He complains of a pain in his chest.
Slightly dull and poorly localised. Present for about 5 months off and on. Worse in the evenings. Not affected by food or exercise.

He is dressed smartly but no smarter than the average young Ugandan male, except for मय्बे the shiny black briefcase he held under his arm and placed on the desk.

It could have been any number of things I guess. Heart. Lungs. stomach. Rib cage. But his heart was clear. No history of cough or breathlessness. And

Most probably it was skeletal or trauma. He was after all a farmer, like the vast majority of the population. So I prescribe some anti-inflammatories in the hope it just clears up. Take two panadol and call me in the morning.

'Do you have any medical conditions?', I ask as an afterthought.

'Oh yes, I have diabetes'.

I raise my eyebrows, and get the translator to confirm this. Not the every day thing in these parts.

He was born with it apparently and is working on the family homestead as a 29 year old subsistence labourer.

He flicks open his briefcase and pulls out a school exercise book neatly ruled into columns. With pride he shows me his glucose readings, nicely ordered and filed under mornings, midday, and evenings. He also shows me his insulin schedule with corresponding blood sugar levels before and after each dose. He asks whether it might be better to increase his medium-acting insulin at lunch-time and decrease it in the evenings to give him a bit more energy in the morning. And whether the long-acting one could be increased slightly.

The look on his face is genuine and concerned.

I just sit there stunned.

Somewhere, living in a thatched hut amongst the rats and snakes, with no internet or electricity or running water lives a young man who controls his diabetes better than half of New Zealand.

Uganda is full of surprises.

The Most Famous of All

Visible only as a silhouette flickering from nearby fires, the old man carries a torch in one hand and a long pole in the other. He swings the flashlight beam back and forth across the ground immediately in front of us as we walk along, pole at the ready. Snakes, including the deadly Black Mamba, are common in these parts. We exchange the usual pleasantries: where each other is from, families, life trajectories, weekend football results. Then he asks what brings me to Uganda. When he hears I'm in a mission hospital he shakes his head sorrowfully. 'There are too many mzungu working in our hospitals', he says, 'too many. You can never really understand them you know?'.

I'm finding it difficult to gauge just how responsible colonialism has been for Africa's current problems.

This weekend marks Independence Day and in Kampala little else seems to be talked about. Celebrations and marches abound, newspapers run columns and experts are interviewed on national TV. It is a time for remembrance, both of atrocities past and present.

Some seem to relish the freedom and autonomy of the post-colonial period. Others decry the rampant corruption and hospitals or schools woefully lacking in supplies.

Extreme views abound and calm voices of reason are scarce. Does such a thing even exist? Can a middle-ground be found that acknowledges wrongs done in the past without buying into the Rousseau-ism that seems to dominate a lot of pan-African thought. The idea that before the Europeans came, aboriginal societies were utopias populated with beings wholesome and pure, untainted by corrupt society, living in a land flowing with milk and honey strikes me as naive, bordering on Pollyanna-ish.

But picture this.

The British arrive and find the future Ugandan tribes disparate and living in mutual hostility -the centralised kingdoms based around Kampala south of the Nile and the nomadic pastoral peoples of the north. Not an ideal situation despite it's economic prospects.

But the Germans are actively mining coal from Lake Tanganyika in modern Tanzania. The French are shipping slaves to Arab settlements throughout. And the Belgians are enthusiastically chopping hands off slaves in the Congo. Everyone has plans to expand in Africa. Everyone wants a piece of the cake. Conflict seems inevitable. But the last thing anyone wants is war, they've only just got rid of Napoleon.

So they all have a sit down in Berlin, sip tea and pull out a map. Foaming at the mouth, they get excited as they draw lines across vast plateaus and divvy up Africa's spoils amongst themselves. Congo to the Belgians. Nigeria to the French. Tanzania to the Germans. But they are ignorant to the centuries of history, the wars and rumours of wars, that have ravaged the continent in the past. With the stroke of a fountain pen, tribes are dismembered and split apart. Half become ruled by the British, half by the French.

Likewise, warring factions and mortal enemies having fought violently for decades, suddenly find themselves lumped together as a new nation and told to relish and embrace their new national identity.

Most of East Africa falls to the British. They need to maintain plantation workers in the West Indies. They need to ensure a steady supply of ivory and tea to the motherland. And most importantly they need to stop it falling into French hands.

And so they establish the protectorate of Baganda, ostensibly to protect the Kabaka and his subjects from the threat of European influence. A region not formally under colonial rule but protected from and the threat of native development.

The populous Buganda, representative of the Southern tribes based around Kampala, are a largely centralised chiefdom. They are selected by the British to fill positions in the British administration.

With the outbreak of the world wars, northerners become the Kings African Rifles. Conscripts employed to do their masters bidding in the Europeans wars. Resilient fighters, skilled in bush combat, they are loaded into transports and shipped off. Backtracking the path made my their ancestors a millenia before, they rumble with Rommel in the Egyptian desert.

But there is no mention of their heroics, no formal expression of gratitude for their sacrifice. No inspiring Battle of Britain speeches, no fighting them on the beaches and on the landing grounds and in the fields and streets.

In contrast, the Southerners in Kampala are applauded for their toil and cleverness. Increasingly they administer the British administration, efficiently funneling the regions spoils into the English economy.

The murmurings of discontent grow throughout colonial Africa.

Rumours spread throughout the land. The epoch of European rule is nearing it's end. The Mau mau arise in Kenya starting a domino effect that ripples throughout Africa. Keen to avoid another blood-stained catastrophe like the Maumau or in the Congo, the British make plans for a peaceful transition.

So they turn naturally to the African cultures most like them to pick up the baton and continue in their absence. They have, in a sense, bred them for this role. The Bagandan kabaka and his subjects are the obvious choices to rule over the 'backward' cultures of the North.

But most of this is lost in the optimism of the moment.

In the heyday of Woodstock and baby-booming and free love, the world celebrates the spirit of independence and anti-imperialism. They prepare to cherish peace and love and the noble spirit of the former colonies.

But the seeds of modern Africa have long fallen amongst the weeds. As the Acholi poet Okot p'Bitek put it, 'The teeth may smile, but the heart does not forget'. Artificial boundaries have long become entrenched without true social cohesion. Unbalanced power structures have been crystallised. There are oppressed majorities and privileged minorities throughout Africa. The Baganda and the Acholi. The Lendu and the Hema. The Hutu and the Tsutsi.

Once the Europeans pack up their picnic basket and leave the continent for good, wave after wave of discontents from the North sweep across the Nile and take their revenge on Kampala.

There is Milton Obote.

Alice Lakwena.

Joseph Kony.

There is Idi Amin, perversely the most famous Ugandan of all

Chinese Whispers

There were five of us in the room altogether: a student nurse from Gulu up north, a mother with her 7^th child originally from Nairobi, the mother's mother, and myself. None of us speak the local Lugandan dialect or even share many in common. Still we undertake an entirely meaningful discussion that consists of Swahili on the mother's part, Acholi on the nurses, and gestures on mine.

By pooling our resources we speak excellent Lugandan.

The grandmother appears to be running the show. She is dressed traditionally in a one-piece Gomesi, a brightly coloured silk number that comes down to the floor with curious points over the shoulders. Like a number of things in Uganda, it looks just a touch Indian

The problem, from what I gather, is a previous miscarriage causing ongoing bleeding.

'What gestation did she miscarry at?', I ask, hoping that a touch of sympathy comes across in my exaggerated body language. On the third attempt the message reaches the target and gets passed back along the circle back to me.

'It was full-term.'

I blink. 'You miscarried at full term? As in 40 weeks'

There is more murmuring back and forth down the chain of command.

'Yes, at term but it wasn't a human baby.'

'Oh really'. After 4 weeks in Uganda I'm beyond being surprised. 'What kind of a baby was it?'

There appears to be some confusion. The mother frequently interjects and cuts off her daughter who speaks excitedly back. I, of course, can't understand a word of what is going on and resign myself to sitting back and letting the situation unfold. Eventually a hush falls

over the room. There appears to be a consensus. Esther, the student nurse, turns to me.

'It was a dead dog', she reports matter-of-factly.

I blink.

I shake my head. Something must be lost in translation.

There is more animated conversation. Excited but hushed tones. Dramatic gestures. I hear the word Simba pop up now and again. Finally the message is relayed back.

'No no, it was a dead lion.'

'Oh right. A lion. ' Good to clear this up.

The Chinese whispers pass back along the line to reach the young woman.

I don't have a wealth of experience in obstetrics but I have never actually come across this before. I wonder how many witchdoctors had been consulted before arriving in outpatients today, how many pacts with the devil had been exorcised en route to Kiwoko. Fortunately there is a rather simple solution. I take her file and write two blessed words. Gynaecology Review.

I look forward to the discussion in doctors meeting tomorrow.

The Great Escape

It wasn't a bad trip from Kampala.

Being a Sunday afternoon, the congestion around Nakasero Hill wasn't it's usual height and only one or two detours through run-down squatter blocks were needed before we broke out onto the Northern highway towards Luweero.

We'd made the 30km trip in little over half an hour and all that remained now was to transfer matatus at the Luweero taxipark and find one going into the Kiwoko town centre. I get shown aboard a van that is reportedly heading direct to the hospital. 'How much', I ask the conductor. 'For you, my friend, is 2000'. I'd had enough bartering in the city that weekend so I simply nod and climb aboard.

It's fair to say that matatus, Ugandan minivan-taxis, are not purpose built for comfort but this one seems a little worse than most. The upholstery is completely tattered. The seats lie in various angles and directions, some even point forwards. One isn't fastened to the floor as far as I can tell. The engine cover is partially broken leaving it's entrails open to the world. A wooden plank sits over the handbrake creating a make shift seat. There are two giant cracks in the windscreen. A giant decal over the front reads Luxury Cruiser.

5 of the 9 seats are already taken as I clamber aboard, a good sign as only 3 more need to be filled before we head off. Before long a Boda Boda, a motorbike, pulls up and a 10-year old girl climbs off the back. She's dressed tidily in satin shirt, shorts and sandals. Her hair is shaved short like may Ugandan children, except at the back where braids are just beginning to form. She waves goodbye to her father on the Boda and climbs into the seat next to me.

We try and have a conversation but her poor English and my even worse Lugandan mean we're restricted to just a few common phrases. She carries a plastic bag holding a jumper and a change of clothes. She tells me she's staying with her auntie in Kiwoko village for a few weeks.

'How much?', she asks pointing at my fare. '2000' I reply holding the ready folders in my hand. She laughs cheekily. 'It's only 1000 to Kiwoko'. Precious. You can always trust children to be honest.

We try and make small talk about the locale and the flash floods that are just starting to hit Uganda.

And time drags on.

We sit in silence for at least 20 minutes, staring at the vans and Bodas entering and exiting the park. We gaze with tedium as the shopkeepers sweep their shopfronts and. No on seems to be filling the seats.

She tells me her theories about surviving crocodiles. Her father, it seems, was attacked by one last year and managed to survive with all his limbs after making use of a machete. His machete technique obviously failed to completely convince Nikita by allaccounts and her last few months have been filled with endless research and brainstorming. Swimming away is definitely out. Running won't work either apparently, even on the flat. Fighting is a bit hit and miss, mostly miss. You can go for the eyes but that leaves a lot to chance. Her currently favoured paradigm is to climb a tree. I promise to bear this in mind next time I am chased by a crocodile.

My buttocks start to ache from sitting so long and I shuffle on the seat trying to get comfortable.

A lady knocks on the window selling chunks of meat roasted on a stick. Even from outside the smell of permeates the van. I wouldn't touch it with a barge pole but Nikita looks most excited so I buy her one. It's probably beef but could equally be pheasant or goat. Or even elephant really. There is no way to tell. She seems to enjoy it though, sucking off huge lumps and grinning. I start to develop abdominal cramps in sympathy.

And the time still drags.

I find myself mentally counting down the number of seats left to be filled. The one in the

back could have been taken except the lady who was about to sit there was invited to squish into the front alongside myself, Nikita, and another young man who looked just as uncomfortable. But at least there's still two seats in the back for additional passengers.

We'd been in the taxipark well over an hour. The trip itself only takes 15 minutes. Would we be there yet had we walked?

An 'elderly' lady in her 50's climbs in with a chicken tucked under one arm and a Cole bottle full of petrol in the other. The van immediately combines the smell of both with stewed goat from the meat skewer.

A breeze builds up, blowing dust and sand throughout the taxi park and into the van. It scratches the eyes and passengers pull up shirts and scarves to take shelter.

If I close the window, the smell builds. Smell vs. Sand. The smell builds to a nauseating level and the window wins.

Surely we must be leaving soon.

I pull a map of Uganda from my bag and show it to Nikita. She points out places she has family and been on trips. Jinja. Nakaseke. Kampala. Entebbe. Even as far north as Murchison.

By now she's partially couched on a sack of grain and partially on the engine cover.

We could take a Boda, I mention casually to the Nikita. She smiles. It won't be easy to climb over the 2 sacks of grain jammed between us and the door. Not without attracting the attention of the taxi driver who will insist 'we are leaving soon, very soon Ssebo'. But there is another way.

I catch the eye of a Boda driver and motion him around the side. I knock on the window and slide it open.

'How much to Kiwoko?', I ask, 'for me and the girl?' I was starting to become attached to her, and besides, she was saving me a fortune on fares.

'Ok my friend, for you today I will do 3'.

'Ea?, no no 2', I reply holding up the appropriate amount of fingers. Thanks to Nikita, I know exactly what the fare should be, the non-mzungu inflated fare.

Eventually he smiles. 'Ok ok, two to Kiwoko'.

Sweet. We have to be snappy. I slide the window open a bit further and pass him my bag. Then Nikita sits on my lap and pushes her feet out the window. She straightens her body

like a pin and I pass her through the window. The driver helps her clamber onto the back of the bike. Next I stick my own feet through the gap and contort myself through the opening. Smoothly I drop down onto the bike behind the girl and rearrange things to get balance. I check my pockets to make sure I have my camera and phone. The driver casts a look at me. I nod back. 'Tugenda', I call out and give the thumbs up sign.

The Boda Boda bumps towards the road with horn blasting, signalling our presence to other road users.

I cast one final glance back at the Luweero taxi park.

Mostly It Goes

The door opens and in walks another mother with a sick child. Fever on and off for a week. I ask if she's ever had malaria. She bursts out laughing. An error in translation perhaps? It turns out that in Uganda, you get malaria like you get a cold. A mere inconvenience that leaves you feeling rather lousey for a couple of days. Occasionally, though, it kills you and therefore any child with a fever tends to be generously dosed up with anti-malarials. With time, this breeds resistance.

Of course there are WHO guidelines to manage this but, like most UN publications, they tend to be enthusiastically ignored.

After my partially successful attempt to prevent any meaningful surgery occurring at Kiwoko, I had moved to the outpatients clinic. Armed with my trusty Oxford Handbook of Tropical Medicine I sit in an office in the outpatients department speaking with a steady stream of patients through an interpreter. There's the usual plethora. Chronic pain. Infertility. Skin infections. And of course the young child with a fever.

This case has an additional caveat. Both mother and son are HIV positive.

A cough plus fever in New Zealand generally means either pharyngitis, bronchitis, or pneumonia, each caused by only a handful of bacteria. In Uganda, there is this standard kiwi cocktail plus Tb and a whole host of bizarre parasites and creatures great and small that God saw fit to bless the tropics with. Then you add HIV infection and the list of possibilities becomes exponential.

For any phsycial symptom, HIV widens your list of possible causes. The virus is fussy. It infects a single type of cell. Not brain cells or liver cells or heart cells but a poorly known set of immune cells that don't kill bugs directly. These helper cells are the communicators of the immune system. Giving orders as to what should be attacked and when. With these cells removed by HIV the immune system is thrown into disarray.

All sorts of weird infections emerge. Most of which are virtually never seen in New Zealand where the HIV is low. 0.1% in contrast to Uganda's 29%.

Sitting in my clinic room in the outpatients department, my knowledge of this immune suppression and the consequent tropical infection comes and goes.

Mostly it goes.

The Prisoner of Azkaban

The boy sits strangely apart from his mother. He plops into the chair by my desk leaving her the other at right angles. They don't look at each other much. She talks in rapid staccato tones to the translator. He looks off sullenly in the distance. Very out of place. He's dressed in European clothes that look remarkably clean. He sports newish looking trackpants and a dark tee-short that reads Harry Potter and the Prisoner of Azkaban in large bright letters. Like all Ugandan children his hair is curly and short. An urban-dweller perhaps? A roamer from Kampala leaving traditional African values for the charms of the West. That would explain the aloofness that seems to permeate the room.

Ugandans, on the whole, seem to be very physical people. Gripping your hand for emphasis while they talk with you. Hugging for just a moment longer than would be considered polite back home. Even the standard handshake has at least three movements plus or minus the thumb tap favoured by the younger generation. Most children his age would be clinging to his mother.

I don't recognise the town listed as his address on the file but then these are woefully unreliable at times. He looks roughly his stated age of 7.

It turns out to be a routine follow up for an incision and drainage at another hospital last week. At least I think that's what the problem is. I'm getting the story second-hand as always, with a nurse interpreter acting as intermediary.

Keen to churn through the waiting room that grows by 10 and shrinks by 1 or 2 a minute , I gesture him to the clinic bed. Suddenly the source of the mother-son disparateness becomes obvious. He shifts nervously and pretends he hasn't heard. The nurse repeats herself. His mother grabs his arm. Suddenly the boy shrieks with terror. Not even the hard-boiled sweets I had picked up from a street vendor in Kampala could console him. He flings open the door of the clinic and dashes howling into the hospital grounds.

Moving to the door I can just make out Harry Potter disappearing behind the motorbike shed. The Prisoner of Azkaban darts in and out of the parked boda bodas.

Perhaps the experience at the previous hospital had been traumatic?

I guess pain and fear need no interpreter