Ward Round

By Dr. Jack, in case anyone thought Kampala was somehow magically better than Gulu. Know these feelings. Know these situations.


No other doctors had arrived yet on the maternal high dependency ward that morning. The nurse calls me over, she looks quite flustered. There is a 24-year-old woman, 16 weeks pregnant, gasping. She still has a pulse but clearly about to go into cardiac arrest. She needs to be ventilated so I ask for the usual bag-mask-valve combo we use to ventilate in the first instance. The nurse is frantically looking through a cardboard box and not winning so I go and help; a tangle of old tubes and oxygen masks, covered in dust, but not the one we need, and it’s not a great surprise. Back at the bedside, things have deteriorated and I ask the woman’s sister to step aside. I ask for a bag of fluids to get things going, but there is no stock. We have a look through the notes, not much is known yet…

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How Uganda and the UN are fooling the world. Refugees for Cash

“Every day for nearly a year, an average of about 2,000 refugees have entered Uganda from South Sudan… Luckily, their new home may be the best place on the planet to be a refugee.”
Washington Post

Impossible. How can reputable news outlets like the Washington post, the Guardian and the BBC make such ridiculous statements? There is no universe where Uganda is the “best place on the planet to be a refugee”.

In New Zealand, I spent some time with an awesome refugee family. They were given a house with electricity and running water. Free education. Top quality healthcare. Mentors to guide them into the country. Money every week to buy food, clothes and other necessities. Life wasn’t easy, but it was possible for them to become well educated, get good jobs and they now live fully fledged ‘first world’ lives.

That dream is impossible as a refugee in Uganda. You live on a tiny plot of land. You have no money. Your kids go to a low quality primary school, and there is usually no chance of secondary school. Would you really rather be a refugee in Uganda than New Zealand? Uganda is not one of the best countries to be a refugee. It’s not even a good place. The claim is ridiculous. So why do reputable newspapers spout this rubbish?

Because they have bought into the misleading narrative created by the UN and Uganda. We have been fooled by this unholy alliance. The UN lauds Uganda a model refugee country and a world leader. They paint Uganda as sacrificial angels because Uganda is apparently so ‘generous’ and ‘welcoming’ to these refugees.

Except it is a lie. Uganda has sacrificed exactly nothing while taking in 1.5 million refugees. They have only gained a huge amount of money, jobs and political leverage. Uganda only benefits from refugees. It is inaccurateto label both the Ugandan Government and the Ugandan people ‘generous’ and ‘welcoming’, when they are reaping massive benefits. Uganda and the UN however have managed to sell the ‘generous poor country’ fairy tale to naïve onlookers, including international media. There is no significant downside for Uganda, and the benefits are enormous.

No down side
Uganda pays for none of the services provided for refugees. Food, education and healthcare is 100% paid for by foreign aid. Developed countries are Paying the Ugandan government and NGOs to house refugees, and provide essential services. I’m not saying there’s anything wrong with that, I think it is a reasonable solution. But we should see the reality. Uganda is being contracted by the UN as a service provider for refugees, and they are being paid very, very handsomely.

But what about all of the land Ugandan people have ‘given’ refugees? Isn’t that a sacrifice? In Northern Uganda well over 50% of the land remains completely unused. It might surprise many readers that nearly all of the land ‘given’ to refugees had no-one living on it, and with few exceptions was not being farmed by local people. It was dead, unused land of little to no value. Also the land is not being given, but temporarily loaned. Refugees or the UN don’t own it. In the West Nile region, where most refugees are housed, most land loaned to refugees was owned by the government, but lay useless and idle. Here is Pagirinya refugee camp, where you can see on google maps that no-one has ever occupied or farmed the land where the refugee camp is now located. See especially the top section, where the photo was taken after roads were made, but before refugees  settled. Loaning useless land is not a sacrifice, but a win-win business decision.

7. Children Run towards Camera.jpg

Pagirinya refugee camp

Benefits to Uganda

Money, Money, Money
Western aid money floods into the country, not only for refugees, but also into the pockets of the government and corrupt officials. There is a strange Ugandan government body called the ‘Office of the prime minister’ (OPM), which helps ‘administer’ hundreds of millions of aid money. Much of this is swindled away to line the pockets of the mega rich Ugandan elite. This was highlighted by one obvious heist, but this uncovered scandal will just be the tip of the corruption iceberg.

Local refugee ‘hosts’ also reap enormous benefits. A staggering 30% of all money given to refugees must be spent not on refugees, but on the surrounding ‘host’ community. New boreholes are drilled, schools are built. “Youth groups” are given cash, goats and cows.  The idea that the local community generously welcomes and accepts refugees is a bit rich, when they are benefiting enormously from refugees housed on unused land. This is illustrated well by a comment made by a settlement commander in BidiBidi camp, one of the biggest in the world

“They (local people) contribute land for free, but of course they expect something in return”

Tens of Thousands of Jobs
Uganda has an unemployment crisis. Up to 8 in 10 university graduates are unemployed . Looking after 1.5 million refugees is a lot of paid work. Ugandans don’t volunteer to look after refugees. They need teachers, doctors and food distributors. NGO managers, nurses and borehole drillers. Refugee camps add tens of thousands of much needed jobs for Ugandans, 100% funded by foreign aid money. I have two friends who couldn’t get jobs in Gulu town, but got lucrative NGO jobs in refugee camps. This helps alleviate the unemployment situation and subdue the disenfranchised educated population.

2. Local Maadi Buisinessmen Charges Phones

A local Maadi Man charges phones for refugees. His shop is made from UN donated tarpaulins



Political leverage
As long as Ugandan maintains their important role as a refugee host, the world turns a blind eye to atrocities perpetrated by Uganda’s authoritarian regime. In November 2016, Ugandan Police and army ruthlessly massacred 100 people in a Western Ugandan Palace. The government then arrested 200 people who have not yet had the dignity of a trial. Beside some weak ‘condemnation’, the world turned a blind eye.

This year Ugandan Government agencies burned more than 800 huts in Apaa, Northern Uganda. Some of these huts are less than 30km from refugee camps. There is a sick Irony that Uganda is creating their own refugees in the shadow of refugee camps. These local people who’s huts are being burnt by their own government, have stormed the UN human rights office in Gulu, desperate for some kind of change. The response of the UN is pathetic, even weakly supporting the government, partly because they want to keep the ‘refugee host’ happy, otherwise perhaps rich countries will have to take in more refugees.

When a country institutes a policy that brings them massive benefits, with almost no downside, they should be considered astute, but they shouldn’t get lauded as good and benevolent. The narrative should be accurate. Rich countries pay for refugees to stay in Uganda, while Uganda’s corrupt government milks the situation all the money and political favour they can. The rich countries then don’t have to take refugees themselves. Win for rich western countries. Win for Uganda. At best, Ugandas refugee policy is a smart, mutually beneficial arrangement between the UN and Uganda. At worst it’s an unholy alliance between the UN and Uganda. It’s time the mainstream media ditch the false narrative of a sacrificial and noble poor country opening their arms to their poor brothers and sisters.

Ugandas refugee policy might be a reasonable option for all involved. Bt it doesn’t come from the ‘good hearts’ of the Ugandan government or people. If international money dries up, the refugees will be thrown out of Uganda just as quickly as they were let in. Uganda’s ‘open and generous’ refugee policy doesn’t come from the heart, but from the brain and perhaps more importantly, the stomach.

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“Never Lose Hope” Stories from the Women’s Prison

This isn’t a call to give money, it’s a call to read the stories of some incredible women.

Phoebe (Tessa’s sister) has worked in the women’s prison for the last 6 months, teaching women to read, and more recently teaching them to teach each other to read. Her work with Pastor Florence and the women inside to start a literacy program is incredible. But this isn’t about that. It’s about something even more exciting.

Phoebe leaves for Malawi in a month, and she wanted to make sure that the prisoners have the resources to continue the classwork. Basic stuff like phonics books, blackboards and chalk. To raise the money, the team decided to put together a book of short stories and poems about their lives. As they share their incredible stories, more fortunate people would share their money to ensure the future of the literacy class. Fair trade I reckon.

The stories were more compelling then I expected. I’ve been in Uganda for 5 years, and I’ve gained new perspectives on the place, and now have even more questions about this fascinating culture.

“Love is delicious like an egg. But it breaks when not handled well”
Kevina Rachael Auma

“The ninth survival occurred when a man was paid either to shoot me and kill me or infect me with HIV…”
Akidi Edith Betty

“The love I developed for them earned me the title, Florence, mother of prisoners. I am not ashamed to be identified with them. It is a command from the Lord himself – remember to visit the prisoners.
Aryema Florence Lagum

To be clear, the fundraising was so successful that they don’t need more money, but they do need you to read their work. It’s not easy to be heard from inside a prison.

I’m passing on a request from the women themselves to give a bit of your time and read. To hear their stories which may seem like they are from a different universe. You will receive more than your time was worth, of that I’m sure.

Please message me through the blog, or Phoebe (without the dashes) at p-h-o-e-
and we’ll send you a digital copy of “Never Lose Hope”. It will be more than worth it!

(Because stories are sensitive, we’re not putting the book up for public download.)


Phoebe, Florence and the guards (photos aren’t allowed inside the prison)

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Gulu’s 5 favourite Music Genres – with surprises!

Everyone loves music, so I thought I’d share what’s popular here in Northern Uganda. The last two genres might surprise you!

Traditional Acholi
Acholi traditional music is fast paced and toe tapping. It can make my hips move automatically. It’s hard to walk a hundred meters in Gulu town without a local tune gracing your ears. The undisputed Acholi music kingpin is ‘Lucky Bosmic Otim’, who has been prolific churning out mesmerizing local tunes for over 10 years. Topics are wide ranging, from peace in Northern Uganda, to martyred Archbishop Janani Lawum to classic love songs. You can even commission him to write you a personal song for your wedding or political rally. Below is one he wrote for a Gulu Mayoral candidate. Unfortunately the song didn’t help him the guy win. If you want to se traditional dance in the middle of the road, a tour of “Gulu town, Gulu city” and politicians trying to dance this is the video for you. Around the world it should be compulsory for politicians to dance during their campaigns.

Ugandan Pop

It won’t surprise anyone that people in Gulu are also into the ‘top of the pops’ Ugandan musicians, who are mostly based in Kampala. My favourite Ugandan song is “I will love you everyday” by Bebe Cool. Fruity, super catchy pop. My sister amazingly heard this song in a Tongan bar, so it got some international traction as well! WARNING. It may get stuck in your head :D.

Local Pop
I wish more western pop music had messages as good as some of the local tunes. My favourite Acholi pop song from the last year is “Weng Nono” (It doesn’t mean anything) by Eddy Wizzy. Its catchy and and the lyrics are awesome.

“If you’re brown or black,.. If you’ve got a car or if you haven’t… If you’re thin or fat… It doesn’t mean anything… The things we have here on earth, are staying on earth. We are only visitors”

Country and Western
Its amazing how often you enter a Ugandan bar and hear ‘The Gambler’ by Kenny Rodgers. I’ve sat on a bus for 5 hours charmed almost exclusively by Southern American crooners. Full of American references from a different cultural universe, you might wonder why country music is so popular? Country music tugs at the heart, and tell stories about real life issues. Country music isn’t only popular in Uganda, but has gained surprising popularity in South East Asia and Europe. There’s a great podcast about it here if you’re interested!

Power Ballads
Last year at our end of year staff party, nursing assistant Eunice performed a majestic Lipsync to “I’m with you” by Avril Lavigne. I couldn’t resist joining her for the last chorus. Ugandans (and myself) love a good power ballad. Emotional, tuneful and awesome.

My sister Emily, her fiancée Will, Tessa and I were knackered after a successful mission. We were standing right on the Rwandan border and were hoping a vehicle could take us back to lake Bunyoni. Luckily a local ambulance rolled by and picked us up, complete with empty IV fluid bag swinging like a pendulum from the roof. Best of all we spent the next 15 minutes singing along to the best of Westlife. What better way to end a day! “I’m flying withouuuuut wings”.


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Yes, they tax us for using facebook!

It actually happened.

Yesterday, on the 1st of July I tried to open facebook on my phone and got an extended loading bar. What? Surely not? The government actually blocked our social media!

Coup leader and Dictator of over 30 years Yoweri Musevini has become more and more annoyed with social media of late. One facebook personality (or group of people) known as ‘Tom Voltaire Okwalinga’  (TVO) has drawn his ire a number of times for flagrantly abusing the regime. Have a look at TVO’s posts, they are pretty funny. I don’t vouch for the accuracy of his tipst but its certainly entertaining!

Museveni even tried to get Facebook to reveal TVOs identity in an Irish court! 

“We will get this man Okwalinga,” said Museveni on Friday while meeting media executives at State House Entebbe. “Now that we have the machines, we will get him.” Museveni has the machines …

Then he became annoyed with all of the “Gossip” going on on social media that needed to be dealt with. “I am not going to propose a tax on internet use for educational, research or reference purposes… these must remain free. However, olugambo (gossip) on social media (opinions, prejudices, insults, friendly chats) …. must pay tax because we need resources to cope with the consequences of their lugambo (gossip),”. By ‘lugambo’ (gossip), it seems that he means free discussions and opinions about the state of the government and Uganda.

Parliament listened and actually instituted Museveni’s tax! The outcry against it has probably surprised even the big man himself. It has made the front page of the papers. Oxfam and Amnesty international have blasted it. Lawyers have claimed the tax violates the constitution and have taken it to court. Many Ugandans are even finding ways to dodge it using Virtual Private Networks (VPNs).

Paridoxically the tax could be a good development in the end. It’s a sign that the leader fears the people and the power of free speech. The people are trying to take back a semblance of power by defying the tax. No-one is getting physically hurt. Who knows? Maybe the reaction against this could be one microstep to a more meaningful kind of freedom in Uganda?

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Gulu Prison: Update and a Plan

Phoebe (Tessa’s sister) has expanded her work in the women’s prison and she’s shared some more amazing stories. The women also need a consistent supply of books and pens so the work continues, so we’ll be raising money for that soon. They will share their stories. You’ll share your money. Stay tuned!

The World-Once-Removed Weekly

Book Exchange

*This follows on from my previous post about the library – read that first 😊

We raided the library a second time. Books sat in piles on a table while we taught outside in the sun, waiting for the post-class book exchange opportunity. At some point Florence (prison pastor extraordinaire) nudged me and pointed, giggling. The guards do a lot of sitting around, and a lot of trying to knock mangos from trees with the butts of their guns. But today they had picked up books and were reading!

I later discovered one of these was Miriam, a gem among prison guards. She sees the value of books for female prisoners. She volunteered to house the books in her office and has requested shelves built. Best of all, she changes books for women on request between our visits, even carrying large stacks between locations so they can choose…

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Head above water. A heartwarming story!

Walter is unique. Of all of our nurses, he’s the only one who makes sick patients laugh before they even sit down. It’s impossible to feel bad when you are around him. We had great hopes for the New health center he ran on the border of South Sudan, when disaster struck. The banks of the Unyama river burst, and within an hour the water was up to his thighs. He saved our drugs. He lost 2 sacks of rice and beans. His wife and baby were safe.

He was shaken, as any of us would be. He moved to another new health center based in the a youth remand home. It’s a place where justice isn’t usually done. Youth between 12 and 18 await trial. Some for one month. Some for a year or more. Many are found innocent after already serving months in a poorly kept, poorly fed institution. Our misson and Walter’s mission is to promote good health for these vulnerable youth. And who better than Walter to do it?

Walther selfie.jpg

The remand home health team is amazing. Nurses Emma and Shirley work with Walter to oversee health education and screening. Every new youth gets screened for malnutrition, malaria, hepatitis B and HIV. Over 30 youth were positive for malaria that was immediately treated and cured. One had HIV diagnosed for the first time, and was started on life saving antiviral drugs. Dangerous outbreaks of bloody diarrhoea, conjunctivitis and skin infections have been stopped with a combination of good treatment, education and public health measures. After 7 kids got bloody diarrhoea, Walther and Emma found that kids were hiding extra food in their rooms, then sharing it later without washing their hands. A hygiene nightmare! This was stopped, the kids were treated and there were no more cases.

Remand clinc (1)

Unfortunately though, it wasn’t working with the community. Its understandable that many people didn’t want to enter through prison gates. People would rather go to drug shops, which were easy to access but expensive and low quality. Others weren’t aware of the service in the sprawling peri-urban area. Some gave up after they couldn’t find the health center. The few Community who did come loved Walter, the fair price and quality treatment, but despite Walter’s amazing work with the youth, it became hard to justify a full time nurse for only 40 youth with only a few community patients.

We felt terrible, but hope wasn’t lost. The team decided to step out in faith and make one last push with the community. They went to market days with free HIV screening and health education. Trusted community leaders reached 200 houses with the services we offered. There was a three month deadline. If we couldn’t double the patient turn-up, the place would have to close. I thought the hill was too steep, and it probably wouldn’t happen. We awaited the response. We didn’t have to wait long.

Walther Tests

Their community push worked better than expected. In the last 3 months, the number of community patients has more than doubled. In March, April and May there have been 170, 180, and 190 community patients respectively, in addition to 40 to 100 monthly consultations with the remand hoe kids. The money coming in from the community sustains our nurse, and pays for the drugs needed for the community. In the meantime, the number of youth in the remand home doubled to 80 and they are now 2 to a bed, so it was crucial for them that we remained. Hope for the future has become a reality, and we’re even hoping a team will come later this year to expand the facility with a couple more rooms. After being here 5 yeas, I’ve found that its easy to on dwell failure, but its important to remember success like this.


Reman Selfie

Emma, Walther and I, looking forward to the future of the remand home clinic!

Its important to say that I didn’t do any work towards this amazing turnaround. I’m just writing what’s happening! Walther, Emma and Shirley had the faith, hope and love required to make this work and it was amazing to see it happen from the sidelines.

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