Sunday, July 25, 2010

It's been awhile...

So a couple weeks have gone by since I've been able to get online and post from Africa. Today I was sitting outside by the Nile thinking...I can't believe I'm in Africa! The past two months have flown by and though I'm excited to be home in a week, I'm also sad to be leaving this place. It feels more familiar here than I thought it would and there is a comfort I find from being in my village with our neighbors. I have many short posts that I will try to upload sooner than later, but for now I have a few albums online that will hopefully speak more than my words.

Thursday, July 22, 2010

VHT elections

Tuesday, we had a sensitization on patient rights as well as our VHT elections. People started showing up after a burial of an older woman that took place in the early afternoon. At first, I was surprised by the turn out. I didn’t see any of the regulars…meaning those (mostly women) who came to our sensitizations. The LC1 was there as well as Eliasa, our mobilizer, and a handful of men who are friends with a guy named Amos. Amos was first introduced to us when we were moving throughout the village. He seemed well respected at first, but soon we began to hear that maybe he wasn’t a man true to his word and of good character. He didn’t show up to a single sensitization after the initial meeting, but here he was at our elections with a group of his friends. Great. We were concerned that perhaps the VHT would not be a good representation of those interested in our work, but of mere figure heads that liked the idea of being on the committee…probably in hopes of some type of financial incentive, which of course we don’t give. Good thing we had a drama on patient rights because it lasted around and hour or so and as a result gave time for more of our regulars to show up and those tired of waiting that weren’t genuinely interested to filter out. The drama was entertaining, as usual and drew a good crowd. By the end the rain had started and the people gathered beneath the mango tree. Nominations for the VHT were shouted out and we tried to write them all down. Some weren’t even there…Amos’s name ended up on the list. By the end 30 names were volunteered, a good start to what will most likely eventually be around 10 or 15 once everything is said and done. We have training on Monday and Tuesday of next week, which not all will be able to make and then after they start working with UVP on a regular basis we’ve been told some will drop out from lack of time and then some will drop off because of lack of incentive. All in all, I think we have a good group that will naturally evolve into an even better group of leaders who can inspire change in the community…only time will tell.

Tuesday, July 20, 2010

Namungalwe Rural

I took some pictures yesterday as we were mobilizing for our Village Health Team elections today. We have finally finished all of our sensitizations and the time has come for the community to elect leaders to serve on the VHT and carry on our work when we leave. UVP will continue to follow up and work with the VHT over the course of the next three years. As we moved through the village, I tried to take some pictures that captured the essence of Namungalwe rural. I’m here only for about another week so I’m working hard on remembering. I don’t want to forget what life is like here. As we talked with people, they were sad to hear we were leaving so soon, after only just starting to get to know us. I thought 2 months would be a long time to live and work in the community, but in fact, it was just enough to get situated and become known and trusted. Hopefully, the follow-up work done by the year-round UVP staff will be successful at continuing to train the VHT and work in the community to improve their health. There are an overwhelming number of problems and frustrations that will take time to resolve with sustainable solutions. Our work here was short and superficial, but a start. I’m excited to see if the villagers elected today will have the motivation and leadership to continue the work.
I’m torn as I think about leaving in just under 2 weeks. I’ve loved my time here and feel as though there is so much more that can be done in the community. Things take longer here…it’s just the way it is…and so it is hard to leave when things are just getting started. I know that there are staff here year round but they are spread pretty thin and it’s not the same as having someone living in the village working alongside the community, teaching and inspiring them to work towards a better quality of life. However, at the same time I’m looking forward to coming home, seeing my family and friends, taking a real shower, using a washing machine to clean the Ugandan dirt off my clothes, and finish my medical school applications. I have loved getting to know Mutesi and her family…a term used loosely here in Uganda as the household includes nieces and nephews, and grandchildren. I will miss them the most.

Monday, July 19, 2010


Mabira National Forest

On Sunday, the team minus the Ugandan interns, took a day trip to hike in Mabira National Forest. When we asked Simon-Peter and Hannington if they were interested in hiking we were given looks of “are you kidding me…why would I want to walk around in a forest?” Too funny. So we left them behind and took off for the small village of Nejembbe. Travel in Uganda is anything but predictable, kind of like the weather. So, after switching matatus (taxis) in Jinja we headed toward the forest into some pretty ominous looking clouds. Next thing we know we’re in the middle of a full blown hailstorm. I pull out my peanut butter and banana sandwhich…by now it’s already past 12pm (after leaving the house around 10am) and hope for the best. We are crammed into this taxi…water splashing up through holes in the bottom of the van, dangerous puddles of water collecting on the roadway, and unfortunately the van’s defrost system wasn’t working…why would it? Everyone is a little on edge…for our safety and plans for hiking. By the time we are dropped off in Nejembbe about 20 minutes later the rain is now a steady Seattle drizzle. Typical Ugandan rain…lasts about 30-40 minutes and then disappears. Lucky for us it was when we reached the forest and as we started our walk the sun was shining through the trees and the butterflies (over 200 species live in the forest) are out.
The forest was beautiful…lush, tropical and full of life…mostly plant life, but we did see some birds, butterflies, dragonflies, spiders, ants…by the time they were biting us, millipedes, and yes…a red-tailed MONKEY! We didn’t happen upon the monkeys until the end of the hike, but we saw a bunch of half-eaten fruit on the ground so we started searching in the canopy high above and sure enough saw what looked like a large squirrel from our viewpoint. The camera’s zoom revealed a red tail with a furry body! We were pretty excited. I tried to get a picture, but the resolution is not that great…but still…we saw a monkey on our own little safari through the forest.

Thursday, July 15, 2010

HIV Testing Day

HIV testing was rescheduled to the day originally scheduled for our nutrition sensitization and we didn’t find out about the change until 2 days before…no surprise. However, we were able to mobilize in the community to let them know the date change…it was just disappointing because our HIV sensitization was all about knowing your status and now we had to delay the testing four another 4 days. We had around 125 people turn out to get tested and St. Mary’s (testing group) did a great job accommodating the large number of people and counseling. I had been asked numerous times at the borehole if I was going to get tested. At first I thought, Africa, needles…no way! However, on the day of, I felt the urge to get tested and went through the entire process…including sitting with the women who were waiting for their results. I wasn’t really all that nervous about my own status, but I tried to put myself in their shoes to try to understand the courage it would take to find out one’s status, knowing it could completely change your life.
When they called my name, I figured they would say, “Great, here are your results, thanks for coming.” But instead, they took me over behind the goat shed (the testing took place at our compound), for privacy, and we sat in plastic chairs (a little too close for comfort), and the counselor began asking me questions, “why did you come to get tested today?” “Do you have a boyfriend/husband?” “Why is it important to know your status?” The questions kept coming…and at this point I hadn’t even heard my status yet. For half a second I thought to myself…could I be positive? No…no way. But I still found myself getting a little apprehensive…finally…I hear the words, “Well, Rebekah, you are not HIV positive.” Huge sigh of relief…not exactly…but I did break out into a smile and thank him for his work, but quickly got out of my plastic chair and back out into the open.
The majority of the turnout consisted of women, which did not surprise me. When we went around doing door-to-door surveys many women said they knew their status, however, they did not know their husbands status. It is sad…the lack of disclosure between husband and wife here. There is a lack of trust and an obvious lack of concern as to how their choices affect one another. Men dislike the idea of using condoms here (at least in the village) and wouldn’t dream of using them with their wives. With a high trend of infidelity (side-dishing) here, I know I would live in fear of contracting the disease, even if I was faithful to my husband.
Hopefully, our message at the HIV outreach was one of hope. Mostly women attended the outreach. We approached the idea of disclosure, of being tested together with your spouse, but unfortunately the ones who needed to hear that the most, the men, where not in attendance. Life is not over here, once you test HIV positive, which we also emphasized in our message, especially through a testimony of a mother of 2 who had lost her husband to AIDS. The health centers have ARV’s available once you reach a certain CD4 count and they have a support program, called Positive Living. The day was a success…I’m anxious to hear about the results!

Thursday, July 08, 2010

HIV Sensitization


We had our HIV sensitization Wednesday afternoon. Our take home message was “Know your status,” and I think it was clearly communicated through testimony, song, drama and discussion. The nearby health center has a Positive Living program for HIV positive people and we asked one of its members to come and share her testimony. It was a powerful opener to the event as she explained how she had lost her husband to the disease and is now living with HIV and raising her family. I wish I understood the language…I miss out on so many of the details as much is lost in translation. It is difficult to not be able to communicate effectively with people, especially when our work is so much about education and relationships. We have great Ugandan interns that help translate, but it’s not the same. Anyway, despite the language barrier, her testimony was powerful. She captivated the audience and delivered a message of hope. She encouraged the people to get tested so they could receive the help and support they need if diagnosed with the disease. My favorite part was she wore a baseball cap with “know your status” embroidered on it…“so perfect,” as Simon-Peter would say.
The HIV sensitization attracted the best turnout so far, although it was all women. The reason for the large turnout was due in part to a performance by a local drama group. Ugandans love to be entertained and any gathering is reason enough to dance, sing or watch a drama. We advertised during our mobilization that there would be drama and dance and as a result our turnout doubled! We still started late (African time), but the audience was captivated by the energy and message of the drama, which again focused on knowing your status and living positively with the disease. We had a group discussion after the first performance, led by our intern Simon-Peter and again I was lost in all of the Lusoga. However, based on the questions and body language it seemed like people were taking the message seriously and asking relevant questions. The second drama was pretty wild…the content being a tad offensive to the politically correct outsider in my opinion, but not to the crowd…it was almost like a Ugandan soap opera, with infidelity being the major issue. The drama’s were beneficial even if a little offensive to those outside the culture, because they stirred emotion and allowed people to talk about sensitive issues. Unfortunately, only a handful of men were in attendance and some left early (the meeting/performances were over 2 hours). Men need to be reached with the message of knowing your status, but many are stubborn and unwilling to listen. Many of the women we’ve met in the community know their status, but not their own husbands. As a result, they live in fear of getting the virus from their husband as many of the men have what Ugandan’s call side-dishes (extra-marital partners). Of course, this type of infidelity increases anyone’s chance of contracting the virus and increases transmission. It’s sad…HIV isn’t taken very seriously, mostly because it isn’t talked about, people don’t know their status, and if they do they are in denial that it will hurt them or those they care about. I hope that people begin to realize that they can’t live confidently in the dark…they must know their status in order to make the right decisions to protect them and the ones they love.
We have HIV testing at our house all day on Monday. I hope that those who heard the message on Wednesday follow through and come to get tested. There is so much fear around the virus that people would sometimes rather just not know. I’m praying that attitude changes.

As always, the kids were exceptionally cute…can’t get enough of them! Hope you take time to check out the pictures and captions…they sometimes do a better job of describing life here than my words.


Click on the picture above to see the album and captions!

Fourth of July!


Yesterday was a good day. It was the Fourth of July, our Independence Day. I had a great idea to celebrate by having an American BBQ to celebrate! Nina made a flag, we went grocery shopping for the goods the morning of and I spent most of the afternoon sitting in front of our small charcoal stove.

The meal: minced meat hamburgers (mixed with onion and egg) with all the toppings…including ketchup! Cassava chips dipped in ketchup and apple crisp. Yum! This Fourth of July was like most at home, it drizzled during the afternoon reminding me of Seattle. Unfortunately, fireworks were out of the question as we would have to go pretty far up on the political ladder to get approval! But, despite not having fireworks, I felt the most American I’ve felt all trip sitting in front of the stove. We shared our traditions with Mutesi and the family. All of them loved the burgers we made and we all ate the chips together. Mutesi had never tried an apple so I shared some raw and cooked with her and she saved some of the seeds to try to plant…I told her it probably wouldn’t work to grow them here and even if it did the apples wouldn’t taste good for a long time. I do miss Washington apples. We buy ours here in the Indian run supermarkets…who knows where they come from.

We also, had our Family Planning outreach yesterday. A nurse from the nearest health center came and spoke with women in a very candid and humorous way. Around 15 of the women who came walked away with birth control pills or had an injection. The nurse thought it was a successful turn out so we were all pretty excited. This week we have our HIV sensitization on Wednesday and then testing next Monday. In between we’re going rafting down the Nile….I’ll be honest, I’m a bit nervous.
On Saturday, we looked at fabrics in the market and I actually found a couple I liked and am having a couple of skirts made. I’m excited to see how they turn out! Hopefully I’ll be able to wear them here the last few weeks and blend in a little. I also had a freak illness on Saturday. I started to feel some severe abdominal cramping and was very uncomfortable. I sat down on the stairs while the other girls ran some errands and found myself about 5 minutes later running to the bathroom at a Café we are regulars at across the street. Something hadn’t sat well in my stomach and I thought I might be in trouble. I sat on the toilet…which I usually just squat over…but I thought I might vomit as well. I started to feel faint and put my head between my knees and next thing I know I wake up with my body lying back to one side…I FAINTED! Weird. (sorry mom, I’m sure you’re freaking out right now) I woke up in a cold sweat, disoriented, nauseous and alone. Right before I passed out I was trying to text the girls where I was (luckily I had just put airtime on my phone) and so when I came to I quickly called them for help. I wiped the sweat off my body and waited outside on the stairs. I could feel the color coming back into my face, but I was still queasy. They came not to long later and fortunately, we had been with some of the UVP staff while we were fabric shopping and they were able to take me back to the UVP office where I rested over the next couple of hours. I felt fine after an uncomfortable bathroom experience and a couple hours of sleep. I was obviously weak after, but felt fine and my symptoms haven’t reappeared. I must have eaten something weird…thankfully it all passed through in one go. I look back and think so many things worked out…even though I was disgustingly sick…God came through with providing airtime when I needed it, the UVP staff, and a real toilet to use at the UVP office (better than the latrine!).

Uganda Fourth of July

Click the picture above to see the whole album and captions!

Saturday, July 03, 2010


The last couple of weeks I’ve spent reflecting. I’ve settled into the routine of the day to day and have more time and energy to think about the big picture. Here is some insight into my favorites here in Namungalwe...

My runs…I haven’t been as consistent as I am at home, when greenlake is right outside my door, an easy 3 mile loop, but I have made an effort to try to run 3 days a week here. I’ve been saving them toward the end of the day when I’m already hot and sticky. It takes a bit of effort to put on the spandex capris, sports bra and running shoes (that are now encrusted in Ugandan dirt). However, that effort is well worth it when I start out on the dirt path and wind my way through the village. Children on their way home from school sometimes join me. Of course, their feet aren’t protected by cushioned soles from the pounding on the gravel/dirt roads. They don’t care…or even seem to notice, but instead run right behind you smiling…huge smiles. Sometimes people ask me, “Madame, where are you running?” And I say, “nowhere, just running.” You start to feel guilty when you don’t respond to every call…”mzungu, mzungu, how are you?” “jambo, rebekah!” It’s flattering they remember my name, even though I will probably never remember theirs. I’ve started into the habit of jumping into the occasional soccer match in a front yard, stopping to chat and giggle with some teenage girls, or pump water at the well. It’s always an adventure, a somehow calm release from the work we’re doing.

My showers…yes, it would make sense that this favorite would follow the first. I make my way back to the house, enjoying the sunset. I take off my socks and running shoes and put on my flip-flops, grab my night clothes (loose pants and ¾ sleeve shirt) and fill the basin with water. I try not to use too much, as we only have 3 jerricans among the six of us living in the house. We’ve designated a cup to use for showering and I love the feel of pouring a full cup of water over my head and the coolness as it trails down my body. I feel exposed in the bathing area. It is a small cubicle on the other side of 2 latrines with eye-level cement walls. I could be in and out in less than a couple of minutes, but I enjoy taking my time to feel clean, to shampoo and condition my hair and to slough away the dirt from my feet with a washcloth that I end up cleaning almost daily. My running clothes make their way to the line to dry for the next day…the sweat accumulating over the week until I do laundry. Feeling fresh and clean is a momentary pleasure here, and I relish it.

My host family…I say host family, but really that isn’t their official title. We live in the home of Dr. Lukandwa. He works in Kampala, about a 3 hour drive away. The compound has two houses a kitchen and a building for the animals (not quite a barn though). The yard is huge and has a prominent mango tree in the front which the village uses as its main gathering place. It is private, set far from the street, although occasionally in the morning and afternoon as children walk by to and from school, I’ll see bright orange, pink or blue uniforms with arms waving from them at us. Our house is situated in front and the sister of the doctor runs the household that occupies the second house. She is definitely the in-charge and maintains the property. The property includes three cows (ente), a handful of goats (mbuzi)…the kids laugh at my goat impression, chickens…including the baby chicks in different stages of growth from cute fresh chick to awkward, almost ugly adolescent, and of course the rooster…he reminds me of his presence or should I say dominance every morning well before the sun is up and then constantly throughout the day whenever he feels is necessary. But of course the highlight is not really the animals, although I do love them and love the scene of the yard when the cow is laying lazily chewing its cud at that perfect time in the early evening when the light is just right, but even more so I love Mutesi (sister of the doctor, who runs the household), Joy, Nicholas, Helen and Lilian (the younger children 11-16 years who are all somehow or another connected to the family). You never know who belongs to who, but it doesn’t matter here. The family isn’t an isolated unit of mother, father and children. It consists of sisters, brothers, nephews, nieces, grandmothers, aunts…some of who are not even blood related. Everyone has their role that keeps the compound alive and running. Lillian leads the goats in at nightfall, Joy fetches the water and helps with dinner, Nicholas kills the chicken and works on laundry, Helen waters the cows and everyone helps in the garden…filled with matooke, groundnuts, potatoes, cassava, papayas, and coffee beans. Overseeing all of this is Mutesi, who has become a good friend and protector. She is always looking out for us and helps me with my lusoga and always appreciates when I come out to help with dinner or in the field. My favorite was when she told me I was a “good girl” because I was off to shower. She works hard, all day. She is a strong woman, but has a limp from a hip problem…she walks slowly but deliberately and I love her. The kids are all off to school by the time I’ve finished my morning coffee, so most of my interactions with them are in the evening when I go to help peel potatoes or dice cassava. Language is a barrier. Some speak better English than others. They try to teach me Lusoga…my favorites are stars – munyenye and moon – omwezi…probably because it is at night when my lessons begin and we are sitting out under the expanse of dark sky filled with the brightest stars and moon. The laugh at my accent and attempted pronunciations of the long words filled with an unusual number of vowels. Soon we’re taking turns singing songs in English and lusoga and maybe Helen or Lilian will even dance. Mutesi is quick to correct them when they fumble in translation and I know she loves it as much as they do. There are others that live at the house, whose relation I do not know, but everyone is so polite and generous. Granted, most of Ugandans are…a signature of their culture, one of long greetings and generosity. I will miss my family here.
2010-07-02 malaria outreach

Make sure to read the captions...

Friday, July 02, 2010

Last couple of weeks....

It’s been awhile since I’ve been able to blog from Uganda. Unpredictable internet speed and availability is the main problem. It’s also difficult to keep up on my journal without electricity to recharge my computer every few days. So I’ll have to do a quick recap of the last couple of weeks.
Most of last week, I was anxiously awaiting my MCAT scores. I had my parents check the day they were out, but didn’t hear until the following afternoon due to time difference and cell service. I was so relieved when I found out I had exceeded my goal score by a point, but also immediately wished the score was better. But that’s usually how it goes…never satisfied.
We had our Safe Water/Sanitation outreach Thursday of that week and I think it was a success. We prepared and made visuals the few days before, mobilized the community by putting up posters at the boreholes and then went house-to-house as well, which was somewhat inefficient as we only have 2 lusoga/luganda speakers on our team. However, we had a pretty good turn out; even if we had to wait about 2 hours after the posted meeting time, but that’s African time. You say 2pm and people show up at 4, 4;30 or even 5pm. We may consider it rude in America, but that’s just the way it is here. I had made an outline of our lesson of sorts and we tried to make it as interactive and interesting as possible. We had one rogue attendee who enjoyed asking absurd questions. One example was when we were introducing waterguard as an option to treat your water. It is a chemical based treatment and you pour a capful into a 20L jerrican. The man asked, “ you say it kills and cleans everything, what’s not to stop someone from using it to clean their clothes, or eye, or maybe they’ll just pore the whole thing down the borehole….” I thought he was rather entertaining and made the crowd laugh, even if he was a bit unruly. We sold a few bottles of waterguard, but most of the women didn’t bring money, so hopefully they’ll be back.
That weekend we went to Jinja for the day on Saturday to indulge in a mocha and use the wireless at flavours café. I started looking over my AMCAS (med school) application and freaked out a little about all the information I have to input about courses and what not. I wasn’t able to spend much free time as I was focused on emailing out about letters of rec and transcript requests. We left Jinja feeling refueled and recharged for the week ahead and excited about watching the US/Ghana game later that night in the village. Transportation in Uganda is a bit sketch and unpredictable. In order to get to jinja (about a 45 min drive from iganga) our team has to walk about 10 minutes to catch a boda boda in our village marketplace to get to iganga (about a 20 minute ride). We then go to the taxi (or matatu) park where we wait for a van-like taxi to leave for Jinja, sometimes you wait 10 minutes, sometimes you wait an hour. We could catch one en route off the main road, but when you travel with a larger group it’s better to wait in the taxi park. This is because Africans don’t abide by obvious car safety standards…like how many people can fit in a row of seats. You would think you would have one person per seat, but that isn’t very profitable so they tend to squeeze one, maybe two extras in. You can imagine this makes for a fairly uncomfortable ride, especially when you factor in all the stops as people get off at different stages and then conductors frantically wave at passerbys to see if they need a ride. It can create a jerky and long ride. On the way home from Jinja that day our matatu actually stopped about 10 minutes outside of iganga and everyone except the Americans got out…we were confused, thinking we would continue on, but after waiting about 10 minutes, being harassed by vendors to buy everything under the sun…one teenage boy even asked Sean if he could buy one of us girls…..what??? Anyway, after we put up a bit of a stink we were shuffled onto yet another matatu that finished the drive to iganga. Later that night we went to “the barn,” a random building in the village that broadcasts the world cup games. It was heartbreaking watching the US lose to Ghana…I feel like the African audience was exceptionally proud and rowdy with a group of Americans in their midst.

The next week we spent preparing and mobilizing for our malaria outreach, meeting with the Namungalwe health center management committee and building a tippy-tap in the primary school after teaching about sanitation and handwashing. The malaria outreach went well on Thursday. We put up posters on Wednesday and Nina and I rode bikes around the village reading off one of the posters in lusoga, inviting people to come. It was fun to try to communicate on our own without an interpreter and people were surprised we were able to ride bikes and were excited we had come to tell them about the sensitization. There were about 50 people that trickled in from about 4:30 to 6pm…over 2 hours after it was supposed to start. We shared about transmission, dispelling local myths, talked about what types of treatments are effective and how to prevent mosquito bites…we pushed using long-lasting insecticide treated nets and sold about 25 after the outreach. I was distracted by the neighbor kids after our presentation and ended up having a photo shoot with them instead of interacting with the adults. Mpulu…a cute little boy who cries if a white person gets too close, was especially adorable and I was able to get some great pictures and play Frisbee with him…one time accidently hitting him in the forehead…oops. I think though he is on his way to overcoming his fear of white people…although the Frisbee incident probably didn’t help much at all.

Yesterday (Friday), we came into Iganga for a mid-trip debrief. Teams were able to share about their work so far and talk about what they hoped to accomplish over the next couple of weeks. We also talked more about what the Village Health Team will look like and heard from the health care team, which is working with the health centers and the follow up team, which is looking in on last years VHT’s. I’m sure I’ll have more to write about that after I process all that was said. I had a great conversation with our Ugandan team leader about the health care and political system here in Uganda, which I’ll share more on later. For now, I just hope to be able to post these couple of blogs and latest pics!
Iganga shoppers...where i buy my yogurt I drink with a straw and apples...imported apples


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