Current Issues with Uganda (IMHO)

Today’s your lucky day, as I’m bringing the James Rodriguez double-whammy of blog posts. This post will consist of an update on what I’ve been doing at TASO, the struggle with HIV in Uganda, and my personal thoughts about the matter. This is a rather long post, so get some popcorn or coffee or something to keep you engaged.

This past week, I’ve worked in a variety of clinics, done some lab work, and ventured out into the “field.” Two Fridays past, I was placed in the TB clinic. TB is common amongst HIV patients because active TB leads to decreased CD4 cell counts and increased viral load of HIV. Thus it is common for HIV patients to contract TB, as the diseases go hand in hand. The clinic is hosted outside, to avoid housing the highly contagious disease indoors. Patients with TB are given masks when talking with clinicians (who also wear masks). The typical conversation between patient and clinician consists of symptoms experienced and duration of them, HIV status, and administering drugs to the patient. A patient infected with TB is put on medication for 2 months, and is then required to come in for a follow-up visit. If the patient is still sick, they are given a stronger antibiotic and the process repeats itself. Being able to shadow the clinician taught me that most clients are unaware of how to take care of themselves and really depend on TASO to supply them with care. The only downside to this clinic (and most others) is that most of the clients know Luganda or other local languages (English is the official language of Uganda, with Luganda being commonly spoken; there are 63 tribes in Uganda, each with their own language, ultimately translating to me not understanding anyone). I usually have to ask for a translation after each client.

This past Tuesday, I was fortunate to work at the Prevention of Mother To Child Transmission (PMTCT) clinic. Probably the most interesting fact I learned was that if an HIV positive mother takes ARV’s before delivering her child, the baby will be born HIV negative. After the birth, the child is frequently tested during breastfeeding, in which the mother still takes ARVs; but if the child can make it past the point of breastfeeding, roughly 6 months to a year after birth, the mother-to-child transmission will be eliminated. These checkups are a surefire way of preventing HIV transmission. The only problem is that not all mothers take ARVs or come into TASO or a hospital for a birth. The clinician I was with informed me that this is not due entirely to laziness, but simply access to hospitals or monetary issues. Some mothers live too far away from hospitals to come in for delivery or they don’t have access to transportation, so they just give birth in their homes. It is crucial that after birth, mothers continue taking ARVs and that they come in so clinics can monitor their children. Scanning through TASO’s logs showed me that any child who was brought in timely remained HIV negative. Babies who were HIV positive had always been brought in much later than 6 weeks, usually ranging from 6-10 months. The clinician in charge of the PMTCT department was very optimistic about eliminating mother-to-child transmission and I agree that the methods TASO uses are on track to reach that goal. The problem now lies in being able to see all HIV positive mothers in a timely manner.

This past Thursday, I had the opportunity to venture out in the field, approximately an hour north of TASO. I went with a small convoy that consisted of a lab technician, two counselors, a pharmacist, and several other interns. We set up shop at an abandoned looking house, but it must have been the center of the village as 50 or so patients were congregated there. The patient flow was as follows: a patient receives their file and waits for blood to be drawn to determine their CD4 count. The patient then talks to a counselor about how they are doing and if any problems have arised regarding treatment, general health, etc. Lastly, the patients visit the pharmacist who doles out medications. I was to assist the lab tech in drawing blood, a technique I had never learned and had only seen done a handful of times in the past three weeks. I was quickly shown how to prep the needle, and collect samples, though it was up to me to find the veins and determine how far to push the needle in. Beginner’s luck got me through the first five patients, but then some bigger patients came and I had a hard time finding the veins (we constricted their upper arm to increase blood flow and enlarge the veins, but it is still hard to find them on a larger patient!) After poking around several patients arms in futile attempts, I was told I can rest if I was feeling tired, an excuse I was some-what happy to take. I wanted to help as much as I could to levy the burden of the other lab tech, but I think I was doing more harm to the patients at that point. I will provide pictures the next time I draw blood! I ended up assisting in prepping needles and mixing samples as they were taken for the rest of the afternoon. This excursion taught me I have to work on my bleeding technique, but also that there are a ton of people without ready access to hospitals or clinics. As a group, we treated 50 patients in roughly 3.5 hours. It would take a much larger convoy and much more time to fully treat everybody in need that can’t come to TASO.

Now that I’ve been here for three weeks, I’m starting to understand why HIV is so prevalent. The short answer is that the issue is very complex and multi-faced. All areas of life and the government contribute to the structural violence that supports HIV. I’m going to attempt to detail the long answer, but even my description may change in the coming weeks as I learn more. So you have been warned.

Uganda is not the worst country in terms of HIV prevalence. Approximately 1.3 million Ugandans out of 35 million live with HIV/AIDS, but HIV prevalence has risen from 6.4% to 7.3% in the past five years. Initially, I had thought HIV prevalence was so high because of children not being educated about the disease or safe sex practices. This is sort of the problem, as children aren’t learning their ABC’s, but the reason is due to their absence in schools. The main problem stems from families and poverty (NB: I don’t have statistics to back up the following claims, but only the stories of staff and other interns at TASO, all who’ve grown up in Uganda). The average Ugandan family contains five to ten kids. Already this is a financial burden on families in terms of food, clothing, books, etc. Uganda is a country still facing gender equality challenges. A husband or brother beats a wife or sister for “acting out of line”. As a result, families can decay quickly and easily, and often one parent, or sometimes both, abandons their children, leaving them to fend for themselves. Children will attend school, which is free, but even school poses problems. Most Ugandan schools are boarding schools, so the students live there. They are fed, dressed and kept in line. Most of the school systems are run-downed and don’t have enough supplies for students. Teachers are few and far between, and those at school are underpaid. Working a somewhat unrewarding job in their eyes, teachers carry a short fuse and often lash out, physically and verbally, to students who make small errors. Just this week, NTV Uganda, the local news station, reported two stories of students being sent to hospitals because their teachers bludgeoned them almost to death.

School in Uganda is nowhere near as nurturing and supportive as American schools. It’s no wonder that 29% of students finish primary school (or 7^th grade), a statistic reported by NTV. There is no real reinforcement or teacher organization to keep students in school, so students can leave at will. There is still more educations after primary school, and I would guess that less than 20% of students make it to the end of University. That means there is more than 80% of Ugandan students uneducated, and unable to obtain well-paying (or any) jobs. As a result, life becomes a game of survival. Boys will become truck drivers or fishermen, and girls will fall prey to prostitution, both being rather reckless jobs that easily succumb to HIV, all in the hopes of getting enough money for food. Once a person has contracted HIV, they seek to be put on ARVs immediately. ARVs can extend the life of an HIV positive patient for 30 or more years; as a result, people don’t care whether they get HIV or not, as they know they can still live for a fairly long time afterwards. TASO gives out ARVs for free, but ironically, ARVs have stimulated the prevalence of HIV. HIV positive patients will then get married, have 5-10 kids, some of which are HIV positive, and the vicious cycle continues.

As you can see, there are several persistent problems: the inability to establish gender equality, and limit physical violence by the police, and the inability to improve schooling and retention of students. I have come to appreciate my family more in the past three weeks, even though I have not seen them, because they really supported me and guided me through childhood, instilling a drive in me to be the best in whatever I do. That love and support is common amongst most American families but absent from most Ugandan families. Ugandan kids don’t receive a hug or toy when they’re upset. They’re told to suck it up or get beat. The lack of emotional care leads to the plummeting spiral of hopes of becoming well-set later in life. Children fail to develop self-confidence and ultimately try to determine how to survive instead of prosper. If physical and verbal abuses are the cause, then shouldn’t the police be informed so they can handle the situation accordingly? They should, but they aren’t because they are hardly around. Ugandan police fail to enforce the law, and instead, take bribes whenever the catch someone in the wrong, sadly because they are hardly paid. The police force is corrupt and is not provided a reason or incentive for carrying out their jobs like their American counterparts do. If the police force is shitty, who’s to blame then?

Yoweri Museveni has been president for 28 years, and shows no sign of stepping down soon. In his early years, he was regarded highly for introducing order into Uganda by establishing courts, and uniting the country from Idi Amin’s reign of terror in the 1970s. But now, the recent budget for the upcoming year has questioned Ugandans' faith in the president. The Ugandan budget for the 2014/2015 fiscal year came out two weeks ago; approximately 38.4 million US dollars, or 8.4% of the 14 trillion Ush budget was allocated to healthcare, specifically HIV treatment for 100,000 patients. The only problem is that same amount was allocated in last year’s budget, and 190,000 cases of HIV were reported this year. There is no way anyone can reasonably expect all HIV patients to receive treatment; the budget for healthcare needs to be increased by at least 50-100%, or up to 15% from 8.4% of the budget, so that the rate of treating patients exceeds the rate of new cases. Regarding education, 11.9% of the budget was allocated to schools, specifically to increasing the salary of teachers by 15-20%. While that is a step in the right direction, the schools themselves are not being directly enhanced, meaning supplies may be scarce. There was no clear funding directed specifically at the police force, but Museveni decreed that defense and security were the most concerning issues for the budget, despite the fact that Uganda is currently at war with no other country.

But there is a bigger problem at hand between Museveni and the Western world. In February of this year, Museveni signed the Uganda Anti-Homosexuality Act. The law criminalizes same-sex relations domestically, and internationally, as Ugandans who engage in same-sex relations outside of the country can be extradited for punishments. Additionally, individuals, companies, NGOs, etc., can be punished for supporting LGBT rights. As you can imagine, some countries would condemn this kind of behavior. Just a few weeks ago, the USA passed sanctions against Uganda, as a form of protest, which ban Ugandan officials from entering the US, and cuts funding to military cooperation and to HIV/AIDS NGOs. In addition, Sweden, Norway, and the World Bank have suspended funds, which total about $140 million US dollars to further protest the laws. Bear in mind that 67% of Uganda’s HIV response is internationally funded, so these protests really exacerbate the already tiny healthcare budget. Museveni has retained his stance about the laws and has even criticized the Western world for bullying Uganda to act in accordance with their morals. He also stated that Uganda will look for other means to find money to replace the slashed funds, but I have no clue where he could pull out so much money.

Did you get all that? As you can see, money to improve decaying sectors of Ugandan life is scarce, and the recent sanctions do not make life any easier for Ugandans. In my honest opinion, Museveni needs to take this matter seriously and try to find a way to alleviate tension with these other countries.  More importantly, he needs to think about whether the anti-gay laws are going to ultimately hurt Ugandans rather than help them. Musevini is like the Western world's stubborn little brother; he stands by his beliefs despite other countries telling him otherwise. Uganda needs money to help reduce the prevalence of HIV/AIDS, and Museveni will deny it because he feels like he is being bullied. While I respect his decision to remain firm in his beliefs, I think that he needs to realize that his country at this time in history needs help. Whether the anti-gay laws are right or not is a different question, and one I’m not going to delve into, but it is foolish for anyone to think Uganda will improve medically without the aid it was already receiving.

I will continue bopping around different departments of TASO this week. Thanks to my mom’s connections through Merck Research Labs, I also hope to talk to some people at the CDC and other social NGOs about HIV prevalence and learn more about how areas can be tightened up. Hopefully, you now have a better idea of how different sectors directly contribute to HIV cases and the areas that need to be improved upon. I will try to expand upon these ideas and current measures being taken in future posts, but if you have any questions, let me know. Thanks for reading!

Bumming Around

TASO holds me captive during the workweek, but as soon as the evening or weekend arrives, I’m free to do as I please. There are a couple of tasks I do daily; running and MCAT studying. Usually, I try to run before work, but if I fail to get up early enough, I’ll run before sunset (which is around 7). As far as training goes, I’m just building a base for the upcoming year; runs are usually just straight distance and I try to explore different parts of town or run to historic sites and back. Jinja is fairly hilly and at 3700 feet above sea level, some normal easy runs really get my heart pumping. At the end of the day, I’ll spend about an hour or so reviewing for the MCAT.

Anytime left during a weekday is devoted to walking around downtown Jinja or watching the World Cup. Jinja is fun to walk around because of all the different kinds of shops and street vendors. The vendors sell all kinds of food ranging from bananas to eggplants and cow intestines (have not tried) to chapattis. One hot commodity is a rolex, which is an omelette rolled up in a chapatti, kind of like a breakfast burrito minus the meat and cheese. All of these snacks range from 500 Ush to 2000 Ush, roughly $0.20 to $0.80, which is pretty cheap by American standards. At home, I’ll try to watch any World Cup games I can. Uganda is 7 hours ahead of the games in Brazil, so I can only see so much during the week, before having to go to bed. I have yet to see the US play, but that’s because they’ve been scheduled to play at 1 AM EAT!

The weekends provide the opportunity to escape Jinja. Most people travel from/to major cities via car or bus. I must comment on the pace of travel though; it is nearly half as fast as travel in America. This is not because of the vehicles, but because of driving rules and road conditions. It seems like Ugandans learn one rule in driving school: don’t cause or be in an accident. Highways are simply just a paved (if that) road without any barriers or very few dashed lines for delineating lanes. Most highways are single-lane and in order to pass, one must move into the oncoming lane to get around. Jinja is 80 kilometers from Kampala, a distance that would take less than an hour to travel in the states, but takes 2 – 3 hours in Uganda. This limit in travel speed reduces the places I’m able to visit, as I only have weekends to explore, and some parts of the country are a full day of travel away.

With that said, I can still get away from Jinja and explore neighboring cities and sites. In my first weekend here, my host family took me to a wedding in Kampala. There are two parts to the whole wedding; the introduction and the ceremony/party. For the introduction, the groom must first write a letter to his fiancée’s parents in perfect Lugandu, asking to meet as he desires to wed their daughter. Should the bride’s parents accept his offer, the groom and his family is invited over to the brides house to meet her family. It is a joyous time in which new friendships are forged, and should everything go accordingly, the couple may then proceed to the official wedding. The wedding consists of a more official ceremony in which the couple is officially wedded. Following the ceremony is a party, which resembles the kinds of parties most American weddings throw. Ugandan weddings are fairly relaxed; there is a lot of eating and socializing. I didn’t observe the introduction (which was a couple of weeks prior to my arrival) but I was allowed to attend even though I had never met the couple before! After cake cutting, friends and family are allowed to say words of wisdom, advice or whatever they seem fit to the couple. This part of the wedding can drag on, as anyone who wishes to speak may say something. Dancing usually follows and continues until the end of the wedding. I had a fun time, as everyone is in good spirits and happy for the newlyweds. 

Tables where guests sit, with the throne for the newlyweds in the back and centerpiece for the cake

The groom and bride dancing in front of chocolate fondue and cake

Jinja has one major attraction itself; it is the beginning of the all-great Nile River. The river begins from Lake Victoria, and flows past a point in Jinja, northwards to the Mediterranean Sea. I was fortunate to travel to the source with Ivan, my host-father’s nephew, for a relaxing Sunday afternoon. The Source is a tourist hub that offers boat rides out on the Nile and Lake Victoria as well as souvenirs from the river. 

The mouth of the Nile, with Rumours to the left

The Nile flowing northwards

There is a small bar called Rumours on the banks of the river, which serves refreshing, cold beverages as you enjoy the sunset behind the opposing side of the gorge. The Nile does not have the lure and warmth Caribbean beaches supply, but it is nevertheless a relaxing place to sit down, have a drink and listen to the calm flow of the river. There are some rapids (Grade 5 at that) that are further upstream, but I don’t know if I’ll venture up to them. Until next time, which is real soon.

TASO

In present day Uganda, there are many clinics and hospitals designated specifically to HIV/AIDS care and treatment. But this was not the case 30 years ago. When Yoweri Museveni came to power in 1986, HIV/AIDS was looked down upon and discriminated against by many; there was nowhere to go that provided care and treatment without belittlement and the negative stigmatization that was almost as prevalent as the disease. TASO’s founders desired to create an institution that removed the general ignorance surrounding the disease, and were dedicated to educating and treating anyone with regards to HIV/AIDS. In 1987, TASO was founded, Uganda’s largest and oldest NGO. Their official mission is to, “contribute to a process of preventing HIV infection, restoring hope, and improving the quality of life of those affected by HIV” in the ultimate hope of living in a “world without HIV.”

There is no doubt TASO has made a major impact on the community and stigma surrounding HIV. The prevalence of HIV has greatly diminished from what it once was in the 1980s due to an explosion of clinics, which assist patients all over the country. TASO educates its patients with the fundamental ABC’s: abstinence, being faithful to one’s partner, and condom use. Additionally, TASO expects patients to both obey the acronym and educate others around them, with the objective of eliminating misconceptions about the disease.

Since I have no definitive research or assignment to finish, I’m free to move around the various departments to see how TASO functions as a whole. The various departments I’ll work in include medical labs, clinics, field work, and counseling for adolescents and adults (the distribution of my time in these departments may not be equal, as the work load varies on a day-to-day basis). My time so far has been spent in the medical lab. I have already conducted medical experiments that I would be forbidden to do in the states, simply because of where I am in my education. I’ve drawn blood for malaria tests, performed urinalysis and pregnancy tests, and have used flow cytometry for CD4 and CD8 screens on actual blood samples. That has actually been the most nerve-wracking assay, as it is important to handle each sample professionally. In school, it is easy to blame faulty flow cytometry results on the machine or reagents or some other obscure detail. But circumstances change when those results dictate whether a patient is healthy or needs to be put on anti-retroviral therapy asap.

On a different note, I have some preliminary observations that may support reasons for the why HIV is so prevalent. Today, I tagged along with a small team from TASO, as we traveled up to O & M Energy, a hydropower plant in Bujagali, just 15 minutes from TASO. The objective of the trip was to educate workers at the plant about HPV and cervical cancer and safe male circumcision (SME). TASO even offered to hold a clinic at the end of the week, specifically for any worker who wished to be screened for cervical cancer or to be circumcised. There were about 20 workers, three-quarters male, all in their late 20s to 30s who attended the presentation, and while they were engaged by the HPV presentation, they became especially rowdy during the SME presentation. Most of them, who were uncircumcised, asked elementary questions about circumcision, ranging from the actual process to the safety measures ensured by circumcision. The discussion then turned towards condom use, which provoked even more questions regarding proper and efficient use. I instantly became rather annoyed that we had to go over the very basics; the workers were asking questions like, “can I reuse condoms?”, “how does being circumcised reduce the prevalence of HIV?”, “should I change condoms after using them for an hour?” It was not until after the discussion that I realized that these workers most likely never received education about this in their schooling. I was fortunate to have had sex education classes in middle and high school, which covered the basics and safety measures of condoms and circumcision. I had been informed by TASO that most primary and secondary schools preach the ABC’s to their students, but it seems like their sex ed curriculum ends there. When talking to Dr. Susan, the head medical coordinator and leader of the TASO contingent, about this naivety, she said that sex ed is a rather embarrassing topic for most people to talk about and is avoided by some cultures in Uganda. If this is the case, than there needs to be an initiative for schools to thoroughly cover a complete sex ed curriculum and mature so that they can hold conversations about these topics. It is very possible that a large percentage of the workers in that lecture today have come across STI’s or are HIV positive, due to a lack of education. If students are not being educated about this, I believe that the cases of HIV will never decrease, since all the initiatives and treatments fail to teach and educate the youth to prevent acquisition of the disease in the first place. While I do not have a specific sex ed curriculum schools use, I am under the impression it is very skimpy, if at all real.  Schools, and even NGOs like TASO, should make an effort to improve sex ed curriculums. The consequences may be more significant than just simply treating HIV patients.

Cultural Impressions

First off, I apologize for the delay in posts. I don’t have ready access to wifi, and the modem I bought is not as compatible with Macs as I thought. Luckily, there are several internet cafes around town. This post will be dedicated to cultural impressions, and I will post another regarding my first week of work in the next couple of days.

When I was in 7^th grade, my family went to India for two weeks. We traveled the country, seeing the sights, and visiting family in both the north and south. Northern India is industrial and bustling. It’s more technologically advanced than the south, which operates at a much slower pace of life. In the south, electric appliances are far and few between, small critters and bugs frequent homes, and walking is the optimal mode of travel. Ironically, the facet of life that stood out the most was how quiet life was. Natural sounds like dogs barking, roosters cock-a-doodle-dooing, and grasshoppers chirping replaces the hustle and bustle of cars, buses, and people.

Jinja reminds me a lot of Southern India. It is very green, low-key, and operates at a slower pace than most other cities. Jinja is known for being at the mouth of the Nile River - which runs all the way up to Egypt and the Mediterranean Sea - and is visible upon crossing the entrance dam, the Owens Falls Dam, that leads to the town. The town itself is pretty small; it takes me about an hour to run around its perimeter. The best way to get around town is on motorcycles called boda-bodas. There are almost as many boda-bodas as people; it is impossible to go a block without seeing a handful of them. While they are cheap and quick, they are very prone to accidents. As a result, many people walk to where they need to go, since everything is relatively close. 

Main Street in downtown Jinja- shops and supermarkets line both sides of the street

While downtown Jinja is more city-esque, the rural areas are pretty quiet. The host family I’m living with is located in a more rural area, close to the dam. The family consists of David, his wife Mariah, and son Solomon. Ugandan families range from 1 child to many, but a lot of families are starting to have two or fewer kids, simply because of the financial burdens that come with raising children.

Education in Uganda is similar to that in the states. Kids attend nursery school for three years (our pre-K and Kindergarten) before starting primary school, which lasts 7 years (our elementary and middle schools). After primary school, is secondary school, which lasts for 4 years, and then high school, which lasts for two years. University follows, but is only 4 years long. One difference with Ugandan universities is that students specialize in a field that many American students specialize in graduate school. For example, if a student were interested in becoming a doctor, he would take classes just for medicine in college, and graduate with a medical degree, at the same age a student in the US would finish college with a Bachelor’s degree. They become doctors, 3 or 4 years before most Americans do, a real time and money saver!

Of course with a new place, there are new types of food. Uganda’s main exports are sugar, coffee, maize, and bananas, so it is very easy to buy any of those. Most meals are comprised of starch and some kind of meat or beans. Rice, matoke (mashed up plantains), posho/ugali (maize flower) and pasta can be found at every lunch and dinner along with chicken, beef, or whole fishes. Pinto beans are also common, and probably the most common (but still tasty) meal is rice and beans. Additionally, there is a strong Indian contingency in Jinja, and thus, it is easy to buy samosas or chapattis from street vendors. Downtown Jinja has lots of different types of restaurants, that cater to Western diets, as well as a fair number of authentic Indian restaurants. I will have to report back on whether these are really authentic or not.

One final note I want to make is regarding the World Cup. As a continent, Africa has sent 5 teams to Brazil. Uganda is not represented, but that doesn’t stop people from watching the games intently. I was watching the Netherlands vs Spain game, when at half-time, a commercial came on produced by Coca-Cola, saying how Africa supports Africa; no matter where an African is from, each team that is represented has the whole continent at their back; one billion fans, each having a coke, cheering on the 5 teams. I found it interesting that while this is obviously a commercial to drink Coke when watching the World Cup, countries in Africa view themselves as a whole. While there has never been an African team to make it to the semi-finals, some Africans believe they have 5 opportunities for this vision to come to fruition. I can’t say Americans would think anything similar. The idea of supporting Canada in the World Cup (if they ever qualify) is quite sickening, and traitorous in my opinion. I guess African countries really want to be known as a force to be reckoned with in the world, and a victory for one country is a victory for all.

Hope to post in a couple of then. Until then, go USA! (against Ghana, that is).

C

Introduction to Embarkation

Howdy! Welcome to my blog. The purpose of these entries are to detail my everyday experiences, while I work for The AIDS Support Organization (TASO) in Jinja, Uganda. How did I finalize an internship in Uganda, you might wonder? Well, it's starts with Haverford's Center for Peace and Global Citizenship (CPGC). Every year, the CPGC funds domestic and international  internships based on the principals that the internship addresses a specific social or global justice issue. Having spent the past two summers working in research labs, and being immersed in the Biology department's molecular biology curriculum this past year, I wanted to step back and examine how other parts of the world deal with diseases, specifically HIV/AIDS. I find it fascinating that a disease that has been researched so extensively in the USA can be so prevalent in other parts of the world. The larger question that I am examining on my trip is how information regarding HIV/AIDS or preventative treatments can be distributed more efficiently to the public in developing countries. Currently, I plan to formulate an answer by working directly with patients at TASO. I hypothesize that activities such as setting up mobile health clinics, working in medical labs, treating, diagnosing, and talking with patients can help illuminate areas in Uganda's public health policies that could be improved upon.

Before I delve into my pre-departure thoughts, there are some people and organizations I'd like to thank: Sam Gant '13, for introducing me to TASO and for helping me find a homestay; Margaret Nassozi for assisting with travel arrangements and the homestay; the Mukisa family for hosting me; the CPGC for funding this trip; Chloe Tucker for her assistance and support in the application process and contacting various organizations; my family and friends for worrying about me.

Currently, I am doing last minute laundry and packing. There are three facets of the trip that worry me. Firstly, I have to be careful and diligent about where my water comes from. Anything that is not bottled or boiled water poses a threat. Water filters, boilers and iodine tablets will provide some defense, but I have to be very mindful of my water source. Secondly, mosquitoes are notorious for carrying diseases like Malaria and Yellow Fever. I am all caught up on shots and have anti-malarial pills and repellents, but I can still become a feeding ground for mosquitoes, and that is never fun. Lastly, Uganda passed "anti-gay" laws earlier this year, essentially making it illegal to identify as homosexual. While this is not a concern for me, I'm curious to know how many patients I interact with are affected by the new legislation and the opinions of Ugandans about the law. This facet was not originally something I had thought of when designing my internship, but I have a feeling it will become very prevalent when I start working.

My flight leaves today at 6:15 PM, and I will have a connecting flight in Brussels. The game plan is to arrive in Entebbe (international airport in Uganda) at 9:45 East Africa Time (EAT) Saturday evening. I will stay the night in a hotel and travel to my host family Sunday morning. The next time I post will be once I've settled down and start work. I currently plan to post two times a week with pictures, but that may increase or decrease depending on what's happening.

Cheers,
C