If you’ve never experienced an asthma attack, it feels sort of like the aftermath of a really vigorous run. The type of an exhaustion a first time marathoner experiences, or the first time you ever ran more than a mile. Now imagine if you aren’t running any more, you’re resting, you’re pacing, you’re breathing deeply, you gasp… But nothing works. No matter what you do, you can’t catch your breath.
An asthma attack is like going immediately to that stage of breathlessness, often while doing nothing at all.
About a month or two ago, I had what was the scariest moment of my life. Sarah and I had gone out with some friends and a few couchsurfers and had wonderful evening. It started around 2pm at a coffee shop and conversation over cookies, coffee and the roaring laughter of fifteen or odd people who had just met and instantly bonded. Then someone suggested we go to a concert featuring a number of touring francophone bands and musicians. By now it was well into the evening and we headed to a local Korean restaurant for a hearty meal.
I remember having a mild attack during the course of this. I measure the severity of my asthma attacks like so: light (eventually goes away, without medication), mild (goes away with the help of medication), heavy (medication followed by rest and a lot of deep breaths) and critical. Until, this night, a ‘critical asthma attack’ was unknown territory for me. After all, although I was born asthmatic it didn’t really manifest until I was around four or five. And by high school it was completely gone. Whatever allergen or cause (the doctors told me dust and pollen were to blame) triggered the attacks, I guess my body built up an immunity to them. Growing up among the lush florals of a south Georgia farm and the thick hazy smog of Atlanta, I suppose those extreme conditions forced me to.
I haven’t considered myself an asthmatic since I was maybe 16, that’s the last time I can remember having an attack. Although much like alcoholics, asthmatics are never cured, we’re just in lifelong recovery. Apparently over a decade later I would relapse.
The relapse happened the day I set foot in Uganda. Maybe not THE day but for someone who assumed that the days of sitting out P.E. and consulting a doctor before exercise were behind him, it was pretty clear right away that something wast right. Whether it was the dust in the air (a thin coat of red dust covers almost everything in Africa), the dense pollution, or the particles in the air here previously alien to my body, I was not prepared for the air here. If not the first day, it was only a matter of days before I needed to purchase an inhaler. The first that I’d bought in ten years. That last inhaler I bought, followed me around for six years (just in case) before I eventually threw it away in a move.
Going back to that night, although I drank a lot and had a splitting headache, there was nothing particularly wrong with me by the time Sarah and I made it home for bed. I was tired from the long day, and the two of us sank into the fake IKEA bed like we do every night.
Just past midnight I woke up with a start. My body was not in the best shape. I assumed it was the rumblings of too much Ugandan beer, which has this substance in it called sorghum, but a few trips to the bathroom didn’t help. My chest felt tight, I keep an inhaler by the bed for mild attacks during the night. I took a puff and went back to sleep. At this stage the attack was light,
Again, I woke up. My chest was tighter. I’d moved to mild. When you’re in bed and you feel like this, you start to toss and turn. You can’t breathe ob your back, side, stomach, sitting-up…but you still feel like you need to do something. Your body wants you to find a comfortable position so you can breathe. I took more puffs from the inhaler and drifted off back to sleep.
Around 4am I felt awful. This wasn’t a hangover, my stomach was convulsing and my head was swimming. This also didn’t feel like asthma but I could breathe. I made a number of trips to the bathroom and rushed over to find an inhaler (we keep several around the house in case we can’t find one when I need it). I took a puff of the inhaler. Nothing. I took another puff. Nothing. Odd. Usually two puffs from the inhaler and I’m immediately feeling better. Something was wrong.
I stumbled back to the bed, still feeling bad. At this point Sarah had woken up from all the commotion. I didn’t want to unnecessarily alarm her, so I told her I was fine and sat on the edge of the bed trying to will the attack away. There are some things that you instinctively know about a situation. I have an asthma attack, I reach for an inhaler. Even after such a long absence from my life, this is the reaction because this is what works. The inhaler was my survival so this was like drowning at sea, and reaching for a rope that’s not attached to anything. So, when I sat on the edge of our bed and tried three separate inhalers, only to have none of them do what they had always done. I was lost.
The inhalers stop the asthma.
The inhalers stop the asthma.
That’s what they do. They stop the asthma.
The asthma isn’t stopping.
That thought ran through my mind, maybe a hundred times in only a few seconds. I was panicking which is the thing all doctors try to get asthma patients NOT to do, because it only makes everything worse. But what does a doctor do when a treatment, the only thing way they know and have studied, doesn’t work? I can only assume they panic a bit too. By now I had broken into a cold sweat. The attack was getting worse and the inhalers weren’t working. The only solution I knew of in the world for a heavy attack was useless….this meant I was critical. This meant it could be fatal.
Well that realization is not one you want to come to when your objective is NOT to panic. Not at all.
Sarah rushed to my side, still awake and sensing trouble. It was time to put my pride aside, I couldn’t breath. I needed to breath.
I could barely speak but I managed to gasp, “They aren’t working.” I think she realized what this meant more immediately than I did.
I stumbled out onto our porch that over looks, Kampala. This time of morning everything was quiet. All I could hear was my own wheezing and the faint sounds of human traffic miles away. The sun was barely over the horizon. I’d gone out there because I thought fresh air would help. But that didn’t work either. I was confused and at this point I was breathing so little oxygen that I could feel myself threatening to blackout. My heart was pounding. My head was pounding. I was fully drenched in sweat. I’m convinced that, in a time before modern medical invention (long before most of us were born) this was how people died from asthma. Not wanting anything more than one final full, glorious breath of crisp air. I was petrified.
By now Sarah had rushed out of bed into some clothes…or maybe pajamas (I don’t remember)….and had called a taxi. The taxi driver usually stages at the bottom of the hill but it was barely 5 a.m. Where would he be? What would he be doing? Would it be a long wait? Were there ambulances in Kampala? Those thoughts raced through both of our minds as we waited.
Needless to say, the taxi driver arrived swifter than we imagined he would at that hour. He could tell by looking at me that there was no time for the normal pleasantries. “The surgery!” Sarah urged him. We went racing off towards the only 24 medical facility in Kampala that I know of. The rest is a blur, I know Sarah was urging me to relax, trying to soothe my breathing while the driver navigated early morning traffic. When we arrived at the Surgery I was rushed in and after explaining that it was severe asthma attack, I was put on some type of oxygen tank. I don’t know the name of the medicine (Beclomatsone?) but Sarah later told me it was a steroid but I was told to breath from it for several minutes. Eventually, I could feel the color coming back to my face, and with it an easing of my lungs. The treatment was working, I could breathe.
There are people in the world with worse asthma that I have. There are people here in Uganda with asthma and NO inhaler…their families can’t afford them. I don’t know the numbers, or have the research to back it up. But one day, provided I’m able to acquire the resources and the contacts, I will work on improving the air in Africa. Whether it’s natural triggers like dust and pollen, or artificial one’s like pollution, I assume that there’s little focus on such a big problem. I doubt the any of cars here would pass the same emissions tests that we have in the U.S. As annoying as it is, those tests were started for a reason.
Never in my life have I had an attack like that and I haven’t had one since. However, it was enough of a shock to me that I realize as long as I’m here I face quite a bit of risk. It’s not my motivation to leave, it’s even more motivation to improve conditions here for others.
Written by Jon in Life ~
May 21, 2009
It’s hard to believe that it’s been exactly a year since I had my first day in the Water For People office in Denver. It’s been a great year. The first two months were spent getting to know my Denver colleagues and learning about Water For People’s current Africa program, then in July, Jon and I made “the big leap” and moved to Uganda. Neither us had ever been here, though I’d spent a lot of time in Western Kenya, which has some similarities, so it was a big leap indeed. At least here, English is one of the official languages, and so most people speak at least a little.
Once we got here, we had the great fun of finding a house to live in and establishing it from scratch. One of the differences we found was that most of the houses and apartments for rent don’t even have appliances when you move in, and so we not only had to figure out how to bargain for couches, dining furniture, and our bed, but also how to assess and bargain for a used fridge and stove. We learned later that we probably paid too much for appliances that don’t really work (and have since had to replace our fridge, which we bought new the second time around), but we laugh about it and chalk it up to being a part of the great learning curve.
During that time, I was also beginning to establish the Water For People’s program in Uganda. That process started in Denver, where I began the process of registering our office in Uganda. Water For People operates as a local NGO in the countries where we work, and so it’s important for us to be recognized by those local governments. Registration establishes us in a country and sets us up to be able to hire staff, make purchases and sign a lease for an office, and more importantly begin to program in the country. I say that I began the process of registration in Denver because the process itself had several steps that couldn’t be completed until after arrival, and even then the process took several months to finally be completed. That said, we were finally successful at registration in September—a huge accomplishment.
While our registration was working its way though the system, I spent several months learning about the water and sanitation sector in Uganda. In so doing, I talked with lots of local NGOs and visited their work. During our visits, I learned about their individual groups, but I also learned about the sector. One of the most interesting things to me about the water and sanitation sector in Uganda is that access to safe water is slowly increasing, but access to improved sanitation has flat-lined in many districts, and in several areas, access is actually decreasing. There seem to be many challenges, but two that stood out are (1) many NGOs focus on water, but sanitation is something of an afterthought, and (2) management of household sanitation seems to be difficult—when a family finally gets a latrine, they don’t maintain it very well and so it collapses or becomes unusable, or even if they do maintain it, once it is full, they don’t build another one. For these reason, Water For People—Uganda is going to start by looking creatively at sanitation management and maintenance and will work to build a strong sanitation program before looking at water. That’s by no means to say that access to safe water doesn’t need to be addressed. I just would like Water For People—Uganda to become set an example in prioritizing sanitation, and in the mean time give some good thought to really understanding what the challenges are in water and how Water For People can help to address them.
Water For People—Uganda has found two local NGOs with which to begin developing a sanitation program. These NGOs helped to determine which districts to begin work. They also helped to lead Water For People’s initial work in each district, which was to take GPS coordinate readings and to fill in a baseline questionnaire for each water point in the chosen areas. The water points and a sample of households’ latrines and hygiene behaviors will be given scores that are color-coded, those colors will be marked on the map where the water points where found. The maps created will be used by Water For People, our partners, and other actors in the districts, including local government and other local NGOs to strategize where to work to be most effective. We’re expecting the results within the next month, which will be a great way to start our work.
In addition to starting the Uganda program, as Regional Manager for Africa, I also work with our ongoing program in Malawi and our new program in Rwanda. It has been great fun getting to know those two programs, and I’m excited because we’re beginning to share program ideas between the three countries. Last week when I was in Malawi, for the first time we had staff from all three countries together, and it was really fun to hear and participate in conversations between the three countries. There are some differences, for sure, but there are also a good number of similarities between countries, and there are enough that I think we’re going to be able to share learning and adapt programs fairly readily.
Water For People—Rwanda is in a similar place to Water For People—Uganda. The Rwanda program was registered in April 2008 and since then has been doing similar needs assessments and programmatic prioritization. One of the exciting things about Rwanda is that the private sector seems to be very strong there. The Rwandan government has been promoting Public-Private Partnerships in the water sector for some time in Rwanda. Those systems show some strength, but still have some challenges, again, primarily in management. One of the things that Water For People—Rwanda is going to explore is what happens if we move from Public-Private systems where a private company builds the water system but then the government manages it, to more of a standard utility model where the same company that builds the system also manages it and users pay a user fee to the utility. The neat thing about a management system like that is that it ties the community and the utility together, which will hopefully mean that when the water system needs to be upgraded, either because it is worn out and needs to be replaced, or because the community grows, the utility will already have a relationship with the community and will be able to offer that service.
An easy way to think about this type of program is like a US cell phone plan. For example, when you sign up for service with AT&T, you sign a contract with AT&T saying that you will stay with AT&T for two years. During that time, your contract says that you will pay your cell phone bill, and in return, AT&T will keep your phone working. If you fail to pay your bill, AT&T will be able to cut off your service to encourage you to keep up your end of the deal, and if AT&T stops providing good service, you’ll hold them responsible by not paying for service you haven’t gotten. At the end of two years, you’ll have the option to upgrade your phone. That upgrade might be free if you get basically a new version of the same phone, or you might pay a little extra if you get a more advanced model or decide that you want more service.
The utility model works the same way. The community and the utility will have a contract stipulating what the utility owes the community and what the community owes the utility in return. It will also stipulate what the consequences are if either party fails to make good on its part of the contract. After the contract period, or as needed, the utility will be able to work with the community to upgrade service as needed or as wanted by the community. It puts the community in charge of making decisions about what kind of service they want—which is a very good thing.
This program is still being developed in Rwanda, but we’re excited to get it going and adapting it as needed to work in the specifically Rwanda context. We will likely look at this model in Uganda, too, when we begin to water programming.
Water For People—Malawi is also doing some really interesting things right now, and in fact, we’re modeling all of our sanitation programs in the region on the work that Water For People—Malawi is doing. Water For People—Malawi recently declared that it was no longer going to support subsidized sanitation. Instead, Water For People—Malawi is working helping to establish sanitation businesses. One model of sanitation businesses that the program is supporting uses the strength of the fertilizer market in Malawi. Malawi has a large agriculture sector, and that sector uses a lot of fertilizer, which is a valuable commodity. Water For People is working with entrepreneurs to start businesses that sell “humanure” which can be abundantly available if more households use composting latrines. The entrepreneur sells composting, or “EcoSan,” latrines to households. Household use the latrines, which creates compost, and then the entrepreneur buys the compost from the household and resells it to a fertilizer company.
Like the Rwanda water model, this model ties the household to a private-sector company who maintains the toilet. Because households receive payment for compost, they are encouraged to keep using their latrine as intended. In this way, household sanitation will be sustained for longer than it might be otherwise. It also encourages the sanitation market, meaning that households won’t have to rely on subsidies for sanitation, which also means that sanitation coverage can expand beyond Water For People’s direct support—a very powerful prospect. Water For People—Uganda is going to focus on trying out and adapting that model for sanitation, and Water For People—Rwanda will begin to try out this type of work as well.
All of that is to say that it’s been a great year. Water For People is doing some really exciting work in Africa. It’s great being in Kampala where I can get to visit the Rwanda and Malawi programs more frequently than if I were in Denver, and it’s been a blast establishing the Uganda program. I’m excited to begin hiring staff in the next few months and really beginning to see that program take off.
Written by Sarah in Africa, Life, NGO, Uganda, water for people, work ~
Uganda is an amazingly beautiful, awe inspiring place. It can make you want to laugh, cry, rejoice and scream all in the same moment. Sometimes I feel it’s aplace that the world has forgotten, because things here aren’t at all like I was told to expect. People here are friendly, eager to work and succeed, proud of their achievements (no matter how big or how meager) and very much attuned to what’s going around them. It’s far more ethnically diverse here than I thought it would be. I’ve been here less than a week and every day I’ve had some interaction with people from all over Africa, Australians, British, New Zealanders, Chinese, Japanese, Indians, Saudi Arbians and more. The number of young people from other countries oputside of Africa surprised me the most. Don’t get me wrong, ethnic and racial diversity is not the norm, but it’s far higher than I initially expected it to be.
Crime seems to be low and one the first full day we spent here Sarah and I walked through what is known as the ‘taxi park’, a place where we were later told to expect to be robbed. Of course we didn’t know this going in but the fact that we walked through from top to bottom without incident is a good thing.
On day three we found and rented a huge house in Kintintale that a former NGO worker used to live in. From the outside there is a huge gate that seperates it from the rest of the world and is has a UNICEF logo on it. We’re not sure of the full history but I imagine it will be an intriguing one when we learn the full backstory.We already know that our land lord started building in this area of Kampala in the early 70’s prior to being chased out of the country by members of Edi Amin’s administration. When he returned several years later he finished his property and began work on three more houses, one of which would eventually become ours.
The most exciting aspect of being here is knowing that when I throw a rock into the ‘waters’ here, the ripples will run far, wide and deep. It’s easy to get people’s attention here, they’re looking for something better and that something better is progress. I get the general feeling that everyone in the tech scene here has been waiting for something like Appfrica. I’ve been invited to host several workshops at Makerere University. Most people from the tech community ignore the developing world so I have the opportunity to offer something Kampala is starving for. There’s unlimited potential here and it’s up to me to make my own destiny, in the same way that Ugandans embrace their roles here, I will to.
Here’s to our new lives without borders!
Written by Jon in Africa, Life ~
