Sorry, No Cervix, No Survey

But what about the men? What about us? We are important also! He was about the fifth Somali man who had interrupted us with the same question.

I paused as I tilted my head to the side and studied him thoughtfully from the rickety stool I sat on, my brow furrowed. Tall and lean, loose black curls on his head his skin nearly golden brown.

Do you have a uterus?

A what?

A uterus. A womb. Have you given birth to any children?

He laughed and shook his head. What was this crazy mzungu all about anyway talking only to women and not to men?

Surveying Somali women has been a challenge for us all along. Not only are we limited by our abysmal Somali language skills, but they are a relatively closed community. As refugees living in a poor neighborhood, they are as suspicious of Ugandans as Ugandans are of them and speak no Luganda. Unlike Ugandans, who approach with friendly greetings, Somalis have a direct, blunt approach. What is happening here? Who are you?

We had occasionally struggled through some surveys in Kiswahili, as a few of them have learned a bit along the way. A survival skill on their tragic pilgrimage across East Africa. But today we hunkered down at a fruit stand, owned by a Somali woman we had interviewed last week, who invited us back. At first, things were a bit rough. What?!? All I get is a piece of soap? Give me another one! But slowly women gathered, curious as to what was going on. All covered in various colours of flowing veils, a circle of cloth framing their faces, others with only their eyes visible. Rarely you catch a glimpse of an ankle, or a toe through a worn through sock.

We had a young Somali woman helping to translate. Her English was good and she reported being an avid BBC World News fan. As a diaperless 14 month-old crawled around a huge basket of papayas under the fruit stand and with flies buzzing around, we heard the now familiar stories. Married at 14 years old. Of course they had never had sex with anyone but their husband, they indignantly reassured us.

You don’t understand, we are Somali women! No boyfriends, only our husbands. We are clean down there! If not… She made a gesture with her finger across her neck. Doreen asked, but what about the men?

Ech, the men, they do what they want. Who knows about the men, you cannot control them! What I did know, is that the men found it was miserably unfair that we only wanted to talk to the women.

The women were confused by some questions. Yes, of course I go to the hospital when I am sick, yes, I am Somali, I must go. Always statements with pride in who they are. But the idea of going for screening, of checking something when you had no symptoms, no pain, no bleeding. No. You go when you are sick. Silly mzungu with the crazy questions.

A cheeky Oxfam gender adviser (my sister) I know added her two bits, "as a gender adviser, i would like to advise you about the issue of gender equality. I am concerned that your research is not addressing the issue in a balanced fashion and seem to prioritize one gender over the other. Concerning to say the least, especially in this day and age."

Money Can Buy Bliss

Knock off pink Speedo swim goggles: 8,000 Shillings

Matatu fare: 200 Shillings

Bodaboda (motorcycle) ride: 2500 Shillings

Munyonyo resort admission: 20,000 Shillings

Swimming in an Olympic-size pool surrounded by palm trees: Priceless

How much does sex cost?

Well that depends. On the time of day. Whose asking. What the ‘guest’ is after. If your kids school fees are due. That turns into between 50 and 1000 Ugandan shillings they tell me (a few cents up to fifty cents), that is, if you’re not looking to spend too much time there. The councilman turned to me and said, you know these women get very rich, see they are fat and healthy.

Hmm. It was the only answer I could muster. The calculations cranked slowly in my head, from the surveys we’d done these women have sex with between 10 and 40 men per week. My math skills have never been spectacular, but that’s not much above extreme poverty as an income.

We had slipped through narrow muddy alleys that morning, the stench of chicken manure permeated everything, apparently this is where you get all things ‘chicken’ in Kampala. Crouching through a low door jam, down a muddy hallway, puddle hopping across a tiny courtyard surrounded by doors. Women in various outfits, most quite simple. All of them with different hairstyles, the diversity of hair extensions in Kampala is truly spectacular. In general most of the women had slightly lighter skin, many had scars across their arms and legs. We were at three different ‘houses’ during the day and the women warmly welcomed us. It took some getting used to. Of course we’re used to pausing the survey when a woman has to go grab some tomatoes to cut into her sizzling pot of onions, or sometimes serve a customer some cassava, or a chapatti. But instead we paused so the women could slip off into a room to do their work. They were generally quite jocular and at the second place we visited, after doing three surveys and teasing each other back and forth they planned a joke on the next client that came in about how much the mzungu would cost. I just had to laugh along with them, the alternative was crying I suppose.

All their stories were different, some had finished secondary school, others could not read. The majority of them had children, a few were married still. Several of them had received screening for cervical cancer, something the majority of the women we’ve talked to had never had. And all these women used condoms every time. No question.

They were hard working women. The only time I glimpsed apology in one of their eyes was when we asked about religion. She said she was a Muslim. Veronica, the research assistant paused. Muslim? But your name isn’t Muslim.

She looked down, embarrassed. Well, I’m actually Pentacostal but you see… her voice trailed off. Veronica just picked up where she left off, putting a hand on her arm. You are what you are, and that’s just fine. It seemed a profoundly affirming statement.

There are many things in our world that are heartbreaking and unjust. But we live our lives everyday, able to live in our broken world without it crossing our minds. We sterilize our lives, separate our daily living from the realities of so many. Whether in Vancouver or Kampala. But when it is thrown in your face, when it happens as you look into a woman’s eyes, you can’t just turn around and pretend you never saw it.

God Lives in Africa

Doreen, is that man crazy or does he just really love Jesus?

She laughed. Maybe both, but I think he's just a Christian Sheona.

The street preachers in Kampala are phenomenal. Seriously. They spend hours and hours eveyday in the scorching sun and pouring rain. There’s the skinny guy who brings his own pulpit and megaphone. He stands on the side of the bustling Entebbe Road going into Kampala yelling at passersby and matatus then intermittently staring intently at the bible on his wooden pulpit, recenlty I think he's run out of batteries for his megaphone. Then there’s the lady with shoulder-length braids who was next to the Nakasero market yesterday when I was buying a pineapple. Her brow furrowed with intensity, she appeared furious as she preached, suddenly whomping her bible against the tailgate of the little Toyota pick-up truck next to her with a loud metallic clank. They just seem so angry, I don’t understand what story they’re telling. Where's all the peace and love folks? I hope they’re describing Jesus getting angry in the Temple about injustice and the rich ripping off the poor…I’m not convinced.

My all-time favourite Kampala street preacher has got to be the guy who strolls around by Shoprite [a South African grocery store]. The same angry, passionate preaching, waving bible in hand. But this guy has a follower…so to speak. He’s a tall Ugandan wearing the long white Muslim dress with the traditional embroidered cap. His face is equally intense but he looks like he has some kind of transcending knowledge. He raises his right hand, his elbow bent at a right angle with each movement and he repeats again and again, “Allah akbar….Allah akbar….Allah akbar….” Whether it’s in response or in harmony with Shoprite man I don’t know. I wonder what God thinks, all these folks fighting for his attention.

I was chatting with my Ugandan family about it, who have been described as ‘serious Christians.’ They likewise think its hilarious and shared a story of a preacher waving his bible chasing a naked man around the central clock tower one day shrieking as he cast out demons from the naked running man.

Faith is everywhere around here.

Sticky Fingers

There are children everywhere in Kisenyi, but usually they’re scared of me and hesitantly curious, never wanting to get too close. But today, in a rather dodgy area of Kisenyi II, a 2 year old little guy spotted me in a store where we were doing a survey. He yelled out, “Mama! Mama, mzungu!!!” And from then on I was his property. He would let no other kid touch me, screaming at them when they got close. Under the beating sun, his sticky, sandy hand grasped tightly onto mine. He laid his sweaty cheek against my hand, his face covered in varying degrees of dried snot. My heart melted, I couldn’t help it. I guess its not made out of stone after all.

Tears

I was with Dr. C today for colpo, one of the gyne oncologists. She’s tall and slim with flowing braids always arranged elegantly. Her belly is unmistakably swollen with pregnancy. She a bit more gentle than some of the other straight-to-business gyne oncs. However, as it is with doctors across the planet, everyone is always rushed and has an important meeting they need to rush off to. All the patients today were HIV positive, not uncommon as cervical cancer is much more prevalent in these women. The first woman was a 32 year-old, here for cryotherapy for her CIN II. It was my first cryo experience and I know they say one of the benefits is that you don’t need any anesthetic, but dang that looked uncomfortable! Tears rolled silently down her cheeks, then weakly she asked us to stop. She lay there dazed afterwards. It must seem rather barbaric. Someone putting a gun shaped instrument in your vagina, which is attached by a tube to a huge CO2 cylinder with a massive monkey wrench on the top to turn it on and off. I knew exactly what was going on and I couldn’t help but envision a medieval torture chamber with a few modern gadgets.

The second woman was slight, her bright turquoise dress flowed to the floor and her hair was combed up into an Afro twice the size of her head. As we broke the news that the biopsy had shown no cancer she clapped her hands together twice and hooted with joy. Her wide smile transformed her face. Her tears were not silent, she thanked us and thanked us and thanked us again. Dancing as she left.

The next came in shimmering in a dress of gold rimmed yellow, black and white. Her news was not as good. Infiltrative carcinoma. We admitted her for a work-up and to set her up for the OR if she was an operative case or for palliative care if not. She just sat in shock. Then tears came with anger as she was shuffled out of the room. I asked about radiation and chemotherapy, Dr. C explained that those were treatments you had to pay for so they were rarely an option.

The next three women played out the same scene, almost exactly the same story. There were no more tears of joy today.

I plodded out of the hospital in the afternoon, turned up the hill and along the dusty road under the sweltering sun. A bit defeated. Sometimes you have the emotional energy to process it all. To fight overwhelming despair. Other days, you can’t. So you just escape.

I had a beautiful cappuccino. Sitting at a café in the shade with a warm breeze, watching the world go by. Overcome by gratefulness. For espresso. For shade. For such resilient, brave women. For the privilege I have to witness their stories. For the hope that I have.

Tomorrow I’ll yell indignantly at injustice again.

Dancing Pea Pods

Yesterday we came upon a group of four women shelling peas outside their home. We stopped to interview one of them as she continued her work. There were a few toddlers around laughing, screaming and occasionally throwing pea pods at each other.

As we stepped closer I noticed the large sac from where the bright green un-shelled peas were being pulled appeared to be gently undulating. Must be the heat I though. A wave of nostalgic memories washed over me, of shelling peas at my grandparents farm with my cousins...our payment for getting to watch Mr. Dress-up.

I looked into one of the pots and realized these were long peas...and they were wiggling. My 'peas' were grasshoppers. Its grasshopper season! The women pull off the legs, wings and antennae before throwing them in the pot and frying them to be sold as a snack. Just like peanuts, they explained.

When I told my Ugandan family of my learning for the day they insisted I have to try them. Now, they're best fresh, we'll get Annette to buy some tomorrow morning and prepare them for you.

Yum.

Laughing Sisters

The breeze blew into the room, gently shifting the lace curtain covering the doorway to reveal the two cow knees roasting on the charcoal jiko. A toddler sat naked next to the smoking stove, using charcoal bits as building blocks and giggling to himself, as if there was nothing in the world more fantastic than his architectural plans. Our laughter from within made him look towards us. I was in a tiny living room sitting on a sagging sofa with Veronica (one of the research assistants) and two sisters. The older sister sat on the floor while we did the survey, she had insisted there was nothing to hide from her sister and she wanted her to stay. She sat on a woven mat, leaning against the wall with her legs folded beneath her and thought our survey was fantastic entertainment.

One of the questions we ask is whether they’ve had sexual intercourse, the research assistants hate asking this one, preferring just to tick off the ‘yes’ box. She smiled as she answered: “Well…you know...I am Catholic, but I’m not the virgin Mary! Where do you think my four children came from? The Holy Spirit?” When asked if she’d be up for doing self-collection for HPV with a swab in her vagina, she said sputtering with laughter, “why not? There’s much bigger things than that been in there!” My favourite answer however, when asked if she would need her partner’s approval to do the self-collection. Veronica pausing for breath attempting to translate for me, “You’re joking! What do men know about vaginas anyway? What he doesn’t know hasn’t hurt him so far!” The sisters shot jokes back and forth the whole time, it may have been the most entertaining interview so far. They were both intelligent, well-spoken, hilarious women. The laughter in their eyes and bursting out every pore lightened the sometimes intense days we’d been having. It was refreshing. Joy in the slum.

At some point that afternoon Doreen the program coordinator caught sight of my feet. “Sheona!” What?!? I assumed I had just made some kind of terrible cultural faux pas. “Your feet!” A bit of relief, she was just appalled at the state of what Kisenyi had done to my feet and declared that Friday afternoon she was taking me for a pedicure. We laughed some more. It was a good day.

April Fools

Written from one doctor to another on their Facebook Wall:

"We have oxygen in the hospital now!"