Monday, August 17, 2015

Bukakaire: getting caught in a downpour with Mr. Kiti

The last two weeks of the summer have been a blur. We have been so busy wrapping up our work and making sure that the villagers and our VHTs are ready to continue the programs once we leave. As our last project for the summer, we are working on the Bukakaire sanitation push. After finding out through our baseline surveys that good household sanitation was rare, we realized how important our work in improving household sanitation is. To educate the people in Bukakaire about good sanitation practices, we held a sensitization where we taught the importance of washing hands using tippy taps, drying plates on “standard” plate stands, and containing decomposable garbage in fenced trash pits. Attendance at the sensitization was great and people seemed excited to begin improving their household sanitation using UVP techniques and subsidized supplies.

After the initial sanitation push, we began “hands on days” at the houses of our VHTs and village Chairman. It is important that they have exemplary household sanitation, since community members look up to them when improving their own health practices. We spent two full days building trash pits, tippy taps, and plate stands as a team. Once their households were perfected, we were ready to move on to the general community members’ households!

For the past week, we have been moving from household to household in the village, promoting the UVP subsidized supplies (nails, wire, string, and jerry cans), to encourage villagers to begin collecting the wood needed to build these very important sanitation devices. Community members are so grateful to have our help, and we often leave with small gifts of gratitude, such as bags of g-nuts or maize.

Our Interview with Mr. Kiti
After helping Mr. Kiti build his sanitation devices, it began to downpour, so he invited us into his house to wait out the storm. While sitting on mats in his living room with about 10 village children who were also seeking shelter, we had a good conversation about his life and his involvement with UVP in Bukakaire. Mr. Kiti is one of the older members of the village, and he is very enthusiastic about UVP’s work, attending almost every event that we have held throughout the summer. He has a wife and 10 kids, five of whom still live in Bukakaire.
After growing up in Bukakaire, Mr. Kiti moved away from the village to attend Elgon technical school as an engineer and began his career in a coffee factory as part of the Lusoga Growers Cooperative Union. Mr. Kiti first learned of UVP when two staff members came to Bukakaire looking for a sample of 10 households to survey to determine the community’s need for UVP’s programs. He attended a community meeting held by these staff members in which they asked villagers if they wanted UVP to work here. He was enthusiastic to participate in the program because he realized that it would improve his livelihood, make community members healthier, and help the current community members to raise their children knowing the importance of home sanitation.

Mr. Kiti stated that UVP has made him a “people’s person”, since our community meetings connected him to other villagers and encouraged him to interact with others. He says that because UVP has helped him to improve his home sanitation, he will no longer be afraid or embarrassed to host functions at his compound. He realizes the importance of improved standard of living. For example, UVP programs have provided him with subsidized mosquito nets. After explaining how grateful he is that UVP has helped him improve his health, he recommended that UVP help the village improve access to safe water, increasing the number of boreholes and renovating the protected spring. The good news is that Bukakaire has two years left as
part of the Healthy Village Initiative, so it may be possible in the future! Mr. Kiti is “grateful to the governments of USA and Uganda for allowing this partnership targeting community empowerment”. He asked us not to forget about Bukakaire. 

We definitely will never forget!

Nabirere B: bringing men into family planning

Time has absolutely flown by! We’re beginning our last full week in the village this week. We’re all sad that our time here is wrapping up, but we’ve had such a productive few weeks of programming! We held most of our sensitizations in the last two weeks. Safe water, sanitation, malaria, and family planning – we’ve covered it all! We often begin our meetings with a drama, which is fun for us to plan and perform, as well as a more entertaining way to introduce the audience to the topics we are discussing. Then we have about a 30-minute presentation, focusing on how disease can be prevented through realistic behavior changes such as boiling water before drinking it and using mosquito nets every night when they go to sleep. Afterwards, we hold a question and answer session. We’ve been very impressed with how engaged our community is in what we have to say. They seem eager to apply the information we’ve presented and we hope through the rest of UVP’s three-year program in Nabirere B that we see significant improvement in sanitation facility coverage, malaria net coverage, family planning usage, and a significant reduction in preventable death and disease.
Presenting how to build standard sanitation facilities in one community meeting

Essential to all these programs are the members of the Village Health Team (VHTs). Elected by the community, these five individuals work with us to mobilize the community for our events and will be the ones continuing the public health work in the village when we leave. One of our most enthusiastic and active VHTs is Sulaina Mutesi. The original two VHTs in the village recommended her to be a part of the Village Health Team because she was already very active with promoting health in the village. During our time working with her, we’ve seen her enthusiasm in mobilization and condom distribution. She says she was excited to welcome UVP into the community because she knew she could mobilize well for the events and was passionate about the educational sessions we conducted. She was especially excited to receive tippy tap and plate stand supplies, which were provided to her as an incentive to be a role model of sanitation in the community.  Sulaina feels very recognized and important now with in the community because they have started to really respect her as a VHT and ask her to help them check their facilities. She now feels like a highly respected woman in the community and that being a VHT has changed her life for the better. She feels so proud to be a VHT for UVP and she is very happy to be doing what she is doing.
Sulaina at one of our events
 One of the most rewarding programs we’ve conducted so far has been our family planning sensitizations and outreaches. We engaged both men and women on the topic, but had to do so separately and with very different strategies because family planning is such a delicate topic. Many men are resistant to the idea because cultural concepts of masculinity encourage them to have many wives and many, many children. However, after having seven or eight children, many women become interested in obtaining family planning because they are content with the size of their family. However, the culture is pretty patriarchal, meaning the woman is not empowered to make that important of a decision. This leads to conflict – often the woman has to sneak behind the husband’s back to obtain family planning.

So, we decided to have a sensitization for the men on family planning, too. We talked to them about the concept of not having more children than one is capable of catering for economically, the health and economic benefits for mothers and children of spacing out children and having fewer of them, and the various methods they can utilize to do this. The men were extremely receptive to the information, and we’re hopeful that the seeds we planted combined with the work of our male VHTs will slowly change the culture to be more receptive towards family planning.

When we had the sensitization for women, we took more time to explain how each modern family planning method worked and how to use them. Afterwards, we provided birth control pills, shots, male and female condoms, and three or five year implants to the women who were interested in longer-term family planning. It was exciting for us to see their interest and excitement directly translate into action as they took concrete steps to begin a family planning method.
Team members from Nabirere B conducting a family planning sensitization
Although we’re very sad to leave Nabirere B, we’re excited that UVP programming will continue for the next three years! We can’t wait to see Nabirere B transform into a model community for sanitation and health.

Kitukiro: Jamilah shows hard work pays off

Time in the village is flying by and it’s hard to believe that we have been here in Kitukiro for 7 weeks. We are continuing to hold sensitizations and have been having a great turn out for each of our events. We have begun doing more creative, interactive events in order to keep the villagers engaged at the sensitizations. We have added a tippy tap raffle, a mosquito net raffle, and a few short dramas to our sensitizations and have received a positive response from the village. Our VHTs have continued to stay committed to the work we are doing, and we have confidence in the village of Kitukiro to continue to improve their own health and sanitation after we leave!

We recently interviewed a villager in Kitukiro named Jamilah about her experience with UVP. We selected Jamilah because she repeatedly took the initiative to attend all of our sensitizations and improve the sanitation of her home by constructing a plate stand and garbage pit. We asked Jamilah about what she had heard about UVP. She told us that she knew UVP was about improving cleanliness, helping to construct proper plate stands, and about mosquito nets. We then asked what had inspired her to come to UVP events and to take steps to improve her own household. She told us that she wanted to learn all of the things she didn’t know. During our time here, she has learned about boiling her drinking water, using the sun to kill germs on plates and utensils, and different family planning methods. She is more knowledgeable about family planning side effects, how often to wash a mosquito net, the importance of plate stands, and how long boiled water is safe to drink. We are encouraged by all that she has learned, and the steps she has taken to improve the sanitation and hygiene of her own home. We were so happy to hear that she has even educated neighbors about family planning and the importance of household sanitation facilities!        

We are thrilled to know that our work in Kitukiro has paid off. It is sometimes easy to get frustrated by language and cultural barriers, lack of resources, and the abundance of incorrect health beliefs. Speaking to people like Jamilah reminds us that the villagers are invested in UVPs efforts, and are benefiting from the time that we have spent here. We couldn’t ask to leave the village on a better note than that!

Our time here has been both challenging, and educational. We are all leaving Kitukiro more aware, rat-tolerant, appreciative, proud, and hopeful for the future. We are beyond grateful for our time and experiences here in Kitukiro, Uganda, and UVP will always hold a special place in our hearts.

It’s been a great summer, y’all!

Kitukiro Killer Whales

Friday, August 14, 2015

Nabirere A: a young family improves sanitation

Wotali is 21 and has lived in Nabirere A for 11 years. She married when she was 19 and she and her husband live close to the village mosque. They are farmers and she sells chapatti that her husband makes. Wotali was the first person to buy a “sanitation kit” from our team to construct a tippy tap and plate stand, the day after our community WASH sensitization.

How did you first hear about UVP?
Wotali: I had never heard about UVP until some of the team came to conduct a baseline survey at my house.

What UVP events have you attended?
Wotali: I attended the family planning and WASH sensitizations and went to the borehole clean-up day at the mosque.

Why did you attend these events?
Wotali: Curiosity, primarily. I wanted to see what these interns had to say.

What impact, if any, have UVP’s activities had in your life so far?
Wotali: I was inspired into action by each of the sensitizations. I had never heard of family planning until I attended the sensitization and afterwards I started on a family planning method. After I went to the WASH sensitization, I decided to buy the sensitization kit because I wanted my house and my family to have a plate stand and a tippy tap to improve our health. I will continue to attend UVP activities and hope to continue learning.

Bukaigo: interview with a VHT

Godfrey Nadomi is a member of the Village Health Team in Buvule (in Bukaigo, we work with Buvule, too). He is a history teacher in a secondary school. He was a resident of Businduka in Ruwuka district where he also served as a VHT before he moved to Buvule where he has lived for five years. He first heard about UVP from Obbo Titus, one of the UVP staff, who was coordinating the UVP programs at that time.

This is what he says about UVP: “The community members in Buvule are so appreciative of the work Uganda Village Project is doing in the village. Before UVP came into this village, sanitation and hygiene here were really poor but now people have changed their status and uplifted their health; latrines and plate stands have been constructed. There was also indiscriminate disposal of solid waste but due to this project, people have been health educated. Therefore the status of the sanitation and hygiene in Buvule has increased from 32% to 78.2%."

“Working with UVP has positively affected [Buvule] because I am enjoying my life as I have access to safe water which was not the case five years ago before. . . I have gained more knowledge from the UVP training on different health issues and this has enabled me to health educated my fellow community members on issues like malaria which has been a problem and how to prevent it, sanitation and hygiene, water treatment, family planning. Before people used to boycott the family planning program, but UVP has taught them easier sensitization procedures, hence more community members have gained interest in controlling the pregnancies and planning for their children.

“Selling water guard to the community members is a nice idea as people now know the importance of using it. Before people used to say that using water guard makes water taste bad, but now they have been educated on the importance of this method of water treatment. After the WASH team sensitized the Buvule community members on how to correctly use water guard, they have been coming to buy the water guard you left behind with the VHTs.”

Buwoira: Working with Timothy

We recently had the chance to interview a Buwoira Village Health Team (VHT) member, Timothy. Timothy's work as a VHT focuses on HIV. We are so grateful for all of his help this summer in Buwoira; we would not have been able to accomplish so much without his steady presence, punctuality, and passion for improving health in his home village.

Timothy was born in Buwoira and has spent his whole life here, and has worked with many different non-governmental organizations over the years. In addition to being a VHT, Timothy is an engineer in the electricity field, a farmer who raises cattle, as well as a husband and father. Timothy has been a VHT for over 20 years, so when Titus introduced him to UVP, he was happy to be trained on UVP programs.

Timothy has experience with HIV, sanitation, malaria, and family planning, so it made sense for him to continue that work with UVP. Also, UVP helps make villagers more aware of the presence and expertise of VHTs. The VHTs in Buwoira have struggled with villagers not respecting their role, and UVP has helped with that. Timothy said he is excited to continue his work after the interns have gone.

Being involved with UVP has shown him the importance of sanitation and hygiene. In the past, there was not clean water for all villagers, but the addition of a shallow well has improved access to clean water. There was also low latrine coverage, but UVP sensitizations have helped increase coverage and reduce open defecation. Though Timothy’s current focus is HIV, his favorite topic is sanitation and hygiene and he especially likes encouraging villagers to build sanitation facilities to reduce the incidence of jiggers in homes. His least favorite part of being a VHT is that people can’t always differentiate good from bad. He does not like feeling like he has to force people to do things that they should be doing for their own benefit.

Thanks for all the help, Timothy!

Wednesday, August 12, 2015

Kasambiika: a VHT with a passion for health

It has been a great summer for every member of the UVP WASH Team in Kasambiika; one that would not have been possible without the help of proactive members in the community. Between mobilizing for events and advocating for UVP’s cause, among other things, the VHTs and other local leaders have been especially valuable to our work. The 10 active VHTs in Kasambiika I & II consisted of motivated men and women, eager to help out our team in any way they could. Naigaga Robinah Kabaale, one of the original two VHTs in Kasambiika II, was one of the most active and valuable to UVP and our team throughout the last two months.

This picture of Naigaga Robinah Kabaale was taken after
our safe water chain sensitization at the Kasambiika II
Catholic Church on 23 July 2015.
Robinah is currently one of six Village Health Team (VHT) members in Kasambiika II, and is 52 years of age. She lives with her husband, Kabaale Edward, and her four children in Kasambiika II -- just down the road from a the Kasambiika Health Center. She is passionate about health and sanitation in her community and throughout Uganda and has always been eager to do work in a health-related field. She began her work in Primary Health Care (PHC) and slowly became one of Kasambiika’s medicine distributors, as well as the government net distributor for the community. In 2013, with the arrival of UVP in the village, the local leader was contacted to hold a meeting with the UVP staff to elect and initiate VHTs to aid in the organization’s work. Robinah was named one of the two VHTs for Kasambiika II, and is now a certified VHT, along with being certified in PHC and Drug Distribution.

She was drawn to the work and mission of UVP because it mirrored her passion for health and sanitation improvement in her village and surrounding areas. This made her very interested in being involved with the interns and staff, seeing UVP as a platform for her to continue working in a field she has come to love. She specifically mentioned Titus and Maureen as two figures in UVP’s staff that were pivotal in her increased presence in the local public’s health. Additionally, Robinah credits UVP for helping her learn a lot more in terms of health -- not just knowledge, but also practical skills she can share with fellow villagers. For example, her knowledge of tippy taps and personal hygiene has grown to the point where she has built household tippy taps for many other homes in Kasambiika. She feels confident in not only helping build, but educating on maintenance and proper usage of this common hand washing facility.

UVP has helped Robinah in meeting new friends and colleagues that share her interests in health, as well as network in health fields throughout the area. She attributes her adept ability to associate and connect with others, a skill we have all witnessed this summer, to her training and experience with UVP. We have all experienced Robinah’s passion, hospitality, and ability to mobilize others to help UVP. Robinah says that the summer interns she has worked with have all been great and she is thankful that they have come to her village to work - despite wanting them all to stay longer.

She has seen increased health in her village since UVP’s Kasambiikan beginnings in 2013, but still sees much more room for improvement in years to come. Despite the fact that UVP will finish the three-year Healthy Village program in Kasambiika next May, she hopes the organization will continue to help out in any way they can.

Robinah has been an integral part of this summer, always attending UVP and other health-related events, as well as her constant efforts to help mobilize for our sensitizations. She is certainly a role model for others! We are very reluctant to leave the village Kasambiika and Robinah, but our experience has not been taken for granted, and we all hope to maintain contact with Robinah and the other members of Kasambiika we have become so close with. We wish Robinah and the rest of Kasambiika all the best with their health and other endeavors.

Friday, August 7, 2015

Kitukiro: The Power of Data and VHTs

A big Jambo (hello) from Kitukiro! We are over half way done and are eager to keep our work rolling. We have completed baseline surveys and were able to survey 98 out of our 160 households. We are very happy we were able to reach so many households in just 8 days of surveying! We were able to analyze the data and pick out myths people had and also realize areas that need further education. We will be using that data to create our sensitizations. We think the data collected shows us a good representation of the education level in Kitukiro.

While we were surveying, we did a lot of mobilization for an upcoming outreach and held our HIV Day on July 21st. We had a team from St. Mary's join us and were able to have 128 people tested for HIV and 213 people tested for malaria. Many people were able to receive medication and get support. The people of Kitukiro were very happy with our services and we received very positive feedback from the village. We have not held other sensitizations yet and we hope that having a successful health day will help encourage more people to come to our future events. 

Another success for our team has been retraining our VHTs using our own curriculum. Each VHT is responsible for a certain health concern in the village, so it is of utmost importance that our VHT's are informed and help us dispel common misconceptions. Our VHTs were excited about the training. It is our hope that our VHTs are confident in their health knowledge by the time we leave so that they can continue to be valuable assets to the people of Kitukiro.

Also, both our fearless team leaders are ill with malaria causing our team to have to work harder and have better team work to have everything fall into place correctly. We are doing great with that and our team is working very well together!

We are looking forward to further VHT training and sensitizations on sanitation, family planning, and malaria. Lots to do in the next 3 weeks!!

Bukaigo: Community Sensitization

On July 9th we held our first community outreach session in Bukaigo. The focus of this sensitization was on clean water, personal hygiene, and sanitation. In an open forum we taught the community about the importance of the WHO recommended safe water chain, which includes maintaining a clean and sanitary water source, proper transport of water from the water source to the home, and correct treatment and storage of water once at home. We also taught about various common diseases caused by poor sanitation practices such as dysentery, hookworm, typhoid, cholera, and schistosomiasis. We focused on the causes of these diseases, their signs and symptoms, and how to prevent them from spreading. Later in the week we performed a needs assessment in two water scarce zones of the Buvule village. Now that the needs assessments are complete, UVP can assist the community in constructing new shallow wells to make access to clean water easier for community members living in these zones. As we were doing the needs assessment, we realized that because of the far distance to the nearest borehole, many people are drinking untreated water directly from the nearby swamp.

Although our first sensitization in Bukaigo was a success, our first community sensitization in Buvule we had very low attendance by community memebers. It was so disappointing since a lot of effort was put in preparing for it. However, this has helped us plan better for upcoming community outreaches since we learned that the venue we chose was not a good one and that we did not mobilize well enough. We have come up with a better community mobilization technique that will ensure that more members of the community turn up and venues for upcoming outreaches are being chosen carefully. Since learning from our failure in Buvule, our more recent sensitizations have had sufficient audiences.

This past week, we held a meeting with our Bukaigo and Buvule VHTs. We spent part of our time reviewing health information about WASH, malaria, and family planning. Since this is the last summer that these villages have UVP interns, it is especially important that they are well educated on these topics. After clarifying some amusing questions about family planning methods, we collected Most Significant Change Stories from our VHTs and took their photographs. They loved looking at their photographs afterwards! During the meeting, we also planned out our borehole cleanup day and brainstormed some ideas on how the VHTs could continue to promote health in coordination with the health center, including encouraging the health center to start selling WaterGuard and hosting a malaria testing or HIV testing day. Overall, the meeting was a great success and we all left feeling motivated to pursue our new ideas.

Tuesday, August 4, 2015

Kasambiika: Water Chain Sensitization


          Our first sensitization started with ideas from a lantern-lit brainstorming session: Tom would draft an introduction in Lusoga (always a crowd pleaser), our fearless team leaders, Gladys and Debbie, would explain our mission while the rest of us would present on the different components of the water chain. We spent the week perfecting our ricebag masterpieces (a term used very loosely) which illustrated the different stages of the Safe Water Chain: Collection, Transportation, Treatment and Storage.
            With the help of Swaga, the best VHT in the game, we spent all of Monday placing event posters around Kasambiika. Thanks to the hours of mobilization our other VHTs put in, people seemed excited. The night before our sensitization, we stumbled through our translation rehearsal and smoothed out the miscommunications. By our last rehearsal on Tuesday morning, Team Kasambiika was more than ready for our Water Chain sensitization.
           Using information from our surveys from the previous weeks, our main goal was to emphasize maintaining existing water sources, treating drinking water, and keeping transportation/storage containers clean. The only thing we forgot to account for was “Africa Time.” We spent two hours waiting for a crowd to accumulate while enjoying everyone’s favorite game: Twenty Questions. Eventually, there we were, standing in front of 20 women, green UVP shirts glowing, ready to educate on all things water. It was great. Some highlights include Tom’s Lusogan introduction, Sarah and Debbie’s clean water demonstration, and Gladys reminding everyone that “water is your friend.”
            We later found out that our sensitization’s attendance was low because of a death in the community and that the funeral the next day would affect tomorrow’s sensitization as well. Our sensitization for Kasambiika II was rescheduled for the following week. This was unexpected, but nothing we couldn't handle. We paid our respects at the funeral ceremony the next day, which turned out to be more of a celebration of life. People appreciated that we came and we were extremely grateful to have been invited. 

         Despite a couple hiccups here and there, Team Kasambiika held a successful sensitization 
with a positive response, surely a sign of more good things to come. 

Monday, August 3, 2015

Bukakaire: A busy three weeks

What a busy three weeks we’ve had here in Bukakaire! After finally conquering our bedbug fiasco (“knock on wood”), we finally got the hang of the daily rhythm of village life and our work. Though baselines started off slowly, we quickly picked up speed; we have now surveyed almost three quarters of the households in our village! During our surveys, we also discovered three women with obstetric fistula, whom we will make sure to steer to the appropriate services and our sensitization on obstetric fistula. The villagers have been very welcoming when we visit their homes and have been enthusiastic about responding to our survey. We’ve also collected many spontaneous gifts of groundnuts (a.k.a. peanuts) and jackfruit in the process.

Overall, we’ve found that there is a general lack of sanitation facilities (tippy taps, plate stands, proper latrine structures, garbage pits) and knowledge of and access to family planning/obstetric fistula services. In the next week we will be starting a house-to-house sanitation campaign to tackle these issues. During this campaign we will be helping people build sanitation facilities using subsidized materials. We will also be holding community sensitizations on safe water, sanitation, hygiene, family planning, and obstetric fistula. We are very excited to begin because we feel that we can make a big impact in the community. This week we gave our VHTs a tour of the sanitation facilities we built at our house to provide some visual examples. Their excitement is definitely a good first step!

We also held Water, Sanitation, and Hygiene Sensitizations (WASH) at two primary schools in the community. At first we were overwhelmed by the 500 children sitting in front of us and gathering by the tippy tap. However, at the end of the day, we managed to maintain relative order and were pleasantly surprised by the amount of knowledge they had about WASH. After we installed a tippy tap at the school, a huge crowd of kids formed a line to try to wash their hands with it. We also taught them a handwashing song in the tune of Frère Jacques, and now we are constantly greeted with that song when kids run into us in the community.

We also had our HIV Outreach Day this week. We were presented with a challenge when we discovered that another organization was also hosting a medical camp on the same day and place. Communication with that organization proved to be very difficult; after many efforts we still were still unsure, even on the morning of the event, about what services they would provide, how they would provide them, and how we would work with them throughout the day.

However, we’ve gotten very good at last minute improvisation and flexibility. In the end, everything seemed to click together nicely. We managed to test around 160 people for HIV and 350 people for malaria! We wish we could have done more, because so many people turned up, but, unfortunately, supplies were limited. In the beginning, we were also worried that the medical camp would attract people from other villages and use up our limited supplies. To help prevent this from happening, we and our VHTs worked extra hard at mobilization. We must have done a great job because the people who showed up from Bukakaire far surpassed the people from other villages!

Despite many busy days, we’ve also managed to squeeze in some fun! One weekend our entire team went white water rafting on the River Nile. Anna got thrown into the rapids 3 times, and everyone, except Diane and the Ugandans, got severe sunburns on their thighs. In addition, Said and Joseph had their first cheeseburger. Said said he “had a good time with the cheeseburger.” On Said’s birthday, we also had a bonfire where we roasted vegetables and squishy creamy bright pink hotdogs…”Yum!” Also, we milked a cow! Johnny laughed hysterically the entire time, and the man who owned the cow was very amused with our reactions.

That’s it for now! Tune in later! “Kalee! Mmm…”

Bukakaire Team – Anna, Brittani, Diane, Johnny, Joseph, Said