doc w/ Pen

journalist + medical student + artist

Tag: Africa

Q: How do you “eat the elephant” in Uganda?

A: With another medical student.

(I’ll explain; just keep reading …)

A Perfect Circle, one of my favorite bands, recently released a new album called “Eat the Elephant.” I managed to find a kindred music spirit here in Uganda to listen to it with me.

When one of my favorite bands, A Perfect Circle, released a new album during my time in Uganda, I figured I would have to wait until I got home to hear it. I figured I would listen to it in my New York City apartment, probably by myself, since I don’t know anyone else in town who likes the band.

Not so.

A medical student from Canada, here at Naggalama Hospital for an international rotation, and I discovered one afternoon that neither one of us could wait to go home and hear the new album, called “Eat the Elephant.” So why not listen to it together? Our own little “release party” here in rural Uganda?

It was settled.

I set up my laptop in his room, propped my phone on the windowsill to get a signal from my Ugandan cellular carrier, MTN, and created a wi-fi hotspot for myself. Then I launched Spotify, ready to stream the album. (I don’t do much streaming here because it eats up data like crazy, but this once was worth it.)

Before I hit “play” though, I went to my favorite lyrics website and loaded the words for each song. My newfound friend did the same.

Then we commenced our concert.

One moment, I was in my own world, lost in the music. Another moment I was agreeing with my concert buddy on how brilliant a particular lyric or metaphor was. We were of like minds.

It was absolutely lovely.

The housekeeper walked in on us during a particularly raucous song, each of us rocking out in our own way.

She clapped her hands and burst into laughter. So did we.

Among the child believers

Puddles and gray skies seen from the front porch of my lodgings in Naggalama, Uganda, some 40 kilometers northeast of Kampala. My thoughts about the cooling rain — and about issues like childbearing and marriage — are very different from those of many people I met in Uganda, as I discovered during my month-long stay there.

This morning it’s raining in Naggalama, Uganda. It’s been raining a lot the last two weeks, both brief, light showers and heavy deluges. Naggalama is my home base during a month-long Ugandan stay in which I’m visiting a number of rural hospitals as part of research into palliative care.

Around Naggalama, gray skies shroud the blistering, equatorial sun and the rain cools the usually hot air.

For me, it’s a welcome respite from sticky heat. But for the Ugandans I’ve talked to, this is their equivalent of frigid winter. While I walk comfortably in a short-sleeve shirt, I see others shivering in their sweaters and coats. They look at me wide-eyed, and I return the gaze. It’s not a critical look, more one of surprise; shock at my (or their) response to this weather.

Other differences have arisen, some of these more philosophical, cultural, and belief-driven.

A common topic of conversation here is family. Family is of utmost importance in Uganda. The measure of manhood for many here is how many children you’ve fathered. Not so in the United States. It is not surprising, then, that the average number of births per woman in Uganda (5.6) is more than 3 times that of the average woman in the United States (1.8, according to 2016 statistics from the World Bank). Some professionals I’ve spoken to want smaller families. But I’ve seen people in the rural villages with eight, nine, 10, even 11 children, and not always enough food for them all.

It’s hard for me to wrap my head around this practice. I understand the desire to have children but my heart breaks when I see families that have more than they can afford.

Similarly, it’s hard for people here to comprehend the fact that at age 36, I don’t have any children. And I may not have any, ever.

“Don’t you want a child?” many have asked me.

“No,” I’ve replied, simply.

The measure of manhood for many in Uganda is how many children you’ve fathered. Not so in the United States.
“But you will not be complete until you have a baby!” they’ve insisted.

“I don’t feel that way,” I’ve responded. “I find fulfillment in other things in my life.”

My principle always surprises, but the level of others’ incredulity varies.

“Lorien, are you normal?” one person asked me.

It took me a moment to fully understand this question. What did “normal” mean in this context? I realized later that normal might have been a euphemism for being heterosexual. The opposite, “abnormal,” then referring to being homosexual —still a crime in Uganda, although no longer one that gets you the death penalty.

This conversation about having children is inherently circular. I orbit my credo, and they theirs. But our diametric circuits never intersect.

Likewise, being divorced is a strange concept here. Being separated from your spouse, finding a new one, or simply having children with someone to whom you are not married — these things are commonplace. The act of a formal, legal divorce though, is not.

“Don’t you want to find a new husband?” people have asked me.

“I would like to,” I’ve said. “But I need to find the right man. It’s better not to be married than to be married to the wrong person.”

Frequently, after exhausting the topic of divorce, the conversation returns to children.

“But you didn’t even have one child when you were married?”

“No,” I’ve said. “And I’m glad I didn’t. It would be very difficult for me to raise a child on my own.”

Saying those words has always made me imagine what it would be like to raise a child as a single mother while also attending medical school. I shudder. I have the greatest respect for anyone raising children during this journey toward becoming a doctor, single parent or dual household. I find it hard enough to take care of myself, let alone take care of someone who is entirely dependent on me for their every need. I don’t explain all of this, although maybe I should.

“But we women in Uganda often raise our children alone,” one woman told me. “The husband often leaves. If you look at 100 schoolchildren, you would find that for 90 percent of them, the school fees are paid by the mother,” she said.

Puddles and gray skies seen from the front porch of the author’s lodgings in Naggalama, Uganda, some 40 kilometers northeast of Kampala.

Those statistics aren’t backed by research, of course. But I know that while there are many good fathers and husbands here, the suggestion that women are the ones who generally tend to the children has some truth in it. Many women do raise their children alone here. If a woman can’t bear children, or can’t bear any more children, her husband may leave her, I’ve been told time and time again.

And if a woman becomes seriously ill, her husband may also leave her. I’ve seen that firsthand with the palliative care patients we’ve visited in rural villages. From a trip I made to Uganda two years ago, I remember one woman who had terminal cancer. She had 11 children, some of them adults with their own families, but several of them young and still living with her. Her husband had left and found a new wife. He continued to “give care” — provide financial support — for the children while the patient was alive. But she worried about what would happen to her children when she died.

Uganda has no formal state safety net. No foster care, no welfare services, no alimony or child support.

To me, having a child in this environment sounds terrifying. But for many Ugandan women, this situation is all they’ve ever known. What frightens them more is the thought of not bearing any children at all.

At some point, I always steer the conversation toward another topic, knowing that we’ll get nowhere no matter how long we discuss the merits of having (or not having) children.

In the end, all I can hope for is that I’ve done my best to listen and remain open to hearing about and discussing beliefs other than my own. To consider why someone might hold those different beliefs, even as I do the opposite.

I remind myself that cultural exchange isn’t about convincing someone else that your ideas are better. It’s about sharing what you do, finding out what they do, and talking about why. And at the end of the day, doing your best to respect each other.


Note: This essay was first published in the online magazine The American, for which I write a monthly column called Bio-Lingual. You can read the original version here.

Home again, home again, jiggity-jig

The Emirates Airbus A380, which provided a much more comfortable flight than the domestic ones I’m used to, also harbored a hidden danger, as I discovered when I got home.
Image from Wikipedia.

I’m home.

And it’s good to be home, although the re-entry process hasn’t been without its own challenges.

Jet lag is brutal no matter how you slice it. Not only that. While the Airbus A380 that carried me to JFK was airborne at 35,000 feet, something else was apparently airborne too. As an almost-doctor, I identify my invisible assailant as an aspiring virus, one that must have targeted me while I tossed from side to side in my barely reclining seat. At least I had the aisle.

I’m gradually coming out of the viral haze, and starting to tackle the jet lag.

One thing — one day — at a time. It’s a good mantra for medical school, and for life in general.

I have two weeks left in this four-month research block. Along with continuing to recover my scattered faculties and resetting my sleep schedule, I’ll be entering my data and putting together a “Work in Progress” presentation on what I’ve done so far.

While the trip is fresh in my mind, I’ll also be posting more thoughts, reflections, and photos. I found so much to write about while in Uganda, but simply not enough time to write it all down in the moment. When an essay idea hit, but when I was short on time or energy, I’d hurriedly type a partial draft or even *gasp* an outline. (Normally, I am loathe to write outlines, and have been since I was in sixth grade, when my language arts teacher, Mrs. Piper, forced the cumbersome process on us.) When I didn’t have my laptop handy, I’d scrawl thematic threads in one of the three pocket notebooks I brought with me. A reporter is NEVER without her notebook and her pen, and she always brings spares, just in case. So stay tuned.

This is not the end of my project, though. January and February of 2019, I have two more months fully dedicated to it. At that time, I’ll be more formally analyzing my data, compiling results and conclusions, and writing my report. I’m sure I’ll have more to write about then as well.

Thanks to all of you who have been following and commenting on my jaunts through rural Uganda. As a writer, sharing my experiences is important to me. It’s a creative outlet. It also helps me process and reflect. I find this crucial all the time, perhaps especially so in a foreign country where it can take extra effort to make sense of the world around you.

As they say in Uganda: Weebale. (Thank you.)

Mpigi: My first Ugandan sunset

Sunset seen from the grounds of Sina Village in Mpigi, Uganda.

In Mpigi last week, I had the most incredible views at Sina Village where I was staying — from my own veranda (click here to see those photos), and also from the grounds. As I walked around Thursday evening, smiling up at the salmon-pink clouds of dusk, I realized I’d never seen a Ugandan sunset. Or maybe I had, but I hadn’t paid any attention to it. (I was probably too busy swatting at mosquitoes.)

I’ve seen my share of spectacular sunsets — particularly those in the Sonoran Desert of the American Southwest.

This was different. A more subtle, subdued beauty. But with the backdrop of birds and bugs, their whistling and humming; with the outline of tropical palms and other strange, dark shapes against the faint glow of the sky; this was something special. Something new. Something to remember.

And something to come back to.

Buena veranda vista

Veranda view: Dusk, and a little path leading somewhere …

“Drinks” and “hors d’oeuvres” outdoors.

Yesterday I wrote about my wonderful experience staying at Sina Village in Mpigi, Uganda.

As I mentioned in that post, for an extra $10, I got a private veranda and toilet. It was worth every penny, and then some. I spent almost every spare moment out on that veranda.

The outdoor furniture wasn’t anything to write home about. I sat on a white, plastic chair next to heavy, round table covered with a worn, spotted animal hide.

But the views … the views were everything.

Here are several photos taken from my lovely veranda during the 26 hours I spent at Sina Village.

I wish this were the view from where I live …

Sitting on my veranda, enjoying my view of the verdant countryside, and propping up my feet — in their very stylish shoes, of course — after my palliative care presentation at nearby Gombe Hospital.


The view from my veranda at midday.


The view from my veranda at dusk.

It takes a village

The colorful interior wall of the hut where I stayed at Sina Village in Mpigi, Uganda. Read on for more details about the hut’s unique construction.

Last Thursday and Friday, I was Gombe Hospital to present my palliative care curriculum. There weren’t any hotels nearby. So Thursday night, I stayed at a place called Sina Village in Mpigi, 30-45 minutes from the hospital. It was intended as just a place to eat and sleep, and maybe write or work if I had some energy. These trips away are exhausting, so I knew I’d crash hard Thursday night.

Staying at Sina Village brought me so many smiles.

But it was so much more. By far my favorite accommodations away from Naggalama, Sina Village was a peaceful, rural respite. And by that, I mean as I sat on the private veranda of my little hut, staring out at the lush, green countryside, I actually felt at peace — something that’s hard to come by anywhere, and almost impossible in New York City. I find the sounds of human activity distracting. Birds, crickets, and cows, on the other hand, somehow allow me space to think. Sonic salve.

It did take me a little while to adjust to the environment, though. I checked in late Thursday morning, and before going to Gombe Hospital for my 2 p.m. presentation, made myself some coffee for a little energy boost. As I was stirring the sugar in, an unfamiliar burst of sound hit me like a wave.

Moooooooooooooooooooo …

The sound didn’t register as anything I’d ever heard while standing in my own bedroom. It sounded like it was coming from my veranda, its mysterious maker on the verge of storming my little hut. I almost dropped my precious cup of coffee.

Regaining my nerves, I cautiously stepped onto the veranda and peered outside.

I’ve been around cows plenty. But standing in my bedroom and hearing one moo? That was a first.

A cow.

A cow? Yes, “mooooo,” of course. I knew the sound, have been around cows plenty and heard their distinctive wail, but have never heard one while standing in my bedroom.

I chuckled at my skittishness — a genetic trait I inherited from my maternal grandmother, I am sure — and at my city slicker reaction.

For the next 24 hours of my stay, plaintive mooooing pealed outside at irregular intervals. At each moo, I smiled.

The bottle hut where I stayed at Sina Village, built with recycled plastic water and soda bottles. The lovely veranda is behind the hut. I will post photos of the view from it soon.

The construction of my “bottle hut,” too, made me smile. “Bottle hut” was literal nomenclature. The building was constructed of plastic water and soda bottles, which had been packed with the ubiquitous, red Ugandan earth and laid like bricks with cement to hold them in place. The picture at the top of this blog post is of my interior wall; below are photos of bottle hut exteriors. The gray-toned hut is where I stayed. The earth-toned hut was down the path from me.

Another aspect of my hut’s exterior made me smile. Each hut at Sina Village had the name of a different African country stenciled onto its metal door. Appropriately, I stayed in “Uganda.”

A view of my bed, and of my “private bathroom.”

I spent an extra $10 for a private bathroom and veranda. “Private bathroom” really means “private toilet.” To wash your hands or take a shower, you have to go outside to the common bathroom facilities. This isn’t what I’m used to, but it did not detract from my stay.

These amazing huts are constructed by local people (see photos below of bottles waiting to be packed with dirt, and a partially constructed hut). Sina Village is not only a cluster of little huts for lodgers. It has a mission — to teach entrepreneurship and job skills. This is much needed in Uganda, where so many people are subsistence farmers, and good jobs are hard (to impossible) to come by.

The place was magical. So were the people. In particular, Flavia, the woman who coordinated my meals and other needs while there, was so kind and welcoming. She also made the best beans and rice I’ve had in Uganda.

If I’m ever in Mpigi again, this is where I will stay.

UgLish lessons

The primary local language where I’ve been traveling in Uganda is called Luganda. The health care workers attending my presentations all speak English, though, to varying degrees. Even so, there are differences between the English spoken in Uganda and in the United States, just as there are between British and American English.

The longer I’m here, the more I find myself speaking Ugandan English — called “UgLish,” and with its own dictionary. People are more likely to understand me. And I seem a little less … foreign. At least that’s my hope.

Embracing and using locally preferred English words has implications for my research as well. Ugandans might better understand so many of the words and concepts in our teaching guides with some simple rephrasing on our part. Now that I’ve given these presentations a dozen times, I have a better idea of what needs changed to make this material more accessible.

Here are a few examples of what I’ve heard people here say, contrasted with what I would normally say at home. Some UgLish represents true differences in meaning; other things are simply words I’ve noticed are more commonly used here, but have the same meaning in both countries.

  • Observe. This means the same thing in Uganda as it does in the United States. But in my experience, people here are more likely to say “observe” when I would say “notice” or “see.” It’s a small thing, but I think making these small changes is important when you’re creating educational material for a specific audience.
  • Mobilize. When I was at Gombe Hospital, the administrator helping me set up told me she was going to “mobilize” the people to come. When I think of the word “mobilize,” I think of the military — mobilizing troops or weapons, for example. Here, it’s a commonly used word in everyday life.
  • Balance. When I first heard this, I was confused. “Here’s the balance,” my driver said to me earlier this week as he handed me the bar of soap I’d loaned him to wash his hands. After a moment of thought, I realized he meant “remainder.” The word “balance” here can also refer to the change you get back after paying for something.
  • Uganda’s version of a “rolex” — not a designer watch, but a delicious, rolled sandwich wrap.

    Rolex. My first trip here in 2016, this word mystified me. Driving down the rural, bumpy dirt roads, we’d pass roadstand after roadstand advertising their “rolex.” I knew this couldn’t mean a designer watch. Someone finally explained it to me. A “rolex” in Uganda is essentially a rolled-up sandwich wrap. Specifically, it’s eggs and vegetables rolled up into chapatti. I don’t buy the street vendor version, because my North American microbiome would probably cry “Mutiny!” But the woman who cooks at the guesthouse here makes it too, in a way that’s safe for my GI tract. And it’s delicious.

Of course, to really feel less foreign, and to really make sure people can understand me, I would need to learn Luganda. Not a day goes by without my thinking that thought.

That’s not exactly an option for me now. So I do my best, using a few simple phrases in Luganda, and tailoring my English as much as I can.

Someday, maybe I can do more.

A taste of the familiar, amid the foreign

I recently enjoyed a post-lunch “latte” (coarse ground coffee brewed in boiled milk, to espresso strength) on the veranda of my hut at Sina Village near Mpigi, Uganda.

Living in a new environment always takes getting used to. You take for granted the little things at home, not realizing how much they’re part of your routine until they’re gone.

For me here in Uganda, it’s been paper towels. They’re not a thing here; neither are napkins, really, except for us mzungus*. I’ve gotten along fine without paper towels, of course. And maybe living without them for four weeks is a good thing. Maybe when I go home, I’ll rely on them less, and waste less paper.

One thing I knew I would struggle without, and so brought with me, is my morning coffee routine. I survived last time here for three weeks without it. So it wasn’t absolutely necessary. But it brings me so much joy! And in a foreign environment, when you expend so much energy to get very basic tasks done, having something familiar can go a long way toward making you feel comfortable, and more at home.

Breakfast of champions: Hot water, hot milk, my travel French press, and a malaria prophylaxis pill. Mmmmmmm.

So as I’ve mentioned before, I packed a travel French press and coarse ground coffee beans. People here in Uganda don’t drink much coffee, but they are serious about their tea. Thankfully, that means getting my hands on boiling water has been easier here than it would be if I were traveling in the United States. It’s available at every meal. And no one looks askance if you request it any other time either, morning, noon, or night.

On my most recent trip, to Gombe Hospital, I stayed in a lovely place called Sina Village in Mpigi. For breakfast, I was brought hot milk. That morning, I discovered that my French press can also make something that resembles a latte. I’ll have to try this at home now.

So yeah … Starbucks? Who needs Starbucks? I found something better, something I can make myself, while living in Uganda. If only I could take a little sliver of the Ugandan countryside home with me too.


*Mzungu. Pronunciation: “mah-zoon-goo.” Language: Luganda. Referring to foreigners, especially of European descent.

Necessity, that dear old mother

The room where I presented my educational modules at Masaka Hospital in Uganda. Setting up for a technology-heavy presentation in rooms like these can be a challenge.

If I were presenting my educational modules at New York Presbyterian Hospital in New York, I would take several things for granted. Access to a projector, for example. A screen to project images or videos on to. Electrical outlets. Electricity.

In the hospitals here in rural Uganda though, things can be a little more challenging.

At Nakaseke Hospital, for example, the electricity went out during a rainstorm. There went my access to power, and to my projector. Thankfully my laptop and little Bose bluetooth speaker had been charging the whole time. So Howard held up my laptop to show the videos, and I held up the speaker. It wasn’t ideal, but it worked.

Electricity was an issue at Masaka Hospital too, but in a different way. Electrical outlets here are sparse. Many rooms have only one. At Masaka, the only outlet was at the back of the long, narrow room. The projection screen had been set up at the front of the room, near the door. It was hanging from a nail tacked high on the wall. My cords wouldn’t reach to the front of the room where I needed to place my projector, not even with my extension cord, and they didn’t have another one.

Rubber bands connecting the projector screen to the nail underneath the window casing.

So a couple of the nurses who arrived early for my session helped me improvise. We carried the screen over near the outlet and balanced it on three heavy, wood chairs. But there was no nail here to hang the screen from. Not in easy reach, at least. And without something holding the screen up, it simply flopped to the floor.

There was a nail above the window, behind where we were trying to hang the screen. But the nail was obscured by a piece of window moulding. The hanger on the screen wouldn’t reach into the tiny, tight space.

One of the women asked if I had a piece of string. I didn’t have string. What I did have was rubber bands. It took a few tries to figure out how to combine them (think back to physics: in parallel? in series?) to hold up the screen. But we got it to work, as evidenced by the photos here.

My most recent adventure brought me to Gombe Hospital, this past Wednesday and Thursday. When I arrived Wednesday afternoon, I was ushered into the lecture room, and began to set up my equipment.

“Do you have a screen?” I asked the administrator who was helping me. “Or should I project onto the wall?”

I crossed my fingers for a screen, because the wall was a mint green color. Both the patients and the palliative care team in my videos would look permanently seasick if I projected their faces onto this background.

The taped-up paper “screen” at Gombe Hospital.

“We will use the wall,” she said. “I will get some paper.”

She disappeared. A few minutes later she reappeared, with sheets of butcher block paper and masking tape. We taped two of the sheets on the wall, contiguously to make a reasonably sized “screen,” as you can see from the photos.

The first day, participants told me it was hard to see the videos. I realized there was too much sunlight in the room. For Day 2, I closed all the curtains, and it was much better.

Would it have been easier to have projection screens and accessible outlets at every hospital? Of course. But being able to use what you have rather than what you wish you had is an important life skill, wherever you are.

This was good practice for me. It was also a reminder that when put to the test, I readily adapt. That’s a good feeling.

The room where I presented at Gombe Hospital, with the improvised, taped-up paper “screen” at the back of the room.

Missing New York City, for an unexpected reason

Brevity is not my strong suit. Just ask my editor at The American, the online magazine for which I write a monthly column called Bio-Lingual.

But I’m working on it. And Uganda is helping.

A week and a half ago, a surprise reptile encounter inspired another one of my six-word stories, Hemingway style (only my second ever; I penned the first in January).

Today, I find inspiration for another brief burst of prose from the local schoolchildren:

I miss NYC. It’s quieter there.

One of the chickens that roam the yard in front of the guesthouse here in Naggalama, scurrying away as I snap a picture. A sign of a peaceful countryside, right? Sometimes, yes. But not this week.

I never thought I would call NYC “quieter” than anywhere else, much less rural Africa. For me, the countryside in any country connotes the cheerful sounds of birds chirping and bugs buzzing. Naggalama has these. Here I also hear roosters crowing in the morning, and the tap-tap-tap of hammers as men build a new home for the nuns. (I don’t mind the hammering; it’s an improvement over the jackhammers the workers are using at my New York apartment complex right now.) Sometimes the sounds of choir practice waft over from the church down the road. Or I will hear the voices and laughter of children from the secondary school nearby.

This week, it’s been more than their voices and laughter. Much more.

I think it started Monday morning. I was awake, but enjoying the fact that I didn’t have to jump out of bed. I could lie there under the sheets, in peace, and just be. This is a luxury when you’re a medical student.

Then came the bass.

thump – thump – thump

I rolled over and checked my phone. Just after 7 a.m. What was going on?

I closed my eyes again, hoping the sounds of music and exuberant singing would fade. They did not. They got louder.

After 5 minutes, I got up. It was too much, even wearing my earplugs, which I sleep with every night.

The music and singing were almost constant that day. When I last checked the time, it was 11:50 p.m., and they were still going at it.

Yesterday, I learned that this is the last week of the term for these students, which means they have a full week of singing, worshipping, and celebrating. Essentially a week-long party. I’m sure it’s loads of fun for them. Not so much fun for those of us living next door.

In New York City, I frequently bemoan the noise. The cabs constantly beeping, the clamor of construction and traffic. But my little 1-bedroom apartment, which faces an inner courtyard rather than my busy street, is surprisingly peaceful. This week, I’ve been reminded just how peaceful.

Don’t get me wrong. I’m glad the kids are having fun. I remember how excited I was at the end of a high school semester, so I don’t begrudge their celebration. Heck, my friends and I certainly made plenty of noise in our day. And sometimes I still do, like when I’m listening to a new album from one of my favorite bands.

Thankfully, I’ve figured out how to manage the noise while the party continues. When it’s too loud for me to concentrate on my work, I shove in those purple foam earplugs, even during the day. I’m wearing them now, as a matter of fact.

Even so, I do anticipate a sigh of sonic relief when I get home. After I’ve lugged my two overstuffed suitcases up the stairs, and after my heavy apartment door clicks shut behind me.

Then I will close my eyes, and as Depeche Mode coos: Enjoy the silence.