Sunday, June 20, 2010

Sunday, June 20th

This weekend we travelled to Sipi Falls, near Mt. Elgon. We left around 7:30am on Saturday morning and after a boda boda ride and two matatus later we arrived at the Crow’s Nest (hostel like accommodations started by a peace corps volunteer) around 1:30pm…it was a crazy ride and very uncomfortable. However, the view and the hiking was worth the trip. We had lunch when we arrived and then hiked around to the top most waterfall and continued down to the second highest when we suddenly found ourselves in an absolute downpour! We speed walked back to the hostel and were soaked! Fortunately, we had a hot shower and even though I didn’t have super dry clothes to put on…the hot chocolate made up for it.

The waterfalls come from a spring up on Mt. Elgon, which I believe is the highest volcano in Africa at maybe some 14,000ft? don’t quote me on that. Anyway, the people in Sipi live and farm on the hillsides and it is incredible. The beauty is awe-inspiring. It is lush and green, and the views astonishing.

The waterfalls are extremely powerful and people collect water, bathe, and do laundry in the streams between the falls. I went hiking again on Sunday morning (you have to have a guide to navigate you through the small paths hidden by tall crops such as corn and matooke. There were also eucalyptus trees and cabbage. One of my favorite photos is from the top most waterfall where the light hit the spray to create a rainbow…just beautiful. My second favorite is probably the bee in flight…the insects here are HUGE! On Sunday, I also went a little way into a cave on the hillside where we saw a few crystals…not many and then I saw a bat fly by and said, I’m out of here!

This week we have our first large sensitization on sanitation and safe water. I’m excited to see the turnout and be able to start distributing WaterGuard (chlorination purifier) to the village members. I also met with Nurse Nalwoga at the health center on Friday of last week to talk about my Nutrition sensitization and she like my ideas. I figured we would have a large meeting and then find 3 or so women who have a keen interest in nutrition to train even further. We would then have them lead smaller group sensitizations within their area of the village on how to have a balanced diet, make baby food, nutrition for pregnant women, etc. I hope that it works out although…you never know here in Africa. There is no rush and rarely efficiency…so we’ll see!

Friday, June 18, 2010

Friday, June 18th

Today we visited a couple of schools after a morning meeting with the LC 3 (sub county political leader) and Nurse Nalwoga (nutrition lead at health center). We visited Bulanga Children’s center (school and orphanage) just a few minutes north of our village, Namungalwe Rural. The headmaster had come to our front door earlier In the week to introduce himself and invite us to visit his private school. So we went this morning and the children were so so excited to see us. They were the most respectful and polite (as schools we’ve visited have been) and absolutely adorable! They ranged in age and after introductions sang us a song and some of the children danced…one of them I found out later was one of Esther’s girls (the women who gave us the yams )…so so cute (she has earrings on in the video). The older kids also recited a poem on Aids, which makes me think at least they are talking about the problem as most of the village is in denial about its affect on the community. Most people don’t get tested and if they do and end up having HIV/AIDS they don’t disclose the information to their partners, which is so unfortunate. It is hidden and in the darkness…which makes me think that most aren’t getting treated, aren’t taking any preventative measures and will likely die from the disease or complications associated with a compromised immune system.
After visiting the primary school, we had a delicious lunch prepared by our pseudo-mom, Mutesi, and then went to the local secondary school to watch a music competition. As distinguished visitors we were escorted to the front to watch the performances as students sang, danced and acted out skits about HIV, family life and social issues. I couldn’t understand everything, but I definitely could pick up on some of the story line. After a couple of the performances they invited us to share a meal with the teachers/administers…I’ll remind you we had just eaten a huge meal at home so of course we weren’t hungry at all! However, it would be rude to decline so in line we went…buffet style. I asked for just a little bit of rice and no matooke and some cabbage…a huge pile of rice and cabbage later I looked at my plate in desperation thinking I am never going to be able to finish all of this (which also was rude, in my opinion). So I grabbed a sprite and looked for the silverware…oh wait…they eat with their hand! Cool. So I take a seat and do my best to scoop up rice with my fingers and shovel (best word to describe) it into my mouth without making a mess…I’m sure you can picture it. Well…a few bites in and one of our hosts comes in with a big thing of matooke (plantain like…not much flavor). He noticed we missed out on it in the buffet and wanted to make sure we had some. We all smiled and laughed and graciously took a helping. At least, it’s sticky and helped me pick up all the rice and cabbage. After finishing the last sip of my Sprite I literally though I was going to lose it…a couple burps later and I was okay…but definitely was thankful for the digestive walk back home….oh Uganda.

Wednesday, June 16, 2010

Wednesday, June 16th

We went back to the Namungalwe Health center this morning as the last time we were there the MO was too busy to receive us (poor planning). So this time we scheduled an appointment with him only to find he was still in Iganga when we arrived around 10am. However, Nurse Nalwoga was there (she had talked at UVP intern orientation) and she was able to give us an informative tour of the grounds and answer some of our questions. I also scheduled a time to come back on Friday and speak to her about nutrition and the feasibility of training and educational program in the village. The hospital is a Level 3, and contains a laboratory, maternity ward, HIV clinic and dental room. I’m not sure how many actual doctors and nursers work there…it does seem to be short staffed. The laboratory looked like a lab you would see in a high school back home with some specialized equipment…but not much. The maternity ward was simply rows of beds with a wool blanket (patients must provide their own sheets and there is no surgery theatre to accommodate cesarean sections…so in that case mothers must be rushed to the hospital in Iganga.
We also heard about a research project that was being carried out in Namungalwe sub-county on malaria. We asked a few questions and the researcher wasn’t too revealing. We were able to find out that they had been working on the project over the past year and had trained community distributers to pass out rapid tests and coartem to village members when they were sick…at least that was the experimental group….I wasn’t able to figure out what the control group was because he wouldn’t tell us the research question…it was all a bit shady and unrevealing, but I liked the idea of the trained community distributer who
Our last stop on the door-to-door surveys was inspiring. An older woman, probably around 50 greeted us and welcomed us into her humble home. She was absolutely beautiful. Her face was so distinct and she had a warm twinkle in her eye. There was just something different about her. Everything about her was warm and generous, from her smile to offering us seats on her most comfortable furniture. She answered all of our questions and talked about how she was born again…how she trusted in God to take care of her and her 4 children. She had such a strong faith. (update…the next day she sent yams to us as a gift…so so sweet!)

Tuesday, June 15, 2010

Tuesday, June 15th

This morning after a run and oatmeal breakfast, Nina and I took a boda boda into Iganga to Sol CafĂ© where we enjoyed a cup of French press coffee and using the internet. I did some research on nutrition and updated my blog with some pictures and posts. When we got back to Namungalwe, we visited the secondary school. Our intention was to carry out a few focus groups for a research project, but I ended up in a classroom with around a 150 female students. It was so fun to interact with them! I talked about UVP, our goals and areas of focus: nutrition, family planning, HIV and STI’s, Malaria, sanitation, eye care, and safe water. They asked questions about the above topics and then of course personal questions such as: how old are you? Are you married? How many kids do you have? All very typical questions for the curious high school aged student. I had to try to explain how American culture is much different and families start later and are smaller…so different than here in Africa where women have many children and at a young age...even while still living with their parents. What opposite worlds we live in. However, when I asked the young women what they aspired to become after graduating from secondary I hear the same answers as from my students back home: doctor, teacher, nurse, lawyer…such high aspirations, such hope to become something more, to move out of the poverty into a position with the power to help and enable others. I do hope that some of their dreams come true.

Dance Party!

Sunday, June 13th
Today has been my favorite day in Uganda so far. It started with a hot shower in Jinja after watching the US tie England in the 1st round of the World Cup at 2 Friends, a ritzy restaurant/hotel on the outskirts of the city. LOVED IT! We spent some time on the internet in the morning and I was able to upload some pictures and blogposts. Once we made the trek back to Namungalwe I laid down for an hour and woke up to drumming and singing. Usually, I need a few minutes to revive myself after I take a nap but this time I poked my head outside to see what was up and there was Mutesi walking down the drive toward the music in her fancy dress. So, I followed. I followed to her to what was a crazy dance party across the street in anticipation for the arrival of a woman candidate for the parliament. Apparently, it’s voting season and so all the women were there in their fancy dresses; singing and dancing. So, of course, I show up with Mutesi and almost immediately some of the older women put this sash thing around my hips and escorted me out onto the “stage.” I absolutely LOVED it! I wasn’t embarrassed at my lack of dance skills, but tried to follow their movements and rhythm and enjoy the music. The women cheered and laughed and I felt like I was accepted into their circle. I continued to clap and yell and laugh as more women and young girls went out to dance. It was absolutely beautiful…the fabrics of the dresses, the rhythm, the clapping, yelling, dancing; it was what I expected Africa to be and I felt a part of it. I didn’t feel like a complete outsider. I felt like I was invited to join in on their life and celebration and was moved by it. We took the opportunity to take a ton of pictures of the kids that come and play with us and the women we had met earlier at our meetings. The highlight of the evening was seeing our “sister,” Helene dance…seriously…I’m glad I wasn’t out there dancing at the same time. She was amazing, I found out later that she is in a dance class at school and I think I’ve convinced her to give me lessons. We’ll see how that pans out . Well, I hope to make a movie of sorts from the footage! Get excited!
p.s. while I was helping prepare the rice for dinner tonight a hen and its chicks hung out under my skirt…so cute…but one of them is sick and weak and doesn’t look well. I hope it survives.

Monday, June 14, 2010

Monday, June 14th

Today was a productive day…I finally feel a bit tired form our work, not just from the sun. I think my body is finally adjusting to the climate and food. We started by creating a set of questions for a door-to-door survey. The questions were to give us insight into some of the issues that UVP is interested in…nutrition, family planning, eye care, malaria, HIV and STI’s, and sanitation. As we were waiting for our team leaders to come back from their weekly meeting I started researching nutrition. I had downloaded some materials over the weekend and glanced through them. One of the resources was from the WHO and outlined 12 key practices that center around child growth and development. It was helpful to see what WHO emphasized as important health practices and potential interventions to encourage a change in behavior and care for children. They are all very basic, but in impoverished areas such as Namungalwe, practically impossible to carry out.

As we went around and surveyed 3 different households this afternoon I saw just how hard it would be for a family in Namungalwe to carry out these 12 practices. The first house we visited the woman we met was the sister of the mother of the household who had passed away 8 years ago. She moved in to help take care of the children…and there were a lot of them…at least 10, maybe 12, but some of them belonged to the older girls of the family. Children everywhere, some obviously stricken with diarrhea as evidenced by their solied underwear and malnourished as seen by the distended bellies. I was astonished when I heard that all they eat are starchy carbohydrates that they grow…corn, matooke, potatoes and posho. They didn’t mention any forms of significant protein and rarely do they eat vegetables. And with that many mouths to feed and lack of finances I don’t blame them. However, I was encouraged that most mothers exclusively breast feed up to 6 months and then continue for 2 years. Breast milk is such a good source of nutrients (the mother must be eating well) and helpful in developing immune response. I’m excited to talk more with the Nurse at the Health Center in charge of Nutrition to see what time of complementary feeding they promote and begin to develop interventions/outreaches to try to encourage some of the key practices.
It’s 8pm now…waiting for dinner, Nina just swallowed a bug while doing lunges outside, a bug just fell from the ceiling and landed on my head, the room smells of kerosene from the lamps, and I’m just waiting to hear the squeals of the bats as they start to hunt. I’m thankful for my time here and I hope our work continues to be insightful and productive.

Sunday, June 13, 2010

Week 2

I am beginning to adjust to life here in Namungalwe; pumping water from the borehole, peeing in a small hole in the ground, washing dishes and clothes by hands in basins, eating rice and beans, the name mzungu, lusoga greetings and African time…always late. The week started off with a visit to the schools, a primary and secondary, just down the road. We introduced ourselves to administrators and then were able to talk to the students. The primary school kids were adorable. They were so excited to see us and after introductions went crazy for a picture. The older students were a little harder to impress and wanted to know how old we were…typical. I told them I was a science teacher and two of the boys quizzed me yesterday to make sure I knew my science. Question #1 – What is an atom…apparently my explanation satisfied their curiosity because they looked at me like I was speaking over their heads.
A mouse scurried into our house the other day and made it’s way into our room. I kicked it out of my backpack once and then heard it again around midnight after it had made its way into my computer bag. So I kicked the bag around a bit hoping it would run out…nope, nothing. So I continued to move the bag around and pushed the computer out and saw a fleshy, pink blob…a closer look revealed, baby mice; two of them, definitely dead. Eew. Elina and I didn’t know what to do about it because we were half awake and I’m pretty sure at some point she said, Sean will help us in the morning, which I seemed satisfied enough with because I fell right back asleep. However, by morning, the mouse was gone again and we still hear it at night…I might try to make a food trail out the front door…or buy a trap in jinja this morning…I guess a mouse isn’t quite as bad as bats. The boys have a bat that screeches all night long next to their room…scary. I don’t know why Simon Peter ever wants to shower at night.
Monday night we had chicken for dinner, which is quite gourmet by Ugandan village standards. A typical meal for us usually consists of a carbohydrate (rice, potatoes, cassava, posho), beans (always) and a vegetable. If we’re lucky we have goat, beef, chicken, fish or eggs. Coming up with daily menu’s has definitely been the most stressful and disliked job of the house. So Monday, I helped Helen go cut down some Matooke from the garden. She is skilled in the machete department; with one swift blow she cut down an entire tree and when I tried to cut down a single leaf I had issues. On the way back to the house, we came across my favorite part of the trail…the ant path. It is seriously just like out of planet earth. Parts of the trail across the path are covered, large soldier ants stand guard, while ants scurry along carrying goods. It is fascinating how efficiently they work. Back to dinner though…so we get back and Mutesi starts showing me how she prepares Matooke and then I see Nicholas holding a chicken and I asked him…are we having that for dinner? Sure enough…we were…so of course I asked if I could watch it all go down since I’d never seen a chicken killed before. So we took it out back, behind the kitchen, he held it down and slit its throat, drained some of the blood, then took off its head. His two sisters joined him after and pulled out all of the feathers. That’s when I left and we met again on the dinner table. There isn’t as much meat on the chicken here, and it’s a bit gamey, but not bad; probably the freshest meat I’d ever tasted.
On to business…this week our game plan was to make ourselves known in the community. I felt I was doing a fairly good job making myself visible – going on bike rides, runs, fetching water, walking around – just making sure people saw us and saw how friendly we are. Definitely, had a lot of opportunity to work on our lusoga greetings and know I’m realizing we need to move on to more advanced language skills. Hmmm…not sure about how that will work out.
On Monday afternoon we visited two of the schools in our village, the primary (elementary) and secondary. We just showed up and the administrators were excited to meet us and held impromptu assemblies so we could introduce ourselves to the students. Each school has near 1,000 students and the schools share 1 borehole (well). WOW! A major issue they deal with is access to water…and then I don’t think they treat the water before consuming it…hmmm. Something to propose. The little kids especially were thrilled to see us. They were so respectful and quiet and then when we took their picture they erupted with energy and excitement, practically rushing us! Loved it! There was a music class going on in the background as well…so good. The high schoolers were typically high schoolers…a little more guarded and more interested in knowing how old we were. The headmistress of the school is awesome, she reminds me of my sister-in-law and is a great leader and works well with the students. We are going back this week to meet in focus groups with the high schoolers to get some more information about health issues.
On Tuesday, we stopped by the health center, which is a level III and provides services for HIV and malaria and has a maternity ward and offers laboratory services. They were very busy when we stopped by so we plan on going back at a scheduled time to meet more of the staff. It was interesting though, during our community meetings last week one of the major issues people brought up was lack of assistance from the center and lack of medications. It seems as though there is some corruption in the handling of medications and most doctors maintain a private practice outside of their work at the health center in order to make enough money to get buy. They also sell medication from these clinics/pharmacies and recommend patients to them when they come to the health center where they expect to get medication for free. It’s kind of tricky.
On Wednesday, Thursday and Friday we met in 3 different areas of the community to introduce ourselves to village members and explain our goals for the summer and how we want to work with the community. Our Ugandan team leader, Simon-Peter did an amazing job as our speaker/interpreter and was able to convey our goal to create a village health team made up of volunteers in the village that would be able to provide initial primary care/resources to members of the village. We also explained we would be gathering information over the next couple of weeks to identify major health challenges in order to know what to center our interventions on. We stressed partnership and ownership, as we really want to empower the community and help them to find solutions and create sustainable programs. It will be interesting to see how our work unfolds. I’m researching nutrition and eye disease and hope to provide some valuable education and resources to the village health team and community members. The people seemed extremely supportive and excited about our plans for the summer and UVP in general. At one meeting location we were even given giant papayas as a thank you!
Overall, the summer will be a challenge, but I must realize that our work is only to get the village health team formed and off the ground running…establishing a distributer for waterguard, condoms, mosquito nets, and train the members on identifying health issues and giving them resources for continued education and treatment. It will be a challenge though because we are dealing with African time (no one shows up on time…really like 2 hours late) and limited resources (internet, communication, etc). But, I will count our time as a success if we are able to motivate the community and help them to take ownership of their health issues and excitement to find solutions.

Village life


Saturday, June 12, 2010

Pictures from the source of the Nile

The Source of the Nile

What to say...

I've been here in Uganda for two weeks already...but it feels like I've been here much longer. I love the people and the landscape. The land is so green, lush and tropical. I've already looked for a field guide to use to identify all the plants and insects...but to no avail. Next time I travel it will be a mandatory purchase beforehand. I'm at a place where so many thoughts and ideas are swirling around in my mind that I am having trouble trying to put it into coherent thoughts I can write about. So I guess I should try and choose a few things to write about...but even that overwhelms me. I've made a web album with pictures...but even they don't do my experience justice.

I miss home a little...the food and my family and friends, being a new aunt, running water, refrigerators, but I wouldn't trade any of that for my experience here. I'm enjoying the freshness of the food...the fruit really (and chicken I watched being killed) and eating lots of beans. My GI tract hasn't had any difficulties yet...fingers crossed and I kind of like using the latrine in the backyard and bathing from a basin. Fetching water is a task even though the borehole is so close. The sun is is so good to be in this climate...I love the tropics that is for sure.
hmmm...more later I promise

Tuesday, June 01, 2010

Tuesday, June 1st

Already, the other interns I’ve met are fabulous. They come from a variety of backgrounds, although mostly public health. Many are working on their masters and using this as an internship or practicum experience. There are also a few medical students who have finished their first or second years, some undergrads, and a couple going into law and policy making. I’d say amongst the international interns it’s about 75% female and 25% male, but amongst the Ugandan interns it’s flip-flopped. I love my team members, they are all pretty relaxed and down to earth and I think we’ll get along fine. Simon Peter, one of our Ugandan team members took us out into Uganda today where we were definitely the only white people and an obvious distraction from normal life. Our mission was to purchase phones so we could be in contact with family and friends back home, since internet access is less available. Kids would run up alongside us yelling “bye, bye” and then others would ask “how are you?” but not be able to continue a conversation after that. It was still pretty cute though. One of the international interns tried a “rolex,” which is like a wrap with egg and vegetables in the middle. We were only out for about an hour because the sun quickly set around 7pm.
UVP staff gave us an introduction to Lusoga, Ugandan history, culture and politics. We had an overview of the healthcare system by the DHO of Iganga and talked more about the role of the Healthy Villages Project. We also heard about other UVP programs providing sustainable development. We went over safety issues and I bought a helmet to wear on the boda bodas. Overall, we are definitely being prepared to succeed in living in rural Uganda with limited resources. I am starting to feel more prepared and confident in what we will be doing…although there really is a lot of flexibility in our work. Realistically, our goal is to assess our villages needs and then begin to hold sensitizations/educations surrounding those needs and set up a VHT that can then be a primary resource for village members regarding general health needs. Tomorrow, we will be talking more about the specific areas of development such as, malaria, HIV, obstetric fistula, nutrition, sanitation, safe water, eye disease, etc.
I definitely feel as though public health and development is an area of interest. I was taken in by the statistics and data showing how plagued the country is with disease and poverty. It is sad to me that the leading cause of death in the country is malaria, that the maternal mortality rate is so high, that children under the age of 5 commonly die due to malnutrition and diarrheal diseases. So much unnecessary death that could be prevented by clean water alone. I realize that there is a lot of global hype surrounding clean water, but there is an obvious disconnect between funds being raised and actually practically meeting the needs of rural life. It sounds like there are a lot of superstitions and myths about best health practices, even WaterGuard, the leading chlorination method for purifying water. It’s not as simple as providing the resource, the people must be educated and convinced of its benefit. I hope that our team can make a difference, that we can relate cross culturally to impress upon these people the importance of hygiene and good health practices. As in anything, there must be value and ownership placed on the ideals and methods, otherwise the information is meaningless and will be tossed aside. People have to want to change, have to be open to change, and I realize how difficult that is in many areas of life. We become used to life as we know it and are afraid to do something different, whose results/consequences we may not foresee. It is comfortable to continue along the same path. Hopefully, we will find some pioneers in our villages that are willing to try something new for the sake of their health.
There is a lack of freedom here in Uganda, especially for women and other minorities. Currently, they are voting to punish homosexuality with the death penalty. There are many taboo topics that are ignored and left in the dark, such as homosexuality and health issues like obstetric fistula. People live hidden lives or are ostracized because of their unique differences. This is so different to the diversity of America…the fact that our culture aggressively promotes diversity and giving power to the minorities. To be honest, I usually get sick of the emphasis and sometimes partial treatment and attention given to minorities in our culture back home, but when you see the other extreme, where people are not free to express themselves or questions themselves, be accepted because of their differences it makes me sad…I wouldn’t want to condone a culture like that. It makes me realize how radical Christ was in his view of people and salvation. How his kingdom was open to all…not just the religious elite who outwardly had it right, but to the gentiles, the outcasts, the tax collectors, the lepers, he came for everyone….the homosexuals, the women with fistula, the poor. Christ does not see these differences the way we do…he sees a person who was created to love him, to be in relationship with him and to experience the life the God created for him. I hope that I can take the eyes and heart of Christ and love the people I work with and meet in an incredible way.


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