Dr Adam Boggon / Clinical Teaching Fellow & Honorary Clinical Lecturer / Royal Free Hospital & UCL Medical School
Tales from travels in Uganda. Adam shares his experiences around his Tropical Medicine and Hygiene Diploma (DTM&H) in East Africa.
Running home in Kampala requires focus. Through a shoal of motorcycles and old Japanese vans the runner must evade potholes, goats, roosters and a miscellany of unaccountably armed men.
Weather here is definitive. It is either hot and bright or there is a storm. Heavy rain is insufficiently descriptive. The sky simply opens. For weeks I wondered why the gutters beside the roads are a metre deep. Now I understand. The red clay soil absorbs little of the downpour: it flies off rooftops, tumbles down hillsides, fills roadside trenches to the brim.
Taking a boda-boda through the city after the rain is hair-raising. I cling to the back of the 100cc motorcycle as it thumps on and off pavements, weaves between gridlocked trucks, heaves into great puddles of unknown depth. There are many accidents here: three thousand people die on Ugandan roads annually. More remarkable though are the crashes which do not occur. Drivers seem to feel their way through the dense traffic as if they were dancers, or water in an endless stream.
For two weeks in Kampala we studied HIV medicine and tuberculosis, outbreak control and meningitis. We donned hazardous materials suits to run a simulated Ebola Treatment Unit. The fog and sweat and heat were overpowering. I was soaked through – as if I’d been caught by a Kampala downpour or dunked in the Nile. Bear in mind that we were in a hotel conference room and our patients weren’t actually sick.
We drove to Jinja, a town on Lake Victoria at the source of the White Nile, for a travel medicine placement. Our accommodation was inauspicious yet lurid. The exterior of Hotel Paradise is screaming pink. Inside, a trail of ants ran around the doorframe of my room, which was full of someone else’s belongings. I requested another suite.
I borrowed a bicycle from a charity shop in the main street. The suspension was fused but the brakes worked and £2 per day was affordable.
My attempt to cross the Source of the Nile Bridge was truncated by a personable but extremely firm member of the Ugandan People’s Defence Force. Thinking it imprudent to quibble with a man in camouflage resting an AK-47 over his knee I turned around to find an alternative crossing.
On the road a group of cyclists rode past me. Teenagers. One of them called to me:
“You go with us!”
I hustled after them. Their bikes were rusty but the moving parts were oiled and carefully maintained.
“We train every day.”
“Tomorrow you ride with us to Kampala?”
“Sometimes we go to Kenya!”
“Give us your number. If there’s a race this week we’ll tell you.”
I apologised. I was going rafting.
The staff of the Nile River Explorers rafting company wear red t-shirts emblazoned in yellow ‘I love my job’. I spoke to Juma Kalikwani, who grew up in Jinja and was once a guide on the Findhorn river in the Highlands. Juma represented Uganda at a freestyle kayaking demonstration at the 2012 Olympics. He’s been a guide on the Nile for 18 years. Does he ever grow tired of it?
“The river is always different. The bends and rapids I know so well but still they can change and surprise you sometimes.”
We go through a set of induction drills. Forward, backward, pivot turn, hunker down, hold on. How to get back in the boat if ejected: haul on the side, lock your elbows, kick with your legs, upheave. Juma makes us aware of important warning signs:
“If you look in your boat and no one is paddling and people are just praying – this may be a problem.”
We learn observed patterns of rafting injury: shoulder dislocation, patella fracture, being pinned against rocks. This information is withheld until you’re on the river.
The opening rapid features a drop down a 7-foot waterfall. I take a deep breath and listen closely to the instructions:
“Forward paddle! Forward paddle! Stop! Get down!”
My heart enters my mouth as we go over the lip, the raft bends in the middle like a book, and springs back into shape as we emerge from the torrent.
The river flattens out. Becomes a fat mass of dark water. I hadn’t expected this: I thought rafting was all white water and shrieking. I zone out.
My thoughts turn to whisky. Phil, our course director, had given me a bottle of Bowmore as thanks for assuring the safe passage of course baggage from Moshi in Tanzania across the Kenyan and Ugandan borders to Kampala. This had been smooth sailing on the whole, save for a small matter concerning whiteboards on the Kenyan-Ugandan border at 5 o’clock in the morning.
We’d been on the road for twenty one hours. I’d carved a niche in a mass of bags at the back of the coach and had accepted half a sleeping tablet from one of my classmates. So when we pulled up to the border in the dead of night I was bleary-eyed and partially tranquillised. Not an ideal frame of mind to protect 80 bags of personal belongings and course material. We were instructed to unload all of the bags for inspection. These passed without question save for six large rectangular packages stowed near the engine.
“What are these?”
“They are whiteboards.”
“Why do you have so many whiteboards?”
“They help us to travel.”
We had been told by our programme director to keep tight-lipped at the Ugandan border. We were tourists; not doctors on a medical course. Travellers pay a low-rate visa but matriculated students are expected to fork out for the more expensive business version. Phil assured us no-one would care once we got to Kampala but if we let the cat out of the bag crossing the border we’d each take a $200 hit. I elected not to inquire if this was what people mean when they talk about corruption in Africa.
We had our party line and were determined to stick to it. The whiteboards were a snag. What sort of tourist goes around East Africa with six whiteboards in their bus?
The customs official clearly had the same thought:
“We will have to keep the whiteboards here at the border.” “No, the whiteboards are coming with us to Kampala.” “But there is a special tax process for this item.” “But it’s a whiteboard!”
I wondered if this was going to be a matter of ‘kitu kidogo’ – a little something. Phil had given me an envelope with $50 with which to pay any necessary bribes. Before guiding the conversation in this direction I thought I’d run another tactic: cultivate bewilderment. “Do you want to know why we have the whiteboards?” “Ok.” “We are from many countries. You have seen our passports: Zambia, New Zealand, UK, Malawi. We met at a conference and decided to travel together.” “What does this have to do with whiteboards?” “As we travel we like to stop and reflect on what we have learned. We use the whiteboards to write on to collect our thoughts.” “I see…” “We can show you how we do it!” The customs official had a wary look in her eye. “No. No. That will not be necessary. You take them. Goodbye.” I doubt she believed us. But my excitable Zambian friend Shahin and I had turned up our smiles and pressure of speech and I suspect she concluded that it was 5am, she was tired, and this particular cabal of eccentrics were likely to rain down a hurricane of inconvenience if she impounded their stationery. Better not to bother. We loaded the whiteboards back on the bus and drove off into the darkness.
Approaching a chain of rapids the world regains focus. One’s mind stills. Reveries end. You listen to the briefing and hold on as the river begins to fizz and boil beneath you. The rapids are named: Bubogo, Itanda Falls, the Bad Place, Retrospect. Most go well – the rafts are buoyant and my grip is strong. But sometimes you get rinsed.
For some time afterwards I couldn’t work out exactly what happened on the Kulu Shaker rapid. It wasn’t the submersion – thrown deep in the thrashing water, relying on the buoyancy aid to tell up from down. Or the resurfacing – for an instant, gasping a breath, then clattering into the belly of another standing wave.
You let your body go slack and wait to rise again.
What puzzled me was the disorientation. We’d been careening down the line of rapids, the raft rolling and tumbling between huge broken waves. Sometimes a wall of water crashed into my face and torso and I closed my eyes.
Then my feet were above my head, my left arm gripping a paddle but nowhere near the boat, scattering into a maelstrom of helmets, bodies and flood. Then there was only the muffled tugging sound of fast water heard below the surface.
Speaking to Sophie afterwards, who had been at the back of the boat, she reckoned we hammered straight into a massive standing wave which fired us upwards. We crossed the vertical line and geometry defined the outcome: the boat flipped end on end.
But capsizing is to rafting what an element of farce is to any great adventure: the sine qua non. Hundreds of wayfarers have been unceremoniously dumped by the Kulu Shaker. Save the few who lose their teeth or unhinge their upper limbs in the process I doubt many would wish it otherwise. So it’s saddening to know that in a few weeks the great rapid will no longer exist.
The Isimba Dam will help relieve Uganda’s chronic energy shortages with a hydroelectric power station. But when the river is flooded much of the broken water will disappear. The rafting companies don’t know exactly how many of the rapids will vanish or how their businesses will adapt to the altered waterway.
Change is coming to this section of the White Nile. But this is as old as Heraclitus: you never step in the same river twice.
For more work by Adam see his website www.adamboggon.co.uk
For those interested in working in the tropics there are a number of diplomas available. The full time Diploma in Tropical Medicine and Hygiene in Uganda and Tanzania is not currently running (at the time of this publication) but the courses in London, Liverpool and Glasgow are.