Notes from the Field 2009

I have taken stance on my blogs to just write about what I see, positive or negative. Regardless of all the negatives I have blogged about recently I am absolutely loving my time here.

Currently I am in Aura, perhaps my most favorite place i have ever traveled. the people are overly welcoming and polite. The peaceful mix of Sudanese, Congolese, and Ugandans along with hints of Ethiopian, Indian, and western peoples has made this place overly diverse and full of life. The food is also delicious. I had a full and scrumptious Ethiopian meal last night for about $1.45. the taste of the food is just as wonderful as walking on the streets. You see men and women wearing beautiful fabric from Nigeria, Congo, and Uganda while carrying mixes of fresh avocado, a variety of mangoes and bananas, jack fruit, watermelon, and many food items that I have never seen before. All of my senses have had their curiosity of the unknown fulfilled from the seemingly endless markets.

It is wonderful place to visit even though there are no tourist attractions here. AS soon as I finish this blog I'm going to walk down the street to meet Anna and Mac for Indian food. Tomorrow I will be sad to leave but happy to be on the road to lay my eyes on the rest of the pearls of this country. This weekend will entail rafting in Jinja and after I will bus East to the mountains of Fort Portal.

Cheers to Uganda!

Posted at 4:27 AM
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Those are the words from an experienced Ugandan Development Professional that I will call John, this is not his name but he asked to not be identified. He felt that exposing his name could be harmful to his career.

Corruption is a leech. Incessantly and quietly it insidiously and maliciously sucks the resources from those who need it most. Jeffery Sachs and I are in disagreement because I believe corruption is one of the hindermost problems for development. The problem with corruption, in general, are that the issues that surround it cannot always be labeled as good or bad, right or wrong, or black or white, but, corruption from the top down can be easily be given the label of stupidity.

"I do not think there is a word for evil in Buddhism. I think this is something you must ask real Buddhist scholars. But we speak of ill will, we speak of ignorance, we speak of greed, but we don't speak of evil as such. There is no evil, just stupidity." - Aung San Suu Kyi

The news papers are lathered with stories about corruption in Uganda. Just yesterday there were headline articles about the selling of the Entebbe airport from the government of Uganda to a Ugandan governmental minister. A separate headline in a different paper explained how many of the government staff have brand new overly elegant vehicles but none of these government officials seem to know where the money came from to purchase the cars. These depressing situations are a norm here, laced into society like an addictive drug.

John told me that President Museveni surrounds himself with his relatives and close family from his origins. Chief justice, tax collections, and revenue authority positions have been magically filled by those closest to Museveni. Let's not fail to mention that Museveni has been in control since the 1980s and is responsible for ridding of presidential term limits. The list continues to stretch.

In the 2007/2008 fiscal year John explained how there was 1.3 trillion Ugandan Shillings available to fix and construct new roads. I can safely tell you that that did not happen (check out my transportation and public health post). The roads here are a death trap. Another newspaper that I saw yesterday had a bloody and grotesque photo of a car accident that killed a number of people. This is infuriating. If the money was placed correctly and responsibly Uganda could have a wonderful road system like Rwanda, its neighbor to the south.

That money could have been used to pave new roads, fix the potholes in the presently paved roads that make everything appear as if it had been bombed, employ more traffic police, install more traffic signs and lights, and more. Instead the alternative exists where people die stupidly every day. It is stupid that the government misuses aid money designated to provide treatments for individuals living with HIV/AIDS, it is stupid that the salaries are so low here that people are often forced into corruption, it is stupid that Museveni is one of the richest leaders in the world while there is Famine in the north of his own country, it is stupid that girls of low SES here have to resort to prostitution just to get an education while government staff have new cars. I'm going to put it as simple as I can, corruption kills.

Corruption does not only exist in the government here, it is on all scales, as explained by John. Local police, headmasters of schools, NGOs, and more have all been known to harness the hands of corruption. The problem starts from the top because it sinks from the top. It sinks into all reaches and no one is immune. In Nigeria the slang term for corruption is dashing and in Swahili it is kitu kidogo. We have it in the USA and so does every country and corner of the world. The discussion can go on for ages but the question should be where does a country, such as Uganda, go from here?

Well not everything here is sinking or stupid. Even the government has performed well in certain cases. For example, Uganda has generally low rates of HIV/AIDs compared to its neighbors because the government took an active role in confronting the virus when it first appeared (Google the ABC program of Uganda). There are also many wonderful individuals and NGOs working to make a fix. John is one of those individuals. When I asked him what needs to changed here is the list he said, "People need to adhere to rules, no one can be above the law, people need to be reprimanded equally, and leadership is supposed to be exemplary." With people like John in the country there is hope for change. Maybe our roll should then be to make sure that people like John are supported and allowed to set the example, and not the stupid people that make society sink.

Posted at 4:07 AM
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By Tyler Weber
Uganda

The means of conducting high quality and successful work in the field
international health and development (IHD) have long been discovered.
Currently I am at the MIHV site in Sembabule with Anna and Sarah. This
past week I have been assisting on a variety of projects including the
reorganizing of the sites' library. It is full of MIHV documents and
papers, brochures, reports, books, and magazines about IHD. This was a
tedious task full of aged dust that pairs lovingly with an already
heinous cough. It was a lovely experience. During a state of boredom I
happened to randomly flip open a book and word for word below is what
I found.

Continue reading "IHD messages from an aged and dusty book" »

Posted at 10:49 AM
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While my Twins cap was likely the only evidence of baseball in the district, titillating reveries of The Dome danced in my head while passing through Chenggong County--an enormous farming community that lies just outside Kunming proper--for the first time two weeks ago. With foothills in the distance, our bus floated through an abyss of greenhouses that stretched for 5 miles.

Continue reading "大棚 = Yunnan's Metrodome" »

Posted at 12:59 AM
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By Robyn Browning

Before I left for Tanzania, I already knew that things rarely turn out the way that you plan them. It appears as that goes double for things in Africa. The few plans that I had for my time here didn't seem to materialize, and the project I came to work on turned out to be vastly different than I had imagined. But that is life.

My trip to Karatu fell through, which is pretty disappointing for me. However, it gave me an extra day of being on safari where we visited Tarangarie National Park, home to nearly 3,000 elephants and many other animals such as giraffe, lion, leopard, wildebeast, waterbuck, warthogs, tree pythons, zebra, baboons, ostrich, elant, mongoose (which I should get extra credit for spotting and correctly identifying), monkeys, impalas, and water buffalo. This was on Sunday, after we had spent the previous day at the Ngorogoro Crater where we saw many of the same animals, in addition to a black rhinoceros. hippos, pelicans, hyenas, flamingo, cheetah, and a good show of lions mating.

As for my project, I definitely learned a lot about public health issues in Tanzania and about appropriate technologies that are being developed and implemented to help improve public health. I was hoping to work on something that I would be able to see go into practice here, but it was just not possible within the time frame that I have had here. I would guess it's my background working in social services that compels me to want to dig it and help as many people as I can, but as we learn in public health, the first and most important step is to listen and develop relationships with the community. With only five weeks, that was a task that could not be accomplished. So I will take the lessons I have learned here and apply them to the rest of my coursework at the SPH. Perhaps I will be able to return again one day to work on the issues that I have discovered to be important and of great interest to me.

I will post photos when I return home to Minnesota at the end of the week.

Posted at 8:21 AM
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By Sarah Brunsberg
Uganda

It is amazing what people can get used to. I am at a point where I do not think twice about bucket bathing or going to the bathroom in a hole in the ground. I haven't even thought about the fact that there is no refrigerator basically since I got here. Although it would be nice to be able to store food, it is also nice being able to buy all my food fresh each day. I think the reason for this is that they don't eat food here that needs to be stored. The downside to this is that the food selection is extremely limited and I would kill for a brownie.

Although it is still frustrating, I am getting used to working with limited resources. The unreliable electricity and internet force me to use my time wisely and it has been a great lesson for me to learn how to produce quality work with so little. I think this is a lesson in patience and hopefully I will bring it home with me.

Another thing I am getting used to is all the animals/bugs that live in the vicinity of my bedroom (and by vicinity I mean within 30 feet and the grossest ones live the closest). I have learned that bats are the grossest looking creatures that ever lived, but I am not as afraid of them as I once was. The cockroaches are awful but I am actually getting used to seeing them around. Goats, cows and chickens are often wandering around our site in the middle of the roads and no one seems to think twice about it. Whose animals are these? I also have a Gecko that likes to sleep in my bedroom that I have tentatively named Henry. At first he made me nervous but Geckos are everywhere in Uganda (restaurants, in people's homes etc.), so now I kind of enjoy his company. In addition, we have three roosters living in our site right now that we plan to slaughter and eat. I have never seen my meat slaughtered in front of me, but I plan to try to watch the entire ordeal. I think it will be very difficult to watch them get killed but am also okay with it for two reasons: apparently roosters do not only crow at dawn; they crow all the time and especially at night while I am sleeping, and two is that I think they have had a better life than the majority of the chickens in the United States.

On the opposite end of the spectrum, it is also amazing what Americans are used to that Ugandans are not. Part of my scope of work is to complete staff development trainings and I have focused on computer skills. I recently taught a "file saving and file organization," training as well as an "Excel" training to the Ugandan staff at our site. Some of the staff had never used a computer before. It was awesome to teach them something new since the majority of my trip has been spent learning new things from all of the staff. Even more exhilarating was how intently they listened and wanted to learn. In addition, cars are a luxury in Uganda. It is not considered a necessity here as it often is in the States, and even if it was most people could not afford them. It is probably a good thing more people do not own cars here because the roads are very hilly and rough and they tend to drive in the middle of the road while approaching a rough hill. Lastly, I don't think any Ugandan would know of the word "privacy." The idea of your own space does not seem to exist here. I often wonder when I get back to the States if it will be hard for me to be alone because I do not think I have been alone for more time than it takes in the bathroom.

Posted at 8:18 AM
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By Katarina Grande
Tanzania

I spent the day helping out with an English class at PeaceHouse. As I wandered about the classroom, I was cheerfully greeted by the students, "You are welcome!" and promptly bombarded with questions. "What do you like about Tanzania?" [Everything! the people, the food, the environment!]. "Why did Michael Jackson want to become white?" [Michael Jackson had a skin problem where his skin was many different shades, he was just trying to fix it.] "Can I study both accounting and science?" [I don't see why not! Go for it!] "What causes muscle cramps?" [A buildup of lactic acid in your muscles. I mean, an imbalance of chemicals in your body. Be sure to stretch and drink lots of water prior to exercising]. "Why can girls get pregnant but not boys?" [Girls have different body parts that allow them to be pregnant. You'll learn more about this in Life Skills class.] "Does the U.S. have a prime minister in addition to a president?" [Nope. Obama is our president. We have congresspeople and senators as well--have you learned about these branches of American government?] "What color of skin do people have where you come from?" [All different colors!] "Your skin is like an albino Tanzanian!" [Yup!] "Do you speak Swahili?" [I'm trying to learn!] "What is New York City like? [Big, full of lights, exciting]. "Do you hand wash your clothes?" [Sometimes, but I also use a washing machine.]

This press conference-like atmosphere lasted all class. I tried to sneak in a question here and there--what is important to you? [Education! Food!] What are your hobbies? [Soccer!] etc. Next, I attended volleyball club, which was a lot of fun. These students are such great kids; I wish I had more time here to get to know them better.

Posted at 8:20 AM
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By Robyn Browning

On Monday we visited a children's village called Food, Water, Shelter (FWS). It's a newer NGO which was started by five women from Australia about five years ago. You can read more about it at http://www.foodwatershelter.org.au/ It is still in the development phase, so the residents have not moved in yet, but the mamas have been selected and the hope is that they will move in with their children by the end of August. The mamas are women from the community who will live at FWS and raise a group of children from the Arusha area who are orphans. Each mama will have their own living space that they share with the children under their care so that attachment can be fostered and a parent-child relationship can be developed..

The most interesting part of FWS is that it has been developed to be eco-friendly and self-sustaining. They have nearly every eco-friendly technology I have seen so far at their site. We saw the rainwater collection system, the aquifer they are building, the organic garden they have planted (which they hope will eventually feed all 60 residents there), the tilapia pond they dug and now eat fish from, and the cows they have for their waste generation to use for bio-gas. We learned about the sanitation system they will be using for human waste. They will use urine as a nitrogen source to grow banana trees and will compost solid human waste to be used as fertilizer for the fruit they will grow. It was great to see so many self-sustaining systems being employed all in one place.

Yesterday we went to the new Arusha Lutheran Medical Center in town to meet with the woman in charge of the subsidized orthopedic surgery program that is operated out of the hospital. The woman in charge, Sarah Wallis, does outreach in communities where she finds children with physical disabilities. She meets with their families and tells them about the program at the hospital where the children can come and get operated on and then stay for the entire time of their recovery. The surgeries performed include cleft palate, club foot, and burn scars. Parents must pay 100,000 shillings for the surgery (approximately $90 USD) so that they have an investment in the medical care. Sarah is hoping to start another program that is focused on education about burns and includes the development of an acute burn unit at the medical center. She explained that she sees a lot of burn scars in the communities, mostly in the Masaii areas because the dwellings that the Masaii live in, called bomas, have a fire in the middle which can easily lead to children getting burned.

Tomorrow we leave for a weekend safari near the Serengeti. On Friday we will do a site visit at a community that will be installing a new water system for irrigation soon. The NGO Global Service Corps will be digging a hafir there so the engineers on our team are going to look at the site and give their input. We will then spend Saturday at the Ngorogoro Crater. On Sunday, I will leave the group and bus to Karatu where I will do site visits and be hosted by Minnesota International Health Volunteers. Monday I bus back to Arusha and then on Wednesday Kat and I will be busing back to Dar Es Salaam for our departing flight on Thursday.

I have finally arrived at the point in my field experience where my remaining days in-country are numbered and time is moving fast. There are still so many things that I want to do and see before I leave, so hopefully there will be time for the important things. I will hopefully be able to post again before I leave next week, but internet access will be limited. I plan to write some follow-up posts when I return home and have the ability to post pictures.

Posted at 3:14 AM
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By Katarina Grande
Tanzania

"I feel good about this--I think she'll let us summit," Frank says, gazing up at the glacier atop Mount Kilimanjaro. We've been hiking for four days; three of them above the clouds. The vegetation has changed from rain forest to moorland to alpine desert. During the day, the equatorial sun beats down in potent UV rays--during the night, the air is frigid. Everything--everything--is coated in mountain dust. Everyone is filthy, coughing chronically from the dry air, peeing constantly from the diarrhetic altitude medication Diamox, and radiating heat from sunburns...and loving every minute of it. The trek has been brilliant, the views comparable to medieval art depicting heaven.

The team will, pending injury or pulmonary edema, summit in less than 48 hours. It won't be a problem for the Scandinavian men on our climbing team--Frank, the bearded Norwegian explorer quite naturally stepping out of the frame of a National Geographic cover and onto the mountain. His adventure buddy, Daniel, a Swede enthusiasti ally referred to as "Supertall" by the porters, is constantly pausing to take photographs with his giant-lensed camera, yet never lags behind the group. Then there's Tammy, the big-hearted aunt of Amber; on the hike because "Amber made her." I'm the 5th team member and climbing Kili because it's a great personal challenge and a way to see gorgeous views of Tanzania. Somehow, these mountain experts--next up is Everest--and the three women make a good team.

We begin the trek wandering through the mountain rain forest, chatting about randomness and playing the Mountain Mens' favorite hiking game. We wonder where our guide--an expressionless Tanzanian man named Crispin was. Hakuna matata, we mutter, and forge on down the well-traveled path. The Mountain Men set the pace--a very slow and steady pace. Step. Step. Step. I had never hiked at such a slow pace but I begin to understand the logic. Groups that had zoomed past us hours ago were leaning against trees, wiping sweat from their faces, as we steadily march upward. We continue this processional through the next two days.

Today, Barafu Wall requires us to pack up the hiking poles and grasp rock hand grips as we scramble upward. Careful not to slip on ice-coated footholds or fall into glacial streams, we meander our way up the wall. I love the variation in the hiking--both scenery and style. The pretty, resilient little mountain flowers, the mist from clouds rolling into valleys, the trees that look like giant pineapples...and of course, the ever-present, majestic views of Kili's summit.

As grandiose and wonderful as this experience is, there is a dark side--the situation of the porters. These underpaid, underappreciated men carry the mzungo (I'm one of them) luggage: backpack, sleeping bag, sleeping pad, clothes, etc. plus the items for each campsite--tents, food, dishes, cooking utensils, pots, pans, lawn chairs--heavy, heavy stuff. And, unlike the mzungos wheezing their way up the rocks, the porters don't have camelbacks, hiking poles, microfiber long underwear, polarized sunglasses. The just put the heavy packs on their heads and scramble through the rocks. Do they like the job? It's probably good to have a job...but ouch, this one comes with a lot of pain. The dozen or so people that die on the mountain each year? Porters, mostly. But to get the more lucrative position of Guide or Assistant Guide, one must prove himself as a porter. Crispin did ten years. Yesterday, when one porter was feeling sick, the guides just were annoyed. It's a rough situation.

July 11, 2009
Unable to sleep, I sit up, alert in the freezing tent as my watch alarm beeps 11pm. It is time to begin the nightlong ascent to the summit. I layer clothing like crazy, switch on the headlamp, and join the group. The Mountain Men look prepared in their high-tech gear. Amber and Tammy toss in a few extra pieces of candy into their packs. I'm nervous--I feel like I was about to enter some sort of Viking battle. We quickly drink some tea and set off. The hill is steep, the footing rocky. I fix my gaze on Crispin's hot pink gaiters to keep pace.

Step. Step. Step. It gets colder. I grab the straw of my Camelback but it's now solid ice. No water. I start worrying about altitude sickness--or worse. But the worries drift like clouds through my exhausted body. It's 2am--our pole pole (pole-ay, pole-ay: "slowly") pace seems to be speeding up--we keep passing pale-faced hikers leaning on rocks for support. Breathing is a challenge: the 50% oxygen level, the arctic air, the physical exertion. I just want to rest...just for a second. But we continue. The usually chatty group is silent as the moonlight illuminates the glaciers above. Step. Step. Step. Just keep walking. My thoughts weave together with my mind radio. "Jump Around" pops into my mental playlist. Hours pass and Crispin pauses at the top of a ridge, his arms outstretched. "Congratulations, you've reached Stella Point," he says. Great, I think, but it's not the summit. I sit on a rock. Frank lends me his giant down parka. I want to take a nap, but it's time to continue to Uhuru Peak--the highest point in Africa.

I shuffle back into the rhythm. To the left is a beautiful, magnificent, blue-tinted glacier. "Wow," I whisper aloud (and then spend the next few minutes catching my breath). The ice looks so majestic--intimidating and peaceful at the same time. It's like seeing the night sky in a really dark place for the first time--the stars are a bit overwhelming. The team makes it to to the famous Uhuru Peak summit sign. However, we had ascended so fast that our summit didn't coincide with the sunrise as planned. We take celebratory photos in the dark and manage to convey, "Congratulations!" to each other through garbled, oxygen-deprived speech.

Posted at 11:23 AM
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By Robyn Browning

As we wrap up our site visits to NGOs in the Arusha area, there has been much discussion within our team about NGOs in general. We have visited most of the NGOs in the region that focus on sustainable technology, from both the development side (those focused on research) and the implementation side (those selling the new technologies to communities). We also visited some NGOs focused on assisting specific populations such as disabled women and street children. Though it is not certain that all of these NGOs are meeting their goals, it is certain that there are a lot of them and still more are being formed. I have heard several people comment about the staggering number of NGOs in the area. With all of the organizations, why are things not improving as they should? The answer seems to be that NGOs are not working together and that sadly, NGOs are a major way to make money in TZ (and perhaps all over the world). It seems to be common that NGOs do not cooperate with one another. They do not know what other ones are doing and they are not interested in collaboration. This is most likely due to the competition for funds. And the funds seem to be going to those in charge-- specifically staff salaries. NGOs are getting the reputation of making money and not helping, at least here in Tanzania. One of my teammates recently made the comment that if NGOs really did what they set out to do, then they would cease to exist at some point. I had never thought of that before, but it makes sense. Some NGOs grow so big that they become mini-corporations. We visited Heifer International, a well-known pretty much world-wide NGO, and it was amazing to see all of the resources they had at their office (amazing Mac computers, video cameras, etc.). We set up an appointment to do a site visit with them, but the man never called us back and did not return our calls to confirm. We heard from a local that they were becoming less and less helpful to visitors who wished to speak with them. Perhaps becoming too big can more than a few negative outcomes.

So what is the answer? I remember while in Haiti hearing one of the volunteers I was with say that someone should really coordinate all of the aid coming into Haiti so that someone can know what issues are being addressed and what needs more attention (this was due to the multiple volunteer groups flying in and out with us on our flights). It is a good idea, but then wouldn't it become like having a second government almost? Things would get lost in all of the overhead and red tape. All of a sudden someone would have to in charge of coordinating all of those resources and all of those volunteers. Would this help or hurt? Would it be worth attempting?

On a separate note, I had the pleasure of attending a church service on Sunday morning. Yup, I was definitely the only white person in a church of maybe 500 or so people. There was a mass both before and after the service I attended. Getting in and out of church was quite an experience. Church-goers really want to get a seat so its a crazy mix of a swarm of people trying to get into church while the people done with mass struggle to find their way out of church. I don't think I've ever experienced a church scene like that in the states. The most interesting part was the huge painting on the wall of the church behind the crucifix. It covered the entire wall and was a scene where a river separated a lush, green space with animals from a dry and desolate space where people were dying and praying. (Due to the placement of a statute on the wall, it looked exactly like Jesus was riding the elephant in the painting-- it made me smile each time it caught my eye!) I asked my church companion, Joel, a student from the Univ. of Dar Es Salaam, what it meant and he informed me that it was a representation of Tanzania. He explained that animals have it good here because they have lots of land and open space while the people here toil and experience death at an alarming rate. A very powerful message to have on a church wall. One that certainly stuck with me, especially as we walked down the church steps, filled with people begging on both sides.

Tomorrow we are off to tour an orphanage outside of town. Everyone is excited to see their facility, one which was designed to be completely self-sustainable and have zero waste.

Posted at 8:43 AM
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Coming from a city in a developed state like Minnesota should make my transition into an European city easy....and yes! It was but I can't seem to get over my fascination with just about everything here in Geneva. From their extensive, well developed and functional transport system throughout the whole of Switzerland, to their beautiful architecture and the mixing of old and historic buildings and modern buildings standing side by side. The public transport system include buses some of which run on electric lines, the trains which are high speed as well as trams which also run on electric lines but relatively slower. The trams are however very similar to the Metro transit light rails we have in Minnesota which runs from Mall of America to Downtown Minneapolis. The difference is that these have tracks which run in town alongside the lanes for private cars. One other fascination is the presence of lots and lots of water fountains that carry potable water throughout the city and beyond. The supposedly highest fountain is the Jet d'eau which can be found in the Geneva Lake close to the centre of the city.

The jet d'eau is on the far right

It's an incredible sight to behold and seems to be the major tourist attraction for most people who come to Geneva for the first time. We the interns at World Health Organization (WHO) usually have our drink ups along the Lake and it's always a refreshing moment when after a long day, we relax on the lawns along the lake listening to the splashing sound of the water and having good conversation about how the internship is going so far in the various departments of WHO and other international organizations like the UN, ILO and UNAIDS as well as tourist sites that others have been to and recommend.
One could not miss noticing the very narrow streets of Geneva and I have been told by residents that it's very difficult to get packing space due to this. One has to roam the same street over and over again to get a place to park.

Otherwise you could park very far away and walk about a few blocks to your destination. One interesting thing that piqued my attention was the neatness of the streets in Geneva! The streets are so neat and every morning on my way to work, I see cleaners on every corner of the streets cleaning up and emptying trash bags. Sometimes, they even use high pressure pumped water to clean the dirt off the street! This was entirely new to me since I never saw this in my home city of Accra.
I live in Grand Lancy which is about 18 minutes to Gare Cornavin, which is the main station for most buses, trams and the train as well as all tickets and shopping centers. Grand Lancy is a beautiful part of Geneva, away from the city centre surrounded by mountains, modern apartments and flowers with grocery shops in walking distance. The two main grocery shops here are called Migros and Coop which is akin to Target and Walmart in the US and both shops happen to be on my street! The tram I take to the Gare is just about a 5minutes walk from my house and makes life easy for me. The tram 13 or 15 goes as far as the Nations (usually pronounced in French). This area showcases very tall and magnificent buildings of the UN, UNHCR and ITU with a large water fountain in the open space separating these offices. I then connect with bus number 8 which is the only bus that goes to the WHO office building. One can't help noticing the people that get off the bus when it arrives at WHO. People from all over the world with different shades of complexion, Americans, Indians, Africans, Europeans, Canadians and Asians as well as able-bodied and disabled men and women. This is what makes me proud working for an organization such as the WHO which employs people from all over the world regardless of nationality, race and have respect and value for disabled persons as well.
My day at work usually involves reviewing national nutrition policies, program of work as well as strategic nutrition plans for some high-burdened countries of the WHO member states. My colleagues and I are working on countries such as Thailand, Fiji, Philippines and I get to work on my own country Ghana! This involves systematic review of these documents and extracting information that would be used for country analysis to assess their national nutrition situation and to map out priority areas that would need action as well as the nutrition capacity development. This is in the initial stage of the follow up to the Landscape Analysis and I am glad to be part of it.
My first couple of weeks here has been very fun and exciting with parties here and there almost each week! My hostess, Neddy who is Kenyan invited me for a barbecue party over the first weekend and then to a surprise birthday party for one of their friends in Carouge, an old part of the city which is about 10 minutes from where we live. This was then followed by a lunch date over at our Lady Pastor's house for some local Ghanaian dish ( Banku with okro stew with spinach) which I missed very much amidst good conversation. The week following my arrival at work saw another colleague intern, Tina who had just finished her internship and was ready to leave. The Nutrition Department organized a breakfast meeting to listen to her experience so far and her plans for the future.

Tina is second from left of those sitting. To my right is Haryeom from korea and to the left is Jason from the Micronutrient section of the Nutrition Department

Her account was motivating and we the interns were challenged to work hard whiles here.
This coming week, I get to present what I have been working on so far with the Ghana situation, so I look forward to a productive week and probably some fun activity with my colleagues from the UN! As usual, we always keep in touch and get busy after work!

Posted at 9:18 PM
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Because the video and pictures will do most of the talking, this entry will be relatively short. The first "go" at the farmer survey has proven to be relatively fruitful: 52 participants from one natural village (total population 446) took roughly 20 minutes each to respond to the 24 question survey. Please watch the video below if you are interested in its preliminary findings. It was against nearly every fiber of my being, but I turned the camera on myself this week. Overall, it seemed that most participants enjoyed sharing their work history and background. This case study is only a drop in the bucket. Chinese agriculture is extremely diverse.

Continue reading "Survey says..." »

Posted at 1:39 PM
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Over 700 long lasting insecticide treated mosquito nets have been distributed thus far. The URF has a distribution initiative but it has operated on a small scale. This is the first large scale distribution the URF and myself have ever conducted. There were many constructive discussions before my arrival here in Uganda. These discussions lead to a basic method of distribution with the assistance of the URF women's group. As described in past blog, the women's group meets every Saturday and operates under a hierarchy system. Moreen, the URF coordinator for the women's groups, leads the Saturday meetings and conducts outreach services for the women. There are 12 districts in the surrounding area and each district has its own women's group branch. Each branch, 12 in all, has a head women. When moreen wants to visit the women in a certain district she informs the head women and then the head women informs everyone in the district. It is a very efficient system for communicating and meeting with people in the community. It is also a great reinforcement system for women to follow through with any assignment or project offered but the entire women's group. This is tied to the mosquito nets because we have been utilizing this system for distribution.

When we go to distribute nets to a district we call the head women and then meet with the women's group as a whole. Then we sit, give introductions, and share basic information about Malaria and the LLINs. After this is over we demonstrate how to set up a net and then give a net to each women. During this process Moreen and Fred interpret and write the name of each person receiving a net. The URF has the names of every person who has received a net.

There have been ups and downs. Since the beginning I have had reservations about just giving out nets. In terms of development, I generally feel that handouts lead to dependency. Dependency is very deleterious and unfair. A disease of dependency has been created in East Africa and I have witnessed it on multiple occasions. A well intended project or program can falter due to hand outs (The creation of dependency). But why? If Apple gave out free ipods would you care if you dropped it on the ground? Maybe, but you probably wouldn't care as much if you bought it yourself. When applying this example to development all too often projects and programs are dropped with little concern. Conclusively people may be more inclined to use a mosquito net if they purchase one for even the smallest amount.

I felt that a better solution for the mosquito need could be searched for and found. After the first few distributions Moreen and I had some wonderful conversations. Overall we felt the net distribution was going well but we felt like it could be going better. The URF has always given out nets for free but Moreen and I wanted to change this. First we decided, mostly moreen, that we did need to finish distributing nets to the women in the women's groups in the twelve different districts. It wouldn't be fair to start by giving out free nets then all of a sudden start charging people for nets in the remaining districts.

Some districts were very receptive to the nets. They asked questions and took part in the discussion about the importance of using a bed net. Some went straight home to open up the package and set up their net. There were other communities that weren't overly satisfied and perhaps justifiably so. The problem with giving out free nets is that you should probably make sure you have enough nets to give out. Because Moreen has the exact number for the women in the women's groups in each district we knew how many nets to bring. But that didn't work once more people in the community heard about free nets. Recently more people have been showing up to the distributions than were in the women's group. We had to prioritize and give nets first to the pregnant women and children. In a very overtly male dominated society, the men weren't always content with this. Deciding who should get a net is not an easy decision to make because Malaria is an enormous problem here. Everyone deserves a net. Even the staff here at the URF claims to contract Malaria 8 to 10 times a year. I was at the department of health for Masaka and I received information about Malaria in the region. Last year there were 350,000 reported cases of Malaria out of the roughly 800,000 people living in Masaka. This doesn't include numbers from private clinics, estimates for unreported cases, and those who go to private clinics. Conclusively, distributing nets, as a hand out or not, is absolutely necessary.

To date we have distributed about 700 nets to all twelve districts. This is a small number compared to those who need them but we wanted to start with a smaller number to evaluate the program. We have not yet visited communities to see who is using them, hopefully we will this week, but we will now start charging for the nets. Moreen announced at a large women's group meeting that each net (LLIN) now costs 14,300 Ugandan Shillings, about 7 USD, but the URF will charge each person 3,000 shillings per net. WE weren't sure how this would be received but the women were all for it. Some stood up and gave 3,000 shillings almost instantly. Those funds may then be used to purchase nets for individuals living in absolute poverty and cannot afford the 3,000 shillings. The net distribution is now in a solid stage where it can have the largest impact on the community as possible.

There were lots of ups in downs in this process but it was all necessary. Hundreds of more nets will be ordered in the near future for the URF and women's group to distribute. A very strong system is now in place to distribute the incoming nets that will have a long-term positive impact on the community. Some of the impacts are already visual. The Nazareth orphanage is fully stocked with mosquito nets, and just over a week ago there was an elderly woman who arrived at the URF just after sunset. She brought with her the empty bag of the mosquito net to show that she already using her net and to deliver a simple thank you. Because she lives alone, she told us, she had no one she could celebrate the arrival of her new net with. So she got up before first light and walked over an hour to say just to thank you. It was incredible. What she didn't realize is that she happened to give me one the best birthday presents I have ever had!

Hopefully I included almost everything. Another large order of nets came in just days ago so the URF has a stock that will last at minimum a few months. A slow distribution process will allow them to target those in most need.

Posted at 6:34 AM
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Once every month the URF women's group, headed by Moreen, meets at Hope Integrated academy as a whole, all 12 districts at one meeting. They meet to discuss their craft projects (basket weaving) and share ideas about marketing, designs, profits, and more. This past Saturday meeting was a little different.

A women's group from the Tekera Resource Center, a completely different NGO, came to meet with this group. The Tekera women also have craft business where they sell beautiful hand crafted baskets and items. Ideas were passed between the groups for the benefit of everyone.

I have never seen two different NGOs come together to create a consortium such as this. There were no agendas. Both of the groups had something to offer and gain but nothing to lose. This is the only way development can move forward.

The Tekera women had wonderful marketing skills but the URF women produced higher quality products. Consequently the URF women shared their designs and techniques with the Tekera women and the Tekera women shared their marketing ideas. The Tekera women keep in touch with tour companies in Kamapala. When a tour group passes through Masaka they make a stop at the Tekera resource center where the women can sell their baskets for a large profit. One tour form this past month group produced over 700,000 Ugandan shillings in profit for the entire tekera women's group. This is an idea that can be adapted by the URF women as well. The two groups also don't have to worry about competing with each other because they live in opposite sides of Masaka.

All too often there isalmost a complete lack of communication, coordination, and collaboration in the field of international health and development. This results in the unremitting reinvention of the wheel. For example, if these two women's groups had not met with each other then the Tekera women wouldn't have new ideas about how to improve the quality of their products. Probably this would cause the Tekera women jump the same hurdles as the URF women. It could take months or years for them to match the quality of the URF women. Because of the synergy that was created the Tekera women will soon be producing higher quality products yielding them a greater income. The hurdles they have are now dramatically reduced. If we, public health professionals, are going to dedicate ourselves to making a better world then we should also dedicate ourselves to working holistically and collectively, just as these women.

It was very heartening for me the see these women meet for the first time in their lives and immediately and collectively create solutions for each other's problems. My hope for a better world lies in them.

Posted at 6:24 AM
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Upon completion of the family planning survey, one of my main projects with MIHV is to research the current birth registration system of Ssembabule district. All I knew about birth registration in the district is that at one point, UNICEF was here implementing a birth and a death registration system for children who were not born in an official health center, but then they left. So basically, I needed to find out if the system was still being implemented after UNICEF's departure. The first activity I did in relation to this was to schedule a meeting with the district planner. During this meeting, I found out that once UNICEF left, the entire birth registration project was halted. This seems to be a large problem with many projects in the developing world. UNICEF came and funded the start-up of the project, provided birth certificate forms, trained individuals and then left, thinking that the district would be able to continue the project on their own. The project was actually working pretty well. Mothers would visit the LC1 (a sort of chief) of the village to report new births, the LC1 would record the birth and report all births in the village to the sub-county, and then the sub-county was supposed to provide birth certificates to the mothers and also report the births to the district. The problem was that UNICEF was providing the LC1s with a small stipend in order to cover their travel expenses and time that they used recording the births. When UNICEF left, this funding for stipends left as well, and so the entire registration project was halted because LC1s were no longer able to document the births. So, it seems that UNICEF did not think about the sustainability of the project they were implementing and now Ssembabule district is back where it started, with no sort of birth registration system at all for children born outside of an official health center.

I continually compare the manner in which these activities happen in Uganda to how they would happen in the U.S. Most children in the U.S. are born in a hospital, which provides a strong infrastructure from which to register these births. Most children in Uganda are born at home, in rural areas, and some of the mothers who give birth do so without the presence of a midwife or other trained birth attendant present. Many women do give birth with the assistance of a traditional birth attendant (TBA), but since these births take place so off-the-grid, it is nearly impossible to track them without an extremely intricate network of communication and cooperation. Not to mention that the majority of TBAs are illiterate, so would be unable to fill out a birth certificate if they were given the resources to do so.

So, why even bother? Why is it important to even record the births of individuals who are living in such rural areas? First of all, it is vital for statistical purposes, to understand how the district is growing in order to be able to provide sufficient government services, etc. But on a more individual level, through various meetings with district and sub-country officials, I have found that a birth certificate, in some cases, is necessary for many things, including;

-Registering for secondary school
-Registering for social security assistance/grants
-Registering for the University
-Getting a scholarship for schooling
-Applying for a passport
-Bringing certain types of cases to court
-Acquiring subsidized anti-retroviral drugs if an individual is HIV positive or has AIDS

So, a cycle of disparity continues out of the lack of a proper birth registration system for rural families here in Ssembabule. The most impoverished individuals do not have the means to travel to a health center to give birth, therefore the births of their children will not be registered, and their children will not have birth certificates throughout life. These are the children who will most likely need scholarships or social security assistance, but these are children who will not be able to provide the proper documentation in order to attain these services. It is important to note that all of this information may not apply in all cases, but even so, for some individuals, the lack of proper registration at birth could affect them for their entire lives.

All of this research makes me wonder about UNICEF and if they even considered the sustainability of their project. It makes me wonder about other large-scale organizations, which drop large sums of funding to implement enormous development projects in rural settings. What good is a big handout if it cannot continue without the constant flow of external funding? How will these recipient communities look upon aid organizations from developed countries after they are left high and dry? For me, this whole experience has brought to life the saying "Give a man a fish, and he'll eat for a day. Teach a man to fish, and he will eat for a lifetime."

Posted at 6:24 AM
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