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.
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.
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.
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.
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.
Here is a another quick post with a few select photos of my experience thus far. You will find pictures of the mosquito nets and transportation. We fit 7 people (including the drivers) on two boda bodas (motorcycles) with 75 mosquito nets. It's nice to be alive after that. Also there are photos of Joseph and Gloria, two young bubbly children from the nazareth orphanage. A tent that is my home wihile working with the URF and more. Hopefully there will be more. Later!
I have yet to share with you the Mosquito net project. The URF has a program where they focus in distributing mosquito bed nets to the community. Funding is always a problem and it has been the lead hindrance of the program. Thanks to EWB, Advent Lutheran Church in Cedarburg Wisconsin, and other supporting members $10,000 USD has been raised to purchase and distribute mosquito. Consequently, we are able to focus on quality, with having to worry about quantity. Permanet mosquito nets are impregnated with an insecticide that can last up to 4 years. This carries great importance because the normal insecticide treated bed nets only use insecticide that can last for about 6 to 12 months. With these nets the owner’s have to retreat the nets ever year. This adds additional costs as you have to purchase the insecticide, which many cannot afford. The name for the mosquito nets I am using are long lasting insecticide treated mosquito nets (LLINs).
Over the next few weeks I will be working with URF to educate the community about Malaria and LLINs while also setting up a distribution campaign. Our primary targets are the URF Women’s and Men’s groups, a special needs facility for children in Masaka, the Nazareth Orphanage, child headed families, and the HIA students. This should keep our hands full for a while.
Tomorrow I will be picking up 500 nets. Next week the education and distribution will begin.
The roads and traffic in East Africa are deadly. This was the case when I was in Tanzania and it is the same here in Uganda. This is perhaps on of the greatest man made public health disasters in this region of the world. I have been told by multiple people that 2/3 of the patients in Kampala hospitals are from traffic accidents (I don't have the exact data for this as my Internet time is limited enough, but, for those of you at home, feel free to do a quick search about traffic accidents and death and injury in East Africa. I would to love to hear what you find) Again, I heard the same stories in Tanzania.
So what is being done? Nothing that I have seen. The global health world should take to care to bring a needed focus to the issues surrounding traffic. I don't have any clear ideas at the moment but it is a conversation that needs to be started. I have seen a handful of smashed cars on the road and one in particular inspired this post.
Carol is a hero. She was born here, at the Nazareth Orphanage in Niendo (spelling may be incorrect), close proximity to Masaka. Nazareth, as explained by a member of the URF Canada branch, needed help when he arrived back in December of this year. Only about three unpaid Ugandan staff worked to literally keep the 23 or so children alive. Many were malnourished. Some were infected. Three have disabilities. What can three unpaid staff do to feed, clean, and love 23 children? I was told one of the children died a year ago. Now the story is different.
Arrivals are pleasant with a no worries perspective. After over 24 hours of traveling we finally made it to Uganda. The first night we slept in a cheap hotel and then were picked up by members of the URF and taken to Hope Integrated Academy (HIA) in Kyetume, Uganda, 45 min. ride south west from masaka. The unforgiving roads between Kampala and HIA were met with a warm welcome of students.
I’ll start my description of HIA by starting with the morning. An orchestra of ducks, chickens and roosters, goats, cows, and dogs, led without a conductor, create a wake up call that can start as early as 2:30 a.m. but no later than 4:30. I'm getting used to it actually but the animals are kept only about 30 ft from our house. Breakfast is bread with jam and hot tea followed by a brushing of the teeth. This last part is one of my favorite moments of the day because HIA is nestled on the top of hill that overlooks kyetume and surrounding green rolling hills. The fields of crops almost appear as if they chose to grow where they wanted leaving small brown snaking paths for locals walk. The rest of the day begins after spitting the toothpaste onto the ground and dodging the farm animals while walking back to the house.
On Thursday we walked with two other URF volunteers to a child headed home just outside of Kyetume. In a small mud hut lives about 7 children ranging from the ages of 3-9 with an older grandmother living. We were never told about the parents. The children are simply too young to help yield a solid income and the grandma, jaja in Lugandan, is too old. For the morning we constructed a garden for the family. This consisted of making a horseshoe shaped garden that had a small fence, only about a foot tall, made of wood stakes and banana leaves. The shape helps trap rain water. We then filled it with dried beans with fertilizer and then dirt. Hopefully I can post photos but it was a very educational and HOT task for me. I wore a bandana that I could have used to fill a bucket when i was finished. The family can now produce their own food as they will be planting carrots, tomatoes, and more.
The internet is a little lackluster here and so i'm going to go ahead and post. I’ll probably be making a few posts all at once as it is a task just trying to find a solid connection.
I love airports. They are filled with unique little overpriced stores that are perfect for wandering. Usually I feel a little guilty about walking into a store without purchasing anything but this is not the case in airports. Picking up a magazine and reading half of it is especially enjoyable when you don't pay for it, but good thing you can't do that with chewing gum. Overall I find airports a prime place for meditation and reflection.
The few days prior to an extended trip are full of last minute purchases, friendly goodbyes, packing conundrums, and lots of to-do lists. The airport is the calm from the prior days of panic and disorder. There really isn’t anything to do except hang-out, people watch, and wait for the airplane. I can't wait!
Thanks for checking out my blog. For those of you who don't know me I am a Maternal and Child Health MPH student with a global health concentration. In that last sentence people usually include if they are a first year or second year but I am more of a 1/2 year student. I found my way to the SPH through the core concepts certificate program and now I’m in MCH!
Anyway, this summer for my field experience I am heading to Uganda from June 1st to August 18th. Until I wrote that last sentence I didn't fully realize how close I am to my departure date! I suppose at some point I should think of moving out of my apartment. When I do travel to Uganda I will be in the company of University of Minnesota's Engineers Without Borders (EWB). Here are some resourceful websites highlighting their amazing work...
Together the EWB group and I will be traveling to Mulobere, Uganda, about an hour south of Masaka. In Uganda we will be staying at Hope Integrated Academy (HIA) which is run and funded by the Uganda Rural Fund (URF). Check out the websites...
EWB will be installing a solar water pump and constructing a water storage system at HIA. This portion of the trip will be a great experience for me as I know next to nothing about engineering. Another public health student, Amber Koske, and I will be holding seminars about proper hygiene and sanitation techniques, conducting a health impact assessment to measure the incidence of diarrheal disease in the community surrounding HIA, and distributing over 1000 long lasting insecticide treated mosquito nets (LLINs). Lots to do!
I'll be sure to post again just before I leave, and, in the meantime, I'll be relaxing at home and keeping my fingers crossed that my Malaria medication will arrive in the mail before my departure.
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