Wednesday, May 3, 2017

Personalities of 2017 Healthy Villages

by Kelly Child, Managing Director

As we select new Healthy Villages each year, we kick off activities with a series of meetings: first, with the executive committee of the village, and then with the community at large. At the meetings we officially introduce our program to the village and set expectations. 

Each village we work in is unique, and these initial meetings give us a little smattering of the underlying personalities we will learn over the next three years. Below are my initial impressions of the villages.

21 March 2017, Irenzi village, Nambale sub-county
Community members at IrenziOur group grows to approximately 50 people seated under a mango tree outside the coffin shop in a small trading center within Irenzi. As the Local Chairman (LC) introduces us, he reassures the crowd that I would be willing to eat dodo (spinach-like greens) with the community. Each of the UVP staff members introduces themselves. Although I get through my introduction in Lusoga, Keneth translates for the crowd. My American accent does not serve my fledgling Lusoga well. While Patrick is discussing sanitation and hygiene, a baby defecates 10 feet away from the group. The Health Assistant shakes his head. As I stand to speak, I mention that the rain is coming (Amadi gali kwida! I will speak mangu mangu.) and that I will speak quickly. We round out the meeting with some words from the sub-county Health Assistant, one of UVP's many partners in Iganga District. He works with Village Health Teams (VHTs) and part of his role is sanitation enforcement. He has great influence in the villages. 

23 March 2017, Bulondo village, Nambale sub-county 
Titus at BulondoWith nearly 500 households, Bulondo village is large and widely spread. Because of this, we decide to conduct two separate meetings, which immediately illuminates the fact that interns living in this village will have nearly double the work as they try to implement activities this summer. Due to a slight miscommunication, the VHTs mobilized the community for 4 pm, even though we've arrived for the meeting at 2 pm. So, in typical village fashion, we wait. When the meeting finally begins, we find the community members are a vibrant and lively bunch. Several participants, both male and female, have questions -- mostly surrounding reproductive health. "Do you provide long-term family planning for men?" one male participant asks, and others request outreaches specifically for adolescents. Later, Titus provides a thorough description of the internship program, and the LC comments, "Please know that we do not have guns, but I can assure your (interns') security." His understanding of American security may have been influenced by Hollywood action movies, but we know that his comment about keeping interns safe is heartfelt and accurate.

31 March 2017, Kamira village, Nambale sub-county 
Keneth at KamiraAs afternoon prayers finish, community members pour out of the mosque to find us sitting under the tree in the adjacent field. We invite them to join us, but they must first go home to have lunch and so promise to return. After a few minutes, members from Kamira's executive committee arrive. When one member is told that his fellow community members are having lunch and will be joining shortly, he remarks that "they might have gone home, but there is no food there." Because of a drought in December and January, many families are struggling to feed themselves, which makes the need to stay healthy even more acute. The meeting begins with only a few participants, but increases slightly as we move through the agenda. As we cover the most pressing health concerns in their village, someone mentions the lack of electricity in Kamira. Patrick, our WASH Program Manager, keenly responds, "Electricity without a latrine is not development. Build your latrine and electricity will find you." 

12 April 2017, Muira village, Nambale sub-county 
Child at Muira community meetingMuira stands out from the other villages because the health issues brought by the community seem more serious. There is a high incidence of malaria, and water access is very poor. There is a burial the day of our first meeting, so only half of the executive committee attends, but we are told that the others are also invested in the upcoming UVP program. On the day of the community meeting, as we wait for things to get started, there are some younger men seated away from the group. Patrick explains to me that in Ugandan culture, it is not appropriate to mingle with your in-laws and that if you wanted to greet them, you should do so a good distance away in a squatting position to show your respect. The Chairperson opens the meeting by asking if community members welcomed health programs, and if so, to clap. There is boisterous clapping five minutes into the meeting and the remainder of the gathering was a continuation of this elation. 

Wednesday, April 5, 2017

Giving young families a head start

In the past year, UVP added reproductive health outreaches specifically for adolescents. Teenagers don’t always want to attend the same reproductive health sessions that their parents are going to, and yet they have unique questions and needs that we are poised to address. We’re not just reaching young people through these outreaches, though. They are participants in all of our programming. In February, UVP held an HIV and Malaria community outreach session in Mwendafuko village. The focus was on voluntary testing and counseling and encouraging people to know their HIV status, and we took some time to talk to one of the teenage participants.

Kagoda Safe is a 17-year-old father of one child who shared his motivation for attending the outreach. He and his son had both been sick for three weeks, so he came to find out his HIV status and test for malaria. His wife was unable to attend because she had obligations outside of the village and wouldn’t arrive home until late, but he plans to go with her to the local health center to be tested.  

Kagoda talked to us about the challenges he experiences as a young father. One of them is being unable to provide the basic needs for his family, including medical care and better nutrition for his baby and wife. Kagoda and his son both tested positive for malaria and were provided with the treatment, and we talked with him about ways to prevent malaria such as sleeping under a net and how to keep his family healthy. Kagoda was thankful that UVP provides these health and education services in his community. We’re glad that people like Kagoda are getting involved with our programs. We want to reach out to everyone in a community, and it’s even better when a young family can make changes now that will affect their health for generations to come.

Monday, March 20, 2017

Innovation in the village

by Titus Obbo, UVP Program Manager

"Necessity is the mother of invention."

Tippy taps are locally-constructed hand washing stations that makes it easier for people living in the village to wash their hands in a place without running water. Re-purposed plastic jugs are hung next to a latrine or living space, and a piece of wood is used as a foot pedal to tilt the bucket and drip water onto your hands. It's a great invention -- but it also runs out of water quickly when used in a public space.

Anna next to her large-scale hand washing stationAnna has been an intern two times with UVP, but she's also an entrepreneur and innovator. While working with rural communities in Iganga to promote hand washing best practices, Anna decided to think about how to improve hand washing facilities in order to support public places that have no running water. She innovated a modern tippy tap that can serve hundreds of people per day, perfect for a busy primary school or other public location.

The new design has a larger-capacity tank that refills the smaller tippy tap with water. One of the biggest issues with tippy taps is the need to regularly refill the jug, so this reduces the number of times it needs to be refilled and keeps it full longer.

Tippy taps help to prevent recontamination after washing hands since a pupil doesn't need to touch it. The students step on the paddle connected to the bucket to enable it tip over and allow water to flow. My dream is to scale up this project to all primary and secondary schools in all the healthy villages where UVP has worked in before and the future healthy villages. Coupled by my interest in sharing knowledge with others, part of my plan is to identify local fabricators and train them to begin producing and supply the local markets around Iganga and the neighboring districts.

Right now we're continuing to focus on household tippy taps, but we're pleased that interns like Anna help us innovate and dream of big plans for the future.

Friday, March 3, 2017

Building on success of HIV program

By Kelly Child, UVP Managing Director

For the first time in months, I see faces I haven't seen. Elizabeth, the nurse in charge, and her barely-walking
daughter; Busoga Christopher, a vibrant Village Health Team (VHT) member who offers me lunch upon my arrival; the ever-smiling, HIV positive actor from the drama group gives me a boisterous hug when she sees me. Though I haven't been here for months, I'm welcomed like I'm family.

As the Managing Director, I don't go to the field often; my role at UVP is mostly based in the office. But the warm reception received in the village makes it seem like I'm here all the time.

Following the thorough review of programs we conducted last year, the first quarter of 2017 has been one of implementation and evaluation; a time to see if our ideas for improvement are working or if they need to be reconsidered. Today in Mwedanfuko, it feels like success. We've been engaging our VHTs differently over the past three months, and you can feel their dedication in the smooth-running event, along with the pride in their smiles. Their success is tangible with the multitude of people that arrive before noon (a rarity, as most people are working in their field, especially at the beginning of rainy season).  Due to the increase in early attendance, we were able to serve 61 more people than during the last outreach.

Titus, our passionate HIV and Malaria Program Coordinator, escorts me through the various points of data entry at the event. We've revised the data collection forms to more accurately capture our efforts and, despite a few misunderstandings, have been implemented successfully. Today's event provided HIV testing to 190 people, malaria testing and treatment to 100 people, and, thanks to our new partnership with Musana Community Health Center, we were able to provide reproductive services including contraceptive distribution and cervical cancer screening to the community of Mwendanfuko.

At UVP, we gauge success by witnessing a community assigning more importance to their health with the passing months. By those standards, today was a success!

Tuesday, January 31, 2017

From outcast to advocate: Janet's story

Janet has a list of names, and it’s changing lives.

Janet is one of UVP’s Fistula Ambassadors. We recently saw her during our Fistula Ambassadors debrief. We hold these twice a year to have the Ambassadors share experiences and personally check in with them about their work. This time, Janet brought a list of five names of women she has identified who are suffering from fistula and on the waiting list for the next repair camp. We asked her how she feels about disseminating information about fistula, and Janet said she’s more than happy to help other women understand the causes of fistula and how it can be avoided. In fact, she’s so passionate about this work that she visits patients at every camp to provide encouragement and dances and sings to make their stay at the hospital more enjoyable.

It's been a long journey for Janet to get to this point. In 1975, Janet had an obstructed labor and needed to be seen by a doctor. The health center was far from her village, and given the bad roads and their transport via bicycle, it took a long time for Janet to reach the hospital. By the time she got there, her only option was a c-section, but the surgery was unsuccessful and Janet lost the baby and left the hospital with an obstetric fistula. She lived with the condition for 35 years. She tried traditional healers with hopes of getting better, but nothing worked and she was isolated from her community. In 2010, UVP’s Fistula Coordinator visited Janet and assured her she could be repaired and rejoin her community. After 35 years of living with fistula, she didn’t take him seriously and ignored the advice, but the idea stayed with her, and after talking with a friend she agreed to try the surgery since it was fully paid for. The surgery was successful and Janet was thrilled to bring back the good news to her family.

Four years after being healed from fistula and nearly 40 years after first living with the condition, Janet was trained as a Fistula Ambassador. Her list of names keeps growing. To date, Janet has identified more than ten women with fistula and encouraged them as they traveled for surgery. Thanks to her efforts, other women won’t have to wait as long to restart their lives. 

Friday, January 13, 2017

2016: Review and Evaluate

By Kelly Child, Managing Director

During 2016, we held a lot of meetings at the UVP office in Iganga: staff meetings, partnership meetings, planning meetings, and, most importantly, SWOT analysis meetings. We used the 2016 - 2018 Strategic Plan, devised in 2015, as a launching pad to analyze and dissect every aspect of Uganda Village Project (UVP). 

Strengths, weaknesses, opportunities, and threats (SWOT) is a simple concept where you take a topic -- or program in our case -- and evaluate each category. During these meetings, we would agree on our greatest weaknesses and best opportunities within each program. From there, we made small adjustments in immediate programming and started developing concepts for additional shifts. 

One of the most notable decisions is something that most people will never witness: a small shift in our human resource. We better aligned similar programs under one person, rather than spread between two or even three staff members. Below are some thoughts from each staff member on the current and future direction of each program.

Keneth oversees all of our Village Health Teams (VHTs) and the internship program. The two main aspects he is looking forward to is the increased accountability of our VHTs and continuing to professionalize our internship program. We’re aiming to formalize reporting procedures for our VHTs and continue development of the Global Health Leadership Curriculum to accompany our interns’ experience in the village.

Patrick will be managing all of WASH (Water Access, Sanitation, and Hygiene) in order to more closely align resources and approach this very important program in a more holistic manner. In additional to a more cohesive approach to WASH, Patrick will be spearheading partnerships. Currently, UVP utilizes partnerships from government and private organizations whenever possible. The fresh approach in 2017 will focus more on collecting partners for our Graduation Fairs and couple that with a farewell sanitation push, also executed by a partner. Patrick muses, “We really want to leave the village with a bang.”

Titus will be taking a closer look at how our HIV and malaria programs interact, specifically with data collection. “Consolidating our health package allow for more efficient data collection and education delivery,” he says. By coordinating our supply requisitions for both programs, we can assist the government health centers to operate more efficiently.
Loy took over reproductive health in early 2016 by adding family planning to her fistula program responsibilities. In addition to adding specific family planning outreaches targeted to men, we are exploring options for expanding our fistula program to serve double the number of women with repair surgeries.

From these SWOT meetings, we are better aware of where we stand and, most importantly, where we want to go. With your help, we can continue to strive to serve our beneficiaries better every year. We greatly appreciate your support thus far and are excited to share with you our future successes in 2017!

Wednesday, October 19, 2016

"Malaria is a problem."

by Keneth Kaggwa, Program Coordinator
Wentegeze Sadadi, Chairman of Bufutula A,
Iganga District, Uganda

“Malaria is a problem."

This statement from Wentegeze Sadadi, the elected Chairman of Bufutula A, a village selected to be part of UVP's 3-year Healthy Villages program beginning this year. Chairman Wentegeze continued: "People don’t know that malaria is dangerous. It affects much the young. We have a challenge during rainy season where mosquitoes are many. This is why I decided to buy a discounted mosquito net from UVP. We must remember that during the UVP interns’ stay in the village this summer there occurred six deaths from malaria, five of which were reported to be kids under five years of age."

The Chairman said that the deaths shocked him, and that one of the problems was poverty. He went on to say that reluctance to take preventive measures also contributed to the death of these kids.

“I think we can do something to prevent this from happening again in my village,” he vowed.

Talking about himself and how the mosquito nets have impacted his life, he says that now he doesn’t have to buy medications as often as he used to. He says, “Nets are good and easy to use and now that I don’t always fall sick of malaria, I have much more time to work and provide for my family.”

He says that when UVP is gone (after the 3-year Healthy Villages program in Bufutula A concludes), he will continue to work with the government health department to continue educating more people and encouraging them to prevent malaria. He says that he will not cease reminding people about these nets. “Though I know that now many of them have nicknamed me 'The Mosquito Net Guy,' I am still going to remind them that if you don’t sleep under a mosquito net and then you get malaria, you can spend USh 200,000.” He also strongly exclaims that “all need to know because this will save a lot.”

Chairman Wentegeze estimates that in the past malaria prevalence in his village was around 70%. Now it is reducing to around 50%. In his mind, he is waiting for that day when malaria prevalence will reduce to around 30 or 20%.

He believes that this is possible.

Tuesday, September 6, 2016

Uganda's First Ever National Fistula Conference

by Kelly Child, Managing Director
The room was full of surgeons, midwives, nurses, social workers, nurses, former patients, and executive directors discussing fistula. And it was electrifying.
It was the first ever National Conference on Obstetric Fistula in Uganda, planned and executed by a small planning committee at the end of August. Approximately 300 people participated including members of parliament with the Speaker of Parliament Hon. Rebecca Kadaga, the guest of honor, and several District Health Officers.
Obstetric fistula, a condition typically acquired by prolonged labor, results in incontinence – an uncontrollable leaking of urine and, in some cases, feces. In Uganda, there are estimated more than 150,000 untreated cases with 1,900 new cases each year. From the efforts of UVP and the other fistula fighting organizations present at the conference, we treat approximately 2,500 cases each year. At this rate, we will eliminate fistula in 400 years. Clearly, we have a lot of work to do.
The United Nations Fund for Population Activities (UNFPA) started the Campaign to End Fistula, which focuses on three key areas: prevention, treatment, and reintegration. In recent years, our community of fistula fighters has shifted focus from solely looking at treatment to integrating prevention and reintegration as key components of fistula services. UVP’s average patient lives with the condition for 10.9 years prior to receiving treatment. Nearly eleven years of being stigmatized, neglected, and ostracized. Even though the physical treatment takes less than a month, the psychological and socio-economic healing process can take much longer.
Erin Anastasi, UNFPA Global Coordinator, congratulated Uganda in several areas:
  • Uganda is part of a small group of countries with a formal strategy surrounding fistula
  • Of 50+ countries participating in the End Fistula Campaign, Uganda is one of only 2 countries to answer the call to conduct a national conference
  • Uganda’s fistula repairs annually is one of highest in the world
Anastasi also mentioned inadequate human resources and expertise, lack of focus on social reintegration, and a backlog of cases as challenges moving forward.
During presentations, representatives from other organizations such as Engender Health, Medical Teams International, and TERREWODE covered topics from nurse care and utilizing VHTs (village health workers) to the proper execution of surgical procedures and improving surgeon mentoring programs. One of the most interesting presentations delivered findings surrounding the effects of fistula on the spouse. According to the study, approximately 65% of men strive to support their spouse and maintain the relationship and are also affected by the social stigmatization of fistula. By focusing on social reintegration of former fistula patients, programming can support the entire family unit.
UVP currently addresses patient identification and social reintegration in a very personal way with multiple in-person visits. Additionally, the programming is evolving to more wholly address social reintegration by implementing a longer approach to social reintegration after treatment in order to incorporate income generating activities and other educational opportunities. Approximately 25% of fistula patients have a primary level of education and most patients indicate a desire to either continue formal education or skills learning. Thank you to the Fistula Foundation and our donors for their generous support of our programming and their role in eliminating fistula in Uganda!

A donation of $260 covers UVP's costs of bringing a woman to the hospital for fistula repair surgery, her room and board, outreach to and follow up with women receiving treatment, and community education initiatives.

Monday, September 5, 2016

Intern Dispatch: Mwendanfuko

by Solome, Brenda, Sheridan, Carmen, Sami, Megan

Mwendanfuko Village Health Team
The day was reaching 2:00 p.m. as our team finished lunch with UVP’s managing director and began prepping for our Village Health Team (VHT) meeting. As we anticipated the arrival of the VHTs we reviewed the different topics we wanted to cover with them—it was going to be an information packed meeting. To little surprise, at 2:30pm Mr. Bumali was the first to arrive. Our team sat outside with Mr. Bumali and decided that as we waited for the other VHTs to arrive, an easy way to pass time was to play a card game.  We decided on UNO and began teaching Mr. Bumali how to play. First Megan explained the rules of the game to Brenda and Solome so that they could then translate the instructions to Mr. Bumali into Lusoga.  With everything translated and with all of the cards dealt, we were ready to play. The game began slowly as people acclimated to the rules and processes. Soon the competition picked up, and as more VHTs began arriving, the game became very fun and exciting for everyone. Each VHT that arrived was equally entranced with the game and eager to join in. After seeing our VHTs laugh and joke over a simple game of UNO, we quickly realized that we had developed a new fondness for laughter and down time with our VHTs beyond working hours.

The next morning, we held a reproductive health day at the primary school.  Our teaching was aimed at the upper levels at the school and therefore focused on the importance of staying in school and abstinence, while also raising awareness about obstetric fistula. As we planned for the day we were anxious about how the students would engage with the topic?  Would they be rowdy? Awkward? Embarrassed? Throughout the day we were happily surprised, the students listened intently and, although shy at some points, were engaged and involved in discussion.

This sensitization helped us to realize the ways in which children are sources of change in their community.  They are very eager to learn, ask questions, and share the information they learn with family and friends.  It is so important to educate children within the community as they are one of the strongest channels to the education of the entire population. We also learned more about the importance of cultural context, as the sex education that we provided at the primary school in Mwendanfuko is very different from that which the international interns would provide or receive in the United States, or many other countries.  In designing this sensitization, our team discussed the importance of recognizing the cultural expectations of a society and taking different perspectives into account when determining how to educate about and address specific issues.

Later that day, we headed back to the school to hold a malaria sensitization for the community. While walking towards the school field, we felt the first drops of rain and quickly sought shelter under a mango tree as buckets of water began to fall from the sky. “Maybe it will go away soon?” we wondered as we saw lightning flash across the field. With the acceptance that the sensitization we had planned and mobilized for all week would not be held that day, we gathered in a classroom to wait out the storm.

Having made friends with a 12-year-old girl named Shanitah, Carmen decided now was a good a time as any to embarrass her in front of all of her friends. Carmen grabbed Shanitah from under the classroom’s protective overhang and pulled her out into the pouring rain.  Using the limited Lusoga she had learned, she challenged her mukwano gwange to a race across the school field. To the amusement of the hundred or so children gathered, Carmen and Shanitah took off at breakneck speed in an Olympic-worthy example of athleticism, which ended with Carmen slipping in a puddle.  Needless to say, the afternoon, while different than originally planned, was a huge success.

After having decided to postpone the malaria sensitization due to the rain, we trekked back to our muzungu house in the rain – shoes in hand and toes covered in mud.  Feet were cleaned, shoes were washed and the few warm clothes we had packed were dug out from our suitcases as we settled in to our cozy house, listening to the rain pattering on the tin roof. As night drew closer and the lanterns were lit, Sheridan decided that it was an ideal time to execute something she had been talking about for weeks – a hair cut. Walking out to the front veranda with our one pair of small safety scissors, she announced that the time had come for Solome to cut her hair. Solome had no experience cutting any hair, let alone muzungu hair, but declared she had a gut feeling that she knew how to do it. So there it began, the Mwedan-salon was in full swing, and as the community members huddled around to see the muzungu cut her strange hair, Solome’s true hairdresser potential was realized.

During the hair cutting process, we hosted three girls at the muzungu house who happen to be daughters to our next door neighbor. They were so amazed to watch muzungu hair being cut and were wondering why Sheridan had decided to cut her hair short. During their stay at our house we taught them how to play UNO; they caught on quickly, pointing out that UNO was similar to the Ugandan card game called MATATU. We started playing UNO at around 7:30pm and didn’t finish playing until two hours later.  The games were long, exciting, and interesting and after the final round every was feeling happy but tired.  Our guests left the muzungu house very happy and looking forward to playing more UNO.

Our sixth week was full of both challenges and successes in the village. We continued to learn more about the restrictions of our abilities in our work, as well as the strengths of our team and our community. As the summer speeds by, we hope to get as much done as possible and continue to empower our community and VHTs to carry on our work after we leave.

Thursday, August 18, 2016

Intern Dispatch: Namufuma

Water, by Joseph, James, Zoe, Lee, and Ashy

It’s raining today. Water is falling from the clouds in thin sheets, parting languidly before a cool breeze carrying freshly wet dust, thrumming against our roof of corrugated sheet metal, echoing through our village house like a symphony. The rain pools, highlighting the imperfections in our dirt yard made by bare feet and bicycle tires, seeping through the mud before being greedily snatched away by the local flora. The occasional villager strolls by, rice sack raised overhead to protect themselves from water eager to soak them, but the majority of the community takes shelter during the storm.

Take a moment to consider all of your daily tasks that require water. My list includes bathing, drinking, cooking, laundry, washing dishes, washing floors, and washing hands. Imagine having to carry the water required for those basic activities for every member of your family. There are days when we use over 10 jerrycans full of water for 5 people (typically on laundry days). Water is a fundamental need for all people.

In the United States, water is a readily available resource. It’s a simple matter of turning a faucet and fresh, clean, safe water is piped directly where you need it. In the villages, collecting water is time-consuming daily workout routine. Twenty liter jerrycans must be carried to a borehole and pumped by hand. The freshly filled jerrycans are then carried back to the house. Some community members use bicycles, women will balance the cans on their head, and some simply walk. Even at this stage, the water isn’t safe to drink and has to be boiled or purified with Waterguard chlorine tablets. Water in the villages is a precious commodity. Namufuma is particularly limited in its options for safe water. They have only one public borehole in the village, which is nearly at the end of its usable lifespan and breaks down, leaving the community without a safe accessible water source. When UVP announced the construction of a new shallow well in Namufuma, excitement in the village began to build.

Celebrating the new community-constructed shallow well
The process of constructing the shallow well was a collaborative effort between the community and UVP. The community supplied the labor to dig the well and bricks to line the inside. UVP supplied the pumping equipment, mason, and engineer to finish and install the well. The actual construction of the well was a series of escalating processes, concluding with the borehole commissioning ceremony. Each step in the construction process attracted a larger audience than the last. People worked to dig the initial hole for the well. When the mason laid the bricks in the open well, people watched with interest. When the hardware was installed, children flocked to play in the water, splashing crazily in a game of king of the well. When the shallow well commissioning ceremony began, half the village appeared.

The shallow well commissioning ceremony was a celebration in the form of speeches, dance, food, and one unlucky chicken. We interns reviewed the safe water chain with the community. UVP staff began talking about the new water source before it began to rain. The newfound waterfall did not hinder the village celebrations, and the speeches concluded amidst shouts of AI-YI-YI-YI-YIII! We were all served large plates of local food, receiving more than a few laughs at our attempts to scoop rice with our fingers (mostly from our loving Ugandan intern team members). The community brought a set of drums and waves of song and dance broke out. The enthusiasm spread through all the interns. We all joined in the dancing and Joseph demonstrated his skill with a drum.

The construction of the shallow well marks our final large event with the community as interns. It is a very physical reminder of UVPs work in the village. We’re all saying our goodbyes this week; to our hardworking Village Health Teams (VHTs), our lovely and welcoming villages, our newfound friends and fellow interns, and all the awesome people at UVP who work tirelessly throughout the year to ensure this internship is a success. Thanks you guys!