Notes from the Field 2009

Okay. I'm finally ready to write about the work that I have been doing! It has been an incredibly busy and intense three weeks. It was quite a dramatic change from doing almost nothing for three weeks to all of the sudden working 16 hour days. We are implementing a mid-term survey on family planning in Ssembabule District in central Uganda. MIHV has been working in the district for almost 20 years and a big part of what they do is train volunteer family planning community health workers (FPCHW) to go out into the rural areas to educate about and distribute methods of birth control to women. The survey is called a Knowledge, Coverage, and Practice (KPC) survey. Therefore, the survey we are doing will assess to what extent the women in Ssembabule district have knowledge about family planning, how much of the area is actually covered by access to birth control services, and how many women are actually using some method of family planning. The survey, which is conducted fully in Luganda, is a 30 page instrument that will be conducted on 300 women in the area who are between the ages of 15 and 49. The past three weeks I have learned an INCREDIBLE amount about what it means to actually collect data in the field in rural Uganda. The first part of the process involved training 12 Ugandans to actually conduct the interviews. Finding 12 Ugandans who were from the Ssembabule area was a feat in and of itself. These individuals had to speak both English and Luganda fluently and they had to have at least a high school education. Originally, MIHV wanted to have interviewers who were actually from Ssembabule district, but it was not possible to find even 12 people in the area who were qualified, so we branched out to greater Uganda for the recruitment process.
The second week of the process, which took place this past week, was the actual collection of data in the field. The process we used to conduct the collection was called a cluster survey, meaning we collected the surveys from thirty clusters through the district. We first randomly chose 30 villages throughout the district and then had to randomly choose the first household in each village once the interview team reached the village. Choosing the first household could take place in two manners. First of all, we would find the home of the LC1, who is basically the chairman or chief of each village. Then this chairman would either have a written, numbered list of each household in the village or they would draw a map of all the households in the village for us. Then, we would assign a number to each household and randomly choose one number to start. One LC1 did not have any paper, so he drew a map of his entire village using a piece of charcoal in the dirt. After finding the first household, would then choose every second closest household until we had conducted 10 interviews for the day. This entire process happened for five days, which six teams each visiting different separate villages each day.
I have to say the days spent in the field were extremely eye-opening for me. I never expected that I would spend entire days here, hiking through the African bush, trying to find extremely remote huts in order to conduct a survey. I had no idea what I was getting into, no clue that I would be walking past cobras and monkeys in order to collect family planning information, but I feel so lucky to have been privy to such an experience. Here are some of the things I learned while in the field:
-In rural areas of Uganda, when we came up a woman or girl, she would kneel on the ground in front of us for the duration of our entire interaction. Women and girls are taught to do this as a sign of respect. It was shocking to me, because it seemed like such an act of submission, especially when I came across a group of eight school children, and all five girls kneeled before me and all of the boys, who were younger, stayed standing.
-A great majority of women do not want to have any more children than they already have given birth to. But a great majority of these women are not using any sort of family planning method.
-The worth of both a man and a woman in rural parts is still solely focused on how many children can be produced. Many tribes have to maintain a certain number of people (I think it's somewhere around 30 people) in order to remain a tribe and with the AIDS epidemic, entire tribes have been or are close to being decimated. People feel an enormous pressure to have as many children as possible so that their tribe is not eliminated.
-Uganda is also still an enormously patriarchal society and so women have little to no choice about how many children they can have or when they are involved in sexual relations with their spouse.
-It is extremely difficult for a woman to access family planning methods if it means traveling five hours one way to get an injection, which means leaving her children unattended for an entire day. It also often means going behind her spouse's back to use some sort of family planning, and then facing discrimination or abandonment when she fails to produce enough children.
-While most people we encountered are aware of HIV/AIDS and condom use, many do not fully understand how the disease is transmitted. Some are still very skeptical of condoms and believe that they do not prevent the spread of the disease.
-Rural Uganda is gorgeous. As I drove out into the field each morning, with the morning mist covering the rolling hills of 3000 shades of green, I felt my heart swell more and more for the people we were visiting. They have such a fertile, beautiful country, which often stands as an utter contradiction to the quality of their lives. A great number of women had lost more than one child and it is extremely rare to see individuals who are older than 55. Countless numbers of families are drinking surface water with no form of filtration or sterilization. It is not uncommon for people to routinely get malaria multiple times a year.
- My guess is that at least 50 percent of a woman's time (and her children's time) is spent finding and transporting water. While the children are little darlings, they are the dirtiest children I have ever seen. In a place where a mother of eight may have to walk over 10 miles a day to carry jugs of water from a source to her home, bathing of her family is last on the list of priorities for how to use the precious water.
-Generosity and hospitality thrives in these rural areas. For people who have so little, they give so much. Every day I have left the field loaded with gifts including, lemons, jackfruit, eggs, avocadoes and one day, two full stalks of corn and two cobs of roasted corn. I wonder how often the individuals who conduct door-to-door surveys in the United States are welcomed into someone's home, invited to stay for tea, and sent home with enough produce to last a week...