Monday, December 28, 2009

Wednesday, December 23, 2009

News from Uganda... Marriage and HIV bills

The "Marriage and Divorce Bill"
This bill is currently in hot debate all over the country - though the part of the bill most condemned by the international community, the bit criminalizing homosexuality, is the part most widely agreed upon by Ugandans.

For a detailed explanation of the anti-homosexual sections of the bill: 

For the latest on Museveni's apparent reluctance to pass the bill after international condemnation and threats to cut aid to Uganda (based on the anti-homosexual parts): 

On provisions of the bill affecting women (e.g. cohabitation recognised with regard to distribution of property at separation, widow inheritance abolished, impotent men to be divorced, bride price not to be compulsory)

While I am unable to find a link to any news about it, I believe that another section of this bill proposes short-term marriage contracts between men and women, where a reduced bride price could be paid to a woman's family in order to attain, say, a year's marriage contract. The contract could then be renewed if  both parties were interested.  This leaves interesting questions about the provision for children produced during such a short-term marriage

The "Prevention and Control of HIV/AIDS Bill" 
A bill that critics say amounts to criminalizing HIV-positive status, might eliminate confidentiality of test results, could discourage individuals from getting tested or from disclosing their status, and will likely increase the level of HIV-transmission...

Explanation of bill

Human Rights Watch critique of bill: 

Thursday, December 17, 2009

Are UVP gifts on your holiday wish list yet?

For anyone interested in giving charitable gifts this holiday season... we recommend you stop by our new Universal Giving site. This is a fantastic clearinghouse for gift packages and charitable projects, including volunteer opportunities.

In the meantime, we've also been listed on Grain Edit's holiday wish list, a design blog based in San Francisco. Thanks for the shout out, Grain Edit!

Friday, December 11, 2009

Uganda Facts

Just a few statistics on Uganda... 
  • Life expectancy: 49
  • Probability at birth of not surviving until age 40: 31.4%
  • Under-5 mortality rate: 130 in 1,000 live births
  • Percentage of HIV-positive adults: 5.4%
  • Children underweight for their age: 20% 
  • In East Africa, underweight prevalence is predicted to be 25% higher in 2015 than it was in 1990.
  • Uganda has the 3rd highest rate of malaria deaths in the world. 
  • In 2007, there were 47,000 reported deaths from Malaria (with likely double that or more unreported)
  • Percentage of adults with "low educational attainment" (as defined by the Human Development Index): 93.5%
  • Adult illiteracy rate: 26.4%
  • Population living under $1.25 a day: 51.5%
  • Population living under $2 a day: 75.6%
  • Government expenditure on health care per capita: $39
  • Urban share of Uganda's population: 11 - 13%
  • Total fertility rate: 6.4 
Fun facts about Uganda: 
  • When a Ugandan is explaining a direction or location, instead of pointing with their hand they often purse their lips out towards the direction.
  • Many Lusoga words repeat themselves.  For instance, "wala wala" means "far away," "mpola mpola means "slowly," and "kumpi kumpi" means "close by."  
  • Mangos currently cost 5 cents each 
  • Women are not meant to eat eggs, in Basoga culture, lest the forefathers curse us.
  • There are at least half a dozen types of banana commonly grown, likely more, each with their own name and purpose: bagoya, ndizi, gonja, matoke, etc. 

Sunday, December 6, 2009

Give To The World

Do you have friends or family members who already have everything they need, or maybe just want gifts that are more meaningful this Christmas?

Try stopping by Uganda Village Project's Give To The World catalog, where you can find gifts from mosquito nets to vegetable gardens that will benefit small village communities in Uganda.

Not only are these gifts meaningful and life-saving, they are effective: 100% of the money you donate will go straight to Uganda to support your designated program, none of it will be spent on publicity or fundraising.

Our Etsy shop features cloth bags and jewelry made by Ugandan orphans who are trying to find a way to earn money for their schools and their families. They're beautiful and unique!

Friday, December 4, 2009

Red Dust

One of the things that I hate and love about Uganda is the dust. Ugandan earth is a dark red-brown, and so rust-colored dust lays over the villages in like a thin, almost-invisible cloak, billows up behind motorcycles and mini-buses on long dirt roads that run through the countryside like red rivers, sticks to your face and your arms and your clothes, gets in your food and your nose and your bed-sheets and your hair. It’s incessant, softly permanent, like the heat or the poverty of the place, patiently waiting for you to accept it, to resign yourself to it, and eventually to love it.

And you do – you learn to enjoy washing your hands and watching the water run off red, clear as you become clean. You learn to wear dark colors when your ride motorcycles, and to laugh at yourself and your clothes when you forget and come back dyed dark reddy-brown. You learn to sweep the floors during phone conversation, when you’re frustrated or thinking, while your water is boiling for tea, and to enjoy the satisfaction of that smooth, clean, tidy look that will last for approximately 3 hours before the next layer of dust rolls in. You learn to shower only at the very end of the day, when it's grown cool outside and you’re done with all your outdoor activities for the day, when you can sit afterwards inside your home feeling deliciously smooth and cool and clean all over.

You learn to live with the dust in Uganda, and you learn to love it, to understand it like a language or a lifestyle or a people. And when you return home to the United States, or to England, or to Canada, you’ll find that you miss the dust, and through that you’ll miss the country and the lifestyle and the language and the people. You’ll remember Uganda, and when you do, you’ll envision a long red road, twisting across a scrubby green landscape of bushes and trees and occasional thatch-roofed huts of red-brown mud, and the blue sky above like an expansive bubble, and the dust rising from little dirt paths and the long red road, rising like a breath, hovering, waiting, rising from the earth like a spirit, like the future, like the stained-red soul of the country, Uganda.

Thursday, December 3, 2009

improving health & sustaining local livelihoods

Meet Godfrey Mulumba, a 30-year-old rural artisan representing a nine member pottery cooperative in nearby Kamuli District. UVP speaks with Godfrey about his background and profession, his previous experience with the pottery business, and the impact of a partnership with UVP's Modified Clay Pot (Mod-Pot) Project on his income and livelihood.

UVP: How did you get started working as a potter?

Godfrey: My great grandfather started producing traditional clay pots in the 1930s. Knowledge was passed down to my father and he taught me how to make clay pots. I started making clay pots at 12 years of age and I am now teaching my son, Ronald, who is 10 years old.

UVP: Has the pottery business changed since when your father started making pots?

Godfrey: When I started making clay pots with my father, we made enough money through sales in surrounding rural areas. Since then, things like firewood costs have increased and there is no longer consistent demand for clay pots from nearby rural villages and towns. With more people moving to cities, we started to sell in cities but high transport costs, competition from other potters, and the difficulty working with middlemen limit what we can sell. Our group resorted to moving our products into towns on bicycles but, whenever we cannot find buyers, we are forced sell our pots at a loss or transport them back to our village.

UVP: Why did you enroll in UVP's Modified Clay Pot Project and how has it impacted your business?

Godfrey: I was approached with the idea of making clay pots with taps for safer drinking water and discussed it with the members of my local pottery cooperative. After making samples for UVP, my group produced 100 modified clay pots as our first order for UVP. The Mod-Pots I make for UVP are guaranteed to be sold because I get paid in advance, and I don't need to worry about finding customers or transporting the products to where they are wanted. This gives me more time to focus on producing pots. For every modified clay pot I make, I get 50% more money than from molding a traditional clay pot. I have appreciated the new sense of security and income; producing Mod-Pots for UVP will help pay for my three children's' school costs and help expand my business.

UVP's Mod-Pot project targets elimination of common hand contamination of household stored drinking water through hygiene education and sale of subsidized modified clay pots to rural communities. The demand for ceramic products, however, also sustains the livelihoods of local artisans who supply the Mod-Pots to UVP. Over the next 12 months, UVP will connect over 20 artisans and their products to new markets thereby opening up opportunities for higher income generation.

Monday, November 30, 2009

Eye Health Program Receives Funding!

Learning to walk with a cane during a training session
Through our partnership with ChooseANeed, we have received funding from a generous donor to support our eye health program based in our target Healthy Villages. We'd like to take this opportunity to thank our friends at ChooseANeed who have helped us in so many ways since we started working together. This funding will allow us to train individuals in each village to identify community members with eye health issues that can be repaired, such as trachoma and cataracts. We then provide counseling and transport for these community members to undergo surgical repair of their condition and have their eyesight restored.

UVP has trained over 60 eye health educators in the Iganga District, and facilitated more than 67 surgeries such as lid rotations, foreign body removals, and cataract removals.

To learn more:
- Visit our eye health program website and donate to help us bring the gift of sight to more and more villages in eastern Uganda
- Visit the ChooseaNeed website to see UVP's featured Needs and Success Stories
- Read an article just published about ChooseANeed's work worldwide

Sunday, November 29, 2009

Thanksgiving, the Incubator, and the Radio Station

From David Dinh in Uganda, UVP Board Member:
I have been working with a District Water Office engineering intern named Emma to carry out water sample collection and filtering/incubating the samples back at the water office. Water Quality testing turns out to be a tedious and time consuming exercise; on average, field testing starts between 11-12AM because of delays in procuring either transport or staff and ends at 5-6PM or within the recommended 6 hours after the collection of the first water sample. The membrane filtration consumes 10-15 minutes per sample. For a set of 10-12 samples and controls, it takes a total of 2 hours. After filtration, you have to sterilize new Petri plates and water sample collection bottles for the following day. On the days Emma could stay to help, I could leave shortly after 8PM.

On Wednesday, in eager anticipation of Thanksgiving in Uganda, I toiled to complete the necessary water quality preparations, recorded testing data from the previous field test, and organized logistics for field work on Thanksgiving Day. I was optimistic Emma and I would finish before 7PM the next day thus enabling me to bike back to the office with ample time to make dinner and, with high certainty, play Thanksgiving Scrabble with Mariam and Marcela!

Field work on Thursday consisted of traveling to Lambala, a well site boardering with Kamuli distict, and back to villages we missed the previous day in central and eastern Iganga district. “It’s only 6:00PM!” I said thinking I had a cornucopia of time (cornucopia being a great Scrabble word) to filter the 10 samples plus bottle water controls. Emma and I set off prepping and filtering our samples but, at the 8th sample, the power cut off. “Not a problem, there is a backup battery inside the incubator,” Emma told me but only to find that someone had switch off the outlet in the morning. The incubator switched on but the green power LED died, along with any hopes of leaving early.

More or less, I thought I had lost my right arm. Six hours of irretrievable field work, 43 liters of fuel, and all our testing reagents would go to waste if we could not find a power source for the incubator. The district was not going to allow me to go back to these sites to repeat testing. I dreaded the idea of repeating the task.

I waited 45 minutes before deciding on trying to charge the incubator at locations with a running generator. We had several generator options but they all necessitated me sleeping near the incubator to make sure the glorified $300 oven was not stolen. The initial plan was simple; rent a room at Mwana Highway Hotel and charge the incubator over night. We entered Mwana and inquired when they turn off their generators and whether we can get a room to charge the incubator to run our tests. I expected the cashier to say, “Ok, that will be 20,000 UGX and have a great night!”; instead he quoted 40,000 UGX and suspected we were carrying a biohazard cased in a blue metal box and called the manager. Before we could re-explain that we were working for the DWO and the incubator is as dangerous as a VCR, the cashier said to the manager, “Look at the box. They are trying to heat up chemicals.” After an unproductive discussion that involved blaming foreigners for causing generator outages during the summer by plugging in their laptops, we found ourselves walking to nearby gas stations with running generators. After two gas stations, however, it became embarrassingly obvious we were being rejected because no one knew what was inside the mystery container. It was better to show what was inside before explaining what was actually inside.

At this point, 2 hours elapsed since we put our filtered samples inside the incubator. I was exhausted. On our way to inquire about the hospital's generator, our last resort, I noticed the bright radio tower for Eye FM Radio, a local radio station across from Our supermarket. It never occurred to me that radio stations made more money and established a better reputations if they ran generators during power outages to continue broadcasting Ads and programs.

First line of action, we opened the case and showed the manager our Petri plates. Second, we explained the testing and emphasizing the large loss of time and effort if we did not find a power source for the incubator. I expected to get thrown out again, but the manager agreed to charging the incubator and even letting me sleeping on the floor next to it.

We plugged in the incubator and nothing happened. We tried a different extension cord and, still, nothing happened. Apocalyptic thoughts bombarded my exhausted brain. What if this glorified Easy-Bake oven is broken? How am I going to finish testing the remaining water sources? What if the DWO thinks I broke the incubator? Emma and I fiddled with different permutations of pressing buttons, trying different cords and extension cords, and different outlets until an electrician walked into the room to ask us what we were doing. Let me describe what happened again: an electrician walked into the office of an obscure radio station and offer to help two strangers bewildered to why their Easy-Bake oven was not turning on. It turned out the electrician was there before to fix a problem with the station’s radio transmitter. He inserted two prongs connected to a voltage meter into the incubator outlet and repeated with the wall outlet. Then, he explained the voltage was too low for the incubator and it is likely there is feedback mechanism inside the machine that switches off power after sensing fluctuations outside of a specific voltage range. It turned out my Easy-Bake oven is more sophisticated than what I had given it credit for.

Ran back to the office to grab the voltage stabilizer, a blanket, and a mosquito net I hung over my desk, and I set up camp on the floor of the radio station. The generator switched off at 3:30AM but the backup battery inside the incubator kicked in. Between 5:30AM and 6:30AM, the battery died but the casing that housed the Petri dishes remained hot until I took it back to the DWO in the morning. Power came back at 11AM today and I turned on the incubator to finish. While waiting for the remaining 4 hours (I thought since I switched off I would give it the maximum incubation time of 16 hours), I wrote this report, slept, and sterilized equipment and collection bottles for the last day of testing tomorrow.

Thursday, November 19, 2009

Opportunities to Support UVP Online!

This season there are a number of opportunities to help support us without it costing any money. After our wonderful success in the Giving Challenge, we are very excited about these new opportunities.

Chase Community Giving is a new program that will be giving out millions of dollars to charities. In order to win, we just have to obtain as many votes as possible. Each person has 20 votes in round 1 (until December 11th), you can only use one vote per charity. Please vote for us in this contest and help us reach round 2! It's easy and free.

If you're a Facebook member, the second contest we're working on with with our fantastic partners at ChooseANeed. They've raised $550 dollars which they will give to the charity with the highest number of votes. To vote, just become a Fan of ChooseANeed on Facebook and you can leave a note on their wall. We're trying to promote our sanitation/latrine construction project for the prize.

Visit the ChooseANeed website to see all the good work they are doing - all Uganda Village Project programs are highlighted with our logo.

Thursday, November 12, 2009

Summer 2010: Come Visit Uganda With Us

Would you like to spend the summer making a lasting impact on community health and development in rural villages in sub-Saharan Africa? Have you always wanted to experience and learn about the culture of East Africa? If so, please consider applying to Uganda Village Project's summer program.

Uganda Village Project – a public health and development nonprofit in rural Uganda – is now accepting applications for its 2010 Summer Internship Program.

Our Mission: Uganda Village Project is a non-governmental organization (NGO) that collaborates with diverse partners on the design of sustainable rural health and development solutions through networking, advocacy and project innovation in the Iganga District, a rural area in eastern Uganda.

Interns will spend 8 weeks living and working in a village in rural Iganga District, Uganda, gaining experience in community education and public health while organizing education programs in the villages, assisting in planning and implementing health care and development oriented programs, and working in partnership with local NGOs and community groups which focus on issues such as sanitation, HIV/AIDS, nutrition, orphan and widow support, and reproductive health.

Applications are due January 15, 2010.

Visit the UVP website to learn more about our programs:
Click here to visit our Summer Internship Center!

"Online Office Hours" for prospective applicants will be held on Skype chat at 2-3pm PST on Mondays, just Skype to username uvp-intern

Uganda Village Project accepts adults ages 18 and over with an interest in medicine, public health, global health or international development. Applicants with previous experience in these areas, with previous experience working in the developing world, or with a demonstrated talent for languages, will be given special consideration. Visit our website and apply today!

For more information, please contact

Wednesday, October 28, 2009

Eye Care Training for Village Specialists

Over this last weekend (Saturday and Sunday) UVP organized and oversaw a two-day Eye Health and Vision Disability training, run by Sightsavers International. We trained one individual from each of our Healthy Villages, who is henceforth the Village Eye Care Specialist. Each of these individuals were chosen by the village’s political, religious, and opinion leaders at a meeting held earlier by Abdul. Each of these individuals was also a member of (or chair of) the Village Health Team, which we took as a positive sign – obviously, our VHTs are indeed made up of the most health-active members of the community!

The training began about 9am each day, and lasted until around 3pm. We gave each trainee the money for their transport to and from the office, and we catered for tea and lunch at the office. Otherwise, the trainees were volunteering their time, purely in hopes of bettering the health of their community!

Here are some of the topics covered during this workshop:

Day One

  • Prevention of eye problems (preventative prenatal care, household health and sanitation measures, etc.)
  • Causes, symptoms and details of all the common village eye problems
  • Treatment available for various eye problems, and where to find such treatment (e.g. which health centers can treat what, available surgical camps in various sub-districts)
  • Contact numbers for key individuals (SSI contact, UVP contacts, health center contacts, etc.)
  • More on specific sanitation measures to be taken at a household level
  • Counseling systems for the blind
  • The increased use of other senses utilized by blind people

Day Two

  • How to help a blind villager to learn to do things by themselves (e.g. take a shower, bath, do washing, go to the latrine, etc.), by utilizing other senses and learning mobilization strategies (e.g. knowing where you are by the smell of flowers, by the angle of sunshine hitting your face, by counting steps from one area to another)
  • How to counsel a fellow-villager who has recently gone blind, making her understand that the blind can be useful, productive members of society (here, Abdul – the SSI trainer – used himself as an example, for he himself is wholly blind)
  • The history of rehabilitation systems in Uganda (in the past, the blind were mostly institutionalized, making them useless and very unhappy; now the government has certain schools for the blind, but otherwise the blind are encouraged to act as normal members of society)
  • Institutional measures that can be taken to help people with disabilities (e.g. slopes next to stairs, for people with wheelchairs)
  • Income generating activities which can be easily done by people with disabilities (e.g. the lame are still able to dig their gardens, the blind can keep poultry, etc.)

The most exciting part of Day Two was the actually mobility training that Abdul did, where the whole group practiced (for about 3 hours) moving about with a cane, counting steps or feeling one’s way from place to place. During the second half of this training, Abdul actually blind-folded his students, and they did amazingly well moving about the garden using his strategies! We even set up obstacle courses for them, with objects representing holes in the ground, large obstacles they had to feel and then safely move around, etc. They also had to do a special ‘using to the latrine’ obstacle course, which everyone found vastly amusing. In general, the entire practical training was a lot of fun, and it was obvious that the trainees not only learned a great deal, but had a great time doing it.

At the end of the training, we gave each participant a certificate, labeling them as the Village Eye Care and Vision Disability Specialist. Julius (UVP staff), told them,

I receive my first diploma, my professor and advisor handed it to me saying, ‘The paper is useless, Julius. It is what you do with this knowledge in the real world which shall count.’ So for you, too, this paper is nothing important, but your actions when you go back to the village, your application of this knowledge to help the blind or other disabled neighbors – that is so important. That is what will make a difference.

The next step of our eye program – These Village Eye Specialists will be returning home to examine all villagers with eye problems and send them to the proper health facility to be screened. (UVP will pay for transportation costs.) After everyone has been properly examined, treated, and advised, Abdul will be coming back into each village to do mobility training with the visually impaired. Then, we shall transport all individuals whose condition allows for corrective surgery a nearby hospital, where they shall be operated on by Dr. Othieno, from Sightsavers International.

We will let you know of our progress as it goes!

Sunday, October 25, 2009

America's Giving Challenge Daily Contest: 10/26-10/27

Uganda Village Project has entered an exciting contest, starting 10/26 and running for 24 hours, called America's Giving Challenge. It is running through Facebook, the social networking site. They are giving our daily prize of $1000 for the charity that gets the largest number of donations above $10 during that 24 hour period. We need your help to win this money to support our programs in rural Uganda!

Here's how you can help:
Any Facebook users can join our cause and make a $10 or more donation starting at 3pm EST 10/26
Non-Facebook users can make a donation directly at
Anyone is welcome to watch the Challenge rankings board and see how we do - daily contest runs to 3pm 10/27
Please pass this on to anyone you think might be interested in helping.

Thursday, October 22, 2009

UVP Attends a Hygiene and Sanitation Conference

Earlier this month, David (UVP board member currently working in Uganda on water issues and a sustainable water storage business), and I were invited to a UWASNET-organized conference on Marketing Sanitation and Hygiene, specifically focused on latrines.

The conference was in Kampala, and representatives from all the largest NGOs were there – from HIP (Hygiene Improvement Project, an arm of USAID), from Busoga Trust (a well-established Ugandan NGO from our region), from Plan Uganda, and from many others. We sat in a huge, shiny conference room with a projector to display lap-top power-points on the wall (wow, how American!), surrounded by officially-dressed Ugandans with PhDs and years of experience working on sanitation issues.

The people surrounding us were friendly as well as knowledgeable, however, and we took advantage of their kindness by seizing them and questioning them on a variety of issues. We are just now beginning to work on the issue of latrines in our villages, and their advice and the presentations were exceedingly helpful. Many of them, too, assured us of their willingness to help UVP in future, and invited us to their own project areas to see their work on sanitation.

Wednesday, October 7, 2009

Mod Pots Featured in Article

CNR student David Dinh is helping rural Ugandans to have access to safe drinking water.

"In every home in Uganda, drinking water is traditionally stored in a clay pot and culturally, there is a tremendous preference for this method of water storage. Unfortunately, water stored through this method can become quickly contaminated from repeated hand contact," Dinh writes. Because of the need for safe water storage, Dinh has helped to create improved clay pots with plastic spigots. They are "an affordable, accessible, and culturally appropriate safe water storage approach for rural Ugandan communities, " says Dinh.

Read the full article at:

Monday, October 5, 2009

The Mystery of the Disappearing Butongole Village Health Team Members...

Today Julius and I conducted a Village Health Team (VHT) follow-up in Butongole, with Rogers Mandu from Uganda Red Cross. Rogers, the program manager from Uganda Red Cross, had personally trained the Butongole VHT, and so we expected to see great things from the members: beautifully-set-up dish-drying racks, immaculate latrines, well-constructed bathing rooms, well-kept trash pits, etc. Saidi, the VHT chair, and Nsoni, the mosquito net distributor, met us upon arrival in the village in order to walk house to house with us, showing us around and learning the follow-up routine themselves.

To our surprise, even though began walking around lunchtime, the first two VHT members were not home. And, to make matters more disgruntling, their homes lacked almost all of the sanitation facilities about which they had been taught during training. We moved to the next homes... still, no VHT members. It was incredible - lunch is taken seriously in Uganda, a sit-down-in-the-yard meal that is rarely, if ever, missed. (No granola bars and coffee to-go here!) We moved to the next houses... still deserted, and this time it seemed like we could see people fleeing as we came! Every house except one was sadly lacking in any sanitation or health measure implementation.

Finally, we actually got to one house where a pot full of food had been left cooking above a roaring fire in the outdoors kitchen - clearly, the family had fled suddenly as they saw us approaching! "Your lunch is burning," Rogers called out to the apparently empty compound. No answer. We moved around the compound as usual, checking on the facilities, and as usual they were disappointing. As we left, we turned around to see a teenage girl crack open the house window to watch us go, giggling at this new and improvised game of adult hide-and-seek.

We stopped about 1/3 of the way through the list of VHT members. Apparently, nobody had been informed of our coming, which is probably why they all ran as we arrived. In Bulumwaki and Nabitovu, Village Health Team members had known for a week or so that we would be coming to do follow-up, and so they had began implementing many of the measures taught in the days before we came. Here in Butongole, we had caught them unawares. We agreed with Saidi, the VHT chair, to come back next Monday around the same time. He promised, this time, to make sure all VHT members knew of our coming, so that they had time to improve their compounds before we arrived. So, we shall see next week how the issue progresses...

Uganda's misplaced health millions - BBC Oct. 4

Below is an article from BBC, describing many of the issues that we face in Iganga daily. As described, our local health centers (around which the Healthy Villages are placed), are sadly lacking in both durable and non-durable supplies. Patients are often neglected for hours or days before receiving any treatment, and may be charged, in the end, for medicine which ought to be free.

As described in the article, much of the international funding for health in Uganda goes to HIV/AIDs programs. Through Healthy Villages, however, UVP address the health issues which are most pressing in the village, instead of the 'trendy' issues or the issues which happen to fall under media spotlight. Diarrheal diseases, as mentioned in the article, are one of the most dangerous but unaddressed health problems in rural Uganda. Through the construction of shallow wells, through education about waterborne diseases, through training Village Health Teams on the safe water chain (from source to point), through working to increase latrine coverage, and tangentially through many other programs, UVP is seeking to lower the rate of diarrheal diseases in our Healthy Villages.

Uganda's misplaced health millions

Two women outside a health centre in Ssekiwumna
This health centre lacks even the most basic equipment

By Jeppe Villadsen
BBC Focus on Africa magazine, Nairobi

On a sun-drenched Sunday after a weekend in the country with his wife and two colleagues, Diego Angemi drives from the Sipi Falls in eastern Uganda towards the capital, Kampala.

He has travelled this stretch of road many times before but this time there is a dramatic turn of events. A hit-and-run accident has left a boy lying unconscious at the side of the road.

They rush the boy to a regional hospital in Mbale, a village about 200km north-east of Kampala, in the hope that they can save his life.

Their hopes are soon dashed. In the hospital's emergency room, apathetic staff must be persuaded even to investigate the boy.

"Unbelievably, the doctor seemed almost annoyed by the fact that we had brought the boy in," Mr Angemi recalls.

The reason for the staff's apparent numbness, however, soon becomes clear.

The plush surroundings of an Aids research centre
In contrast to the health centre, this research centre is worth millions

There is no equipment in the department, not even for basic resuscitation procedures. The emergency room has neither oxygen nor equipment for monitoring blood pressure. There is not even a simple penlight to investigate eye movement.

"While we sat waiting and hoping that the doctor would take responsibility we realised that the boy's hands were turning cold and that his pupils were dilating. He died right there in front of us," Mr Angemi says.

Huge imbalance

Although the emergency room of this local hospital is dysfunctional, right next door is a newly-erected building belonging to Taso, a Ugandan Aids support organisation, which houses medicine and hospital equipment worth millions of dollars.

Nearby is an arm of the Joint Clinical Research Centre (JCRC), the self-governing state institution which researches HIV and Aids. JCRC is the largest provider of anti-retroviral (ARV) medicine in sub-Saharan Africa.

Why then should foreign donors continue to multiply Aids spending but use small change on projects which, for example, provide safe drinking water?
Daniel Halperin, Harvard University

Both these organisations are recipients of multi-million dollar support from the US. One of the main American funders is Pepfar - the President's Emergency Plan for Aids Relief.

In 2008 alone, funding from Pepfar reached $283.6 million - an amount which easily exceeds the entire annual budget for Uganda's ministry of health.

"It makes you wonder whether this assignment of funds is justified when the most frequent cause of death in Uganda is, in fact, malaria," says Mr Angemi.

The Ugandan health ministry acknowledges the imbalance.

"Since ARV medicine is very expensive and HIV testing equally so, expenditure on HIV completely overshadows what is otherwise available in the health system," says the state's head pharmacist, Martin Oteba.

After many trips throughout Africa, Harvard's Daniel Halperin, who has been researching the disease for 15 years, has made the same observations.

"Many people in the West believe that all Africans are impoverished and infected with HIV. Yet the reality is that many countries have stable HIV statistics of under 3%," he says.

But in spite of this, the vast majority of support, particularly from the US, is given specifically to the war on Aids.

"This is because it is a disease that we ourselves have dreaded and have therefore placed it at the top of the global agenda."

Multitude of diseases

Sometimes African health ministries become over-burdened with the huge deliveries of ARV medicine which they do not have the time, finances or manpower to distribute.

Aids: 94,000
Malaria: 41,000
Diarrhoea: 30,000
Tuberculosis: 15,000
Measles: 7,000
Tetanus: 7,000
Source: World Health Organisation, figures from 2002

"The healthcare systems cannot keep up," says Esben Sonderstrup, chief health consultant for Danida, the Danish international development agency.

"Then, there is the serious risk of medicine expiring and becoming unusable."

For Mr Halperin, it is completely mindless to target aid with such a narrow focus on a single disease.

"Why then should foreign donors continue to multiply Aids spending but use small change on projects which, for example, provide safe drinking water?" he asks.

Last year, according to Mr Halperin, the US spent $3bn on Aids programmes in Africa but invested a mere $30m on safe drinking water.

Mr Halperin cites other examples.

One fifth of the world's diarrhoea-related deaths occur in just three countries: the Democratic Republic of Congo, Ethiopia and Nigeria, all of which have relatively low HIV statistics.

Yet diarrhoea, which is relatively straightforward to combat, is largely ignored by donors in favour of Aids programmes.

No-one turned away

At the main Taso centre in Masaka, southern Uganda, there is a new building with a bright, newly furnished office stocking an excess of campaign materials.

We are always able to offer the right medicine to our patients. It has never been necessary to turn anyone away
Martha Nakayma, Taso

Martha Nakayma, a 26-year-old public-relations assistant, relays the demands of a district which has an estimated 80,000 HIV-positive inhabitants.

Already more than 25,000 people have received help from the centre.

Aside from doctors, nurses and social workers, personnel at the Taso centre include nine information technology assistants and two marketing people.

Pepfar is Taso's main donor, providing approximately 60% of the funding.

"We are always able to offer the right medicine to our patients. It has never been necessary to turn anyone away," says Ms Nakayma.

She explains that one day each week is reserved for home calls to those who live far away.

A skills development programme for patients means the hum of sewing machines is often heard. In addition, there is a theatre group for productions on HIV-related topics.

"We also offer massage and special aromatherapy which can help to alleviate pain," she says.

Elsewhere, there are local general medical clinics like the Ssekiwumna Health Centre situated on a dirt track off a main road outside Kampala.

On an average day, up to 30 patients visit the clinic, typically with conditions like malaria, skin infections or diarrhoea.

Its annual budget is just $3,500.

No apologies

One of the biggest problems in institutions like this is the unreliable delivery of medicine and the lack of transport facilities, says Charles Mugyenyi, a health worker at the centre.

His dream is to purchase a motorcycle for the small clinic.

African leaders at a UN summit
African leaders recently announced a joint bid to tackle malaria

All this stands in stark contrast to the large sums pumped into Aids' centres by international donors.

"Of course a lot of money goes to HIV/Aids because it is a terrible illness, but more should go to programmes like vaccination campaigns, tuberculosis and family planning," says Mr Mugyenyi.

So what do the representatives of Pepfar make of the criticism?

Premila Bartlett, Pepfar's coordinator in Uganda, says they have nothing to apologise for.

She argues that, unlike many other international organisations which had "lofty goals" to get people on treatment, Pepfar has actually committed resources to the disease and in doing so has made things happen.

Pepfar, she says, is certainly not trying to undermine the existing system but rather to repair something which "in many cases is in pieces".

One of the problems is government commitment.

"If that isn't there, the system isn't going to get fixed and the people won't get the services they need."


Friday, October 2, 2009

UVP Health Clubs, Coordinated by Julius Mbabani

Julius Mbabani, a Summer 2009 Ugandan volunteer, is continuing to volunteer with UVP as our Club Coordinator. We are lucky to have him! Julius is currently a sophomore in collage, but while in secondary school he was part of a well-known school drama group which did dramatic sensitizations on HIV/AIDs. The Sub-County use to actually hire his drama group to perform in villages, and even today when Julius travels through his sub-county people recognize him from the plays, and thank him for his good work.

Because of this background, Julius is deeply enthusiastic about helping UVP-founded clubs (some focused on HIV/AIDs, some focused on sanitation and safe water) develop and perform educational dramas. Mariam and I went to visit the Nile High School HIV/AIDs club with him last Friday, and were deeply impressed by his advice to the club’s staff advisor – “It seems that you are missing any section on living positively. This is a very important thing to address, and can come right after your play’s climax - as of course every play has a beginning which builds up, a climax, and then a resolution. The information that you give on avoiding contraction of HIV is essential, of course, but you must not leave those who have HIV as feeling that all is lost. For these, we must relay information about how to live a positive, healthy life, taking ARVs, and speaking openly about their experience to avoid others falling down the same path.”

Or, “You must encourage your club members to be creative, think freely, come up with new means of expressing their ideas. For instance, you can open the play with a poem – ‘AIDs, AIDs, why are you taking my people AIDs? Why do you steal away my neighbors and my aunties, my brothers and my friends, even my teachers and my doctors - why must you take my people from me, AIDs?’ - you know, like that. I just made that up, and the students could easily make up something just as good. Or they can make up a song, or they can break out of the play and address the audience directly, bring them into the drama, make them part of the story and the tragedy. All your members should be encouraged to come up with their own ideas, creative ways to express the message, new ways of reaching the audience.”

Or, perhaps one of the most touching bits of his advice, “You know, secondary students will graduate and go away to college, or to get a job; they’ll move into Iganga, or Kampala, or they’ll marry somebody from another village and leave this place forever. So many of them. This is their last chance, really, to give back to their community. This is their chance to make a difference in the place that raised them up, to the people who raised them up. So they should not only do education through drama, but they should be encouraged to volunteer in general. They could go to cut the grass every month at Kiyunga Hospital, for example – this type of volunteering will teach them to love and value their community, and it will build in them a general sense of community service. It will also be an example to the rest of the community – for surely, if you as an adult pass a group of students volunteering to tidy the compound of the hospital, you will feel that you should also be serving your community. And, it will be a great advertisement for Nile High School!”

Julius is coming every 3 weeks or so, for two days. We pay for his transportation to Iganga, and for his costs while here, but we give him no salary what-so-ever. We are so glad that he is willing to continue volunteering with UVP, and we expect great things to come out of his club programs!