Day 8 Bwindi

Sweat is a normal human response to heat.  It moisturizes the skin so that any breeze can cool the skin, using the principle of both conduction and convection.  The smell of sweat can be offensive, hence the market in antiperspirants and deodorants.  In Africa, you just can't worry about it.  Most people, including whites and blacks, bathe frequently and are clean, but there is no escaping the humid heat that causes people to perspire.  Generally, deodorants and antiperspirant aren't used nor should they be, because blocking this natural normal process that occurs twenty-four hours a day is not healthy, and the products are expensive.  So, I've smelled sweat on everyone I've come in contact with here at some time or another, women and/or men, myself included.  It is a normal smell and like everything else about Africa, part of the undercurrent running through the continent.

Today I went on a walking tour of the area with a guide, it was raining most of the time, but I stayed humidly dry under my rain gear.  We went to see a village, Mokono, just a short walk up the hillside.  No surprise, there was a bar and a small store.  We went on to a banana plantation where I got to taste banana juice (sweet, fermented flavor), banana wine (no sweetness at all, clear and a dry finish), and banana gin (70% alcohol--a lot like good tequila, goes down pretty easy), and a drink called Matwa, which is the banana gin plus banana juice.  Tasty, but I'd watch out.  I was offered a pint of the banana gin for $10 US and did not dare to buy it.  I'm all alone here with no one to say "are you sure"?  So, no.

Night, banana plantation worker

Then we went on to see a Herbalist, a healer or "witch doctor" who uses herbs to cure.  This was all on trails through the jungle, mud and cow dung everywhere.  The herbalist showed me a lot of different herbs that he uses--one to cure "tiredness with breathing problems" (probably CHF, maybe he was showing me digitalis...I didn't recognize it).  Also one he dripped into baby's mouths with a funnel for problems with feeding.  Also a gourd with measurements on the side that he would prescribe amounts of depending on age for those who needed a concoction of multiple herbs.  He explained how he examined the person afflicted (looked in eyes, ears, mouth, etc.), and put together the mixture based on their complaint.  It was horrifying, not because of the herbs--there are many that are effective against various medical conditions--it was the showmanship of it, and the appeal to mysticism that was appalling, especially if, as has been reported, the people spend their money on the witch doctors before seeking medical care.

Herbalist, Witch Doctor

Last we visited a faux Batwa village, the huts where they prepared food (or ones just like them) four generations ago before they left the jungle, the family eating structure, and the ladders into the trees where the women and children would hide while the men went hunting.  They danced and sang for me (I'm not sure they did that in their previous culture), and showed me baskets and beads that they made (I know they didn't do that in their previous culture).  The Batwa were forest people, who hunted for their food, had no permanent villages, and gathered as small family units for protection.  They were removed from the park when it was created, provided housing and land, and encouraged to develop some crafts to sell to instead of begging from tourists who patronized the national park.  Of course I bought a basket and tipped them for the dance....too much it turned out--to see the expression on the "chief's" face.

Batwa villagers dance

Day 7, One Week at Bwindi

Day 7
It is thundering outside, has been for a couple of hours.  I expect wind, pouring rain, and cracks of lightening, but so far not.  Down in the valley between rows of mountains, we are sheltered from most of the storms, but in the wet season, as it is now, the rains are inevitable.  We've had two days now with no rain, and Denis, the Guest House Manager, says that just means that more is in store for us.  The air is still, as it generally is before a storm, and I can hear all the sounds of rural Africa.  The river down in the valley echos as a backdrop, but the rooster also crows and the cows moo, louder as it gets closer to milking time.  There are pygmy goats as well, who wander about eating, but they generally are very quiet.  There is also the sound of drums, and the sound of people.

The Guest House sits above the hospital, and there area always people there, talking, laughing.  But there is a whole village around the hospital as well, and here, where the equator is a mere 1.05 degrees latitude north of us, people's lives are lived outside, except at night.  So babies are crying, although not as much as you'd think.  Many babies are carried on their mother's backs in a sort of sling, and are content there.  People are talking, singing, washing clothes, and generally carrying on their daily living tasks, all outdoors.  I've only seen one dog, loose of course, and he didn't look like anyone's pet.  Of course there are birds singing, some loud squawks, and some parrot like bird that I haven't been able to see yet.  I did see a Grey Crowned Crane, which is the bird in the middle (facing the staff) of the Ugandan flag.  The bird was chosen because it was on the crest of the Uganda soldiers when they were a British colony, and also for its gentle nature.

I don't know what I expected as a back drop to the scenery and weather, but it wasn't the sound of people and farm animals here in the African jungle.  There are also a lot less bugs than I expected.  I've seen the dreaded malaria carrying mosquitoes  and I've had a pet gecko in my room for a couple of days (he's now gone), and the wood ants are nothing to fool with (so I've heard, and you don't need to tell me twice).  I heard about a big snake, but no-one came to get me to take a picture, so haven't seen it myself.  I've also seen and tried to photograph the red-tailed monkeys who are all around, but the monkey moved, and the camera moved, and it's all a blur.  I have not seen any gorillas, nor lions, hippos, or other large animals.

Reverend Bernard gave the Good Friday prayer this morning and drew an analogy of how Jesus must have felt as he gave up his life on the cross, as the Reverend remembered the day in 1979 when soldiers from Tanzania (to Uganda's south) crossed the border and stormed Kampala to oust the dictator.  He said that when the people heard that Idi Amin had fled and abdicated, they relaxed and let go of their terror.  It was what he was thinking, and I would never question a Ugandan's interpretation of religion or oppression.

Here are the classrooms of the Uganda Nursing School, Bwindi.

The Bench

On a bench outside the Operating Theatre sit a group of young men in their late teens or early twenties.  They come every day sometimes 10 or more, never less than one, to get circumcised.  There is a profound look of concern and anxiety on each face  as he clutches a prepared booklet of handwritten instructions that tell him  what's to come, theoretically reducing his panic.  It's a big business here in Buhoma at Bwindi Community Hospital, and I was curious why young men at the beginning of their sexual experience would wait hours for a circumcision.

The bench

USAID, sponsored by the US Government, pays the hospital to do circumcisions, having done the research to show that circumcised men don't spread the HIV virus nearly as much as those who aren't.  In fact, the rate of HIV infection in Uganda is now 6.7%, down from I don't know what.  Here's what Jane described.

At the height of the epidemic, whole families would be affected.  It was not unusual for a 14 year old girl to be left an orphan, having the care of 6 or 7 younger children, all affected, as was she.  Spreading the disease even more were those who were infected and choosing to partner with those who were negative, as if somehow they would be made well again. There were so many dead that there was no one to bury them.  As a result, the villages created groups of men and women who were willing to be a sort of burial squad...the Bataka, or "people of the land".  They buried those who died in shallow graves in the fields, no formal graveyards and no formal services, there were too many and there was no time.

The Bataka are used now in community outreach to contact the young men, telling them the stories, which they well know, of the AIDS virus and what it does.  So their serious expressions tell not only their immediate concern, but also about their sense of responsibility, not only for their own lives, but for those who they love and will love in the future.  This is a serious business.

The irony is that yesterday, together with all of those on their tea break (every day at 11:15 and it's HOT tea) I watched CNN and the US Supreme Court debate over same sex marriages.  Everyone in the room looked puzzled and eyeballed me as if I could explain this craziness.  They told me that in Uganda the only reason to get married was when you wanted children, so they didn't understand at all why there was a fuss...people of the same sex can't have biological children, so why worry about marriage at all?  I responded that I thought it was a waste of resources to have the debate, that people should be able to do what they wanted, and they thought that was pretty funny too.

Today's picture is of my bed here at the Monkey Guest House

Bwindi Day 5

Providing electricity for the school involves bringing it from the hospital via two additional poles and a drop.  The local hydroelectric power company is getting us a cost for that.  However, that's only the beginning of the story.  The power generation is excellent in the wet season, and sometimes has enough surplus to last the dry season as well.  When it doesn't, power cycling begins among all of the customers on a rotating basis.  This means that the school will need a generator for those times, such as the hospital has.  Happily there is a generator supplier in Kampala, in fact two. We also will need a converter.  We priced the generator, but have not yet priced delivery, which will be significant.

We also priced 3-1000 liter holding tanks for rain water.  We now need to understand how to outfit a commercial kitchen and handle furniture procurement for the dorms, staff accommodations, classrooms, and offices.  We thought we had done well to outfit the lab!  Jane has done a remarkable job of getting the information gathered, but there is so much more to do that we're a bit overwhelmed.

It turns out that she needs to go to Kampala next week to see the attorney at Uganda Christian University (UCU) to finalize the Memorandum of Understanding that must be signed with UCU in order for Uganda Nursing School, Bwindi to provide a diploma.  We've discussed my traveling with her because we can see the commercial kitchen at UCU and perhaps see, measure and get estimates for  furniture if there's a vendor there.  So then she tells me that she's getting married next weekend as well, AND I'm invited to the wedding that will be held at her village--she'll be traveling there from Kampala.  The logistics and arrangements are daunting.  I asked her how she normally traveled to Kampala, and she takes the bus--12 hours, then stays the night and takes a taxi to do her errands, and comes back the third day.  Alternatively, she takes a night bus, sleeps a little on the bus, does her errands during the day, and comes back the next night.  Neither of those would be appropriate for me, for many, many reasons, so we are investigating a hired car, or renting the hospital vehicle.  Happily, there is almost a week to plan.

Today's story is about the oats.  As I've told you, there are Danes staying here, medical students, who've been here seven weeks.  Evidently, they were served oatmeal (the oats) when they first arrived pretty regularly, and they even asked for them as opposed to the unrelenting eggs, toast, and occasional sausage.  The oats consequently ran out three weeks ago, and there were none to be found in the village here or Kihihi.  Yesterday, a Scots couple, both of them physicians volunteering for a year at Bwindi Community Hospital and returning from Kampala, brought three containers with them to much celebration.  Oatmeal was served this morning to great acclaim--I had eggs, toast and sausage.  I like oats, but I hadn't the heart to take away from the stash.  The Danes are here for another six weeks.

Emile and Anna

Meet Robert, the Head Nurse for Nursing and Midwifery at Bwindi Community Hospital.  He will be one of the adjunct faculty at the nursing school as well and is struggling to implement the nursing process and nursing care planning at the hospital.  I told him that the school would take care of that, and that he could assume that our graduates would be doing care planning every day for every patient.  

Robert, Head Nurse, Bwindi Community Hospital

By the way, if you'd like to know more about the hospital, see their website.  http://www.bwindihospital.com/

Day 4: Bwindi
The day started as usual with prayer and announcements, briefer than yesterday.  Jane and I are making steady, but sure progress, and you should meet her.

Jane Anyago

We took a trip over to the school to see the progress and plan the furnishings, and worked more on the budget for opening this school in November.

The maternity department at Bwindi supports women's health in many ways, but one of the most profound visions of that is shown by the area surrounding the maternity unit.  There is a women's hostel where those who have high risk pregnancies or live too far away to be certain of reaching the hospital come at week 36 or 38 to stay until deliver.  They bring their other children with them and also their bedding and food for cooking.  They pay a minimal amount to stay, but are in the company of other women to learn, be supported during labor, and have ready child care when they deliver.  They also sit in the sun on the grass or in the shade and teach each other about living, motherhood, men, and various other things that women need to know to survive in this harsh area.  The image of the colorful laundry hanging in the open area expresses all of that.

And then there is Nurse Ruth, who works in Pediatrics.  The nurses here in Uganda have the core responsibilities of nurses everywhere, but do a variety of things and see many visions that we in the US might never experience.  When was the last time you gave an anti-helminthic?  More about that later. 

Nurse Ruth at morning meeting

We are having company for dinner, a visiting physician from England and his wife.  They'll be with us until Saturday.  Two Peace Corps workers will join us, who are staying at the other guest house.  They will be housed locally, and work on projects here in Buhoma, the village where the hospital is located.  Jane showed me a large plot of land that has been bought by an Englishman and planted for crops for the local villagers.  His plan is to teach them how to grow and incorporate vegetables in their diet.  I've been discussing this abundance of help with Denis, the guest house manager, who believes that the closeness of this area to the Bwindi Impenetrable Forest, and other beautiful spots in Uganda as well as the Mountain Gorillas, makes it very visible to an affluent group who can also see the great need.  In this remote area of Uganda, which is off the grid and 12 hours from the nearest large city, poverty and need are overwhelming.  Help is also given by those who can.

Day 3 Bwindi

Day #3 Monday

My first day of work was today.  Each day at Bwindi Community Hospital starts at 0800 in the area outside the outpatient department with a prayer and meeting of all staff who can attend.  Reverend Bernard read scripture about Jesus and the Last Supper, and then chastised those who had found other things to do than attend the services Sunday afternoon, telling them that as part oft the community, it was their obligation.  There of course was singing and clapping. I felt righteous, having done my part.

The Hospital Administrator, Charles, introduced himself and again welcomed me.  He and a group from the hospital were spending the day going out to one of the nearby communities--"visiting their stakeholders".  During these visits, they discuss the upcoming nursing program and also recruit participants to the health plan that the hospital has.  Patients pay monthly for the ability to use the hospital services when they need them--sounds kind of like insurance.

Jane and I attended a "Learning", held each Monday and Wednesday in the Dining Hall--all interested staff may attend.  The presentation today was provided by the HIV Outreach Team who travels to surrounding communities to educate and provide testing services for HIV.  The raw data was presented by a volunteer from the community who is part of the team and HIV positive.  She said: "I'm the advertisement for the reason to get tested, I live a full rich life with HIV."  The numbers tested had declined slightly over the previous year and the team felt it was due to a lack of funds.  They have not been able to visit the villages the day before to promote the next day's testing, relying on radio advertising instead.  There was a lively debate which it was a pleasure to watch.  Gently, and without blame, the group questioned the conclusions and discussed other ways to recruit, as well as point out different ways to determine success.  The dentist told a story about traveling to a village to provide dental care and, finding no one waiting, going to the school and asking the teacher to send all of the students home for a visit to remind their parents.  He got 10 patients.  Another asked whether they were looking at the right data...he wanted to know why they were not tracking those who tested positive to ensure that they had received follow up care, asking "Isn't that why we want to test?--in order to treat?"  There was no defensiveness, and no animosity among the group, only love and support.  They elevated their practice, and provided ongoing quality improvement by their actions.

Jane and I have been charged with developing the budget for supplies, equipment and other costs associated with the school and we are already late.  We organized the data and were pleasantly surprised to find much of the work already done, just needing to be combined into a presentable form.  We worked on that today, tomorrow will take the plans and go over to the school, taking pictures of progress, and placing furniture where it will be needed.  If we get that job done, we'll travel to one of the local schools to get an understanding of what it takes to outfit a kitchen for 3 meals a day....that's what the schools provide.

Jane and Charles (the administrator) have gotten a quote for a BioGas generator in order to fuel cooking. The BioGas generator will produce methane from the septic system.  There has been some discussion about whether the location of the septic was close enough to the kitchen to be economical to transport the gas, but evidently so.  We'll include that quote in the proposal for funding to Rotary International.   The electricity to the school may be able to be provided by the process which the hospital uses, a small hydroelectric company that is locally run.  Rain water caught in barrels will provide drinking water.

I had a surprise when I visited the restroom, for which I wasn't prepared.  The toilet was the eastern variety--within the floor.  I've used them before, but it takes thinking and practice, as well as strong leg muscles and a sense of balance.  I'm not always good at all of those things at once, so also need a potential hand hold.  I was only moderately successful.  Happily there are hand-washing stations everywhere.

Breakfast:  Scrambled eggs, toast, water, fruit, Nescafe.
Lunch: Beans, rice, plantains
Dinner:  Fried fish (probably perch), rice, mashed potatoes.  Oh what I'd give for a salad...

Monkey Guest House

I sleep at night in the back bedroom, which has two bunks.  Happily, I'm the only one in there.  I have a mosquito that wraps around the bed, and there's an open window with bars and hard screening attached.  There is a communal bathroom, but it has a real toilet, and a shower with a trickle of hot water.  Meals are served at the big dining room table in a great room.  My home for the next month.

Bwindi Day #2

Church of Uganda at Bwindi Community Hospital

Bwindi Day #2

NOTE:  In order to post a response you will need to have a google account.  They are easy enough to set up, just be aware.

Still recovering from jet lag, I was awake at 0100 for good.  I rested after breakfast, and spent the morning visioning my camera returning to me, having found Houssein and asked him to look in the pick-up truck and under the seat for my very small, but very precious camera. 

At 1500 the guests were all invited to attend Easter thanksgiving services for the United Church of Uganda-Anglican, held at the hospital in the administrative wing.  To follow was a good bye ceremony for 2 of the staff who were leaving the hospital.  Just before they started, Aida, the Communications Officer returned my camera to me--Hussein had found it!  So I have pictures to add to the blog. 

Other guests at the Guest House are a videographer doing a documentary on the Batwa pygmies, and two medical students from Denmark doing a rotation at the hospital.  Last night we were joined by four people from the other guest house who are part of a sonography company interested in and training sonography techs.  They are providing ultrasound machines used during pregnancy and the training to go with it.  I was excited to discuss the possibilities with them for including this training in the second half of the program during the midwifery component.  We exchanged cards.  Then the videographer, who is a Rotarian from Nevada City told me about an email he had received from the West Sacramento Rotary club seeking input on whether to support the Rotary International grant that is being submitted by Sacramento.  Since he is now very familiar with the project, thanks to dinner table conversations, he was happy to do so.  That must be what Scott and Carol Kellerman had in mind when they developed the Guest Houses and organized them along the hostel model. 

The Ugandans take church and all ceremonies very seriously, although not time as a specific thing to keep track of.  After starting ½ late, we were there 2 ½ hours, and the choir sang 14 songs, every stanza of each.  And then the good-bye ceremony started.  There was more entertainment, and I’ll say that the singers were excellent, heart-felt, and fervent in their religious expression, while all the time having a good time.  I was introduced, and received well wishes from all present.  There were many babies, and the Ugandan women were stunningly dressed with head scarves, dresses, good shoes.  They were beautiful.  All this in the midst of babies needing feeding and rocking, and a pouring rain storm.  Swallows flew in and out of the service, stopping to perch on the rail around the second floor balcony, and I swear they were joining in.  Dr. Burundi played the electric piano, which also had percussion, so it was quality entertainment.  Then it was time for dinner, for which I didn’t stay.  I’m still full from lunch.  I heard that it was utensil-less and pork, all parts.

For breakfast, we got one piece of toast, eggs (omelet or scrambled) and fruit, which was a banana and some very ripe watermelon.  Nescafe, tea and water are on offer all day and night, but there’s no ice (no refrigeration) and nothing else.  I’m already a bit sick of warm water, and you haven’t really experienced the need for coffee until you’ve settled for Nescafe with powdered cream…..it’s hard to find the resemblance to coffee in that mixture.  For lunch, it was spaghetti, Uganda style.  Some meat, sauce of tomato origin, over spaghetti, surprisingly good, but I’m still full.  And I’d probably pay $100 USD for a cold beer (or two).  It’s early days, but the Danes are game for finding some next weekend, but it won’t be in this area, perhaps Kihihi (40 km away).  

Eggs are served with most meals, and I love eggs, but the yolks are very, very pale.  The chickens are all free range and plentiful.  It seems that since they eat lots of grass, they don’t get anything to make the yolks yellow, they are pale—I think I’ve also heard that it’s a sign of iron deficiency in the chickens, now why would they be any different?  Overall, we probably eat better than 90% of Ugandans, and certainly higher than those in this area.  I'm not complaining,just discussing what there is to discuss.  Food is always important.  

I've made a list to begin discussing with Jane.  I wish I had a large chart pad to use as a brain storming device, but we'll make due.  I'm excited to get started.

Day 1: Travel to Bwindi from Entebbe

Day 1: March 22

I arrived about 1100 at the Monkey Guest House here at Bwindi, having flown from Entebbe on a 13 passenger propeller plane through rain to the mountains.  I was driven through the red mud, gully crossed roads by Hussein, who aired up his tires for my comfort.  I told him I'd been on roads like this in Nevada.  

Mist covers the valleys and mountain tops, but all is green except for the houses and the road.  People walk in the road to and from their business of the day.  There were at least 10 men at the Petrol station to help air up the tires, 5 men in Entebbe to help lift my suitcases up the stairs at the airport, 3 men and the woman pilot to help unload them at Kihihi Airport, 40 km from Buhoma, the village where Bwindi is located.  All labor appears to be manual…no electricity here except in the hospital and guest house and supposedly it’s solar, although I haven’t seen the panels.  There were many women with head burdens and I saw one with three small girls all walking with their head packages, it looked as if she were teaching them.  Pedestrians take to the ditches for vehicles, even small children.  All are curious about white faces. also very reserved--no smiles.  

Hussein explained that there are three roots of the many dialects spoken in Uganda.  Each dialect with one of the roots can usually be understood by those within the root one.  In Entebbe, they spoke Lugandan, here in the southeast, it's Rukiga.

Hussein showed me the Congolese border in the distant peaks, which is closed.  Along the way we had given a ride (back of the pickup) to a couple of soldiers, one with a gun…who was several miles from his destination.  We picked up a second in uniform, but without a gun.  We let them both out at the tea factory.  The soldiers patrol the border to prevent raiders from coming across.  There is a barracks not far from the village, Buhoma, where the hospital is.  He assured me that their president had promised there would be no more raids after the last one in 1999.  Fourteen years is a good long time to feel safe.  But Denis, the Guest House Manager also introduced me to Joshua, who is the nighttime guard.  The hotel in Entebbe had a fenced compound, with a gate and guard.

The hillsides and valleys are covered with tea plants, with some being hand-harvested.  One hilltop had women plugging rice plants—I guess at the start of the wet season it grows without irrigation.  The hills are softly molded, bespeaking the age of the countryside, with streams and rivers in the valleys, running brownish red with the rain.  Everywhere people are walking in the road, both directions.  

I had lunch here, some potatoes with mayonnaise, a small sausage, and a delicious cabbage salad.  There is tea 24 hours a day, and Nescafe with powdered cream.

 

I met Jane, the Director of the nursing school about 1430 and we had a tour of the hospital, without invading privacy.  I had been walked over to the hospital by Dr. Bugana, who was at lunch and is the Executive Director, turns out.  He showed me wood ants on the trail (very poisonous).  They were swarming across the trail as ants do.  There was talk of a snake, unseen, but I did see a small monkey in a tree briefly.  When I ran into the doctor a short while later, I mistook him for the hospital administrator, Charles and was embarrassed when he reminded me he’d had lunch with me.  He was sympathetic and said that when he’d met five new people at the Guest House, they all began to look alike to him.  Joke on me, although it wasn’t a joke. 

Jane and I walked around the hospital, a small boy was at the exit from the Pediatric unit, holding the large iron door.  I looked around for his mother.  I didn’t see anyone watching or concerned, but he also didn’t go out, probably already knew enough to stay put.  It was hard to tell if he was a patient or not, since the whole family comes when one is sick.  I didn't notice many men around, except one waiting for a circumcision…the doctor said they do several each day--but there were some in the maternity wing.  We walked over to the school, still visibly under construction.  It will be beautiful, but is very rough at this time.  There is a great room and administration building, with offices already designed.  I told Jane she needed the corner one with two windows.  There is a computer lab and a faculty office area.  The central area is for student work and study.  The dorms outline the perimeter, the kitchen area is open, with some sewer connections.  The dining hall and storage area on the other side….no connection between the two sides, which I’ll ask about, but it does bring up a clear almost class line between the professionals and workers, which I’ll ponder later.  I’m uncomfortable having people cook and serve me continuously, do my laundry, and watch me for what I might need.  They don’t do it out of concern, but because it’s their job, but they do it politely and with integrity.  Moses got as irritated as he probably gets (which is not much) when one of the dinner guests from the other Guest House was fooling around with a broken guitar when dinner was about to be served.  The rule is you sit down-at your own specified time-and they bring your plate.  This 20 something from Vermont, was just a kid on a trek who was exploring his surroundings, and hadn’t a clue until his (female) partner said, “I think he wants you to sit down for dinner”. 

Jane wants to start work Monday morning.  I’ll go to the meeting at 0800 where the staff plan and discuss the day in the Outpatient Clinic, then we’ll get started. Everyone has consistently said how much they’ve been waiting for me to get here, and are happy that I am here.

One example of their challenges is childhood malnutrition.  When a child is malnourished, both Jane and the pediatrician, Leonard explained over dinner, one of their goals is parent education.  They have a garden where they show the parents what foods to grow for the children and they do lots of other education as well.  Leonard said that the children's diet is high in carbohydrates and very deficient in protein.  Also, once they’re weaned the parents tend to feed them an adult diet, which does not meet their needs.  He says bananas are bad for children, especially since the ways in which they are prepared removes all nutrition.  However, just as in the US, malnutrition always has a social component, such as a mother ill or dead, or money being diverted for alcohol.  Also, the ground to cultivate for even a small plot is of poor quality because the tea plants take the very best soil, which led to a question about who owns the land, and he said ownership pre-dates colonialism, which I found fascinating, but in this corner of Uganda, evidently it’s been handed down from ages ago through the former tribe structure and is now divided up many times.  He says, it’s just “known” whose land is owned by whom.  Huh. 

So we certainly have to include much about nutrition in the curriculum.  I did tell Jane that I thought the basic curriculum to create a diploma nurse was adequate and doable--we didn’t pursue the topic.  

I'm in the backyard at the Guest House having morning Nescafe.  There are a mother and child red tailed monkey in the trees above me.  Pictures later.