Sunday, October 23, 2011

ROTW (5,6,7...now I'm almost caught up): Blendin' stuff

  • The Eskimos have 400 words for snow.
  • According to Jonathan Safran Foer in Everything is Illuminated, the Jews have 400 words for schmuck. (My Yiddish-expletive-fluent grandma could attest to this better than I, but I think it's close to the truth.)
  • According to me, hot days have 4 words for heaven:  smoothie, crush, milkshake, and icy blended beverage.
Today was hot. Really hot. ... So ... Guess what I did??????


ROTW (5):  When you buy a large PAPAYA (and when do you not? I picked up the smallest pawpaw I could find in the market today, and it was - as my friend puts it - the size of a small child)

Ingredients
1 cp chopped papaya, juice of 1 lime, 1/4 cp mint leaves, 1 tsp grated ginger (or ginger crystals), 1/2 cup milk, honey to taste

Instructions
Blend the stuff. Garnish with mint leaves. Eat!

ROTW (6):  When the AVOCADO is so soft it might melt in your hand, and you feel like drinking a meal (but it's still too early for beer)

Ingredients
1/4 large avocado, 1 small banana (equals 1/2 regular banana), splash of water, honey to taste

Instructions
Blend. Eat!

ROTW (7):  Whenever - seriously, WHENEVER - you have PASSIONFRUIT on hand (sadly I polished off my last one this morning, but this would have made trip to heaven #3 of the day)

Ingredients
2-3 small bananas (peeled, cut, and frozen if you thought this far ahead), guts of 2 passionfruits, 1 cp plain yogurt

Instructions
Blend. Eat!

Now I know that some of these might sound weird, but don't be a schmuck - putz, schmendrik, or schmo - and knock it before you try it. Just blend and eat, then tell me how it was.
And by "it", of course, I mean your trip to heaven.

Saturday, October 15, 2011

Why Kampala is crazy (1): Islam and boxing

I think I owe you some stories about Kampala, and why it is one cRaZy city.

I want to tell you a story about boxing, boxing and Islam, and boxing and Uganda.

Boxing and Islam have an interesting (if not entirely consistent) connection. - Remember Cassius Clay, the most famous of all boxers, who converted to Islam and became Muhammed Ali? - Did you know that Mike Tyson, famous or infamous boxer that he was, also converted to Islam? - Now I have met a pair of twins in Kampala, Hassan and Hussein Khalil, who both are devout Muslims and former boxing champions. They tell me that boxing is considered the ultimate sport in Islam. It requires strength, but also strategy. You need to have speed, but also stamina. As a sport for individuals, it tests personal fortitude and self-sufficiency. Discipline. Timing. Dedication. Both physically and mentally, boxing is - to be brief - JUST PLAIN HARD.

I was curious about the history of boxing and Islam, so I did a quick Google search. I was surprised to find a web-world of questions about whether boxing is even allowed in Islam. Allowed? Really? Again to my surprise, many Muslim scholars are of the opinion that competitive boxing is not compatible with Islam:
According to a juristic rule in Islam stating “Taking a lawful act as profession is permissible, save what’s made exceptional by a clear proof”, sport is basically permissible in Islam, if not obligatory. The Prophet, peace and blessings be upon him, urged his followers to practice some sort of sport and exercise that help keep the body fit, as long as that it doesn’t entail harm. 

As for boxing, it is permissible if it’s taken as a mere hobby to train oneself on how to practice this sport, without taking a human being as a target (i.e., one should direct the fists to a punch bag and not to a person). But, one should not think of adopting it as profession. This is not permissible, due to the great harm and untold risk it involves, especially to the body and life of the victim. Islam never allows inflicting harm on any person; Muslim or non-Muslim. This is based on the juristic rule: “There should be neither harm nor reciprocating injury”. 

Besides, boxing entails directing blows to the head and face. This is forbidden in Islam, according to the Hadith of the Prophet, peace and blessings be upon him: “If anyone of you fights (or, in another version, beats) a person, he should not hit him in the face." (Agreed upon by Al-Bukhari and Muslim) 

Looking at the evidence against boxing, it is not hard to realise that boxing must be considered haraam(forbidden) or undesirable to the point of being haraam (Makruh al-Tahrim). The object of boxing is knocking an opponent unconscious by physically hitting him with excessive force about the head, the intent is physical damage to your opponent. At the end of all fights that I have seen, the face is left severely damaged and scarred, we know from ahadith that the Prophet (Allah bless him and give him peace) forbade hitting the face

Narrated Abu Huraira: The Prophet said, "If somebody fights (or beats somebody) then he should avoid the face." [Sahih al-Bukhari Vol III Hadith 734.

and also 

Narrated Salim: Ibn 'Umar said, "The Prophet forbade beating (animals) on the face." [Sahih al-Bukhari Vol VII Hadith 449

[...] When the damage to a person is so severe such as brain damage or worse, fatal, then this has to be considered haraam, for there is no reason to suffer such injuries. Our bodies and lives are anamanah (trust) from Allah ta'ala given to us for safe keeping, they do not belong to us to do as we choose, so we have no right to participate in a sport or any other activity that violates the amanah and whose objective is intense physical damage. 

It is sad to see such people as Muhammad Ali, who once "floated like a butterfly and stung like a bee" now a shadow of his former self (although still has a remarkable dignity about him), Muhammad Ali once one of the finest examples of masculinity coupled with charisma, physical beauty and elegance, an object of pride for the entire Muslim Ummah, now an object of pity and a distant memory of bygone glory. Ironic isn't it considering the current downtrodden predicament of our Ummah? Should a man have to be reduced to this through his own doing? 

[...] Any parent whose child takes an interest in boxing should bear in mind the severe dangers and consider answering for their decision on the Day of Judgement, since our children are also an amanah from Allah ta'ala. The physical training and discipline offered by boxing is excellent and children should be encouraged into physical exercise. Rather than encourage them to do boxing, parents should encourage children to learn semi-contact Karate or Kung-Fu, since the object of semi-contact is not physical damage but to score points by minimum contact, anyone one using excessive force is penalised. Semi-contact Kung-Fu and Karate also teach vital self-defence techniques that are needed in an increasingly violent society and parents should instill discipline and good adab (manners) in their children not to show off the skills they may have learned.  

This seeming disconnect, between embraced boxing among Muslims in Kampala and forbidden boxing in various Islamic online communities, is explained by the next subject:  boxing and Uganda. The love of boxing in this country is so strong, it seems to overwhelms any religious controversy about boxing in Islam. Four of Uganda's 6 Olympic medals have been in boxing. This country has also won boxing medals in international competitions like the Commonwealth Games and the World Championships. Children train at boxing gyms around the city. Boxing is even revered as a peace-making sport, because it channels fighting energy from the streets into organized, supervised activities of self discipline. The Eye (local coupon book/city guide/magazine) writes, "[Boxing is] the perfect outlet for that favourite sporting tale:  rising up from rough surroundings with nothing but yourself and perhaps a little support, putting in your work and making something of yourself".

Now for one final surprise:  I have gotten swept up in the Kampala boxing craze. No joke. I bought my own wrapping, and am semi-serious when I say I hope to spar one day! My trainers are Hassan and Hussein, former champions I told you about; the place is East Coast Gym, a very modest but renowned boxing establishment attached to a mosque on Naguru Hill.


Up the hill, past the gospel church, behind the mosque, say hi to the kids, mind that you don't step on a goat
East Coast Gym! (outside...
...and in)
Between prayer calls, the brothers are dedicated coaches. They take us on grueling hill runs, count out jumping exercises and calisthetics until our muscles go numb, and withstand practice blow after practice blow, with pads on their hands, in the newly-roped boxing ring.

Hassan, ready for the punch
Helping us to get the wrapping right - must cover knuckles several times, and make sure to support the wrist
If it's not already obvious from the photos, East Coast Gym is not a boutique Mzungu attraction. This is a hard-core training center.

On any given day at East Coast, I may find myself jumping and punching next to the likes of:  runner-up at last year's heavyweight World Championship (and Olympic hopeful); a member of Uganda's 8-person national team; neighborhood heroes and role models; the one and only female boxer in Kampala; and a blind boxer who bravely returned to the sport after losing his sight in 1995. It is a total trip - and honor - and fright - to be in the ring with these guys and gal. The 5,000 Ugx (less than 2 USD) that I pay for each session helps to maintain the gym, buy equipment, and support competitions for these local boxers.

Just an example of the kind of musculature you can witness at East Coast Gym
My fellow Fogarty in Kampala, Devan, hits hard and runs even harder
POW! BAM! POWPOW! BAM! POWPOWPOW! BAMMM! - it's a busy place


Finally, I should mention that this is the best and toughest workout I have ever experienced. So much adrenaline and exhilaration cannot be found anywhere else - except perhaps on the end of a bungee cord, which I'm just not willing to try.

I know that Uganda supports my new love. In view of the fact that I'm a long way from hitting anyone in the face - and even farther from being able to pack a punch that inflicts any kind of harm - I hope that Islamic scholars, my own religious leaders, and other pacifists everywhere in the world can accept my new love, too.

BAM!




Discontent in Uganda, Uganda in the news

Read this. Real stories about Rolex, political unrest, commodity prices, and stark have/have-not contrast that will probably sound familiar to you by now...

Wednesday, October 12, 2011

Follow-up on follow-up

Photos from Kiboga today:

STRUGGLE

Patients waiting to fill prescriptions at the pharmacy. The wait is usually several hours long, and sometimes can stretch over days. When I told our research assistant that I wanted to show how many people wait for so long, he protested, "But, they are not many today!" Well...you get the idea.

&

SUCCESS

Despite the inconveniences of long travel distances and endless waiting times, most of our patients act with grace and graciousness. We like to think that it's not just because they have great manners, but also because they are happy with the care they receive. Here are the contents of one particularly lovely "bag of thanks" brought in by a patient today.

Saturday, October 8, 2011

Follow-up: challenge and opportunity in HIV testing and treatment

Here's a nice, short article from the New York Times this week, which brings up an important point about HIV diagnosis and care:

Follow-up is key.
And, oh, so tricky.
...

Our study team works very hard to maintain close follow-up with our patients. We see a rural population, so the average patient travels a long distance - sometimes a whole day - just to keep an appointment. Also, since our study population is extremely poor, the price of travel is a considerable barrier. The trip to the hospital can cost over 20,000 Ugx (7 USD) in each direction. That is more than 10x the average daily income, dispensed twice per visit - not to mention the opportunity cost of missing a day in the fields, at work, or at home with the family. We reimburse up to a fraction of this expense, but the money we give cannot replace all the money spent (nor should it, ethically - else we border on coercion). The only additional help we offer is a hospital bed where a patient may spend the night, for free, before traveling back home all day the next day.

Mothers and babies leaving the hospital - how many miles to go?
Considering so many obstacles to care, every visit feels like a minor miracle. So you can see why this (recent data from our interim analysis) feels like a MAJOR miracle:  99% of our patients complete all, or almost all, of their 7 monthly visits. Amazing! They come to get prescriptions refilled, to have a trained ear listen to their heart and lungs. But more than that, I think they come to have a caring hand placed on their shoulder, that hand belonging to someone who knows them well and cares for them, who wants to hear about their pains, their nightmares, their dreams, their families, their hopes for the future. I credit our clinical staff and community health worker for the VERY strong relationships that they create with our patients. This personal brand of medicine brings the doctors and patients closer, and gives the patients a reason to keep coming back.
...

Now, of course, things could be better. We do not have point-of-care testing in Kiboga, as was shown to be so helpful for that clinic in Mozambique, so there is an inherent delay between (a) testing the blood for HIV and CD4 counts, and (b) starting the patient on appropriate ARVs.

In the general ART clinic, the median delay to treatment is just under 3 months. That statistic is obtained by looking at all patients who actually started ART, i.e. those who reached point (b). Meanwhile, a quick glance into the clinic records room would reveal to you a collection of patient files that gather dust in a "pre-ART" section, i.e. the patients who passed point (a) but then got lost. Did they move, transfer, forget, decline, or die before starting HIV meds? We don't know. In truth, many probably died, but these are the hardest patients to find, and their deaths can be very hard to confirm. With such losses occurring but not reflected in the "median 3 month delay", you can see why it is critical to shorten and track patients through the (a) to (b) time.

Row 1, transferred out; Row 2, lost on ART; Rows 3-4, lost pre-ART
In our study, by scheduling the initial 2 visits close together, we have reduced the delay to ART to 1-2 months. Perhaps more important, we keep track of every patient recruited for the study - phone calls when they have a mobile, and "neighbor watch" or home visits if needed - so we lose almost no one between testing and treatment. In the coming weeks I will be returning to the general ART clinic records room to sift through the "pre-ART" files, and try to track those patients to find out what happened to them. Then, with the past outcomes counted, we will be able to estimate how many deaths have been averted with closer follow-up. Looking at those dusty folders, filling 2 whole rows...I think it will be many. I will let you know what I find out!

Filing folders for patients in our study
...

To bring it back to the article:  the shorter the delay between HIV testing and treatment, the greater the number of patients who will actually get the care they need. Innovations like rapid CD4 counts allow for fewer visits, especially in the treatment initiation stage when patients are sickest and most vulnerable. This could save many, many lives.

Still, in the absence of such new tests, our study is proof that the provision of quality medical care - with individualized patient visits and continuity with providers - can be enough to motivate patients to seek care in the most adverse of circumstances.

Combine the strengths of thoughtful, new technologies and focused, age-old patient care, and we may finally see how much better things can get.

Wednesday, October 5, 2011

How is Uganda is funtastic...let me count the ways

I haven't been to much of Uganda outside of work in Kampala and Kiboga, but the little that I've seen has been AMAZING.

Which brings me to my second topic, how Uganda is fantastic. Uganda bulungi nnyo nnyo.

#1. It contains the source of the Nile.

View from Kayak the Nile / Nile River Explorers, near Bujagali Falls
I have been making my pilgrimage to the source of the Nile in Jinja, a peaceful and slighty-sleepy town (from a different perspective, the 2nd largest metropolis in the country) only 2 hours away from Kampala, just about every other weekend. I go there to kayak mild rapids, work on my self-rescue roll so that I can soon kayak harsher rapids, and lounge about by the side of a beautiful water. Jinja also has a few coffeeshops with the best coffee I've tasted in Uganda - and nice warm (real chocolate, not just "chocolately taste!") brownies to go with. Even when it rains all day, kayaking here is the most funtastic way to pass the weekend.

KTN / NRE campsite
Porch (HAMMOCK!!!) at friends' amazing house
#2. It invented the rolex.

Love...rolex...fresh tomatoes and egg with ??? ...is all you need
Ugandan Rolex does not tell the time, will not last long, and is not made of gold - but still, I'd choose it over a fancy watch any day. The rolex is this country's most celebrated street food. I love it because it's warm, satisfying, and 100% vegetarian. Not so many meat-loving countries put a veggie street food first, so you know it must be good. I'll post the (long-overdue) ROTW for rolex soon, but here's the gist of it:  make omelet, place on chapati, and roll it up.

It's good to be a rolex man
Rare view of a rolex mid-meal, LakeVictoria in background

#3. It builds teamwork and fuel-efficient transport through shared commuter taxis (matutus).

Read my ode below.

#4. Uganda Cranes are just coming into their age.

(Uh huh, like the Pittsburgh Pirates.) On Saturday the Uganda Cranes will be up against Kenya's national soccer team in the qualifying match for the Africa Nations Cup. Uganda is favored to win. Uganda just needs to tie to advance. The last time they were in the Africa Nations Cup was in 1978 - loooong time ago - so it's time. Tune in to see history unfold, or read next week for my report on the match. GO CRANES! HELLO CHAOS!

#5. Passionfruit.

I'm so passionate about this food. Passionfruit is great in a fruit salad, a banana and yogurt smoothie, or as a juice on its own, but I can't help just eating them straight out the shell. Sometimes I slice a banana into the half-shell and mix it up...I call it nature's fruit cup. (Let me know if you think this has a market, and I'll trademark the name and start selling them to Whole Foods...) Here are snapshots from an afternoon on the porch in Kiboga:

Passionfruit, cocoa brownie, good book, and tea - heaven!
Skeletons and guts - I am truly a menace to the fruit kingdom
This passionfruit affair is great now, but I know it's going to be terrible when I try to feed my addiction in the States at $5 a pop. My only hope is to get sick of them before June 2012... Wish me luck.