South Africa (Johannesburg) – Reality

“So Frank, what are you returning home with from Africa?” Tineke asked. Her and husband, Tom, moved from the Netherlands years ago and in addition to retirement activities, they also tenant a guesthouse for accommodation.

I sliced a piece of egg white, pierced it with my fork, but paused before lifting it off the plate. “A lot of things, outside a few material possessions.” I sank into the kitchen chair. “Last night, I kind of reviewed the last seven weeks traveling through Africa. I find it difficult to imagine that I’m returning home; I’m not even sure I want to go home, but I miss a lot of people.” Answering the question, “Certainly, I’ve learned a lot and been to places I’ve only dreamed about visiting. There’s a also the appreciation value as well.”
“You know, Africa is like AIDS,” Tineke linked together. Not sure if I liked that comparison, though. “It lives with you for the rest of your life. Africa will always be a part of you.”
That is very true.

Alan, lead researcher for the Arbovirus division, and I arrived to NICD to find the power off in the Special Pathogen Unit (SPU) offices. Running blackouts are not uncommon in Johannesburg, but today’s outage was due to someone stealing the power cable outside the institute.

“Someone stole the power cable?” I asked amused by the concept.

“It’s not the first time this has happened,” Alan explained. “People steal the cables to resell the copper. It’s quite a problem. They’ll take a truck and rip the cable from the ground.” Backup generators provide power to computer systems and prevent key areas like the BSL4 lab from going down.

Under bright fluorescents and leading into the closed-door BSL4 lab, Bob and I were welcomed into the office for the Head of Special Pathogens, a position once held by Dr. Swanepoel, but passed forward after reaching retirement age. I sat against a corner behind a small round table and poured milk into the coffee graciously brought by Janusz’s secretary. I leaned forward over the mug and introduced myself and project—a monologue I delivered by that point with plenty practice.After much agreement and topic reinforcement, Janusz added, “Aside for maybe next year, you might be back here in a few weeks.”
Bob’s attention was piqued. “Something happening?”

“A guy died three weeks ago mysteriously, and now a paramedic servicing him has also died. Blood samples from the medic are on their way.”
Lucile, a woman highly respected for her work with hemorrhagic patients entered the office. The three talked over details; I leaned onto the seatback and listened. This is how the process of research, mobilization, and control begin: First a case mystery, agency notification, and then old-fashioned detective work.
“The key to identifying any disease is through determining an exact case history,” Bob strongly instructed me, his South African accented voice rising with commanding purpose deeply punching each word. “Before anything is done, the epidemiologists must get an exact history on the patient. How many days from contact? What are the symptoms and when? Who and where has this patient been?” Different pathogens incubate (the time between contact and symptoms) in a host at different lengths of time with varying onset symptoms. Many false alarms can be avoided if doctors can get a correct history from the patient.

Returning to the SPU/Arbovirus offices, Bob added, “And that’s how things happen, but more often than not it’s chasing at nothing or some coincidence, but we have to treat it seriously.” A lot of money and resources are spent investigating potential special pathogen cases, which is why a good report is necessary. “Of three thousand leads, maybe ten go somewhere.”
With grid power back online, Alan walked me across the brick building campus to one of the smaller structures on the lot; the block path leading in cut by an unmarked meter-wide trench to piping deep below. Through the tinted glass entrance and maze-like corridors, we stepped into a room dominated by a space-filling cage, housing dozens of bats huddled together in a tight roost. On the floor are a couple round trays of water and nicely diced assorted fruits.

“So, they’ve been tested for rabies, Marburg, etc., right?” I semi-jokingly asked Alan, both of us ducking into the nest.
“A lot of them are second generation born here. So, yes, they’re clean. And they have to be for control purposes.”
Once the BSL4 lab is operational again, the bats will be used for Marburg and Ebola studies including transmission means from bat to animal and human. Is the virus transmitted via direct contact, birthing, guano, or some other means?

Inside, the bats became agitated by our presence and several leapt from their perch and flapped to any corner of the cage. A small drop of urine splattered on my arm.
“Hmmm, that’s nice.”
“They’ll do that when nervous, especially jumping into flight.”I stood still and watched one on the floor scale the linked rod cage wall to his mates above, its long reaching caped arms and stubby feet reminding me of a skilled rock climber with his stro

ng body agility.
“Can I hold one?”
“Sure.” Alan gathered a box and covered one in flight. With a thick rag, he covered the bat and flipped it upside down into the cradle of his palm. “This one is a female and she’s pregnant. Probably why she’s very hostile”Obviously unhappy, she reared her canine like teeth and jaw, struggling for freedom. Alan gripped the bat’s feet and allowed her to hang naturally. After a moment, she flew off into the mass gathering.
“It’s interesting, even though they’re away from any predators and when no one’s around, they still jockey for space on top of each other, scratching and cutting each other.”
I looked at one motionless female, her baby clinging to her underside, staring at me with huge black eyes. “This one hasn’t moved at all.”
Alan looked around her to notice a male mounted behind. “That’s because they’re copulating.” It’s an Animal Channel soap opera in the making.

Early into the evening now, I sat at Dr. Swanepoel’s desk reading into the first chapter of his memoirs, the tiny headset speakers for an iPod Nano blasting character music in my ears. Like the couple other virus hunter books available, his story epitomized the excitement surrounding the events leading up to an outbreak. In this case, an Ebola case in Johannesburg amidst an outbreak of Crimean-Congo Fever, another viral hemorrhagic fever. But I couldn’t help draw an ironic parallel with what was going on behind me.
On the phone with CDC-Atlanta’s top special pathogen brass, Bob elaborated on the details pertaining to the case discussed that morning, however intensified. Now there were potentially five suspected related cases included two fatalities. Illustrating his point to me earlier, Bob ripped into the epidemiologists for not getting exacting facts. Within the few hours transpired, PCR tests had not confirmed the existence of Ebola, Marburg or any other known tropical disease, but more testing was in the works. Symptoms suggested a contagion like Lassa or a Hantavirus, but the incubation times were much too short, even for a filovirus like Ebola and Marburg, on the order of a couple days—as described by the epidemiologist already in the field.
Lucile entered the office and discussed flying to the location a couple countries north of South Africa the next day. Bob expressed hesitancy knowing though he would return to the office later that night after shuttling me to the airport to follow-up on lab results.
“Should I cancel my flight?” I asked. In fact, I had already spoken to Tyler Batson from the Kenya documentary inquiring about making a flight change through his travel agent just in case.
“Frank, like I said, the reality is, this is most likely nothing. This is our bread and butter. We deal with things like this on a regular basis.”
“And the PCR tests confirmed negative for Ebola and Marburg,” I reconfirmed. “And if it were a new strain?”
“If it were a new strain, we wouldn’t be able to detect it.”
A PCR test, short for polymerase chain reaction, detects viral nucleic acids and tests them against a database of known genetic sequences.
“So, like what happened in Bundibugyo,” I identified.
“Yes, exactly. And the only way you can tell it’s a new strain is by isolating the virus through an electron microscope and looking at its shape.” In the case of a filovirus, a cigar shaped moderately large structure sometimes curled at one end like a Shepard’s crook.
“Look, you can do whatever you want, Frank, but I’m telling you we see this stuff all the time.”
Less than eight hours before departure, and according to Tyler, I need to make a decision real soon… like now. I have a tendency to draw patterns as if there’s some mystical significance behind what goes on in my life. That “A Chance for Peace” would bring me to Africa when the opportunity to capitalize on this project—a project I’ve waited over ten years to produce—would conveniently occur at the same time. That almost everything to this moment has seemingly fallen into place with gentle effort. And now, reading in a memoir the exact events transpiring right now as they did almost two decades ago on my last day in Africa. (I know that’s a stretch.)
Earlier the day before, Bob and I discussed previous journalists tagging along in the field. During the Kikwit outbreak of ’95, one went on to follow a lead that claimed having seen patients prior to the suspected index case. Apart for Bob redefining ‘index case’ as pertaining to the first case bringing attention to an epidemic and not ‘patient zero’, he defended, “People can believe what they want to believe, but this is our job and we’re not going to let something fall through the cracks for whatever reason. What makes a journalist think he can do our job better?” After all, they are the pros, and for that reason…
The reality was, I chose against my instincts and would board the KLM flight 23:30 that night; the action of not staying a haunting thought. I would have to wait until I got home, twenty-four hours later, perhaps even a couple days before knowing if my decision to leave was amiss.

South Africa (Johannesburg) – BSL4

A gray haired man treads his way through tall blades of grass and brush into a forest of tall bare-trunk trees with bushy leafed tops. A local man scales a single stock of bamboo, its branches trimmed into ladder rungs to a height exceeding thirty feet. From his high vantage point, he connects one end of a net to an adjacent tree forming a near invisible barrier in the forest canopy. Here bats are caught and taken into a mobile lab for bleeding and dissection, stored in liquid nitrogen for later analysis. The process is repeated for other animals and insects alike. The year is 1996 outside the then Zairian village of Kikwit a month following one of the most historically devastating Ebola outbreaks.
In a lab-office at the Special Pathogens Unit of the National Institute of Communicable Diseases, three of us stood around my laptop watching Final Cut Pro ingest footage from a mini-DV tape recorder. One of many investigative studies filmed over the last ten plus years in search of a reservoir for the Ebola virus.
“I was old then doing that,” Dr. Swanepoel commented watching himself wrangle a bat.
“If you were old then doing that, what did you do when you were young?” I asked smartly.
Bob grinned under his large tinted wire frame glasses, “I was doing as many girls as I could.” We laughed.
At 72 years, Dr. Robert Swanepoel is as sharp, witty and energetic as someone in his middle ages, or perhaps younger. That was the idea those who’ve before spent time with him impressed upon me. He did not disappoint.
I sat behind Bob in his office sipping a Singapore knockoff of Nescafé, which for an instant coffee was surprisingly good. I was on my second cup. Bob scrolled through pictures from previous outbreaks and field investigations and painted a deeper story to the virus with each instance.
“So why has it taken so long to isolate the virus?” I asked.
“Timing.” On a used sheet of paper, Bob drew two circles, one within the other representing the basic structure of a cell. He labeled the inside circle ‘nucleus’ and its surrounding space ‘cytoplasm’, noting each one as headquarters and factory respectively. “If this were Henry Ford’s assembly line, the headquarters sends out a blueprint to the factory in the form of messenger-RNA, or we call it mRNA. The factory assembles many spare parts, but inefficiently produces more than it needs.”
He dotted the cell’s interior and continued, “Windscreens, tires, steering wheels—nucleic acids to build proteins for a virus.” A third circle was drawn on the cell’s outside and labeled virus. Again more dots. “So of all those parts, you get a few viruses with all these spares. We were always seeing the parts, but never the whole virus because we weren’t catching it at the right time of production.” Bob went on into more detail, involving the factors involved with determining the ‘right’ time and the tests used.
I asked Bob about Kitum cave.
“The Dutch schoolboy’s family lived on the Kenya side; he went in on the Kenyan side.”

The next day following lunch, Bob led me to a tall brown speared fence. Inside the fence is a three story isolated brick building, two large stainless steal vents piped into the walls.
“This is our maximum security lab,” Bob explained. “There are only two like this in the world. Here and at the CDC.”
There are more labs like it sprouting up throughout the world, but this lab was the second to be built a year after the Centers for Disease Control constructed the first high containment lab in 1978. “I am going to take you inside, but I cannot take you onto the floor. We are under surveillance now being close to operational again.”
The lab is under the process of being remodeled, and after four years in the process should open again by the end of the year. We crossed through a narrow opening through the gate and entered from the back of the lab. Beside a bright red biohazard flower emblem in small letters, a sign read: BSL4; for Bio-Safety Level 4, also known as a ‘P4’ or ‘Hot Lab’. Within these walls, the most infectious diseases known to man including at the top of the list Ebola and Marburg are grown and studied. Bob swiped his card key, the red LED light turned green, and he opened the door. The heightened risk of bio-terrorism has made such facilities a security fortress, and as of right now, I do not have clearance to photograph or film anything.
In contrast to many of the other hallways I’ve walked through at NICD, the paths skirting the outside of the lab proper breathe a sterile slick laboratory atmosphere of expansive white walls, pipes and polished steel. We passed a series of narrow windows looking in at glove box workstations, tables and storage closets and cabinets. Hanging from the ceiling, a number of yellow hoses.
“Those hoses are what you connect to your suit for air-intake for your suit,” he walked past a couple steal boxes marked, ‘Autoclave’. “Here you can put something in and close the door for someone to access from the other side with out it being incinerated, but anything put in from the lab is automatically autoclaved.”
Down another corridor, and through a series of open airlocks, we could look onto the lab floor and through to a locker storing yellow spacesuits. The lab directly in front of us is labeled, ‘Animal Room 2’. On one wall are a dozen cages for small animals including rats up to perhaps guinea pigs. Between this room and another lab leading to the suit room is a double heavy door airlock. The space between those two doors acts as an intermediate shower room decontaminating an individual crossing one area into another.
The decontamination and undressing procedure is a cumbersome and timely process. Coffee is not recommended, as bathroom breaks require exiting the lab. Wearing a diaper is a touchy subject and is useful for long stints inside the suit. From what I gather, people do not freely admit to wearing a diaper even if they do so.
The hair on my arms stood and I couldn’t help stop smiling excitedly. “You know Bob, to me this is an equivalent to visiting the space shuttle.” And going inside would be equivalent to going into space—or close to in my book.
“The engineering and control for this lab is on par with the space shuttle, monitoring everything to prevent contamination. There is a lot of money built into here,” Bob added.
In contrast, my visit to the developing Ugandan Virus Research Institute (UVRI) a week earlier in Entebbe illustrates the use of a barebones operation. Primarily built for HIV research and immunology, the limited BSL3 laboratory is authorized to handle viruses like Ebola with very specific restriction. The CDC, through the introduction of the BSL3 lab, is fostering a long-term relationship with the Ugandan government to establish a foothold in east Africa for VHF (Viral Hemorrhagic Fever) testing.

South Africa (Phinda) – Vacation

When I return to the States, I will face what I’ve come to recognize as reverse culture shock, and oddly, that reverse culture shock is greater than the culture shock from arriving on the continent. I do not quite understand the difference except something about returning to a common routine is… well, shocking when everyday is literally a radical experience.
So when I got off the South African Airways flight from Entebbe, Uganda and walked into the main terminal at Johannesburg International Airport, my mind wasn’t prepared for an appetizer to western culture.
Suddenly I’m not in minority, but that seems alien to me. Technology is everywhere and I feel like sitting down to absorb everything. I was told the drive to Phinda Game Reserve is a rough road, but subtract driving manual from the literal right side of the vehicle on the proverbial wrong side of the road, a speeding ticket halfway out to the South African ‘bush’, and trucks making half the designated speed on a one-lane highway, the handful of potholes and windy roads are a Sunday pleasant drive compared to where I came from. Even the eight-hour haul from Jo-burg airport to the game lodge felt like a regular commute to work, minus the persistent freaking out about stalling into 1st gear (seldom happened, in fact, but I think the gear box will need some work).
Roughly 10 kilometers of grated dirt road through darkness, past warthogs and zebra brought me to Phinda Mountain Lodge. I was warmly greeted by the pleasant and confident smile of host-manager, Karen, then directed to my cottage for a brief freshen-up before riding into the reserve for a bush dinner.
Room 21: the bathroom is four times bigger than the thatched roof hut I slept under in Transmara with an indoor and outdoor private shower and stand-alone bathtub. I guess it’s like taking a hand-bath with running hot water. Brilliant!
A soft knock at the door.“Hullo, sir. Are you ready for me to take you to dinner?”
At night, all guests must be escorted on the property in the event a lion or some other ‘Big 5’ animal wanders into the lodge premises. Later, when I would actually ‘camp out’ on the reserve, I wouldn’t have that protection.
“What would you like to see tomorrow, Frank?” Ian, my arranged group’s park guide asked at the dinner table. Two couples, one from the UK and the other from South Africa sat across from each other. I was seated at the head of the table across from Ian.
“I’ve seen pretty much all of the ‘Big 5’ animals, except I would like to see a cheetah.” The ‘Big 5’ include: lion, elephant, leopard, rhino and buffalo; not based on tourist appeal—I had thought giraffe was on that list—but based on the most dangerous animals to hunt back in the day. I can understand the first four, but asking how buffalo made the list, the answer I received summed up explained that a wounded buffalo is extremely vicious. Meaning, if hunting a buffalo, best you kill it on the first shot.
“We haven’t seen cheetah in a while, but that’ll be something to work towards tomorrow morning,” Ian offered.
Although I slept comfortably in Room 21’s pillow queen bed, I couldn’t shake off the awkwardness of sleeping in luxury.

At lunch that afternoon, I met with Ilze, former general manager of the Sossusvlei Mountain Lodge (refer to the first four Namibia blog entries). Ilze and Bryan had moved to Phinda after a short stint at SML, and now conduct training for new rangers into the CC Africa organization (they are undergoing a name change as their lodge expands into India and South America).
“Bryan has a tough life here,” Ilze joked. “He travels to Tanzania, Botswana, Namibia to train rangers and look at wildlife.”
I laughed, “I get the same thing. It’s like a vacation, only I’m operating a camera and working pretty much every day. Admittedly, I can’t imagine myself doing anything different though, but today is the first day in, I don’t know, weeks I haven’t done anything regarding ‘work’.” I lied. Later, on the afternoon game drive, I would bring out the camera even though I said I wouldn’t.
“I’m in a bit of a shock, Ilze.” I took a taste of my drink cocktail. “Not only am I in a bit of a shock, but I guess I’m really sensitive to snob bullshit right now—pardon my language.”
“Oh, tell me. I must hear this.”
“For one, this morning on the game drive we’re following this cheetah and her three cubs and from the looks of things she’s on the hunt for food. I want to see a kill, and this would be just awesome if we could catch something like that, you know. So we loose track of the cheetahs ‘cause the stupid cubs go off chasing some zebra and disappear behind the trees. Ian suggests we look for a little longer than go back to the lodge for breakfast if that’s all right with everyone. Well, everyone’s all for getting some food, and I’m like, ‘What? Screw breakfast. I want to see a kill!” Of course, I just thought that and didn’t say anything given I’m not really a guest. But seriously, it’s not like you can witness a kill anytime.”
Ilze agreed.
“Then all I hear is moaning and bitching at breakfast about the water being shut off. So go wash your hands in the pool or use the bottled water so nicely left for you. C’mon, this is Africa. T.I.A. Be resourceful. I understand they paid hundreds of dollars to stay here, but you’re in the middle of the f-ing bush and shit happens.” I took another taste of my cocktail. “Guess I just see things a little differently now is all.”

Not that I didn’t enjoy being pampered the first two nights, but the real fun was ‘camping’ out with the guide trainees a few kilometers outside the lodge overlooking the reserve’s flood plain. 

‘Camping’ is in quotes because there is running hot water and modern amenities on generator power switched on for a couple hours at night. So not quite roughing it, but living with restrictions. I felt more at home and certainly the company of the trainees made for a fun experience through their practical joking.
My job was to present an applicable introduction to naked eye astronomy for the purposes of entertaining guests during night drives. The night was overcast, so the trainees had to endure a two hour lecture in the conference hall. Drawing from my experience at Sossusvlei Mountain Lodge, as well as a night drive the day before I condensed Astronomy 101 into a dramatic narrative of human insignificance through bright object examples. As with all astronomy lectures, the green laser pointer became the instant star of the presentation.

You know how cats are captivated by a laser dot? How do you think a lion would react to it?” I half-jokingly inquired.

“Hmmm. I don’t know. It would be interesting to try.” Bryan offered.
“I asked Ian that same question on the evening drive yesterday when we were parked beside a lioness and her four cubs, but he suggested trying it when no guests were around.”
A good idea, but unfortunately the experiment will have to wait for my next visit. After my last experience with lions (Namibia – The First), I’ve since evolved like modern man has from throwing rocks to shooting laser beams.

Uganda – Bundibugyo: Part Two

Accepting a stranger with a camera into your home must have been awkward to say the least for the Myhre family. Who is this guy? What does he want? And awkward doesn’t begin to describe what emotions surface reliving a difficult past.
Arriving with the Chedester family, I was welcomed to a weekly team meeting dinner party. Today’s menu: brick-oven roasted pizza, plain cheese to supreme and everything in between. Not that I dislike east African cuisine, in fact I very much enjoy the native dishes, especially the charcoal barbequed bush meet speared and sold on the street. From the bus window, I would spend the thousand Ugandan Shillings (~.65 cents USD) for two long toothpick-like skewers knowing very well my digestive track would hate me for it that night and day after. But a change in menu is very appetizing, especially a taste from home. Odd I would find it here far removed from anything near western civilization, and better tasting than most pies back at home. After a brief astronomy lesson navigating around tree canopies, followed by an episode of Band of Brothers on DVD, Scott and I sat across from each other in the family living room and talked about Ebola. I looked at my arms; the skin looked like a few dozen mosquitoes had bitten me. The pink blotches in fact were bukukuni bites, a gnat-like fly with a taste for human skin. Bob had warned me earlier about wearing a long sleeve shirt at night, and that in conjunction with not taking his advice about getting on an empty bus because it won’t be leaving anytime soon (that morning, resulting in a three hour departure wait), were now two things I should have listened to.
“Don’t say too much, you’ll end up repeating it,” Jennifer suggested from the kitchen, switching off the lights. Jack, Julia and Caleb, three of the Myhre’s four kids had already retired on the school night. The next day would be a whirlwind event at the school celebrating Parents Day, which in addition to their respective doctor roles at two different local institutions, both Scott and Jennifer are heavily involved with the school’s development.
“I, Dr. Sessanga, and Dr. Jonah were in the room together looking over Jeremiah Muhindo’s chest x-ray trying to figure out what was causing the illness, this was before knowing it was Ebola,” Scott recounted the days just before the announcement. “He was having shortness of breath, his eyes were real red, and I remember putting my hand on his hand to check his pulse. His hands were just cold as ice; the man was in shock. We all came in contact with the patient. In a way, it’s not fair two of the three of us would get Ebola, and one of us would die.” “Were you afraid?” 

“After Jonah got sick and Sessanga gets sick, then Ebola is confirmed … I was afraid. It was right at that point we decided we had both been exposed because of our visit to Kikyo and having been in contact with a number of patients that had died, we had twenty-one days to determine if we were developing symptoms or not and decided we needed to send our kids away from us. If we got sick, we didn’t want to expose them.”

“What were you going through those twenty-one days?” I feel like the answers to my questions are obvious, but I needed to ask. Scott and later Jennifer were pros; going beyond what I thought was an obvious response.
“You’re super-sensitive. After Jonah was buried, I was sitting at church and had a headache. I don’t usually get headaches. I leaned over to Jennifer and said, ‘I just don’t feel well,’ and she said, ‘Well go home and go to bed.” There was a knowing exchange of looks that this… and I laid down and I thought, ‘Well, this could be it.’ And I told her, if I really felt like I was sick, I was going to go across the street to a vacant missionary house and lock myself in there, because I wasn’t going to have her take care of me and expose herself and leave our kids as orphans. Nothing ever came of that, but I talked to an MSF worker [Doctors Without Borders] and she said that, ‘Typically if you do come down with Ebola this late after contact, you’ll get sick, but probably not die of it.’”

The following morning, Scott drove me the thirty minutes to Bundibugyo hospital. We stopped 

at the gravesites of the four healthcare workers, including Dr. Jonah Kule, whom died caring for Ebola patients during the outbreak.
“Not many people came to Jonah’s burial in fear of getting Ebola. Afraid they might get Ebola from the air, or from the bodies. It doesn’t help to see the MSF burial team, dressed in their Tyvex spacesuits disinfecting the bodies sealed in bags then dropping the coffins into their graves,” Scott quietly explained before he and I walked across the medical campus. Men and women of all ages loitered through the open covered pathways. Some women waited outside the x-ray building for an ultrasound. Some just sat on the sidewalk ends looking at the many people passing by. Through the antenatal ward where the Ebola infected healthcare workers we treated, an education workshop was underway. Nurses sifted through disorganized books and records; I honestly couldn’t guess what was going on. Over a shallow hill of drying grass took us to a chain link fence enclosing the isolation ward.

We walked around the two-car garage-sized building to an unlocked door. I walked inside.
Sunlight seeped through a gap where the wall would meet the floor, and from the middle seam between blue painted wooden window panels. Eight bed frames, four on each side are planted on the grey polished cement floor, their white latex coatings peeling from its metal bars. I visualized the beds made and occupied. A suited individual examines one patient through his plastic helmet mask and thick blue gloves, checking the still individual’s pulse and examining his eyes.

“I was partially conscious, but not alert to all my senses,” one Ebola survivor told me. “I would not be able to drink. I would not be able to turn my body. I would sleep like that until someone could assist me. The thinking was not so easy. You could think of either surviving or death. And you just hand everything to God to decide on your fate.”
I then pictured myself inside one of those Tyvex suits and contending with the heat and humidity compounded underneath the protective garment. Leaving the isolation ward, I further imagined drenching myself with a concentrated bleach solution in one of the many white tents established by the MSF team, sealing the suit in a biohazard bag before redressing into my clothes and allowing the thickness of the air become a sad refreshing relief.

“You. What are you filming? What are you doing here?” a burly man in a suit approached me mounting the back of a motorcycle, the camera gripped tightly by my left hand over my lap.
Denato spoke to him, but the man ignored whatever was said stepping over banana bundles charging forward. People in the market stopped in mid-commerce to witness the exchange. In particular, I recall one older woman holding a food item frozen in transaction.
Being the only mzungu around draws enough attention, regardless of the few white families residing on the outskirts of town. But a mzungu with a camera rivaling anything the country begs special attention whether by lens happy children or protective elders.
“I ask you, why are you here?” The man stood dangerously close. I looked to Denato; no more help there.
“I’m filming a documentary,” I calmly stated, knowing I’m not going anywhere unless I direct Denato to drive.
“What again?”
“A documentary on the Ebola outbreak here last year.”
“On Ebola?”
“Yes.”
He smiled. And almost immediately, his whole body relaxed and he said shaking my hand, “Oh, that is good. Thank you. Welcome. Be free, you are welcome here.”

Not quite the reaction I expected, but a welcome one. Denato, Scott’s assistant, revved the engine and I prepped the camera to film over the driver’s head while riding the uneven dirt road. Even after replaying the footage days later, I’m still shocked at myself for putting faith into a motor bike and its driver at the stake of breaking my camera—or injuring myself. I did regretfully pack the camera for the thirty-minute return drive back to the Myhre’s on a motor-boda. Over steep inclines and sharp drops, dodging people and potholes, the choice was probably a good idea, although the mountain and valley views were breathtaking.

In her blog, Jennifer drew a parallel between the Ebola and HIV viruses, “HIV attacks the disease-fighting cells of the body, so that a person succumbs to other illnesses. Few AIDS patients are technically killed by the HIV virus alone, almost all die from things like TB or fungi or common bacterial infections that can no longer be resisted. On a macro level, Ebola acts in a similar way. Ebola attacked the disease-fighting personnel and programs of this society. Only 37 people died of Ebola during the epidemic, but many more, untold numbers, have died because of the lack of medical services. I think we will never really know the true impact.”

*Pictures from the 2007 outbreak courtesy Scott and Jennifer Myhre.

Uganda – Bundibugyo: Part One

Four brothers ascend into the Rwenzori Mountains, crossing orchards of cocoa trees, coffee and kasava to reach the untouched woodlands approaching national park land. The sky is most likely clouded over from their perspective, but through the cold mist, not much ahead is seen other than the dense forest at arm’s reach. Perhaps the monkey was already dead when they found it, or maybe out of hunger or pleasured desire they killed and then consumed the mammal together.
Each brother would tend to his lively duties as normal over the coming days visiting the local markets, socializing with neighbors, seeing to their crops, but after the second or third day, one of the brothers falls mildly ill with a headache and fever. Malaria, he may have thought. Maybe he had a blood smear done at Kikyo Health Unit and found evidence of the parasite, or maybe they simply prescribed the necessary drugs on a clinical diagnosis, but regardless of the treatment his symptoms progress with vomiting and diarrhea. His body is weakening, and by the disease’s fifth or sixth day, the brother’s eyes are turning red, his neck and body is stiff, and his kidneys, liver and respiratory functions are failing. A week has now passed and the one brother falls into sudden shock, maybe bleeds out then dies. The three other brothers follow.
The passing of a community member is followed-up by a series of funeral rites to bring closure to a person’s life. The body is washed and embraced by loved ones before carried then lowered into a grave outside the home. Here the virus is spread and over the next couple months a mystery illness rattles the local countryside.

ONE YEAR LATER…

The Kenya documentary brought me good reason to visit Uganda and South Africa. Proximity is one factor. A round-trip airline ticket is another; and serendipitously timed near perfect. Until a little more than a week before arriving in Kampala, I really had no solid plan for Uganda except I wanted to visit a cave and talk to people. For that reason, I allocated one week’s time in the country before hoping on a one-way flight to Johannesburg before returning to the States. In retrospect, I should have blindly planned for two weeks as I initially felt before the perceived absence anxiety set in.
Through my contact at the Centers for Disease Control and Prevention in Atlanta, I was initially provided with three leads to follow and a link to Scott and Jennifer Myhre’s blog, a pair of doctors living with their family in western Uganda. Through a snail’s paced Internet connection in Kericho, I downloaded and printed 67 pages of entries dating from the end of November last year to early this year chronicling a local’s perspective to the most recent Ebola outbreak in the remote town of Bundibugyo. Admittedly, I had difficulty sleeping one night in Transmara after reading up to the passage, “Grief and Fear”.
With only a couple days of preparation, I met Bob Chedester and family from the World Harvest organization in the city of Fort Portal. I was creating space in the aisle for departing passengers, when a mzungu got the attention of the driver who then directed me to get off the bus. By coincidence, Bob and family were planning to visit the Myhre family in Bundibugyo and offered a seat in their already packed Land Cruiser saving me the adventure of hitchhiking with my equipment and bags over a 100 kilometer stretch of narrow, non-maintained dirt road around and through the Rwenzori Mountains.
“Bundibugyo is about forty kilometers straight that way,” Bob pointed, “but there’s no way to go through the mountains so we have to go around. You could hike it though; it’ll take about six hours—at a good pace.”
Instead, I’ll settle for a three-hour rocking fest squeezed between my luggage in the SUV’s boot seated across three year-old Samuel. I said this before we started and I seriously meant it after, “This will make up for the four and half hour bus ride, and three and a half hours of waiting for the bus to depart, because I let myself be directed to the wrong departing bus.”
Almost immediately I picked up air off my seat and smashed my head on the ceiling.
“Watch your head,” Bob smiled through the rearview mirror.
“I’m used to it, that was number twenty-five.”
“Twenty-five?” Someone asked like I had already hit the ceiling that many times.
“Twenty-five times since arriving in Africa I’ve hit my head on low door frames, beams, rocks, whatever. I’m keeping track.”
“You’ll hit it a bunch more times on this road,” Bob assured me.

“I can’t wait.” The road snaked over what seemed like dozens of ridges in replace of switchbacks as we climbed to probably 8,000 feet.
“We have to stop at the lookout. It’s my favorite spot,” young Elizabeth claimed, one of nine passengers in the vehicle including Samuel and myself. The vehicle bounced.
“Twenty-six.” And bounced again. “Twenty-seven.” Everyone laughed. Glad I could provide comic relief. 

From the lookout, a vast gully between mountains receded into the flat plains of the Democratic Republic of the Congo (DRC). Outside the Rwenzori National Park, the mountains resemble a quilt, as Elizabeth observed, of various crop plantations patching the landscape. It is believed by one tribe the land is more fertile on the mountain slopes. Either that, or people don’t want to admit location, location, location is everything and worth the insane effort it must require to haul material and food through the forest and up onto those slopes.

By thirty and thirty-one, we arrived at what must have been the most anticipated destination on the 

entire drive, second only to our destination: the bridge. But not just any bridge, at maybe three cars’ length it is the flattest surface anywhere in the region.
The Land Cruiser shutters with bated anticipation then … silence. Everyone sighs a happy relief enjoying the moment of tranquility. Then, back to shuttering. This brought on a series of songs from “B-I-N-G-O” to “Ol’ McDonald”. In between travel ballads, my dialogue exchange didn’t quite go this way, but I’d like to remember it did:
“Can’t you sing some

thing with a little more pep to it?” I asked to no one in particular.
A pause. “It’s a small world after all…”
“No. No. Anything but that!” I cried. But in actuality, I prompted the song just so I could shoot it down quoting that last line.
Thirty-two.

OCTOBER 2007

Unlike traditional Ebola, this new unofficially titled Bundibugyo strain is weaker and partially asymptomatic killing roughly 30% of patients against a typical 70-90% mortality rate without the sensationalized “bleeding” from every orifice. These factors contributed to a prolonged identification and the much needed guidance of outside experienced organizations.

By late October, the mystery illness inspired the attention of Dr. Jonah Kule from nearby Bundibugyo hospital. The following is excerpted from Scott and Jennifer Myhre’s blog titled, “Grief and Fear” with an excerpt from “Bundibugyo, Where the Tears Never Run Dry”. The entry summarizes the events transpired at that time, text and pictures courtesy of the Myhres:

Jonah was a man of integrity. He refused to charge patients extra fees for his services, even though that is widely practiced in government hospitals. He was completely trustworthy with his responsibilities and resources. He was a leader who knew how to motivate, listen, draw consensus. He was not afraid.
Jonah first went to investigate this epidemic weeks ago; it was probably still October then. Rumors had reached him of a mystery illness. I remember well the day he came into the Pediatric Ward and told us about it. I gave him gloves and my bottle of alcohol hand gel, pitifully inadequate measures now. We had not heard of any bleeding, just vomiting and diarrhea and unusual deaths. We wondered if it was a cholera outbreak. I remember him slinging his backpack on, and getting on his motorcycle saying, “If I die, I die.”
When he came back he guessed typhoid fever, due to the prominent abdominal pain and even what seemed to be two cases with intestinal perforation. He noted the family grouping of the cases and held some community meetings to sensitize on hygiene, the basics of hand washing and latrines. He dispelled rumors of witchcraft and poisons. He wrote up a report. Then over the next week or two there was a task force set up, some Ministry of Health epidemiologists came and took blood samples.
We got the good news that it was not Marburg or any Viral Hemorrhagic Fever based on samples sent . . . Not sure where. Then there was the message that more samples had been sent to South Africa. Days went on. Uganda’s attention was on CHOGM. Jonah continued to attend to patients as they came into Bundibugyo Hospital, as did Scott. Jonah was the primary doctor for Muhindo, Jeremiah, an older gentleman who had been active in visiting the sick in Kikyo then fell ill in Bundibugyo. [Friday November 23 is the day Jonah believed himself to have been infected. That was the day he and Scott examined Jeremiah Muhindo. In between two of the times they saw the patient together, Jonah went in alone and arranged a facemask of oxygen onto the dying man, hoping to provide some relief or comfort. He was not wearing gloves because he could not find any at the hospital at that moment, and he felt that his friend needed the oxygen. That was his greatest exposure.] A week and a half ago Muhindo died.
A few days later Jonah went to Kampala on personal business; he has a house there still from medical school days with rooms he rents out, and three of his daughters are in school in Kampala, and his mother and brother stay with them there. We went to Kikyo the day Jonah went to Kampala, all of us still wondering what this disease could be, still being told the samples had been sent from South Africa now on to the CDC in Atlanta. Then last Thursday the bombshell announcement came, that it was Ebola, a new strain. That day we talked to Jonah on the phone, he had a headache he said, maybe early malaria, he’d watch. By Friday morning he found it prudent to admit himself to Mulago hospital. That was his last act of bravery and wisdom. We talked on the phone that day, he sounded so normal, so himself. I went to find his wife Melen who was still here. We prayed and wept and embraced and called him again.
Saturday morning I drove her early to town to get on transport to go to Kampala, even though she knew she would not be allowed to see him. She’s six months pregnant with their sixth child. From Friday until 4 pm yesterday every report we got from the doctors was hopeful. He was walking and talking, drinking. His doctor even said he was wanting to call and talk to us but they were looking for a way to charge his phone which he had with him in the isolation. He did have a couple of days of reduced urine output indicating an effect on his kidneys, and he did continue to have fever. With each new symptom and passing day the hope that it was all just malaria became less and less. Still Jonah is a strong man, healthy, smart. He was in the country’s main hospital, not out here in Bundibugyo. He was getting lab tests. He had a team of doctors, including MSF Spain. We had hope. Then suddenly last night they called back. He had died. Maybe there was bleeding, involving his kidneys and lungs, I don’t have the real story yet.

You can read the Myhre's complete blogs entries at: http://paradoxuganda.blogspot.com

Kenya/Uganda – Conclusions and Beginnings

For the consistent reader, I only posted a summary—at best—of my one month through southwestern Kenya. Many worthy stories remain scribbled in one of two notebooks or are vividly retained by memory. Stories of generosity and salvation at a government hidden IDP camp. The love and insecurity of a mute outcast mother and her leashed preteen son (one of many touching and complicated stories at Sister Freda’s Clinic). Meeting an American missionary family living in north Kenya and learning of their life with the Trukana tribe deep in the north deserts (and their unexpected ties in the film business), are only to highlight a few as I reflect on the past four weeks walking down a foot-worn trail over green pastures.

A Maasai herds-boy bowed his head in passing. I laid my hand atop of his head and continued forward. I had made the mistake of shaking a child’s hand in greeting early in the visit. Shaking one’s hand is a ritual reserved for adults in the Maasai tribe— those having passed the rite of manhood (or womanhood) through an annual community public circumcision ceremony for adolescents aged 14-17 followed by a month of isolation together into the bush. Wearing nothing but animal skins, the boys are mentored by the generation previous to become fearless adults under the influence of intense “medicine”. The details are kept secret, and for this herds-boy, he must continue to bow his head in respect aspiring to prove he is ready to be a man.
“It’s a form a brainwashing,” Emmanuel Tasur explained the following day with utmost respect for the tradition similarly shared by many tribes in Kenya, as well as eastern Africa. His son will go through the rite next year at age 13.An eastern breeze cooled the beads of perspiration formed on my brow. I easily weaved between the cypress and eucalyptus trees crowning Pirrar Hill. The steep hike reminded me of climbing SP Crater, an extinct cinder cone volcano in northern Arizona, but without the cinders sinking me down. Along the tree line, I sat on an exposed rock overlooking one side of Transmara.The name Transmara is indicative to its meaning. The area is a transition zone between the mountainous Rift Valley and the low-lying savannahs. “Mara”, a Maasai word for “spotted”, refers to the sporadic grouping of trees dotting the land similar to the spots on a leopard or cheetah. From above, a word for “checkered” would be more appropriate, as farming has quartered the grassy hills like a relief chess board. I spotted the school Emmanuel is building on the slope of another hill and where I played football with the primary-grade students at break.
Last year, Emmanuel campaigned for a Minister of Parliament position, but backed out of the race for one of many reasons, including the construction of a primary and secondary school system in Transmara.“I would like to bring hockey into our sports program,” he expressed, but not referring to the common field hockey version. “Something no one here I Kenya could offer. We would be the first.”
Ice would be a logistical and expensive impossibility, but roller or plain street hockey is certainly doable. Emmanuel walked me down the hill from the four classrooms, over the rocky slope soon to be developed into a soccer field and to the future secondary school site.
“Right here is where we could place the rink.”
“Problem is there wouldn’t be much competition,” I noted.
“At first, but I plan to have five schools throughout Transmara, which they can play against each other.”
I pondered the idea. A hawk glided overhead and dipped down the hill blending into the background as a distant dark speck. A small pack of goats grazed just below my position, and I could hear the steady ringing of cowbells further down. As the day approached noon, I watched the evening clouds develop on the horizon and eventually engulf the sun.

Heavy rain fell long into the night. Victor’s bus had broken down followed by his matatu while en route to meet me in Kericho, a small city two hours north of Transmara. Fifteen past midnight, I bid farewell to Tyler before squeezing into the taxi to take Victor and I maybe two kilometers at most to the Akamba bus station.
After haggling down the cab-fare, I tried to sleep through the rough eight hour highway bus ride, stopping several times at towns along the way discharging and accepting passengers until the border. The predawn hours dragged me down as I brushed off money-exchange hawkers at the visa office to the sound of Islamic chants broadcast over loud speakers from a nearby Mosque.
Looking out the bus window at passing southeast Uganda and its shallow contrasting hills of banana palms and eucalyptus against rusted earth trails and corrugated metal roofed homes this is what I pictured Uganda and east sub-tropical Africa to look like, but seeing it in person sends a slightly apprehensive chill down my spine. The cold humidity bites hard and for the first time in weeks, I’m wearing pants on purpose. But as morning turns to afternoon in Kampala, a near equinox sun cooks the air and I wish I were wearing shorts.

"Can you take us to a hotel near a bus station that'll take me to Fort Portal?" I asked a taxi driver gathering my bags from the bus's boot.
Moses, the taxi driver, delivered us to the Amber Hotel in the local commercial district--not the best part of town--just outside city-center Kampala.  Even though the traffic is just as congested as in Nairobi with matatus inches from each other and motor-bodas skillfully weaving in between, the air is cleaner, and thus the city is brighter.
“Uganda is a very friendly and safer than Kenya,” Victor restated what so many others have said before.
“Is that because of Museveni?” President Museveni over threw the Amin regime around the turn of the century starting with a guerrilla army of 26 men and since has turned the face and future of Uganda one-eighty.
“It’s time for change. He is on his third term and needs to step down. A man he fought with is now fighting against him,” Moses laughed. Afraid of handing over the country to another corrupt regime, one could say Museveni is forming a dictatorship while also preventing the creation of additional political parties to serve a Western democratic system. But, why break something that’s making positive steps?
My first positive step that afternoon was taking a warm continuous shower. Although one can turn hand-baths into an efficient cleaning process, streaming water does the job faster and is a relaxing pleasure I take too much for granted. Four minutes later, I am dressed, shaving and fifteen minutes from my first meeting.

A thirty-minute ten-kilometer taxi ride brought us to the front entrance of the Ugandan Ministry of Health. Taped to a window is a yellow poster titled from small print to bold:

FACTS ABOUT EBOLA

Over ten years of interest and study have finally paid off, and even after months of legitimate preparation, I have to pinch myself to its reality. And as I sit across the Assistant Commissioner of Health Education for the Ugandan Ministry of Health, the feeling dawns on me that this is really happening.
“Tell me about your assignment,” Paul Kagwa directed handing Victor and I a cold bottle of Coca-Cola.
“In the mid-nineties there was a documentary called, ‘Ebola: The Plaque Fighters’…”
“Yes, I know of it,” Mr. Kagwa pushed forward.
“This is its sequel, picking up where their story left off. It’s been over ten years and we now know where Marburg hides and Ebola hopefully soon to come. This is a historical time forty years in the making. But beyond that, this documentary is not necessarily about the virus itself, but the human story behind dealing with it,” I explained and continued with the current plan. “Right now, I’m establishing the contacts and gathering the necessary knowledge so when I get the phone call that something is happening in … the Congo, I’m prepared to move forward immediately and mobilize my crew to best achieve our purpose.”
“You know, we shot a one-hour documentary to show the community. The footage from that would be very useful to you. Let me make some phone calls and get this to you. Also, you need to speak with our director general, Dr. Okware. He is in charge of all outbreaks and has been around them since the beginning. There is no better person to talk to.”
And so the week in Uganda begins.

Kenya (Mount Elgon) – Kenya Side

The tiny stream cascaded over the eroded pyroclastic rock wall and splashed onto rounded solid black basalt boulders and vibrant green shrubbery. I shielded the camera and tripod from the tiny waterfall’s spray behind a large volcanic block and hopped from stone to stone over a heavily cratered pond of mud and shallow still water into the wide mouth of Kitum Cave. The rocks disappeared beneath a porch of fine dry dust that exploded into ankle-high plumes of soft mist with every footstep—one of many different animal prints pitting the floor. With the entrance now a broad sliver of iridescent green vegetation, I switched on the headlamp before handing my spare flashlight to the guide. Dressed in military green camouflage with an AK-101 gripped tightly by his right hand, he kindly led me up a series of large blocks. His narrow face and wide smile reminded me of the rapper Tupac.
Echoing around me, the cries and whooping of short screeches and dull fluttering quickly escalated in volume. I turned my light to the vaulted ceiling and caught the glitter of hundreds paired rusty-gold blinking beads.
The screeching stopped to give way to waves of rubbery flapping. Dozens upon dozens of agitated Rousettus fruit bats fled from of an unseen cavity in the dome roof and surrounded us with movement. I turned the light away and almost as immediately as the storm began it subsided with the bats returning to their roost. We pressed forward, I every now and then glimpsing clusters of citrine eyes nestled overhead in shallow indentations. The unsettling chatter and movement continued.
“You can see here,” the guide said tracing his finger inside one of many pickaxe scrapings in the wall, “these are ‘tuskings’, where the elephants carve at the rock to get to the salt.” Elephants, as well as many other animals like buffalo and bushbuck, will eat the porous soft agglomerate for the salt embedded within. “Some predators will take advantage of those animals and eat them for food,” Tupac noted over piled hyena bones beside an enclosed underground pool.
“When do the elephants come around?” I asked.
“At night, but you cannot see them now because they are on the other side of the mountain.” The “other side” meaning the elephants are on Ugandan portion of Elgon Mountain, which both Kenya and Uganda share including the national park. “Kitum cave goes into Uganda.”
“Really? That’s like forty kilometers from here.”
“Yes, but you cannot get there because a few years ago there was a cave in. You see, the elephants scrape at the rocks and can sometimes cause large boulders to fall.”
“Can you access the Ugandan Kitum entrance?”
“Ah, I don’t know. I think it’s spelled, Kip-tum. Kitum means sacred, I do not know what Kiptum means.”
Could a “border” be all that separates the transmission of a virus? I absurdly mused. What would make the bats on the Ugandan side harbor the Marburg virus, and not those from the Kenyan side? …A number of factors drew in my head, assuming the virus does in fact exist in Kitum cave as spotlighted in Richard Preston’s book, The Hot Zone. The truth is, two victims of Marburg during the early 1980s had visited the cave prior to dying from the disease, but it is not known if the virus was contracted there. Field studies of Kitum cave and its occupants (bats, rodents, insects, etc) revealed no evidence linking Marburg or sister virus Ebola to Kitum cave. As a result of the book, Kenya’s Kitum cave has received a bad stigma, and when asked about the virus in association with Kitum cave, park rangers will quickly laugh and assure you there is no association. Unrelated though, a few scientists studying the bat flu disappeared in the cave and never returned, Barasa, the grounds keeper informed us over a campfire.
From the top of Endebess bluff we watched the late afternoon bring its routine seasonal downpour to Elgon’s east facing forested slopes and the endless crop fields dipping below the horizon. In timelapse, the clouds develop and expand over the world’s broadest mountain slope returning to the valley with brief but sometimes drenching rain. Upon clearing, the mass movement of bushbucks, dik-diks and baboons roll past our banda’s doorstep near the park’s entrance below. Dusk passes and the clouds part revealing a moon-washed southern Milky Way overhead. Like last summer, Jupiter graced its yellow brilliance at zenith now positioned on the handle side of the teapot shaped constellation, Sagittarius. Although being just north of the equator, I noted the north and south poles at the horizon and from my seat beside the fire and watched the sky rotate directly toward the west. I discussed elementary (college) astronomy to a skeptical Carolyn and quiet Michelle. Both girls were volunteering at Sister Freda’s for the month, and knew Tyler from last summer’s volunteer work in Transmara; our next and last destination.

Kenya (Mount Elgon) – SLDF

Reverend Steven Mairori leaned his head through the open window over a vacant driver’s seat and said, “Wait here and I will let you know when you can come out.”
Following Mairori into the Mount Elgon District Commissioner’s Office was Africa Inland Church’s (AIC) bishop leading 4000 homes of God and Kenya’s retired military general under former President Moi. Just an hour earlier, we prayed over glasses of water and Sprite while munching on butter cookies together at the AIC’s Mt. Elgon home office. Neither Tyler nor I expected such a meeting, let alone an opportunity to film in the village of Kapsocony that suffered tremendously two years ago when the Sabaot Land Defense Force (SLDF) attacked and chased off people from their land. With the exception of a French medical team, we were the first film crew invited to visit this area of Mt. Elgon and report on the events that transpired over the last two years.
“The French medical team filmed activities in Kopsiro shortly after the elimination of the SLDF, but were given 24 hours to evacuate the area. One doctor was arrested.”
“Why was he arrested?” I asked the retired general.
He chuckled, “For practicing medicine.”
“For practicing medicine?”
“For practicing medicine,” he finished the conversation.
The question I wanted to ask was, “Why was the French team instructed to leave,” but I surmised an answer.
The French medical team, there to lend assistance to the violence affected Sabaot members delved too deeply into the torture inflicted by military forces ordered to hunt down and exterminate members of the SLDF and were evicted from the area. The creation of the SLDF followed former President Moi’s directive opening land t all Kenyan’s with a price tag. Land bought by those financially able left those struggling to make ends meet homeless, thus forcing the need for Internally Displaced Person camps (IDPs). Those buying the land include politicians, as well as rich tribal members. In the case of the Sabaot and Mt. Elgon, rich Sabaot bought out the land of their brother tribesmen forcing many to seek refuge. Some though took action and created a guerilla militia force out to punish the new landowners and reclaim the land. Punishment included humiliation, mutilation and death. In response, the Kenyan government deployed its national military force to combat the situation. The military went door to door and without due process executed the right of extrajudicial enforcement, which included similar tactics employed by members of the SLDF. The Mt. Elgon Sabaot population now had two forces to fear, their brothers and the government. Some sided with the SLDF in order to place food on their family’s plates, while others ratted out members to the military, sometimes erroneously with sad outcomes.
“I was hearing some youths that were saying that after their parents running away, that they have no food to eat, so they thought that it was good to join the militia so that they can steal the cattle and eat in the bush. Others were forced to join the militia because if you are a youth and you do not join the SLDF, it is better that you go outside Mount Elgon,” Crispin, a Pasteur in Mt. Elgon church community explained to us.
“My nephew was killed and damned into a pit latrine,” a man told us outside a primary school converted into an IDP home. “We only found him after twenty-one days in the pit latrine, removed him and buried him. Those people [SLDF] called me and used a private number and they told me the direction where they damned my nephew.”
Fast-forward two years to present day and peace—for now—is on Mount Elgon.
“I’ve never felt more insecure being a mzungu in Kenya than now,” Tyler expressed emphatically.
“Here at Mount Elgon?” Michelle asked.
“Yeah.”
I rested my head on the rear passenger window and in bold letters on the District Commissioner’s office wall read:

WE AS SERVANTS OF THE KENYA PEOPLE PLEDGE OUR COMMITMENT TO THE PUBLIC THORUGH OUR MOTTO: INTEGRITY AND JUSTICE.

The reverend, bishop and retired general exited the building with an entourage of district officials and church members. Mairori opened the driver-side door and sat behind the wheel, “Okay, we’re going.”
“To the rally?”
“Yes.”
A couple hundred or so locals attended the government/church/military presentation encouraging the public to accept the military’s presence and the construction of a permanent base. Although the leaders assured justice would come to those who committed the horrendous atrocities, all parties urged the community to forgive their neighbor as Jesus would.
Crispin a couple days later elaborated, “So people joined for different reasons and as the church, that is what we are telling people about who joined the militia group unwilling, forced, others were desperate, they had no where to go so they saw the option that they must join those people so they can continue surviving.”
Even though the military deniably condemned innocent lives, the public did express support for a military presence to protect the population.

Two days after the rally, we received word the military had left Mt. Elgon.

Kenya (Kitale) – Sister Freda

“Come inside, Franck,” Sister Freda offered under the doorframe of a mud-brick house the size of a middle-class apartment bedroom. “It is okay. The mother just gave birth ten minutes ago.”
Mother lay on her side with her back to the door. I stepped quietly on the dirt floor, tiptoeing over scraps of firewood and the checkered blanket she nursed the newborn above from.
Sister Freda caressed the top of mother’s head with her thumb speaking to her softly in Swahili. The girl, late in her teens, removed the suckling infant from her breast and allowed Sister Freda to pick up the child wrapped in a sparing bundle of cloth, the umbilical still attached and disappearing under the sheets.
The infant cried. “This little boy was born just ten minutes before we arrived. It was a quick birth. Very easy for the mother,” Sister Freda quietly repeated and expanded upon, cooing the child with her delicate and calming demeanor. Her heavy white fabric dress and overcoat against the dark walls holding the baby made me think of Mother Theresa.
An old woman arrived at the doorstep with a small blue and white striped T-shirt. Sister Freda set down the baby beside his mother, opened the sheets and carefully with assistance pulled the shirt over his pudgy head and thin arms. Mother then drew him onto her chest and the newborn quieted.
“You can see the conditions she lives in. Thirteen people sleep in this tiny space and this is all the food she has.” Sister Freda pointed to a small pot of unpeeled maize, sighed and folded her hands across the waist. “I do not have my delivery package with me, so she will have to wait. Either I or I will send someone to take her to the hospital.” She made an accepting murmur and stepped outside after speaking with the old woman.
I remained standing at a corner in the hut and watched the mother and her infant together.

I followed Sister Freda’s white Land Rover through the camera’s viewfinder as it turned the corner and disappeared behind a wood fence. Further down the two-wheel track dirt road fenced by a crop of maize was 31-year old Catherine, stabilizing with her right hand a yellow container of water balanced on her head. A cattle-herding boy snapped his switch ushering the group of animals up a shallow embankment out from her path. The woman turned the same corner as Sister Freda and disappeared.
Appearing no older than a girl in her mid-twenties, Sister Freda took Catherine’s free hand into both of hers and graciously bowed her head, gently closing her eyes with a kind and humble smile. The girl shyly smiled.
“This is Catherine,” Sister Freda introduced, “She is HIV positive, but her son Issac is not. We did all we could during the pregnancy with anti-viral drugs and instructed the mother not to breastfeed after birth.”
Issac, just under the age of two, ran to Catherine for a brief hello before bouncing around the front porch and my camera. “Issac’s father left Catherine after finding out she was pregnant. We have been helping in whatever way we can. Providing food. Providing medical care. It is a miracle he is negative,” Sister Freda continued slowly.
Catherine directed us to the far corner of her yard where two shallow mounds lifted the dark green lawn. She spoke in broken English and Swahili, and Sister Freda translated, “Her first husband and daughter are buried here. They died of HIV.”
We paused for a moment. “What do you do to comfort yourself, Catherine?” Tyler asked.
The same shy smile, but no answer.
“Come on. You can tell us,” Sister Freda encouraged.
“Sing,” Catherine whispered.
“Sing? Can you sing for us?” asked again Tyler.
And as soon as he completed the request, Catherine and the surrounding family neighbor children clapped and sang in unison about the love of God. Catherine embarrassingly laughed finishing the verse. Sister Freda hugged her.
“You’re very close to your patients.” Tyler stated later, his eyes watering after listening to the story of Catherine’s life.
“Yes. They are my children.”

I could write a book about Sister Freda, and in fact one has just recently been published. The lady works non-stop from dawn until dusk, caring for her patients and staff, overseeing the construction of nursing classrooms, organizing and treating community clinics, and guiding volunteers and guests around the hospital and Kitale. Everyday hovering around fourteen and fifteen hundred hours (2 and 3PM), the volunteers, guests and Sister Freda with her husband Richard, a retired Bishop, assemble for dinner at ground’s cottage and eat lunch together after sharing a prayer together. On our last day in Kitale with Sister Freda, she gave thanks to our visit and prayed for each one of us individually and together as a group.
Sister Freda is fond of saying, and said this while fastening a bead necklace around my neck made by a displaced Kenyan refugee as an opening gift, “A neighbor is not someone who just lives next door. Whether it is the Congo or Uganda or the United States, everyone is a neighbor and this is your second home. The doors are always open.” And they are.

Kenya (Kitale) – Polythene

“You must be strong,” Pasteur John encouraged me. With his nice dress shoes, he casually treaded sewage soaked mud from a topped-off set of latrines past an adjoining shamba (vegetable garden). The fecal mix caked to my hiking boots like wet clay. I dragged my feet on the dry earth, but a sliver of plastic wrapping had wedged itself between my right boot’s indents, carrying with it a thick mass of sludge. I sighed and followed the only suit in the village Kipsongo to a woman washing rotted tomatoes and potatoes in a metal bowl of intense brown water.
“See here. This is from town. They went to town to collect this from garbages,” Pasteur John explained picking up a perished head of cabbage from an assortment of low-grade produce. The holy momma continued with her task uninterrupted by our presence. “They use as a food. They wash with this dirty water. But because of poverty, there is no other way to get food.” He held up a tomato and with gentle pressure flattened it. “You use this as a food to kill hungry for a day.”
Kipsongo is a small slum of roughly 300 families not far from Kitale, but hidden from the roads by a wall of flowered trees and shrubs. During the early 1960s, members of the Picot tribe pillaged the Trukana people forcing their relocation. Forty years later, tribal segregation has kept these people from creating income, and the same government land policy that affected the Sabot and the resulting SLDF has isolated these people into a compact area of polythene huts—plastic wrappings over a wooden dome frame.
“Come, let’s move on.” With a brisk stride Pasteur John weaved his way between corridors of tarnished plastic and few mud-brick homes. “See the girls sleeping—no job. Hungry,” he elaborated like a real-estate agent showing off the corners of a mansion. One girl flapped her arm in the air shooing us off.
Born in 1967 Kipsongo, Pasteur John, through the Christian church and the goodwill of westerners, has brought meager portions of food, housing, education and money to the community, but many in that same community accuse him of abusing his position for self-gratification. This is a common criticism shared by all those providing good to a community, even by those of a similar mission.
“Okay, you can see this house,” he pointed to a polythene hut standing beside the narrow curtained entrance. “The owner has died and he is sleeping inside. You canna go inside.”
“Inside?”
Pasteur John was already halfway through the tight arch signaling for me to follow. I squatted down and waddled up a slick slope leading to the entrance. My right foot gave way and I fell to my knee. I quickly picked myself up and crawled inside.
The translucent plastic coverings lit the space with a deep orange hue. A myriad of shirts and trousers hung from a curved branch-frame wallpapering the enclosure like a closet wardrobe gallery. At the hut’s center, resting over rain soaked cardboard tile, a red and green-checkered wool blanket and a pair of chigger gnawed feet exposed from underneath the cover.
Pasteur John bent over the opposite end and unfurled the blanket’s end. I sidestepped to my left.
The man’s right fingers pressed ever so softly to his forehead as if in despaired thought. A fly scurried across his sunken cheek and into the hollow of his shriveled and bluing left eye before dropping through the stubble of his graying beard and parted frown. Through his frozen expression and empty stare, I could feel his sorrow and pain. He was like a statue chiseled from marble into a symbol of Kipsongo.
“We have been giving him a treatment, but now he’s lost his life. He’s dead. Do you see this house? His polythene house?” Gaps in the plastic allow for rain to drip through and soak the floor. “This is hard for me as a Pasteur here.”
I better get used to this, I thought.
Pasteur John continued, “Now I have to look for money for a coffin, and for a cemetery.”
I zoned out of what he was saying and interrupted, “Can we say a prayer for him?”
“A prayer?” He seemed surprised. “Yeah, but I can say it Swahili.”
The man’s son joined us following Pasteur John’s plea. The twenty-something year-old sat across from his father, his eyes wide and tearing. He wiped the dry and bloody mucous from his nose with the palm of his hand and spoke helplessly with his arms, barely forming words.
“He says he has no money to bury his father. He has beaten his knees because he has lost his father. So he needs only help.”
The man’s son turned to his father then to the Pasteur and then to me. I’ve never seen anyone’s eyes so wide and vulnerable.
Pasteur John stood. “Okay. Let’s go.”

I dreamt of our visit to Kipsongo that night, but through a skewed reality. I imagined what Havasuapi Falls must have looked following this summer’s scenery altering floods. Instead of the clear blue-green water, mud now spilled over Havasu Falls into a chocolate river also rich in sewage. At the waterfall’s base, the same polythene huts and Trukana people of Kipsongo.
An old woman plainly washed her clothes in the torrent stream, while soiled children picnicked at its shore, tinged avocado creaming their fingers. The sky began to rain and I ducked for cover under a polythene hut, slipping again on the same slick slope. Rainwater poured through seems in the plastic and pooled at my boots; the hut’s owner resting as he did when I saw him that day. I hugged my knees and leaned against the thin wood frame. Several other children and adults sat as I did, or slept cuddled beside the old man*. We waited for the storm to end.

*The week before our visit to Kipsongo, we were told, a mother had passed away in her plastic tent and left there for five days. Her children slept beside their mother until the necessary funds were gathered for a proper burial.