Location: Kampala, Uganda
From the moment our plane touched down in Entebbe, Ugandans have received our group with open arms. In fact, I cannot think of a single day when I have not been warmly greeted with the words, “You are Most Welcome.” I do not think that any of us could say that we have at any time felt as if we were not wanted here. As Americans, we have come to see respect and friendliness as a fundamental characteristic of Ugandans. Though my own naivety led me to expect every Ugandan to be welcoming to every “outsider”, my dealings with refugees and other non-Western in-migrants has challenged this initial belief. Though most of the refugees I have interacted with generally seem to feel accepted by their Ugandan peers, I have been shocked to learn of the hostility that they face on a daily basis.
The first time I witnessed this hostility occurred on the night of April 29. Though much of our group left the country for our short break, I decided to stick around Uganda to visit with some family friends from Ethiopia. Before I left the United States, my father emailed me the names and numbers of several people that he knew from his hometown, Debre Zeit. Like much of my own family, many of the Ethiopians residing in Kampala came during the 70s to escape the violence of Mengistu Haile Maryam’s regime. One longtime family friend was able to escape from such circumstances and now owns a successful restaurant in Kampala’s Kabalagala district and several guesthouses across the city. As I was eating a meal with her grandson, a Ugandan friend of his named Kevin got into a heated argument with a man named David over football. Rather than stick to a criticism of his sports knowledge, the Ugandan friend lashed out at David, telling him that he was a refugee that did not belong in the country and making fun of his difficulty with English. Though this may merely have been an outburst of anger and nothing more, the look in David's eyes throughout his rant suggested that he was expressing some deeply embedded attitudes.
Another example of this negative perception of refugees revealed itself to me during an interview with a 48-year-old Congolese refugee named Michael. Two years ago, as he was sleeping outside of the InterAid Uganda Urban Refugee Centre with his wife and ten children, Michael was awakened with the kick of a Ugandan police officer. As they violently beat his entire family, Michael claims that the police simultaneously assaulted them with vulgar and xenophobic remarks. After telling me this story, Michael showed me a picture that had been taken by onlooker as his family was being beaten by the police. Though he had come to Uganda because of its supposedly generous attitude toward receiving refugees, the harassment that he has received from both the police and from private citizens has caused him to fear for his own safety on a daily basis. Given that this same fear was the very reason that Michael had left the Congo in the first place, I found this very disturbing.
I find it difficult to be too critical of those Ugandans who hold hostile attitudes toward refugees. Uganda is a resource strapped country, so I can see why many of its citizens are not open to the idea of letting in more people who may overstretch those sparse resources. However, I also know that many of these prejudices are entirely unfounded and inexcusable. Most of these refugees are not receiving a single dime from the government. Most of these refugees are not receiving a single grain of rice from the government. What little assistance they do receive comes from NGOs such as InterAid and UNHCR. I firmly believe that most Ugandans are aware of this fact. However, the ones who are not seem to be making life for many refugees in Kampala miserable.
-Article covering beating of "Michael" and his family:
http://allafrica.com/stories/200808220104.html
Thursday, May 6, 2010
Week 5- Kigali
Location: Kigali, Rwanda
For my free week (which was actually our sixth week here, after Rakai), I decided visit Kigali, the capital of Rwanda. I purchased a bus ticket for $12 (so I can’t complain) and left Kampala at nine in the morning, arriving in Kigali after a hot and cramped ten hours on the bus – about two hours later than expected.
Unless for some reason you have studied Rwanda, in the United States, any mention of Rwanda conjures thoughts of the genocide that took place sixteen years ago. People think of Rwanda exclusively in those terms, it seems, and for many Americans, Rwanda has the reputation of a dangerous place torn by genocide and war.
Kigali is actually a very beautiful city. It is also one of the safest cities in all of Africa. It is clean and modern, and it is hilly and lush and cool, and it is even possible to find a good, properly brewed cup of Rwandan coffee. There is very little traffic, and each breath of air you breath is not tainted with diesel fumes and dust. You can take boda-bodas (motorcycle taxis) safely – helmets are compulsory and all drivers must be registered, and this is actually enforced – and the roads are paved, so your ride feels unnaturally smooth after spending a month in Kampala. It is also a very expensive city, largely because of all the international aid that was pumped into the county after the genocide. In fact, it almost feels like Europe, especially when you hear French being spoken all around you.
Despite all of this, the effects of the genocide are of course still very prominent. The interesting thing is that they are subtle. On the surface, Kigali is a relaxed, modern, clean and friendly city, but as I spent time there, I began to notice an underlying sadness that almost seemed to surround me. It hit me, I think, as I was eating dinner at a restaurant with a couple of people who I had met. One of them spoke some Swahili, and she was speaking with our waitress, who also happened to speak Swahili. She told us about her life very briefly – that she had lost her whole family in the genocide.
This waitress gave a human face to the genocide, and it was her very reserved manner and quiet demeanor, friendly without being overtly happy, that I think characterized many Rwandans and pointed to the underlying sadness that will be present there for many years to come. It is amazing to think that nearly everybody of my generation or older are survivors of the genocide who witnessed atrocities that we can barely imagine. I realized that nearly everybody I saw and interacted with were in some way affected – most of them probably lost friends or family members, and many of them probably watched as they were killed.
As impressed as I am by how far Rwanda has come in less than two decades, I am equally intrigued by how Rwandans will continue to negotiate the underlying sadness that shapes their society.
For my free week (which was actually our sixth week here, after Rakai), I decided visit Kigali, the capital of Rwanda. I purchased a bus ticket for $12 (so I can’t complain) and left Kampala at nine in the morning, arriving in Kigali after a hot and cramped ten hours on the bus – about two hours later than expected.
Unless for some reason you have studied Rwanda, in the United States, any mention of Rwanda conjures thoughts of the genocide that took place sixteen years ago. People think of Rwanda exclusively in those terms, it seems, and for many Americans, Rwanda has the reputation of a dangerous place torn by genocide and war.
Kigali is actually a very beautiful city. It is also one of the safest cities in all of Africa. It is clean and modern, and it is hilly and lush and cool, and it is even possible to find a good, properly brewed cup of Rwandan coffee. There is very little traffic, and each breath of air you breath is not tainted with diesel fumes and dust. You can take boda-bodas (motorcycle taxis) safely – helmets are compulsory and all drivers must be registered, and this is actually enforced – and the roads are paved, so your ride feels unnaturally smooth after spending a month in Kampala. It is also a very expensive city, largely because of all the international aid that was pumped into the county after the genocide. In fact, it almost feels like Europe, especially when you hear French being spoken all around you.
Despite all of this, the effects of the genocide are of course still very prominent. The interesting thing is that they are subtle. On the surface, Kigali is a relaxed, modern, clean and friendly city, but as I spent time there, I began to notice an underlying sadness that almost seemed to surround me. It hit me, I think, as I was eating dinner at a restaurant with a couple of people who I had met. One of them spoke some Swahili, and she was speaking with our waitress, who also happened to speak Swahili. She told us about her life very briefly – that she had lost her whole family in the genocide.
This waitress gave a human face to the genocide, and it was her very reserved manner and quiet demeanor, friendly without being overtly happy, that I think characterized many Rwandans and pointed to the underlying sadness that will be present there for many years to come. It is amazing to think that nearly everybody of my generation or older are survivors of the genocide who witnessed atrocities that we can barely imagine. I realized that nearly everybody I saw and interacted with were in some way affected – most of them probably lost friends or family members, and many of them probably watched as they were killed.
As impressed as I am by how far Rwanda has come in less than two decades, I am equally intrigued by how Rwandans will continue to negotiate the underlying sadness that shapes their society.
Week 5- Interview
Location: Kasensero
Week 5 Interview from PublicHealth Uganda on Vimeo.
An interview with Guinness Charles, a fisherman from Kasensero Landing Site.
Week 5 Interview from PublicHealth Uganda on Vimeo.
An interview with Guinness Charles, a fisherman from Kasensero Landing Site.
Week 5- Cool as a Banana in a Fridge
Location: Makerere University, Kampala, Uganda
The notion of privacy and consent is so different wherever you go. Back in the states, privacy is strict. You have the right to whatever information you want to share and provide to others. Any sense of your invasion of privacy, there is always administration available to talk to or help you through it. If you ever wanted a chance to witness a personal incident, such as a surgery, you wouldn’t just have to ask the consent of the patient, but there would be forms from the hospital you would have to fill out and credentials you must have. Our trip to Rakai and the vacation to Zanzibar were a perfect example showing how even in a more educated and modern project in Uganda, their sense of privacy is completely different.
The educational tour and classes at the Rakai Health Sciences Program (RHSP) was probably one of the most eye-opening experiences anyone could have. We first got a chance to tour the workplace, and even the research lab, that would usually be off-limit in the states. The most privacy invasive experience was when we were offered a chance to watch a circumcision taking place. All this occasion required was the consent from the patient (one patient didn’t wasn’t even asked for his consent; it was automatically assumed he would say yes, since all the other patients did). We were allowed to walk in, wearing extra coverings over our head, body, and shoes, and stand next to the musawos (doctors) and patient through the whole surgery. Not only that, but pictures were also allowed. Needless to say, this would never be allowed in the US. RHSP is an institution that is highly regarded as one of the best research centers in the country, let alone Africa. The education level of all health workers there are high and the facilities are top notch. The institution serves only as a workplace, as most workers there go home on weekends to see their family and friends. I assumed, while being there, that the ideas and customs held at Rakai would be much more similar to the United States, rather than Uganda. It was very surprising that their culture and customs resided still strongly. Their sense of privacy as a nation is much less relevant. This experience puts ideas into perspective and provides a better international mindset.
The Rakai circumcision situation was a very evident difference in privacy. A more common occurrence would just be cultural customs walking down the street. I witnessed this while in Kampala, but even more strongly so in my trip to Zanzibar. The culture here provides that there is no personal space. You can walk down the street and someone can grab onto your arm very tightly and not let go until you have reached your destination. There have been occasions where I shake someone’s end, but eventually we end up holding hands for the next 30 minutes (I love holding hands, but come on, 30 minutes? And we’re not even in a relationship). This was especially evident in Zanzibar. April is low season for vacationing, so we were part of the few tourists there. As you walk down any street, there will be people following you and grabbing at you to ask to come into their store “just to take a look”. There have been multiple occasions where I ask people to seriously stop following me, I don’t want your ganja, and I know how to find my own way, but they don’t seem to grasp the complete meaning of “stop”. In the states, this could be considered harassment. Nonetheless, I really enjoyed the vacation to Zanzibar! Hakunana Matata and everything is as cool as a banana in a fridge.
Privacy is something that will always be a concern at the back of my mind through the many activities carried out here. Learning the culture and customs is important as to not offend them, and keeping their privacy in mind is very important, even though it may seem they are more open here. Consent, even for just taking pictures as a tourist, is important to obtain before performing any of the activities. I hope to keep this trip as an open-minded and learning experience.
The notion of privacy and consent is so different wherever you go. Back in the states, privacy is strict. You have the right to whatever information you want to share and provide to others. Any sense of your invasion of privacy, there is always administration available to talk to or help you through it. If you ever wanted a chance to witness a personal incident, such as a surgery, you wouldn’t just have to ask the consent of the patient, but there would be forms from the hospital you would have to fill out and credentials you must have. Our trip to Rakai and the vacation to Zanzibar were a perfect example showing how even in a more educated and modern project in Uganda, their sense of privacy is completely different.
The educational tour and classes at the Rakai Health Sciences Program (RHSP) was probably one of the most eye-opening experiences anyone could have. We first got a chance to tour the workplace, and even the research lab, that would usually be off-limit in the states. The most privacy invasive experience was when we were offered a chance to watch a circumcision taking place. All this occasion required was the consent from the patient (one patient didn’t wasn’t even asked for his consent; it was automatically assumed he would say yes, since all the other patients did). We were allowed to walk in, wearing extra coverings over our head, body, and shoes, and stand next to the musawos (doctors) and patient through the whole surgery. Not only that, but pictures were also allowed. Needless to say, this would never be allowed in the US. RHSP is an institution that is highly regarded as one of the best research centers in the country, let alone Africa. The education level of all health workers there are high and the facilities are top notch. The institution serves only as a workplace, as most workers there go home on weekends to see their family and friends. I assumed, while being there, that the ideas and customs held at Rakai would be much more similar to the United States, rather than Uganda. It was very surprising that their culture and customs resided still strongly. Their sense of privacy as a nation is much less relevant. This experience puts ideas into perspective and provides a better international mindset.
The Rakai circumcision situation was a very evident difference in privacy. A more common occurrence would just be cultural customs walking down the street. I witnessed this while in Kampala, but even more strongly so in my trip to Zanzibar. The culture here provides that there is no personal space. You can walk down the street and someone can grab onto your arm very tightly and not let go until you have reached your destination. There have been occasions where I shake someone’s end, but eventually we end up holding hands for the next 30 minutes (I love holding hands, but come on, 30 minutes? And we’re not even in a relationship). This was especially evident in Zanzibar. April is low season for vacationing, so we were part of the few tourists there. As you walk down any street, there will be people following you and grabbing at you to ask to come into their store “just to take a look”. There have been multiple occasions where I ask people to seriously stop following me, I don’t want your ganja, and I know how to find my own way, but they don’t seem to grasp the complete meaning of “stop”. In the states, this could be considered harassment. Nonetheless, I really enjoyed the vacation to Zanzibar! Hakunana Matata and everything is as cool as a banana in a fridge.
Privacy is something that will always be a concern at the back of my mind through the many activities carried out here. Learning the culture and customs is important as to not offend them, and keeping their privacy in mind is very important, even though it may seem they are more open here. Consent, even for just taking pictures as a tourist, is important to obtain before performing any of the activities. I hope to keep this trip as an open-minded and learning experience.
Week 5- Rakai
Location: Kampala
In coming to Africa, there has been one thing I have wanted more than anything else: perspective. While here, I have endured cycles of happiness, sadness, joy, homesickness, self-defeating thoughts, and courage. In retrospect, I had already known that the things I have come to see existed, and it haunted me. Now that I have seen it, I know it will haunt me the rest of my life. Sometimes I wish that I could live with the perspective of a child, who knows nothing more than his or her needs. Yes, that is selfish, but I am now overwhelmed and guilt-ridden over my love of the American life.
Secondary to perspective, I have sought self-worth and purpose in Africa. What I have found is confusion as to how to live my life and how to proceed from here. The guilt I now feel will surely not leave me. I know now that every death statistic, AIDS statistic, malaria and TB statistic- those men, women, and children all have a name and a face and a personality. They are no less important than your mother or child. Why do we treat the lives of those in third world countries as if they are expectedly and normally transient? Those people are just as loved as we love our families!
In the slums, kids have to worry about little worms that can enter their feet from standing water. These worms then fester for weeks until they finally leave the body—wherever they choose—in a long, long strand of matured parasite. Yet, many kids have no shoes to wear and go around barefoot. Yesterday, I witnessed this in Kasansero, where the first cases of AIDS in Africa were diagnosed. In this cruddy, dirty shantytown along Lake Victoria many little children didn’t have shoes in the pouring rain. (Random note: a little kid- around 1 or 2- instantly burst into tears upon seeing me; I may have been his first musungu! [white person/foreigner]) This past Friday, I was in a Kampala slum while PCA fed the kids one of the two meals a week it can provide. A teenager brought over a dish to my two friends and I and insisted fervently that we eat it. We told him that we weren’t hungry, that we had just eaten lunch beforehand and that the other children should get it. He was much more concerned that we, the well-fed musungus, were given lunch even if others were hungry. Eventually the plate was passed down to three kids sitting on the floor awaiting Neosporin and bandaids, who scarfed it down together. On this day, we taught a group of boys-I would say around 8 to 17- the alphabet and how to form words with consonants and vowels. Some kids already knew these concepts but others struggled to write out the letters. Paul, the leader, wrote on an old overused chalkboard while the kids wrote on the cement floor with some paper and pencils. We then went over the alphabet song- theirs is different than ours- and played a few games. One of those was musical chairs, except that there was no music and we used a bench- in the end, it was who sat down first, not who couldn’t fit. It was…an interesting experience. Not happy nor particularly sad; in a way, it was just a regular day.
Today we were given the opportunity to watch a circumcision as a part of the Rakai Health Services Project that we are currently visiting. Circumcision is a very important HIV/AIDS prevention method for various reasons that I won’t go into now. Obviously, this is a huge breach of privacy but it was no less allowable then seeing into patient rooms at Mulago Hospital. We were dressed up in gowns, face masks, and hair nets, took a couple pictures of how silly we looked, and then entered the rooms. Men were laying down, naked outside of a shirt, on the metal tables and watching us. (Only local anesthetic was used.) I looked at their faces and felt what I had felt years ago getting my spinal check-ups pre-surgery- exposed, anxious, and angry at my perceived loss of dignity. I felt that those doctors had lost their realization of how profound these feelings could be for a scared patient with no control. I had to leave without seeing the circumcision, not because of discomfort at blood but for each man’s sake. Everyone deserves their sense of dignity, and we as undergraduate students who are mostly not even pre-med had no right to be in there or to strip these men of their pride. Maybe that was not the reality, but it’s what’s in the perception that matters.
Being in Africa also inspires me to often think about my career plans. Intern during my senior year, graduate, intern with the UN, go to grad school, get a job…I feel internally and externally pressured to be successful. I wonder if, even upon achieving my goals, I will happy in the end. And then I wonder if that even matters. Is it not selfish to be happy, when other people suffer and you could sacrifice your happiness to make a contribution to theirs? [By happiness, I am referring to stability, material comfort, entertainment- the American dream. At the same time, however, I am also referring to the state of mind: if you truly are sacrificing yourself for others, it would be a struggle to be “happy”.] Is happiness really what we should be pursuing? Is that pursuit even ethical?
To live without complaint, to love regardless of flaws, to appreciate every moment of my life: those are my new goals.
Week 5- Cool like a Chicken in a Salty Egg
Five of us took a mini-vacation to Zanzibar island in Tanzania. Zanzibar is an archipelago off the coast of Tanzania that is a popular tourist site due to its rich history, beautiful architecture, and abundance of beaches. We enjoyed 5 days of "touristy activities" from snorkeling to a spice tour.
It was a really interesting cultural experience leaving Uganda and coming to Tanzania. We've traveled all over Uganda, east to west but this was our first experience to another African country. Taking a break in Zanzibar was great but I have to admit that I missed the people and culture of Kampala. Several people that we've met in Uganda have stated that Ugandans are generally friendly. I have to agree. Almost everyone we have interacted with has been really friendly towards us.
Yet, in Zanzibar, people were really agressive and seemingly out to get us. Street vendors tried to charge us more than double the price, got angry when we didn't go into their stores, and followed us down the street hassling us to buy their products. Don't misunderstand me; I had a great time but I missed the polite, respectful culture of Kampala. In Zanzibar, we were revenue sources; we were one of the few tourists that come during the slow season so we were prime targets for all the shop owners, taxi drivers, and various vendors that depend on tourism to make a living. While see some similar things in Kampala- being charged the "mzungu price" and being asked for money from children- we're always respected when we negotiate prices or say no.
It's hard to know whether these differences are cultural or simply due to the differing economies. Either way, it made me realize how much I've connected with the people in Kampala. Landing in Entebbe felt like arriving home after a long journey away. Taking the hour long drive back to Makerere somehow seemed quick and enjoyable despite the jams and bumpy roads. As a taxi driver said to us in Zanzibar, it was "cool like a chicken in a salty egg." We have no idea what that means but it seems fitting somehow.
Location: Stonetown, Zanzibar, Tanzania
Yet, in Zanzibar, people were really agressive and seemingly out to get us. Street vendors tried to charge us more than double the price, got angry when we didn't go into their stores, and followed us down the street hassling us to buy their products. Don't misunderstand me; I had a great time but I missed the polite, respectful culture of Kampala. In Zanzibar, we were revenue sources; we were one of the few tourists that come during the slow season so we were prime targets for all the shop owners, taxi drivers, and various vendors that depend on tourism to make a living. While see some similar things in Kampala- being charged the "mzungu price" and being asked for money from children- we're always respected when we negotiate prices or say no.
It's hard to know whether these differences are cultural or simply due to the differing economies. Either way, it made me realize how much I've connected with the people in Kampala. Landing in Entebbe felt like arriving home after a long journey away. Taking the hour long drive back to Makerere somehow seemed quick and enjoyable despite the jams and bumpy roads. As a taxi driver said to us in Zanzibar, it was "cool like a chicken in a salty egg." We have no idea what that means but it seems fitting somehow.
Location: Stonetown, Zanzibar, Tanzania
Week 5- Rakai
Our recent visit to Rakai was my favorite and most memorable trip so far. I love getting out of Kampala on these trips because the country is beautiful and green with rolling hills as you move away from the urban center. The air is cleaner and easier to breath, free of the constant dust and diesel fumes found in Kampala. This may sound a bit dramatic, but there is a marked difference between city and country pollution and I feel healthier outside the city. On our drive to Rakai we stopped along the equator and took the obligatory group picture on the equator line. Later in the day we toured Masaka Nursing School where students from both Uganda and other countries train. One of the program coordinators is currently studying there and the school is very impressive.
Leading up to our trip to Rakai, I was extremely excited to attend the lectures and learn about the HIV/AIDS cohort study that is being conducted. The HIV/AIDS epidemic in Uganda is exactly what I want to focus on while I'm here so I was thrilled to be focusing on that topic for 4 days. Before we left for our trip we had a lecture by Professor Serwada on much of the background to the epidemic that they are facing today. The picture was grim, but the progress that has been made and the pioneering advances in research and treatment that have come of the AIDS epidemic are inspiring. The time spent in Rakai made me realize that, while sky-high morbidity and mortality figures are extremely sobering, they also inspire you to have a positive impact and enact change.
Rakai Health Sciences Project is a perfect example of a project that started off small and uncertain, just like the AIDS epidemic, but developed into something phenomenal, adapting to the changing situation and pioneering new methods for research and treatment as more knowledge was acquired. While fancy, high-tech labs and research centers are common in the United States and throughout the developed world, Uganda is a different story. At least one third of the population lives on less that $1 per day and approximately 6% of the population is HIV positive. Thousands of people are dying each day from the disease, but the country has very few resources to do anything about it. Despite the overwhelming problems, Rakai seemed like a beacon of hope to me, something I wasn't sure I would find during my time in Uganda. They may not be able to treat more than a subset of the population, and they may not have found the cure for AIDS, but they are having a major impact on the epidemic. They have grown and expanded over the years, developing new protocols and new research questions to further expand knowledge on HIV. It was at Rakai that researchers conducted a study and discovered the positive, protective factor that circumcision has on contracting HIV. They have subsequently carried out thousands of circumcisions on study participants and other community members who want the procedure. Using the resources and knowledge that they have, RHSP is making a huge impact on the lives of HIV positive and negative patients in Uganda, as well as on the knowledge base regarding the disease worldwide.
If I could spend more time in Uganda I would definitely go back to Rakai to learn more about their projects. But, after our 4 days there I feel better knowing that positive advances are being made to fight this deadly disease. I believe it is projects like Rakai, community-based studies and treatment, that will ultimately combat the epidemic most effectively. Only when you understand HIV in the context of Uganda and adapt the prevention and treatment to the environment can you really see change. I am honored to have met and listened to lectures from Professor Serwada, Professor Wabwire, Professor Sewankambo, and Doctor Kiwanuka. This program has provided me with some great opportunities to learn from the best in the field and I hope to come back and study more in the future.
Week 5 - I'm so amazed!!
Location: Rakai/Kasensero, Uganda
This week we spent a few days in Rakai where we attended lectures and had site visits. I didn't really know what to expect going into this trip. Before we left, we had a lecture with Dr. Serwadda who was absolutely amazing and one of the first journal authors and descriptor of HIV in Uganda and specifically in the Rakai region. After his lecture I was really inspired to learn more and to find out what is going on in the community now. Everything about the trip was absolutely perfect. Our accommodations were not only beautiful but very close to the center where we would have our lectures. Once we arrived, I was so excited because so many great things started there. It was also a huge asset having Professor Stewart with us to help ask questions and really get a feel for the work they are doing. On our first day of lectures, we attended a drama and had a tour of their facilities. Both were top notch!! Of course not all of the buildings and offices were spacious and organized but it didn't really matter because the work could speak for itself. The program is in charge of about 48 villages and each year they make their rounds to make sure that everyone is being taken care of and peoples needs are met, regardless of HIV status. We learned that RHSP pioneered self administered vaginal swabs as well as the use of photos with patients charts and identification numbers. Funding is still an issue but they have done such a wonderful job sensitizing, educating, and treating their communities. They have also done a wonderful job with community involvement which is essential to changing behaviors.
The second day of lectures included a visit to Kasensero. Kasensero is significant because the emergence of HIV in Uganda began in this area. Once again, I didn't know what to expect and I don't think anything could have prepared me for it. The village was very dirty and clustered. Unfortunately, it was raining that day but most of us decided we wanted to take a tour anyway. As we walked around the village I saw animals everywhere and children peeing in the grass. I don't recall seeing any pit latrines there which was really sad because after 25 years, this community is still not receiving the help they need. The children were jumping around in puddles with no shoes completely unaware that their behavior could affect their health. After 20 or so minutes of walking we finally reached the Clinic! It is not up and running yet but I was glad to see that help was on the way. For many people, getting to a clinic is very difficult because they are so removed. RHSP services do not reach Kasensero so having a clinic there is essential. This trip was definitely an eye opening experience for me and I can't wait to learn more.
This week we spent a few days in Rakai where we attended lectures and had site visits. I didn't really know what to expect going into this trip. Before we left, we had a lecture with Dr. Serwadda who was absolutely amazing and one of the first journal authors and descriptor of HIV in Uganda and specifically in the Rakai region. After his lecture I was really inspired to learn more and to find out what is going on in the community now. Everything about the trip was absolutely perfect. Our accommodations were not only beautiful but very close to the center where we would have our lectures. Once we arrived, I was so excited because so many great things started there. It was also a huge asset having Professor Stewart with us to help ask questions and really get a feel for the work they are doing. On our first day of lectures, we attended a drama and had a tour of their facilities. Both were top notch!! Of course not all of the buildings and offices were spacious and organized but it didn't really matter because the work could speak for itself. The program is in charge of about 48 villages and each year they make their rounds to make sure that everyone is being taken care of and peoples needs are met, regardless of HIV status. We learned that RHSP pioneered self administered vaginal swabs as well as the use of photos with patients charts and identification numbers. Funding is still an issue but they have done such a wonderful job sensitizing, educating, and treating their communities. They have also done a wonderful job with community involvement which is essential to changing behaviors.
The second day of lectures included a visit to Kasensero. Kasensero is significant because the emergence of HIV in Uganda began in this area. Once again, I didn't know what to expect and I don't think anything could have prepared me for it. The village was very dirty and clustered. Unfortunately, it was raining that day but most of us decided we wanted to take a tour anyway. As we walked around the village I saw animals everywhere and children peeing in the grass. I don't recall seeing any pit latrines there which was really sad because after 25 years, this community is still not receiving the help they need. The children were jumping around in puddles with no shoes completely unaware that their behavior could affect their health. After 20 or so minutes of walking we finally reached the Clinic! It is not up and running yet but I was glad to see that help was on the way. For many people, getting to a clinic is very difficult because they are so removed. RHSP services do not reach Kasensero so having a clinic there is essential. This trip was definitely an eye opening experience for me and I can't wait to learn more.
Week 5 - Zanzibar Lesson 1: Avoid Spray Sunscreen.
Location: Kampala
During our two week hiatus from class, between our trips to Rakai and Ssese Island, a few of us opted to do some independent traveling. We decided on Zanzibar mostly for its tropical allure and touristy reputation and were certainly not disappointed. Aside from the breathtaking beaches and scrumptious dining, Zanzibar offered a unique cultural perspective as well. As a famous historical trading hub, the island had a fascinating mix of Indian, Arab, and African traditions all interwoven into one people.
One of my most memorable experiences was taking a cooking class from a local family, preparing the following: pilau, fish curry, sweet potato and coconut and papaya and coconut. Our hotel arranged a number of touristy excursions and this was the first on our list. We were escorted about twenty minutes outside of Stone Town and invited into a traditional home with a large family. From there we were asked to select four menu items from a list of twenty and then proceeded to cook under the supervision of some of the family members. My favorite activity that night was coconut-scraping. In fact, there is actually a special chair that serves a dual purpose -- sitting and coconut-scraping. From the middle of the chair, there is a large, rough, rounded blade that is used to scrape the coconut flakes from the shell. There is even a technique that ensures efficient coconut scraping. We tremendously enjoyed the lessons as well as the company, but probably most of all the meal we prepared with the family.
Another exciting episode from the trip was snorkeling off the coast of Prison Island. However, the most enjoyable part was not the snorkeling itself, but the transport to the island. We took a privately hired boat, but were permitted to stand on the front of it -- not inside (something what would certainly have been deemed a liability and therefore prohibited in the United States). Though the experience was exhilarating, the memory is embedded twofold. One, of course, is the traditional memory, and the other I embarrassingly wear on my back and shoulders. It seems that while applying spray-on sunscreen, I managed to avoid several areas that resulted in an awkward patchy sunburn resembling arbitrary land-masses on a geographical map. Suggestion: stick with lotion sunscreen, it may be slower, but at least it's much more accurate.
Despite the glamour and charm of Zanzibar, I oddly found myself feeling homesick--though not for America, but for Kampala. This resonating nostalgia of Kampala as home has made me realize how important and moving this study abroad trip has been. To find myself longing for a country I had spent less than a month in makes a powerful statement about Uganda and its people.
During our two week hiatus from class, between our trips to Rakai and Ssese Island, a few of us opted to do some independent traveling. We decided on Zanzibar mostly for its tropical allure and touristy reputation and were certainly not disappointed. Aside from the breathtaking beaches and scrumptious dining, Zanzibar offered a unique cultural perspective as well. As a famous historical trading hub, the island had a fascinating mix of Indian, Arab, and African traditions all interwoven into one people.
One of my most memorable experiences was taking a cooking class from a local family, preparing the following: pilau, fish curry, sweet potato and coconut and papaya and coconut. Our hotel arranged a number of touristy excursions and this was the first on our list. We were escorted about twenty minutes outside of Stone Town and invited into a traditional home with a large family. From there we were asked to select four menu items from a list of twenty and then proceeded to cook under the supervision of some of the family members. My favorite activity that night was coconut-scraping. In fact, there is actually a special chair that serves a dual purpose -- sitting and coconut-scraping. From the middle of the chair, there is a large, rough, rounded blade that is used to scrape the coconut flakes from the shell. There is even a technique that ensures efficient coconut scraping. We tremendously enjoyed the lessons as well as the company, but probably most of all the meal we prepared with the family.
Another exciting episode from the trip was snorkeling off the coast of Prison Island. However, the most enjoyable part was not the snorkeling itself, but the transport to the island. We took a privately hired boat, but were permitted to stand on the front of it -- not inside (something what would certainly have been deemed a liability and therefore prohibited in the United States). Though the experience was exhilarating, the memory is embedded twofold. One, of course, is the traditional memory, and the other I embarrassingly wear on my back and shoulders. It seems that while applying spray-on sunscreen, I managed to avoid several areas that resulted in an awkward patchy sunburn resembling arbitrary land-masses on a geographical map. Suggestion: stick with lotion sunscreen, it may be slower, but at least it's much more accurate.
Despite the glamour and charm of Zanzibar, I oddly found myself feeling homesick--though not for America, but for Kampala. This resonating nostalgia of Kampala as home has made me realize how important and moving this study abroad trip has been. To find myself longing for a country I had spent less than a month in makes a powerful statement about Uganda and its people.
Week 5 - Rakai Community Cohort Studies
Our trip to Rakai has been one of my favorite experiences here in Uganda. I found the Rakai Community Cohort Studies (RCCS) truly inspirational. The project at Rakai not only studies the prevalence and incidence of HIV/AIDS (and other health issues), but it also provides services to all of the community members in the study district.
Let me first state that RCCS involves around 12,000 participants. Now, these 12,000 participants aren't members of a single community; they are people living in several rural communities throughout the Rakai district. Keeping track of all of these people becomes a bit of trouble in any research study but especially so in a large, rural region. The researchers have to deal with people moving in and out of the communities, not showing up to the community hubs for their follow-up appointments, and impersonating study participants. To deal with these issues, the RCCS has come up with a means of tracking participants that involves catalogued photographs and home visits.
We were lucky enough to visit two of the community hubs where the research interviews are conducted and services are provided to community members. The hubs move between communities in the district, staying in each for a couple weeks before moving on to the next site. Several tents are set up at the site including one for waiting, one for testing, and several small ones for individual interviews. I was astonished by the level of organization and efficiency with which the researchers operated. I have never really seen a large research project in action in the United States and certainly have never seen research that operates at the level of the RCCS.
I think one of the most striking aspects of the research in Rakai was the dedication to the provision of services to people in the study communities. This was a topic that was emphasized heavily in our lectures. The researchers in Rakai understood the need to maintain the trust of the study community. This trust was sustained through involving the community in the design and implementation of the study, keeping cultural issues in mind, and giving back to the community in ways that exceed the parameters of the original studies. Although the researchers in Rakai cannot afford to treat everyone in the district, they have set up a great referral system and are able to provide basic treatment to some members in the community.
Ultimately, the Rakai Community Cohort Studies are research, but this project has managed to be more than just that. The researchers have gone above and beyond the call of their studies to give back to the communities. Giving back to participants and the community is not always easy, and I feel like the studies in Rakai can be used as a great model for how research should really be done.
Location: Rakai, Uganda
Let me first state that RCCS involves around 12,000 participants. Now, these 12,000 participants aren't members of a single community; they are people living in several rural communities throughout the Rakai district. Keeping track of all of these people becomes a bit of trouble in any research study but especially so in a large, rural region. The researchers have to deal with people moving in and out of the communities, not showing up to the community hubs for their follow-up appointments, and impersonating study participants. To deal with these issues, the RCCS has come up with a means of tracking participants that involves catalogued photographs and home visits.
We were lucky enough to visit two of the community hubs where the research interviews are conducted and services are provided to community members. The hubs move between communities in the district, staying in each for a couple weeks before moving on to the next site. Several tents are set up at the site including one for waiting, one for testing, and several small ones for individual interviews. I was astonished by the level of organization and efficiency with which the researchers operated. I have never really seen a large research project in action in the United States and certainly have never seen research that operates at the level of the RCCS.
I think one of the most striking aspects of the research in Rakai was the dedication to the provision of services to people in the study communities. This was a topic that was emphasized heavily in our lectures. The researchers in Rakai understood the need to maintain the trust of the study community. This trust was sustained through involving the community in the design and implementation of the study, keeping cultural issues in mind, and giving back to the community in ways that exceed the parameters of the original studies. Although the researchers in Rakai cannot afford to treat everyone in the district, they have set up a great referral system and are able to provide basic treatment to some members in the community.
Ultimately, the Rakai Community Cohort Studies are research, but this project has managed to be more than just that. The researchers have gone above and beyond the call of their studies to give back to the communities. Giving back to participants and the community is not always easy, and I feel like the studies in Rakai can be used as a great model for how research should really be done.
Location: Rakai, Uganda
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