On Saturday, Clare, her father, Sergio, Sanni, and I went to see the secondary school that Clare’s father had helped build and found. As a culture founded on religious values, it was not so surprising to see signs posted all over the campus like “HIV/AIDS has no cure,” “Abstinence only,” and more. (More will be said in a later post about how the heavy moral values of Uganda’s culture drives its ABC model of HIV/AIDS prevention.) This was also the day I was first exposed to the African notion of time, and the frustrations that accompany it. As we made many stops both to and fro the school, we waited in the car for some hours, and it was frustrating that unlike in the States, it seemed nobody displayed much consideration for other people’s time and schedules. You might know that I’m the kind of person who plans things on an hourly to daily basis, so you can imagine how this sort of thing isn’t exactly for me. But I’m making it work…
Sunday, I rode my first boda boda (a motorcycle taxi) alone to Sol Cafe, a Western-style cafe on the main road whose profits all go to support a local NGO. After returning home, walking way too far but eventually finding my way, I waited another 2-3 hours for a van to come pick Clare and me up to take us to the UDHA party being held for the leaving interns. Another encounter with the frustrating notion of African time… Still, we made it to the party, where I had a good time hanging out with the UDHA staff and their families, went for a swim in the pool, had a beer, and finally met Michael, my supervisor at UDHA. Being with all these individuals who were passionate in many of the same things as I was was so refreshing; this, along with Ugandan hospitality, made me start to feel right at home here. A home away from home (9,300+ miles away, that is).
Monday, I tagged along with Sergio and Sanni to Maina, a more rural and remote town a 30 minute drive from Iganga. UDHA’s health center facility there is a bit run-down and old, but with long term plans to build a bigger and better center which would allow nurses to perform deliveries there. Sergio and Sunny, representing the Swedish Institute of Global Health (SOGH), were hosting a training for the local community health workers of the Mayuge District. The training was on improving maternal health services in the area, one strategy of which would be implementing prenatal and postnatal visits to pregnant and post-labor mothers, as currently only 6% of women are making all 4 of their required prenatal visits to the health center. Sergio and Sanni had with them “Maama kits,” to be distributed to the expecting mothers on their 4th prenatal visit, containing a bundle of supplies necessary for a woman to give a safe and comfortable birth. As supplies are often rarely available even at the health centers and hospitals where women give birth, women are expected to bring their own, which the Maama kit implementation hopes to make it easy to do. Ideally, SOGH hopes to increase the number of women delivering in hospitals and health centers, which involves expanding UDHA’s facility in Maina, and ensuring that CHWs and mothers are meeting their required pre and postnatal visits, as the incidence of deaths that occur during childbirth are high due to infection from unsterilized equipment (or total lack thereof), misinformation, miscarriages, etc. A few years ago there was a similar project being carried out by USAID, but as often can be the problem with large-scale organizations working globally, nobody on the “inside” was available to ensure or account for the health workers, leading to its termination.
On Tuesday, I went with Sumaiyah to deliver the helpbox reply letters. Briefly mentioned in my previous post, the helpbox is set up at different schools so that students can submit letters with any questions/concerns they may have about their overall health, although mostly of puberty and reproductive health, to members of UDHA, who reply with advice and information on their concerns. These are put in place so that students can have a safe space to talk about their bodies and the changes they are going through, as often they are too shy or not wanting to talk to administration about it. As Sumaiyah and I walked into the different classrooms, each class, in recognition of visitors, proceeded to stand up and sing something like: “Welcome visitors. We are Iganga Central Town School’s primary 5 class. Our motto is ‘Education pays.’ We welcome you.” Everytime I introduced myself, there yielded many giggles and googly stares from the students. I think they thought that my English was funny or somehow entertaining. We delivered the response letters to each student individually and headed back to the office, where I had my first meeting with Michael. I’m looking forward to this week at UDHA, where I will be able to follow the various projects being worked on at UDHA, with the goal of narrowing in on one in the following weeks.
Wednesday, the first thing I noted upon arrival to the UDHA office was that the wifi wasn’t working (ah!). Turns out, the whole village’s power and electricity was out all day. Even when the power came back later in the evening, the onpour of rain led to the Internet going out again. Still, I made the most of my day– I went on a mobilization outreach visit, with Jairus and Clare, to King of Kings secondary school, where we talked to a classroom of students about the LinkUp project and the resources provided to these youth through the project. LinkUp provides a voucher for these youth for family planning, STI management, and HIV treatment services for multiple visits at the Mercy Health Center (where the UDHA office is). This voucher is invaluable as treatment for STIs like chlamydia, gonorrhea, etc. can cost up to 40,000 UGS (equivalent of 15 USD). They made sure to mention to let their friends know– their maids and their friends not in school especially, as these are the kinds of individuals that are different to outreach to. Although I thought they were joking at first, they told me that next time I would be the one giving the announcement in front of the class… I’ll fill you in on how that goes another time!
Today, the HIV outreach team and I set up a mobile HIV testing site also with counselors, STI treatments, and hundreds and hundreds of condoms both male and female. The mobile clinic tested 120 individuals for HIV (including myself for the fun of it) today. Although Michael wanted me to practice counseling some, nobody really spoke English and so Sam (a Ugandan who is from a different region of Uganda and thus speaks a different language than Lusoga) and I manned the condom distribution. This was my first time seeing a female condom, but Clare taught us both how it is to be used, and we taught a couple other women who had never used one but were interested. I was surprised by how casually the testing and counseling took place in such an open setting outside on the road, and how casual the demeanors were of individuals getting tested, even among the sex workers.
This week has been amazing in getting exposure to each of the different projects at UDHA. I think I underestimated how much the organization could do with such a small number of staff, and a tiny office consisting of 1 room in the Mercy Health Center and 2 rooms across the road. But what I noticed was that the staff are all involved in various projects, not just working exclusively on their own but collaborating on all of the various projects going on. Their dedication to serving the community and health equity shows, and I am more than glad that I was able to find them, even if a little last minute, for my first real introduction to global health fieldwork.