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Three months on

It’s now almost three months from when we left Kisiizi due to the DVT (blood clot) in my groin.  Here’s a wee update on my progress & my reflections on our time in Kisiizi three months on.  

I wrote that post about being diagnosed with a DVT at the time, but have only just got round to posting it.  What strikes me when I read it back is how naive I was about the road ahead of me, but I’m glad I didn’t know, as I think I would have just given up had I known how difficult it was going to be!  I had previously thought DVT’s weren’t too bad, but I’ve since realised that they have a wide spectrum of severity, & unfortunately I had a particularly bad one (it extended from my knee to at least my belly button, & possibly further).  I now have a new level of empathy for all the poor patients I’ve previously treated for DVT’s.  I’m not going to lie, the past three months have been the hardest of my life.  I was unable to weight bear on my left leg for almost four weeks due to the pain &  risk of embolisation (the clot moving to my lung).  I spent most of this time in bed, & only mobilised when absolutely necessary using crutches or a wheelchair, which as I reflected on previously was a very eye opening experience.  As a previously very fit & active person I was horrified at how quickly I lost fitness & muscle mass during this period.  I’ve always been naturally very skinny, & self conscious about it, but over recent years I’ve learnt that I can give myself some shape through building muscle, so as I lost muscle mass I also lost all body confidence.  When I started walking again it was very difficult initially, as even walking a few steps made my leg swell & it would become very uncomfortable.  However, this did gradually improve.  I was determined to regain my strength & fitness, & so I have put myself through a rigorous rehabilitation programme, exercising daily, gradually increasing the work load.  However, unfortunately I still struggle to walk very far or uphill, & I can’t run or cycle, as the leg swelling & discomfort is too bad.  I saw the haematologist a couple of weeks ago & he was very honest that the veins where the DVT was (for the medical among you, my illiac & femoral veins) will likely remain occluded forever due to the scarring, & so my leg may not improve significantly from how it is now.  This was pretty devastating news for me, as hill walking, cycling, & in particular running, & three of my passions.  However, I think it was important for me to hear this, so that I can be prepared for the worst.  I sat this morning watching the London marathon coverage in tears, as it now looks like my lifelong dream of running a marathon seams unlikely to be fulfilled.  However, I’m trying to be positive, I’m determined this is not going to stop me being an active person, & I’m already thinking of alternative hobbies that will get me outdoors & being active, whilst not involving too much work from my legs, I’m considering kayaking which is something I’ve always enjoyed anyway.  I’ve also started swimming as I found that it caused less swelling & discomfort of my leg than any other forms of exercise.  I’ve never particularly enjoyed swimming or been very good at it; I’ve always fancied doing a triathlon as I love running & cycling, but it’s been the swimming that’s prevented me from doing one.  However, as with anything in life, the more you do something, the better you get at it, & under the instruction of my swimming coach (my husband, Robert), I’m very pleased to report that today I swam 100 lengths of a 25m pool (2.5km) in 55 minutes, something I’ve never been able to do before, & I actually quite enjoyed it!  So, IF I ever return to running & cycling, I will definitely now do a triathlon, & if not, maybe I’ll give an open water swim a go.  However, I’m feeling more positive this evening as I came across a blog by a young American lady who is also a runner, & had a DVT, & with lots of hard work has managed to return to running, & even ran a marathon, & feels that her running has actually helped her leg symptoms, as it has encouraged her body to develop new veins (collaterals) to help get the blood back out of her leg, so I’m going to take inspiration from her.  But, I am so aware of how lucky I am in so many other ways, & how much worse my situation could be.  I have also really appreciated all the love & support that I have received from my amazing friends & family.  And I always feel that life’s challenges, such as these, are character & strength building, & make the highs all the better.  But anyway, that’s enough of my sob story.

At the time when we had to leave Kisiizi very suddenly, I was feeling very frustrated & negative about my work in the psychiatry department in Kisiizi Hospital.  Along with my colleagues there I faced many challenges, some of which I have mentioned in previous posts.  I had been relatively well prepared for some of the challenges that we faced, such as the massive stigma around mental health in Uganda & the frequent maltreatment of people with mental illness, however, I think for me biggest challenge was having differing opinions from my colleagues on how best to manage some of our patients, in particular, as I’ve previously mentioned, their tendency to oversedate patients.  I understand that this is how they were trained.  It was difficult to challenge my colleagues on this whilst maintaining a good working relationship with them.  However, I’m pleased to report that I left on good terms with everyone!  However, with time I have become more positive about the department, & I’ve gained an appreciation of the amazing work that it does.  The British Consultant Psychiatrist who has a link with the department, & through whom I organised this placement had arranged to come out & visit  at the end of my time there, however, unfortunately due to our early departure we missed her.  However, I was very pleased to hear from her that she feels that my time there had a positive impact on the department.  Whether or not I have made had any impact, I know that my experience there has had a massive positive impact on me, both as a person & in my practice as a psychiatrist.  Additionally it gave me lots of talk about in the job interviews that I’ve just had.  I think this experience has also made me realise that I could never work longterm in a culture very different to my own, such as Kisiizi Hospital; I’ve always been aware that having a good understanding of a patient’s culture is important in psychiatry, but this is has helped me to realise the extent of this importance, & unfortunately this understanding is something I will always lack in many other cultures.  I’m looking forward to returning to work in the UK where I have a good understanding of most of my patient’s cultures.  

It’s been crazy how quickly we have adapted back to life in the UK, after living in Uganda for 5 months.  When I was in Uganda I was constantly reminded of how lucky we are, when I saw how little some people there had.  However, I seam to have forgotten this all too quickly, & I could do with being reminded of this from time to time.

Having got the go ahead from my haematologist I am very excited to announce that Rob & I are heading back to our favourite continent tomorrow, this time to travel around Southern Africa (South Africa, Namibia, Botswana & Zimbabwe) tomorrow for our next adventure.  

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Reflections on Kisiizi

Here in Kisiizi our house neighbours those of all of our fellow volunteers, & there’s a great sense of community between everyone.  We are constantly in & out of each other’s houses, borrowing things, looking for advice or a helping hand (for things like killing mice), preparing & enjoying food & drink together, & just popping round for a wee chat.  This is very different to our isolated existence in our flat back in Glasgow, where we barely knew our neighbours.  We are really going to miss it!

This is probably the one & only time that Robert & I will ever work together.  It has been nice to be able to walk to work together, enjoy our breaks together & see each other in action.

One of the best things about our time in Kisiizi has been getting to our fellow volunteers, in whom we’ve made friends for life.  We have been planning our first reunion when we’re all back in the UK.

As we’ve mentioned previously Kisiizi Hospital is a church of Uganda hospital.  It has been interesting living within this Christian community.  It is a very orthodox & conservative version of Christianity that is practiced here.  At times I have felt angered when I have heard discrimination being advocated in the name of Christianity, particularly against females & homosexuals.  At other times I have felt like I’m being suppressed, as I feel that I can’t freely express some of my views that do not conform with the conservative Christian values held by this community.  However, I have also seen many positives of Christian faith here, in particular the sense of community that it creates, & the support that it provides for many people.

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Reflections on mental health services in Uganda

My time working in the mental health service in Kisiizi Hospital has been amazing, but it hasn’t been without it’s challenges.

I came here under no illusions that I was going to make any earth shattering changes to the service in my short time here.  However, I hoped that I could make some small improvements.  I took some time initially just to observe, & try & gain an understanding of the service, & the culture of the population it serves.  I carried out several projects in areas that I have identified as needing some improvement.

One of my big concerns has been the over sedation of inpatients.  Sedation of patients with severe mental illness is sometimes necessary, in order to ensure the safety of themselves & others.  However, my opinion is that some patients in this service receive unnecessary & excessive doses of sedation, which I feel is both a violation of their human rights, & puts their health at significant risk.  This has led to some interesting debates with the staff, who generally disagree with me on this issue!  An audit I carried out of sedation of patients, confirmed my concerns that larger than recommended doses were being given.  I have now written a guideline on the use of sedative medications, & delivered teaching to staff on the issue, & hopefully this will reduce some of the unnecessary & excessive sedation of patients.

One particularly difficult time for me was when one of our inpatients died.  She had been on our ward for some time, & so I had got to know her well, & grown fond of her.  She was young & healthy, until her physical health suddenly deteriorated one day, & within hours she was dead; the cause of the deterioration was never discovered.  I was absolutely devastated by her death.  I tortured myself for weeks afterwards, over whether I could have done any more.  However, I have now come to terms with her death, & at least get some peace from the knowledge that I did my best.  People here seem to have a lot more acceptance of death.  Unfortunately here death, including the death of young people, is a common relatively occurrence.  And those with a Christian faith generally view death as part of God’s plan.  I think both of these factors contribute to people’s acceptance of death here.  We don’t only witness this acceptance on the wards, but also in chapel where we commonly give thanks to God for that we have survived another to live another day.  This contrasts to home where we generally feel we are all entitled to live a long life, which unfortunately isn’t possible for all of us, & accepting death is often difficult.

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Our sudden departure

I got to experience being a patient at Kisiizi Hospital for myself before we left.  I developed sudden swelling of my entire left leg.  Concerned that it could be a DVT (deep vein thrombosis/ blood clot), I headed to the outpatient department, where I received excellent care from my colleagues.  There is very little confidentiality among the hospital staff, & it seemed that instantly the whole staff were aware of my condition, which I didn’t mind at all, but had it been a more sensitive matter I might have felt differently.  The investigations included an abdominal & pelvic ultrasound scan; Rob & I both got a bit of a shock when the man performing the scan suddenly announced, “you have the womb of a young child”, which we both took to mean that I was pregnant, however, with clarification we realised that he simply meant that I had the womb of a young child, as I have not yet had any children myself yet.  

We had to travel to Mbarara, one of the neighbouring towns in order to get the Doppler scan to confirm whether or not I had a DVT.  The first hospital we arrived at was a government hospital.  It looked a bit like a war zone; there was complete chaos, with sick people lying everywhere & one very stressed out doctor looking after everyone.  During our time here doctors in these hospitals have taken strike action against low pay & poor working conditions, which from what we saw we can understand.  It made us appreciate how developed Kisiizi Hospital is compared with most other hospitals.  I was quite relieved when they told us that they couldn’t do a Doppler scan, & so we would have to go elsewhere, & we went to a NGO hospital down the road instead.  Unfortunately it showed that I did have a big DVT in my groin.  

Over the next few days my leg became increasingly painful. Mobilising became a challenge, meaning I had to rely on others for help in doing even the simplest of tasks, such as washing & dressing.  Robert was amazing as he patiently waited on me hand & foot, but this reliance on others was something that I found very difficult.  I also realised just how much it gets you down when you are in constant pain.  After a few days we got some crutches that were a big help with mobilising.  I was touched by the number of our new Kisiizi friends that came to visit when they heard I was unwell; I don’t think I’ve ever been the subject of so many people’s prayers!  

I started treatment which I will now have to continue for at least three months.  A British consultant that was visiting Kisiizi Hospital at this time advised us to consider going home due to the risk of developing a PE (pulmonary embolism/ clot on the lungs), & the better care that I would receive in the UK.  It was something we hadn't even thought of until he mentioned it, & after much deliberation, we decided to follow his advice; we were absolutely devastated to have to leave Kisiizi early, & in such a manner.  However, when we contacted our travel insurance company about flying home early they raised concerns about the risks of flying with a DVT.  We had an anxious wait over the next few days as our travel insurance company banded around various ideas about how I should be cared for, & in the end they arranged for my care to be transferred to a fancy private hospital in Nairobi, Kenya.  

The journey to Nairobi was challenging due to my worsening leg pain & increasing immobility, but was aided by wheelchairs, & countless numbers of good samaritans along the way.  It has been enlightening for me to experience the world as a disabled person.  One of the main things that struck me was how often people would refer to Rob, as the person pushing my wheelchair, rather than me, or refer to me as if I wasn’t there.  The hospital in Nairobi was very impressive, & we felt a sense of relief when we arrived there.  The experience of receiving private healthcare was very alien to us, where basically we could request anything we wanted, & we spent most of our time queuing to pay large bills (that thankfully our travel insurance company are going to pay).  Unfortunately when they repeated the Doppler scan, they found that the clot had increased in size significantly, now stretching from my knee to my belly button, despite treatment (although it didn’t surprise me with the pain I had been experiencing), so they increased the dose of the treatment further.  After a few days the doctor was happy that my condition was stable, & so gave me the all clear to fly home.  We then spent almost a week hanging out in a hotel room in Nairobi while we waited for our travel insurance company to organise flights home.  We borrowed a wheelchair in order to help me get around the hotel.  I just felt absolutely exhausted, & spent most of the time asleep!  In between caring duties Robert rushed around the craft markets of Nairobi panic buying gifts & souvenirs, that we hadn’t got round to buying yet.  Thankfully over this time the pain & swelling in my leg began to improve.  We finally got word that we were going to be flying home first class with Emirates, in order that I could have my legs raised throughout the flight.  Our first class tickets gave us an insight into the lives of the rich & famous with the on board Wi-Fi, personal widescreen TV, fully horizontal beds, complimentary pyjamas & toiletries, shower, fine dining & drinking, being waited on hand & foot, & chauffer drive to my parent’s home.  We very much didn’t fit in amongst our fellow first class passengers of middle-aged businessmen, as we excitedly pointed out all the extravagantness to each other, & took pictures of each other enjoying it.  I realise it’s going to be a long journey over the next few months, as the leg pain & swelling gradually improve, & I regain strength.

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More of life in Uganda

Both Rob & I’s parents came out together to visit us in Uganda in January.  They spent the first few days of their trip with us here in Kisiizi; it was lovely to share our Ugandan lives with them, & for them to meet all our new friends.  By coincidence a lot of the other volunteers’ parents were also visiting around the same time, they enjoyed meeting each other & discussing their shared experience of having children volunteering in Uganda.  One evening during our parents time in Kisiizi I invited all the Ahumuza staff round for a Scottish themed evening, it was nice to spend some time with my colleagues outside of work, & for them to meet my family, & to experience some of my culture; the haggis which my parents had smuggled in was a big hit with everyone.  We even took them to Kisiizi Hospital to show them where we work, which is something you would never be able to do at home.  They particularly enjoyed visiting the paediatrics ward & handing out balloons to the children, which brought big smiles to both their faces, & those of the children.  We then sent them off to go on safari whilst we went to work, before we all met up again at Lake Bunyoni at the end of their trip.  We enjoyed a relaxing few days, at Lake Bunyoni hearing our parents reflections on their trip; we were relieved to find that they had thoroughly enjoyed the trip we had planned for them ...& that there hadn’t been any disagreements.  We went on a boat tour of Lake Bunyoni which included visiting punishment island; this is where in the past unmarried, pregnant girls would be left to die.  Our tour guide was the grandson of one of the few survivors of punishment island, after she was saved by a passing fisherman who she went on to have a long & happy marriage with.  We were honoured to go & visit this extraordinary women, & hear about her experience on punishment island, as part of our tour.  She & her family gave us the most amazing welcome, with all the generations performing traditional songs & dances for us.  

We debuted the outdoor cinema for Home Alone on Christmas Eve, & since then it has become a regular occurrence; we have shown lots of blockbusters & had lots of satisfied customers.  All viewings come complete with fairy lights, bunting, campfire, snacks & mulled wine.  One showing had the added excitement of a heavy downpour partway through that we all had to make a mad dash indoors for.

Kisiizi Hospital faced some challenges while we were there.  It was found that some members of staff had been stealing from the hospital, leading to several people being charged, which was really sad.  Interestingly with it being such a small hospital all of this played out in full awareness of all the staff.  The hospital also faced some financial difficulties with reduced government funding, & decreased amount of donations from the UK, due to Brexit, which unfortunately led to some members of staff being made redundant, including some we had developed friendships with, which was really difficult.

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Seeing the new year in Ugandan-style

Along with all of the other volunteers in Kisiizi, & a couple more we had met in Bwindi, we travelled to a resort on the Sesse Islands, on Lake Victoria, to see in the New Year.  The resort was packed, mostly with Ugandans, & had a great atmosphere.  Rob was pleased to find a golf course at the resort, & enjoyed a round with some of the others.  We enjoyed a delicious barbecue put on by the resort, as we sat on the lakeside, around a big bonfire, accompanied by the resort’s resident DJ who played a mixture of classic tunes & African beats, interspersed with some random chat.  At midnight they set off a fireworks display from a rowing boat on Lake Victoria, which we enjoyed from the beach.  And then we danced the rest of the night away around the campfire.  Some Ugandan ladies gave us a lesson in how to throw some Ugandan shapes; we struggled with the bum shake, when only your bum is supposed to shake, while the rest of your body remains completely still, we just couldn’t help but shake our whole bodies, making it look a bit like we were having seizures -I think we need a bit more practice!  We ended the night by doing Ugandan style speeches about our highlights of 2017; we all got caught up in the moment, & after a few too many beers, & in the presence of good friends, it all got a bit emotional!

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Ugandan Christmas

We enjoyed a Ugandan Christmas with our Kisiizi family.  For a long time we weren’t feeling particularly Christmassy due to the sunshine & lack of commercialism that we are used to accompanying Christmas.  But we came to realise that Christmas is very much present here, it’s just a different version of Christmas than the one we’re used to.  The celebrations kicked off with the annual Kisiizi Hospital ward Christmas decoration competition, which took place on the last working day before Christmas.  It was taken very seriously, & little work was carried out on this day, with the priority very much being Christmas decorating.  In chapel that morning the Reverend warned that we not, “defile nature”, based on scenes he had witnessed in previous years, but they did not heed the Reverend’s warning, & nature was very much defiled.  I have never seen anything like it.  All the staff trekked up to the nearby woods, & returned with whole trees.  Each ward recreated the nativity scene, with patients, students & staff dressing up.  The maternity & paediatrics wards had an advantage here when it came to taking their pick of cute babies & children to dress up.  Some wards even went as far as having real animal dung & live fires –imagine the health & safety issues that would cause at home.  They also all had a Christmas tree; in Uganda Christmas trees are generally decorated with lots of multi-coloured balloons.  The competition was judged by an impartial panel, who toured the wards at the end of the day of decorating.  At each ward they were greeted by singing & dancing, & the reading of a bible verse.  The patients on Ahumuza thoroughly enjoyed the spectacle, although I’m not so sure the same could be said of the sick patients on other wards, as they were neglected by staff who instead clambered around their sick beds in order to decorate the ward, & created a dim when welcoming the judging panel.

The ward Christmas decoration competition got very competitive, & there was much speculation as everyone waited with bated breath until the winner was announced at the staff Christmas party that night.  There was much excitement when the maternity ward was announced as the winner, with the runners up being the outpatient department, where Rob works.  The party started with an enormous feed of traditional Ugandan food, which we ate with our hands, which involved spilling a lot down the front of our party outfits.  We had been told in advance that there would be an opportunity for performances for the party, & so all of us volunteers had customized the song, “The twelve days of Kisiizi”, & even added some actions.  We felt slightly embarrassed when the only other act was a serious choir.  The audience were not familiar with the song, as we have found is the case with all non-hymnal Christmas songs.  The subtleties of our parody seemed to be lost on the audience, but they enjoyed the slap-stick nature of our actions, which seems to be Ugandan’s favourite form of humour.  Most of the rest of the party was taken up by speeches by, & about, those staff retiring in the coming year.  The only drinks at the party were strictly non-alcoholic, & the party finished very promptly at 10pm –in stark contrast to many of the office Christmas parties at home.  

On Christmas eve night we created an magical outdoor cinema to watch the Christmas classic, Home Alone.  We hung a white sheet on the wall, onto which the film was projected, & hung fairy lights all around.  We had mince pies & mulled wine as an accompaniment.  

On Christmas day we got together with some of the other volunteers for a cooked breakfast, washed down with bucks fizz.  We then headed to the two & a half hour chapel service, where we sang a mixture of English & Rukiga Christmas hymns, & we were preached at about needing saved.  There are two rival Christmas dinners that take place in Kisiizi that volunteers are invited to; we had been warned about the politics surrounding these rival dinners from when we arrived in Kisiizi in September.  One option was the, “white Christmas”, where the ex-pats get together, & having a full Christmas dinner with all the trimmings.  And the other was the pot-luck dinner at the Medical Superintendent’s home, to which all of the Kisiizi Hospital staff on-call on Christmas day are invited.  We opted for dinner with our hard working on-call colleagues.  Rob & I’s allocated dish was plain rice, which we managed to spectacularly ruin, by creating something that resembled rice pudding, & had a strong burnt taste.  On Christmas evening we got together with the other volunteers, & exchanged our secret Santa gifts.  With the limited present options available in Kisiizi, lots of different items of custom made clothes in African fabrics were exchanged.  

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Our first Ugandan wedding

We attended our first Ugandan wedding, with the marriage of Prima, one of the nurses from Kisiizi Hospital.  When engagements are announced here, a wedding committee is formed, who are those responsible for planning the big day, which usually takes place only a few months after the engagement.  They are very liberal with their invites; generally all those at the bride, & groom’s place of work are invited, which for Prima meant that the almost 500-strong workforce of Kisiizi Hospital were invited, including us.  Before the wedding all of those invited are issued with a price list of all the components of the wedding, & asked to pledge what they are going to contribute, & if you pledge a large enough amount it seems that is a ticket to the wedding ceremony, which we think is the only reason we were invited to the ceremony.  Usually there is a “give away ceremony”, the night before the wedding, when the bride’s family “give her away”, which is often as big as the wedding itself.  But due to family circumstances, Prima did not have a “give away ceremony”.  

We got some interesting insights into Ugandan wedding preparation from Prima.  Generally the bride-to-be’s family will pay a dowry to the groom-to-be, for the service of taking their daughter off their hands.  She also explained that it is desirable for brides to be “chubby”, & so Prima, who is naturally slim, had been on a weight gain diet in the months leading up the wedding, & was chuffed with the little potbelly she had developed.  She told us that in some rural communities, brides will be encouraged to drink five litres of milk per day in preparation for their wedding, & that the grooms-to-be will lurk outside her home in the hope they can catch a whiff of her farts, in order to assess how to fattening up process if going.  This all seems alien compared to our skinny-obsessed culture.  

The Ugandans like to get all dressed up, & the wedding guests were all adorned in brightly coloured, shiny fabrics, with a liberal smattering of diamantes.  Robert wore his kilt, which received a big, mixed reaction, with some guests informing him in no uncertain terms that, “men in Uganda don’t wear skirts”.  The wedding ceremony was held in a catherdral in one of the local towns, & conducted by the local Bishop; we are getting to know the Bishop & his purple robes quite well now as he is a regular visitor to Kisiizi.  December is wedding season here, so Prima, had to share the catherdral with two other weddings on the same day.  In true Ugandan style the wedding ceremony kicked off two hours late.  Prima wore a beautiful princess style wedding dress, while the groom & his groomsmen wore very large, shiny red & green bow ties, & the bridesmaids were equally bright in their green & yellow outfits, & matching accessories.  The bridal party made their way down the aisle very slowly, in a rhythmical two steps forwards, & one step back.  Most of the wedding ceremony was in Rukiga, so we were oblivious to what was going on.  Some highlights included the row of priests in reclining chairs at the front.  Abraham initially put the wedding band on Prima’s wrong hand under the instruction of the Bishop, which meant they had to start that bit all over again.  And a pre-recorded fan fare, that was played at certain points throughout the ceremony, such as when the best man had remembered the wedding bands, & when no one gave any objections to the marriage.  There was also a full choir dressed in ornate robes, who lip synced to pre-recorded tracks.  

After the ceremony we travelled to the reception which was held outside at a venue in the same town.  The venue was decorated in bold red, green, yellow, orange & zebra print.  The reception started with a buffet, where we were each served a mountain of traditional Ugandan food to eat.  After the buffet we took our seats in rows.  The reception was led by an MC, & consisted almost entirely of speeches, from pretty much anyone who had any connection to the bride or groom, however tedious.  There was one worrying moment when we thought we were going to have to get up & make a speech, & started frantically trying to put one together in our heads.  As with the wedding ceremony most of the reception was in Rukiga.  Throughout much of the reception the wedding party, including the little flower girls & paige boy, stood as a group rhythmically sidestepping to the music.  There was one brief moment of dancing, when we all got to have a go at traditional Chiga dancing, which involves a lot of jumping, & the Ugandans had a good laugh at our attempts.  The finale of the reception was speeches from the wedding party themselves at around 7pm, but unfortunately by this point many of the guests had already left, & the tidying up had commenced; the whole thing was over by a very prompt 7.30pm.

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Lake Mburo National Park

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Goma, Mountain gorillas, Mount Sabyinio, Lake Mutunda & Kisiizi

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Nyiragongo volcano

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We’re off on our holidays!

After a tough couple of weeks at work we had a much needed fortnight off.  We planned a trip around Uganda, Rwanda & the Congo.  Our friend Sarah joined us from Scotland for the trip, & our fellow volunteers Gordon, Sophie & Lara also joined for part of it, so we had good group of us.

We started in Kigali, the capital of Rwanda, where we had a bit of culture shock.  Rwanda in general, & Kigali in particular, is very quiet, clean & organised, which is in stark contrast to the  noise & disorder that we have become accustomed to in Uganda.  Rwanda is also relatively more developed.  These differences were accentuated by the fact we were coming from a rural village to a big city.  From our discussions with Rwandans these differences seam in part due to different characters of the populations of the two nations, with Rwandans naturally being more introverted, whereas the Ugandans are more extroverted, & also the strict state regulation of many aspects of life in Rwanda, which at times seams to be a little extreme.  

While in Kigali we visited the genocide museum, which documents the Rwandan genocide of 1994.  It was very well done, & highly emotional.  It was interesting to learn about the factors that led to the genocide, which shamefully included the population being divided into unnatural groups by Colonialists based wealth & physical characteristics, (these groups included the Hutus & Tutsis, with the Hutus going on to commit genocide against the Tutsis), & then state propaganda brainwashing the Hutus into thinking the Tutsis were their enemy, & a failure of the international community to intervene fast enough.  The brutality of the genocide was shocking.  However, amongst the horror there were heroic stories of people who risked their lives to help others.  The speed with which the Rwandans appear to have moved on from this dark piece of their recent history is impressive.  We also took advantage of being in a modern city, & enjoyed frequenting various cafes, restaurants & bars. The boys even got a haircut from a hairdresser trained in cutting, ‘muzungu’ hair, after which they looked very smart.

After Rwanda we ventured into to the big, bad Congo.  The UK home office advice regarding British nationals visiting the Congo at the time of our visit was, “avoid all but essential travel”; this is mainly due to violence from rebel groups.  We figured our holiday was pretty essential travel!  The day we left the Congo we learnt that 14 UN peacekeepers had been killed by rebels in the neighbouring province to where we had been, which just shows how real the threat is.  Our introduction to the Congo was me being told my yellow fever certificate was invalid (it’s valid), & having to pay $70 for an unnecessary yellow fever vaccination from a fierce looking Congolese lady, who didn’t speak any English.  The Congo had a very different feel.  The noise & chaos of Uganda returned, but with a very strong Congolese army & UN peacekeeper presence.  There were also a strong presence of aid agencies, like MSF & The Red Cross. 

On the first day we climbed the Nyiragongo volcano.  As we made the 3700 metre ascent, we passed through various different vegetation zones, & had to negotiate several walls of volcanic scree.  At the top not only were there magnificent views of the surrounding area, but also the world’s largest lava lake, which was 200 metres in diameter, sat within a large crater.  We spent the night at the top watching the lava lake as it’s black crust cracked revealing red hot lava, that bubbled away, omitting a red glow into the sky.  We were mesmerised by the constantly changing lava lake, & we found ourselves watching it as if it were a television, commenting to each other, “look what the lava’s doing at 3 o’clock”.   We could feel the warmth from it.  We got creative with our photography, taking photos of the lava lake, & of our silhouettes against the red glow.  It was a magical experience.  We slept up the top before making the descent the following day.  

The volcano last erupted in 2002, destroying the Congolese city of Goma that sits below it.  The city is still being rebuilt, a process which is hampered by the hard lava rock that it is now set upon, which is very difficult to penetrate, meaning that they have been unable to restore a water supply to the city.  Once down the volcano we went on a fascinating tour of Goma.  The city has a very distinctive look; it is covered with rocks of black lava that are used to build many of the houses, & there is a distinct lack of greenery as the ground is very infertile due to the lava.  

The next day we went gorilla trekking.  Gorilla trekking is expensive business, costing a whopping $1600 in Rwanda.  However, due to the safety issues in the Congo, when it’s half price in the rainy season (which just happened to be when we were visiting), it costs a bargain of just $200.   On the way to gorilla trekking our vehicle broke down after driving into one of the many potholes in the Congolese roads.  When we finally reached our destination we were told we were going to trek to see the Nyakamwe group of 12 gorillas.  We trekked for almost two hours through rural Congolese villages before we entered the rainforest of the Virunga National Park. The gorillas had been tracked by rangers earlier that day so they had a rough idea where they would be.  We had to put protective masks on as we entered the rainforest to prevent diseases being transmitted between humans & gorillas, because we are so similar.  Within five minutes of entering the dense rainforest we stumbled across a silverback casually lying on his back on the rainforest floor.  Once we’d got over the initial shock, & we looked around we realised he was surrounded by his group.  We got to spend strictly one hour with them.  In the group there were two rival silverbacks (we learnt that all mature males are silverbacks, but there is only one chief per group, who is the boss & he alone gets to mate with all the females in the group), who seamed wary of each other.  There were some very cute babies who enjoyed play fighting & climbing trees, whilst an elderly female looked on at them disapprovingly.  And there were some moody teenagers who sulked alone at the edge of the group.  We stood in amongst them, just metres from them.  We got to experience all areas of gorilla life including lots of flatulence, & even one doing a great big poo.  The gorillas have been habituated, which means they have become used to human contact, & they appeared to be oblivious to us, however, I do wonder what they make of these strange humans who stare, & point little black boxes (cameras) at them.  They were fascinating to watch, & the hour flew by; they are enormous, with the largest silverback weighing an impressive 220kg, & they are remarkably human like, particularly their faces, & their hands & feet.

Then we returned to our second home, Uganda.  Robert had organised for us to stay in a fancy resort with rooms on stilts overlooking the beautiful Lake Mutanda for my 30th birthday, which was a lovely surprise.  Continuing the volcano theme we spent my birthday climbing the dormant volcano Mount Sabyinio, which has three peaks, the highest of which is 3700 metres, & at it’s peak, the borders of Uganda, Rwanda & The Congo intercept, so you can stand in all three countries at once.  Again we passed through various different vegetation zones, including a bamboo forest, rainforest & moss draped trees.  The climb was very steep, & so they had developed a novel method of assisting our climb, by placing a series of rickety wooden ladders along the route, made from trees from the forest covering the volcano.  As we traversed the ridge between the peaks the climb was at it’s steepest, with a sheer drop either side -it’s not a climb for those without a head for heights.  We got magnificent views of all three countries from the first two peaks, unfortunately the cloud had descended before we reached the third peak, but it did make it very atmospheric.  And soon after the heavens opened, as we negotiated climbing down the mud & slippery wooden ladders.  It was only near the end that our guide told us that the success rate for reaching the highest peak is only around 50%, which added to our sense of achievement.  After our climb we returned to our hotel to enjoy a celebratory dinner & drinks, with a surprise birthday cake, & everyone in the hotel singing happy birthday to me, which was lovely.

We stopped off in Kisiizi for a night in order to let Sarah see where we have been living & working.  And my lovely new Kisiizi friends threw me a surprise birthday celebration; they created a magical wonderland of fairy lights, balloons & flowers, where we enjoyed a delicious Indian meal courtesy of Krupa.

We then travelled to The Mburo National Park, where we stayed in tents overlooking it’s beautiful savanna.  We rose bright & early in the morning to do a walking safari, on which we saw lots of zebra, impalas & water bucks, as well as a wide variety of birds.  Walking safaris are relatively unusual, & we think are only possible in this National Park due to the relatively low number of potential predators, there’s only 1 lonely lion & 20 very shy leopards, (there were previously more, but they were unpopular with locals as they preyed on their livestock, & so were poisoned by some).  The walking safari was nice as you felt that they you were right in amongst the animals.  We then did a bit of an unintentional boda-boda safari, as we travelled by boda-boda across the park to the lake for a boat safari, & saw lots of baboons & water hogs on our way.  On our boat safari we then saw lots of hippos, & lots more varieties of birds, & some baby crocodiles, & a large one from the distance, who unfortunately got shy & hid whenever we got close.

We then travelled to Jinja by matatu.  Matatu’s are public mini-buses that are very cheap, they generally cost about 50p for an hour of travel, & are licensed to 14 carry passengers, but will regularly carry 25, so you have to get up close & personal with your fellow passengers, who can include livestock, so you might find yourself sat next to a goat, or a chicken.  We regularly use matatus, & they are great for short journeys, but this journey was very painful.  First we were shoved into an already full Matatu with all of our luggage on top of us (we’re not light packers), & so we were unable to move an inch, below the weight of our heavy bags, & we’d pissed off our fellow passengers who had the inconvenience of sitting next to our luggage.  The matatu itself was swelteringly hot, & smelt strongly of body odour & vomit.  We left Kampala in the crazy rush hour traffic, which involves waiting in a lot of chaotic queues of very inpatient drivers.  The journey which is only 50 km, took us over 3 painful hours, & the only reason it was that fast was due to the efforts of our kamikaze driver, who thought nothing of driving on the wrong side of the road into oncoming traffic, or mounting a pavement with pedestrians on it.  It’s safe to say we were relieved to reach Jinja.

The following day Sarah & I went white water rafting in the rapids of the Nile, while Robert tandom kayaked with a guide.  Robert spent five days kayaking the Nile seven years ago when he was in Uganda on his elective.  We made our way down through seven rapids of up to grade 5 (grade 6 is the highest), (& we walked round an eighth as it was a grade 6 rapid, & no one has ever made it down in a raft without capsizing), with our 2 American companions, & our Scottish guide, who seamed a bit jaded by living in Uganda long term, while Robert & his guide kayaked down alongside us.  We had great fun battling the rapids, & managed to keep our raft the right way up until the final rapid, when the Nile got the better of us, & we capsized.

At the end of the stretch of Nile that we rafted/ kayaked down, lay an island paradise, which was to be our home for the next couple of days.  It’s a hostel situated on a small island in the middle of the Nile.  It has a lovely hippyish vibe, with lots of little corners to chill out in, & is a hangout for lots of keen kayakers.  We chilled out during the day reading, going for walks, doing yoga & swimming in the Nile, & then hung out in the hostel bar with  all the kayakers in the evening, playing games like the cereal box game (you have pick up the cereal box of decreasing size with your mouth, & without your hands touching the ground), & climbing around tables & chairs (the aim is to climb around a table without touching the ground, & to pick up a lighter from the ground with your mouth, whilst on chairs of increasing size, without touching the ground), which we played with variable success!

We finished our trip in Kampala.  We stayed in a backpacker hostel, something which we haven’t come across much when travelling around Sub-Saharan Africa.  We took advantage of being in a backpacker hostel, & headed out for a night out in Kampala with some of our fellow backpackers.  It had been a while since we’d had a good night out as the nightlife is somewhat lacking in Kisiizi.  Kampala is famous for being a good night out, & is apparently known as, “the city that never sleeps”.  The night started with playing drinking games on the hostel roof terrace overlooking the lights of Kampala, before we headed out to some bars & clubs.  At one point during the night Sarah & I innocently ventured onto the dance floor, & instantly found ourselves surrounded by men as if they were preying on some fresh meat, however thankfully they took our refusals graciously.  And as is the case in many cities throughout the world, the place with the best atmosphere we came across was an Irish pub, that, in an interesting fusion of cultures, sold shisha alongside the usual Guinness.  On Sarah’s last day we headed to a craft market so that she could buy some souvenirs to take home; I was in my element in the market, & I just couldn’t help myself, & ended up getting quite a few pieces of Ugandan clothes & jewellery for myself.  And then it came time to say a sad farewell to our lovely travel partner, Sarah, & for us to make the long journey back to Kisiizi to restart work.

We had got into a Matatu to Kisiizi for the final leg of the journey.  However, when we reached 30km away from Kiziisi, & all our fellow passengers had already departed, we were informed by the driver that he would no longer be taking us all the way to Kisiizi himself, & instead he had arranged for a single boda-boda to drive both of us, plus all of our luggage, the rest of the way.  With our boda-boda loaded up with our luggage into a precarious tower, & Rob & I forced to get very up close & personal with our driver, whilst hanging on for our dear lives, we headed off for Kisiizi along the long windy, bumpy road.  What we hadn’t realised was that while we had been away the rainy season had ended, which meant that without the regular rain fall, the red, dust roads were even dustier than normal.  When we arrived in Kisiizi we were caked in orange dust, & looked like we had just had the world’s worst ever fake tan!