Dr. Gladys Kalema, barely out of veterinary school, looked at the tranquilizer dart she’d just filled with anesthetic, then looked again at the mountain gorillas. She counted three females, two juveniles, three infants, two black-backed adult males, and naturally, a silverback—the patriarch. This one, Gladys saw, approached five hundred pounds, about as big as they come. He had a conical forehead head atop a pumpkin-sized jaw, arms that bent entire treetops toward a wide mouth flashing with oversized canines, and long, thick black body hair, except for the saddle-shaped, silver-gray patch on his well-muscled back. His close-set, round black eyes ignored the nervous park rangers and fixed on Gladys, as if he knew what she was planning.
Two hours earlier, Gladys, the rangers, and a visiting Kenyan vet had hacked their way into southwest Uganda’s Bwindi Impenetrable Forest, following three trackers who’d been there since dawn. After lurching uphill, they’d finally found this band in a stand of corkwoods, the juveniles in the trees, swinging among the newest leaves, the adults lolling on the ground, pulling branches toward their mouths and within reach of the babies.
Less than half the size of Chicago, the Bwindi forest crowns a biologically fabulous escarpment containing more endemic species than anywhere else in Africa. The estimated four hundred Bwindi mountain gorillas account for nearly half those remaining in the world—the rest are scattered through Rwanda and the Democratic Republic of the Congo, mostly in the Virunga volcanoes thirty miles south, where those countries and Uganda meet.
Sometimes called the Switzerland of Africa for its 8,500-foot inclines, Bwindi owes its great biodiversity both to elevation changes and to being one of the oldest forests on Earth, dating back at least twenty-five thousand years, before the last Ice Age. It wasn’t until the latter part of the twentieth century that biologists knew that the apes raiding surrounding settlers’ fields were, in fact, rare mountain gorillas.
The gorillas might have claimed the opposite: they were the ones who’d been raided. Once, this cool forest and the Virungas’ skirts formed an unbroken rainforest canopy along the Albertine Rift, a western branch of Africa’s Rift Valley that forms the Uganda-Rwanda-Congo border. The sole human presence was forest-dwelling Batwa pygmies, who hunted bush pigs and duiker and gathered wild honey, coexisting peacefully with their primate cousins.
But over the past few centuries, Bantu farmers, who cut and burned forests for fields, kept coming. The jungle that filled the Rift was chopped into three discrete fragments, their gorilla populations isolated from each other. Later, when British colonials introduced tea as a cash crop, the fragments kept shrinking as dark green tea rows advanced. Gladys Kalema first saw Bwindi Impenetrable Forest in the early 1990s, when confirmation of mountain gorilla presence led Uganda’s government to elevate it to national park status. By then, Bwindi resembled a shaggy green toupee plopped atop fields of tea, cassava, banana, millet, maize, sorghum, and pink potato flowers that smacked hard against the forest’s edge.
And that, Gladys had guessed, was the source of the trouble that had pulled her across the country from Uganda Wildlife Authority headquarters in Kampala, the capital, where she’d just begun as the UWA’s first full-time veterinarian. A distress call had come from the Bwindi park rangers: gorillas were losing their hair, leaving patches of scaly white bare skin, big enough to be noticed by tourists. The whole reason for the national park was that Europeans and Americans would pay $500 apiece for a chance to glimpse these creatures. The park’s boundaries had been gazetted, Batwa pygmies had been expelled, and teams of biologists had trudged through Bwindi’s dense lianas and hardwoods, counting gorillas by measuring the different sizes of dung left in their night nests. Then they’d focused on acclimating two of the thirty-eight separate gorilla bands to human presence, creeping a few meters nearer each visit, not retreating when the silverback charged, hoping he remembered that he was a vegetarian.
After two years, they could get within seven meters without the silverback threatening or the other gorillas fleeing, and they began to bring in tourists. As gorillas and humans share about 98 percent of their DNA, they kept people and these lucrative primates a full seven meters apart: a bad measles outbreak among mountain gorillas in Rwanda a few years before had probably come from humans. It had taken more than ten years after the ouster of macabre dictator Idi Amin, who exterminated hundreds of thousands of his citizens during the 1970s, to finally convince tourists to return to Uganda, and they couldn’t risk something else going amiss.
Before the ten-hour trip over unpaved roads to Bwindi, Gladys called a doctor in Kampala. “What’s the most common skin disease in people?”
“Scabies.”
Gladys had done her veterinary studies in London; her mother was a Uganda parliamentarian who entered politics after Gladys’s father, a government minister, was among the first that Idi Amin killed after his 1971 coup. In England, people hardly ever got scabies. But hygiene was wretched in rural Uganda, and from what the rangers described, the gorillas might well have human scabies.
Now she would see. The rangers were used to viewing gorillas, but not to taking skin scrapings and blood samples from them. A six-year-old with a half-bald back was in the worst shape, but if Gladys approached him, the silverback was sure to charge. The rangers would be no help, she saw, and the Kenyan vet looked terrified: Kenya might have lions, but not 500-pound gorillas. Sighing, Gladys stood, all of five foot four, faced the silverback, and started clapping and shouting. During Rwanda’s measles outbreak, she had seen vets do this with gorillas habituated to humans a lot longer than these. She hoped it would work. The massive creature moved a few meters away, clearly upset, but kept his distance as she advanced and fired her air gun into the juvenile’s thigh.
Ten minutes later, she had taken samples from the sorry creature, so afflicted that he kept scratching under anesthesia. As he began to stir, to the rangers’ amazement the young veterinarian lifted the fifty-pound youngster in her arms and carried him back to the silverback. A few days later, the scabies diagnosis was confirmed—a relief, because ringworm would have been much harder to treat. The following morning, Gladys returned to the forest with enough darts and ivermectin to cure the entire gorilla band with a single dose.
She had a hunch how they’d been infected. Once, the fields and land beneath local wattle-and-daub huts and tourist lodges were part of their range. Habituated gorillas, having lost their fear of humans, ignored park boundaries more than ever, especially since farmers were growing bananas, whose succulent stems and leaves they savored. One reason people here had big families, Gladys learned, was because they needed kids to shoo gorillas from their crops.
But children couldn’t throw rocks and bang on pots day and night, so they’d make scarecrows, dressed in discarded clothing. Every one Gladys tested was crawling with the same scabies species. More curious than frightened, apes were examining the clothes and picking up mites.
In her report, Gladys wrote that people needed to learn basic hygiene for their own good and for the sake of wildlife that brought income to their communities. That wouldn’t be easy: nobody had toilets or piped water, and most couldn’t afford soap. The Uganda Wildlife Authority and the International Gorilla Conservation Programme asked her to design an education program for the Bwindi region. With a conservation ranger, she arranged workshops in eight villages for more than a thousand people. She came armed with flip charts. “Gorillas can get our parasites, our measles, dysentery, pneumonia, and tuberculosis,” she explained. Uganda had one of the world’s highest rates of TB. A quarter of the chronic coughers in communities surrounding the park tested positive, as did 5 percent of Bwindi’s park staff.
She was about to flip to a list of solutions, such as using charcoal to wash when there was no soap, when the ranger touched her arm. “Let them suggest solutions,” he said.
A city girl who’d studied abroad, she’d assumed that uneducated people were ignorant. They actually knew their own situation best, once they understood the problem. Gladys listened. They wanted closer health services. They wanted safe water. They needed more and better pit latrines, and covered trash heaps.
They discussed what they could do themselves and what required government assistance. They needed help scaring the gorillas from their fields, so that they weren’t putting their children at risk. That eventually resulted in “HUGOs”—human-gorilla conflict resolution patrol teams, paid with gum boots and rain slickers from a gorilla conservation NGO, cornmeal rations from park headquarters, and the respect of the community: a commodity that Gladys learned was especially prized.
After two years as veterinarian to the Uganda Wildlife Service and two more getting a master’s in public health in the United States and marrying a Ugandan telecommunications specialist, Gladys made a decision. To really safeguard mountain gorillas, she needed her own NGO: There was another human health issue to confront for wildlife conservation to stand a chance, and no one in Uganda’s government was doing it.
July 2010: Dr. Amy Voedisch puts down her ring forceps and speculum, removes her exam gloves, thanks the nurses for a good day’s work, and walks out of the Bwindi Community Hospital’s maternity ward into afternoon sunlight. In the courtyard, women in flowered cottons sit in the shade of the plastered walls. Most walked for hours to stay at the hospital’s hostel for mothers waiting to give birth. Amy saw four of them today. For the Uganda shilling equivalent of US$1.50, a woman can buy a voucher to cover prenatal care, her stay in the hostel, delivery, and postnatal care. The vouchers are subsidized by Marie Stopes International, Britain’s analog of America’s International Planned Parenthood Federation,1 although the program is running out, and they have yet to find a new sponsor.
The Bwindi hospital literally began under a tree. When the park was founded, about a hundred Batwa pygmy families had been evicted and left to fend for themselves on the bare margins of an already marginal setting. Landless, considered subhuman by the Bantu, their hunting skills and their uncanny ability to smell honey now useless because they couldn’t forage in their former forest home, they were among the poorest of Africa’s poor. Most Batwa children died, and life expectancy was twenty-eight years. In 2003, an American missionary doctor named Scott Kellermann held an impromptu outdoor clinic for the Batwa. But as he learned, beyond some drugstores, the hundred thousand Bantu in villages ringing the national park had no more medical care than the dispossessed pygmies. He ended up starting a foundation to raise money for a hospital.
By the time Amy, an OB-GYN from California in her early thirties, arrived, Bwindi Community Hospital comprised four reinforced concrete buildings. They included a maternity ward recently expanded to forty beds through a Japanese Embassy donation. Even as it was inaugurated, however, the Kellermann Foundation was already seeking bunk beds to double those numbers. In a country with one of the world’s highest fertility rates, where many men have multiple wives—the 33 million Ugandans will more than triple by 2050—Bwindi is on the high side of the national median, with families of eight children or more common.
A breeze rustles the flame trees as Amy follows a footpath from the hospital, past a billboard proclaiming that “Smaller Families Are Richer Families” and through a thicket where sunbirds dart at peach-colored hibiscus blossoms. It leads to a road filled with barefoot women clutching plastic jerry cans of water and balancing baskets of fruit on their heads. They are headed home from the dusty market at the center of Buhoma, the village at the entrance to Bwindi Impenetrable National Park, two kilometers from the Congo border. Amy’s destination, just across the road, is marked by a small white wooden sign protruding from the foliage. It reads, “CTPH—Conservation Through Public Health: Field Clinic for Mountain Gorillas and Other Species,” the NGO that Dr. Gladys Kalema-Zikusoka and her husband, Lawrence, founded.
A voice calls out. Amy doesn’t speak Rukiga, the local Bantu dialect, but she turns. A skinny woman who looks around sixty, walking with a stick between two banana-laden companions, is hobbling toward her, smiling toothlessly, arms widespread to embrace her. The day before, Amy delivered this woman’s tenth child, a daughter. Afterward, through a nurse-interpreter, Amy asked if she wanted any more.
The woman, who is actually thirty, had burst into tears. “Lord, no!” she whispered. She was HIV-positive, and already had suffered one stroke. “I’m too weak to go through this again.” Her husband, however, had other ideas. So Amy had explained that she could put something in her uterus that would keep her from conceiving for the next twelve years. “Right now, if you want.”
She wanted.
Her dark blond hair tied back in a ponytail, Amy stands before fourteen women and twelve men seated in wicker chairs under a thatched roof on CTPH’s patio. These are family-planning peer counselors recruited in surrounding villages, who are paid with soap and goats. Their job is to educate their neighbors about the availability and comparative advantages of condoms, daily birth control pills, Depo-Provera injections that last three months, and hormonal upper arm implants that last five years.
Gladys Kalema-Zikusoka and five of her staff are also present. There was no way, Gladys had concluded while getting her master’s, that she was going to save any gorillas if she didn’t deal with western Uganda’s double bind. Like so many of the world’s biological hot spots, for the same fertile reason that animals abound here, so do humans. Even with no city for hundreds of miles, nearly a third of Ugandans live in their country’s southwest quadrant around Bwindi, one of Africa’s most densely populated rural regions. More than half were under fifteen years old, and farms already had been subdivided so many times that most were now under a hectare.2 Eventually, Gladys knew, hungry people would convince park officials by bribes or threats to let them keep chipping at the boundaries.
To keep animals healthy, she had to keep people healthy. But the healthier people were, the more they survived, and the longer they lived. So many were already pressing up against the Bwindi forest that its gorilla habitat was imperiled, and with better health care, there would be even more. The logical thing was to limit the amount of healthy people, by providing them incentives, and the means, to limit themselves. Having earned the public’s trust in campaigns against scabies and tuberculosis, CTPH now added family planning. Managing the number of humans was the gorillas’ only chance.
A factor in Gladys’s favor was the importance of gorilla tourism to the area: 20 percent of park fees were shared with surrounding communities. Nobody wanted to jeopardize that. Everyone remembered the day in 1999 when a Hutu death squad that had fled into the Congo jungle after the Tutsis won in Rwanda crossed into Uganda, entered Bwindi Impenetrable National Park, and captured fourteen tourists and a park warden. Their targets were British and Americans, whose governments had supported their overthrow. The Hutus let German and French tourists go free, including a deputy French ambassador. The two Americans, four British, and two New Zealanders who got lumped in with the other English speakers they hacked to death with machetes. A warden who tried to stop them was bound and burned alive. It took three years for tourism to recover, while the entire region reeled.
“If we have too many babies and keep growing bigger,” Gladys explained, “people will cut more forest to grow more crops, we’ll lose the gorillas, and tourists will never come back.” Women needed little convincing. The local tradition of respect accruing from having many offspring was rooted only in men. Women simply accrued each other’s commiseration as their broods grew.
The concept of family planning doesn’t exist in Rukiga, so women soon learned to say it in English. But willingness to have fewer was useless without access to the means. One obstacle was Uganda’s president, Yoweri Museveni, a popular leader who had restored calm after years of bloody chaos under Idi Amin. Now in his second quarter-century in office, President Museveni believed that the surging economies of China and India were due in direct proportion to their vast populations—so the more Ugandans, he reasoned, the better off Uganda would be.
He saw the fact that the country’s population had doubled in just seventeen years as a window of opportunity to leap through: Population growth meant more people earning more money to buy more domestic goods, and paying more taxes to fund more education to teach even more people, and so forth. His government didn’t prohibit contraception: the health ministry even offered it. But its meager budget depended on foreign donations, and didn’t reach half the country’s fertile women. In 2008, only 6.4 percent of it was actually spent, much of it on handheld abacuses that the president’s wife advocated for calculating ovulation days. Known as Moon Beads, this variation on the rhythm method resembled prayer beads, and was about as effective in averting pregnancy.
“Yebare munonga,” says Amy, exhausting most of her Rukiga vocabulary as she thanks her audience of community-conservation health workers, as they call themselves. In English, she explains that she is a women’s doctor who came to share an important family-planning tool, one that lasts much longer than ones they already have. She pauses as one of Gladys’s colleagues translates. Like Amy, he wears a gray T-shirt with the CTPH logo: a mama and baby gorilla with a human couple.
Amy holds up a ParaGard T-380A, the American-made intrauterine device she has been inserting since her arrival earlier in the week. She passes the T-shaped IUD around. It is an inch long, made of milky polyethylene, with two nylon monofilaments dangling from the end. Fine copper coils circle the stem and the arms of the T, which are about 1/32 inch in breadth. Its cost here, courtesy of Population Services International, a U.S. NGO, is under a dollar.
The women heft it: it is practically weightless.
“How does it work?” one asks.
“The copper,” Amy explains, “releases ions that block sperm from reaching the egg.” A lengthy translation ensues.
“How long does it keep working?”
“Twelve years. You can put a new one in when the old one is removed.”
“What about side effects?” This was always the biggest concern. Many birth control myths, often traceable to men, circulated in Uganda, such as women on Depo-Provera retaining so much menstrual blood that their uteruses rot.
“An IUD has none of the side effects of hormonal methods, like headaches or weight gain or mood changes,” Amy replies. “In some women it does make menstruation heavier.”
Groans follow the translation. “But that usually normalizes after a few months. In my experience, very few women are unhappy with it. If heavy bleeding persists, it’s easily removed by these cords that hang into the vagina.”
“Can the man feel them?”
“The strings are clipped, and they curl up where he can’t reach them. They’re invisible.”
From a bag she produces an oversized leather model of a uterus, Caucasian-flesh pink. Everyone titters. Using an instrument resembling a small forceps with a loop at one end, Amy demonstrates how easily the IUD is inserted and removed.
“It doesn’t move around inside you?”
Amy shakes her head. The advantage, she explains, is that this is a long-term method that’s completely reversible. No need for another Depo shot every three months, no trek to the clinic for a new implant. A young woman might insert one until she’s ready to have a baby. After giving birth, she can replace it, then remove it when she wants to have another. An older woman with enough children could put one in and leave it for the next dozen years, at which point she wouldn’t need contraception anymore.
“And,” Amy adds, “one of the easiest times to insert an IUD is in the forty-eight hours after giving birth, when you’re already in the hospital anyway.”
She pauses to let this sink in. “And the husband wouldn’t have to know?” asks a woman swaddled in orange.
“Not,” Amy replies, “unless his wife tells him.”
Everybody grins.
Several peer counselors here have been trained to give Depo injections in their villages. None is qualified to insert an intrauterine device, but they can refer women to the hospital, which will offer postpartum IUDs for free. They scoot their chairs into groups of three to role-play referrals. Amy gives each a scenario. In one, a twenty-seven-year-old woman with tuberculosis wants long-term birth control. The proper response is to counsel her to get an IUD, because there are no hormonal side effects to complicate her illness or conflict with other medications. A twenty-year-old woman, eight months pregnant, wants space between her first child and subsequent births—what kind of family planning should she use? In this case, all methods from condoms to chemicals to intrauterine devices should be explained, so she can decide which fits her circumstances best. But it’s a good idea to mention that, other than requiring a hospital visit to remove it, a postpartum IUD is the least worrisome. Once out, she can get pregnant the next time she ovulates.
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 Goodall, 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 Louis 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.
“You could climb to the escarpment and look east: chimp habitat as far as you could see, green rolling forest. Gradually those forests have disappeared.” Tanzania’s Gombe National Park, where her institute is based, is down to twenty square miles, and fewer than one hundred chimpanzees. Only on the steepest surrounding slopes, where farmers desperate to cultivate and women desperate for firewood can’t reach, are there still trees.
She turns and glances at the oil executive. “And now,” she says, “we’re killing ourselves to try to save the Albertine Rift from the oil companies.” Again, she smiles, exactly like before, and everyone laughs. She does not mention that apart from global warming, the two biggest nonnuclear environmental disasters in history are ones that oil companies have left in the jungles of Nigeria and Ecuador.
She ends with a fund-raising appeal for Roots & Shoots, an international environmental education NGO she has founded for young people in 120 countries, lest they lose hope in the future.
“Let’s help as many young people as we can grow up with the right values. And,” she adds, “let’s see if we can level out human population growth, to have optimization: the right number of people living in the right places.”
An auction follows for a portrait of a chimpanzee with Jane Goodall, and for signed copies of her memoirs. The oil executive and his striking blond wife outbid everyone for the portrait, and Jane resurrects the smile once more as she poses for a photo with them.
Lynne Gaffikin wins one of the books. “It’s for you,” she tells Gladys, who goes to the podium, where Goodall inscribes it. The elegant, elder woman who has devoted fifty years to saving the world’s chimpanzees, only to watch four-fifths of them disappear, hands her life’s story to this young veterinarian who is trying her best for the world’s last few hundred gorillas.
The smile of recognition they exchange is genuine.