Notes from the Field 2009

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 | Permalink | Comments (1)

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...

Posted at 9:37 AM | Permalink | Comments (3)

Seriously. Sometimes I just want to shout "Shut up, Uganda!" It's 6:40am. I'm in a hostel in Masaka. It sounds like they are demolishing some large cement blocks with steel pipes just down the hall from our room. I finally got to sleep at 4:30 am, when the restaurant downstairs decided to stop blaring their hip-hop music. I have to say that I definitely wonder when Ugandans actually sleep over all of the noises here. Take the guards at our site in Ssembabule, for instance. I stay up until around midnight each night, and there has yet to be a night where I haven't been trying to go to sleep to the sounds of their radio and chatter. There are also not been a morning where I have not awoken to the same guards and the same radio going strong at 4:30am. And when I say going strong, I mean it's the loudest radio I have ever heard. Not to mention the rooster in our neighborhood that has no internal clock and just cock-a-doodle-dos incessantly all day and all night. Or how, around 9pm every night, every single dog in Ssembabule joins up for a good, ten-minute long howl. It's quite an uproar: the crooning of thirty-plus dogs can drown out all the sounds of our community. The place where we stay is also across from a motorcycle repair shop, where the repairmen are constantly revving up motorcycles to test their engines. Yesterday, a cow that was staked in the yard next to our place pulled up his stake and spent the day meandering around town mooing like he was heartbroken. No one seemed to think this was out of place. I imagine that when I come home to Minneapolis, the silence in my neighborhood will be nearly deafening.

Posted at 9:31 AM | Permalink | Comments (0)

I have not been able to reach internet for the past few weeks. This blog entry is a couple weeks old, but I thought I would post it anyhow. I am in Masaka for the next couple of days, where there is more access to internet, so I will continue posting, if possible. I have so much to share with all of you!!

June 10th, 2009.
I had a very humbling experience today. I was sitting outside of the gate where we live, talking to my sister, Katie, and to be honest, I was complaining. The work we are supposed to be doing here is getting off to a VERY SLOW start. Every day I look around this village, and as I join up with the big "I traveled to Africa" cliché, I have to say it is the worst kind of poverty I have ever been witness to. There is SO MUCH work to be done here and for the past week I have found myself sitting at a desk with two other volunteers, staring at the wall as we twiddle our thumbs. Many times I have been told, in regards to working in Uganda, that "nothing goes as planned here" and "everything takes twice as long to finish" and I am so new to this country and this culture, and I hesitate to just walk around this village to find something to help with. I don't want to impose myself upon anyone, so I just sit. And wait. And call my sister to talk (complain) about the situation, as I was doing this afternoon. While I was sitting and chatting, I noticed a boy who was maybe 11 years old, standing about 20 yards away and just watching me. At first, I didn't think anything of it. I stand out a great deal here and it's not unusual for the villagers to completely stop what they are doing, drop their jaws, and just stare at someone who is, quite possibly, the whitest, blondest person they have ever laid eyes on. But this boy, dressed in his tattered blue school uniform, stood firm in the middle of the road for a good ten minutes. In the midst of receiving some sage advice from Katie (she has lived and worked abroad all over the world), I waved at the boy in greeting. He tentatively took a few steps toward me and so I walked over to him and he just handed me a tightly folded piece of paper and walked away very quickly. I unfolded the paper, not really sure what to expect, and read:

"Good evening. I am called Henry. This is my telephone number. I want you to become my sponsor and take me in your country. I am at K---- Secondary School. Please help me and support me."

The timing of this note couldn't have knocked the wind out of me more quickly. Here I was, a grown woman from a very privileged life, grumbling impatiently and missing home, and here is this child who, based on the language I was speaking and the way I looked, was sure that I had it better wherever I was from. All I could think to myself was how selfish I was to be having such a hard time in a new culture that I will only be in for three months, whereas he would be willing, at such a young age, to leave his entire family and probably the only home he has ever known, to seek a better situation for himself and his family. While I find myself at a loss for how to respond to his note, Henry reminded me of a saying from South Africa that I once learned call Ubuntu. It means "I am a person through other people. My humanity is tied to yours." It is impossible for me to understand where I come from and who I am without first considering my relationship and my connection to other people in the world. Sometimes, it is so easy to become self-absorbed and frustrated when things are not going my way, or the way I expected, so I am thankful that Henry showed up when he did. He brought me much some much needed perspective on the situation. I think, ultimately, this is why I chose to come to Uganda this summer. It was time to step out of my comfort zone, to test my limits, to understand the various ways in which to achieve my goals, to find diverse meanings for beauty and hardship, and to see similar situations through a new lens.

Posted at 2:04 AM | Permalink | Comments (1)

By Anna Bartels
Uganda

I have arrived! After 38 straight hours of travel (Minneapolis-Amesterdam-Nairobi-Etebbe-Kampala-Ssembabule), I safely made it to Ssembabule, the site where I will be staying for most of my time in Uganda. The last four hours of the trip were in the MN International Health Volunteers (MIHV) truck, heading over some of the roughest red dirt roads I have ever seen. The driver, Richard, skillfully maneuvered around various bikes loaded with matooke (green bananas), crafty boda bodas (motorcycle taxis), countless numbers of people walking, and rifts in the roads that I made me cringe as I thought about how hopeless my little Hyundai would be in this country. Uganda is so GREEN! There is vegetation everywhere and so far I have seen tons of coffee, banana, and palm trees, as well as papyrus plants.

I am working with Minnesota International Health Volunteers (www.mihv.org) on two different projects. The first one is a mid-term evaluation of the family planning project that MIHV has been heading up, and the evaluation will entail interviewing women in the surrounding parishes (grouping of villages) about their knowledge and/or use of family planning methods. I have already learned a great deal about what family planning entails in Uganda from Elijah, who is the field officer for the Ssembabule site. He has very wise opinions, telling me that “AIDS and Poverty are brothers” and he also shared with me that men especially, are against any kind of contraception because they often see their manhood in terms of how many children they can produce, regardless of if they can afford them or not. He said that because of vast number of people who are dying due to AIDS, many people feel a pressure to repopulate their clans with as many children as possible. I am excited to learn more from Elijah as my time progresses here. Here he is pictured next to the site (Elijah).

Continue reading "I have arrived!" »

Posted at 8:44 AM | Permalink | Comments (5)

I leave for Uganda in 10 days! Yesterday, I handed in my last two final papers and I can finally start thinking about packing up my apartment and carefully packing my backpack for travel. My favorite part of preparing for a big trip is tightly rolling all my clothes up so that they take up the smallest amount of space in my pack. In the next ten days, I am also flying to NYC to see my sister graduate (Congratulations, Katie!) and driving to Iowa to see my grandma one last time before I head out. It’s a busy time, to say the least.

For the past eight days, I have been taking the oral typhoid vaccine - one pill every other day. I chose the oral vaccine because it lasts for five years and it’s cheaper than the injection, which only last for two years. I wish I had gotten the injection. Eight days of abdominal cramping and nausea (side effects of the oral vaccine) made me wonder how important immunity to typhoid really is. A friend, upon reading my doubts via my Facebook status, declared that it was “better to be sick here than abroad.” I guess I agree. About an hour ago, I also got the meningitis, polio, and hepatitis A vaccines. I was feeling a bit like a pincushion, but then while the nurse was sticking needles into my arm, she commented that I “must work out,” so I took the injections like a champ. I’ve often thought that it would be pretty sweet if you could notice every instance in which a vaccine actually prevented you from contracting a disease - like a little light flashed or a bell dinged when you were exposed to polio but didn’t get it because your vaccine did its job. I think such a light or bell would also remind me that, while I complain about the process of getting these vaccines, I am so exceptionally lucky to have the access to and the means necessary to receive them. Just another reason to be grateful to the field of public health…

Posted at 12:15 PM | Permalink | Comments (5)