Prologue

‘There’s a strange disease killing people in Kikyo,’ Kisembo tells me, a frown spreading across his face. Whenever I go in to pay my bill at his drug shop – the one with a black and white fence a few houses down from Nyahuka Health Centre – if I settle onto a bench and lean my head against the wall, I know I’ll get more than just a receipt. This morning I hadn’t intended to stay.

‘A strange disease? What could it be?’ Crossing my legs, I notice the shop smells like damp cardboard, probably due to the recent rains.

‘They don’t know. Some are saying cholera. Others think typhoid. It’s been going on for some two months. So far no response from the Ministry.’

‘Eight weeks and they don’t know what it is?’ I shake my head.

‘Only the Bakonjo are dying. People believe the Babwisi are poisoning us.’ His voice is strained.

‘Kisembo, you know that isn’t true,’ I say, trying to assure him.

‘I know but the people in the mountains, they’re not educated, they believe it.’ His expression is distant as if his mind’s on other things. ‘I want to go there, see what’s really happening.’

‘Good idea.’

‘But some of the roads are blocked. The mud is too much. You can’t pass. I have to wait.’ Worry lines are etched on his forehead. Because he works nights at the hospital as a psychiatric nurse, I’m tempted to attribute his solemnity to a lack of sleep but I don’t think that’s the case today.

‘I’ve been to Kikyo,’ I tell Kisembo, hoping to sound positive. ‘Those hills are steep. When I went, I followed a small path. It was very rough. I thought I could manage, but one of my tyres got stuck in a hole.’

His eyes shoot up, revealing a hint of amusement. ‘What did you do?’

‘A boy wearing a Christ School T-shirt was passing. He helped me.’ I smile.

‘What were you doing there?’

‘Taking mama kits to the health centre. That’s what made the boda boda so heavy.’

‘You took them on your motorcycle?’ He raises his eyebrows in disbelief.

‘I know. It was foolish. I had gone before with Joseph so I thought I could find my way but I got lost.’ Standing, I roll my shoulders backwards a couple of times to loosen the tension there.

‘Kisembo, look, I am on my way to Nyahuka. Was just passing when I saw you were open. Can you prepare my bill? I’ll come back later.’

‘Yes, please.’

‘And let me know if there’s any more news about that disease.’

He nods.

Stepping out, I mount my bicycle, tuck my skirt around my legs, and cycle carefully, dodging the puddles drenching the path. The lush green of the Rwenzori mountains and the elephant grass on either side of the bridge up ahead are hints of the magnificence I never tire of seeing here. Yet among this breathtaking terrain, death, or talk of death, seems so prevalent. It’s as if the beauty is somehow literally taking away people’s breath.

Grinding the pedals through the wet sludge makes me winded. I stop for a moment to rest. Standing there with the bike leaning up against me, I can’t help thinking that all this loss of life is not what I signed up for. When I decided to come to this remote area of Uganda, I knew I’d be around AIDS patients and that some of them would die, but it didn’t occur to me that I’d encounter different kinds of death. Or so much of it.

When does the risk of doing this kind of work become too high, I wonder.

Part One

1

The District

Since the terrorist attacks on 11th September 2001, I’ve become a jittery flier, aware that a journey that seems predictable can give way to tragedy. At the moment, I’m wedged into the cockpit of a five-person Cessna about to take off from Entebbe, Uganda’s international airport. Industrial-size headphones flatten my ears, dampening the roar of the engine.

Half an hour ago, when I was standing on the tarmac inhaling fumes and contemplating my first flight in this tiny aircraft, someone called out my name. Turning, I saw three women approaching, all smiling. A slim brunette in jeans stepped forward.

‘You must be Pamela. Hi, I’m Jennifer.’ She looked more like a carefree postgraduate student than a mother of four in her early forties and the paediatrician half of the doctor couple I’m going to work with for the next three months. Jennifer wrapped her arms around me, and introduced the others. Karen – built like a mature mango tree – enfolded me enthusiastically. Bethany, a younger twenty-something woman, embraced me too.

‘Nice to meet you all,’ I stammered.

‘How was your flight? You came through London?’ Jennifer asked.

I nodded. ‘Fine. Landed this morning. Then, this afternoon, a man who works at the airport brought me out to the plane.’

‘We all just flew in from Nairobi, from a women’s conference, which was great,’ Jennifer told me. ‘Three days without our kids. Really missed them, though.’

‘I missed mine too,’ chimed in Karen. ‘Michael and I have three.’

‘Scott and Michael will have had their hands full,’ Jennifer grinned. I tried to look sympathetic but couldn’t relate. I don’t have children.

We’re on our way to Bundibugyo, a district on the western border of Uganda, near the Democratic Republic of the Congo, where these women live. The plane taxies down the runway gathering speed, and my heart begins thumping. As we lift off, the ground below us disappearing, my stomach lurches. I throw up a frantic, silent prayer, try to slow down my breathing and will myself to focus on the view. Staring straight ahead, a panorama spanning more than 180 degrees unfolds before us. The city behind us now, I see fertile fields bordering a series of small lakes which shimmer like liquid mirrors. Alongside them, brown terrain resembling a dried-up riverbed becomes visible in the distance. As the plane climbs higher, my tummy settles down. When we level out, our pilot begins talking to me through the mikes attached to our enormous head gear.

‘Great day for flying.’

‘Yes, the view from up here is unbelievable,’ I say. I look over at his red hair and freckles and watch his hands guiding the controls.

‘Visibility can change quickly, though,’ he tells me. ‘The weather too. In about twenty minutes, we’ll hit some rain clouds, but it won’t last long.’

Right now, this Monday afternoon is radiant with sun and a smattering of fluffy clouds. When we glide through these, the plane hops and dips, and my body protests again, but I discover that seeing the clouds before we fly through them helps to reduce my apprehension.

‘How long will it take to get to Bundibugyo?’

‘Never been there before, but given the choppy weather ahead, a little over an hour. What do you do there?’ He’s never flown to Bundibugyo before? My insides do a flip.

‘I’ve never been there either,’ I say, slowly. ‘I’ll be working with an HIV prevention programme. My background’s in public health. Will be looking for pregnant women who tested positive then disappeared. They never came back to have their babies.’

‘Why look for them?’

‘To see how they’re doing, and their babies too. When the women found out they had HIV, midwives gave them a pill to take during labour and a dose of syrup for the baby. If mother and baby both got the drugs, most babies should be fine.’

‘Didn’t know that was even possible.’

‘Amazing, isn’t it? Most babies born to positive mums don’t get HIV. Only about a third do. These drugs cut that down even further.’

‘Seems like incredible work.’ He glances at me. My lips quiver. It’s too early for him to sound impressed. I’ve not done much yet. Except several months ago, shortly after my fortieth birthday, I left a prestigious public health job in New York City and have now flown half way around the world to the other side of the continent I grew up in to volunteer with a group of Americans I’ve never met before.

Does that count?

Though this is my first time in Uganda, Africa’s no stranger to me. I was born and raised in Jos, a modest city in Nigeria, but my upbringing was hardly typical. Papa was Nigerian, Mum from Northern Ireland, and my four siblings and I were educated at an American missionary school. We learned early on how to navigate multiple cultures on a daily basis and were part of an emerging middle class.

Having lived in Jos until I left home for the US, I’ve spent little time in rural Africa. More than twenty years ago now, I, like my father, went to university in the States but, unlike him, I eventually settled there. I’ve returned to Nigeria for regular visits but have not been back to Africa to live.

Suddenly, as the pilot warned, we collide with some turbulence and bounce through the thick grey of a massive cloud. My insides tumble again and the muscles in my upper back tense up, but before my uneasiness settles into fear, the Cessna powers through to the other side, and our vista returns. A quiet breath finds its way out of my lungs.

Conversation ceases but the engine drones on, harsh, dominating, the smell like an overworking generator. After we’ve been in the air for forty-five minutes, the terrain becomes hillier. Up ahead, the hills give way to mountains.

‘The Rwenzoris,’ the pilot points out.

‘Wow. When I think of snow in Africa, I imagine Kilimanjaro, but I’ve heard the Rwenzoris not only have Africa’s third highest mountain, they have snow on them too.’

As we get closer, the mountains unfold majestically before us, revealing rows and rows of foliage in an array of greens and purples. Soaring over them, however, I see no snow, not even a hint. Disappointed, I wonder what other surprises lie hidden on their slopes.

Leaving the mountains behind and flying low through a valley, we begin descending. Tingling with anticipation, I peer intently at the ground below and am rewarded with my first glimpse of the airstrip, a half-kilometre patch of mowed grass. As we approach and touch down, it extends beneath us like a royal welcome carpet, flanked on either side by thick vegetation. However, there’s no terminal, no control tower, and no wind gauge, which couldn’t be more of a contrast to the endless concrete of New York City’s JFK airport. We taxi to the end of the airstrip adjacent to a dirt road, and there, pressed against waist-high grass are about fifty Ugandans. Most are men and children. The women, I later learn, are working in their gardens. A few white faces are visible, also men and kids. The plane comes to a bumpy stop in front of the crowd.

Releasing his seatbelt, the pilot opens his door. While the others start to file out on his side, he comes around to open mine. A blast of hot air engulfs the cockpit, moistening my armpits. It’s early November but I’m glad to be wearing a sleeveless white cotton top and an ankle-length skirt over bare legs. I unstrap myself and stumble down the steps. Trying to appear nonchalant, I push my glasses up on my nose and run my hands through my dark curls. Not sure what to do, I watch the others. My eyes catch Jennifer hugging a tall, lean man. He’s dressed in jeans and his hair is a shock of white. Moments later, he approaches, saving me from the awkwardness. He extends his right hand.

‘Welcome to Bundibugyo. I’m Scott. Glad you’re here, Pamela.’ His handshake is solid.

‘Thanks. Me too.’

We retrieve the luggage, pile into three four-wheel-drive vehicles, and pull away from the airstrip. Palm trees, grass tall enough to hide elephants, and acacia bushes line the dirt road. The mountains, to our left, are on the same side that we’re driving on. They seem close because they are, as if forming a barrier for this faraway place. Winston Churchill called Uganda the ‘Pearl of Africa’ and I’m beginning to see why. Its beauty has a raw, arresting quality, like an attractive woman who doesn’t know the power of her captivating good looks. She’s already seducing me, helping me to forget – at least for now – about the insidious virus lurking in this community that I’ve come to help tackle.

Beyond the physical beauty, my eyes are drawn to the people. Most women are wrapped in bright, colourful pieces of material, rather than fitted dresses, many with babies on their backs. Others are walking with infants; some are balancing firewood or a basket on their heads. Men stroll along, wearing slacks and Western-style tops. I notice an Arsenal and then a Manchester United shirt, presumably sent abroad from charity shops in England. I see school-age children in blue uniforms, many laughing together, a few carrying notebooks. Girls wear their hair closely cropped; they are distinguishable only by their skirts. Smaller children who aren’t wearing uniforms are in tattered clothes. Some have nothing on except a pair of worn underpants or shorts. Few are wearing shoes or sandals. Many smile or wave as we pass them. As I observe these Ugandans, excitement bubbles inside me. I’m definitely back in Africa again.

After ten minutes of non-stop jostling over rough terrain and around several blind curves – the road far worse than any I’ve travelled on before – we pull into a driveway that wraps around a mango tree. The Nissan Patrol stops in front of a large house with unpainted cinder-block walls and cheerful blue shutters on either side of the windows. Blue screen-covered doors are at both ends of the building. I hop out after Bethany.

‘Follow me,’ she says. ‘I’ll let you in on my side.’ We head to the far door, where she unlocks a hefty padlock, and step into a room empty except for a long bench against a wall. Bethany kicks off her slippers. ‘This is the greeting room where we see visitors. You can leave your shoes here.’ I take off my sandals, sticky with sweat. Cool cement floors soothe my soles. Past a curtain, Bethany leads me into an open sitting-dining room next to an exposed kitchen. Beyond the dining table is a door that’s ajar.

‘You’ll stay with Pat, through here. She’s driving back from Kampala tomorrow since there wasn’t space on the plane.’ We pass through the doorway into another living-dining-kitchen area identical to Bethany’s. ‘Here’s where you’ll be.’ She motions to the back corner on the right.

The room has two large windows with wooden shutters, wire screens and horizontal bars, but no glass. The furniture is basic but looks comfortable: a simple desk, a dozen hangers strung across a pole hanging from the ceiling, and a narrow bed encased in a white mosquito net. I lift the net and ease myself onto the bed.

‘I’ll let you unpack. Shout if you need anything,’ Bethany calls out before disappearing.

Sinking onto the mattress, I exhale, grateful to have come this far. I close my eyes, eager to rest. I’d like to linger, even lie down for a short nap, but there isn’t time. Scott and Jennifer have invited me to dinner. So, after using the toilet, which I discover is a latrine outside at the back, and hanging up my few clothes, I splash cold water on my face, get directions from Bethany, and head back out – for my first supper with my new bosses.