Tanzania: Car Jackers!

Many months later, fleeing from the dark, we would remember these dazzling steps along a sandy ridge in the Sudanese desert. At midday we had tramped away from the quivering road to an old fort on the dunes. Among the crumbling ruins we found a hovel concealed in the shadows of the fort’s walls. A man clothed in rough cloth became visible in the doorway; he beckoned us inside. Slowly, hibiscus tea simmered on coals and he watched us. He murmured gently as it boiled, “on your road you have a danger, you have to move as one.” He said, “you see it first and run. Before the time to chase, you run, all in their place and all eyes forwards.” The hermit hissed as he spoke. Quietly finishing our tea, we spat back the hibiscus petals that fell into our mouths. We did not make sense of the man’s words until the day we were chased.


Broken Brake line (Photo AV)Tanzania was in bloom as we crept up behind the lonely blue hulk of Kilimanjaro. The rocky Mwenzi peak looked like the prow of a great ship, wrecked on an atoll in a wide green sea. A smattering of snow at the summit was a rare and melancholy sight, simply because it bears such cruel comparison to Hemingway’s“impossibly white” mountain of a few decades earlier. In Tanzania the borders of game reserves are less well defined than in Kenya. Elephants scuff the bark from the trees at the side of the road and impala flee, bouncing across the plains, from the roar of our engine. We found our camps by pushing a path from the road into the 10 ft elephant grass to fall asleep with the rustle of crickets and the barking snarl of leopards. At Lake Challa we climbed down 100m of steep jungle to jump from rocks into splendid blue water in the crater. In Moshi we tried to sell our old tyres. We were discovering that they were worthless, even in Africa, until we met a man plying a trade in recycled shoes made of tyre rubber. This was particularly opportune as Bas was woefully undershod subsequent to a disastrous flip-flop blowout a few days earlier.


In the sparsely populated interior of Tanzania, our route took us through several vast national parks, this gave us all a great sense of moving through the real Africa, the wild, empty Africa of Livingstone and Stanley. We traversed hundreds of kilometers of green bush, red dirt and sunsets stained violet by the rising dust. In the Mikumi national park we came across a male water buffalo grazing a few metres from the road. In person they are enormous, like a huge cow, reinforced for Africa, with heavy crescent horns and a square frame of thick muscle. Rich got out of the car to photograph the placid animal when another, very different, bull arrived from the bush. The second had a broken horn and a face covered with scars and bitterness. He took an immediate dislike to Rich and dropped his head low to scowl through his thick brows. We shouted to Rich to get back in as the animal was clearly spoiling for a fight. While buffalo damage to the car might be a fun story, buffalo damage to Rich would be difficult to explain to his mother. Rich could not reach his door so leapt onto the back ladder and scrambled into the window as the bull feinted a charge at him.

Angry Buffalo (Photo DN)

Angry Buffalo (Photo DN)

This was an incident that prompted the development of a system for unexpected hazards. Should we need to get out of a situation quickly and someone is trapped outside the car they must climb to the roof, rather than gamble on the temper of any of our fickle door mechanisms, and then slither down into a window while the driver makes good the escape.

We have a system for communication from the roof as well. This was developed after a surprise elephant encounter in thick woods (the person on the roof had no means of telling those in the car that they were eye to eye with a grey wall of angry wrinkles).

When parking Tess we have learned a rhythmic tapping system from a pair of parking wizards in Istanbul. This has now been expanded to include other signals. Two taps for stop, three taps for go, and a continuous frenetic rapping for “an elephant is about to pull my head off!”.


We have many and varied systems for coping with the problems that have arisen so far on the trip. One is a system of co-piloting Tess in the worst of off-road conditions. The navigator uses a map and an old shabby sat-nav with an African tracks program to give the driver real time guidance on the contours of the road ahead. We have a code for communicating the location of approaching holes, rocks, mud, deep sand etc. The system allows us to effectively use six eyes instead of two to scan the road ahead. In addition to saving us from several catastrophes when we had no head lights the “six eyes is better than two” approach allows us to pretend we are racing in the (as yet un-realised) Cornwall to Cape Town Rally. _DSC0919

Before leaving Tanzania for Malawi we visited Ruaha national park. As we arrived the sun rose over a hill and shone silvery on the surface of the river. The waters of the Ruaha wind long loops among giant granite shards that burst roughly through the rolling green landscape, polkadot with Baobab trees. Being off-season and fairly remote we had the park to ourselves. We lost the day following elephant and antelope over some of the most breathtaking scenery we have encountered on the trip so far leaving the park long into the greying twilight.

Ruaha River (Photo DN)

Ruaha River (Photo DN)


Conversation bubbled through the car as we rumbled along the ruined track away from Ruaha. A few kilometres from the park gate we came across a pickup flashing it’s hazard lights in the narrow track ahead. Our voices lowered as we noted that there was no way past them. We could not think of a reason for a pickup to be on this isolated road and car-jackings being prevalent in this area, we paused a hundred metres short to investigate. I took the binoculars from the dash and focused on the distance. “There are a few men standing around the pickup, they have guns!”

Bas pointed out calmly, “everyone has an AK here that doesn’t mean very much”. “True” I replied, “but this is different, they aren’t slung over the shoulder like a rusty farm tool, these are on a short strap across the chest, and their hands are on the grips”


There was a hush in the car. “We should wait a little, to see what unfolds before we approach,” said Rich “Maybe turn the car around incase we need to get out of here quickly.”


Bas got out to help Rich to turn the car without dropping a wheel into either of the ditches running along the sides of the dirt track. Tap tap…tap tap…tap tap…TAP. “That is enough we will make it around”, said Rich.

Bas crept down the track to check on the pickup again. As soon as he raised the binoculars he started shouting, “they have seen us turning, they are after us!” At that moment the distant engine snarled to life and began burning towards us in a cloud of red dust.


Bas ran back down the track towards us, “go go go they are coming.” He leapt onto the ladder at the back and beat out the emergency rhythm on the bodywork to show he was aboard and we should bolt. As we gathered speed on the rough ground Bas scrambled up onto the roof and held tight. He cast a backward glance at the headlights that cut a swathe through the darkness behind us then slipped in through the passenger window.


The track flew around several bends and straightened. Rich threw a furtive look back in the mirror. The lights were gone. They must have given up. Maybe they knew we could not go back through the park gate. We were penned in. We consulted the map and found an older route away from Ruaha Park. The old road returned to the main track after 60 km. We had to take the old road and hope that we could reach the junction faster than they could or they would head us off. Minds set, we raced away though the high grass and low branches; this path had not been used in a long time.


Our spotlights shone a yellow corridor in the obscurity. Rich drove among the potholes and corrugations faster than we had ever dared before. The only sounds in the car were the raking branches, spitting stones and barked instructions. “Pothole 1…Rut running 2 to 3…Wooden bridge 300…Wet ford 100m”. My heart was beating tight as a bowstring as we approached for the crossroads.


For 90 minutes we drove, all eyes pinned on the road ahead, Hole 1 to 2, Rock 3, All silent. All stock-still. The sound of the car shaking itself apart on the ruined road jarred. Rut 3, Rocks 2 to 3, Ford, may be wet

How far is it, 17km.

Rock 3, Ditch 1, Soft Sand for 50m, 3km now

We peered into the distance, eyes bloodshot now from staring, the junction appeared. It was dark, too dark to see if anything waited for us there. We approached at ramming speed and skidded through the junction without stopping. No one saw the pickup, but who could say in the dark. We drove on for five kilometers, regularly scanning the mirrors, nothing. Still not safe, but we were forced to stop for respite. Rich’s white fingers were peeled from the wheel and he was thrown in the back to recover. It was another hour before we reached the nearest town. Lights and people, at last. The tide of adrenaline receded slowly over a jittery beer and we collapsed into a motel to sleep.

Kenya: The Swahili Coast

Like a worried war-time family gathered around the wireless, we crowded around a small window in a Greek hotel room to see a torrent of protesters surge around the Landie, hurling rocks and abuse at the riot police. In Tahrir Square we ate roasted sweet potatoes bearing inverted impressions of the anti-government pamphlets in which they were wrapped. In Sudan the people marched in anger at the murder and concealment of two student protesters. It has felt to us as we have traveled that the world is in mutinous temper. Kenya revealed itself to be no exception.

While we were discovering Uganda and Rwanda, elections were taking place in Kenya. We had not particularly intended to avoid Kenya during this period but it was a happy coincidence considering their last elections were marred by quite widespread political and intertribal violence.  On our return we crossed Kenya quickly, arriving on the Swahili coast after only the briefest of stops to attend a party that confirmed every rumour we had heard about the Nairobi expatriate scene.


Our arrival was greeted with the warmest of welcomes from Bas’ parents, William and Lucy Wallace, and their friends Martin and Dawn Whetstone. A wonderful week was spent lounging by the pool, visiting idyllic beaches and mixing with the who’s who of the Malindi social scene. As we sipped cold beers in the Driftwood club we quickly forgot all about our intrepid expedition. We were delighted to be given the opportunity to speak at the Driftwood and tell a few of our tales as part of a cervical cancer screening fundraiser, which was excellent fun.


On our final night this paradise was sadly a little tarnished. While sitting up late trading safari stories with the Whetstones and Wallaces, conversation was interrupted by the unmistakable sound of gunfire. Five shots echoed from the night and then it was calm. For several minutes we waited for more, hushed, then a crescendo of automatic fire filled the air. The volleys became more regular as shots were traded. It was a pitched battle between two well-armed adversaries and the sound was close by. David, the askari,estimated that the shots were 200 metres away, near the beach. The clash continued for half an hour and then stopped suddenly.

Martin and Dawn were calm and pragmatic as one might expect from old hands in Africa. “We would have heard on the phone if there was something to worry about” said Dawn. We speculated that it might have been Somali pirates fighting the police. Raids on the North Kenya coast were more common a few years previously before the international navy presence in the Gulf of Aden was increased significantly. After a nightcap to settle the nerves we retired to bed.

In the morning, the town was going about business as usual, it takes more than a gunfight to upset the balance in Kenya. It transpired that the police had stumbled across a terrorist militia, training in an abandoned building by the beach. In the resulting battle 4 policemen and 8 militiamen had been killed. The remainder of the militia had scattered. The story at the Driftwood club was that Bob, an 80-year-old ex-pilot and policeman, had spent the night keeping watch on his roof with a rifle, while his two askaris patrolled the grounds. It seems that lessons learned in the Nairobi police force die hard.


With a fond farewell to the Martin, Dawn, William and Lucy we set off through Tsavo national park on our way towards Tanzania. A few hundred kilometers south and the wet season was in full swing, a mixed blessing. At 6 o’clock in the morning during a particularly miserable camp in the gravel of a petrol station forecourt we found ourselves in the heart of a tropical storm. It became apparent that we had pitched our tents in an almost imperceptible trench, which was quickly filled by the deluge, drowning us and all of our sleeping bags with us. On the other hand, however the recent rains had covered the, normally arid, Tsavo savannah with a lush green blanket. The red dirt track that transected the park was gaudy in its bright contrast to the insufferably verdant plains. The landscape was all the more beautiful, as one is so accustomed to seeing dry African savannah in wildlife documentaries.


The Tsavo national park was the stage for the story of the infamous Tsavo Lions. In 1898 the Leut. Col. John Henry Patterson led a project to build a bridge over the Tsavo river as part of the Great Kampala to Mombasa railway. During the project two male lions repeatedly broke into the camp by night and dragged the Indian workers away to devour them. In an effort to deter the animals Patterson built huge fires and thorn fences around the camp. For nine months he hunted the cats, wounding them on several occasions. Patterson attempted to trap the lions by equipping a train carriage with steel barred cage in which two workers slept as bait. In the morning he found the carriage destroyed and the workers abducted. After 135 lives had been lost Patterson finally killed the pair and their huge nine-foot skins spent the following 25 years as rugs in his home before they were retired to a museum in Chicago.

Episode 15: Uganda. Where Alki arrives, a mad Dan runs off to the Congo and the boys find gainful employment…

Part 3:

A gentleman is defined, not by the distance he keeps from his own, internal wildness, but by his ability to scrub up afterwards.

Iconic  (Photo: RWH)

Iconic (Photo: RWH)

Having left all chance of contact with the outside, Dan and Alki dropped off the edge of our map and headed to the border of the Congo. Here are some of the stories that eventually filtered back…

Many years later, as he faced the interview panel, Dr Daniel Nuth would recall that distant evening when he and Alkisti were taken to speak with spirits. They had travelled for several days, beyond the large roads and up into volcanoes, asleep in the clouds. These rolling rainmakers lay stacked in a ridge, under a blanket of jungle, climbing to snow. They held back a great spreading unknown; an immense, roadless, lawless canopy. Only rumours came back across the border, where endless river basins absorbed hidden villages, rival armies and fire capped mountains.

The people of the Rwenzori Mountains had an easy relationship with the overgrown slopes. Houses and farms were woven amongst the trees and any surprise intruder would be innocent to the scrutiny given them from the safety of the bush. The memory of the rebel raiding parties, wanton and brutal, lingered heavily.

(Photo: DN)

(Photo: DN)

They chanced upon a village school. A heavy set teacher, sweating into his shirt stood square to his blackboard. He struck out at a chalked word as he barked it.


The packed classroom of seven-year-olds fixed their determined eyes on the word and repeated with the staccato severity of a military drill.


Without pause the teacher moved on.


At the end of the lesson they were welcomed in. The children shuffled away uneasily as they sat among them.

“Hello,” Alki hazarded

Silent stares;

She remembered the importance of personal inquiries in Ugandan greetings.

“How are you?”

“WE ARE FINE!” came the kneejerk response. All children in the area were well trained in this exchange from the age of five.

The adjectives of the day were ‘sad’ and ‘shabby’.


Failing to find passage into the mystery beyond, Dan and Alki tracked south into Rwanda. Expecting to find a country reeling from its tortured past, they instead found a cosy utopia. Crisp, new roads crested over the wooded hills; uniformed police officers, bins, busses and traffic rules tidied the landscape. Among other acts of benevolence from the outside world, Irish cows were being airlifted in for their superior milk.

In the western mountains they made their way on foot through the thick rainforest. They joined a party on a trek destined for a bottomless crater lake. Exhausted at the humid summit they sought to wash themselves in the silver water. A terrified guide flung himself into their path, pleading for them to stop. They saw the fear in his eyes and hesitated. Why was the lake out of bounds?

“Nobody ever swims in the lake,” he warned “As we do not know how deep it is.”

He told them of the still, dark water that ran through the rock to the very heart of the earth. He told them about the magnets and about the Ox, which had jumped into the steep sides and had sunk without a trace.

“Can Oxen swim?” enquired Dan curiously.

An ominous glare sufficed for an answer.

They continued west through the Bwindi Impenetrable Forest; named from the scholarly belief that when the young earth froze, this was the only rainforest to keep the ice at bay. Finally they arrived at a wide river, where Rwanda ended and the Congo began.

A small town had grown up along the banks. A wooden bridge spanned the calm waters. They left Rwanda and crossed the frontier to try their luck. All the trucks were coming from the Congo, creaking over the mossy planks. They were laden with people.

A week ago the leader of M83, one of the larger rebel armies in eastern Congo, had turned himself in – voluntarily. Few were to greet the warlord’s resignation with optimism however. Something had driven him from his power base. These shifts in power usually spelled turbulent times ahead. Sure enough, the trucks brought news of renewed fighting.

(Photo: DN)

(Photo: DN)

They sat in the Spartan immigration office as the hours ticked by and it began to rain. Hurricane lamps were lit and the officials remained silent. The AK-47 is a sleek and arrogant tool that has spread to every corner of Africa and dan was familiar with their snarling barrels. However, they are usually slung lazy and unused, on the loose strap of a security guard of or policeman; their dormant barrels long since fired. These weapons seemed as veteran as their humourless owners; kept tight on the strap or brandished in ready hands. Eventually they were turned away and instructed to wait for approval from the immigration office in Kinshasa. They crossed back over the bridge in the dark. It was here they met the spirits at work.

A rhythmic chanting pounded the air and through a gap in the plank fence, plumes of white mist unfolded. A single spotlight dimly illuminated the scene. Kasava flour; mountains of it were piled up in the courtyard. Animated figures moved in and out of the cloud like pistons, wiry and bone white. As they moved closer they could see the porcelain faces. Cracks followed the lines of exertion around their dark, stony eyes. The flour golems moved in unison, shovelling their loads into sacks, held open by steady hands. Along the top of the heap of kasava roots, silhouettes climbed; sorting and pounding the edible roots.

Dan knelt down to take a photograph. A misfired flash broke the spell; stopped the scene dead. The sacks were dropped and everything was engulfed in clouds. Three faces emerged ahead and fixed the pair in their gaze.

“You do not take our pictures.” A voice announced with deep, flattened vowels.

“Who are you? Where are you going?”

Alki explained to the faces, which drifted in and out of sight in the fluctuant light. There was a pause and the clatter of work seemed to resume behind the interrogators.

“The land will never allow you in.” came a reply.

With that a pair of hands grabbed Dan’s shoulders and pulled him out of the settling dust. Back under a streetlight of the main track, a small, muscular man revealed himself.

“My name is Julius, you said you would go to Goma? I am from there. It is a very bad place.” He swung between French and English as he told them of his decision to flee the town. Many of his family had been brutally murdered or scattered in recent years. Goma, Dan and Alki’s chosen destination 100 miles downriver, was worse than ever. The strong preyed on the weak and the authorities extorted or robbed as much as the rebels. The fighting had also intensified in recent months.

“I can help you with the border posts, and you can bribe them,” he explained, “but any good guard would send you back.”

Two days later, they were indeed let across the border and into the Congo. Julius seemed to have a positive effect on the grim officials. However, after an afternoon’s drive into the interior, they were stopped at a road block and sent back. The border guard was a good man and it was too dangerous. They agreed it was time to head back to Uganda and re-join the expedition.


These were the shreds off stories that Rich and I, working in central Uganda, later heard. We would of course be reunited later as a group. Meanwhile, away from the hospital, we were trying to find some adventure of our own. When we weren’t on the wards, or rebuilding Tess, we would peruse the many street-side stalls of Iganga. Rows of kiosks and trays sold spiced kebabs and tender sweetmeats to the passing traffic. The ‘Rolex’ (omelette rolled in chapatti) became a staple. On the balcony of Sol bar, the trendy NGO worker hangout, we planned our weekends. Kat, Keeley and Morgan joined in our planning.

Our first weekend was spent on the banks of the White Nile as she left Lake Victoria, young and fresh, on her long journey north. We had last seen these wayfaring waters at Khartoum and had a lot to catch up on. If only she knew the changing lands and distant people she would meet. There was not much time for anthropomorphising however.

In the campsite we saw a familiar Landrover and motorbike. It was our old nemeses the ‘Cruising to Cape town’ boys and Claire (also overlanding to Cape Town). We had last seen them in Addis Ababa, as they set off before us on the Lake Turkana road. The stage was set for an eventful weekend. By day we would swim and rope swing on the riverbank. By night we would cook, eat and sample the delights of ‘David Beckham Gin’ (with the reassuring slogan: Clear Mornings Guaranteed). At the campsite bar we met a large NGO group called ‘One Acre’. They had called-in their volunteers for the upcoming Kenyan election and were having a bit of a party. The scene was set for merriment.

One lasting memory was of the Sunday night. There had been a slight misunderstanding over supper. We had been casually invited to eat at the One Acre buffet. However the restaurateur took issue with our apparent freeloading and demanded payment. He issued a warning in rounded South African syllables.

“You’re taking the piss guys. This is Africa. People disappear out here.”

We calmly explained that we were unable to pay but were prepared to sing for our supper. This seemed to diffuse the situation. Before we knew it, we had a concert on our hands. The word spread over the following day and another act signed up: A guitar-fiddle duo of legendary reputation. That evening a great fire was lit and an intimidating crowd gathered. Both acts gave it their all, taking it in turns to play and sing. The two chaps we were supporting were magnificent and our novelty seemed to be holding the crowd. We almost exhausted our entire repertoire. At 3am the crowd had thinned out and the adrenalin worn off. We returned to our tent, exhausted.

(Photo: DN)

(Photo: DN)

Tess was now looking healthier and was ready for the road. We took her up for a rainy weekend at Mount Elgon, on the Kenyan border. The car was loaded with fine food and drink and the camping gear prepared. An afternoons driving through the lush eastern farmland brought us to the foot of yet another Great Rift Valley volcano. As we wound up the switchback roads, a typically almighty storm broke. It was to last all night.

This however only increased the fun. Rich and I raised a great tarpaulin shelter and walled the sides. Hurricane lamps were lit and we clustered into a cosy circle. We were determined to show off how camping for us was an art that we had perfected. Pots, pans and spices clattered out and a great chilli-con-carne prepared over our single petrol stove. The glasses were charged with beer and stiff G+Ts to drive out the cold. The guitar was handed around and a fuzzy glow descended onto the evening’s memories.

The storm broke that night and in the clear morning we awoke to find that we had pitched camp on an immense cliff. Waterfalls in spate, crashed down to the flatlands below us. We spent the weekend exploring the caves and raging watercourses on the mountainside. We also met Jasper, a Danish ex-pat, African adventurer and former coach of the Ugandan Olympic cycling team. He had come to train for an upcoming road-bike event on the mountainside. We bonded over music and stories of Africa. We arranged to meet up in Kampala.

We arrived in the Capital for the following bank holiday weekend ready for a much needed break from work. Kampala is a fun, easy going city, that doesn’t seem to sleep. Like many capitals the traffic system renders the roads unusable for most of the day. We saw in Friday, mingling in restaurants and bars, an experience we had almost forgotten on our long road through North-eastern Africa.

We met up with Jasper, who we found to be a bottomless well of knowledge on Africa and seemingly friends with everyone in Uganda. He recommended the restaurant of a good friend and some good bars. Rich, Kat, Keeley and I expressed our desires to push on west to the Rwenzori Mountains, jealous of the stories filtering back from Dan and Alki. Jasper put us in contact with his friend Benjamin, who lived out by the Bwindi Impenetrable Forest on one of the crater lakes. We left Kampala the following morning.


It was a long day’s drive after a long night but the Ugandan roads were of excellent quality. Benjamin had to arrange a friend to meet us at Fort Portal, the Rwenzori frontier town. It was dark and we had driven the length of the country. We were pushing ourselves hard. An hour’s drive on forest tracks made it clear that we would not have found him ourselves.

Spotlights glaring, we slipped and climbed along a muddy off-road track and met him outside his house. With the engine off, the jungle closed in. Benjamin was warm and welcoming with dreadlocks and a smooth French accent. He had worked for the Red Cross in most of the trouble spots of Africa over the last decade and had settled in this remote but peaceful corner of Uganda. He had a small wooden house and a few acres of land sloping down to the lake. Here he was creating his own Eden; nurturing hundreds of species of rare trees, plants and flowers, which in turn had attracted an array of bird and animal life from the forest. Monkeys, Forest elephants and even Chimpanzees had been sighted around the house.  As well as the local people for company, a lone male Hippo had recently appeared in the lake and was a regular visitor onto his land, although only cautious attempts had been made at befriending it.

A night time tour of the forest was abandoned when we were driven out by army ants so we retreated back to the candle lit cabin. We listened to Benjamin’s stories of life in Somalia and the Congo and ate cheese, bread and forest fruits. We then retired to pitch our tents by the lake. Nobody was trampled by a Hippo that night.

In the morning we realised why Benjamin had chosen this place. The morning sun glowed through the High buttress root trees and in the canopy monkeys, hornbills and great blue torracos hopped between branches. Flowers exploded out of the undergrowth and everything was wet and earthy. The lake was still and, apart from the bank where we had camped, walled by mossy granite. Benjamin came down to join us for a swim (true to form in tight, French Speedos). We checked the water for Hippos and dived in.

Another day’s drive brought us into the mountains, where Dan and Alki had traversed before us. Rainclouds obscured the snowy caps and the sheer, forested sides looked like they might rise up forever. We celebrated Saint Patrick’s Day with a Guinness sitting on the west side of the range, the great Congo basin spanning before us. We trekked up into the hills, soaked in rain. The paths were slicked in red mud and the sparse inhabitants vanished into the elephant grass as we approached. When the clouds closed in, it was easy to get lost.

We camped down in the thin strip of forest between the Rwenzoris and the Congo border, where we were allowed to stay in the ranger’s compound for free. The extra shelter proved invaluable against the ensuing downpour. It remains the most violent deluge I have ever seen.


The long drive back to Iganga began the following day at 6am and finished at 9pm. Our way was guided by the steady flashes of lightning in the eastern horizon. We were fatigued to our absolute limit but had managed to see a good deal of the country without sacrificing much time from our work.

A week later we were reunited with Dan and Alki and it was time to say our goodbyes to a country that had given us an unconditional welcome and so many stories.

Episode 15: Uganda. Where Alki arrives, a mad Dan runs off to the Congo and the boys find gainful employment…

Part 2:

Iganga Hospital is a 200-bed district general hospital run, and largely funded by the government. It has male, female, paediatric and maternity wards, an outpatients department, pharmacy, laboratory, x-ray, ultrasound and an operating theatre. The gate opened straight out onto the main road and once inside there was always a great crowd shifting around the white buildings. Clusters of outpatients, families preparing food and mothers strapped to their infants would sit in the shade of the avocado trees.


If there was a rota, or system of job allocation, we never found it. However our day-to-day-role in the hospital was quickly established. We did a brief spell in the humdrum of outpatients with the cheerful Senior Clinical Officer. This acquainted us with the disease burden, the tests and the limited array of treatments available. However, the outpatient conveyor belt was reasonably well staffed and it became quickly apparent that we would be most useful on the wards.

A pay dispute with the ministry of health had shifted the attention of many doctors toward their private clinics. Appearances were limited to sporadic, fly-by reviews for the sickest patients and a weekly ward round. Specialist teams from the bigger hospitals would occasionally appear, friendly and unannounced. Despite finding written evidence in the notes from mysterious evening visits, it was three days before we met another doctor.

Running the wards were ward sisters dressed in nightingale-era uniforms, commanding a milling shoal of nursing students. White-coated Clinical Officers were appointed to each ward. The ‘C.O.’ is a great African compromise. They train for only three years with a more practical slant and gain their experience on the job. They admit, diagnose, prescribe and make decisions in lieu of the doctors input. They cost a fraction of a doctor’s salary. We found them to be excellent for treating the common, uncomplicated conditions such as malaria. The problem was that they didn’t have enough doctor contact for feedback on the decisions they had made. This usually meant that anyone without a clear diagnosis would tend to get all the bases covered with a combination of antibiotics, high-dose steroids, anti-malarials and various other contradicting combinations. In a job that relied on practical experience, nobody was taking the time to provide feedback or explain the clinical reasoning for management. In short, whilst their moments of good practice were repeated, so were the mistakes.


Both with some experience of Hospitals in Africa, Rich and I were prepared for a fewer clinical options, a less systematic approach and general inertia. We were also very mindful of our brief intrusion into hospital and how minimal our impact would probably be. We had to pick our battles. A daily, systematic ward round seemed like a good place to start. Initial management was usually as optimal as the resources would allow. However even post-surgical patients could then sit and get better or worse without being regularly reviewed.

The male and female wards were long squat buildings with corrugated iron roofs, crowded with patients in closely packed iron beds, usually surrounded by their families sitting and sleeping on mats (who were cleared out for drugs/ ward rounds). There were no cubicles or curtains, although there was one set of screens. Despite this, there was always a calm, easy atmosphere. Every morning we would arrive to a welcome of protracted handshakes and somewhat undeserved congratulations. Everyone was doing what they could. The patients would lie stoically as they improved or deteriorated with treatment and nature took its course.

If there had not been a senior visit that day, Rich and I would divide up the ward into two rounds. The clinical officers would often join us but if they were too busy, there were usually five or six attentive nursing students each, competitively keen to learn, translate and run errands. Our ward rounds would often include quite a lot of bedside teaching. When the senior doctor did their weekly ward round, we would follow in the throng, presenting the patients we had become familiar with. These were always lengthy, slightly jovial affairs with lots of academic discussions in English and difficult questions fired at the petrified nursing students.

By mid-morning, the sun beat down on the thin roof and the humidity was asphyxiating. At 2pm, we would walk the short distance home and quickly change into shorts. Here, the worries of the day would be overshadowed (quite literally) by an enormous and extravagant lunch. Mountains of rice, matoke (mashed Plantain) or poshe (mashed millet) piled with rich beef of ground-nut stews. We were spoiled. By this time, the afternoon heat would have built to a sweltering climax in anticipation of the evening storm. We usually needed a siesta before heading back in.

Rich and I both pride ourselves on our ability to befriend the ward sisters, which I maintain is the single most important skill a young doctor can possess. However it was the Clinical Officers whose toes we were treading on. They were essential to our integration on the ward; they knew the patients and were able to turn requests into actions. Every morning it was them who would take us to review the patients they were worried about. We were careful to maintain a dynamic of working together as equals and remain magnanimous. It was important to explain the changes we suggested and agree on them together. It wasn’t always easy. One particular patient caused a tense but cordial debate between me and the clinical officer who was determined for me to drain the fluid out of a certain patient’s abdomen with a tap. I thought that this was dangerous and largely unnecessary but despite the protracted courtesies, neither of us would change our stance.  The patient left of their own accord before the matter was settled.


Although the ward rounds were largely harmonious, turning the plan in the patient’s notes into action was a greater challenge. There was no formal ward list, no jobs list and a very casual system of delegation. Any tests had to be pushed-for relentlessly or done oneself. Furthermore any progress could hit a brick wall if the equipment or drugs were not available that day. Needles and gloves for example, were at a premium and guarded by the ward sister. Cost to patient was another common show-stopper. Save for critical emergencies, all equipment, medication and tests had to be paid for by the patient’s family who often would struggle with the bill. The ‘disappearing patient’ became an expected phenomenon. The tense, swollen belly of a patient with ‘nephrotic syndrome’, a fever who’s origin remained hidden from all tests or an HIV positive man stable but in a coma; we would ponder, discuss, research and plan, only to find another patient in their bed the next morning. It was hard to get a straight answer as to where they had gone. Whilst some had been taken to a bigger hospital, died or recovered, it is likely that many simply returned home when their families to fight their illness without our help.

We were doctors by day and mechanics by night. In our spare time we were had a lot of work to undo the ravages the journey had inflicted on our car. The first half of Africa, especially the endless rocks and corrugations of the Lake Turkana road, had shredded our tyres, and left our suspension a sorry state. We were also dripping from several points. We replaced a lesion of bushes, gaskets oils seals and wheel bearings, serviced the engine and installed new tubeless all-terrain tyres. The age of the puncture was over. Every morning, we would furiously scour our fingers to remove the oil, dirt and grease ready for the wards.

The case-load differed wildly from the UK. The prevalent infectious diseases which we became familiar with were once in a lifetime diagnoses back at home. Brucellosis, bilharzia, and typhoid were endemic, as were tuberculosis, syphilis and HIV in their countless manifestations. Sleeping sickness, virtually eradicated a decade ago had made a steady comeback owing to the fact that the expensive anti-microbial needed to treat it, became unprofitable to manufacture as the demand waned. At any one time, malaria took up a third of the beds. In fact, most unwell patients, no matter what their underlying diagnosis, probably had malaria compounding the problem.

Forgot to put the hand brake on?  (Photo: DN)

Forgot to put the hand brake on? (Photo: DN)

Trauma cases were also very common and had the power to spring all staff into action. The majority came from the country’s primary road, which ran outside the hospital. Children were often the victims and whilst the hospital could manage simple fractures, we were limited beyond that. Once stable, we would try and refer these patients to Jinja, the nearest city, four hours away. This was usually a problem as the family were expected to pay for the ambulance. We had two paediatric head injuries in the space of a week. One had fallen from a mango tree, sustaining a deep depression skull fracture. He was conscious but with a weak leg, corresponding to the area of brain injury. The second was unconscious and seizuring, having been hit by a truck. Their right pupil was blown out; a bad sign. We controlled the seizures and the patient’s level of consciousness improved. We also managed to persuade the x- ray department to take a ‘trauma series’ free of charge (a set of x-rays surveying neck, ribs; pelvis etc). With both cases there was a long delay whilst the family dashed around borrowing money for an ambulance. Although the ambulance had been donated by the UK government, there were no funds available for diesel or a driver. Patients would sometimes decide to take crowded public transport instead.

The patients were, on average a much younger demographic then the U, if they could get good early management it was amazing how they could bounce back into good health. However they would only come in when they were really unwell. Severe malaria was often a positive example. Children especially would come in profoundly unwell. Fluids, Anti-malarials, antibiotics and not to forget glucose (malaria causes hypoglycaemia) and they could be sitting up and eating in a 24 hours. HIV patients were of course an exception to this; the end-stage of the disease being a slow loss of ground to recurrent infections.

As our time there lengthened, we learned how to play the game. Even in the hyper-systemised NHS, every hospital has its knacks, shortcuts and magic words; its go-to people, favours and trusted professional relationships. Iganga wasno different. A good example was with a man who was brought in unconscious, although breathing slowly and seemingly stable. The only other history we were able to illicit, was is his positive HIV status. We did what we could, but he needed referring. We had learned that research projects often funded patient treatment, so we made an urgent referral to the Cryptococcal Meningitis Research Programme in Kampala. He was accepted the following day as a possible diagnosis. Unfortunately we don’t know what happened after that.

Of course we didn’t spend all our time at work. Also in the hospital, we met Kat, a medical student from Boston who would often join us for a ward round and escape with us for coffee. In the Sol café, a bar popular with NGO workers and Peace Core volunteers we also met Keeley and Morgan, who were working on projects nearby. Together we began to plan a few trips away to see a bit of Uganda.

I was finishing a ward round with Rich and Kat one morning when I received a text message. It was from a Rwandan number I didn’t recognise. It read:

Crossing_the_DRC_border_today._Back_in_six_days._If_not_back_send_condolences_to relevant_loved_ones._Dan_and_Alki.

(Photo: DN)

(Photo: DN)

Episode 15: Uganda. Where Alki arrives, a mad Dan runs off to the Congo and the boys find gainful employment…

Part 1:


Children on the DRC border March 13 2013


Six feet in a drumroll

syncopate with the downpour,

rasping on broad-leaf snares.


In an instant, we meet

under haphazard semaphore,

tumbling shrieks cut short.


Each of us receiving a face;

a frozen, flash photograph;

glossy and sleek, panting clouds.


 Charging steep, you lead the game.

Mouth set in mirth,

faster eyes widened, alarmed.


The jerk of a knee,

the blade of a foot

slid sharp into slick, scarlet mud.


Darting, they dive like sunbirds,

rippling over the edge, free-

falling through elephant grass.


Crashing to a crouch,

enveloped in bush,

the rain’s chattering fuzz.


Bold with invisibility,

a chorus of greeting.

The intruders are tested.


“How are YOU?”

“We are fine.”

“We are FINE.”


Screeches of relief, of

novelty, of connection

are echoed from below

                              and above

                                     and ahead

                                            and behind.

(Photo: DN)

(Photo: DN)

  The Lake Turkana crossing had provided a spark of adventure to which none of us could compare. With our Swiss friends, we had become a close convoy, moving through a wild, lawless and occasionally hostile landscape; making and breaking camp; guiding our vehicles over a thousand empty miles of rock, sand and bush.

 Blinking and bewildered we hit the smooth tarmac of South/central Kenya, one of the most developed belts on the continent. Amazed, we watched our average speed jump from 14mph to 55mph. There were people, shops, lorries, noise and lights all around. Was this really the same country where remote police outposts were perpetually battling tribal bandits to bring law?

Tess rolls over the rocks in the midday heat (Photo: RWH)

Tess rolls over the rocks in the midday heat (Photo: RWH)

Once on proper roads, we sped to the Ugandan border, leapfrogging the freight. The rain clouds gathered. We were late for our placement at Iganga hospital where we were to spend the next months. We were also late to meet Alkisti (Alki), Dan’s girlfriend who had flown out from Australia to meet us.

 At the border, we were subject to many questions whilst trying to stamp out of Kenya. The way we had arrived from Ethiopia, there were no border posts for hundreds of miles. We had never been stamped in. Our first contact with Kenyan immigration was trying to leave. There was a good chance we would have to iron out this bureaucratic glitch in Nairobi. Fortunately, an understanding senior stamped us through just as the clouds broke.

  Uganda was two weeks into its rainy season, defined by slow-building pressure and humidity, preceding earth-shattering thunderstorms. At night you could sometimes drive by the flashes of lightening alone. The heavy greens and flooded fields were a world away from the barren scrubland and dry bush we had recently been living in. Barefooted men and women worked the fields under rounded hills where the last shreds of jungle still clung.

 The postcolonial history of Uganda is well know for its brutality and harrowing atrocities. Civil war, Idi Amin and child soldiers all spring to mind. Joseph Koni, the paranoid leader of the Lords Resistance Army, famous for child abduction, mutilation and inflicting bizarre punishments for breaking the Ten Commandments, is still at large in the Congo and fresh in the memory of the northern states. Musavene, the president, is hardly a democratic leader and also has a warlike past. All this said, Uganda was probably the easiest and most pleasant country we had visited so far. The people were witty, cheerful and polite with fantastic, slightly old-world English. Everything, from farms to roads, gave the impression that things were working. The rain, left hand driving and roundabouts gave the place a homely feel.

(Photo: DN)

(Photo: DN)

 The entrepreneurial spirit was taking root in this nation. Advertising billboards, a concept we had almost forgotten in Sudan, Ethiopia and Somaliland. Competed like rainforest trees for all available space. Mass advertising (as much as we hate it in the UK) is a reliable sign of an affluent middle class, meaning a smaller Rich-Poor divide and a more stable country. The Ugandan Passion and hyperbole came out in the many of these signs, plastered on the numerous vehicles and small businesses.. They made British advertising seem drab and understated. A few favourites included:

‘Winning beer for winning men’

Doctor Millionaire’s Hotel,

Hero’s Stopover (and booze den)

Maganatu tea ‘I take things personally’

‘Choose ‘A’ for abstinence’

Sandolin paint ‘Trust no one else!’

Mzuzu coffee ‘Through research, we discovered our coffee gives more health benefits than pleasure.’

‘What a Pilsner drinker wants, a pilsner drinker gets’

Metro Signs ‘A business without a sign is a sign of no business’

‘This bus is drenched in the blood of Jesus’

and the winner… ‘The King of Love, Vampire Clan Unisex Hair Salon and Barbers (the clan is for both whites and blacks, one blood)’.

(Photo: DN)

(Photo: DN)

 For the first time on the continent, we even found real-life westerners in large numbers. Uganda, as well as being a growing holiday destination, is Africa’s biggest NGO worker honey-pot, diffusing them out to the farthest villages. Everyone in Africa has their opinions on the effectiveness of NGOs, from the positive to the disillusioned. Staying out of this argument, it’s worth contributing the point that the NGO workers, drinking in local cafes, bars and eating in small restaurants create a huge amount of business. They also integrate far better than fly-by tourists. It was certainly nice for us to have a captive audience for our stories.

 Halfway along the main road from Kenya to Kampala, lay the bustling truck stop-town of Iganga. We arrived at dusk to a riot of lumbering freight, packed minivans, noisy bars and a thousand smoking food stalls. We let Dan go up to the hotel bar first to meet Alki before we followed.

 Alki had last seen Dan in Istanbul three months ago. Since then Dan had undergone a change. His stylish coiffured look had been overgrown by a thicket of beard and hair. Only a tiny portion of his face remained. He perpetually wore a headband made of two socks with Cargo shorts and a vest top. The real changes, however, had happened underneath the tangle of hair.  As he had writhed in and out of consciousness in the Ethiopian bush, wrestling with a fever, something had called him. Adrift on the dark ocean of delirium, he had held on to this alluring force, a distant drumming in time with his pulse, an atavistic summons from the heart of the jungle. When his illness was driven out, his wide-eyed, distant stare remained. Some mornings, we would find him awake before us, staring South over the horizon, as if drawn to something.

 “I’m not coming to work with you in the hospital.” He announced at the reunion supper.

 “I’m going into the Congo.” He paused, seemingly entranced.

“and I’m taking Alki with me.

That night, the background strobe of far-away lightning heralded an almighty deluge that washed away the last memories of the dust and the desert. In the morning, Dan and Alki were gone.

Much needed coffee stop  (Photo: RWH)

Much needed coffee stop (Photo: RWH)

 On that same crisp, wet morning Rich and I met David. David was a head-teacher turned governor of the local school and a tireless community leader.  After the Hospital had accepted our CVs, he offered to look after us and to put us up. It didn’t take us long to realise how lucky we were to have him as a host. David lived with his family in a quiet corner of the town, next to the hospital. We creaked our car into his compound and piled our dusty luggage into the guest annex. We met the household who were equally welcoming: Prossie, his wife; Paula, Caroline and Susan, who would continuously help us out, laugh at our poor clothes washing technique and prepare us lavish meals; and the three present children, who were to become enthusiastic helpers with the work on the car.

  It is difficult to describe how worn by the road we had become but Tess (the car) is more quantifiable. The tyres were cracked and bald and the suspension sagging. The transfer box, front and rear differential had joined in a trio to drip on the floor. It was going to need some serious work. David kindly said that we were welcome to use the compound as our garage.

  Our plan was to work on the car and find new parts, in our free-time out of hospital. We were also hopeful to see the country on our weekends and catch up with all the reading and writing projects we had neglected. Surely there would be plenty of time in the following month…