Kasensero

Last Thursday through Sunday I traveled to a small fishing village on Lake Victoria called Kasensero. It’s taken me a while to finish writing this blog post, maybe because I’m still mentally and emotionally processing. This is by no means a complete account, but I’ll try to share some of my thoughts and observations.

Kasensero is a rural village whose local economy depends upon commercial fishing in Lake Victoria. However, the boats used are small and hand woven nets are utilized to bring in the catch, probably much like what you can read about in the Bible. The waters have been over-fished, so it is increasingly harder for fishermen to make a living. To get to Kansensero from Kampala it is a 3-4 hour trip on paved roads, then another two hours on a dirt road with ruts that can be up to 4 feet deep and literally the size of a pickup truck. When it rains the road is almost impassable. Naked telephone poles line the road all the way through town, but without electrical wires. There is almost no electricity and no running water in the town. When you arrive in Kansensero it literally feels like you’ve reached the end of the world with the lake on one side and the road on the other, and little more than swampy marshland on either side.

Kasensero’s unfortunate notoriety comes from the fact that the first case of AIDS in Uganda was documented there. This is a village that has been devastated by the disease. It would not be far-fetched to say that every single household has lost someone because of it. There is one small clinic on the outskirts of town, but only three nurses work there. There are no permanently employed doctors. Every two weeks someone comes from the district health center to deliver antiretroviral drugs for adults and children, and to do HIV testing.

One of the many terrible consequences of this epidemic is the number of children who have been orphaned because one or both of their parents died from AIDS. The word ‘orphan’ in Uganda is also used to describe a child who has lost their father. Typically, in most places in Africa, when a child is orphaned she or he is absorbed into the larger extended family and cared for by an aunt, uncle, cousin or grandparent. However, when those extended family members are also dying from AIDS the social support network begins to collapse, overwhelming the family members who do remain and often leaving orphaned children as heads of households. I met one resilient grandmother who was single-handedly taking care of 24 grandchildren because all her sons and daughters had died. The level of destitution seems magnified in rural areas where there are few opportunities for economic advancement and markedly less formal social service systems.

In response to this crisis, several years ago an orphanage was built in Kasensero. Currently, about 40-50 children reside there, though not all of them have lost both parents. Then 70-100 more attend school there during the day. Their ages range from 3 – 14 years old. When we arrived, all of the children rushed up to greet us, each one wanting to ask how we are and to hold our hands, eager for attention. Two small girls named Lita and Florence latched on to me and would not let go for hours. We sat in a classroom where we were formally greeted by everyone and filled in by the headmistress and other teachers about the state of the orphanage. We learned that the finances of the orphange are in dire straits, exemplified by the fact that the children only receive one meal a day (usually a corn meal porridge) and other basic necessities. Last year three of the teachers left because they were not being paid. One of these teachers with whom I spoke (she was visiting in town, though she had left) told me she had worked there for three years without pay!

I had come to the orphange because the doctor with whom I traveled – Dr. Charles Holt (from Iowa) – wanted me to help him conduct physical exams for all the children residing at the orphange and make up a medical chart so they would have a bit more continuity of care in the future and any very serious medical issues could be addressed. For two solid days I examined every inch of their little bodies, carefully recording any abnormalities, noting signs of malnourishment like protuberant bellies and fine, lightened hair. My parents had graciously given money for me to buy toothbrushes and toothpaste for all the children, so I gave one to each of them and taught them how to brush their teeth. That many of them had never brushed their teeth before was quite evident when I looked into their mouths – almost all of them had widespread dental caries and about half of them had teeth that would need to be extracted. I hope perhaps from now on their teeth will be in better shape. About 20% of the kids had symptoms serious enough that I felt needed to be treated, so on the last day (under Dr. Holt’s approval) I went to a local pharmacy and bought medications for them, writing out instructions for administration in their new medical charts. In addition, there were a handful of adolescent girls who had begun menstruating, but many of them did not have underwear, much less pads (they often use old rags instead). So I bought them all underwear and a large box of pads. It broke my heart when I gave one girl a pair of underwear, a package of pads and a small bar of soap. Her face broke into the biggest smile I have ever seen, she knelt in the traditional way at my feet to say thank you, then impulsively gave me an enormous hug, smiling all the time. It is hard enough to be 13 year old girl going through adolescence, much less to go through it without a mother and without underwear while you are menstruating. This same girl took me through the village to show me her house, left by her parents who had died. It was a small shack, made of pieces of driftwood with a rusty corrugated iron roof. She was the head of the household, in charge of her younger siblings. It made me wish I could stay longer, to talk with these girls more, encourage them to study hard and keep going. Another 13 year old boy, Fred, interpreted for me while I was examining the rest of the children. His English was nearly impeccable and he was very quick at understanding exactly what I needed asked – I almost never had to repeat myself. He introduced me to his mother, who is very sick with AIDS, and shared that he wanted to continue onto secondary school but did not have school fees. It is hard to see such bright children like Fred limited by socioeconomic circumstances and choices they did not make. Dr. Holt is doing what he can, sponsoring the school fees of the older kids to continue on to a boarding school in another town – there is no secondary school in Kasensero. He says it is an investment in the future of Uganda.

I wanted to paint a stark picture with the above description because it is just that. Kasensero is a terribly impoverished villaged that has been ravished by HIV/AIDS. But that said, I’d like to end on a positive note. I traveled to Kasensero with a group of Ugandan evangelical Christians who went in order to carry out a 3-day revival with a local church. They were a lively bunch, singing hymns on the way and shouting, “Hallelujah, Amen!” every time we would manage to get through a massive pothole without getting stuck. Kind and generous, they called me ‘sister’ and brought lunch to me at the orphanage when I didn’t have a break until 5pm. The church members and pastor of the church in Kasensero took care of us like we were family, feeding us delicious, fresh fried tilapia every day and walking us home to the guest house each night (the village is pitch black after dark, but the stars are incredible). They thanked us profusely for coming to help ‘their’ children. The local pastor worked tirelessly while we were there to arrange for a volunteer board of community members to be established to oversee the orphanage and school in order to provide more accountability and transparency. In some ways the church there reminds me of the early church as described in the book of Acts in the Bible: meager resources are pooled together to support those in need, particularly widows and orphans.

I’d like to believe that there is hope for Kasensero.