Racing up the mango tree!

6/23/13

            After a tiring week of research, Jim and I took the day a little bit easier and did some work in our host family’s garden. For you Americans, a Ugandan garden is around 6 acres and used to harvest bananas, cassava, and mangoes, amongst other plants…definitely not your small plot in the backyard for a tomato or two. Our host family seemed to be extremely amused by their guests wanting to work in the garden. They insisted on setting up as many photo ops as possible in order to get the best “snaps” of their new sons working.

            While I did many new things, none was more invigorating than the mighty climb to the top of the mango tree. My other lonely American partner here, Jim Ley, had been telling me for weeks about crossing this task off of his bucket list. As soon as we saw the tree, it was a race to the top…but instead of victory, all I found was a colony of angry ants willing to each my skin for the mangoes. Nonetheless, we made it back home safe with pockets (and stomachs) full of fruit.

Creating a Center of Excellency

These past few days have been especially focused on the health clinic being constructed here in Kikandwa. Friday, we began to service map the area. We walked all throughout the local trading center and the land surrounding the health clinic in order to effectively “service map” the area. This means taking note of the locations of other clinics, drug shops, churches, and schools in order to analyze their strengths, weaknesses, services offered, and sources of funding. A total of 5 drug shops, 1 clinic, 2 health centers, and 6 schools were mapped and analyzed by combining our entire week’s research.

This led into our main objective today, which was to look at this research and discuss how to turn the clinic into a center of excellency. To help this community, an change is needed. The difficult part is that it needs to be the right change. It’s easy to raise funds for a structure, but hard to provide a valuable service to the community that fulfills a need and occupies an otherwise empty niche.

This past week we have found multiple education resources to be available to primary school students. However, our interactions within the community, as well as in the trading centers, have revealed that this learning is not reinforced in the household. Moreover, the village health teams created to educate the community often find themselves stressed for funds to provide transportation – an extreme hindrance in a rural community.

This was just one of the numerous discussions that have centered around the future of the health clinic. However, it seems we have come close to a very realistic option that addresses this need and creates a center of excellency within the clinic. The option is to provide educational outreach programs through the clinic using Ugandan doctors (through our relationship with the Mukono Diocese) as well as health professionals and University students from the U.S. This will also enable the clinic to be a continual learning experience for students in the future – something we have always looked for the clinic to provide. However, our research is still ongoing, as are conversations about the future of the clinic. In any case, we can be certain that the Kikandwa Health Clinic will be a center of health education excellency to a rural Ugandan community in great need. 

A moment I wish I could change

6/20/13

            This post is rather short, because I only intend to paint a picture of a culminating moment of the day…

            I spent the second half of our day at Central College Primary School. The first thing on the agenda was a school wide debate on the topic, “A teacher is better than a doctor.” You could tell that each student had been prepared to fight to the death over his or her stance. “Teachers are the ones who teach doctors in the first place!” some students yelled. This was immediately combatted with, “You can teach and teach and teach, but at the end of the day who will you go to in order to save your life? A teacher? No. A doctor.” Needless to say, it was outstanding to see such a sustained and heated debate over a tough topic.

            Upon the conclusion of the debate, the students were rewarded with some free playtime. Some decided to play a boy vs girl game of handball, others decided to ride the merry-go-round, and others decided to rest on the sidelines. Everything seemed to be in accordance with the typical 10-year-old free time. There was lots of screaming, laughing, playing, and those kids that are way too competitive for their own good. I was watching from the sidelines in an attempt to relive my childhood days through their fun and excitement. The merry-go-round caught my eye. As the kids piled on and spun it faster and faster, my attention was diverted to a little boy who had just kicked a large water jug. This happened to be one of the jugs used to collect their drinking water from the nearby borehole. It was at this moment when the emotions of the day drastically changed from that of intrigue and fun to a moment of shock and confusion.

            As soon as the boy kicked the jug, he began to untie his pants. He couldn’t have been no further than 10 feet from the merry-go-round, as the kids right next to him were jumping on to join their classmates. After untying his pants, the boy exposed his genitals and began to urinate on top of the jug. I didn’t know what to think. His classmates saw him, yet no one bothered to stop what was going on. Even worse, no one seemed to care. As soon as the boy was finished, he pulled up his pants and joined the students on the merry-go-round. It was as if nothing had happened at all – and I wish with every inch of my being that that were the case. Better yet, I wish someone had stopped him. I wish I had stopped him. The reality is that I didn’t. I still do not know what to even think about the situation. It’s a moment I will always look back on and wish it did not exist.  

Aliens...

6/19/13

            I’m going to start off by saying that the first 15 minutes of sitting through a primary school class is nearly impossible. In a rural Ugandan school, you are basically an alien in the back of the classroom. You look out of place, dress strange, and come from a distant place. I couldn’t count how many hesitant laughs and funny stares I got today, but I somehow loved every single one of them. Especially when I noticed that it takes one funny moment to ease the tensions and break the unfamiliarity.

            Visiting the Kabimbiri Primary School was one of the most thorough looks at the typical day of a Ugandan student so far. I spent the entire morning with a P5 class (our equivalent of the 5^th grade)…and yes, I was able to blend into the back wall of the classroom as time went on. I was especially excited, as one of the subjects taught today was science – the subject we had been hearing that health education fell under. The teacher began the lesson by introducing the “hot” topic of heat energy! As time went on, I was very surprised to hear that germs were mentioned with the lesson. The teacher discussed the importance of ironing clothes in order to kill germs and remain healthy.

            After the lesson, I was lucky enough to ask questions to the students of the P7 class as well as the head mistress. Most of my questions focused on the frequency and content of health related lessons. We found out that the last lecture on health took place in October of 2012. We were skeptical to say the least after finding this out. However, the students described how their health knowledge is often gained outside of the classroom during their general assemblies. Additionally, the students later described how their health education – or “sanitation” as it is often called – is applied three days per week when they spend time as a school to clean their facilities. This application of knowledge is also practiced through the school’s use of a borehole for clean water, as well as the posting of multiple signs throughout school grounds that have tid-bits about malaria on them. It was amazing to see the extent to which a school of ~200 students practices what they preach with health.

            We still have one concern: hand-washing within the community. Again, this was the one topic that was never mentioned in the schools. We observed that none of the students washed their hands before eating their porridge during the break time. We were curious as to why a school that puts emphasis on cleaning the bathroom does not also put emphasis on preventing fecal to oral transmittance of pathogens. Upon discussion, we found a potential justification. Culturally, many students do not eat anything besides porridge before finally eating dinner at the end of the day. Our host father, James Galabuzi, described how many of these children will even fight over a mango on the side of the road because of the hunger they feel during the day. I feel that this adds to the challenge of encouraging hand-washing in these rural communities. Hunger and thirst will kill you sooner than disease will. When hungry, these kids worry about the very present feeling of hunger, as opposed to the possible future feeling of illness.

Kasawo Health Centre III

6/18/13

            This morning, we deviated from our original plan to attend a day for newborn immunizations at the local Kasawo Health Center III. Our host mother was planning on taking her 4-month-old daughter there, so we decided to tag along.

            What was interesting about the health center was one of the services that were offered. Like other level III health centers in Uganda, it offers antenatal care, delivery services, HIV care, vaccinations, and lab services. However, it also offers programming that is extremely unique to the area.  It employs multiple full time employees to provide educational programming to the youth. This takes place in both its facility and out in the community.

            Because they target the youth, they have an approach that is conducive to their efforts. They emphasize the importance of connecting with the youth while in school, especially to help maximize their reach and efficiency. While at the schools, they put on educational shows, distribute pads and condoms, and host games and sporting events to increase awareness for their services. They partner with the Naguru Teenage Health Centre, a Ugandan organization for youth education, to provide various teaching aids and teaching guides to their staff. Their programming has been so successful in the community that the nearby schools even send students there when they are sick in order to both treat and educate them. Some of the emphasized topics are listed below:

•          Life skills

•          Abortion

•          Behavior change

•          Abstinence

•          HIV and STIs

•          Hygiene

•          Pregnancy

•          Stigma/discrimination

•          Relationships

            While these programs seemed extremely promising, their educational services to the community did not. They currently have a Village Health Team to inform the patients about the illness they have come in with. However, the challenge with these teams lies in their lack of pay. Because they do not receive compensation for their work, it is difficult for them to find the funds necessary to travel throughout the community, let alone make it to the health center and back everyday. The VHT has not worked in the community (the original purpose of their duty) since a year after the center opened.

            We saw a group of students walking in for the educational services. We took the time to ask them a few questions in hopes of finding more out about the program’s effectiveness. Here’s what we found:

Youth Q&A

How often do you visit here?

We visit the health center only when we are sick. The headmaster sends us with the other sick students.

Do you ever come here to learn on your own, or only when you are sick?

Sometimes other students come alone but only because they are worried that they might be sick [with STIs], but most are only sent here when they are sick.

What are the common problems you face with your health?

Malaria, cough, tetanus, measles, headache, and sometimes diarrhea.

Where do you go to in order to get health education?

Sometimes we learn about it in science at school. It is mostly about hygiene, sanitation, and keeping a balanced diet. We also learn a little about water sources.

*Unfortunately for this last question, multiple students stated that they get water from an unprotected well (essentially a ditch that water has accumulated in).