Howareyoumzungu?!

The average haemoglobin level in men is 135 – 175 g/L. Women are allowed to be a little lower, to account for menstruation, but ideally they shouldn't dip below 115, or they start to feel run down and constantly tired. Haemoglobin carries oxygen around the body and so less haemoglobin means less oxygen and more tiredness. There's a constant struggle to retain one of the earth's most abundant elements. The human body just seems to have a design flaw in that department. Much below 90 g/L, and symptoms set in – kept at bay perhaps a myriad of iron tablets and injections. In New Zealand, people below 80 are generally given blood transfusions.

The haemoglobin level amongst the patients at Kiwoko varies between 20 and 50, occasionally a 70 or 80 is recorded. At times they get so low, I didn't realise they were compatible with life. Every now and then, someone comes in with signs of heart failure. Not because there's anything wrong their heart at all but because it gets such scant oxygen from anaemia it has to work overtime, filling double and triple shifts just to cover the rent. I don't think I've seen a patient yet with a normal New Zealand level. I've given up even including anaemia as a diagnosis.

I mentioned this phenomenon to Dr Rory Wilson, the medical superintendent of the hospital. A softly-spoken Irishman in middle age, he has been in Uganda and Kiwoko in particular for many years now. He puts it down to a combination of malaria (mosquito-supplied parasite's that burst open red blood cells with a voracious appetite), malnutrition (which needs no explanation) and genetic mutations in the red cells themselves - gifts of biochemistry that happen to interfere with the parasites life-cycle. In a cruel twist of irony, they also predispose to anaemia.

As you drive out of Kampala, the urban sprawl eventually subsides, the tar-sealed road gradually becomes metal then pot-holed red dirt, and the houses change from brick and tin city apartments, through thatched huts and finally to the clay-baked shacks that comprise rural Uganda. And then you see them.

Working in the field from day-break to dusk. Manually chopping the ground. Leading cattle to more fertile fields. I see two siblings till the field. The brother gently turn the dirt. His sister bends down to sow the seed. Row after row, field after field. T here are adults around working too of course, but the vast quantity needing to be harvested mean the children must help. Perhaps they attend school during the morning and work the field in the afternoon. I really can't say. The patents might earn a wage if they moved to the city. But the country seems to be their life. And unemployment means subsistence farming is the most realistic alternative. I guess Uganda never really industrialised.

The women sit in front of their houses, scrubbing clothes and laying them on the field to dry. There are no washing machines here. No clothes driers. Not even running water on tap.

The children throw down their rakes and hoes as you ride past. They bounce up and down and wave their hands in the air excitedly. Howareyoumzungu?! Howareyoumzungu?! They chant in a single syllable.

And for the life of me, I can't fathom how they do it. I can't understand how they keep up such an arduous lifestyle while running a haemoglobin that'd make western doctors queasy.

I guess it's reasonable to assume not everyone is as anaemic as the hospital patients. They are, after all, in hospital for a reason. But it also seems reasonable to assume they run on a tank far lower than 'normal'. Malaria often runs a subacute course. Malnutrition seems an almost universal phenomenon. And genetics are genetics, once you're born with a variant blood cell that's your lot for life.

Labour amongst fatigue. Joy amongst toil. Energy amongst deficit. I find it a fitting tribute to Uganda so far.