by Alan Weisman
They go through other situations: a thirty-two-year-old tired of injections every three months; a wary twenty-year-old who would like the ease of an IUD but has heard that they can migrate in a woman’s body all the way to her heart—or that it can fail and wind up inside a baby’s head. Everyone takes turns playing client and counselor; afterward they critique each other. Did they remember to say that an IUD is reversible? Did they tactfully ask a mother of eight if each new child brought more happiness or more problems? Did they mention that besides being an effective, nonchemical form of contraception that can’t be detected by a libidinous husband, the option of receiving a postpartum IUD is another good reason for having a hospital birth?
That’s important, they’re reminded by a nurse who’s worked with Amy all week, because mortality of women having babies in hospitals is 80 percent below the national average. “It’s the same for infant mortality,” she adds. “If you die in childbirth, the chances of your baby surviving without you aren’t good.”
An arm around each of her two toddler sons, Gladys watches from the back, her long curls framing her wide smile. Four years have passed since CTPH added family planning to its mission, after building trust by raising awareness about parasites and disasters like TB, Ebola, or polio that could leap between humans and their hairy relatives. Until now, family-planning programs had rarely reached western Uganda. Now they had teams of field counselors, and a hospital embracing the program.
This has taken much work, much of it involving neither women nor gorillas. Like every charity, she must constantly find new funding as old sources become exhausted. During her master’s at North Carolina State, Gladys learned to write grants, and to register CTPH as a nonprofit organization in the United States. Her first funder was the Washington-based African Wildlife Foundation. From there, she tapped the John D. and Catherine T. MacArthur Foundation, the Irish government, the U.S. Fish and Wildlife Service, and Bayer, the aspirin maker. Her expansion into reproductive health was abetted by a fortuitous meeting with an exuberant, copper-haired American who now sits to her left, jotting notes and nodding as Amy’s workshop proceeds. She is Dr. Lynne Gaffikin, a public health epidemiologist who brought Amy Voedisch to Buhoma, and who connected Gladys to the funder of so many of the world’s struggling family-planning efforts: USAID.
Lynne Gaffikin had spent her junior year of college abroad, sorting fossils for paleoanthropologist Richard Leakey at the University of Nairobi. With two fellow exchange students, she hitchhiked across Kenya and Idi Amin–controlled Uganda to see chimpanzees and mountain gorillas in the wild. Four years later, in 1978, she returned with a Fulbright to study African culture. Her anthropology career, however, derailed in Kenyan villages she’d visited years earlier, now engulfed by children with flies in their eyes. Back in high school, she had read The Population Bomb and even belonged to a Zero Population Growth chapter. Now she saw what Ehrlich meant. The following year she returned to UCLA, to begin a master’s in public health.
There she met Dr. Paul Blumenthal, an OB-GYN from Chicago on leave from Michael Reese Hospital and Planned Parenthood. Lynne told him about Africa, about seeing mountain gorillas peaceful as Buddhist monks, and how tourists turned silent and reverent in their gentle presence. There were so few left, and the land supporting them was being overrun by their human primate relatives. Unless something changed, both people and gorillas were going to lose.
After they married, Lynne Gaffikin earned a doctorate in community health and epidemiology, and Paul Blumenthal eventually became director of reproductive health at Johns Hopkins. Through the 1980s and 1990s, both were frequently in Africa and beyond. Lynne became an advisor to Kenya’s Ministry of Health and to the Mountain Gorilla Veterinary Project, a legacy of Dian Fossey (another Leakey protégée—in this case, Richard’s archeologist father, Louis, who also sent Jane Goodall to study chimpanzees).
They spent two years in Madagascar, a global biodiversity hot spot where a traditional wedding blessing, “May you have seven sons and seven daughters,” reflected a population doubling every two decades. However, a new president, declaring that the health of the economy and the island itself depended on sustainable human numbers, renamed Madagascar’s health ministry the Ministry of Health and Family Planning. Paul was an advisor there while Lynne, a fellow of a new USAID program titled Population, Health, and Environment—PHE—coordinated African sustainability initiatives.
In 2007, Paul was invited to direct family planning at Stanford, where he started a program that in its first year saw two hundred eighty thousand women in fourteen countries receive IUDs. In California, Lynne reunited with her old hitchhiking companions from Nairobi, now married to each other. The wife, children’s book author Pamela Turner, returned to Africa with Lynne to write one about mountain gorilla veterinarians. There they heard about a young woman vet who had stopped a gorilla scabies epidemic in the Bwindi Impenetrable Forest.
A few years later, Dr. Amy Voedisch, who had spent her honeymoon in Rwanda watching mountain gorillas, saw a copy of Turner’s Gorilla Doctors. Not long thereafter, she was off with the epidemiologist in the book to teach about postpartum IUDs at Gladys Kalema-Zikusoka’s veterinary-cum-maternity NGO.
After the workshop, the community-conservation health workers pose with Amy for a group portrait. The USAID grant that Lynne Gaffikin midwifed to enable CTPH’s family-planning program has now run out, although a bit more sluices through a program run by the Bronx Zoo–based Wildlife Conservation Society, which has an office in Uganda. By piggybacking environment, public health, and family planning, Gladys can troll for donations in all three arenas. Still, each year is a survival trek through the impenetrable jungles of philanthropy. Every NGO in every developing country competes for the same pool of charity—which, as economies contract and populations grow, is shrinking like Arctic ice.
All week, Gladys and Lynne have worked on a CTPH evaluation to present to funding agencies, Lynne translating it into the acronym-studded bureaucratese she’s mastered to keep family-planning funds flowing. A grateful Gladys feels like she’s swimming in alphabet soup when Lynne effortlessly produces donor-dazzling sentences such as: “USAID early recognized the lack of access to RH/FP services in the BMCA, and for close to a decade it funded CARE to implement CREHP in the area.”
They each hug Amy good-bye. Lynne is headed to Kampala, the capital, to consult to urban NGOs battling with fragile supply lines: from fickle funders to corrupt bureaucrats to inept warehouse managers who let medical supplies overheat; from shady middlemen and lazy drivers to aging delivery trucks, impassable roads, mislabeled shipments, overwhelmed clinics, and overworked nurses, the chain can break anywhere and frequently does. Not long ago, the entire country ran out of condoms. After all the effort to raise awareness and educate women about their options, a week’s delay in restocking birth control pills or injectables can mean hundreds of unintended pregnancies.
Gladys is off to an emergency at Queen Elizabeth National Park fifty kilometers to the north. An open savannah with two lakes connected by a natural channel, it is where thousands of fishing families, goats, cattle, elephants, cape buffalo, waterbuck, crocodiles, leopards, and hippopotami converge. Now an outbreak of anthrax has claimed sixty-seven hippopotami. Amid growing scarcity and growing numbers, people have been increasingly poaching hippo meat, and Gladys is praying that no one’s infected. Somehow, she needs to burn or bury a lot of three-ton hippo carcasses before hyenas and vultures start spreading anthrax spores all over the Rift.
At the word anthrax, Amy shudders: As an undergraduate, she worked in a St. Paul, Minnesota, Planned Parenthood clinic where one day an envelope arrived containing white powder. That scare taught her what was at stake in helping women make their own reproductive decisions, but it also confirmed her choice about what to do with her life.
“Enjoy your time here,” Lynne tells her. She turns to Gladys. “See you in Kampala.” They have plans to meet at a fund-raiser that a mutual hero, Jane G
oodall, is holding for Uganda’s chimpanzees.
“Pray for the hippos,” says Gladys.
Dr. Joy Naiga, senior national programme officer in Uganda’s Population Secretariat, looks glum. She sits in the restaurant of the Sheraton Kampala in her slim black suit, having stopped for coffee between meetings. Beneath the table, her bare feet rest atop her high heels.
“It’s the fiftieth anniversary of the birth control pill. I take the same pill my mother took. Women use the same IUDs. This is not new technology. And we still can’t afford to have enough contraceptives in this country. I wish we could market them like mobile phones.”
She likes the president. She has met with him and his first lady. She has tried to explain the math: even if Uganda suddenly strikes oil and annual GDP rises by 10 percent, they still can’t become a middle-class country with a fertility rate of seven kids per woman. “Only when we reduce to 2.1 can we achieve that.”
But the president still wants his country to be Africa’s version of an Asian tiger, still insists that China and India’s incipient superpower status results from their huge workforces. It’s particularly frustrating for Naiga, because President Museveni responded so brilliantly to the AIDS epidemic with a ubiquitous nationwide publicity campaign, led by his slogan of “zero grazing”—like goats that always find food close to home, men shouldn’t stray. It was a smart strategy. Without moralizing, it simply told men to keep their sex life at home, however many wives that meant, and it worked: In less than a decade, Uganda’s HIV infection rate dropped from 15 to 5 percent.
“If we could do that, we can do anything,” says Naiga. Yet a national health sampling shows that 41 percent of women lack access to birth control. “And they just counted married women.”
Her government, she admits, simply doesn’t procure enough contraceptives. Most are donated through UNFPA, the United Nations Population Fund, which has its own problems trying to meet needs. Uganda’s contraceptive shortfall translates into at least a million unplanned pregnancies a year. A study concluded that three hundred thousand end in unsafe, illegal abortions. The ones that don’t produce a surplus of unwanted children.
“Family planning is the most cost-effective way to get us out of poverty. It would buy us time to deal with our environmental ills. It would save women’s lives. God help us if we don’t slow down.”
Outside, Kampala has transmogrified into another of the world’s impossible cities, with incomprehensible traffic and tendrils of chemicalized air curling among withering jacaranda blossoms. Unbroken humanity stretches from Kampala’s hills for thirty kilometers to Entebbe on the shores of Lake Victoria. Roads swarm with men doubled under loads of green bananas, mothers with armloads of infants, and throngs of children in a kaleidoscopic palette of school uniforms. At Lake Victoria, long, narrow pirogues, their gunwales nearly at the waterline, sputter up to jetties piled with teak and other hardwoods deforested from islands hours away, used for charcoal to smoke diminishing catches of tilapia and Nile perch. The world’s second largest freshwater lake, Victoria, “the water tower of Africa,” is both Kampala’s water supply and the lowest point of its waste treatment chain. From the opaque green liquid lapping the greasy jetties, it’s apparent which one is winning.
The oldest family planning NGO in Uganda is Pathfinder International, here since the 1950s, including through the Idi Amin nightmare. Its current director, Anne Fiedler, is one of twenty-seven children: her polygamist father, a school principal, had five wives. Upon entering university, she went to the infirmary and asked for a tubal ligation, saying that she didn’t want kids: her parents had enough for her, too. She was told that she needed a signed consent from her husband or boyfriend or father. Even for contraceptives.
At the height of the AIDS epidemic, Anne Fiedler started Straight Talk, a radio program for teens. She now tries to tell her audience of sixteen-year-olds who are about to become mothers the difference between loving, feeding, and schooling two—or trying to do that for seven.
“After surviving Amin, and then HIV, everyone felt decimated and wanted to replenish our numbers,” she says, pointing with her red-framed glasses. Even herself: she lost a sister to AIDS, contracted from a university colleague who, it turned out, had three other girlfriends, two already dead. “She was using pills. She didn’t know she should be using a condom, too.” Anne is now married, and has one child. Some of her other sisters who didn’t get to college have six apiece.
“Population growth is outstripping our future. I’m not waiting for our leaders anymore, but we have to give families a reason to change behavior. Otherwise,” she says, fingering an open ledger on her desk, “we’re just peddling commodities: pills, condoms, injectables. But it’s hard to tell someone in a village to have fewer because their whole country is at risk.”
On the last Friday in July 2010, Lynne Gaffikin finishes her work and hurries to the Serena Hotel, Kampala’s fanciest. It is twilight; army snipers that for the past week manned twenty-four-hour positions atop government buildings, embassies, and five-star hotels, including the Serena, have finally taken their AK-47s and left. The triple gauntlet that hotel guests had to cross is back to normal: one metal detector, not three, plus just a single X-ray following a hand search of luggage and purses.
The paranoiac security was for the fifteenth summit of African Union leaders. A week before it began, two bombs exploded simultaneously, one in a rugby club, the other in a restaurant. Each was packed with patrons watching a World Cup match between Spain and the Netherlands. Seventy-six died, including several foreign tourists. Things worsened with the arrival of Libyan dictator Muammar Gaddafi, the chief suspect behind the bombings. Gaddafi, in power for forty years, detested President Museveni—his junior, having led Uganda for only a quarter century—for opposing Gaddafi’s calls for a United States of Africa. Under this plan, Africa would become a single nation; although Gaddafi claimed that it would create a strong economic front, Christian African nations such as Uganda smelled a scheme to entrench Islam. Suspicions were not alleviated when Gaddafi’s three hundred bodyguards picked a fistfight with Museveni’s presidential guard during the summit’s opening ceremonies.
But the rest of the week passed uneventfully—as usual, the summit produced nothing of import—and now the Serena’s pool terrace, lined with palms and artificial waterfalls, is the scene of the fund-raiser for Dr. Jane Goodall, founder of the institute that bears her name, dedicated to the survival of Africa’s chimpanzees.
Waitresses bearing trays of wineglasses and flaked pastry hors d’oeuvres circulate among women professionals in silk blouses and tailored pants and men from the diplomatic corps in jackets and ties. The American ambassador and several staff are present, as are World Wildlife Fund, the Wildlife Conservation Society, and the Uganda Wildlife Association.
Lynne, in a black sweater and green slacks, finds Gladys, who’s in sandals and a CTPH polo shirt. Her husband, Lawrence, the telecommunications specialist, wears a blazer. Lawrence had a polygamist great-uncle who sired one hundred children whose ages spanned generations, several younger than some of his grandchildren. Lawrence’s grandfather, one of Uganda’s first engineers, only had six, which bewildered his prolific brother. “Do we really need more?” he’d reply. The whole family had to help support his brother’s offspring.
“We needed a private NGO just to take care of our relatives,” Lawrence says. Lawrence was a rarity in Uganda—an only child, which was all his mother wanted until she married his stepfather and inherited six more. When relatives would ask if she and her new husband were having some together, she’d ask if they were offering to pay school fees.
A murmur on the patio as Jane Goodall joins the gathering: a thin, erect woman with long gray hair, wearing a deep orange shawl over a black turtleneck. She is immediately surrounded.
“With the right publicity,” whispers Lawrence, “I think Gladys could be to gorillas what Jane Goodall is to chimps.” The gorilla chair is vacant, sadly, because Lou
is Leakey’s other famous protégée, Dian Fossey, was murdered, likely with her own machete, either by the poachers she fought, or by enemies in the tourism industry, which she hated because she felt it needlessly exposed mountain gorillas to human diseases.
Fifty years have passed since Leakey sent Jane Goodall off to study chimpanzees in what is now Tanzania. She has come to Uganda to tell the African Union summit that when she started her life’s work, there were 1½ million chimpanzees spread across twenty-one African countries. Today there are fewer than three hundred thousand. Uganda’s small chimp population is in the Albertine Rift; some in the Bwindi Impenetrable Forest; but most of them north of Queen Elizabeth National Park.
And that is right where, it turns out, Uganda’s fortunes have recently turned. The country has indeed struck oil.
President Museveni’s visions for Uganda suddenly feel like more than dreams. Leases have been awarded. In fact, the event this evening is sponsored by a UK oil exploration firm that has the contract for the areas of the Albertine Rift with the greatest concentration of chimpanzees. A company executive is present, in an open-necked blue shirt.
“We’re proud to be associated with chimpanzees,” he tells the gathering. He describes the tree planting campaign they’ve begun where they are drilling. “The environment is close to our hearts. We have a responsibility to leave it better than we found it.”
He does not mention the refinery they are also building there, and he doesn’t say that they will stay for at most twenty years, the life expectancy of the oil field. The Ugandan deposits are estimated at 300 million barrels, what the United States consumes in about sixteen days.
After he speaks, he introduces and hugs Jane Goodall. She smiles. She then describes her first trip to the Rift, when it was unbroken chimpanzee habitat from north of the Burundi border all the way south into Zambia.