Ssese Islands

August 19th, 2017

Cool breezes. Delicious fish. Runny-nosed children. An AIDS crisis.

I hate to breeze right past so much that is beautiful about the Ssese Islands, including the breeze itself, such a refreshing change from the sometimes stuffy congestion of Kampala. The ferry ride to Bugala Island was especially cool on this rainy morning. Once arrived on the island, we stopped into a small restaurant and were each served an entire fresh poached tilapia, along with a bowl of aromatic soup to pour over a generous plate of matooke, posho, cassava, and rice. This fish was perhaps not even as delicious as the fried tilapia and fire-roasted sweet potatoes that we were treated to in the afternoon by the family of our host, Emmanuel Zziwa.

Over our first meal, Emma told us that his local savings group was a cultural departure on the islands. He and Sadhat laughed that there is an expression in Luganda, “save like a fisherman,” which is to say, not at all. There will always be plenty of fish, the traditional logic went, so why save? In just the last decade, however, Kalangala natives realized that their traditional fish stocks were badly depleted. Currently, Lake Victoria is a source of Nile perch, tilapia, and a small silver fish called makene, but it previously used to offer at least five other species. There used to be an island tradition, Emma told us, that new guests to the island were served a soup containing all eight common species of fish, and whichever type the guest ate the most of is the one he would be served thereafter.

Overfishing, Upheaval, and Development in Kalangala District

Once the natives realized that their fishing way of life was in danger, they began to focus more on developing their land-based resources. Now, most of the natives of the island are engaged in agriculture, not fishing. The community-based organization Emma started works to enhance skills and institutions for his family’s neighbors on Kalangala. He hadn’t really intended to start an organization, but two years ago the national government made it illegal for non-registered groups of more than three people to gather for a meeting, essentially eliminating freedom of assembly. In order to continue the work he’d been doing with friends and neighbors in his home district, he had to organize, and ZziwaEmma Foundation was born.

Emma started by linking qualified young people with scholarships. He continued doing agricultural vocational skills training using his knowledge as a university lecturer with a Ph.D. in grazing and rangeland management and as a consultant for the Food and Agriculture Organization. He also started the savings and lending group to allows locals to save in small amounts and to obtain microloans to start or scale up businesses.

As natives moved into agriculture, the fishing industry changed. Though now subject to monitoring to ensure more sustainable fishing methods, Lake Victoria still offers livelihood – if a dangerous one. A new group of fisherman – migrants from the mainland – have taken over the profession. With them have come sex workers and HIV/AIDS from the transient populations moving through the fishing villages.

The Newcomers

The village we visited was more like a collection of shacks with aluminum walls than a village. Unlike the green of most of the island – offering a vacation spot of lush green forests and white-sand beaches for middle-class Ugandans and foreigners – the fishing village was all brown except for the silver walls of the shacks. Nothing grew there. How improbable, then, seemed the group of children who quickly gathered and followed this strange group of visitors, including two muzungu women, through the village to the lakeshore. One of the muzungu women (me) turned to the children and said, “tugende,” the Luganda word for “let’s go.” The children giggled excitedly and repeated “tugende!” to one another, as amused and delighted that a muzungu could know a word in their language as they were by the invitation itself. Most were not timid in their interaction, laughing and running and seeking attention. One little girl with her pants on backward came over for a hug. When my small handbag fell off my shoulder and onto her slender one, we engaged in a genuine tug-of-war before I retrieved it as gently but insistently as possible.

Most of the children in this damp, chilly settlement had runny noses that they seemed to have long since stopped bothering to wipe. I wondered how many of them were born with HIV. A 2015 study by the Church of Uganda in partnership with a parliamentary committee and an association of women lawyers found that the HIV rate on the Ssese Islands was around 27 percent, more than three times the national average of 7.2 percent. In some fishing villages, estimates put the rate as high as 40 percent. This high prevalence has been attributed to a combination of disposable income, poverty, irregular working hours, dangerous work, long stays away from home, alcohol consumption, prostitution, and migration away from health care interventions.

Since 2015, the World Health Organization’s “test and treat” program has been making headway in reducing transmission rates, according to The Guardian. In the past, people who tested positive for HIV were told to return to clinics for repeated testing until their immune system markers fell below a certain threshold. Under the new program, patients who tested positive were immediately started on antiretroviral therapy. The prospect of immediate therapy may have induced more people to be tested and to take more precautions to prevent transmission.

Health officials in the community initially worried that the migrant workers would not return for monthly visits to receive follow-up treatments, leaving them resistant to the medications in the future. One clinic worker told The Guardian that he’d been pleasantly surprised by the compliance rates with the recommended therapies. A fisherman on Bugala, the largest of the eighty-four islands, said he had begun scheduling his fishing trips around his monthly visits to the clinic for treatment. Aside from occasional dizziness, he said, he’d felt well.

As we drove from the home of Emma’s parents to the village, we passed a cheerful salmon-colored structure with white trim. The sign over its door announced it to be the Ssese Islands African AIDS Project, or SIAAP. The project was started by Colonel Frank Musisi, who grew up in Kalangala District and moved to the United States in 1990 to obtain degrees in computer science. He enlisted in the U.S. Army and, after a tour in Iraq, was commissioned in 2005. Around the same time, he started the AIDS project in the Ssese Islands that now provides the drug therapy that is beginning to reduce HIV transmission there.

All the Little Children

On the way home, I asked Emma about some of the kids I’d seen at his parents’ house. There was a teenage boy named Plinton (we mistook it for “Clinton”) who was sent out on a bike to run an errand; a tiny girl with a runny nose and chubby baby legs that she had surely just learned to walk on; another teenage boy who peeked out from under a sheet in a room I had thought empty except for construction debris - I guess we had awakened him when Emma came in to show us the new rooms they were building for interns. Plinton, we learned, had come in with the workers they hired for the construction. “I guess he found it better here than where he was before, so he just – stayed,” Emma said with a hint of a smile. The baby girl was “a grandchild.” As for the other children, Emma said his parents were always taking in someone. “You don’t ask too many questions.”

I wondered about adoption laws in Uganda; I had read that the country recently changed its laws to make international adoption more difficult. That was partially true, Emma said. The laws were made more difficult to prevent cases where a parent gives up their child for adoption in a more developed country, and then years later resurfaces to claim parental rights – either to bring the child back to Uganda or to be able to accompany the child to its new home. In cases where it was well documented that the child was orphaned or abandoned for a couple of years, however, international adoptions were permitted and granted quickly, he said. He mentioned a case of a child whose abandonment had been notorious in the community and had been raised by the church. A visiting priest from Europe offered to adopt the child, and the adoption was granted easily.

I asked Emma and Sadhat what they thought about the objection that is sometimes raised to international adoption – that you are taking the child out of his or her home, and out of communities that need them. Emma and Sadhat both dismissed the idea out of hand. “You’re helping the community,” Sadhat said. Those arguments, they said, assume that the child even survives to adulthood, and that he or she has opportunities to develop skills or education that will contribute to the community. The World Bank lists the infant mortality rate in Uganda at 3.8%, and average life expectancy at 58. “A child who has the chance to get an education, but knows that he or she is from here, may come back and do something that can really help the community,” Emma said. “Most people here want there to be international adoptions.”

It’s really not an either/or proposition. A few weeks in Uganda impress that point unmistakably. Some children may be adopted outside the country – but millions of orphaned, abandoned, and neglected children will stay behind, fending for themselves, staying anywhere that they can (hopefully) find enough to eat and get some sleep in safety. Even if it’s under a sheet in a construction site in the middle of a Saturday afternoon on Bugala Island.