International Fogarty International Center/Ellison
Clinical Research Fellow Issues
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I am currently (2005-06) an FIC/Ellison Fellow in Uganda and I decided to try to keep a list of the issues that I dealt with on my journey through this whole experience and process. As such, these are just my thoughts and the way that I dealt with the issues that arose. This site is not sanctioned by FIC/Ellison, but I hope it provides some answers and advice on how to deal with things throughout the process because since this program is so new, often times, it felt to me like I was not getting answers to the questions that I felt were pretty important. I have sort of organized this into the sections of the Fellowship process. Some of the issues dealing with settling into life in Uganda or abroad are still rough as I am going through that process myself right now. If you have additional questions that I have not covered or want more detail, please don't hesitate to ask: kyle.luman@ucsf.edu
The most confusing part of the application to me was the home institution mentor. Officially, there is not much of a role for that person during the interview process or during the year abroad. They should be kept up to date with e-mails periodically during the year abroad. I guess that they really are supposed to help when you return to your school after the year abroad.
If selected for an interview, you probably will be asked to rank the various sites where you would like to interview at. I think they will try to guarantee that you get an interview at your top site, but anything after that is based on what is available. The Peru sites were the most highly ranked sites last year, so some who ranked them 1 & 2 only got to interview at the top spot and did not interview at their second spot. That goes for the other sites as well. I think I interviewed at spot 1, 3, 5, etc. I had ranked Uganda 8th, but by the interview time, I was really quite interested in it, so I was very disappointed that I was not assigned an interview slot there. I was able to add on an interview with Dr. Whalen for Uganda as his last slot was open and he was willing to let me interview. Interestingly enough, that is where I ended up. My point here is just to let you know that you are most likely not guaranteed an interview with all the sites that your rank, no matter how high you rank them (with #1 being the exception – although they may change that as well).
I was caught off guard at the first of my interviews when the PI asked me, “So, tell me about yourself”. I was expecting a question that cut through a little of the surface material that seems to come out when answering that question, particularly when we have prepared our applications and there is so little time for the interview. That being said, quite a few PIs asked that question, so you need to think of a way to answer it in a relatively short amount of time, but bring up the salient points that you think should be brought up – the ones that made you want this fellowship and got you selected for an interview. Once I got that relatively short synopsis of my life down, I enjoyed these interviews because it also ended up bringing up the major points that I thought should be discussed. One PI asked me to start with my High School education when answering this question. Some other PIs started with a question that dealt with the meat of your application and really got into a deeper discussion much quicker. I enjoyed those interviews more, but both styles were present.
In general, the interview experience is a good one, but it can be a little stressful. There are a bunch of you there and everyone is asking, "So what is your top choice?", "Where are you interested in going?", etc. The first year, they only invited enough people to fill all the spots, so the interview was just a way of matching. The second year (my year), there were about 50 individuals interviewing for 30 spots which created a little more tension and anticipation.
The weather was decently warm on the weekend prior to the interviews and on Monday (only needed a light coat), but by Tuesday morning it was snowing lightly and by lunch had dropped ~3-4 inches of snow and was quite cold with just my California light coat.
health form: there is no health form that you need to have filled out like all of the FIC sites state on the web. I was told that you need to have a MD check your health, but there is nothing the physician needs to do to communicate with NIH/FIC.
airline tickets: some sites have you purchase them and reimburse while some purchase them for you. Either way, if you are flying from a US airport or over US territory (including water), then you must use a US carrier or one of their affiliates (Northwest & KLM, etc.).
computer: the word from FIC is that there should be a computer for each Fogarty fellow (US & foreign) that will be left at the foreign site for the next fellows, but this varies widely by site. Some sites purchase a computer with funds from some other NIH source and so those computers belong to the site and are left at the site for the following years. Other sites use your expense stipend (~$6,000) to purchase the computer and then they let the fellow keep the computer after the year is over. Some other sites might use your expense stipend to purchase (or reimburse) the computer, but then still keep the computer for next year’s fellows. This variation can be frustrating and is the source of confusion. From my perspective, if they are going to use my expense account, then I should get to keep the computer. Otherwise, next year’s fellows’ expense account will be spread further than mine was able to be spread – great for next year, but not exactly equitable. My site was going to do the 3rd method of buying computers, so I just purchased my own (cheap) laptop that I can control completely during the fellowship and after.
health insurance: NIH requires this as your med school also probably does (not to mention your parents). Usually you can get this from your home med school or from the US Fogarty site.
property insurance: this was not really on too many of the fellow’s lists of things to secure prior to heading to our countries until we heard that the folks in Vellore were vandalized twice during the first year of the Fogarty Ellison program. Given that we all act on anecdotal information, many of us tried to find out where we could find insurance for our computers and cameras, etc. A couple of fellows were able to get insurance added on to their home owners insurance. Obviously, most FIC fellows do not own homes or condos though, so some tried to see if they could add on to their parent’s property insurance. My wife and I were able to get this insurance through Geico’s WorldRisk insurance program for quite a reasonable price.
evacuation insurance: this can be purchased through SOS or some other company. My med school purchased this for me through MedJetAssist and then I was able to add my wife on by just paying the difference between the individual cost (which my school paid) and the family plan cost. It seemed like it was quite reasonable.
malpractice/liability insurance: this is something that NIH does not require at the present and neither did my US site, but my home institution would like all its students who have any patient contact internationally to have this insurance even though the possibility of a law suit is very minor. If a patient did file a suit, it seems that they might be able to name the international hospital/clinic, the NIH, the US Fogarty site, the US home site and the med student. This might be required sometime soon for this program. That being said, my home institution has no way of breaking this cost out of the overall cost of tuition, etc., so the only way to get this insurance is to enroll for the whole year which is an impossible solution. Anyway, until the med schools (either your home or the US Fogarty site) break out the expense or the NIH comes up with a way to provide this, there is no good way to get this as an individual.
school enrollment: this depends on several issues. 1. Do you want credit for any of the time spent abroad? 2. Is your school set up to allow you to receive credit for the time spent in this fellowship? 3. Do you need to be enrolled for any other reasons (loan deferral, health insurance, evacuation insurance, etc.). If none of the above applies, then you should have no problems with this issue. Otherwise, this can be quite an issue. I had to withdraw from school for the summer, then reenroll for the fall (to get credit and some insurance) and then withdraw again for the winter & spring as I did not need credit for the whole year and I will not need the insurance at that time anymore, either.
money/banking: you will probably need to be careful with how you spend money leading up to the initial month(s) in the foreign country. You may have to front the money to pay for airfare to DC and possibly also to the foreign country. It may take a little time for these expenditures to be reimbursed (longer than 5 weeks in one particular circumstance - this depends on the individual US sites). You may want to purchase a new camera or other photography equipment or computer, etc. for which there is no reimbursement. Some fellows purchase a vehicle for use in country as well and you won’t get that money back until you leave in a year. In addition, there are start up costs when you first arrive. Some housing is not furnished and at least one landlord in Uganda requested 6 months rent up front (he says that is common, but our landlady did not mention this). This all equates into a financial situation that might be a little painful upon arrival, especially if you do not get your first monthly stipend until the end of August or worse (see below). It all works out in the end, but I am just trying to give fair warning.
Some possible ideas that might help this situation. 1. encourage the sites to get us on the payroll on time or 2. maybe we could all be NIH employees so that the administration is all done at one site and not at 15+ sites with varied ability, etc. 3. give us the $6,000 expense money up front and not require us to keep receipts for our flights, tuition, hotels, etc. These might not be possible for any number of reasons.
One almost "life saving" change that was made between the first and second year, was FIC gave us our meal allowance money up front for the time in DC. Most people did not spend all of that money on their meals so they had some extra cash in hand when they traveled to their country. This helped to offset some of the initial financial issues.
Stipend: the monthly stipend is direct deposited in your bank in the US. You are actually an employee of the university that is associated with your foreign site (in my case it is Case Western Reserve University) and you have to fill out W-4 forms, etc. We did not get our first check until the end of August, but we expected it at the end of July. It sounds like the NIH's plan was for the first payment to be at the end of August. Hopefully that will be different next year. Some sites started receiving their money at the end of July, but unfortunately, some sites didn't get money until much later so there is significant variation. Hopefully those wrinkles will have been ironed out. What I might suggest is to contact your PI and see if you can fill out that W-4 paperwork in May or early June to get that through the university’s payroll system.
Cash: As you may know, some countries are very picky when it comes to changing money. They money changer will give you a worse exchange rate for some bills. Many places give a worse rate for Traveler’s checks and small bills ($20 or less). In Peru, they don’t like bills that are creased or have marks on them. In Uganda, they don’t like bills that older than a certain year (bills that are creased or look used do not matter). I am not sure what the magic year is, but 1996 is too old and currently 2000 is OK. For Uganda, I would try to bring bills that are as new as possible. No older than 2000 if you plan to change them into Shillings or use them in Ugandan game parks. If you use the bills for rent, then the date and denomination might not matter.
Credit Cards: You can withdraw money using your visa credit card at some machines throughout town, but this is considered a cash advance and thus has an associated fee that will most likely be charged. You can avoid the immediate charging of interest if you completely pay off the visa card and putt extra money on the account (have a positive balance), but there is still pay a 2% cash advance fee.
We have traveled in Kenya and Tanzania and the credit card (a Visa) works well at the Standard Charter and Barclays banks that are rather ubiquitous in East Africa.
ATM/debit/check cards: you need to have an ATM card that is on the PLUS system to be able to withdraw you money with this method in Uganda at this time. There are largely two systems worldwide, the PLUS system and the STAR system. I don’t understand this really. There also is Cirrus, which is linked to one of these (STAR, I think). Anyway, evidently, you need to have a PLUS card here in Uganda. My bank was on the STAR system, so I opened a new account (B of A) and had my Fogarty stipend electronically deposited in the new account so I avoided monthly fees, etc. The B of A debit/check card charges $5.00 per transaction and the local bank also charges some for the service as well. Thus, the charge ends up being more than 2%, so I only use my credit card as described above. The only banks in Kampala where even this system works are: Standard Charter Bank (Kimathi Rd near the Sheraton) & the Barclay's Bank branches (Kampala Ave, Garden City Mall, etc.). We recently discovered that B of A entered into a new agreement with Barclay's bank and now there are no charges for withdrawing money with our B of A ATM card at Barclay's banks. This is the best way to go, obviously.
Checks: the way last year’s fellows obtained shillings more often than not, was to write a check to themselves from their US bank account and a bank in the Sheraton or the Sheraton itself would cash it giving them Ugandan shillings. They would only cash a personal check made out the owner of the account evidently.
Transferring funds from place to place: Since my original bank was not on the PLUS system, I needed to open an account at a new bank that was on the PLUS system (B of A, others) in case I wanted/needed to withdraw money with my ATM/debit card. With multiple accounts, you can imagine it might be necessary to move money from one bank to another. This is where the internet comes in very handy. In order to do this, I actually used a 3rd bank which does not charge to transfer funds. Some banks charge when you move funds out of their bank and others don't have a system set up to transfer funds between banks. ING Direct, Inc has a good online system that helps with the transferring of money from bank to bank and they have good interest rates as well. Start this process early as getting checks and linking accounts can take a little time. The other way to transfer funds is to write a check to yourself from one bank and then have your parents or other individuals stateside deposit it in the other bank. This takes a little more planning and time.
Taxes: the stipend is likely to be taxable as a regular paycheck would be. In fact, the university should withhold taxes from your monthly check. Officially, from the NIH, you are supposed to consult a tax professional for this advice, but none of us are likely to have access to those individuals, so here is what I am doing. Now, the amount that we are paid is enough to live on, but is not enough to really get taxed heavily, so we should end up getting most of the money that is withheld back when you fill out your forms in the spring. I have recently found out that since we are employees of Case Western, Ohio state taxes are being withheld. I am not sure if we can get these back - as I am sure we still have to pay California state taxes as well. I am using TurboTax to fill out the tax forms and having all my financial documents (W-2, etc.) scanned in the US and sent over e-mail. I think I should be able to file everything electronically. Hope it works out.
Certificate of Biomedical Research understanding: each fellow is required to do an online course reviewing the ethics of research. This is required by all research funded by the NIH. Make sure you keep the ‘certificate’ at the end of the course so you can provide a copy of it to the Fogarty center as well as your US Fogarty site as both need verification prior to you starting work on any of the research protocols. I went through the JHU public health training which sufficed for both NIH and Case Western.
Attire for the NIH orientation:
“Casual is fine. These are working sessions. But clothing should be appropriate to the surroundings. Until proven wrong, I trust your judgment. There may be some high level people talking to us and for those sessions a bit more "business casual" would be in order. We will give you fair warning.”
That was exactly what we were told via e-mail, but when we arrived in DC, we were asked to sort of dress up pretty much each day. I don’t think anyone ever wore any shorts to the sessions, although many of us were planning on it when we arrived. By the end, some were wearing Levis and t-shirts. Of course, some individuals did not really go home after the orientation, so they had to wear what they were planning on wearing for the rest of the year abroad. The weather was hot and very muggy which made dressing in pant/slacks and dress shirt all the more ‘enjoyable’ as you were sweating by the time you arrived at the session each morning.
Projects: all participants (US & foreign fellows) are broken up into about 6 groups to come up with a research idea and begin to develop an application for funding for that idea. This means looking up the literature, developing methods, sample size, timeline, budget, etc. This was a helpful exercise and a good way of getting to know some other participants that you might not have been hanging around with.
Visa: If you need to or want to personally go to the Ugandan Embassy, you can get there by taking the Metro red line to Dupont Circle, then walk to 16th St and taking the S2 or S4 bus up 16th. If you cross Military Ave/Missouri Ave, you have just gone a hair too far. It is near the corner of 16th and Manchester Ln NW. The embassy is located in a residential looking house. One-year multiple entry/exit visa costs $190 and you need 2 passport photos, your passport and the filled out visa application. If you mail in the application, include all of the above along with a self addressed stamped envelope as well. You can get a visa once you arrive at Entebbe, but you might not be able to get 1-yr multiple entry/exit status and you don’t really want to spend any more time in line when you are that tired. You can also do this by mail, the info is on their website.
Post DC Course: After the course was over, about 15-20% of the US fellows essentially left for their site from DC., while the others probably went home to pack and then left soon after. The Ugandan site was one of the only ones that had their US fellows visit the university in the US prior to leaving for the foreign site. We spent Monday-Friday in Cleveland talking with the US project staff about the study protocols, assays that are being run and general information about Uganda. It was very helpful, but 5 days was slightly too long as some of the info began to be repetitive by Thursday afternoon. Housing during this week was paid for from the expense stipend.
Flight: it was tough to find a ticket for less than $2,500. We finally did on Orbitz. It was with Continental from Cleveland to London (Gatwick), then London (Heathrow) to Nairobi, then Nairobi to Entebbe for about $1,500. I almost wonder if it would have been better to use a travel agent this time. Of course, my colleague used the CWRU travel agent who screwed up on his ticket, so our time spent scouring the web was worth it. Maybe even check into an around the world ticket that you can complete on your return trip to the states. You might end up getting a cheaper ticket in the end if you are able to buy a round trip ticket all at once. I did not know exactly when I wanted to return when I bought the ticket, so that seemed premature to me.
Actually, we are glad that we purchased our own tickets and are getting reimbursed. This gives us the opportunity to chose the return date when we are closer to May. In addition, it looks like we might stop over in a few places on the way home (Dubai, Egypt, New York? - we'll see) which might have been more difficult to plan or arrange with a round trip ticket a year in advance.
Uganda specific info: during the week, there are British Airways flights directly from Heathrow to Entebbe, but during the weekend, you have to fly through Nairobi. If you are flying from Cleveland, I believe you might not have any other option than to fly into Gatwick and transfer airports. If you fly out of some other US airport, you might be able to fly into Heathrow. In talking with the Case folks, a long London layover during the daylight hours seems standard. There seems to be an increasing amount of flights and business between eastern Africa and UAE (Dubai). Emirates Air is another airline to check out. If you do go through Dubai, you should buy a cell phone there as they are much cheaper than here in Uganda (we hear).
What we have found after living here for 6 months is that Nairobi is really not too far away from Kampala. If you are finding it difficult to find airfare at your price into Entebbe, check out Nairobi. You could then catch a bus from Nairobi to Kampala and save yourself some money as the expense of a little more time. This might be too much of a ready though having just landed on the continent. We are thinking of leaving from Nairobi, though. The bus ticket is about $25 and a transit visa through Kenya is $20.
Transport: one of the TBRU project drivers picked us up from the airport which was very nice.
Initial Housing:
Project House (CWRU): It is expensive ($50/day/person), but has some amenities: large rooms, 3 meals each day, TV, dial-up internet access, project cars ‘sleep’ here over night so it is easy to get rides in the morning and home at night, etc. We stayed here for the first few nights because there was no room at the other places. This was advantageous because the PI was staying there for those nights as well, so we had some good conversations.
Makerere Guest House: this is less expensive (~$38/day/person) than the project house, but not as close to Mulago as the Mulago Guest house, but is still within walking distance. This has a more active social life as there are other students here, etc.
Mulago Guest house: this is the cheapest ($18/day/person) of the three options and is the closest to the clinic. You share bathrooms and breakfast is included (make sure you request eggs if you want to feel as if you have eaten something substantial).
Other places: You could easily just find a hotel to stay at in your price range when you arrive in Uganda by using a guide books. That is what we usually do when we travel, so that way there are no surprises financially. We did not do that this time, but in hindsight it might have been better.
This initial housing arrangement was paid for out of the expense stipend and the Case Western administrators were able to do that directly between Case and the guest houses.
Guide Books: There is no Lonely Planet book that just covers Uganda. We think that the Bradt guide is the best if you want one book that just covers Uganda. We also bought the Lonely Planet guide for East Africa which was very helpful when traveling in Kenya and Tanzania.
Issues to consider: reliable electricity & water (hot?), internet connectability, kitchen furnished or not (pots, pans, oven, refrigerator, microwave, etc.), other furniture (bed, couch, etc.), proximity to the work site, security, quiet area, number of Marabou storks J
Location: you do not really want to be living on the south side of Kampala as Mulago is on the north side and there is pretty bad traffic in the city center during rush hour. You can probably live on the east and west edges and avoid the center of town by taking less major roads if you are driving. If you do not have a vehicle, then these are probably the best neighborhoods to live: Nakasero, Kamwocha, Wandegeya, Makerere, Bukoto.
Finding it: There are at least 3 general methods.
1. You can use a real estate agent. My wife tried this and used someone who came highly recommended and did not have a great experience. What the agent shows you is only those places which will pay the agent a fee for finding them a renter, so by definition, this is only a fraction of the market. It so happens (not surprisingly) that it is the upper end of the market. There were some unfurnished 2 bedroom apts for well over $1,000/month without a real obvious reason for the high price.
2. Look at the message boards message boards around town where the folks who do not want to pay a real estate agent place ads listing available things like apts and vehicles, etc. These locations are at the Shoprites, Kisementi – on Cooper Rd off Acacia Rd, Blue Mango, Kabira Club, Garden City Mall, etc.
3. Many ex-pats have found housing by word of mouth. This can be the best way to find housing, but the most unreliable. You might be able to housesit for someone who is gone for a time or sublet for someone who is gone for a year or rent a room from someone with too much space, etc.
Cost: Furnished apts cost more, but since you are only here for 10 months, the extra might be less than you would pay if you had to buy everything, especially if it has dishes, refrig, stove, TV, etc. Some landlords may require 6 months payment up front, I am not sure how common this is in Uganda. You might get a slight discount on rent if you offer to pay for the whole 10 months up front. We paid for the whole 10 months and only got a $150 discount ($15 per month). The downside of this is that you can’t leave partway through since you have already parted with your money. If you have transportation, you could possibly look at places that are on the way out of Kampala and thus are cheaper. I heard that it might be possible to rent a house for quite a reasonable price, but then it might be unfurnished and without a guard, etc.
Prior Fellows’ Housing:
2004-2005:
A: 2 bedroom apt in Wandegeya Flats for $275/month. Utilities, maid service, security not included. This is within walking distance to Mulago. This was found by subletting from another ex-pat (who works for the Makerere Univ.-UCSF collaboration) who was leaving for a year, but planning on returning. This was very nice timing, but clearly things won’t work out like this for everyone.
B: 1 bedroom apt in Nakasero for $450/month. Utilities, maid service, security included. This is also probably within walking distance of Mulago, but this individual had a vehicle and drove more often than not, I believe. This was found by looking at various places around town where people post listings of available places.
2005-2006:
A: 2 bedroom apt in Kamwockya (Kamwochya) Flats for $425/month. Utilities and refrig and stove/oven included. This is within walking distance, but takes about 30-40 minutes, so taking a matatu is probably better and it is just a straight shot down Kira Rd on one of these vehicles. This was found by looking at the ads in the newspapers.
B: 2 bedroom apt in Bugalobi Flats for $485/month. Utilities, maid service once a week, security, fully furnished (dishes, microwave, refrig, stove/oven, beds, couches, etc.). This is not within walking distance and it takes 2 matatus to arrive at Mulago. If you live out here, you probably should plan on having your own transport. This was found by looking at the ads placed at the various spots around town.
Food/cooking: this actually takes a while to get used to, at least it did for us. We have a stove (cooker) with 3 gas elements, 1 electrical element and an electrical oven and a small frig. This allows us to do a fair amount of cooking. We also eat at restaurants, the best of which are some of the Indian ones!
- where: rounds at Mulago hospital, seeing pts at Komamboga (a health clinic in a rural area of Kampala), National TB & Leprosy Program clinic, rounds on the TB wards, TB & HIV clinic, the TB Research Unit (TBRU) clinic, etc.
- what: the only place out of this list, where you can see patients on your own and then present them to a more senior person is at Komamboga. The other places are more observation and following and relatively little direct care, although on rounds, you can practice some physical exam skills, ask questions and sometimes you get pimped a little as well.
- walking: the city (the part you want to spend leisure time in) is actually not that big and walking is a good way to get to know it fairly quickly. It seems counter intuitive that you would get to know it quickest on foot, but I think you do.
- boda bodas: riding behind the driver of a scooter or motorcycle. This is relatively cheap, but seems dangerous, although many people do it.
- matatu (taxi): these are the beat up minivans that put at least 14 people inside and drive regular routes. These are cheap (500 Ush for the longest ride) as well and are safer than bodas. These will save you a lot of time once you figure out what the guys are saying when they call out where they are going.
- taxis (special hires): these are quite convenient, but are the most expensive.
- personal vehicle:
Officially, you have 4 weeks of vacation that you are supposed to take in June (the re-acculturation process) as well as the national holidays wherever you are located. Unofficially, you have to be able to see the country where you are located.
My advice is the hit the ground running at your site and work as if this is a job. (Now, "hitting the ground running" will most likely be a slow process, so be patient.) Show that you are serious about being at your site and doing research, etc. Wait to take a long trip until Christmas and the second half of the year, if at all possible. Here in Uganda, many of the places to visit are close enough to do so over weekends, especially if you take a little time from a Friday afternoon. I have taken off after lunch on Friday a few times. On these trips, we have gone to Murchison Falls National Park, Sipi Falls, Lake Mburo National Park, Port Portal, etc. Each time, we returned Sunday afternoon/evening. There are more details of these trips in the blog section, which you can read if you want. Going to the Hairly Lemon or Samuka Island or rafting on the Nile (i.e. Jinja) only requires a weekend as Jinja is quite close. You can also make it to the Ssese Islands, Mbarara, possibly Queen Elizabeth National Park and other locations in a long weekend as well. Some folks have taken a 4 day trip (Friday-Monday) and traveled to Rwanda. They say that the two days in Kigali and environs is enough as the country is quite small.
There are quite a few holidays here in Uganda. The main one being Christmas so far. The clinic shuts down for almost 2 weeks over Christmas, so we took off for Tanzania (Zanzibar, Christmas with friends in Dar, and the Ngorongoro Crater, Serengeti and Lake Manyara National Parks) and I only missed 4 days when the clinic was open, but I was gone for a little more than 2 weeks.
Everyone (well, at least 50% of the Kampala residents) has a cell phone and you will get one quite soon after arriving. There are 3 different providers. MTN (South African company), CellTel and Uganda Telecom (the government run company, also called Mango). CellTel is the least popular in Uganda, but does have the advantage of being throughout all of East Africa (Kenya and Tanzania, at least).
At home: if you have a land line in your house, you can get dial-up internet access through InfoCom or Bushnet. The Project House has it and it was surprisingly satisfactory. It was faster than our wireless access is at Mulago sometimes. If you don’t have a land line, you might be able to have one put in. We have heard that there is one other possibility. You can get a data transfer box from one of the telephone companies and this basically gives you wireless access (that is, your computer is plugged into the box, but there are no wires from the box to a network). Like all other types of access, this can be slow when use is heavy in Kampala. I have heard that this last option costs ~$200 for the box and then about $40 a month.
At work: there is a wireless network at the TBRU (TB Research Unit) at Mulago, which can be finicky at times, but when it is working, it provides ~54Mbps access to the net which is satisfactory. You can’t access the wireless network everywhere, but there are some select rooms where it is best. There are also a couple of hard lines that you can use to plug into your laptop which gives a little faster speed, if the access is fast at that time in general. It definitely would be advisable to have a laptop that is wireless enabled. This is satisfactory most of the time, but on some days, neither method gives good service at all.
Around town: there are many internet cafes around town where you can use their computers. The typical price for access right now is about Ush 3,000 per hour (1,770 Ush/1 US$). There is no place that has the access that DSL or better provides in the US, and they don’t compare to the speed of the cafes in Mexico or Peru, etc. There were various cafe's that were offering wireless access for free as long as you paid for some food or drink. That ended a while ago and now many are charging about $6 per hour!! I can't imagine many people are using that anymore. There is still one place, Cafe Pap that is providing 2 hour access codes if you buy some food or drink. That might end soon as well.
The word from the NIH is that trying to learn the local language is really a good thing and that this would be a reasonable thing to get reimbursed for out of the expense stipend, but that ultimately it is up to the individual PI whether they will reimburse you for that expense or not. Some sites will reimburse for this, others might not.
White coat, ID badge, etc.: Your white coat is an important item to bring if you plan to see patients at all. It is an instant sign of an MD which goes a long way toward allowing you to work clinically.
Work clothes: Ugandans really pride themselves on looking good (‘smart’). I was told ahead of time that I would need a dress shirt and tie when seeing patients, but I sort of blew that off as I did not want to bring that many nice shirts, etc. It is true. If you dress like you think you should because you are in Africa, you will feel very underdressed and at times a little sloppy. I have never seen as many dress shirts with the cuffs turned up once and tied with cuff links as I have seen in my first week here in Uganda (obviously I was never an investment banker).
There was a comment in a magazine here that I recently read that said, “Why do foreigners have to dress sloppy, like they are in their own backyard?” I think that there are two sides to this coin. The first being the Ugandan side and I agree that it would probably be nice if the foreigners looked a little nicer or cared a little more about their appearance like the Ugandans do. On the flip side, Africa is hard on clothes and we probably don’t have the time or money to buy a whole new wardrobe either for Africa or for the US when we return. Then there is a little commentary about the issue. Looking nice and dressing up has actually moved way beyond just being presentable. It is a status symbol and a way of showing others what you are worth, etc. Many Ugandans are too preoccupied with this issue. This small example with give you a taste of how pervasive this issue is. The house help that is include in our monthly rent came to clean and wash yesterday for the first time. He walked in dressed in slacks and a nice dress shirt – nicer than what I was wearing to work. But, before he started to work, he changed out of these clothes and into something more sensible for the day’s work. There is nothing wrong with changing clothes when you get to work (surgeons do it all the time), but what I think this illustrates is that the man did not feel comfortable dressing in his work clothes while he traveled from his home to our apt.