Week 9- Strength

As our program draws to a close, I feel that I can honestly say that I have learned a lot about the character of the Ugandan people. Much of it comes from our daily interactions, both in the classroom and around town. For me, the greatest insight came from working on my independent research project. Unlike in the United States, here in Uganda HIV/AIDS is not something you can ignore. In fact, it is something I chose to embrace. As I began my research on the HIV/AIDS experience in Uganda, I was introduced to and interacted with HIV positive individuals. As we discussed their experiences and the problems they have encountered because of their illness, I was impressed by one resounding quality--strength. HIV/AIDS, as we all know, is a devastating disease that affects all types of people, especially here in Uganda. Stigma runs rampant and treatment is hard to find and often expensive. Despite all of the challenges that HIV presents, the individuals I talked to, one woman in particular, embodied a sense of perseverance and courage. These Ugandans have not crawled under a rock and prepared to die, even though without a cure this disease is a death sentence. Instead, they are out raising their children, holding jobs, and making a good life for themselves.

Now, I'm sure for most of you reading this, it is nearly impossible to imagine a life with HIV. On top of that, your perceptions are based on a first-world, super developed standard of living. Uganda is far from that, which makes living with HIV an even harder endeavor. Living conditions are tough, jobs are hard to find, and HIV treatment can be incredibly expensive, if available. Against all odds, the people I have talked to are not letting this pandemic get the best of them. They fight the stereotypes, hold jobs, make money to send their children to school, and form relationships. An HIV diagnosis is not the end of the line; instead Ugandans fight the disease with strength and grace. While only 6-7% of the population in Uganda is HIV positive, I believe this characterization holds true for the majority of Ugandans.

The leaders of our program, Centurion, Dan, and Joel, took us on an incredibly journey, shared amazing experiences with us, and didn't give up on our group despite our missteps and naivete. Our professors, especially in the School of Public Health, demonstrated the strength it takes to work and research in Uganda and the importance of working to benefit your own country. An incredible body of HIV/AIDS research has been conducted here in Uganda, despite the lack of funding and resources. This perseverance to learn more will ultimately benefit Ugandans and the rest of the world. Finally, the people we have encountered on the street have been wonderful. Despite our foreign status, Ugandans are willing to help us with anything from directions to how to say "half a chicken." No question is too small and almost everyone seems to want to help us learn.

To me, the backbone of Uganda is strength in the face of adversity. The country may have a long way to go in terms of development, but the Ugandan people don't let that bother them. They have proven to me over these 9 weeks that you just have to believe, work hard, and keep on going. Hopefully I can take even a small amount of this knowledge back with me and start to see life in the US in a slightly different light.

Location: Kampala

Week 7- That could be me

This past week, while accompanying a nurse on adherence home visits in an effort to better understand the HIV/AIDS experience, I came across a situation that made me pause to reconsider my own life. I met a young woman, 21 years old just like me, who is HIV positive. She contracted the disease from her parents, but she is the only one of her siblings to be HIV positive. In the course of my research I've come across many HIV positive patients, but meeting this woman reinforced the reality of the disease. Like me she is not married and doesn't have children, but instead of planning a carefree future, she must consider how HIV will affect her life and how she can best manage it. Now, I can't comment on this woman's state of mind. I have no idea if she has come to terms with her disease, whether it dictates how she proceeds with her life, or how it might limit her. But I can, to some extent, consider what such a diagnosis would do to me. At 21, with so much of life still ahead of me, it would be absolutely devastating to receive such news. I don't believe it's possible to go on with the same life that you lived before the diagnosis--HIV/AIDS is too big of a disease to simply push to the back of your mind. In the United States, where the prevalence of HIV is less that 1% and being positive no longer constitutes a death sentence, I think it might be easier to live with HIV. But here in Africa, Uganda specifically, where the prevalence is back above 6% and only a tiny fraction of those in need receive ARVs, there is not the same positive outlook for all HIV patients.

What really makes me pause over this woman's story is how she contracted HIV. This is not a case of a woman being promiscuous and having multiple partners or of someone who is reckless and doesn't get tested. Instead, she received HIV from her parents at birth, something completely out of her control and left to fate. Perhaps, on the one hand, it's better to know that she had nothing to do with her status--perhaps that alleviates guilt that others might feel over unsafe behavior. But on the other hand, I know that such a situation would make me feel powerless. How could my parents, the people who were supposed to protect me, give me such a life sentence? I can only imagine how difficult it must have been for this woman to come to terms with what her disease meant for the rest of her life.

Ultimately, seeing what kind of an effect HIV can have on all portions of the population gave me serious perspective on my own life. This could happen to me. Perhaps not in quite the same way, since i didn't contract HIV from my parents, but I could go out and get the disease in a different way. It could drastically alter the course of my future. Despite the advances of modern medicine, there is still no cure for HIV/AIDS and I would have to live the rest of my life knowing that. I think that many of us at a young age feel that we're invincible--that nothing bad will happen to us. My time in Uganda, however, has shown me how wrong that assumption can be. I've seen children, teenagers, and young adults all HIV positive and dealing with that reality. Although this might sound cliche, I will leave Uganda a bit more conscious of how often we take life for granted, even though it's incredibly precious. I am more thankful than ever to be a healthy 21 year old who is not faced with such a life-altering diagnosis. HIV/AIDS can happen to all of us and it's up to us to fight the climbing prevalence of HIV and protect our lives.

Location: Kampala

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.

Location: Rakai Health Sciences Project

Week 3: Miscommunications, eehhh?

Location: Makerere University, Kampala, Uganda

The first few weeks of Uganda have been very eye-opening, yet there are still much more to learn. One concept I encountered multiple times was the problem with miscommunication. There are many factors that may seem to cause this: even though Ugandans speak English, their accent makes it hard to understand, and vice versa; the vocabulary used by both parties are completely different. For example, as discussed in a group meeting the other day, the word “funny” has a completely different concept describing George. In his stead, “funny” would describe someone who says one thing, but does another thing, basically breeding incompetence. There have been several occurrences where I have fallen into a pit of miscommunication.

As part of my experiences here, I wanted to incorporate an observational and experimentational project involving the community perception of quality of HIV/AIDS healthcare. In order to carry out this project, I wanted to be part of a renowed NGO, Joint Clinical Research Centre (JCRC). We had fair warning behind “Luganda time” before coming to this country. People will show up late and meetings will be canceled without prior communication. In the States, this would be considered rude, but here, it almost seems like an everyday activity. I went almost every day of this week to try to solidify my plans for the next few weeks, only to see that I am only treading water getting to a shore that doesn’t exist. Every time a formal report was presented, they would direct me to someone else of “higher importance” who needed to review my proposal before approving the research. It seems that the hierarchy is much less structured here and it would take months just to be active in the research I wanted to perform.

A second smaller involvement I wanted was an MDD (music, dance, and drama) training that involves a play by a group that communicates a significant life story or message. The past week, I met with a very nice and humble man named Charles who was the director of a professional MDD group named Sansa Troupe. I originally presented my project which involves being part of a performance in which they present to audience theories against stigma and violence against those with HIV/AIDS. I wanted to join a story in which people with HIV/AIDS was presented as normal. However, Charles had the impression that I would direct this group, bring them to Chicago, and present a tour of African/ Ugandan culture in Chicago. No matter how much I pushed the fact that I was a student with NO MONEY, provided that I only have a month’s time to do this project, he would consider me as a muzungu who had the ability to bring change. I was brought to him as a student, but he brought his mind to interpret me as a professional. He wanted me to write a program and story, and he would perform the MDD behind it. Obviously unable to develop something at such a large scale, this NGO, though effective and impressive, had to be scratched.

It’s difficult to stray away from the attention we attain from the way we dress, walk, and present ourselves, but it’s very important to try to learn their culture, not from the perspective of a muzungu, but as if you were one of them. Miscommunications tend to happen very often, and if you are never straight forward of your intentions, a humbling relationship could result in a disaster. There are always going to be preconceptions of you because of your skin tone, but the adjustment to their culture is undeniably something to strive for.