I sat waiting in a cafeteria at a medical student dormitory for an hour before calling it a day. Every time a door would open I would turn around to look. I would sigh, as it was a worker coming in or leaving the kitchen. I had laid out all of my materials- notebook, audio recorder, consent forms, pens. I had been waiting for interview participants for my research project. I had been told that a group of five 5th-year medical students would be gathered when I got there so we could have a focus group session. I got to the medical school early and waited for my contact to pick me up. He was 5 minutes late but I wasn’t concerned because nothing here starts on time. On our walk up to the dorm he told me that he hadn’t actually spoken to any students but he was sure I could gather enough people at the dorm. Finals were starting the following week so I was doubtful that I could persuade anyone. As we walked up to the entrance of the dorm, my contact introduced me to several men that were there. Half way through my “hello, my name is” speech, my contact said he thought I would be okay so he was leaving. Feeling a bit nervous, I went on with my speech, asking if anyone would be interested in being interviewed.
No one volunteered. One guy asked me where my research office was. I explained that I was a student so I was interviewing participants in a variety of locations based on their convenience. Apparently that wasn’t a good answer. The same guy told me I should get my contact to organize people for me (I thought I had?) and come back. I told them I’d sit in the cafeteria adjacent to us if anyone would be interested in being interviewed. I thought, “So much for the focus group idea. At this point, I just need data whether in a focus group or individual interviews.” So, I sat and waited. One student who was in the group I spoke to came in to be interviewed. I got the feeling that he agreed out of pity for me. After our short interview I waited around. I texted my contact that no one else had showed up. He assured me again that people would once dinner started. Once dinner started? I felt like an ambulance chaser on the hunt for interview participants. However, I waited for another hour thinking dinner had to be soon. It was already 6pm by this point. Unfortunately, no one else came. Dinner must be served late. So, after an hour of waiting, I packed it in.
Interviewing participants has been incredibly difficult given students’ time constraints and the unreliability of people to show up. In the United States I live my life by a calendar. I try to be no less than 15 minutes early to everything and have my life color-coded by type of activity: work, personal, school, etc. Here in Uganda, things don’t work this way. Unpredicted situations always seem to arise and estimated travel times are never a reliable estimate. Plans are never confirmed more than 12 hours in advance because situations are constantly changing. This had made the process of gathering interviews difficult given our own limited time schedules. Despite being here 7 weeks now, I’ve still yet to adjust and plan for the delays.
Location: Kampala, Uganda
Thursday, May 20, 2010
Week 7 and Homesick
Location: Kampala
We’re back in Kampala, and I’ve been homesick…a lot. I’m really saddened by the fact that I can’t enjoy myself fully here due to my homesickness. I’ve always wanted to come to Africa, so why do I wish so much to be home? It’s not as if I’m unhappy in Uganda. I’m taking interesting classes, meeting new people, and achieving my life DREAMS through volunteering at PCA and Sanyu Babies Home. Who gets to achieve their life dreams by 20 years old?? I wish this inner conflict would go away so that I could just savor every moment, because before I know it, I will be home and depressed that I am not here. I know in my heart that being here is a supreme blessing, and as such, I will do my best to internalize that. For now, I am going to continue pushing myself- because if I don’t, I will miss out on the opportunities of a lifetime.
Saturday, May 15, 2010
Week 6 - Let there be water!
Location: Ssese Island
Our trip to Ssese was definitely the highlight of my week!! Since taking a course on infectious diseases, I have been very interested in water and how essential it is in preventing or causing disease. Our wonderful leader Joel took us to the villages water source and after walking through a long stretch of field and trees, when he stopped and said "This is it" I thought he was joking. The "lake" was about 7 feet deep with about a 4 foot radius. When we were walking, everyone was stepping in water and puddles which we didn't realize lead to their water source. During the heavy rains, which we experienced there, everything is practically washed downhill into this lake. I realized that on our way to the lake, I didn't see any pit latrines which meant that everyone would go where it was convenient and unfortunately, that would end up in the water they would consume later. Before we left we were told about the poor conditions but seeing it and inadvertently contributing to it by visiting it made our presence there much more significant. It was made clear that our purpose was to bring water to this village but seeing what they had been dealing with completely changed my whole attitude and thought process. After that visit, we returned back to the site to put everything together. My eyes were glued on the engineered and I sat there and prayed to myself because it had to work. Everyone was tired and hot but after seeing there source, we were all energized and ready to finish this project which is basically an essential human right! At the end of the day when we saw water flowing, we were all so relieved and I was really proud of what we had accomplished and I hope work like this will continue in the future!
Our trip to Ssese was definitely the highlight of my week!! Since taking a course on infectious diseases, I have been very interested in water and how essential it is in preventing or causing disease. Our wonderful leader Joel took us to the villages water source and after walking through a long stretch of field and trees, when he stopped and said "This is it" I thought he was joking. The "lake" was about 7 feet deep with about a 4 foot radius. When we were walking, everyone was stepping in water and puddles which we didn't realize lead to their water source. During the heavy rains, which we experienced there, everything is practically washed downhill into this lake. I realized that on our way to the lake, I didn't see any pit latrines which meant that everyone would go where it was convenient and unfortunately, that would end up in the water they would consume later. Before we left we were told about the poor conditions but seeing it and inadvertently contributing to it by visiting it made our presence there much more significant. It was made clear that our purpose was to bring water to this village but seeing what they had been dealing with completely changed my whole attitude and thought process. After that visit, we returned back to the site to put everything together. My eyes were glued on the engineered and I sat there and prayed to myself because it had to work. Everyone was tired and hot but after seeing there source, we were all energized and ready to finish this project which is basically an essential human right! At the end of the day when we saw water flowing, we were all so relieved and I was really proud of what we had accomplished and I hope work like this will continue in the future!
Friday, May 14, 2010
Week 6 - Ssese Island Video
Ssese Island Water Project from PublicHealth Uganda on Vimeo.
Community project to expand access to clean water on Ssese Island.
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.
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 - Ssese Island Interview
Ssese Island Interview from PublicHealth Uganda on Vimeo.
Interview with Robert Tumuramye the engineer for the water project.
Week 6 - The Importance of Ownership
Location: Kalangala, Ssese Islands, Uganda
After weeks of classroom learning and field observations, the group anxiously awaited the chance to participate in an actual hands-on public health-oriented project. With our trip to the Ssese Islands in Lake Victoria, we were finally presented with such an opportunity. Given the mission to help extend a waterline to an unserviced village in Uganda’s Kalangala district, we were excited to finally contribute something that was both meaningful and sustainable to our host country. Not only would we be helping to improve the overall water security of the village, we would be helping to stop the spread of waterborne diseases. Needless to say, we were ready to give it our all.
Across the board, the group seemed to be fairly disappointed at our level of involvement in the project at first. Coming in with the expectation that we would have a pivotal role in the planning and implementation of this project, we were disappointed when we arrived at the site and saw that there were only enough tools for two or three of our group members to work at a time. Even when we were given the opportunity to participate, the villagers were quick to ask to be given their hoes back so that they may continue to work on the project themselves. In some ways, this only made sense. Many, if not all, of the villagers had been engaged in agricultural work for their entire lives. They were simply more suited to handle the hoes and machetes that we were using in the project, and they were not afraid to let us know it. Even after we came to this realization, we were still frustrated. Frustrated that we had come all this way to simply watch as others did work. Frustrated that we had yet to contribute anything sustainable to the people of Uganda. However, with the words of our friend and project director, Joel, this frustration quickly eroded.
As Joel explained to us, the active participation of the Kalangala community was absolutely essential to the long-term success of this project. Though it bothered us, it was necessary for the villagers to act as the greatest contributors to this effort. Had we done everything for them, they undoubtedly would have had great difficulty in seeing their stake in the success of the project. Through contributing their sweat, time, and energy to connecting the water line to their village, the townspeople had gained ownership of the project. This ownership, Joel elaborated, would motivate the villagers to keep using this line as their primary water source and would prevent them from turning to the dirty, contaminated sources that they had previously used.
Though we were able to participate in the project more and more as time went on, we were careful to give the community a significant role in the implementation of the project at all stages. Through contributing so much to the project, the villagers have gained ownership over it, ownership that will in turn ensure the success of our efforts for years to come.
After weeks of classroom learning and field observations, the group anxiously awaited the chance to participate in an actual hands-on public health-oriented project. With our trip to the Ssese Islands in Lake Victoria, we were finally presented with such an opportunity. Given the mission to help extend a waterline to an unserviced village in Uganda’s Kalangala district, we were excited to finally contribute something that was both meaningful and sustainable to our host country. Not only would we be helping to improve the overall water security of the village, we would be helping to stop the spread of waterborne diseases. Needless to say, we were ready to give it our all.
Across the board, the group seemed to be fairly disappointed at our level of involvement in the project at first. Coming in with the expectation that we would have a pivotal role in the planning and implementation of this project, we were disappointed when we arrived at the site and saw that there were only enough tools for two or three of our group members to work at a time. Even when we were given the opportunity to participate, the villagers were quick to ask to be given their hoes back so that they may continue to work on the project themselves. In some ways, this only made sense. Many, if not all, of the villagers had been engaged in agricultural work for their entire lives. They were simply more suited to handle the hoes and machetes that we were using in the project, and they were not afraid to let us know it. Even after we came to this realization, we were still frustrated. Frustrated that we had come all this way to simply watch as others did work. Frustrated that we had yet to contribute anything sustainable to the people of Uganda. However, with the words of our friend and project director, Joel, this frustration quickly eroded.
As Joel explained to us, the active participation of the Kalangala community was absolutely essential to the long-term success of this project. Though it bothered us, it was necessary for the villagers to act as the greatest contributors to this effort. Had we done everything for them, they undoubtedly would have had great difficulty in seeing their stake in the success of the project. Through contributing their sweat, time, and energy to connecting the water line to their village, the townspeople had gained ownership of the project. This ownership, Joel elaborated, would motivate the villagers to keep using this line as their primary water source and would prevent them from turning to the dirty, contaminated sources that they had previously used.
Though we were able to participate in the project more and more as time went on, we were careful to give the community a significant role in the implementation of the project at all stages. Through contributing so much to the project, the villagers have gained ownership over it, ownership that will in turn ensure the success of our efforts for years to come.
Thursday, May 13, 2010
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
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 Ssese Island
Location: Ssese Island
This past week we were at Ssese Island, located on Lake Victoria. The purpose of our visit was to carry out a water development project. The past two years, Northwestern students had built pit latrines. We even saw one of them, which was built for a small, smelly fishing village with practically unfurnished little tin “houses” and many, many children (as always). Our project was to bring running water to an area with many elderly residents who would have to walk either to the lake where the water was unsanitary or to a disgusting 5 foot circumference “pond” that looked like a wet spot in the grass. Apparently it was nearly seven feet deep. People would just scoop this stagnant, parasitic water out from the top. Honestly, an entire animal could fall into that thing- there are plenty of goats running around- and no one would even know until they either became severely ill or the stench permeated the water. That was truly eye opening and just disgusting. There were so many very poor people there, and even the more populated village in Ssese was run down, overcrowded, and merely a conglomeration of tin shacks. I do not know how these people live as they do, and realize more and more every day how glad I am to be American.
The project itself lasted for three days. The first day we helped the community dig a half mile trench to connect an existing pipe to the one we would put in. The second and third day, we laid the plastic pipe in the trench, connected it to two new taps, and ran the water. For a while, we were unsure if the task would be completed in time, but fortunately in the end it worked. It was up to the community to then fill in the trenches with dirt.
The project underwent a few challenges on the way, challenges I am glad to have seen since development work is what I believe I will focus on in the future. Firstly, there was a woman who agreed to have us dig a trench through her potato garden on the first day, but then changed her mind on the next day and asked for a large sum of Ugandan money in order for us to proceed. Our group leaders theorized that the male household members most likely told the woman that she must ask for money, as we were interrupting their garden and property. After some calming down (she was holding a machete and threatening our group leaders with it) she ultimately realized the importance of the project and backed down. Another difficulty was community mobilization; a majority of the project was carried out by the community members so that they would “own” the water and take responsibility for it. Previously, a company had installed a water pipe there but then subsequently disconnected it because the community refused to pay. (They had provided the first six months free of charge.) Though one may think it wrong to ask the community for money, this is not unusual- everywhere in Uganda people pay utility charges as we do in the U.S.- and it allows the person who is in charge of the pump to use collected funds for maintenance. Sustainability is really difficult to achieve, and charging is a method of realizing this goal. Luckily, the community pulled together in the end and completed the project; hopefully next year, the new NU students will get to see that our project continues to work a year later.
I’m homesick but happy; one month left!
week 6 - manual labor
Location: Sesse
Our trip to Sesse was valuable a experience for a number of reasons. We were able to see what life is like in one of the poorest areas of Uganda, and we were able to help some people in this area helping to bring clean, running water to their community. It was also beneficial because I think it gave many of us a new appreciation for manual labor and those who do it on a daily basis.
One of the purposes of our trip was to bring running water to xxxx (a community in Kalangala on the Sesse Islands). This involved digging a trench about 600 meters long in order to lay pipes that would connect the community with the nearest source of running water. Of course, this was not done using any type of machinery, rather, it was all done by hand, using rough wooden shovels and hoes. Unsurprisingly, our labor contribution to the project was somewhat limited, and although this was due to other reasons as well, one reason why this was so was due to our lack of experience doing such labor with our hands. I think it is safe to say that we all became tired rather quickly, and it was not the type of work that we could have sustained for a very long period of time.
Our Ugandan counterparts, on the other hand, worked for many hours, and many of them were older men or others mothers carrying their babies on their backs. Many of them did not wear shoes, and although we were advised to wear gloves (our hands were not calloused enough so we did not really have a choice), none of them did.
Manual labor is difficult and strenuous and oftentimes tedious, but it is very important in many places. Many depend on manual labor both as a livelihood as well as a means of production, especially in places where tools to take the place of manual labor are unavailable. In developed countries we tend to look down on those who do manual labor, but I think this experience was good for us, as we can now better understand both the importance of manual labor as well as the difficulty of spending even several hours of a day engaged in it. As with many of our experiences here, I think that this will also give us a great deal of perspective as to the lives of many people.
Our trip to Sesse was valuable a experience for a number of reasons. We were able to see what life is like in one of the poorest areas of Uganda, and we were able to help some people in this area helping to bring clean, running water to their community. It was also beneficial because I think it gave many of us a new appreciation for manual labor and those who do it on a daily basis.
One of the purposes of our trip was to bring running water to xxxx (a community in Kalangala on the Sesse Islands). This involved digging a trench about 600 meters long in order to lay pipes that would connect the community with the nearest source of running water. Of course, this was not done using any type of machinery, rather, it was all done by hand, using rough wooden shovels and hoes. Unsurprisingly, our labor contribution to the project was somewhat limited, and although this was due to other reasons as well, one reason why this was so was due to our lack of experience doing such labor with our hands. I think it is safe to say that we all became tired rather quickly, and it was not the type of work that we could have sustained for a very long period of time.
Our Ugandan counterparts, on the other hand, worked for many hours, and many of them were older men or others mothers carrying their babies on their backs. Many of them did not wear shoes, and although we were advised to wear gloves (our hands were not calloused enough so we did not really have a choice), none of them did.
Manual labor is difficult and strenuous and oftentimes tedious, but it is very important in many places. Many depend on manual labor both as a livelihood as well as a means of production, especially in places where tools to take the place of manual labor are unavailable. In developed countries we tend to look down on those who do manual labor, but I think this experience was good for us, as we can now better understand both the importance of manual labor as well as the difficulty of spending even several hours of a day engaged in it. As with many of our experiences here, I think that this will also give us a great deal of perspective as to the lives of many people.
Week 6- There's no place like home
This past week, after returning from Rakai and our travel break trip to Zanzibar, we were scheduled to spend 5 days in Ssese Island working on a community service project. In past years the students have dug pit latrines for the community to use since very few exist in the area. This is due in large part to the wet soil on the island, which makes it difficult to dig a deep pit latrine that will remain hygienic and functional. Instead, this year the project was to extend piped water to a community with a high number of elderly individuals. The work would require digging a trench, laying the pipe, and connecting the sections.
Unfortunately, the night before we were scheduled to leave I became very sick and could not go on the trip with the rest of the group. Instead, I was left to stay by myself in our apartment and recover. My three days in the apartment shed light on the differences between Ugandan and American settings. At home in the US there is always clean drinking water in the taps, there is usually a good supply of food, and friends around in case of an emergency. Here in Uganda, the context is quite different. My roommate and I had purchased large bottles of water, but I started running out after a few days and it's nearly impossible to go out and buy more when you're really sick. The same goes for food--since purchasing ingredients and cooking here is difficult, we tend to eat out a lot. But, the lack of basic food supplies in the apartment made it difficult to find enough to eat. Luckily, our Professor was around and able to help a bit, but it was clear that the level or preparedness was different. In a foreign country where you only plan to spend 10 weeks, it's difficult to think about stocking up and preparing for a worst case scenario. Subsisting on bottled water, stale bread, and crackers made me appreciate the modern conveniences of the US. While the time here in Uganda has been wonderful, it is admittedly difficult to completely adjust to a different way of life. The expectations that we have developed in the US don't disappear when you step foot in a different country, in fact they tend to make deviations from the familiar and unexpected even harder to accept or to deal with.
After two days of sickness, I decided to get checked out at the hospital. Luckily, we have a brand new hospital about 5-10 minutes from campus that caters to foreigners and people with money. I went late at night, which meant that the out patient area was empty and the entire visit only took about an hour, including lab work. I was able to see a doctor, get lab work done, and get prescriptions--sounds like a typical doctor visit in the US. But, that wasn't quite the case. Much of the time I felt like I was self-diagnosing myself and just going to the hospital for the blood tests. While the lab was high-tech, quick, and helpful, the doctor was not particularly helpful. She didn't tell me anything that I didn't already know and she prescribed two medicines that I didn't end up taking. The lack of explanation as to the purpose of each prescription made me wary of taking them. Since I was already self-administering one prescription, I didn't feel that it was appropriate to take a second one on top of that. Ultimately, the lab work was able to rule out the most concerning illnesses and I was sent home without a problem. Plus, unlike at home, the entire hospital visit was extremely cheap compared to US standards.
Now, I don't want people who are reading this to think that medical care in Uganda isn't safe or effective. I'm sure that if I had been really sick that this hospital would have been able to treat me and give me the proper care. But, my outpatient experience did make me appreciate the Western medicine that I'm accustomed to. Despite the high price, I usually walk away from a doctor in the US feeling fairly confident that I know the diagnosis and the proper course of treatment. The purpose of prescriptions are explained and they are not prescribed lightly. While I'm sure many people would disagree with that assessment, I simply mean to suggest that I walk away from a medical facility in the US feeling more confident in and satisfied with the experience than I do here. Despite the best efforts to provide quality health care in Uganda, Uganda is not a country in which I would ever like to be very sick. I have confidence in the US healthcare system to provide better care for me than I can receive here.
In addition, if I am not satisfied with the quality of care that I can receive as a foreigner with plenty of money to spend, that does not bode well for the quality of public health care available to the average Ugandan. Having toured one of the major public hospitals in Kampala and seeing the state of overcrowding and lack of staff that they experience, I feel guilty complaining about the private hospital care that I received. But, as I said before, it is hard to accept something so different from the standard of care that I'm used to at home. My expectations did not change overnight and I would still choose not to go back to the hospital for medical care unless I really needed it. All of this suggests that a much stronger healthcare infrastructure is necessary in order for Uganda to develop in the future. If all of the money and resources are going into private hospitals and government health budgets continue to get cut, I can't imagine how poor the quality of healthcare will be in the future. On a daily basis I often feel ashamed of my status as a wealthy, white foreigner here in Uganda, but when it comes to healthcare I appreciate the resources and care that my home country provides me.
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.
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 6: There Is No Need to Break a Glass Window with a Stone
Location: Ssese Islands, Kalangala District, Uganda
This whole trip thus far in Uganda has been very eye-opening for me. Not only did I get a chance to see the healthcare of a developing country in motion, but I think it has given me a chance to realize the specific goals I had in life. From our public health classes, and our trips to Masaka, Ssese Islands, Rakai, etc. we have learned about the structure and hierarchy of Uganda’s healthcare system and how referral systems operate.
At the highest level, there are the national and referral hospitals. These are the biggest and most well-equipped hospitals in the country that takes referral patients and patients with more serious conditions. This is followed by the district hospitals, such as Mulago Hospital. The conditions of these hospitals may not be great, and they are severely understaffed per patient basis, but they do have the faculty and doctors who are knowledgeable and educated in practice. Following the hospitals are health centers IV, III, II, and I, respectively located in the county, sub-county, parish, and village. Health centers IV should have a presence of a doctor and an operational theater increasing equity and access especially for emergency obstretic care. According to law, there should be a HC IV in all divisions or counties. Further decentralization from HC III – I serve subcounties, parishes, and villages. These may not necessarily contain a doctor, but need to be staffed with well-trained enough to test for HIV/AIDS, provide counseling to patients that need it, and have the knowledge to deliver treatment for the characteristic diseases.
The structure of this health system is strong and foundational, providing decentralization of power and a higher integration of rural villages into the healthcare system. However, the problem is actually staffing and providing all these health care centers to the people. Ssese Islands is an archipelago of 84 islands, I think 72 of which are inhabited. The inhabited islands are separated into two districts and counties. You would think that with over 34 thousand inhabitants, they would have hospitals available to the people of the Kalangala district. Keeping the knowledge of the health delivery system in the back of your head, gather this: The whole district of Kalangala has one HC IV, six HC IIIs, four HC IIs, and no hospital. The HC IV (which should always be staffed with doctors and operational theaters), do have a maternity and general ward, but have no functional theatres at the HC IVs and most health centres do not have adequate space, equipment and staff for the effective delivery of health service. Five parishes don’t even have any form of health centers whatsoever. And finally, there is only ONE doctor in the whole Kalangala district, and he doesn’t even live there. He goes back to Kampala on weekends. The quality of healthcare is so low there is still no clear assessment as to how prevalent HIV/AIDS is in that region.
Needless to say, the healthcare system, though improving, is very far behind. Joel has showered us with those facts and has provided us with the capacity to realize how far behind the rural part of Kampala really is in terms of healthcare. Living in Kampala most of the time, we don’t really get a chance to see how the majority of Ugandans live. Activities such as these and our MDD performance in Busabi put everything in perspective, giving us a better understanding of the challenges a third world country faces. Now, I can only hope that we can make a difference.
Much of the data was gathered through Joel's brain, our great Public Health classes, and this link: http://www.ugandatravelguide.com/kalangala-sseseisland.html
This whole trip thus far in Uganda has been very eye-opening for me. Not only did I get a chance to see the healthcare of a developing country in motion, but I think it has given me a chance to realize the specific goals I had in life. From our public health classes, and our trips to Masaka, Ssese Islands, Rakai, etc. we have learned about the structure and hierarchy of Uganda’s healthcare system and how referral systems operate.
At the highest level, there are the national and referral hospitals. These are the biggest and most well-equipped hospitals in the country that takes referral patients and patients with more serious conditions. This is followed by the district hospitals, such as Mulago Hospital. The conditions of these hospitals may not be great, and they are severely understaffed per patient basis, but they do have the faculty and doctors who are knowledgeable and educated in practice. Following the hospitals are health centers IV, III, II, and I, respectively located in the county, sub-county, parish, and village. Health centers IV should have a presence of a doctor and an operational theater increasing equity and access especially for emergency obstretic care. According to law, there should be a HC IV in all divisions or counties. Further decentralization from HC III – I serve subcounties, parishes, and villages. These may not necessarily contain a doctor, but need to be staffed with well-trained enough to test for HIV/AIDS, provide counseling to patients that need it, and have the knowledge to deliver treatment for the characteristic diseases.
The structure of this health system is strong and foundational, providing decentralization of power and a higher integration of rural villages into the healthcare system. However, the problem is actually staffing and providing all these health care centers to the people. Ssese Islands is an archipelago of 84 islands, I think 72 of which are inhabited. The inhabited islands are separated into two districts and counties. You would think that with over 34 thousand inhabitants, they would have hospitals available to the people of the Kalangala district. Keeping the knowledge of the health delivery system in the back of your head, gather this: The whole district of Kalangala has one HC IV, six HC IIIs, four HC IIs, and no hospital. The HC IV (which should always be staffed with doctors and operational theaters), do have a maternity and general ward, but have no functional theatres at the HC IVs and most health centres do not have adequate space, equipment and staff for the effective delivery of health service. Five parishes don’t even have any form of health centers whatsoever. And finally, there is only ONE doctor in the whole Kalangala district, and he doesn’t even live there. He goes back to Kampala on weekends. The quality of healthcare is so low there is still no clear assessment as to how prevalent HIV/AIDS is in that region.
Needless to say, the healthcare system, though improving, is very far behind. Joel has showered us with those facts and has provided us with the capacity to realize how far behind the rural part of Kampala really is in terms of healthcare. Living in Kampala most of the time, we don’t really get a chance to see how the majority of Ugandans live. Activities such as these and our MDD performance in Busabi put everything in perspective, giving us a better understanding of the challenges a third world country faces. Now, I can only hope that we can make a difference.
Much of the data was gathered through Joel's brain, our great Public Health classes, and this link: http://www.ugandatravelguide.com/kalangala-sseseisland.html
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