Riley Poe: Handwashing Workshop in Review

The following post is by a fellow Drake University student named Riley Poe. I was lucky to work with him on some of his prep work for the workshop he was planning to complete as his project for the Drake University Uganda Summer Seminar (a 6-credit course through Drake). He spent a great deal of time and effort planning for a workshop on proper hand-washing procedures and their significance. After presenting this workshop in Kikandwa, here's what he had to say about his learning experience:

In the United States, it is expected to have soap, running water and either paper towel or an air dyer in just about every bathroom. However, in other places around the world, specifically developing countries, this is not always the case. I proceeded to conduct some internet research that would inform me about the situation surrounding hand-washing in Uganda.  In a matter of minutes, I found some staggering statistics straight from the New Vision which is the main government newspaper in Uganda that I would like to highlight. The first was that “only 28% of the 34 million Ugandans have access to hand washing facilities” and the second was that “only one in four or 25% of people in Uganda wash their hands with soap and water after using the toilet”(Ogwang 2013).  These statistics were mindboggling to me coming from the United States where just about everyone has access to hand-washing facilities. However, it was not these statistics that motivated me to do this project. It was the facts that showed how devastating not washing your hands can be and ultimately how many people and specifically children die as a result of not washing their hands.

From this little bit of research, I began to draft a project proposal that would focus on the importance of hand washing in stopping the spread of preventable sicknesses such as colds and diarrhea.  After some debate, I decided that my project would be most beneficial if the information was presented to a community of people; children and adults together. After spending two weeks in Uganda observing and taking notes, I found hand-washing facilities were sparse and hand-washing practices were almost non-existent.  The only places that had soap, running water and a way of drying your hands other than your pants were hotels, restaurants and upper-class homes. Since being in country, I had been planning my presentation and talking with Makarere University Business School (MUBS) students to get their opinions and suggestions on how I should present the information I wanted to. 

Sunday June 9 was the groundbreaking of the Kikandwa Health Clinic and also the day that I would give my presentation on hand-washing to members of the rural village. I was prepared with a good basis of information that I wanted to present to the audience that included what I had attained from the newspaper article and what I got from the MUBS students I spoke to.  Along with the informative portion of the presentation, I also wanted to give a demonstration of good hand washing and leave time for a question and answer session at the end. 

Finally, it was my time to shine.  Amazingly, I had an audience of around 50 community members total attend my workshop presentation; 35 children and 15 adults. I started off with informing them of the statistics I found in the New Vision article, explaining why hand washing is so imperative for good health, told them when and how you should wash your hands. Then, I demonstrated good hand washing techniques.  After a presentation and demonstration that lasted for about ten minutes I opened the floor for questions and surprisingly received a boatload of very good questions from the audience members. The questions I received were mostly related to hand washing and other health practices, but some questions were about food preservation and what you should and shouldn’t eat.  After answering these questions to the best of my ability and with the help of Ratiibu’s translation, I passed out a handout to each audience member that stated when you should wash your hands and also showed the techniques for washing your hands correctly. The workshop concluded with one the adult community members thanking me for coming followed by a huge applause from the rest of the audience.  This made me feel as though my presentation had an impact on them. 

Overall, I believe that this presentation was very successful, but as with anything there are some aspects of it could have been improved.  The main thing that made the presentation difficult was the language barrier between me and the adults in the audience many of whom only spoke the native language and knew little or no English. For the most part, I was able to overcome this with the help of my friend Ratiibu, a MUBS student, who was able to translate everything. This aspect could have been improved by me by having more direct communication with the children in the audience who do indeed know some English.  When questioned were asked, I should have told them what the question was and then answered it for them in English before Ratiibu translated in to the native language. The second thing that could have been improved was the handout.  These handouts, although they did include some pictures, were in English.  Looking back, these handouts would likely have been more effective if they included more pictures and were in the native language rather than English.

Stepping back and looking at the sustainability of hand washing practices as a whole has taken some critical examination and thought. Hand washing is something that is a fairly simple task that can have a giant impact on the overall health of an individual. If the members of the community have taken to heart what I have taught them they will become more economically, socially and environmentally sustainable.  Economically, they will have the chance to farm more and thus make more profits because they are healthier. Socially, healthier people will be able to attain an education, sustain good family lives and be active members in a democratic government.  The environment can be improved because the education can provide famers with more ecofriendly farming methods. As you can see, the economy, society and the environment can all directly benefit from the practice and habit of hand washing.  

In the future, I hope that someone else will pick up this project and continue to educate people in Uganda about hand-washing and how important it is to their health.  I would suggest to them that they do a similar set-up to what I did, but maybe perform more than one workshop and do them in different locations (i.e. schools).  They might even look into providing cheap soap or hand sanitizer to Ugandans. I believe their efforts should focus on washing your hands after using the bathroom.  At the rural village, there was never anything outside the bathroom that you could wash your hands with.

Through doing this project I believe that I learned a lot about the hand-washing culture in Uganda and gained many valuable experiences through my interactions with the MUBS students and members of the community during this whole project. I truly hope that the members of the community who attended my workshop benefit and become healthier as a result.  I would be extremely interested to see how the hand washing behaviors and culture were affected by my workshop. This fall, I hope to keep working with things involving hand washing in conjunction with the ongoing health clinic building.  I would like to look into things like getting hand sanitizer to the rural village so that water is not needed for proper sanitization of hands. By dealing with such a simple topic, I have finally realized how truly privileged we are to live in American and have access to things like hand washing facilities.

References

Ogwang , J. (2013, March 22). Only 28% of Ugandans have access to hand-washing facilities. Retrieved from http://www.newvision.co.ug/news/640928-only-28-of-ugandans-have-access-to-hand-washing-facilities.html

Taking it all in

6/28/13

As my last day in the Galabuzi household comes to a close, everyone has been joyfully reminiscent about the past two weeks. We’ve talked about the research, the food, the countless moments of “firsts,” and the small inside jokes that have been brilliantly and effortlessly created. I apologize for not keeping up with the blog posts as much as I really should have during the past few days. I have found it more important to focus on the present moments as the trip comes to a close, considering my stay here has been so short. Tomorrow I make the trip back to the capital city of Kampala where I will have the chance to spend a great deal of time analyzing the over 100 pages of notes that have been written. During this time, I will also finalize my findings and formulate concluding remarks – all with help from the final discussion that took place yesterday with the village elders. In the next few days, look forward to a more in-depth post regarding these findings. For now, I must get back to my last matooke-filled meal, my last cutthroat game of Ludo, my last laughter-filled conversation with the Galabuzi family, and my last few moments in Kikandwa…at least until next time.

Time to rethink some policies

6/25/13 and 6/26/13

            During these past few days, I have continued the approach used in the last blog posts in the schools. I have spent the past two mornings at two of the four senior secondary schools surrounding the community and have talked about health, sex, contraceptives, and views of the community – only after all of the adults have left the room. Our interactions have shown that many of the students know much more factual information about sex, pregnancy, and contraceptives than we initially were led to believe. This is especially true with a few of the students we have met that have been educated by the local Naguru Teenage Health Centre. This is especially true with awareness and knowledge about pregnancy and contraceptives. Essentially, there’s very little difference in what many of the secondary school students know compared to a typical U.S. high school student.

            However, we have also found something very surprising. As a matter of fact, we are lucky to have even discovered it as it was brought up through a passing question. While at Central College Secondary School, a student asked, “In the U.S. do they also drop you from school if you are pregnant?” Confused, I asked the student to elaborate. She went on to explain that females at the school are expelled if they become pregnant, and over 30% of girls in the school are affected by this. Holy shit.    

           After further investigation, we found out that nationally about 10% of women are expelled from school for this very same reason. “It is done in order to make an example of what happens to the students who become pregnant,” said one of the elders. I was extremely confused. The policy attempts to reprimand early sexual behavior and promote the success of students. How is this so? (1) Women biologically cannot inseminate themselves, so how do they justify only one party being affected? (2) How do they promote the success of students with the policy? They are eliminating the chance to pursue higher education at a very pivotal time. There is a baby about to come into the world, and an added mouth to feed when this woman is at a young age. She could really use that shot at increased income through her education…even worse, once expelled from school it’s virtually impossible to receive enrollment elsewhere. I can’t imagine the effect this policy has on students, especially to a community that values education so highly.

            On a different note, we have continued our conversations with various homes in the different communities within the area. Our findings have supported the community’s reliance on low income since the last blog post. Based on our conversations with the 14 households from 3 different communities that we have asked about income, we have found the average daily income for the families to be $3.37 per day. Amongst these homes, the wealthiest gained $8 per day and the poorest gained $0.06 per day. With this limited income, it is also a common theme that the families pay for school fees and education first. Many times, we weren’t even told it was an expense priority since it is expected that these fees be covered before any other expenses.

            Something interesting we have learned from the past few days has been a community-wide support for contraceptives. In a quarter of the homes we have visited, the wife has or is currently using the injection method of birth control (lasts 3 months). Because of the community wide support and popular use, it’s expected that we also found wide distribution of the injection method, branded “Injectaplan.”  What’s shocking is that this injection can be bought in one of the 6 local drug shops, and can even be self-delivered. We will continue to research the availability of these drugs and the manner in which they are regulated, if any. 

Talkin sex with the youngins

6/24/13

            Today I visited the last school on the agenda: St. Andrew Senior Secondary School. I decided to change my approach with the school, considering it is my last week in the village. As I stated in an earlier post, I have feared that my accompaniment by one of the elders would prompt untruthful answers to questions. Because many of the secondary school students speak more advanced English, Jim and I decided to ask the adults to leave us alone with the students. On one hand we thought it would help us obtain truthful information. On the other, we were afraid of being misunderstood due to the language barrier. Let me just say that we were blown away by our morning discussions with the students.

            We first asked them to relax and feel at home because we were going to be asking some tough questions and wanted them to be truthful. We began by asking general health questions (i.e. where they learn about health, what they practice in their homes, etc.). This allowed us to ease our way into the desired topics of family planning, contraceptives, and sex – the topics I decided to focus on for a couple of the days this week. From our three interactive sessions, we found multiple trends in the answers. Students often learn about sex in less formal learning environments from older brothers and sisters, peers at the school, and from newspapers/other forms of media. We also found that the students were subjected to very little amounts of factual information. Many stated, “I’ve heard that…” or “Is it true that…?” when talking about their knowledge about family planning, contraceptives, and sex.

            As we delved deeper, we noticed that this lack of information might have had an effect on their knowledge about contraceptives. We asked two questions: Why do people feel contraceptives are bad? And why do others feel that it is good? We were a little worried about the kind of responses we’d get, especially since we have experienced mixed emotions about the matter. Below is an outline of some of the responses we received:

Contraceptives are bad because…

·      It is a sin to use them

·      Our culture does not promote contraceptives because we rely so much on agriculture. The more children you have, the more work can be done on the land

·      Condoms pollute the environment

·      Condoms “don’t help you feel it”

·      The pills poorly affect your health

·      The pills “can give you cancer”

·      The pills destroys your eggs that you have to give birth

Contraceptives are good because…

·      With birth control, you can feel good without worrying about pregnancy

            As you can see, while many students said that people are open to contraceptives, they often find a greater amount of justifications against it than for it. We saw that this also held true as we continued into the community later in the day.

            After the interactive sessions with the students at St. Andrews, the second part of the day was spent in the community focusing on family planning, contraceptives, and birth. The five homes visited were spaced every three houses or so throughout the same general community. The homes visited included families that live on $4 per day (the wealthiest family) and families that live on as little as $0.20 per day. Remember, these are families living on this income, not just individuals. These families commonly grow upward to 10 children and women are often encouraged to have as many as possible. Not many women visit antenatal clinics because of the distance they often have to travel (3 km or more). Considering many can’t pay the $16 in services necessary for birth, it is easy to see how they are willing to pay even less for non-emergencies and preventative measures. They simply do not have sufficient funds. As a result, women said they often gain information about family planning and pregnancy information from nearby traditional birth attendants. Those who can afford the visit to the hospital only do so when they are nearing date for birth (~8 months after conception).

            In terms of contraceptives, each woman I talked to was open to the idea of family planning. However, each woman supported the “God’s will” approach. In one woman’s words, “I go until God says it’s the end.” This again aligned with what I saw in the school. While the contraceptives are often considered an okay alternative, the culture here often promotes that of no family planning whatsoever. This is a definite theme that has been identified during my stay here in Kikandwa, and is one I will continue to revisit as my research continues this week. I’ll keep you all updated as these common themes begin to gather more weight!