Clinics and cakes

Last report - sent June 10th, 2007

Greetings all! I hope this find you well and enjoying spring (…or summer for some of you further south). It still seems to be the rainy season here as we’ve had several heavy rains here this week. Everyone here thinks that the seasons are changing – the rains are more erratic than previously - and they blame it all on global warming. I understand that Calgary had a huge rainstorm last week and unfortunately they’re not as well equipped to deal with it. (In Kampala there are no basements to flood, the roads have specific run-off gutters and there aren’t nearly as many large auditorium-like buildings with roofs that can collapse) I hope that everyone is coping OK with things. Dang global warming.

This may be my last “Uganda report” as I start my last week of work tomorrow and it depends on how ambitious I feel when I start vacation the week after. Last week and this coming week I have been and will be doing some outpatient clinics at the IDI (Infectious Disease Institute) that is just across the way from Mulago Hospital. In a sense “IDI” is a bit of a misnomer because it’s pretty much all HIV – at least the clinical side is. (Although, really, the same could be said for the “ID” wards at Mulago, and for that matter, many of the other medical wards). I really wanted to get a sense of outpatient management of HIV because most of what I’ve been seeing has been what happens when HIV is NOT managed in outpatient. (For the non-medics: outpatient = basically, people not in the hospital – they can still be quite sick though).

There are numerous HIV and other clinics that I could have gone to but I chose the IDI for a few reasons, not the least of which is the proximity to Mulago so I can go back and forth. Several people I have come to know also work there as well and finally, I am still trying to figure out just exactly what I want to do/be when I grow up (I know, it’s pathetic at my age…) and the IDI is sort of one model of a very long term collaboration/organization between resource wealthy (mostly U.S.) countries and a resource poor country that I was looking at to evaluate the setting I want to work in. I’m still not sure exactly what I want to do but I am enjoying my time in clinic. It is more of a primary care type clinic. The care is free there and therefore the patients very seldom would see any other doctor. There are lots and lots of patients (called “friends” at the IDI) to see, although not as many as at the free Mulago clinics where the stack of charts seem endless, and one has to be very efficient.


The IDI


Dr. Kalule and I at the IDI
Overall I have really enjoyed my time here in Kampala and I can’t believe it’s almost over! Time flies when you’re learning lots and having fun. Yesterday afternoon I went with some of my friends to an “Introduction”. It is the first stage of the traditional Ugandan wedding ceremony. It was quite fascinating although given that it was all in the tribal language (which happened to not be Luganda) I really didn’t understand much. They tried to translate for me but it’s hard and given I was the only foreigner there I already stuck out so tried to create as little ruckus as possible.

My friends (5 sisters) are close friends with the bride and her sister and one of the 5 was a bridesmaid so they wanted me to come. The day was very long and I was quite tired by the end of it. I had gone into the hospital in the morning for awhile and then went over to my friends’ house at around 1pm. I’m not sure why 1pm since we didn’t end up leaving until just after 3pm so that gave them plenty of time to dress me up in traditional clothing for the wedding. I seem to attract this wherever I go – I’m not sure why as I generally look kind of funny (hmmm, maybe that’s the reason): this tall awkward white girl (made taller by the heels that I’m inevitably given to wear) with traditional clothes that don’t quite fit properly and that I’m always tripping on and adjusting because traditional clothes in the places I’ve traveled tend to involve long flowing/draping styles. Ah well, at least it provides entertainment. Maybe I’ll show you the pictures at home.


Traditional clothes

We arrived at the venue by around 3:30 pm and it was good that we hadn’t gone sooner as nothing started until around 4:30. It was at the bride’s family home and they (excluding the bride and her attendants) all sat on one side of the yard waiting until the groom and his entourage (mostly family members and close friends – all male) arrived seeking entrance. Female family members of the bride and her brothers meet them at the gate and the groom’s side have to “negotiate” to come in. Once they do they sit down on the opposite side of the yard and the ceremony begins. They are served some sort of traditional drink – no one could really explain what it is (some sort of fermented sorghum drink?) and a whole bunch of speeches welcoming and receiving welcome occur. One uncle of the bride and one uncle of the groom do most of the talking (the bride and groom and their immediate family say very little the whole day) and those who are funny and good at speeches seem to be preferred. (Hmm, I’m not sure who I would choose of my uncles – it has to be one of your father’s brothers so couldn’t be Uncle DeLoss – he’d be good but then, so would all Dad’s brothers too, I think they’d get into it).

Once it’s been established that the groom’s family came seeking a wife for one of their members (more speeches), girls start coming out. First they send out a bunch of young girl cousins between 10 and 14 years and the groom’s uncle makes a big deal of the fact that these are too young. Then some of the bridesmaids are brought out and the uncle make another big deal comparing them to a picture he has of the girl and deeming them not right. Finally another group of bridesmaids come out this time with the bride and her aunt (mother’s sister) and the groom’s uncle proclaims that he’s finally found her. At that point they have to “find” the groom so the aunt and the sister (sort of like the maid of honor) go over to the groom’s side and “identify” the groom. He then comes and they are “introduced” and he gives her a small gift (necklace in this case). I guess traditionally these would have been arranged marriages made by your aunts and uncles and you wouldn’t meet until the actual day, hence “introduction”.

The next part was…interesting: the negotiation of the bride price. They finally settled on 6 cows, which is apparently quite a lot. It kind of gets my feminist ire up a little bit (I was never a great fan of “Johnny Lingo” like many were – sorry, inside joke for those of you who didn’t understand that). One of my friends was sitting beside me and explained that it is still traditional, especially amongst this tribe, although many feel it’s quite archaic and should be done away with. (Mormon comment here sorry) She told me they’ve been very strongly counseled by Pres. Hinckley and other leaders to celebrate as much of their culture as possible that is positive but to not participate in things that denigrate people and the bride price is a commonly cited example. It equates woman to property and encourages a negative unequal marriage partnership.
Anyway, after that, more celebratory speeches and a tradition that I think we should emulate. A cake was brought in to celebrate (not a true wedding cake as I guess that’s for the next ceremony) and the bride and groom cut it along with the aunts and uncles. Then the bride, groom, bridesmaids and groomsmen handed out cake to everyone. Great tradition I thought! Not only do they get to move around and quickly greet people that they might not otherwise, they also get rid of the wedding cake. Not that they would have had troubles getting rid of it – it was very good chocolate cake! It just seems like most North American weddings have massive amounts of excess cake left over which wouldn’t happen if you actually brought it around to people.

There were more speeches of celebration at this point and then introduction of the family members (although only the males on the groom’s side as the females don’t participate in this part I guess). I didn’t really understand much of this and I was getting quite tired by this time. It was about 8pm by the time they finished all the speeches. Then we got to eat (Hurray!!) traditional food, which I have come to really like. The “give away” is the next ceremony, in a couple of months I guess, which is the actual traditional wedding and nowadays is usually accompanied by a church wedding the same weekend.

I had brought my camera and had taken a few subtle pictures prior to this but then took a whole bunch of all the bridesmaids and my friends, which they were very excited about – very few people have cameras here. In fact, I burned them a CD of all of the pictures and gave it to them today because they were so keen on having them. We came home late and I was very tired but it was a really great day.






Once again I’ve blathered on a long time so will sign off. I hope you are all doing well and I’m looking forward to seeing you soon.

Love Jo