I spent one summer in college living and working on Mackinac Island, the tourist destination where bicycles and horses replace cars and trucks and hotels charge money just to get on the porch. My roommates and I watched a brilliant sun set behind the Mackinac Bridge and the waters of Lake Michigan and Lake Huron and I wondered if there could ever be a more beautiful place to live.
But that was before I saw Uganda. Here, a five hour drive on a bumpy, two-lane freeway is a spiritual experience as you look out on a landscape of rolling hills blanketed in every shade of green you could imagine. The colonial powers called this place “The Pearl of Africa” for it’s stunning diversity, and the vast majority of people still living in rural areas of the country which, although remote and lacking in many public services, have maintained a pristine landscape as inviting as any vined slopes of Tuscany.
In Mbarara, where I am staying, the cultural heritage of many people is determined by farming. Two main ethnic groups composed the old Ankole Kingdom in this region of modern Uganda, and the Bahima and the Bairu maintain their identities and traditions even while daily life has changed over the years. The Bahima are known as the cattle keepers, and in Western Uganda, cattle are everywhere. (President Yoweri Museveni comes from this culture, and still keeps a massive country house very near to Mbarara Town). The famous Ankole cattle apparently is the best meat around, but the cattle are also raised for their milk products and in the past, rather than kill a cow, people might let their blood and cook it into a kind of soup to eat. The Ankole cattle have been bred with other varieties of cows over the years, and I’ve only seen a few that my co-workers/tour guides tell me are pure Ankole. Their horns curve around to meet each other, and the main landmark in Mbarara Town is a brass cow in the center of a traffic circle called Mahembe Gente, or “horns of the cow.” Even the female cows have horns, I’ve learned.
The Bairu have historically farmed the earth rather than raised cattle, which made them a socially inferior ethnic group. Today in the villages, each household typically keeps its own farm to feed the family and sell at market. A typical compound in Kashongi or Kitura will have mango, banana, avacado, and jackfruit trees; potato mounds; ground nuts to dig up; beans; maize which may be ground, cooked into posho, or roasted over a charcoal fire; millet that can be made into a dark, textured mush called kalo; and maybe some chickens and/or goats. I’ve had fresh fruit of the tree at almost daily since arriving in Uganda, and these are not your local Kroger’s mangoes. There is a strong dependence on the land and the rains for many people who have little in savings or capital. The plates of food we order at small, local restaurants are far less colorful than the landscape, and my diet at least has been very regular and monotonous with few green vegetables and almost no meat.
The tumbling hills and rugged landscape that make this region so wonderful to behold also account for some of the challenges in health care delivery that I’ve been learning about and have already been able to observe. Each subcounty has a health center III to serve the villages within its boundaries, but these are large areas of land and transportation to the health center for a woman in labor may be prohibitively expensive for a family with little income outside of small farming and difficult in particular for a woman who likely has no control over what little money her husband has. If a laboring woman does arrive at the health center (probably on the back of a boda boda/motorbike) and it turns out that her labor is obstructed, the overworked midwife in this remote health center will refer her to one of the district hospitals like the one in Mbarara Town. That will mean another 45 minute drive, and a much more expensive one. It is in settings like this, amidst poverty and without adequate health infrastructure, that maternal mortality reaches astonishing rates and obstetric fistula becomes a devastating disability for those women who might survive the child bed. It is so foreign to me; I grew up in walking distance of a world class hospital and my loved ones have always had access to cars, ambulances, and skilled medical care for any need. Of course I didn’t have to travel around the world to see an example of poverty and inequality, but the drastic difference in lifestyle and opportunity here in rural Uganda has offered a stark and upsetting contrast to my own experience of privilege.
In the 7 weeks remaining of my short internship, I am determined to appreciate all that this beautiful country has to offer. The land is astounding, but the people are the true wealth of Uganda. My colleagues: committed to social justice and eliminating the burden of disease in Kashongi and Kitura; our partners: working for sustainable economic growth and development in the community; and the women: laboring the feed and care for their families and neighbors and speaking out to offer solutions to problems they know too well.