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Technical Foul - Part 2

4/27/2018

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My relaxed breakfast finished, I look out at the fields below me, field workers’ spades working the earth, dull machetes hacking banana fronds, hoes scrape, scrape, scraping during this spring planting season.  They hope for the gentle rains, not heavy ones, that will produce the harvests in a few months.  (I’ve been told the hospitals are much emptier during the planting time, potential patients trying to stay home so their families can complete the important tasks at hand.)
I think back to yesterday.  We had left Naggalama at 6 am to make sure we reached Nakaseke in time for our meeting with the staff at 9:30 am.   Having sought out the opinions of some of the staff at Naggalama the day before as to how how much time we needed to reach Nakaseke, I got vague and variable estimates, so I turned to the trusted map app on my phone to plot the route.  And being the savvy traveler that I prided myself in being, I added 50% to the time estimate, doubting that a software coder in Silicon Valley had ever considered the Ugandan deep rutted mud roads in their algorithms. 
When we got in the pickup truck that cool dawn morning in Naggalama, I took the front passenger seat and proudly showed Brian, our familiar driver, my iPhone and the mapped route on its screen.  He looked at the phone, stared out the dusty windshield, and put the pickup into gear.  As we started to roll, he said to the road, “This is OK”. 
I plugged in my charger to the car lighter, hit start on the route app, and delighted in watching our progress down the asphalt covered road on which the hospital sits.  “In 3.4 kilometers, we turn right”, I held the phone up to show him the map.  No comment.  Siri (or whomever was this app’s voice) announced, “In one and a half kilometers, turn right.”  I looked at the driver to see if he had heard her.  Brian showed no reaction.  I looked at our progress on the phone.  Perhaps he didn’t understand the phone’s accent, so I updated, “Ok, 700 meters and we’ll turn.”  Brian stared straight ahead.  Trying again to get a reaction I said, “Get ready to turn.”  We whizzed by a dirt path that I was certain corresponded to the turn.  I groaned as Siri disappointingly chimed, “Recalculating”. 
Trying again, “Ok.  In 500 meters.”  “Ok, right up here” I pointed out the windshield at another dirt path.  We drove past.  “No problem, we’ll get the next one”, I said to no one.  
Brian stared ahead and said, “Gayaza.  We’ll turn at Gayaza. That is a good road.” 
“Sure, sounds good” as I flipped off Siri’s voice on my phone.
I continued to look at the phone every few minutes, making sure we were heading toward our destination.  Pinching the screen, I could see our whole route to Nakaseke.  It was due north until the very end. A little over two and a half hours was the phone’s estimate.
Soon the asphalt ended, the roads got narrower, muddier, ruttier as the trip progressed.  Soon we were driving very slowly, Brian doing his best not to maroon the truck in a ditch or hit a goat.
Two and a half hours into the trip, our estimated time of arrival kept being pushed later and later.  I blamed the road conditions, worse than I had estimated and certainly nothing Ugandan Siri had dealt with, even with her infinite algorithmic wisdom.
Then Brian spoke.  “We must ask for directions now.” 
“Why?” I held up my phone.  “The phone says we need to just stay on this road for another 83 minutes.” 
He pulled the truck up to a barefoot, nearly toothless man of indeterminate age walking up the road toward us.  He nodded as Brian rolled down the window. After a flurry of Luganda back and forth, Brian looked at me, “He says we need to turn around. The turn for Nakaseke is back there.”
“Really?”, I protested.  I held up the phone and tapping the glass said, “No, it is straight ahead.  “See?  Here,” I pinched the map to show him the whole route with Nakaseke marked clearly due north and the glowing blue dot of our location.  I wondered, was it possible that he was going to believe a nearly toothless man with a walking stick over Google?
Brian put the truck in gear and began to turn it around to head back down on the very narrow, rutted road from where we had just driven.  I closed and re-opened the app. I retyped Nakaseke.  Again, Google proclaimed that Nakaseke was straight ahead of us, not behind us as the barefooted GPS had suggested.
I persisted.  “Unless there are 2 Nakasekes, this says we have to continue the same direction we have been goin.”  “There is only one Nakaseke”, said Brian with quiet certainty. He stopped the truck 4 points into his 7-point turn to turn around, now straddling the truck fully crosswise in the road, he turned to face me and said, “Tell me what I should do.”  I paused, weighing the two choices.  “Let’s keep going” and pointed to the phone as if to show that it was two against one.
He pointed the vehicle back to the direction we had been headed and resumed the jostling down the path.  As we drove on, I saw the cell signal drop from 3 bars, to two, and then one.  I stared at the blue dot as it traveled toward Nakaseke.  Finally, “No Signal” the phone declared, but no matter.  It wasn’t complicated, the directions had been simple, straight until Ngombe, then turn right, and a few kilometers we will have reached our destination.
An hour and a half later, an actual sign, not a common occurrence, stood on the side of the road.  “Ngombe”.  And, with two bars marking our cell signal. I tapped on the Maps app and re-entered Nakaseke.  I stared at the phone.  “94 minutes” to Nakaseke . . .  Behind us!
What?! How could that be? “Stop the truck!”
I rebooted the app.  Siri stood her ground.  Nakaseke was now an hour and a half behind us.  And ahead of us.  Both. I pinched and unpinched the screen.  There were now two Nakasekes on the map.  And we were due at one of them in 17 minutes.   Brian remained quiet, seeing the panic on my face. 
 I looked through my emails and found the name of one of the hospital administrators with which we had been in touch. 
              Hello, Richard?  Um, we need some directions to your hospital.  I think we’re close.  Where?      Um, Ngombe.
Richard said, “You are very far, maybe an hour and half.  (pause) Why are you in Ngombe?”
              “I’m going to let you talk to our driver.”
Brian took the phone.  “Ae.  . . Ae. . . Aaaaaaae. . . Kali.”  (Yes, Yes, Yes, Fine.) He handed me the phone. In silence he turned the truck around. 
After driving a ways, I stammered, “Brian, I’m so sorry. I was wrong. The man on the side of road. . . you were right.”
He smiled sweetly. “It is okay.”
By the time we arrived at Nakaseke Hospital, an hour and a half late, I had learned yet again a lesson I have learned many times during my visits to Uganda.  Technology is only useful if the environment in which it is used, can support it.  How often have I seen the uselessness of advanced technology in under-resourced settings.  Whether it is having an EKG machine sitting unused because of a single broken lead that could be easily replaced in the US but not in Uganda, or an expensive blood analyzer that gives a test result that changes nothing because there is no treatment for the underlying disease, or donations of 3 months of a medication that will run out long before the patient’s benefit is realized.  And now, add to the list, phone apps that have been developed for engineer designed roads and not the terrain dictated winding paths of an impoverished nation. 
Sometimes a barefoot man with a walking stick understands the needs of his community better than any programmer sitting in a glass and concrete building 10,000 miles away. 
As he put the truck into Park, Brian said softly, “I miss the fuel.”
              “Huh?” I asked.
“So much fuel we used. I miss the fuel.”
For a Ugandan, it wasn’t the waste of time.  It was the waste.  For a country where everything, so limited, is precious, waste is the crime.   

Nakaseke, Uganda
19 Apr 2018

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Technical Foul - Part 1

4/25/2018

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The early morning light falls upon the stack of handmade mud bricks, pieces of straw punctuating many of them, stuck there from before the clay was molded into blocks.  A crane flies overhead.
Over the cacophonous din of the morning birdsongs is the rhythmic chopping of a young woman hunched over her mound of dirt with a short-handled spade lacerating the dark red dirt still wet with the morning’s dew.  She is grateful that the air is still cool, and the morning moisture minimizes the spread of the earth’s fine red dust that will soon lay a fresh coat over everything as the air dries in the rising equatorial sun.
I’m sitting on the porch of the hospital guest house where we arrived yesterday to pilot our educational program in palliative care at yet another Ugandan rural hospital; our mission to educate more healthcare workers in the principles of relieving suffering. 
As I drink the instant coffee I’ve made with lukewarm bottled water, I’m thinking about the previous day’s events when a young woman in a bright and boldly patterned yellow and red dress, her bare feet padding up the dirt path, smiles broadly as she approaches me.
“Good morning, Suh.” As I answer her back the birds seem to have stopped to listen, yet the sound of the distant chopping never misses a beat. “I will make breakfast?”, the delightful lilt of her Luganda dialect making every word carry music of its own. “Now?”
I look down at my watch, the one I use only for my trips to Uganda, a Walmart $19.95 Casio World Time® watch with its LED picture of the world map and various other dials I’ve never mastered nor needed.  07:02:54 it displayed.  My jetlagged stomach not yet ready for breakfast, and knowing my traveling companion, a medical student assisting with our project, was still sleeping. Satisfied with my tepid coffee, I suggested to her, “8 o’clock? Is that okay?” 
“It is okay”, she smiles and walks back down the hill to what I realize now is a cooking hut and disappears behind its curtain door.  
I look around from my perch on the porch, now aware of the awakening bustle of the hillside below me, a man struggling with a heavy jerrycan doing his best to avoid spilling any of the precious well water he’s carried up the hill, a small child in a school uniform swinging her book bag at a mango tree waiting for her brothers and sisters before starting the long walk to school, and so many others walking to their plots of land to start their morning farming before the blistering sun make it untenable.  All the while, the sepia smell of cooking fires rising, showing like exclamation points across the hillside. 
And suddenly there she is again, the bright yellow and red dress, coming up the path, accompanied now by a young man wearing a torn Justin Bieber Believe 2012 Tour t-shirt, both carrying trays of food and the traditional pots of hot water and hot milk, walking, smiling, toward me.  
Could it be 8 already? Had I been lost in a reverie of early morning Uganda longer than I thought?  My Casio reassures me that I hadn’t had a petit mal lapse, blinking 07:11:14. The young man and woman put the trays down on the rickety repurposed plastic patio table next to my chair.  I thank them, they smile broadly and walk back a way down the hill a short way where she picks up a spade, he a watering can, and they hurry to their small land plots halfway down the hill.  I look again at my watch. From a nearby tree an unseen hornbill laughs. 
I should have known better.   Here in rural Uganda, time is measured by the sun’s rise from the dawn horizon, not a watch or clock.  Each day is divided not by hours, but by the chores dictated by the sun’s position and the heat of the air.  Time to go to school, feed the chickens, start the matoke, hoe the land, are set in the day’s rhythm, a different more fluid metre than the monotonous metronome of our western clocks.  Though most villagers can in fact tell time as we westerners do, mostly from the digital readout of their ubiquitous cell phones, they just choose not to be constrained by it, preferring to heed the conversation between the sun’s station in the sky and the chore at hand. 
My breakfast preparation that morning occurred when breakfast fit into the scheme of the necessary chores and events of the day, not when the Casio reads 8:00:00.  Breakfast occurs just before the work in the field must start, for good reason, or else the heat of the day and the dryness of the soil forces the necessary work to halt.  I drank my tea and ate my sweet mango, slowly savoring my breakfast. 

April 25, 2018
Nakaseke, Uganda
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    Howard Eison MD is an internist who follows his wife Randi Diamond MD to the ends of the earth and becomes a better person because of it.

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