Tuesday, September 6, 2016

Uganda's First Ever National Fistula Conference

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

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

Monday, September 5, 2016

Intern Dispatch: Mwendanfuko

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

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

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

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

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

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

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

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

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