Tag Archives: Uganda

On international media representation of Uganda

The international media today picked up comments from Uganda’s President, Yoweri Museveni, saying that Uganda’s tourism industry should rival that of Spain’s.

His comments, made in Uganda’s ‘New Vision’ newspaper were then picked up by Agence France-Presse (AFP) and published in global news platforms such as The Guardian.

After reading The Guardian article I did something I very rarely do – I read the comments section.

The first comment came from one Herman Lategan and said:

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Other early commenters followed a similar theme in their comments:

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Whilst I find the hateful and widely misinterpreted rhetoric of anti-homosexuality in Uganda deeply worrying I equally find it sad to see a country lumped with such a characteristic as its one defining feature.

Equally, I am not convinced that by choosing to not visit Uganda (let alone leaving comments under Guardian articles) you are doing anything to help alter this hateful and misunderstood rhetoric that is a much larger than just Uganda.

What I do know though is that Uganda faces a huge image problem in ‘the west’ and these comments, at least in part, are a symptom of this.

This image problem is one exasperated by painfully fictitious portrayals in the media such as the one in Series 2 of the Newsroom that I have just finished watching (other than the lyrics of Band Aid 30 I struggle to think of anything recent that is so crass).

Or, closer to home, try searching Uganda on the Guardian’s home page. All you will find are articles about the anti-homosexuality bill, the hunt for war-lord Josef Kony or bizarre novelty pieces quoting some supposedly hilarious thing an official once said.

Whilst all legitimate issues to cover they are, by themselves, playing into a mainly false perception of what Uganda is like.

In short, it’s crass, it’s unhelpful and it represents a form of low level journalism that I dislike. And importantly it’s all people in the UK (my home country, the place I love most), hears about Uganda (my home, the place that is pushing for that top spot in my heart).  

I find that really fucking sad.

I was about to write something along those lines in the comments section when this well-intentioned comment, one which many in Uganda would see as a balanced response but many in the UK will read like trolling, popped up.

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I wasn’t sure I had the stomach to ever enter into the comments section of The Guardian let alone on a subject like this and so I headed back here to the safe shores of Hynd’s Blog.

Sane and respectful comments welcomed!

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Some reflections on learning to kayak on the River Nile

Paddling past 'The Bad Place' on the River Nile

Paddling past ‘The Bad Place’ on the River Nile

I have always loved the outdoors and growing up I occasionally ventured out onto the flat waters of the River Wye, close to my parent’s house in the UK, to do some paddling with my local scout group.

As much as enjoyed these ventures out into the pleasant surroundings of the Wye valley, kayaking remained for me a sport that failed to conjure the passion or excitement of other sports I loved in my teenage years such as mountaineering, football or skiing.

When I moved to Uganda then, it took me almost a whole year until I was persuaded by friends into trying my hand at white-water kayaking on the River Nile.

In retrospect my biggest regret is that I waited this long to try it. Equally though, it was far from love at first sight, or perhaps a more appropriate axiom, all plain sailing from the start.

Getting off the water at the end of the first lesson I knew that a seed had been planted that had the potential to grow into a real passion. I made a conscious choice, despite feeling apprehensive, to give this seed the best chance possible to grow and booked myself onto an additional four lessons with the kayak school ‘Kayak the Nile’.

At that stage, I can remember distinctly feeling that my enthusiasm for kayaking could go either way. As much as I enjoyed the adrenalin of kayaking my first rapid, I also remember a few hours earlier the less pleasurable spluttering for air as I first attempted an upside-down ‘t-rescue’.

Looking back on the last 10 months of padding, I can see though that it was as much the spluttering for air moments, the times I had to work hard, to persevere at practicing skills as it was the exciting splashing down rapids that have helped grow my initial excitement into a real passion.

The hours I spent alone in mate’s swimming pools practising, sometimes successfully and sometimes not, my flat-water role and the sense of achievement at now rolling in (quite) big white-water stands as just one illustration of this.

Unlike some friends that I see now out on the water I don’t feel like kayaking came naturally to me. It took me a bit longer than what I have observed to be ‘normal’ to start feeling relaxed out on the water and especially upside-down.

Even now, 10 months after starting this sport, I still feel panicked when I move into territories that are new to me. Just last weekend I went to surf a wave that was much larger than I was used to and this filled me with an apprehension that, at least in part, dictated how I kayaked on the wave.

It only seems fair at this point to give a virtual hat-tip to the instructors of ‘Kayak the Nile’ who seemed to instinctively know that when I said my goal was to ‘feel in control on the wave’ I was not just referring to the physical challenge of staying up-right but the psychological one of staying relaxed and confident.

Without the careful and consistent guidance of the instructors I am convinced that my seedling of passion planted on that first lesson could easily have been flushed away at any moment.

For as much as I am grateful to the instructors though it is an interesting reflection to note that learning to kayak is also a lot about learning to understand and control yourself. It is not just about taught new skills.

It might sound like an exaggeration to say kayaking teaches you to ‘learn about yourself’ but from a personal experience I can say that one of the most rewarding parts of learning to kayak has been the journey of learning to stay psychologically more in control (for I still don’t feel 100% in control) out on the water.

My passion for kayaking on the Nile though goes beyond all of this.

There is something really profoundly special about being about being on such a huge powerful expanse of water.

Out the Nile I feel something comparable to how I do in large mountain ranges. I feel a sense of my own size and vulnerability in the grand scheme of nature, I feel a sense of wonder at the amazing beauty that surrounds me and a sense of profound appreciation that I am lucky enough to have experienced it.

Even the experience of being near the Nile the night before feels magical. I love waking up after camping on the banks of Nile to see the strong sunlight breaking through the trees with the sort of intensity you only really get on the equator. I love lying in my tent hearing the powerful sound of the water in the rapids carving itself through the rocks in the Nile. I love the, admittedly quite hippy, idea that kayaking is about harnessing the amazing power of nature and working with it.

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Most of all though I think enjoy sharing this passion with people. I love seeing friends do their first lesson, first roll, or first trick on a wave. I love watching those with less experience than me and seeing them progress as much as I love watching those with far more experience than me and feeling that mixture of aspiration and dread about what I might, or might not, be able to achieve in the future.

When I move away from the paddler’s paradise of the River Nile I have no idea if this passion will stay with me but I do know that at this moment I really hope it does.

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Why I will be running for the African Palliative Care Association

APCA_logo final_NEW STRAPIt is important to state from the start, I don’t like running and nor am I any good at it. You would be right then to comment that it seems just a smidgen odd to decide to run 21 kilometres, out of my own free will, however good a cause it is for.

Well let me assure you that it is for an exceptionally good cause. I am fundraising for the African Palliative Care Association (APCA). APCA has been my employer now for the last 18 months. I am not too proud to say though that when I started working for them I knew little about palliative care – let alone palliative care in Africa.

I guess I was a little naive but I never expected the raw reality that I was met with on day one of my job. Literally millions of people suffering the most debilitating of pain because they don’t even have access to basic elements of palliative care such as access to pain medication.

I started to grasp the magnitude of what this actually meant when I went with staff from Hospice Africa Uganda on home visits. I met patients and their family who benefited from having access to oral morphine and who had grappled back a sense of normality in their life.

I remember meeting Bruno on the outskirts of Kampala. I remember how he had said to me that “You cannot be happy to see your dad suffering”. But most of all, I remember how deeply sincere he was when he thanked the hospice staff for coming, for caring and for bringing his monthly does or oral morphine.

This realisation though of how important palliative care services are only truly sunk in when I met someone who, like most Ugandans, did not have access to this service.

That person asked me not to publish her name and I can understand why. She spent 6 months nursing her mother who died of cancer as the rest of the family refused to let her seek medical help because of the financial implications. She watched her mother everyday lie in bed unable to move because of the pain she was in. With tears in her eyes she said to me one of the most powerful sentences that I have ever heard: “When I die, I don’t want to go like that.”

This is what APCA campaigns for. To ensure that no-one in Africa dies without access to palliative care.

Over the last 18 months of working for APCA I have almost every day had a realisation of some sort. Sometimes it is still about how dire the situation is in many parts of Africa. Other times it is about these faceless numbers impact on people lives. But increasingly these realisations come through meeting the varied and wonderful volunteers and staff who working to change all this.

Because of a small band of committed people there are now policies, projects and pain killers popping up all over Africa. The staff and volunteers I have met have at times humbled me but more often than not, they have inspired me.

In South Africa the national association is supporting the training of traditional healers in palliative care. In Uganda they have been training journalists and editors. In Zambia they are engaging the HIV AIDS community. All people who used to see themselves as separate to palliative care all now working to ensure everyone has access to these services.

When the palliative care community reaches out – others cannot help but to respond seeking out what they can do, how they can contribute to helping to end this perfectly preventable humanitarian disaster of untreated pain.

It is a natural response that I too felt.

But what can I, as a non-medical professional, contribute? And that’s when it struck me that even if I was already over stretched professionally, I could always do something that anyone of us could do…run a half marathon to raise money and awareness for APCA’s work.

And so, not only do I want you, if you can afford to, donate to APCA through my ‘Just Giving’ page. I would also love you to help me raise awareness of palliative care in Africa. Can you share this article on facebook, visit APCA’s website, or share this video?

Together I know we can do this – there are already hundreds of talented wonderful people out there doing the most amazing work. It might not be obvious how you can help but believe me, just by reading this article you have taken your first step.

There is a long-way to go and my half-marathon is really just the first few steps but together we can make a real difference.

You don’t have to believe me, just go and listen to patients both with and without access to palliative care and you will soon see the difference it can make.

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Video: ‘This is Uganda’

There are lots of reasons why I love living in Uganda. Equally, it never ceases to frustrate me the distorted and perpetually negative way Uganda is so often portrayed in my home country of the UK.

It is partly because of this I wanted to share this video I have stumbled across. Not because it encapsulates ‘Uganda’ like the title suggests but because it gives just the smallest of glimpses of some of the many wonders that Uganda holds.

If nothing else I hope that it will entice more people by to come and see for themselves everything this place has to offer.

This is Uganda – 2014 from Anne und Björn Fotografie on Vimeo.

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3 steps to improving Uganda’s education system

This is an edited cross-post from Anya Whiteside’s blog.  

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Education in Uganda is in crisis. This is not an exaggeration, it is a fact. Out of all the children who start school in Uganda, only 33% complete primary education. This is compared to 84% in Kenya, 78% in Tanzania and 81% in Rwanda. In addition, many of the children who do remain in school are not learning. In fact, less than half of children in P6 reach the defined proficiency levels in numeracy and literacy.

I could continue with the facts – 1 in 20 children of school going age have never enrolled in school at all, 84% of teachers want to leave their jobs and on average teachers are absent from the classroom an equivalent of 2 days a week – I could go on but you get the picture.

Uganda has the second youngest population in the world, with 49% if the population under the age of 15. This crisis in education is their crisis, and it is a crisis for Uganda. Given all of this, I have inevitably spent a lot of my time here trying to work out why education in Uganda is in such a crisis and what could be done to improve the situation.

There are many, many answers to this question. I could talk about the drop in education funding – the dilapidated classrooms and shortage of textbooks. I could talk about the plight of Uganda’s teachers – badly paid, de-motivated, poorly supported and badly trained. I could talk about the failure of Universal Primary Education – free education in name only as children have to pay for textbooks and uniforms and parents have disengaged from a process they have been told is now the state’s responsibility. I could talk about corruption, inefficiency and the politicization of education funding. I could talk about all these things and more and they would be true. They all contribute to the problem.

Yet the thing that is continually baffling the Ministry of Education, NGOs and big donors in Uganda is what to do about it. Because time after time after time ‘interventions’ , ‘solutions’ and ‘projects’ have been designed to improve education here, but things do not seem to be getting significantly better – in fact if anything they are getting worse. Books have been provided, teachers have been trained, all manner of stakeholders have been ‘sensitised’ over and over again. Vast amounts of money have been thrown at improving education in Uganda, yet the system keeps spiralling out of control with a will of its own.

Despite all this, I cannot feel completely hopeless about it. You can never feel completely hopeless in Uganda – the vivacity, friendliness and strength of the Ugandan people forbids it. But I do feel that Ugandan children – from my grinning, squirming neighbours’ kids to the children exploding with excitement at the Mzungu passing by their village – deserve better. This is why I continue to battle to try and understand what ways forward there can be in this bubbling bureaucratic melting pot that is education in Uganda.

One necessary step is to look beyond the dilapidated classrooms, lack of books and fed up teachers to try to unpick some of the systematic and underlying causes of Uganda’s broken system. There needs to be a public debate in Uganda as to what these are and some hard choices may need to be made on prioritisation of funding – both how much should be allocated to education, and which parts of the education sector the money should go to.

One underlying issue that hits me in the face wherever I look is the lack of accountability and incentive from top to bottom in the education system. In the government education system here there seems to be little benefit in doing your job well and little consequence to doing it badly.

Teachers face an incredibly difficult job in Uganda and teaching has become the last option that people choose when they can’t get a job anywhere else. Add to that the fact that neither promotion or pay are linked to performance and very few teachers are held to account for what they do, and it is easier to understand why so many education interventions are failing. In this context providing new books, building beautiful spangly classrooms or telling communities they ‘really should send their children to school’ will have a limited impact. After all it is not ideal to teach children under a tree, but it is possible if you have a teacher who really wants to teach, and a system that supports that teacher to do so.

Instead I would argue that money could be best spent improving some of the broken systems at the heart of the education crisis in Uganda. There are three I suggest should be particularly prioritised:

  • Creating a functioning scheme of service that links teacher (and all education officials’) promotion to performance.
  • Overhauling the entire teacher payroll system so that teachers are paid on time and so-called ‘ghost teachers’ (those teachers who don’t exist but are on the payroll, meaning the money being paid to them is going somewhere else) are removed.
  • Investing in inspection and ensuring that the follow up is rigorous – no head teacher should be allowed to rape children because he is mates with the right people. This also means working on how to ensure the Directorate of Education Standards at central level and school inspectors at the District level can work together to ensure proper follow up and accountability.

These are not the only issues that need to be addressed in the education sector in Uganda, but from my time here I feel they are some of the central ones. Mending Uganda’s education systems will not be easy, but it is the only way that education in Uganda will be improved. Without political will and funding to do so, we will continue to see sticking plasters trying to mend a gaping wound.

More information:

(Steve adds) If you are interested in education in Uganda you might also be interested to read:

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2014 Banff Mountain Film Festival comes to Kampala

The Banff Mountain Film Festival World Tour is being held in Kampala Uganda at the National Theater on the evenings of the 2nd and 9th September 2014. The tour consists of an incredible collection of short adventure films from across the world.

You can buy your tickets from the theater box office.

Not convinced yet?

Check out this preview:

See you there!

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Breaking: Uganda’s anti-homosexuality law null and void after Constitutional Court ruling

Breaking news: Uganda’s Constitutional Court has decided that the anti-homosexuality law is ‘null and void’.

The Constitutional Court found that the speaker of parliament acted illegally by moving ahead with a vote on the law despite at least three lawmakers objecting to a lack of quorum.

Despite this ruling, homosexuality remains illegal in Uganda as it does it most other African countries. Section 145 of Uganda’s Penal Code, which remains in force, continues to criminalize “carnal knowledge of any person against the order of nature”. The harsher penalties that were introduced under the 2014 legislation though such as life-imprisonment for ‘repeat offences’ no longer apply.

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Is Panadol made from dead people’s brains?

The answer is of course, no. Panadol is not made from dead people’s brains.

In case there was any doubt though the New Vision, Uganda’s largest national newspaper, helped clear this up for us today. This is from page 24:

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Wonderfully obscure!

A hat tip to my friend Malcolm who spotted this. 

 

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A visit to Mulago Hospital in Kampala, Uganda

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As we enter the long corridor a strip light overhead flickers for a final few seconds before finally joining some of the other lights in the corridor that have long since given up and now do little more than collect dust. The few remaining lights throw strange long shadows down the corridor next to the wheeled beds that rest head to toe along the side of the corridor. It reminds me of the Kampala traffic jam that stacks up outside the hospital in the choking city heat.

No natural light makes it into the corridor but somehow the faint smell of congested traffic makes it up onto the third floor of Mulago Hospital to intermingle with the smell of humans and disinfectant. Avoiding the few harsh strip lights that still work, patients lie either in the shadow of their own headboards or with their thin sheets pulled over their heads.

As I walk down the corridor I step carefully over the relatives, water bottles, half eaten meals and other day to day items that are dotted across the floor. The patients rely on relatives for not just company but also for a lot of the day to day care they need. The smell as you pass some patients makes it abundantly clear that some patients are not receiving the care they need.

I glance sideways making small talk with my eyes to some of the patients whilst trying to keep moving on and keeping up with the representative of Hospice Africa Uganda who I am shadowing. Dressed in the dark blue shirt with a golden collar that marks her out as a member of the palliative care team my host takes large confident strides that exposes her familiarity with the surroundings.  She doesn’t look down as she steps over brothers, books and broken bits and pieces. Instead she angles her thick note book that she is carrying towards the strip light above and looks over notes of the patients she is there to visit.

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We push through some thick wooden swing doors on our left into a room that has one of the young patient we are there to visit as well half a dozen others. The patient we are visiting has terminal cancer and relies on the visits of the Hospice Africa team to bring oral morphine to help her with the considerable pain she would otherwise be in. My host from Hospice Africa Uganda goes straight to her bedside and lowers herself and her voice as she makes confident but kind eye contact with the patient. Speaking in the local language, Luganda, my host subconsciously runs her fingers over the shoulder of the patient as she speaks.

I am told that they ask how bad the patient’s pain is and decide that the current level of morphine is suitable. The sister of the patient, herself barely out of her teenage years, looks on with the juxtaposition of her own youth intermingled with the inevitable death that rests so close to her own, and her family’s, life. Looking as though she is unsure of her role in the nurse/patient dynamic that plays out in front of her the sister reconciles her position by just being physically close to her sister. Both protective and supportive she leans on the bed side throughout the consultation.

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Selfishly my thoughts drift as the Luganda speech drifts around me. I start to think about how if I was diagnosed with terminal cancer I would want to be free, bathed in natural light and surrounded by fresh air not stuck in a overcrowded hospital. Almost immediately I catch myself and realise how ridiculous this thought is – all across Uganda there are patients who are dying of cancer in natural sunlight, surrounded by fresh air with their families who are also in insufferable pain because they have no access to the medical support they need. The pain medication, oral morphine, which the hospice team was there to deliver is little more than an aspiration to most cancer patients in Uganda – let alone early diagnosis and treatment.

Just before we leave, a colleague from the US organisation ‘Treat the Pain’ asks if the patient would like a Polaroid picture with her sister. For the first time a flicker of excitement crosses the patient’s face and she shuffles a symbolic couple of centimetres up the bed for the photo. Together the two sisters sit with their heads pressed together watching as their own images slowly appears in the Polaroid picture.

As we stand to leave we collect up our belongings leaving nothing but the sister, the patient and the Polaroid picture behind.

Speaking later when we are far away from the cluttered dark corridors of Mulago I talk to my colleague from Treat the Pain and we both reflect on how the photo felt like a symbol of how little we could offer as non-medical staff in such situations. The stories we write, the advocacy we engage in, and people we interact with will hopefully change the lives of many more patients to come, but for that one girl and her sister we could offer nothing more than a Polaroid picture – it felt useless.

I know in both my heart and mind that it is important to record stories, to take down testimonies, to photograph suffering. I know it, but sometimes it is hard to feel it in the intensity of the personal suffering you have barged in on, especially when you can offer so little in return.

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Click to enlarge the photos.

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One novel way to avoid paying a bribe to traffic police in Uganda

I got that all too familiar feeling in the bottom of the stomach that I get when faced with confrontation with authority. A traffic policeman waved me into the side of the road with a stern, if slightly comic, reproachable look on his face. Walking calmly up to the car I can remember hearing the heavy clump of his standard issue boots on the hot cracking concrete as he approached my car window.

Sat looking forward through my dusty windscreen I prepared mentally for the relentless burst of enthusiasm that had served so well before in dealing with traffic policeman. I had of course not done anything wrong but I knew from experience this was not enough to avoid trouble.

I knew the drill. The best way to escape either an arbitrary fine (an offense in Uganda is ‘the inconsiderate use of the motor vechicle’) or in many ways worse, being forced into paying a bribe, was to speak in a friendly, informed and most importantly, relentless way.

From previous experience I knew the subject matter wasn’t important, and so I rehearsed in my head…The weather, wonderful. The place I am going, I heard it is magical. The place I have come from, even better. My friends first experience of Uganda, perfect!

The policeman leaned on the passenger’s window:

Traffic policeman: ‘How are you today?’

Just as I was about to launch into my boundless tirade of optimism my fiancé started speaking:

My fiancé: ‘Ahh, I am well ssebo (sir), how are you? Today is the perfect day for being in Uganda I think. You know ssebo, I love you Uganda so much. I love it so much that I have learnt the national anthem. Do you want to hear me sing it?’

She then breaks out into the national anthem. I sit and watch. I try not to smirk at the ludicrousness of the situation. Most of all though, I try to read the policeman’s face. Looking on I am caught in a mixture of apprehension to what the policeman’s reaction would be and, utter awe for my fiancé’s formidable friendliness.

Questions started to swim to the tune of national anthem in my head…Is this pushing it too far, to literally and totally inexplicably start singing the national anthem?

Of course not.

Within a few lines the policeman starts to join in. The contort reproachable burrows that were resting on his forehead relax and before long he is positively beaming as the two of them are singing in unison.

With a big smile on his face, the traffic policeman waved us off wishing us a good day in English to which we subconsciously respond in unison with the Luganda, ‘bera bulungi’ (good day!).

At this point I glance in my rear view mirror I can see the policeman taking the concept of jollity to a whole new level.

I can’t guarantee this approach works with all law enforcement officers, but on this occasion on this particular stretch of road in Uganda, it worked a treat!

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If I can vote from Uganda then you can walk to your local polling station

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It’s a simple message, if I can vote from Uganda then you can walk down to your local polling station!

Go on, off you go! Vote.

UPDATE:

Thanks to Andrew Sparrow at The Guardian for posting this photo in their live blog.

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An atheist’s reflection on a prayer meeting

As a de-facto atheist people often assume that I might be troubled by being asked to attend or even take part in religious events. This is rarely the case and indeed I often find the opposite to be true. 

Today I attended a joint prayer meeting for palliative care practitioners from across Uganda who wanted to pray for the palliative care resolution that is currently going through the World Health Assembly. At the meeting I was asked as a representative of my work to read out a short prayer asking God to offer the decision makers wisdom and compassion.

Not only did I not mind this but in fact I found the whole event a real pleasure to attend. Let me explain why.

To start there was a wonderful feeling of unity at the meeting. This sense of ‘unity’ is what I chose to highlight when I wrote it up for ehospice news. It was also what I tried to capture in some of my photographs.

*Click to enlarge*

It was wonderful to watch how different organisations came together in a moment to share a common aim – the furthering of palliative care. It also got me thinking about the potential that faith has to break down hierarchy.

Uganda is incredibly hierarchical as a culture but in this short meeting the focus on the presumed ultimate leader (‘god’) broke down the created hierarchy.

It was both interesting and inspiring to watch.

So even being a hardened (and let’s be honest, argumentative) ‘de facto atheist’ I have to admit to finding this event not only a pleasure to attend but also pragmatically useful.

It brought people together in a powerful and profound way.

In my work, often with NGOs, I often stumble across stupid and badly thought out ideas. Some of them stem from a religious perspective but many don’t.

For as long as a religious meeting or belief system passes J.S Mill’s principle of harm test I cannot see any reason not to let people get on with it. And, in cases like today’s meeting, I cannot see any reason not to positively celebrate it.

Today’s prayer meeting not only passed J.S Mill’s ‘harm principle’ test with considerable ease, but it also I felt contributed something quite profound to the common good – a chance for colleagues and strangers to come together on an equal footing and to focus on what they have in common opposed to their differences.

 

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Watch the first of the Al Jazeera series on access to medical morphine

aljazeera011613I occasionally link here bits of my work with the African Palliative Care Association that I think could be interesting to a wider audience.

Here is a short Al Jazeera report on access to morphine in Uganda that I helped coordinate. It serves as a nice introduction to the subject that leaves millions suffering from perfectly preventable pain.

The film was shown on repeat last week. On Thursday they had our Executive Director, Dr Emmanuel Luyirika, on to speak about the subject. You can watch the interview here:

In Uganda, a regional leader in terms of medical morphine availability, only one in ten people who need medical morphine have access to it!

For more information:

Help out:

At the moment millions of Africans suffer terrible pain because they don’t have access to really basic pain medication that many people in Europe take for granted. If you feel like I do that no-one should be left to die in pain then please consider:

 

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I have malaria, but so did over 2 million others last year alone!

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Yesterday I found out that I have malaria. For those of you who haven’t had malaria before I can promise it is no fun. The symptoms come in waves but yesterday I took myself off for a blood test because I had a driving headache, aching bones and muscles, felt like I needed to vomit and was having hot and cold flushes all morning.

As I say, it is no fun.

Here in Uganda though malaria is an alarmingly common occurrence.  90% of the country is considered by the WHO to have ‘high transmission’ rates. This is partly explained because it is a tropical country with lots of Anopheles mosquitoes (who pass on the parasite when they bite you).

But there are also sociological factors. Anopheles mosquitoes predominantly bite humans at night. If you sleep under a mosquito net this massively reduces your chances of getting malaria. There is a big NGO drive in Uganda to distribute nets (and research suggests that most people who get them use them) but millions in Uganda still sleep without the nets.  Only a few stupid westerns actually chose to sleep, without a net, under the stars on top of a rock after a day’s rock climbing!

But this issue is not limited to Uganda, over half the world’s population live in areas at risk of malaria.

In 2012 the WHO recorded 207 million cases of malaria worldwide. Out of these 207 million, 627,000 died. Although the disease affects large parts of the world, the deaths caused by malaria are an overwhelmingly African issue. 90% of malaria deaths in 2012 occurred in Africa.  African children are especially at risk – 460,000 African children died before their fifth birthdays.

But this is the real travesty of the situation – malaria, with early diagnosis, is completely treatable.  With early diagnosis and a simple course of medication malaria is treatable and leaves the patient (normally) with no long-term effects.

Because I went to the hospital quickly and started my medication within a few days of showing symptoms, in all likelihood I should be back to my old self in the next 2 to 3 days. So for the friends and family reading this, I’m fine, you’ve got nothing to worry about!

And there is some more good news, since 2000, the WHO has recorded a drop in malaria fatalities in Africa by 49% – this is largely through greater prevention methods (such as net distribution).

Malaria is one of the big killers. In the 21st century it doesn’t have to be like that.

For more information:

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10 incredible pictures from the white-water kayaking Nile River Festival

1 by Alexey Dudkov
I wrote a short report for The Great Outdoors (TGO) magazine of the Nile River Festival 2014

Click here to read the article and to see the 10 incredible photos.

 

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An inspiring start to the week

Totally humbled. That’s how I felt this Monday morning. Reading, editing and publishing the story of Moses Byomuhangi after a weekend of partying and rock climbing has inspired me to be back in the office working for a palliative care organisation.  

After a weekend of having a lot of fun I made my way back into the office of the African Palliative Care Association where I work. I was feeling a bit ‘Monday morning’ when I started to work on an article submitted by a recent graduate, Moses Byomuhangi.

I would really encourage you to read Moses’ story.

Reading his account was a really inspiring start to my week. It left me feeling not only humbled but also inspired to keep working for the roll out of palliative care. It reminded me just why it is so important to communicate palliative care to a wider audience: because no one should have to experience what Moses’ parents did and no 15 year old should have to watch their parents die in pain.

There was so much of Moses story that took my breath away. I cannot even begin to imagine how hard it would have been for Moses, at the age of just 15, to watch his parents die in pain.

At the age of 15 I was playing football and drinking cans of beer in the local park with mates. To this day I have not experienced such a level of responsibility that Moses experienced at the age of 15. I am not sure how I would cope with being the primary care giver if my parents fell ill. If I had that responsibility at 15, I am not sure if I would have coped at all.

This is, at least in part, because growing up in the UK I was sheltered from suffering. If someone was dying or in extreme pain I would (we would?) take it for granted that they would be prescribed strong pain killers. They would almost certainly go to hospital for medical attention.

As a result, the prospect of watching (let alone caring for) a loved one in their dying moments suffer excruciating pain simply does not occur. In the age old British adage, ‘it doesn’t bear thinking about’.

It is worth reflecting though quite how unusual this is though. It is thought that about 90% of those who are in need of palliative care around the world do not receive it. In fact Australia, Canada, New Zealand, US and parts of Europe account for over 90% of the global consumption of opioid analgesics (strong pain medications).

In short, Moses’ parent’s reality of dying in pain is the crushing, devastating and completely avoidable reality for the majority. My British experience of being sheltered from such suffering leaves me in the absolute global minority.

But it is not the suffering that Moses has experienced that left me feeling so humbled and inspired. It was the fact that he used this suffering as catalyst to work so incredibly hard to work towards such an admirable goal – the relieving of suffering of others.

I hope that I can take on just a little bit of Moses’s passion, dedication and spirit in my work.

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How the anti-gay bill was reported in Uganda

Ugandan media has made headlines around the world in the 24 hours after Museveni signed the anti-gay bill. Here are a selection of newspaper headlines from Uganda*.

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The Red Pepper
made the most headlines after it once again named suspected homosexuals.

The Daily Monitor – the biggest independent paper – ran with the conciliatory headline, ‘Joy, anger as Museveni signs law against gays’. It also quote Museveni directly in it’s follow up article, ‘Museveni: Homosexuals have lost argument in Uganda’.

The New Vision ­– Ran with the complete text of Museveni’s speech under the headline, ‘President Museveni’s speech at Anti-gay Bill signing’.

The Observer – who have previously reported n LGBT rights issues – reported the signing of the bill saying that, ‘Museveni happy to ‘collide with the West’ over homosexuality’.

*This is not intended as a complete list. If there are any articles you think I should have added then please do leave them in the comments section below.

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The smokescreen of science. Homosexuality in Uganda.

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President Museveni of Uganda has agreed to sign the now notorious ‘Anti-Homosexuality Bill’ which could impose a lifetime jail sentence on anyone who commits homosexual acts.

What is curious about this latest crackdown though is the justification that the President has adopted to justify the signing of the bill.

A State House statement released last Sunday quoted Museveni as saying that ‘there is no scientific proof yet that people are homosexuals by genetics’

It goes onto to quote Museveni further saying that ‘It is on the strength of that I am going to sign the bill. I know we are going to have a big battle with the outside groups about this, but I will tell them what our scientists have to say.’

For a lack of a better word, curious…

The scientific committee, which included respected health professionals and scientists, set up to advise the President on this, concluded with 6 points:

The following are summaries of their observations;

  1. There is no definitive gene responsible for homosexuality.
  2. Homosexuality is not a disease but merely an abnormal behavior which may be learned through experiences in life.
  3. In every society, there is a small number of people with homosexuality tendencies.
  4. Homosexuality can be influenced by environmental factors e.g. culture, religion and peer pressure among others.
  5. The practice needs regulation like any other human behavior especially to protect the vulnerable.
  6. There is need for further studies to address sexuality in the African context.

The Executive Director of the Uganda Media Centre and Spokesperson for the Government of Uganda, Ofwono Opondo, summarised the report findings saying:

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These conclusions represent some spurious claims intermixed with a sprinkling of loose language and half-truths that allow for differing interpretations to emerge from this ‘science’.

Take point one for example, ‘There is no definitive gene responsible for homosexuality’. A negative statement that may well be true. But in this context it has been used by the government to justify the positive opposite ‘that homosexuality is a chosen lifestyle choice’ – a statement which flies in the face of the majority of available scientific studies on the matter.

The BBC for example yesterday published an article looking at how a genetic tendency to homosexuality sits with Darwinian concepts of evolution. In this article it starts by asserting that the idea homosexuality has biological origins has become the ‘scientific orthodoxy’. The article goes onto say that whilst there is no ‘definitive gene’ that determines sexuality, it is thought that there are alleles – or groups of genes – that sometimes codes for homosexual orientation.

The same BBC article quotes Qazi Rahman who offers a reasonable summary saying, ‘it’s the media that oversimplifies genetic theories of sexuality, with their reports of the discovery of “the gay gene”. Genetically speaking, Rahman believes that sexuality involves tens or perhaps hundreds of alleles that will probably take decades to uncover.’

Although the exact nature of the biological determinants of sexuality remain unknown, it is widely accepted that sexual orientation is determined, at least in part, by your pre-existing biology. Something that the report fails to mention.

The same pattern can be drawn from the other five conclusions. Loose language and scientific half-truths being interpreted for ideological and political purposes. Point 2 for example – if you take the word abnormal without moral judgement (scientifically) to literally mean, differing from the norm, then of course homosexuality can be considered abnormal (in the same way fishing could be considered an ‘abnormal activity’). But, in the context of this debate it is understood, and intentionally conflated with, other ‘abnormal’ practices that hold near universal condemnation such as rape and paedophilia ensuring that it is interpreted with a pre-existing moral framework (very unscientific).

Indeed, it should be noted that whilst Museveni’s interest in the science behind homosexuality is quite new, his eagerness to condemn and discriminate against homosexuals though is far from it. To give just one example, it was clear he needed no science to back up his popular, if insulting and simply wrong, statement that ‘women become lesbians because of “sexual starvation” when they failed to marry’.

In short, though the science behind sexuality in Uganda is simply being used as a smokescreen here to further a populist political and ideological agenda.

Indeed, it seems hard to disagree with Edwin Sesange’s summary: ‘The strange thing about the scientists’ report from Uganda’s Ministry of Health about the origin of homosexuality, is that much of it was right. But what was left out, the way the words were twisted, the flaws in the scientists’ conclusions, make it false…In fact, the report…is little more than science providing political cover for Museveni. It allows him to sign the bill, gain political popularity at home, dismiss criticism from the international community and blame it all on the scientists if his decision is wrong’.

Of course, there is one way for this scientific report to hold credibility. Publish it!

If it were to be published in a scientific journal and face a peer-review process then it might hold some weight. Until that happens we can assume that the science remains a smokescreen for a wider political and ideological move against the LGBT community in Uganda.

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Dan Smith on Britain and languages: “The world is laughing at us”

Blogger and good friend Dan Smith recently wrote a reply piece to my article “Britain: Is it time to consider living, studying or working abroad?”. Here is an edited version of his blog. To read the full article click here.

For a start, I implore you, the British public, to get out of our wonderful rainy little island and explore the rest of the world.

So in this respect I couldn’t agree more. I deeply regret not taking the opportunity to study abroad whether on a free Erasmus scheme as part of my degree or by taking a full degree over the puddle. Europe has excellent Universities and you can learn a second language while you’re at it.

You could even take up the opportunity to do an apprenticeship in another country like the two thousand or so young Brits apprenticing in Germany with Siemens and earn while you learn.

But to counter this, if you’re studying an employable post graduate degree in the UK there are plenty of funding opportunities. The Panasonic Trust with the Royal Academy of Engineering, for instance, provide opportunity for £8,000 of funding for sustainable engineering MSc courses.

If you put engineering/science, environment and sustainability in a funding application then people fall over themselves to hand you cash.

Then there’s working in Europe. This is where it becomes trickier. I’ve done it and know plenty of other linguistically challenged people working in certain hubs of Europe. I was in Geneva where there are many businesses and international NGOs all working in English. The same can be said for Brussels and I’ve been assured that many of the large international corporation’s lingua franca is English too.

But that’s where it ends.

The simple fact is that if you want to live and work in a European country you will eventually need to speak a different European language. And we’re terrible at it! I’ve been relentlessly ridiculed by my European friends about this, most of whom could speak 3 languages but often multiple. These aren’t linguists or teachers, they’re everyday run of the mill people, like me and you. And it’s a similar story on every other continent in the world.

Britain, we suck at speaking other languages!

So if I, Steve, you, or any other British person truly wants to go work in Europe I’d suggest we take a long hard look at our linguistic capabilities first.

Steve also suggested we go work in Germany because they’ve got terrific employment rates. They’ve also got a terrific education system and primarily operate in German – but they are nice about speaking English. It’s certainly not impossible, I have good friends doing just that, but it’s not as easy as he portrays.

Or how about we all emigrate to the colonies for the good life of cheap beer and endless sunshine?

Well, first of all, Britain tried this a while back and it didn’t really go according to plan. Secondly, just like Germany, to work (or indeed get a work visa) in many of these countries you need a productive skill set. Fortunately for me Engineering is on the list for most visa fast track systems.

Uganda, like many African countries, has a skills shortage and a huge unemployment problem. Unlike Germany it has an education system that is not meeting the needs of the populace.

Furthermore the economy, although growing, isn’t big enough to provide jobs for all of the young people that do have skills and education. So unless you, dear British comrade, have useful skills to offer or can produce employment opportunities for the thousands of unemployed Ugandans, the government doesn’t really want you.

And so it shouldn’t.

Just because you’ve got a sociology degree from the University of Hull and a burning desire to help poor Africans (or perhaps just to live the good life in a sunny country) this doesn’t mean you should come to do a job that you wouldn’t be qualified for in the UK.

Britain does produce many highly qualified and useful people. I passionately believe that we could be leading the way in socially beneficial business, engineering and research. As a country we really do have the experience to do that and as a global population we need more people doing it.

But if you want to export your skills to another country, whether in the EU or the rest of the world, you need just that – skills.

Apart from that we all need to learn some languages.

Britain, the world is laughing at us.

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What is palliative care? Views from around the world

ehospice has today launched a series of articles looking at different understandings of palliative care from around the world. Each edition (there are currently 10 around the world) has produced an account of one person’s understanding of what palliative care is, and why it’s important to them. These articles include accounts from patients, carers and health care professionals. 

On the Africa edition of ehospice I wrote this account after speaking to my colleague, Mackuline Atieno – a Kenyan palliative care nurse. 

Palliative care is…accepting that “death is a part of life”

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Mackuline Atieno, a palliative care nurse based in Kampala, sits patiently, thinking carefully before answering:

“When you find life, you also find death because death is a part of life.”

The question she had been asked was simply, what does palliative care mean to you? When asked to elaborate Mackuline once again exhibits a thoughtful nature and an articulate manner.

“Palliative care means that you have to live life well no matter what circumstances you find yourself in. If you have a life-limiting illness, you have to find the best way to live with that because you only have one life. And when death comes, all we can do is deal with it the best we can.”

Mackuline Atieno is a Kenyan palliative care nurse who is currently studying for a Masters in Medical Anthropology, working for the African Palliative Care Association (APCA) whilst also still finding time to be a full-time mother.

Mackuline grew up a long way from Kampala in Iten, a small Kenyan town high in the hills. 

When Mackuline was growing up the village was “quite rural” with few health care facilities. Mackuline explains, “We had just one district hospital that provided basic care. When I was growing up I had not come into interaction with palliative care.”

From an early age Mackuline experienced death but at the same time, as with many cultures, she was also encouraged not engage with the subject.

“I stayed with a relative who had HIV/AIDS but I know that [residents of Iten including the Keiyo and Nandi Tribes] have a real fear of the dead. It is a real challenge about how to deal with death, how to talk about it. There is a story [in Iten] that says when people were close to death they would take them to the forest with a long rope and pull on the rope. If the person did not pull back they knew they were dead.”

As a young professional Mackuline left Item to study nursing at the University of Moi in the neighbouring town of Eldoret. Here Mackuline had her first experiences of interacting with death in a professional setting.

“I was in a Labour ward where the mother died on the table. I remember coming out of the Labour ward and the relative was looking at me intently and I just shook my head. Looking back, this is such a bad way to send a message. I was not able to do justice to this patient because of my fear of how to handle such a situation.”

Since training and working in palliative care, Mackuline has become much more used to talking about, and supporting others, in issues around death and how to deal with difficult situations. Looking back on these early experiences Mackuline commented that, “You do not even need to speak sometimes, palliative care is in the attitude with which you approach someone. That can be good enough. If nothing else, I can be with a patient.”

It was also however during these early nursing years that Mackuline started to develop specialist interests that she would take with her into her palliative care career.

“It was in this time that I became interested in paediatrics. I really felt like I needed to give myself to help children, especially children’s palliative care because that is something few people are comfortable with talking about.”

This interest has continued throughout her career. Just last week Mackuline was featured on Ugandan national television talking about the new UNICEF/ICPCN report on child access to palliative care in sub-Saharan Africa.

Mackuline now works for APCA where she is responsible for supporting Kenya, Gambia, Rwanda and Zambia in implementing and integrating palliative care programs. However, Mackuline continues to work with a passion for learning. Now studying for a Masters in Medical Anthropology, Mackuline insists that only by understanding individuals within their cultural heritage can you truly hope to offer effective palliative care.

Part of this Mackuline says is, “to breakdown the paternalistic nurse/patient relationship and start to learn from the patient. Once you understand and are interested in where they have come from you can start to do better palliative care.”

When asked what palliative care has taught her Mackuline once again looks back to her early days as a nurse before responding:

“From my first experiences I felt helpless, as soon as I did my first placement in Hospice Africa Uganda though I stopped feeling so helpless. In palliative care you can support someone who is dying. You see a situation where there is no stigma, where people who are dying are smiling. Palliative care has also taught me never to give up.”

As well as supporting her patients Mackuline has adopted a ‘palliative care ethos’ in her own life. Just before rushing back to work Mackuline commented: “There is always someone who is in a worse situation than you who is enjoying their life. I think I have to live my life well. When death comes, we just make the transition as comfortable as possible. Until then we can just live in the reality we have been given.”

*You can read more personal stories from around the world on ehospice:

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