Budongo Forest and Chimpanzee Treking: Safari Day #2 (Morning)

Our second day started off with an added-on Chimpanzee Trek. This, I highly  recommend! Anyone with the opportunity to silently watch chimpanzees in the wild, must-must-must take the opportunity. With 98% similarity between our DNA and theirs (Yes! This is true), chimpanzees are the closest living relative to humans. It is an understatement to say how uncanny it was to observe so many human mannerisms. I was able to see breastfeeding, hand grips, lip smacking, scratching bellies, combing each others hair, folding arms behind head to rest … so very entertaining!

To see them in their natural habitat, you being just a few meters from them to see them foraging in the wild, building nests, tending their young, not in zoo, but in an African rainforest in Uganda, that experience cannot be replicated anywhere. I am so glad that I went.

A large area of wildlife called the Burongo Forrest that is directly south and attached to Murchison Falls National Park. We met out guide about 7 am to begin the trek into the rainforest, fingers-crossed we would find the chimpanzees. This is the only caveat of the trip – it cannot be guaranteed that anything will be seen. It took us about 1.5 hours of walking in silence, stopping every 15 minutes or so to listen, smell, and look out for the big fruiting trees where they most likely would be feeding (well, our guide was doing all this). We wandered deep into the forest and our guide decided to go right rather than left because he saw knuckle prints in the soft dirt. This indicated they had moved in this area only a short time before.

 I could smell their urine and musty smell before I heard or saw them. We saw a nest that had likely been inhabited the night before, which indicated we were on the right track. A huge fig tree emerged in front of us and there they were! Four or five families were there together with only one dominant male. Our guide said they were quieter with less fighting on our day because there was only one male (go figure!). Lots of mothers and babies in our group, which was so fun watching the curious little ones.

We watched for about 1 hour and then trekked back. It took all morning long and was highly worth my time! Because this was part of our whole tour package, I am not 100% on the cost. I could not find it online anywhere. I think I heard someone mentioned $65 USD?

Jane Goodall has been to this same forest doing her research, which is a pretty cool thing we now have in common. Did you know she can ‘speak’ chimpanzee?

Impossible!

Impossibly hilarious ... I caught this baby late the other night. The next morning, the family informs me that they are certain this baby looks just like me, "chin and all", they say.

Umm...do what?

No amount of convincing them that actually she looks like her own Mom worked.

I relented and was forced to agree.

Ah, the conversations I get myself into here.

Meet Little Elizabeth

Gloria holding Elizabeth.

Up early for a beautiful birth at 4:15 am for a young 18 ? year old who barely made a sound … the baby was premature and came too early, but made for a rather easy pushing stage for the mother because of the small size…

(Was she really 18? The TBA taught me today that 18 is a popular age because anything below that, the family could take the father to jail for rape … )

...having no plans for a name, the Mother-in-Law and Village Midwife decided it best that I name the baby … (having the white woman, I have learned, name the child is very much liked by all)

Gloria, her mother-in-law and the Village Midwife, Paraseska

…cute as a little button and works so hard just to eat, breathe, live and survive given the odds here & her prematurity … I named her Elizabeth, after my sister – not that she was premature or has to work hard to eat, breathe, or live, but I just thought it fitting...Then again, maybe as an ER Resident her similar needs of basic food, sleep and warmth are more parallel to her namesake here in Uganda than I originally thought!

 

Happy Birthday to me...Ugandan style.

My BD was yesterday and unless you *truly* remembered or are getting the emails I’m sending outside of this blog, you wouldn’t have known. I avoid having it be a part of the massive on-slaught of FB posts from people who otherwise wouldn’t care …. So, thank you to the few true friends and family who sent messages. In remote Africa, they mean more than I can ever adequately explain. Truly.

So, I am officially 35 now. Even I can’t believe it myself, probably more so than my parent’s disbelief because simultaneously my birthday ages them another year. We’re all growing up, I suppose. 35 full years! Time is going so fast! And it feels really good and nice and all the things that I guess “aging gracefully” encompasses. Plus, no wrinkles! Double bonus.

This year I am thankful that I am finished with school (for now!) and in a place that I truly love, doing work that I feel is so much a natural outpouring of me. It fits me well in so many ways - all the grit, dirt, grime and energy it takes being here included. I often daydream of what a life here would look and feel like full time, knowing deep down that this isn’t the end for me here….maybe not necessarily here in Uganda, but here in Africa somehow. Of this, I’m pretty sure. 
Predictably, I feel more at home here than even at home in Mississippi - or the USA. I reflect and am shocked how long I can exist there in an imposed ‘coast’ mode, obviously in the wrong place. After 2 years of Graduate school, taking Boards and immediately hopping the first plane, this truth is very evident to me now that I am away. This might not make sense, or even be offensive to some, but in  deep, meaningful, yet subtle ways I know it is true. What this might mean for my future, I’m not entirely sure, I just know that I am 35 now and not getting any younger.

All this narcissistic hogwash to say, I am really glad my BD was spent here … despite it being radically different than any other … it was one I’ll never forget. In a quick nutshell, all I asked everyone for was eggs and one chapati for my BD breakfast. This is basically a fried doughy bread that I fill with eggs. They call them a Rolex here (Yes, like the watch). We have them periodically but it is a lot of work to make the dough, roll them out and then individually fry each…but they are SO good...and pretty much the extent of BD presents to receive in these parts. This, and coffee with fresh milk from the guy who comes each morning to sell us fresh raw milk from his nearby farm. Simple request, no? I even pilfered the last two eggs to assure this one birthday wish.

In typical African style … none of it took place. And, in fact, we ran out of food. For 2 days, we were skimping on the basics and desperately needed a trip into town for food. But, ...in also typical African style ... our car broke down a few with a broken engine block days before that so we are stuck with very little transport and a dwindling supply of rice and beans…. Ahh…the realities in remote Africa.

Fortunately, a very sweet student here used some rationed millet flour to make her best biscuit attempt and brought them to me as a replacement breakfast. It was very kind. Later on, another midwife was packing to leave and discovered ½ a Snickers bar in her bag which we then cut into a small piece for everyone. This 1/8 of a candy bar dubbed as my cake alongside a candle that she melted from pieces of leftover wax and made for me to blow out.

The Birth Center was oddly slow, so I painted and sewed, played backgammon and got into great conversations about world religions and its effect on modern society. It was a perfect day of drinking tea and relaxing. They sung Happy BD in 3 different languages and the day ended with a group movie.

It truly was all that I needed to turn to my 35^th chapter of life. Thank you again to all those who remembered and contacted me – such special people you are.

Village Outreach 101

So what is a Village Outreach?, after getting so many questions to explain…

My hands are definitely my best assessment tool here.

   

There are several villages that surround our Birth Center that we travel to twice a week to hold Prenatal clinics to avoid the women having to travel to us. This is a service that we offer to be able to reach more women.

These villages can range from 30 minutes to about 1.5 hours away, traveling on bumpy dirt roads in our Jeep (aka ambulance). We go in small teams and see the women here just as we would here.

The Traditional Birth Attendant from that village is responsible for mobilizing the women to be present when we arrive. Ideally we aim for 10 am start … but as typical in Africa … there are many, many things that usually prevent us from arriving on time. And - the women patiently wait. I’ve never, ever seen any frustration from any of them towards us. Waiting is just a part of this culture which is so opposed to any waiting room I’ve ever witnessed at home. Think of the last time *your* appointment wasn’t on time and there were 20 people ahead of you…

The idea of being seen multiple times during a pregnancy, like at home, is almost non-existent here. We are lucky to have seen them once or twice the entire time, sometimes seeing women for the first time when they show up in labor.

Our visits are much pared down to what the ‘standard of care’ is at home – doing no lab work, very basic prenatal history and at the most giving them prenatal vitamins. … and surprisingly, this works! I have only seen 2 fetal anomalies since being here (something is wrong with the fetus’ growth/development) and most babies come at or beyond 40 weeks …

Christine, our translator. Something I said was probably lost in translation

Which brings up the next point: dating a pregnancy. Who really keeps up with their period date anyway? I certainly don’t. So, it’s all a best guess. With no such thing as ultrasounds or dating scans, we do our best to gauge how far along she is – while taking into consideration the measurement of her belly, fetal heart tones, her perception (which is nearly pretty accurate for these women who have been pregnant many, many times … they just know) and our best guess. It completely erases the dogged demand to know how far along she is.

Waiting Room

Here, it doesn’t really matter. Inductions are not routine like at home and women simply go into labor when they go into labor. There is no lab work done throughout. Village birth is fairly simple: You make a baby and then you have a baby. There are no bells and whistles complicating the process  -- it has certainly proven and reassured me that Birth simply Works!

The women here are extraordinarily healthy. Their physique from working so hard in the garden – and LIFE – makes them healthy and strong. The most I treat here is UTI (urinary tract infection) from dehydration and lots of malaria, which I've had to do a lot of learning about because it simply is not part of our world at home. Occasionally, there is back pain from a particularly stressful digging day – at 39 weeks pregnant! – that a Panadol easily relieves.

 

I have been impressed of the ease of pregnancy & birth, especially coming from a Western training where hospitalized obstetrics was my training ground. The majority of time, it really is as easy as Sex >> Baby >> Birth.

Hope you can see the curious cow out the window.

Sunday Funday

This shot pretty much sums up my Sunday...sewing while swaying her to music. This is the life!

Ziwa Rhino Sanctuary, Uganda: Safari Day #1

The next few posts on this blog will be chronicling a 3 day Safari I took in Western Uganda during the last week. It is September and the Rainy season here, which impacted the trip both good and bad. I don't think there is a "perfect time" to take a safari, but perhaps better times than others to consider coming based on your interest area. If you were like me and just wanted a great overview of "The Big 5" and was generally up for a typical Safari experience then anytime of the year would be sufficient. 

The information supplied is my best attempt to inspire or encourage readers to make the trip to Africa for a safari themselves. It is a "Bucket List" type of thing and ranks (for me) up there with some of the most memorable experiences of my life. I have never been on any other safari, so I cannot compare to other countries or touring outfitters or guides. This is solely my experience so take it at surface value.

Ziwa Rhino Sanctuary

Ziwa Rhino Sanctuary is home to Uganda's only rhinos – making this a must for anyone who has come to Uganda to see Africa's "Big Five"! (Elephant, Lion, Buffalo, Rhino and Leopard)

Tracking these enormous creatures on foot through the savannah and swamps is a thrilling experience, and one I found to be so exciting. We arrived after about a 4 hour drive from Gulu with our tour guide, driver and two of us -- another volunteer Midwife from Israel made the trip with me.

This sanctuary is a result of the Rhino Reintroduction program after the last Rhino was killed in Uganda in in 1983. The war was going on here during the 80's (see previous posts re. the Birth Center I am working at and the history of the war) and as a result there was very little control over poaching rhinos. It is the horns that are prized -- mainly for Chinese Medicine and the liquid inside that is equivalent to Viagra.

Rhino Fund Uganda was formed to protect with the ambition stated as:
"To everyone young or old who has had the privilege of seeing a rhino in the wild or even in a zoo, you will be horrified to see what is happening to these magnificent animals. "

(All of this info was taken from their website, including the pictures)

There was a time when rhino poachers were almost always on foot, armed with only rifles. This trade has become so big and so financially beneficial, we are now contending with the following:
1. Helicopters
2. Poachers with military training
3. Expert veterinarians
4. Top of the range communication and equipment
5. Lots and lots of money

 

Most rhinos being poached today are darted with the very same immobilizing drugs that we use when we are giving them veterinary care. The horror of this is that while this majestic animal’s horn is being hacked out of its face with a machete or panga or being cut off with a chain saw, the rhino is fully aware of what is happening to it. The pain it is going through can be compared with the immense pain you would feel if someone was chopping one of your limbs off while you are awake.     

 

There are many cases where the rhino carcass is found with tears running down what is left of its face and rhino with chopped off faces have been found wondering around while bleeding to death.

We are dealing with a rhino poaching mafia that is so organised, wealthy and so well protected by their legal aid it is like fighting a losing battle. When you win the battle of arresting the poacher or carrier, you then have the war of overpaid attorneys who are protecting these thieves to contend with. Clearly there is no difference between the man with the machete and the man with the porché – they are the very same breed of evil.

Close your eyes for a moment, picture this process of poaching, imagine the trauma and pain that this animal is going through for an age old tradition that has created a frenzy of greed amongst beings with no consciousness.

___

The reintroduction program has been given rhinos by South Africa and the USA and has bred 6 of it's own over the years. Each rhino has a name and a personality and our guide was great to talk about each of them as their own.

There is a guard that treks the rhinos 24 hours a day and is there solely to protect from poaching. Our guide said there had been no threats since the sanctuary opened, but they aren't willing to risk it.

Mainly the rhinos sleep during the day and eat and swim during the night. When we were there, we were able to drive into the sanctuary with our guide, kitted out in long pants and gum boots to go walking through the wet grassland savannah to find a group of them resting. The guard also helps with this as he always is able to communicate where the rhinos are.

The group I saw consisted of a few 'teenagers', one male and a few females. In July, a new rhino had been born and the guides were very diligent on keeping us away from that mother and baby as the suspicion that she would become aggressive and protective was high.

Interesting fact -- they only eat grass and are in fact vegan!

Once the group gets to #30, the introduction back into the wild in Uganda.  

 

 

 

 

 

 

You can see how close we got!

 The sanctuary is a non-profit organization. There is no charge to come into the sanctuary itself, although money donated to Rhino Fund Uganda goes directly towards this program.
Accommodation is available on site - both camping and cottages, as well as a restaurant. This is also an excellent place for birding and trekking. There is a gift store available as well as opportunities to volunteer.

* A super cool opportunity for those of you into this sort of experience would be to come and volunteer as a Ranger. They accept volunteers from all over the world to help run this program and it would give you an up close look at animal protection and dealing with and handling large game. Perhaps a college student interested in veterinarian medicine, a biology major, or just someone out there that wants a cool experience!

Also inside the park were heards of African Long-Horned Steer, which I'd never seen before. They exist very peacefully with the rhinos.

This bird, which is the crested crane, Uganda's national animal.

Plus this really cool tree ... a cactus tree!

Overall, this place was a great site to see -- if nothing else because it is the only place you will see Rhinos in the wild, but also because it is a very easy add on, right to the South either coming or going to Murchison National Park for the game drives.

Where does the Placenta Go?

Not too many people give much thought to their placenta. I question why this is and strive to educate women on the amazing capabilities of this disregarded "organ". 

A placenta with the cord barely attached -- only by the vessels. This is not normal.

Once the baby is born all eyes, focus and attention seem to resonate only with the new little person. This is fine -- except for the Midwife who knows how equally important attending to the placenta is. Making sure the placenta is delivered, bleeding is controlled and the uterus is contracted down is THE biggest life saving skill involved in a birth. Postpartum hemmorhage ensues because these things do not take place ... or do not take place completely. It is an essential piece for a birth to be safe for the mother and baby. 

Because I deal with placentas often -- inspecting, comparing and handling -- I'm always so curious at the differences of each; some being big, others being small; some being filled with vessels, others being quite dull in appearance. I had one the other day that was literally in the shape of a heart (It would have made an excellent picture had my camera there). 

There are some people who believe consuming the placenta after birth is a good thing. Their reasons stem from the fact that humans are the only mammals who do not eat their placenta ... think of cows or cats or horses you've seen have their babies. After the baby is delivered, the afterbirth is then consumed. Brimming with hormones, the belief is that the consumed placenta delivers huge boosts of essential hormones to the mother making breastfeeding, postpartum depression and hemorrhage all function better. I have heard of people eating the placenta raw (placenta smoothie?) but mostly, 'placenta encapsulation' takes places where the placenta is cooked in a special herbal mixture, dehydrated and then ground to a powder to place is capsules. 

Of course, the details and opinions of this are too much for this one post. You should out this for  more information. 

Here in Uganda, no one eats their placenta. It is very normal; however, to delay clamping the cord for several hours after delivery. This entails placing the placenta in a covered bowl next to the baby on the bed. It is really not a big deal and allows ALL of the blood in the placenta to drain into the baby before cutting. So much research has looked at the benefits of this practice ... and so far, on all indicators, it is preferred and is practiced by many Midwives. (This would be something easy to request from your OB/GYN in a hospital birth if he/she is not already doing this as a routine part of their practice)

Once the placenta is cut, the Traditional Birth Attendant then takes it into the 'bush' ... a large grassland area behind the birth center to bury it. This system works quite well...typically. Although I haven't seen it myself, I've been told of the wild pigs coming along to dig them up and running around with a placenta in their mouth! Umbilical cord behind them, flapping in the wind! You can imagine how disconcerting this scene would be for a new mother to see. 

To alleviate this possibility a placenta pit is being built. Requiring massive amounts of manual labor, the pit is being dug by hand by two local guys and then cemented inside. It is no where close to being finished, but certainly a new addition for our center.

Contraception in these parts...Marie Stopes

My internet has been abnormally slow over the last week....the lull is as frustrating for me, as you?

Marie Stopes came last week to perform family planning for our women. This is an international British NGO who rotates every 3 months through our center. Their funding comes from outside and they provide ‘the pill’, IUD’s, Implanon, and tubal ligations. On this day, we had a group of women to come for education – an overview of the different types with emphasis placed on why family planning is necessary. This was taught by the Marie Stopes team, primarily a physician from Kampala.

Of this group of women, only one stayed for contraception. I was told the rest “had to go home and ask their husband” first. Umm….

For the one woman who decided to stay, she opted for a tubal ligation. I thought, for sure, this would be done in some modified fashion vs. the OR types I observed in my training.

Instead, ‘when you don’t have an OR of your own, you make one with what you have’ took place. Laid out on a table, injected with only 20 cc of Lidocaine (you Medical people will understand!), two incisions were made, and the fallopian tubes cut. They did have sterile towels and equipment, which was good. She was instructed to lay on a mat outside for a few hours to monitor pain and bleeding and then jumped on the back of a motorcycle with her husband and went home. 

Total African style Surgery!

This series of pictures are what a tubal ligation looks like ... This is a fallopian tube.

Fallopian tube being tied off before cutting.

Fallopian tube being cut.

All with the bats (rats?) climbing in the roof above us making their scratchy, nibbly sounds, sterile field illuminated by a pocket flashlight, and no pain medicine to be had.

Just goes to show you how much of a fuss we can make very simple procedures or how normalized the operating room can be in this setting.

*photos are not mine. Taken by Rosie Meroz