district doesn’t yet have the infrastructure or the information to really capitalise on its mountaineering-tourism potential. But it does have mountains that are as beautiful as any in the national parks of Uganda.
With a good 4X4 and sense of adventure there is no reason why you cannot enjoy them as well.
If you fancy the trip – feel free to be in touch.
This is an article that I wrote for ‘ehospice‘ about my recent visit to a hospice in Kampala.
An incongruous collection of books sit on the shelves next to hand-made jewellery and other bits of bric-a-brac. I stand and flick through the books for a minute enjoying being out of the hot Kampala sun. As I rummage around looking for a bargain the shop assistant, Joy, begins to talk to me about her role at Hospice Africa Uganda.
Joy is one of a dedicated team of volunteers who make it possible for the hospice to carry on offering palliative care services to patients with Cancer and/or HIV/AIDS. Joy, a recently retired surgical nurse, is clearly someone who is driven by the need to help others. When I ask her why she gives up five days a week to help at the hospice she explains:
“The pursuit of happiness is enshrined into the US Constitution, the subject of countless books and is now even being measured by governments. Policy makers and development agents are now recognising that ‘progress’ should be about increasing human happiness and wellbeing, not just growing the economy at all costs. In light of this, the UN today marks its first ever ‘International Day of Happiness’.
To read the full article click here >>>