Week 5

Hippos and the Peak District

I went on safari with Florence. When I called Pete after and he asked how safari was, I asked him ‘what do you think I thought?’ he replied ‘that had a lot of thoughts.’ Correct! The guy knows me well, could he be the one? He also text me telling me not to get into the water with the hippos just because I like their faces, which I read just in time.

All my thoughts were good thoughts, but they were plentiful.

My thoughts on safari go back a long way, about 2.5 decades. When I was young I really loved wild animals. I’d do sponsored things for Born Free and WWF, name the Tiger in year 7 most famously. I was very aware of threats to these endangered species and the environment and can picture the National Geographic pages with photos of skinned or caged big cats and medicines made from tigers. I’m so pleased the internet wasn’t so accessible to me then because who knows what dark places it might have led too. Fortunately, I could only go as far as physical pages and newsletters would allow. I’d try and shoehorn this interest into school work: my science projects would focus on detailing how these animals adapt to their environments and ecosystems, and my English Language projects would be campaigns in which I’d use adjectives in the power of three, alliteration and hyperbole to dramatic effect, and as I write this I realise not much has changed. I sponsored every animal going and, according to my direct debits, still do and used to email scientists in Russia asking about how I can get involved in conservation. I boycotted the end of year 8 trip to Flamingo Land because it had a zoo and I’d regularly find myself bargaining hypothetically: what would I sacrifice to ensure the survival and thrival of lions and tigers? Myself? My brothers? Easily. I think any reluctance I have to have bébés is founded partly on my fear of a world where these animals live only in zoos, and also how it might affect my ability to just pop to the cinema.

As I’ve got older I’ve just had to stay away from anything to do with endangered species and habitats. It depresses me more than I can handle. I think the reason (one of the reasons) I love Sheffield city centre so much is because it’s supposed to be a city centre. It’s supposed to be full of people, concrete, MacDonalds bags, Costa cups and building developments. One of the reasons I’ve perhaps boycotted the Peak District is because it’s supposed to be full of nature, it’s supposed to be covered in forests and full of deer, eagles, probably some sort of big cat, bears, woolly mammoths, wolves…. that can all walk around without getting killed by cars. But instead when I go I just see trees that have been cut down, farmland that should be forests, a half reminder of what once was. Tufts of trees here and there like bits that have been missed on a chin than was once covered beard…. I'm sorry, it's not you, the Peak District, it's me.

Maybe the reason I turned to nursing and invested in people was because I don’t have to worry about this species becoming extinct anytime soon. I struggle watching nature programmes because I don’t need reminding about all the threats out there, I see them every time I see a plastic bottle or Cadbury’s chocolate. I don’t do anything about it though, I bury my head in the sand and the City Centre and once a week will ask Pete if he thinks there’s hope for the environment, and he does.

Alora, here I find myself on safari, the ultimate Sunday night Attenborough documentary. And it was really gorgeous. We went with Red Chilli, which means being part of a group of people and follow more of a set itinerary rather than designing your own exclusive safari. This I love, I prefer it when things don’t revolve around me….or like somebody’s schedule has shifted too much to accommodate me. I like to slip into things that would be happening regardless of whether I’m there or not, for example, a moving train carriage rather than getting a taxi or a lift, somebody else’s party rather than my own.

En tout cas, my thoughts are thus: 

1.     Humans are a funny bunch

We are driven around by Sula, with Lilian, the ranger, in the front and we pass other people doing the same. The bits they don’t show you in wildlife photography is the 3 van loads of people straining and craning to take photos of a non-plussed lion. And then there are those who are less cool: groups of American tourists looking mardy and unimpressed, perched - elevated - like big toddlers on big golf buggies, asking ‘you seen an elephant? A lion?’ when you pass. Nothing shows the daftness of people more than in the indifference and dignity of animals.

Apart from some people. Some people are impossibly cool on safari. Lilian, in polished black boots and camo, hanging out the front window with binoculars, being able to sense an animal which we all struggle to see even once she’s pointing it out really clearly.

Also Florence, she’s cool on safari. When an animal is coming up the first thing she does it not reach for a phone and panic tap in pin numbers or pull out a pneumatic camera with a foot long lens, she just seems to calmly watch, not breaking her gaze when she takes one photo then puts her phone away. While I'm just babbling away 'I've got no words! It's like Jurassic Park!'

It makes you think about seeing things. The first time you see a giraffe or a hippo you’re falling over each other to get a photo, but then you realise they’re ten a penny – like pigeons on the Moor – the next lot you see you might take a photo while the car is moving but it’s not worth stopping, and then on the way back, you’re positively indifferent and not even looking up from your phone as you glide past the animals which three hours ago you’d almost put your back out trying to see.

 I tried not to be too phone and camera heavy, there was a moment I realised I’d not properly appreciated a lion’s paws because I was fannying about trying to take a photo of it which really taught me a lesson. And now I've got google telling me I'm running out of space because I took too many videos of lions but how am I supposed to delete a lion from my phone?!

2.     Conservation efforts

On a boat trip I ask the ranger a lot of questions, which can all just be summarised as ‘look, Ordance, I just wanna know, is the situation of the lions such that I can consider having a bébé or what?’. I don’t think there’s an absolute answer, there rarely is. Ordance tells me about initiatives that seem really promising. The Ugandan government has realised that tourism is Uganda’s greatest asset so it’s important to protect the things that attract the tourists. And then, 25% of tourism money from the park goes to the people (40,000) who live in the park (90,000 on its peripheries) and whose lives are affected by elephants sticking their heads through walls and lions eating their livestock. Understandably this would be pretty upsetting, especially given how little these people may have and so it’s not surprising that there are tensions between the animal and people communities. This can lead to retaliation killings, and there is also general poaching for meat which disrupts the perfect, self-sustaining eco system. However, the idea of this 25% is to enable the people to see the wild animals as beneficial rather than destructive and people are advised about how to keep wildlife at bay and how to live with the animals and to not see them as the enemy. However, the extent to which this 25% is seen by the people – and not just the leaders- is uncertain.

Also, giraffe and elephant numbers are about 3000 but lions are only around 150 – I think. Which sounds ok for the former two, and quite precarious for the latter. There is a rhino sanctuary next to Murchison falls with about 25 rhinos in which are kept under close surveillance and armed guards because they’re really threatened due to their horns being perceived as medicinal. I think they’re entertaining letting them into Murchison’s but it would be tricky.

And then there’s the oil. Uganda and Tanzania were found to have oil in them? under them? and part of this oil supply is in (under?) Murchison Falls, which means drilling for oil. Fracking a national park? Fracking in the presence of lions and elephants?! Come on are you serious? Put a fork in me, I’m done. It has given people jobs which is great, but is pretty depressing from an environmental perspective. I ask how the oil stuff is affecting the animals and Ordance says ‘if a bomb went off near your house you’d run away, that’s what they’ve done’. There’s also a highway going over the river separating the camps from the safari, which used to only be crossable by ferry. The first elephant I saw actually was crossing the motorway, an incongruent image indeed: tusks and tarmac. Sula said he liked the bridge because it made the crossing so much easier; Ordance said it makes his heart hurt every time he looks at it.

In conclusion, I don’t know how bright things look for these animals, it all sounds a bit like the shrug emoji. It’s great that so many things are happening to support the environment and people and animals living in it. It’s quite sad that their being able to exist boils down to tourism. Especially, considering that most tourists will be getting to Uganda by flying. Which I know I did so I’m not sitting here being smug, I know I’m a hypocrite.   

3.     Friendship and unexepected things

I’ve known Florence for three weeks and we find ourselves here on what is becoming an increasingly popular honeymoon. Florence is gorgeous and effortless company, we enjoy chatting about all sorts from our shared eco-anxiety and our guilt around flights, toxic masculinity, what it means to look like a hippo, our relationships with the UK and its divisions but how we’ll not hear a bad word said about the North, our horror that anyone could consider shooting a giraffe, the state of our pig tails and also what we’d do if we need a wee in the middle of the night and there’s a hippo knocking about (this is a high probability and our welcoming speech we’re briefed on hippos). I am struck my the unexpectedness of this friendship, of all these unexpected connections and people and conversations and insights whether fleeting or longer term friendships I’m making here: Dr Anne and her family, los sestros Merrimans, the nurses and everyone at hospice, my revolving rota of housemates, Dianah, Monique, all the Uber drivers, my aerobics on the hill amigos, bods I chat to when I order coffee… this was all unexpected. This safari. This trip, which in some ways came from a train delay at Manchester station on a Friday in November. And yet, here Florence and I are, two sestras from South Yorkshire, getting side rained on in a tent in the Ugandan jungle in a thunderstorm, worrying about how to go for wees and whether to keep the windows open to see hippos. I find it really reassuring that life is full of these unexpectations.

I'm so pleased I went of safari. It was a nice combination of fun, magnificent and met some really great bod doing a really great job. I don't know how this experience could be topped and I don't know if I'll go again, jsut to keep it speacial and perfect. I wouldn't want something so magique to ever become normal. I like its inaccessibility and other worldliness. 

Seeing the most beautiful and most vulnerable things in the world leads to a very heady mixture of emotions.

Mbarara

I’ve crossed the equator with one of hospice’s drivers, Siraje, this week to work in the Mbarara site.  Mbarara is a five hour south west of Kampala and the Mobile Hospice Mbarara is one of the hospices making up Hospice Africa Uganda and came about it order to spread palliative care. I’ll be working with the nursing team here.

On the first day I go with Martha, who I had heard of many times before through Dr Anne’s appreciation of her, to the local hospital. This has ended up being my first trip to a hospital since I’ve been here. And I suppose as a very much inpatient nurse this is where I’m used to. We first go to the children’s ward, it’s very bright with beautiful artwork on the walls of smiling animals and people, alongside messages like ‘you can’t catch cancer’ and ‘be nice to people with cancer’, the side effects of chemotherapy and how to eat a healthy diet. About ten very young looking doctors surround a bed with a toddler and the mother on it, nobody is really talking but they are stood there for such a long time. We visit the oncology ward too and set up a camp behind the nurses’ station and visit various patients. When you arrive on the ward it does initially look a bit chaotic, the beds probably have only a foot and a half distance between them, loads of people around the beds, loads of people queueing up, I see the odd nurse, the toilets are plastic bins underneath the beds, I think these are also the sick bowls. 

If it looks a bit chaotic I’m not sure if it feels it. It feels fairly calm, there’s no shouting or drama. The relative of one patient may be leant over with their bum on the bed of the patient next door and this doesn’t seem to bother them. There’s no privacy at all, I guess privacy is a luxury. Families bring food in and it looks like they’re sharing it. Maybe it's resignation. I’m not sure. I really want to have a good chat with a ward nurse to discuss what it’s like, something that is very different to nursing in the UK is that many of the things we do are delegated to the families: washing, feeding, dressing. I’d really miss doing all those things.

One of the patients we see on the children’s ward is one of the bleakest situations I’ve seen. It’s a 17 year old boy with osteosarcoma, and he’s had one of his legs amputated. Martha later describes him to the other nurses as ‘he looks like he’s carrying all the sadness in the world’, I don’t think this is an exaggeration. He’d had his leg amputated a couple of weeks ago, but the cancer had metastasised and is incurable. He’d started on chemotherapy – six days after the amputation which is much too soon and may hinder the healing process (this is a whole other issue in itself – the ? inappropriate prescribing of chemotherapy and ? regulation around it. We see people who are receiving treatments that they wouldn’t be having for that disease site and stage in the UK and mostly aren’t having scans to check if it’s working. I don’t know enough about how it works here but I got the number of a chemo nurse and hope to chat to her to find out more). And he’s been abandoned. He was raised by his grandparents but they abandoned him when his wound began to smell and now he’s in hospital with nowhere to go after. The Hospice team are desperately ringing around, trying to find somewhere for him to go, Antonia, one of the nurses, says it’s nearly impossible in Africa to find anybody who has nobody.

On the second day we go to on an outreach to Ishaku, 40km from Mbarara. On the way to setting up our clinic we make a few roadside stops which is not something I’ve seen before. The community volunteers organise for patients to meet at a designated spot between the Hospice and the destination and we pull up to assess them, just there by the road or in the car. I ask Francesca if this is common practice in Uganda, it isn’t, but rather another way the Hospice Africa team have adapted to meeting their patients’ needs. I love them. We give patients bottles of this fizzy drink called Mirinda – though I prefer to call it Miranda – and a snack, because they’ve probably been waiting for a while or had a long walk to get there. Once, again, things that work in Uganda are difficult to imagine in Sheffield: ie a pit stop on Park Way to hand out morphine and Mirandas. Or could it .…

While Martha assesses a patient in the car, I chat to Francesca about her nursing life. I ask if she has worked in the hospitals before, she shakes her head and says she couldn’t because of the lack of autonomy. I suppose I’ve only worked with Uganda’s nurses in a very specific capacity, c’est a dire, as Hospice Africa nurses. And it’s true they are very autonomous. She tells me about how sometimes they have to acquire extra skills out of necessity, giving the example of patients with ascites (fluid on the abdomen which makes breathing, eating, everything …difficult and uncomfortable). In UK you’d have an ultrasound to work out if the fluid it one big pool across the belly, or in little pockets. If it’s in one big pool then you may be able to have a needle put in to drain the fluid off. As that an ultrasound scan is rarely an option here, Francesca tells me that she taps on one side of the abdomen and if she feels ripples on the other side then she can be quite confident that it’s one single pool and then insert the drain. SO smart.

This is just one of the many skills the nurses acquire through necessity. I am seeing more and more often anaemia being speculated through pulling the lower eyelid down and assessing the pallor, or looking at how pink people's palms appear. 

Francesca tells me they'll regularly take phone calls from patient's who are short of breath, and there's not really much they can do. No oxygen cannisters available or affordable, or quick fix. So instead she'll tell them to make sure a window is open and talk to them and sooth them over the phone, take some morphine maybe, do some breathing exercises together until they feel calm again. And Francesca says this is usually enough.   

We arrive at the hospital and set up a clinic there. have two assessments going on at once in the same room. And patients sit on two benches outside the room with Martha is acting as pharmacist, dispensing medications and nurses Francesca, Betty and I assess patients in the clinic. We review patients’ presenting complaints, generally pain relief, constipation, appetite, nausea as well as the psychosocial bits.

All the patients are well dressed. I don’t know if it’s that dress up for the doctor kind of thing or just a general smartness. I’m temped to say the latter because the style is good here. Men tend to be in shirts and trousers and the women in fruity dresses or skirts and tops. Fast Fashion can’t really exist here in the way it does in Europe and US because people can’t afford to buy something for a wear or two and then discard and fast fashion depends on mass fashion. People  herewear things until they fall apart, and a lot of clothes are made by local seamstresses. It would be tres bougie to get anything made to measure in the UK but here it seems fairly quotidien. As a result of this, so many women wear this bright Kitinge print, puff sleeve long cotton dresses, and they look gorgeous.

As far as my naïve eyes can tell this seems to be the only dominant kind of style. In the UK we are all wearing uniforms of because we’re all targeted with the same messaging and we can get hold of a version of that message or the exact content of that message in (buy this) . Holly Willoughby’s Instagram tells us what to wear every day she’s on This Morning, the Love Islanders, we click and buy. We wear long floral dresses with bright white trainers and blonde bobs, and sleeping bag coats and Ugg boots, tractor tyre boots and chunky sandals, tight dresses from BooHoo.com and square toe wedge sandals, Lucy and Yak dungarees and doc martens, puff sleeve voluminous dresses, hot for the spot, co-ords, we’re onto Y2K, low rise jeans, acid wash and baby pink and pastels now and before that it was 90s, and have gone through six SIX decades of fashion and one decade of time. I know this because when I first started dating Pete ten years ago it was 1950s twee: Peter Pan collars and skater skirts. 

I text Emma and ask what people are wearing and she says ‘hhmm currently the teens are wearing crop tops, basically S Cub 7 is back in’. Stone Island jackets and athleisure. Dark Academia, Vanilla Girl, Clean Girl Beauty, and now Rock Star girlfriend – I guess this is indie making its inevitable return. I’ve not got my finger on the TikTok pulse AT all but I know it churns out trend after trend. And of course it doesn’t stop at fashion: it’s bodies too. Thick legs, big bums, small waists and now apparently it’s in to be thin again. 

When I ask the social worker interns, Daisy, Renatte and Niece, how they choose what to wear they just say something like 'if it fits and feels nice'. So not if it stalks you on social media because you clicked on it once or heard you talking about something to a friend or shouts at you through TV, high street windows or every public place? How bizarre. 

Sorry, je really digress now. Yes, the patients look smart, and one besuited man is wearing a cowboy hat. The first patient we see is a midwife and Francesca tells me that healthcare professionals are often even more wary of morphine than patients, because they really associate it with dying. Francesca tells me how they allow morphine-wary patients to just start low and build up in their own time, while seeing that it isn’t stopping them from breathing. This midwife’s pain is now nicely managed and she goes back to work.

There’s a charming moment when a patient with back ache was encouraged to do some exercise and it ended up with the other two nurses, me and both patients in the room trying to touch our toes and do some stretches. One of my favourite activities is group aerobics so I obviously loved it. Also, Ugandan women are so good at … bending. I know this is a strange observation but honesty they can fold themselves in half. Effortlessly. When these women touch their toes they become a compressed stapler, a perfect hinge in their hips, when I touch mine I’m an inverted tear drop – big round back. Even the older women. It must be a practice they’ve just kept up staying supple because we’re all born with it but maybe a life time of sofas and TVs has taken it away.

You really see nurses in their full spectrum here. Nurse as physio, nurse as dietician. Not sure if I’ve already mentioned but a huge chunk of the nursing assessment is spent talking about food. How to prepare paw paw seeds for constipation, beetroot for anaemia, … there’s a real live off the land culture here. A real respect for the environment. There’s this food called matooke which is a staple of this diet … I don’t know if in the UK we’ve moved quite far from ‘the land’ because of: importing food, supermarkets, mass packaging, but here you see the food growing in fields, see it transported round in the back of trucks, then in mass along all the roadside markets, and then on your plate.