Fort Portal

We are still fairly near the DRC border along the Western of Uganda which means we are right near the mountains. Not small hills although there are plenty of foothills, real mountains with the largest topping 5000 meters which is a significant height. Unlike other area of the world that are well known with good base sites and guides the area here is a bit more wild which means there is a real opportunity for western climbers to be stupid and get themselves killed. Hiking and climbing during the rainy season are not advised.  In fact a couple of climbers died just a few weeks before we arrived in country not that it made the news anywhere.  The population allegedly is around 55K, 

The hills are green, the roads are red and packed reddish dirt and clay. When it rains they are extremely slippery; those parts which are not ruts deep enough to lose a bicycle or small child walking to schol of which the roads are littered with in the morning.

Remember the joke about “walks to school 6 miles each way barefoot uphill in the snow?”  Well, these kids are walking 1-7 km in the mud each way in their bare feet for the most part.  Since sunrise is about 0700 this close to the border it means that schools don’t start till closer to 0900 or a bit after in order to give the children a chance to walk when it is light.

Across the countryside the land is lush and fertile. The people are fertile but not lush. I am starting to believe much like we can predict who has diabetes in the west and far east based on BMI (body mass index) you can make a good guess at HIV status by the skeleton appearance of many of the patients.

It is like Baron Samedi of Voodoo fame strides through the countryside with his cane and polished skull head harvesting souls. The ancient patient smaller than a 40kg shadow curled in bed suffering from malaria turns out to be barely 50 and newly diagnoses. Malaria, coccidiomycosis, TB, are the major weapons he wields to bring his subjects low. ART (anti-retroviral treatment is provided by the government free of charge. Women get diagnosed in pregnancy if they get prenatal care. Men only when they show up with secondary infections. So where we see people for years on ARTs, here there are all too many who are first diagnosed when they have already progressed to AIDS. It feels like the 1980s all over again.

Like all other regions, there is a government hospital here. Fort Portal is big and bustling. There is a copper mine in the area. There are banana plantations and tea plantations. For that matter, there is as much of a population explosion here as anywhere else. You can buy health insurance: it will cover injuries, maternity, the occasional chronic illness. It doesn’t cover family planning, ART, anything even remotely resembling a voluntary pregnancy termination (to include complications), or dental, or eye care or immunizations or……. In fact, other than maternity it really doesn’t cover much of anything….

We made rounds at the hospital, talked to several patients in depth and the doctors on staff. The nurses seem to operate at a dead run. The head nurse stopped to talk for a few minutes. White dress, traditional nurses cap.

This afternoon we joined a couple of local public health workers conducting surveillance at one of the schools. Schistosomiasis affected 57% of the children at this school not that long ago. With a control program and treatment it is now down to 11%.  I skipped the slide down to the crater lake on the snail catching expedition in the rain.

pictures to follow.

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