Kampala dreams

I arrived in Kampala, Uganda on Wednesday. I really like this town, although I have to admit I haven't seen anything on this trip except for a couple of hotels, the university, and our office. Still, people are really friendly and it is not as big as Nairobi or as hot as Dar es Salaam.

We're here to start discussions with different stakeholders about a needs assessment for the introduction of male circumcision as an HIV prevention method in Uganda. Several large, randomized, controlled studies have shown that circumcising men can reduce the risk of their being infected with HIV by up to 60%. So some countries (like Kenya) are aggressively promoting it. Uganda hasn't decided what they are going to do so we have been asked to do a needs assessment to see how normal people would react to such a campaign (i.e. acceptability) and if the health system can handle a large demand (feasibility). I'm in charge of this one. Unfortunately, our big stakeholders meeting with the Ministry of Health and other big guns was cancelled today because so many people were absent, largely due to the Ebola virus outbreak in the Western part of the country.

Ebola is a hemorrhagic fever with nasty symptoms that causes death in 70-90% of cases. The really scary part about it is there is no cure. Medics just try to keep the person hydrated. Nobody knows why some don't die. The U.S. Centers for Disease Control reports that during the last epidemic here in 2000-2001 the majority of cases were associated with attending the funeral of a sick person, having a sick person in the family, and treating a sick person with improper protection. So there is little to no risk for me staying at my swanky hotel in Kampala. Worse, though, is that there are actually three additional deadly communicable disease outbreaks in Uganda right now: yellow fever, cholera, and the plague. None, though, are causing as big a scare as Ebola.

The other event that caused low attendance for our meeting was the Chogm meeting here a week ago, which forced everyone to move their meetings to this week to get them in before the holidays. Chogm is the biennual Commonwealth heads of government meeting, which drew 53 heads of state, 5,000 delegates, and the Queen of England. Of course, the meeting was extremely important for the economy and image of Uganda so a lot of cleaning up was done beforehand. New hotels were built, roads were paved, and riff raff was moved out of town. My colleague pointed out one downside of the meeting though: a blank corner where a fine primary school used to stand. Apparently, despite protests, the president agreed to let an investor raze the building in order to build a hotel for the meeting but after they cleared the spot they backed out. That's the breaks!

On my flight from Amsterdam I sat next to a woman who was born to Ugandan parents but was raised in Germany and the U.S. Apparently, her mom bought her a ticket to go to Kampala for 2 months and sent her off by herself. The poor woman was scared stiff. She had not been in Africa since she was 5, she didn't know what her "family" would be like, and she had decided not to eat for 2 months because her relatives apparently didn't have a toilet in their house. I found myself in the bizarre position of reassuring her that all would be fine and that her relatives would be thrilled to see her and take great care of her, and I was the foreigner and she was the African (at least by birth)! I helped her through customs and waited for her seven enormous suitcases, which of course were the last bags off the band. But when customs said they had to look through her bags I gave up. Besides, she had a family member who worked at the airport with her at that point so she was doing fine.

I called her up tonight to find out how she was getting along. She said she was in the "deep, deep village with no water or electricity. The people are weird but treating me nice. Everyone is asking 'why doesn't she speak the language?'" Apparently, she hadn't slept a wink since she arrived because the house is always full of people who want to meet her: “They want you to eat all the time. I can’t do that! This is too much!” But she was laughing and said she was having a great time. I told her that she was seeing the real Africa, not the one that I am staying in. But for some reason she wants to come here to see for herself!