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!

Friday, August 12, 2016

Intern Dispatch: Bufutula B

Permagardening in Bufutula B, by Max, Jack, Isaac, Rose, Bailey, and Allison

As we rapidly approach the end of our stay here in Bufutula B, the days have only seemed to grow shorter and shorter. Faced with this impending departure, we have only become more motivated to make the most of our remaining time here.

With this mindset, we began to tackle the much-recognized problem of malnutrition within the village. To do this, we enlisted the help of a local Peace Corps volunteer, Becky White, who works on Agribusiness and sustainable farming. Like most of our experiences here in Bufutula B, contacting Becky was a process longer than expected. It took several weeks to reach her, but once we did things began to move quickly. For two days she traveled out to Bufutula B to teach a small and dedicated group of community members the ins and outs of a sustainable farming technique called Permagardening. 

Uganda, known as the Pearl of Africa, has historically been known for its incredibly fertile soil. The Eastern Region we occupy is no exception. The surrounding farmland is blessed with nutrient-rich earth that sustains many different agricultural products. Despite these circumstances, many villagers lack key nutrients in their diets, leading to diseases associated with malnutrition, especially amongst children. Part of what causes this is the distance from the garden to the home and the belief that planting one crop is more economically sustainable when it comes to selling. 

Permagardening seeks to break down some of these barriers by providing a solution that is cheap, accessible, and sustainable. Essentially, it is a small 4 m X 4 m, climate-proof garden, placed as close as possible to the kitchen, that can provide an entire family with fruits and vegetables all utilizing local, free materials. It doesn’t require continuous digging every season, and requires very little management, making it an easy solution that doesn’t sacrifice the land the villagers use to make cash crops. In addition, the method of digging renders the most stubborn earth fertile by treating the dirt with several key elements that nourish it.

The first day, Zaina, one of the members of our Village Health Team (VHT), let us interns, Becky, and a few other villagers into her home to lay the groundwork for the construction of a Permagarden. True to form, she was quiet yet determined: the first one with a hoe in her hand ready to dig, having already prepared many of the requisite materials prior to our coming. The rest of the VHTs followed her lead: David digging the water catchment areas, Inid helping prepare the fertilizer. Together, with the rest of the villagers we dug the small plot of land and finished one berm before the day’s end. Our clothes were sufficiently dirtied, but our hopes raised at the fervor with which the villagers took to this solution to malnutrition. 

The second day began in similar fashion. By then we knew the drill and began to work to dig the rest of the planting areas. By the time we had finished we were as dirty as the previous day, but before us lay a beautiful new garden ready for planting; the VHTs experienced enough to teach others this valuable gardening technique. 

As we look back at what we’ve done here in this village, what will happen to the villagers once we leave, and what we will leave behind, we can’t help but think of the garden at Zaina’s house and its humble attempt at beginning to combat malnutrition. It seems, in a way, a good representation of all our work here. The village needs more than just this, but the garden marks a first step at empowering our VHT’s to take ownership of their and their fellow villagers’ health; and we know that UVP’s work in Bufutula B for the next three years will build on what we’ve started. We have deeply enjoyed our time here and cannot express the level of respect we have for this community and the individuals with whom we have worked, lived, and learned. We hope that when it comes time to harvest, they will remember us as vividly as we will remember them.

Intern Dispatch: M&E, Purposes & Experiences

From Nabirere A & B (aka The Nab Nyabs), by Fiona, Lou, Anna, Dorothy, and Maria

As the only Monitoring and Evaluation (M&E) team working with UVP this year, it’s safe to say that we believe in the power of data! It has been a busy and fulfilling summer spent in the field conducting follow-up surveys and collecting important health data about the two communities that we are working in. Being welcomed into the homes of community members has not only allowed us to build strong relationships with them but also to gather essential information about the general health status of both Nabirere A and Nabirere B villages.

The team monitoring and evaluating some mangoes 
To add some context to our work, let’s start with a quick background of UVP’s implementation model. UVP’s programs are undertaken over a three-year period. Simply put, in the first year, Launch Teams have the hefty task of introducing all health initiatives associated with the Healthy Villages Program. In the second year it is our job, as the Monitoring and Evaluation Team, to follow this up by collecting and analyzing data in order to gain perspective on where things lie from the previous year’s activities.

Casual conversations have helped us to uncover gaps in knowledge levels and to learn what the community’s main health priorities are, especially since it’s not always possible to capture this valuable information from the surveys alone. So, while the numbers often reign supreme, in reality both the quantitative and qualitative data that we have collected have been invaluable to our understanding of whether UVP’s interventions are making a genuinely positive contribution to improving people’s health…which, after all, is why we are here! Having collected all of our data, we were in a great place to design and plan effective health education sensitizations that addressed the central health issues that persisted and to consolidate health knowledge and literacy amongst the villagers.

So, while to some people M&E may not always sound quite as fun or sexy as launching a whole new program into a village (even though it totally is!),  we should remember that this is a space that a lot of very important work is done. While implementing innovative and fresh programs is incredibly important (not to mention a tough job), an equal amount of the hard work is done when gaps need to be addressed, failures to be admitted and solutions to be made. After all, sustainable impact comes from continually assessing and refining what can be done better as well as by putting these systems into place while we are still here so that they will last long after we have left.

On a final note, going through the villages and collecting follow-up data is a whole bunch of fun! We have always felt so welcome and at home as we ‘jambo’ our way through the village. And if educating the community that you now call home about important health issues wasn’t incentive enough…there were also all those peanuts, mangoes, jackfruit and avocados that were gifted to us during our surveys that made the end of a long day sitting on our back step together just that much sweeter…literally!

Monday, August 1, 2016

Intern Dispatch: Nabirere

A day in the life of the UVP interns in Nabirere. by Louise, Anna, Fiona, Dorothy, and Maria

Interns meet with women during an HIV outreach
As the sun rises and the roosters start to crow, the 6 of us interns in Nabirere begin to emerge from our mosquito net covered beds, and before we know it, the morning chores have begun. The floor is being swept and mopped, the compound cleaned, the dishes are being washed, the latrine smoked with dry banana leaves, and water is being fetched from the shallow well down the road. Once finished, we make our own breakfast with the fresh milk that is brought daily straight from the cow. We are then ready to start the day’s work for Uganda Village Project.

Beginning with a short planning session for the day, we kick off our weekly Global Health Leadership Curriculum meeting. Meanwhile hearing a bunch of little kids voices outside calling “HELLO” or “JAMBO” to us, and not stopping until they receive some reply. After we eat the delicious local Ugandan food for lunch, consisting of many starches and vegetables, we are ready to move onto sensitization planning. Focusing on our first malaria sensitization, we discussed the community needs, placing more emphasis on the basics of malaria. This was to ensure that there is effective communication about the causes and treatment, tucking in mosquito bed nets, going to the health centre when symptoms are observed, and the truth about myths surrounding malaria. After previous weeks work of data collection within the 121 community households, and conducting SWOT analyses, we were able to design an engaging education session, which also incorporated a Q&A sessions and a funny skit at the end.

Furthermore, with the help of the Village Health Team of Nabirere A, we were able to begin mobilizing for the sensitization session 2 days prior by placing posters around the community and bike-riding to visit different households. After all this preparation, it came time to set off down the dirt road and through the rows of growing fruits and vegetables to the meeting place. We were all prepared for a waiting crowd.

Nevertheless, once we got there we encountered the challenge of the village clock. This meant we spent 2 hours waiting for our audience to arrive, which definitely exercised our patience and flexibility. Once the sensitization finally got started, our morale was high and we were ready for anything. We continuously created rapport and engaged community members by answering all questions that arose, and welcomed all late comers. At conclusion of our session, we sold numerous long lasting insecticide treated mosquito nets and left the community space feeling rewarded and empowered as a team.

Over dinner, when night fall came, we debriefed about our day around the lanterns, highlighting all the strengths and weaknesses of the process. Throughout the entire day we worked productively as a culturally diverse team, all bringing our different skills to the table. After we took our malaria prophylaxis and made a group trip to the latrine through star lit sky, we tucked ourselves back into our mosquito nets to conclude the day.

Intern Dispatch: Bufutula B

The Reframe Game.
by Max, Jack, Rose, Isaac, Bailey, and Allison
Bailey, Rose, and neighbor children
Before we made it to Bufutula B, while we were still relishing the novelty of Iganga in the relative haven of Nekoli’s Guest House, there was a saying that Rachel, our GHC Fellow, indoctrinated into our collective noggin. It became a mantra of ours, a way of keeping our wits in the most unexpected of circumstances and keeping heads high in the lowest of circumstances. The mantra was this: POSITIVITY, BRIGHT SPOTS, REFRAMING. By reframing, we mean reshaping the way we perceive the experience to notice what we have learned, shared, or gained from an otherwise disappointing moment. And if there is one thing Uganda and our wonderful village, Bufutula B, has taught us, it’s the value of this particular skill.
The first week we were welcomed into the village, we had our first slough of reframing moments. Everyone was extremely welcoming and kind, and we (the Internationals of our team) struggled to maintain propriety and greet in passible Lusoga. There were lots of laughs all around, and while there were many tongue-tied trials, we also managed to convince most people we were a friendly bunch and not afraid to laugh at ourselves.
The next week, we took our REFRAMING lessons a bit further. On Monday, one of our team leaders, Jack, tackled doing laundry for the first time in the village. Laundry here is no joke; it takes skill, patience, and a few buckets full of water (sometimes even a trip to the bore hole for more!). Jack tackles the task with the same dedication as he applies everywhere, with our other team leader, Max, looking on to advise as necessary. The clothes, two pairs of pants, are cleaned and triumphantly hung on the line outside the front of our house to dry -- a success all around for the Bufutula B team.
We have a wonderful home, situated across the street from Naisanga Primary School (P1-P7) and at the edge of the village trading center. There are always plenty of people coming and going, giving us plenty of practice at the whole greeting thing, and providing loads of entertainment, welcoming, and small crowds of children. That night in the village, there was something of a celebration, as some members of the community identified with a political party that had won a victory in a high profile court case. There were drums, yes, and even some drinking. We hunkered down in our common room, exhausted from a day well spent, and relishing the delicious food made for us by our sweet and sassy cook, Sarah. The pants, of course, were still out on the line in the hopes that the lingering waves of heat would wrestle the last bit of dampness from their folds. From the open doors of our common room in the darkening dusk, we could barely see the laundry line in the front, and we soon forgot about the pants. Big mistake.
Between the hours of 8 and 9 pm the pants went missing. Jack gracefully accepted this eventuality, even though it meant he was now in possession of only one pair of pants. His only inquiries as to their whereabouts were directed to us and to Sarah, the cook. And, because ours is a good village that looks after its visitors, it was only an hour later that the Chairman of the village called us, and our neighbors began expressing concerns. Before long, there was a criminal investigation on the Case of the Missing Pants, and our first village meeting was slightly derailed at the end by villagers expressing their intent to find the missing pants.
It would be easy to discuss how the tale of the Pants altered what we planned for our first week in the village. But, in truth, we agree as a team that the Pants Saga has helped us far more than it hurt us (except for perhaps Jack, poor pants-less lad). The reality is our village rallied behind us rapidly after the code of hospitality to visitors had been breached. We received far more offerings of duma (corn) and mangos than were necessary, and people came to our meetings just to apologize to us personally. Talk about a good mobilization technique!
Jack eventually found a new pair of pants, and the Pants Saga found a satisfying conclusion for the villagers. But this story isn’t about the pants. Not really. The truth was we learned how to work through the distraction of a village scandal. We learned more about the culture faster because of our rapid exposure. We worked to optimize the publicity as mobilization. And we ate loads of duma. That’s reframing.  
We’ve been here for 5 weeks now, or somewhere thereabouts. And we’ve certainly learned many skills since that first week. But the most used skill has to be Rachel’s omnipresent “REFRAMING”. From a teammate finishing our HIV sensitization while having malaria, rained out sensitizations, and even our cook’s disappearance due to malaria, we’ve kept rolling and reframing.

Intern Dispatch: Bufutula A

Great Expectations. 
   by Debbie, Jake, Kennedy, Bridget, Kirsi

There are a lot of things that we (mostly I) didn’t expect upon arriving in Bufutula A. Most are mundane: I didn’t expect the rooster that lives in our neighborhood to crow at literally any hour of the day (I thought they were trained?); to my surprise, I love wearing the maternity skirts that my grandmother bought me to wear in village, despite the fact that they are outrageous colors, clashing with every shirt I attempt to put on to make a cohesive outfit; the latrine is terrifying at night – many of us (again, mostly I) struggled to go to the bathroom between the hours of 7 p.m. and 6 a.m. for the first solid week. (This fear has subsided in most team members I am happy to report.)

Members of the Bufutula A community.
One unexpected thing, however, has been essential to our work here in the village and our hopes for sustainable change: everyone in Bufutula A is so excited to have us here, especially our amazing Village Health Team (VHT). Their enthusiastic welcome and support throughout our weeks here has been the most unexpected (and freaking amazing) thing we have encountered during our time here.

The first member of the VHT we met as a team was Hadija (the VHT specializing in the Family Planning and Obstetric Fistula areas of the Healthy Villages Initiative). We met her so informally I didn’t realize she was one of the people we would be working so closely with during the next eight weeks. She approached us while we unloaded all of the things we would need to live in the village for the next eight weeks. I was hot and sweaty – I’d only been in Uganda for three days. She approached each of us and gave us an extended hug and greeting, which none of us besides Kennedy and Debbie (Lusoga speakers) could understand. She was all dressed up - for what, I still don’t know. This woman could have been (should have been, really) a model. I almost didn’t recognize her the next day when she came back in her work skirt to help us dig our compost pit, carrying two hoes and wearing a determined look. We would not have been able to dig it without her – she was a machine, making the work look absolutely effortless. When I hopped down in the pit to continue the work she had started, I must have looked like a child trying to get the hang of using utensils for the first time. Hadija was patient, directing me when necessary, jumping back in and helping when directions just weren’t cutting it. My overall sweatiness and exhausted expression and posture after this project perfectly contrasted hers. She stood at the edge of the freshly dug pit, looking regal, not a single speck of dirt on her skirt. My green-gray-pink-purple striped maternity skirt was definitely going to need a wash. Over the weeks I have seen her hardworking spirit in everything she has done – during baseline surveys, in meetings, raising her children – all the while maintaining enough energy to express her words in large arm and hand motions. She’s a central community member, and is respected by people in the village (I being among them), but she has certain things she is uncertain about. She only shows one side of her teeth while she smiles, and I get the feeling that she is thinking a lot more than she says behind her eyes.

The next VHT we met was Faziri. He’s the only male in the group, and also the oldest, his shoulders bowed with years of hard work, hair thinning in a way that makes it seem like he is bald. His wisdom shows in the cadence of his speech. He talks slowly and steadily, listening with kind and gentle eyes that seem to twinkle all the time. The first thing we noticed about him was his memory and attention to detail. He can (and frequently does) recall and repeat entire conversations that occurred while someone was absent or not paying attention, even if the conversation was a half an hour long. Where Hadija has an energy for life, Faziri has an energy for health. During our first meeting he told us, “Oh, I wish I wasn’t so unfortunate as to live in Bufutula A,” while informing us of all of the health problems the villagers encountered. I didn’t believe him for one second – his is so crazy passionate about his village, it wouldn’t be off the mark to say that he considers himself the physical embodiment of Bufutula A. His thoughts about village health, his plans for the future, and his commitment to and pride in his work have made him the well-respected village man to the community and an absolutely invaluable VHT.

The specialist in the HIV area of UVP’s programming is a woman named Brenda. Her jovial and carefree demeanor belies her quiet power as a strategist and mobilizer who can adeptly juggle demands from all sides. This became clear to us on our HIV Day last Tuesday. Brenda was the glue that held the event together and kept everyone organized and energized—she helped cook lunch, directed people to seats, directed our team to the wonderful lunch she made, and pushed mosquito nets on every person that milled around the testing area waiting for results, all the while being 6+ months pregnant. The laid-back, calm woman who always keeps us laughing during planning meetings disappeared for the day as Brenda transformed into our expert in all things HIV. It’s clear that her gift for setting people at ease and making them feel like a part of her personal community is an indispensable asset to the work of the VHT, and her joy will continue to be a motivating force for many in the months to come.

Last, but most certainly not least, we have Betty, our head VHT, and quite honestly our BeyoncĂ©. The first time we saw her, she was biking as fast as I’ve ever seen anyone bike on our dirt paths in a beautifully colored satin dress. I had no idea where she was going, who she was, or why everyone got so excited to see this impeccably dressed stranger blazing by us. When she approached us from the direction she had just raced off to dressed in a VHT shirt, I understood. As the head of the VHT, she is decisive and outspoken. As a mother and a village member, she is also a leader – all of her children went through school, her home is amazingly hygienic, and she can “show up late to a party long after food is done and a plate will be waiting for her.” (This fact particularly impressed Debbie, our Ugandan team leader.) When she listens, her brow furrows just the tiniest bit to indicate respectful concentration. This same brow furrow occurs when she speaks, except instead of indication concentration, it tells the gravity of her words even though I have no idea what she is saying most of the time. This expression is the secret to her leadership and gravitas. It makes everyone, even those not VHT members, jump to action and do whatever she is saying.

HIV Day activities in Bufutula A.
Last Tuesday, each one of these amazing individuals worked for so hard and so long to make our HIV Day a success. There had been some bumps along the way – the drama group scheduled showed up late due to a truck breakdown, pushing back lunch and throwing the entire day’s schedule into chaos. At the end of the day when the drama group brought out their drums for one last song, every single one of them got on the dance floor and shook it like no one was watching – Hadija forgot to be self-conscious about the other half of her teeth and smiled a full smile; Faziri looked 15 years younger; Betty lost her iconic brow furrow and allowed herself to be sucked into the beat; and Brenda, pregnant and all, completely stole the show with her moves. I stood on the outside of the circle, partly because my dancing might be generously considered sub-par, but mostly because I wanted to capture the moment of the dance circle. I felt so blessed to be watching them. That day we tested 180 people for HIV and Malaria, and it never would have happened if it wasn’t for the four wonderful people dancing like there was no tomorrow. Every day, but especially in that moment, our VHT inspire me to work harder, make more of an effort to be an agent of change like they are. If I become half of the pioneer that they are, I will feel as though I have succeeded.