Week 6 - From Rakai to Ssese -- Putting Theory into Practice

Location: Kampala


The previous week in Rakai, we were introduced to the theoretical methodology of how community health initiatives are implemented in rural areas. This week we had the opportunity to participate first-hand in the process. Our purpose -- to extend access to clean water by installing a new water pipe that would reach other parts of the community. While in theory this seemed easy enough, in actuality, we faced a number of challenges that were directly outlined in the theoretical protocol of our Rakai trip. One of the key features of this protocol was community involvement. We learned that a similar project was undertaken a while back only to be met with failure because the community was not actively participating. Either the maintenance of the water was inadequate or they refused to pay because they misunderstood the conditions of the water, in any case, the lack of community involvement crippled the project in the past. This time around, there was a large emphasis to mobilize the community in the project. During the process, there were many locals involved in digging, cutting grass and negotiating on behalf of the the water project. In fact, in areas beyond those completed by us, there was a requirement for each family to contribute labor.

Additionally we also witnessed the effects of improper community sensitization. After previously clearing the project with a woman whose land we would be digging through, we later realized that she had objections that she quite emphatically began to raise just as we were about to begin digging. Luckily, Joel, our community ambassador, had such a powerful reputation in the area with all of his previous work that the issue was eventually dropped and we were able to proceed as planned.

Aside from the logistical concerns and planning processes, I was surprised by the size of the project in terms of manual labor as well. The pipe was extended roughly a half a kilometer from the old pipe and involved many key steps including locating the old pipe, clearing tall grass, digging a three foot deep trench, untangling the pipe, laying it down, connecting the pipe to the pump and tap and finally replacing the soil to cover the new pipe. Luckily, the community was very involved in the initial digging process, which was the most physically daunting task. Ultimately the project was a success and we left with the satisfaction of knowing that we contributed to bringing a vital resource to a community previously depending on a less than adequate alternative.

Week 6 - Public Health Firsthand

From the several public health classes I have taken, I have heard and read about what goes into a public health project, and this week I got to see what such a project looks like firsthand. Below are a few of the lessons that I saw put into action.

Lesson 1: Choosing a project that is relevant to the specific community

Many people in Mulabana use water from Lake Victoria and a small pond for drinking, cooking, and bathing water. Often these people become sick after using this water because it is highly contaminated. As Joel and several community members explained, fecal matter from shallow pit latrines and from defecation in places other than latrines ends up in the lake and pond, especially after it rains. Because they do not have a source for safe drinking, cooking, and bathing water, the installation of a water line to the community was a relevant project for the people of Mulabana.

Lesson 2: Community involvement

Much of the groundwork for the project had been done ahead of time by Joel. He was responsible for getting the proper approvals and speaking with the community about the project. He came to Mulabana at least five times to make sure that the people of the village were informed and invested in the project.

Lesson 3: Sustainability

By involving the community members in the project from the beginning, Joel ensured that they would take ownership of the project. This ownership would lead to the ready use and maintenance of the water system. The people receiving water understood that there would be a small fee for getting water from the tap and that this small fee would be used to pay for the treatment process. Furthermore, the community members dug the trench for the new pipe and agreed to become caretakers of the pump. It was important that they did not just see the water as simply a gift.

Overall, working on this project was quite rewarding. It was truly amazing to see water flowing after working on the project for just three days. Of course, Joel has been working on the project for much longer, and I know this is what made everything possible. I really hope that the people in Mulabana use the clean water and maintain the system.

Location: Mulabana, Kalagala District, Ssese Islands

Week 6- Sustainability

Each year our program does a community service project in Kalangala, an island that’s a part of the Ssese Islands in Lake Victoria.  For the first two years of the program we helped build pit latrines in two different communities where there were few or no pit latrines previously.  This year we worked on a project extending the line of clean water further into the island.  My initial excitement for the project was somewhat quelled when I found out that we were adding a water tap in a place where there had already been a tap.  Robert, our engineer assisting us on the project, explained that each community that received a tap would need to pay a small fee for each jerry can of water.  Apparently, the community we worked with previously had a tap but refused to pay for the water once the initial free-trial period of six months was over. So, the company took out the tap.
    We were now adding back a tap and extending the line further into the center of the island.  While I was excited about getting our hands dirty and doing some real public health work, the idea of sustainability lingered in the back of my mind. Would a community that already once refused to pay for the water now agree to pay? When a new group of NU students comes next year will our project still be operating?  I hope so.  There are signs that it will succeed and signs that it will fail.  Joel, a well respected member of the community, worked on this project to convince the community that it was a worthwhile venture.  He sensitized the villagers, a tactic that might not have previously been successful.  However, we still saw very few villagers assisting us on the project.  We were repeatedly told by several people that more villagers should be helping with the project. So why weren’t they there?
    My fear was and still is that they are not that interested in the water taps.  I wondered if a pit latrine would have been a better investment or would have drawn better community involvement.  How did we decide to work on this project rather than build another pit latrine as the other two groups did?  It’s unclear but I hope that this was not a case of foreigners pushing an agenda on a local people. Water sanitation is a “hot topic” in global health and the office that sponsors our program has made it clear through a variety of new programs that they are interested in water sanitation.  It’s definitely an important topic as we saw the awful, contaminated water source that those villagers were using. However, I wonder if we pushed our agenda of focusing on water sanitation too much at the detriment of providing a product that would actually be accepted by the people in Kalangala.

Week 1- Impressions

This first week seems to have gone by at lighting speed and we fit an incredible number of new people, places, and experiences into our first few days here. There has definitely been culture shock, starting as soon as we got into the bus at the airport, but it seems to be getting better every day that we're here. Hopefully, as time continues to pass we'll feel less like foreign tourists and more like we belong here. It may never be our permanent home, but at least we might be comfortable and fit in. Here are some of my experiences and impressions from our first 7 days.

Once we landed in Uganda following our 24 hours of travel, we took about a 45 minute bus ride from the airport in Entebbe to Makerere University in Kampala. We got to see part of the city at night and it was a bit of a shock to pass through portions of the Kampala that were pitch black. Since city street lights are such a common occurrence at home, the ability to see the stars was a welcome change. The reality, however, was slightly unexpected. Professor Stewart told us that, although there are power lines running through the area, people in these parts of town can't afford electricity. Something as simple as the ability to see where you're walking at night, which I take hugely for granted at home, is not a luxury that many people here in Uganda have. I think that was my first official wake up call as to how I couldn't expect life in the U.S. and here to necessarily be comparable.

On a more trivial note, the lack of internet, hot water, and water pressure, combined with the need for mosquito nets and bottled water, definitely made me rethink and appreciate more the life that I live in the States. Most days seem to bring a new challenge that we must face in our living situation, but at the end of this experience I think looking back on our accomplishments will be well worth it.

Once our group settled in and started touring the city of Kampala, it was hard to ignore all of the people who looked at us. Driving down the street in the big University van everyone turns and stares, which is a rather uncomfortable feeling. Hopefully I will get more used to the fact that the color of my skin is seen as a novelty by many, but this was definitely one of the first times where I felt particularly out of place or like I stood out. Perhaps over time we'll start to feel a bit more Ugandan and less like silly tourists, but it seems like no amount of adjustment will change what people see when they look at our skin.

As we explore the area around the University, one of the first places we have frequented is Wandegaya, a market just a few minutes walk down the street. But, walking down the side of the busy street is a feat in itself. Trying not to get hit by cars, accosted by the taxi and boda boda (motor bike taxi) drivers, and watching your footing at night is quite tricky. Once we reached the market, though, the walk was worth it because the place is fascinating. The combination of tiny convenience stores, hole in the wall restaurants, hair-braiding salons, and the fruit and vegetable market is a site unlike anything at home. Stores and people are on top of each other, but in this market it seems like you can find just about anything you might need.

One of the most memorable experiences of the first week was the three hours we spent at a tiny gas station along the side of the road in a town called Kakooge. After a blown tire on our way to our safari at Murchison Falls, we waited at the gas station for the tire to be fixed. As soon as we got off the bus an ever-growing group of children started to gather around. At first our group and the kids stood around rather awkwardly. We tried to smile and wake, but the kids seemed to be very shy. But, once we took out our cameras and started taking pictures of and with them, they opened up, started posing, and interacted more. They absolutely loved when we showed them the picture of themselves on the little digital screen. We learned that some of the older kids spoke very basic English so we were able to communicate a bit. As we continued to wait for the tires to come back, the kids decided to teach us some circle games which was very fun. They were basically cat and mouse games and dancing while the group sang a little song. Very fun and much less awkward since everyone was closer to being on the same level! 3 hours later, the tires were repaired and we were on our way again. The experience at the gas station was our first real interaction with children and it was truly enlightening. They were all very curious about us and wanted to interact. I feel like spending time with children was easier than adults because we can relate more to each other, there is less judgment, and more acceptance.

After our first week I think we've seen many surprises and experienced things I didn't think possible before this trip. As the tourist feeling wears off and we continue to settle in, I look forward to our first week of classes and our site visits to different NGOs around the city.

Location: Entebbe, Makerere University, Wandegaya, Kakooge