She was Beautiful

Ngorongoro Crater 5/15/12

Beautiful Bukoba

Last weekend I made my second trip to Bukoba. It is one of my favorite places to go in Kagera . Remote and full of history, Bukoba is beautiful, enchanting and alluring and at the same time dangerous. Despite or maybe on account of its beauty bad things have happened here. Because it is a port town on Lake Victoria and near the border of Uganda and Rwanda and The Congo it has mix of cultures, religions and desperate people that have liked staying off the grid and below the radar before either term was invented.

The happy story, and it is a story, is that this place is the true source of the Nile. Since Lake Victoria is the source of the Nile and since the Bukoba River is the source for Lake Victoria. The argument goes that The Bukoba River is the true source of the Nile. Of course you could continue the logic and say the true source of the Nile is a raindrop being formed over the Indian Ocean or maybe that mythical butterfly flapping its wings in India...

The dark side of Bukoba, not shown in the first picture, goes back to 1978,79, the famous Tanzanian - Ugandan War, Idi Amin and the explosion of HIV/AIDS. All very bad things. At that time Bukoba, was a run down, lawless, out the way place. There where refugees fleeing Amin and his sadistic atrocities. There were breakaway elements from his his Ugandan army itching to cross back over the border an overthrow him. There was a loose collition of Congolese and other African nationals, mercenaries, arms dealers and agents all smelling the lucrative market of a coming war. Best of all there were 30,000 Tanzanian soldiers waiting for the command to head north, attack Uganda and get rid of their evil neighbor Idi Amin. Since Bukoba is the last big town before the Ugandan border it became the perfect staging area. As it turns out it also supplied the perfect environment for the rapid proliferation of a disease that turned into a pandemic by a virus that, at that time, had no name. If viri live to spread then the HIV virus won the jackpot when 30,000 0r so desperately sex starved males in their 20's got stationed here with money, free time,battle anxiety and who knows how may prostitutes brought in across neighboring borders to serve the troops. The virus had been here for ever. Over time it morphed, evolved and made the jump from primates to humans. ( not the way you think... people do eat and butcher raw monkey meat here). And people had been dying of a "wasting disease" here for decades or more. Post mortem exams and so called coroners cases are not a big item in Kagera. Cause of death is not on peoples minds in rural Africa and Death Certificates are still not used to this day. But the disease never had the conditions to spread in rural Africa. Now suddenly conditions became supercharged and the virus jumped from an out break to an epidemic to a full blown pandemic. And it got its kickstart in Bukoba. After the relatively short war, short enough so that carriers didn't have time to get get sick or die. Infected soldiers and others returned home to Rwanda, Tanzania and the Congo or even better got on jets to international capitals and served as perfect rapid vectors to disseminate the virus worldwide. .

The rest is, of course, history. The story caught up to me in 1981-2 when my mother in law, then a nurse at Sloan Kettering in NYC told me about a disease that was killing young men in her hospital and no one knew what was causing it or how to treat it. At the time I was as a surgical PA intern in NYC at Montefiore Hospital and Medical Center. I was on a surgical trauma team at the time and would return home every few days with under wear and socks "starched" with dried blood of trauma victims. We were a reckless, macho, aggressive bunch and never worried much about gloves or gowns in the heat of trauma resusitation. My favorite event was gunshot or stab wounds wounds to the chest. Always plenty of that ,thanks my new friends in the South Bronx and always plenty of blood. Anyway my mother in laws message was be careful about exposing yourself to other peoples blood and "wear gloves all the time". I kinda blew her off at the time. But since then I have learned always listen to your mother in law. How right she was and wow, how medicine and the world has changed since then. The cause for those changes started, in part, right here. And don't I wish I had invested in a medical glove manufacturing company back then.

The story isn't without controversy. Even though no one denies the fact that the first case of HIV/AIDS in Tanzaia was diagnosed in Bukoba, many argue to this day that the documented high incidenc rate of HIV/AIDS in Bukoba at the time and through out the 80's and 90's is an example of western biasness.

Some have written that the early HIV/ AIDs tests were inaccurate creating false positives from people who simply had TB. Other writers talk about the African immune system is weak because of malnutrition and repeated exposure to insect vectored parasites and this created more false positives. And still others point out that HIV virus a has always been here. This last point is true. HIV testing on old stored tissues and blood samples here as well as in the US show evidence of different strains of HIV virus infection dating back to the 1950’s and 60's and even earlier.

But the fact remains Bukoba was a fire storm. . Every virus's day dream is a epidemiologist nightmare. And if you want a model of how to create a sexually transmitted disease that becomes a pandemic and kills millions and brings out the reactionary ignorant fear in humans than Bukoba is your place to visit.