Working Towards Social Justice

By: Julius Kirya, Global Health Corps Fellow

In the communities where we reside, often times we encounter injustices, but how do we react? Are we bystanders or do we take action? Fighting for social justice is does not require wealth, power, or political capacity. Those without it can still mobilize a community into cleaning a water source, or providing sensitization campaigns urging households to build sanitation facilities and safely dispose waste.

A newly constructed shallow well by UVP        

Community members cleaning a well

Martin Luther King asked us to look closely and honestly reflect about our motives for acting – is it a common desire for recognition, to be important, to achieve a distinction? We should ask ourselves how we can act to leave a legacy for the future generation to carry on.

A team of UVP interns educating rural communities about sanitation and hygiene in a model home.

You don’t need a college degree to serve, you don’t have to know the legacy of the most prominent freedom fighters to serve, nor do you need to know theories and principles discovered by the best scientists to serve. All you need is your belief, sacrifice, a heart full of care, a soul full of love and you can help make the world a little more just. The world is looking for you men and women who serve others with love, honesty and in justice without question! Let’s take moment to reflect as we remember the legend in the history of social justice, Dr. Martin Luther King.

Public Service

by: Orrin Tiberi, Global Health Corps fellow

Life, for many of us, is a series of comfortable experiences.  We roll out of bed in the morning to shower with water that comes at our command, and use a coffee machine that can make the exact blend of coconut and mocha that we desire.  Throughout the day we face few opportunities to step out of our comfortable bubbles, and even fewer that compel us to challenge the status quo.  Sliding from one comfortable and familiar scene to the next, it is often hard for us to understand the struggles and trials that many of our fellow humans undergo every day.  Public service is a way to challenge those bubbles of comfort, and ultimately find a greater sense of what it means to be part of your community, your country, and your world.

The United States is fast approaching a day of service honoring Dr. Martin Luther King Jr., who was a civil rights activist and public service advocate. He once said, "Life's most persistent and urgent question is: 'What are you doing for others?'”  As part of Global Health Corps, Julius and I have committed a year working to push for health equity and social justice, two tenets ingrained in Uganda Village Project’s mission and goals.  By providing health services and information to the populations in rural Iganga that are least likely to have received them, UVP is able to significantly impact the lives of the community members.  This process has impacted Julius and me as well.

At a well cleanup in Kasambika 2

During the past six months at UVP, we have been confronted by issues outside of our experience and understanding, and consequently have grown as both public health practitioners and as people. When we first began our work, I was shocked at how rural some of the villages we work in are.  My preconceived notions of rural Africa were swept out by the reality we were confronted with.  Reading about malnutrition and child mortality is never the same as seeing the child, nor hearing the mourning of the community.  Our service will stay with us for the rest of our lives, and inform future decisions and actions we make in our profession. Though our year of service is not something everyone can commit to, it is still very feasible for anyone to get involved in meaningful and impactful public service.

Public service in the United States can be as easy as calling the local church, soup kitchen, or park in your neighborhood to ask about service opportunities.  If they don’t have one, they should be able to refer you to an opportunity nearby.  By going outside your bubble of comfort you may learn something new about your local area and yourself.  Take the initiative this coming holiday to give back a little to the community where you live and work.   

For those of you interested in coming to Uganda, the applications for Uganda Village Project Summer 2015 Internship are up.  It is a great chance to learn about a different culture and support great health programming that is happening here.

At a malaria training in Kasambika 1

If you want to see more of the day to day life in Iganga, please follow me on Twitter @otiber or on Instagram @ofteted. Any questions or comments you may have can be directed to my email orrin@ugandavillageproject.org.

It's been a great year in 2014!

Early in December, all of the UVP staff got together at our office in Iganga to reflect on the past year. The takeaway? Things have gone really well in 2014 – but there’s still lots more work to do for 2015. 

One of the most encouraging things was seeing the successes dwarf the challenges we listed. Staff talked about the great reputation that UVP has with the local government and in the villages. We have strong partnerships with government, schools, and NGOs: the district has started saving us HIV testing kits from their procurement cycles so we can test more people, health center nurses are collaborating to use our outreaches as opportunities to reach community members with other health messages, and we’ve expanded our reach on family planning thanks to partnerships with national NGOs like Marie Stopes.  We’ve loved watching entire families come test for HIV, every member of households learn how to correctly hang mosquito nets, and reaching exponentially larger numbers of women with fistula education through the Fistula Ambassadors program.

We hope to build on these successes in 2015, and address some of the things that make UVP’s work more difficult. These include some Village Health Teams that are less active than others, ensuring that men understand the need for family planning and support our work, and ensuring that all village leaders have sanitation facilities that can be used as examples for the rest of the community.

Working in the rural areas of Iganga has its challenges. Sometimes we go a full day without internet because power is out for the whole town. Staff members travel on rough roads to reach our rural villages, often working long hours to accommodate village farming schedules. It would be easy to get caught up in the things that make work difficult. It was exactly the opposite as we sat and reflected on what’s happened in 2014. Our review of 2014 showed that great things have been happening in Iganga over this past year.

After the meeting, staff members pooled funds to celebrate the year in true Ugandan style: with lots of matooke, meat, soda, and dancing. We invited all the family members, too, and they sat and listened while we gave each staff member a special message of thanks for their work throughout the year, and encouragement for what’s sure to be a great 2015!

Common Goal: Uncommon Roles

By: Orrin Tiberi, one of UVP's two Global Health Corps Fellows

When Global Health Corps (GHC) started the Common Goal, Uncommon Role campaign just in time for the 5th anniversary of GHC in November, I must admit I was a little confused. The Common Goal part of the equation was a simple one for me, and a belief that I hold deeply. Health access and social justice are two of the main reasons that I am here working at the Uganda Village Project (UVP), and are among the guiding principles of Global Health Corps. The staff here also holds these values in Iganga, and I see them act out their belief every day we are together. We recently had a mini staff retreat where each program was examined for both successes and challenges.

Julius and I, still newcomers in many aspects, were amazed to see the depth of understanding by the program managers of the individual people and politics that affected them. It was clear from their statements and discussions that the staff here is 100% invested in their projects and intimately knowledgeable of every aspect of the villages. My personal success was the ethical approval we received for the survey evaluation project that we will carry out in early 2015, as well as being almost done with many of the goals and objectives for each organizational area. Happily (and not surprisingly), the list of successes was longer than the challenges, a tribute to both the management and staff.

Uncommon Roles threw me for a loop. I asked myself what about monitoring and evaluation was uncommon? I didn’t see how my position at UVP fit into this mantra. I discussed this with the other GHC fellows that are also in M&E and started to understand how uncommon my presence here really was.  Many organizations, especially ones that focus on a single country or area, do not have the extra capacity or funding to have an M&E staff member. UVP fits this description well, and despite the fact that there has been a focus on M&E in the past few years, there has never been a person solely focused on that area. Many of the initiatives and ideas that started off strong within the office here in Iganga or the organizational board in the states slowly tapered off as time went on.  Understandably so, as everyone involved in the process has a job outside of monitoring and evaluation. By working here full time on M&E, Julius and I are supporting UVP in a way that would never have been possible without Global Health Corps. The work that Julius and I have done, and are doing, will impact how UVP works for years.

 Global Health is an expansive field, with the need for professionals from almost every background and with every interest. For those of you attracted to global health, applications are open for the next class of Global Health Corps fellows. You may not get as amazing as an organization as Julius and I (UVP UVP UVP!!!), but with over 70 placements in 5 countries you are sure to find something interesting.

Article 25: Global Day of Action

By Orrin Tiberi, Global Health Corps Fellow

Though not a holiday anywhere, October 25 has been enshrined by the United Nations as the Article 25 Global Day of Action to promote health as a human right.  More than 65 countries celebrated with rallies, marches, health promotion, and advocacy.  Julius and I were lucky enough to help coordinate and participate in an Article 25 event on Kaaza and Serinyabi Islands in Lake Victoria both to gather signatures requesting better health access and to provide basic health services on the islands. Uganda Development and Health Associates, a public health NGO based in Iganga that provides periodic health services on the islands, orchestrated the event and funded much of our time there.

Article 25 is just one of the 30 articles that comes to us from the United Nations Declaration of Human Rights.  It states:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

The basis of the Day of Action is to confront the inequities and injustices in global health and foster the movement for health equity that has been gathering momentum around the globe. Because many of the issues with health are man-made, there should also be human-centered solutions to the same problems.  For more information on the aims of their program you can check out their website here.

Uganda Village Project was able to donate two boxes of condoms to the events on Kaaza and Serinyabi islands, providing access to condoms for more than 600 individuals.  This is extremely important in an area where there is very little health access and the nearest clinic is a forty-five minute boat ride away - a ride that can cost up to 40,000 shillings for emergency trips.  For fisher folk who live on the islands that cost is prohibitively expensive, and because of the physical and financial barriers to health services the fishing islands of Lake Victoria have some of the highest rates of maternal mortality in Uganda.  Being so isolated from services, they also have very high rates of HIV, TB, and other preventable diseases that regular check-ups can diagnosis and provide treatment for. 

Regular access to antiretroviral therapy (ART) is also a problem for many of the islanders that have HIV.  The district officials come once a month to distribute the therapy, but the dates of each visit is not a consistent 30 days, and they only hand out a months supply each time.  This leaves all HIV+ individuals missing 5 to 10 days of their treatment each month, which may have profound impacts on the future of HIV treatment on the islands.  With each cycle of non-adherence the islanders are allowing the HIV in their body to adapt to the current regime they are given and become drug-resistant.  If the HIV is then spread to a new individual it means that they will have to be on a completely different set of ARTs for the desired effects, which usually means a more costly treatment.  By building a health center in a more proximal location it would allow the medications to arrive on a consistent basis, and keep a budding problem from emerging any further.

Though a collaboration of Uganda Development and Health Associates, Mercy Clinic, Uganda Village Project and Global Health Corps (the organization that is sponsoring both Julius and I), we were able to test and counsel more than 350 people for HIV, provide ANC for expectant mothers, give immunizations to newborns, and have a great time getting to know the community and their lives.  In addition to the health services provided, we gathered more than 1,600 signatures to request a health center be built in closer proximity to the island communities.  Our days on the island were but a jumpstart to the momentum that needs to be built to motivate the local government to construct and fund a health center.  It will not be an easy process, as the government of Uganda is already underfunded and over stretched, but it can be done.  With the passionate voices and stories of all the amazing individuals we came to know in our short time on the islands, and in the Uganda in general, I have high hopes of a future for Uganda that includes the voices of such populations in determining healthcare choices and access.

Creating High-quality Goals and Objectives

Written by: Julius Kirya, Global Health Corps Fellow 2014-2015

Many projects’ successes are measured based on the degree to which the different deliverables meet the set goals and objectives. Exaggerating while setting organization/ project goals is irrational because it results in setting ambiguous targets which in turn leads to a perceived failure of programs/projects. Orrin and I have spent the past one and a half months focusing and brainstorming how to revise Uganda Village Project (UVP)’s goals and objectives for the next 5 years, as we measure their impact of programs that have been under implementation since 2009.

Communication is key when designing program objectives. We needed to involve many stakeholders before and during the entire process of setting objectives. These include funders, program coordinators, supervisors, implementers, politicians, partners, and beneficiaries. Without their immense support, many programs are bound to fail. We’ve worked extremely hard over the past month and half, moving to the district headquarters for inquiries, writing to funders, getting taskforce feedback, meeting with program supervisors, getting verbal consultations from program coordinators and reading beneficiary reports to craft our objectives.

In any monitoring and evaluation effort (see Orrin’s post for more information about monitoring and evaluation) an M&E plan needs to be drafted prior to implementation. The most effective tool in m & e is the logical framework, commonly known as the “log frame”. This matrix displays by row the major stages in the projects life, emanating from resources, activities, outputs, outcomes and impacts all in pursuit to measure the program, goals and objectives; the column addresses objectively verifiable indicators, means of verification, assumptions/risks for the row entries.

This framework is key in assessing loopholes in the set objectives and goals, because it displays the entire project at a glance on a page. We use it to make sure that all objectives can be objectively measured and verified. For a couple of weeks now, Orrin and I have tirelessly been working on the log frames for UVP’s various programs. We thank the Uganda Village Project staff and Board members for their continued support to ensure that we successfully play our role.

Research in the Morning, Research in the Evening, Research at Supper Time!

By Orrin Tiberi

Hello again!  Once again this is your M&E specialist writing to you from the lovely Iganga, Uganda!  Rainy season has officially started with a bang, or an appropriate boom of thunder, and I think it is a great improvement on the relentless sun that usually beats down on the UVP compound.  The afternoon storms do seem to kick off the power for all of Iganga north of the main street, but a few hours spent in pitch-black reflection are not bad.  I have gotten use to the sun setting and rising at the same time, and am still enjoying exploring the red dirt roads that branch out in every direction from the town center.  All of this comes at an important time for both Julius and myself - we have officially been Global Health Corps fellows for 3 months, or ¼ of the total time we will be here.  Scary but exciting!

As you may have guessed, we have been concentrating for the past month on getting a research proposal up, running, and submitted.  We finally were able to send in the documents, all 8 of them, to The AIDS Support Organization’s Internal Review Committee, or the TASO IRC.  IRC approval is needed for our research project, which hopefully will be starting early January, as we will be working with human subjects and also looking to publish.   The research project, entitled The Evaluation of the Impact of Uganda Village Project in the Iganga District, is an approximately 100-question survey that will be conducted in the graduated, current, and future Healthy Villages.  We hope to be able to compare villages that have received the Healthy Villages program with those that have not to compare health outcomes. Lets back up to IRC approval and see why this is necessary for UVP.

Circa 1932 there was a researcher than wanted to know the effects of syphilis on the human body.  At the time penicillin has not been approved for human use, so there was no cure for most of the bacterial infections, like syphilis, we are able to treat so effectively today.  The research team was based in Tuskegee, Alabama, and they were able to find a rural population nearby that already had high levels of syphilis and were willing to participate in the study for the monetary and perceived health benefits.  Though not 100% ethical (they never told the participants that they had syphilis), there was definitely a need at the time to understand the course of the disease on the human body.  In the 1940s, however, when penicillin was validated for curing syphilis the ethical position of the research team became clear.  The study team decided to withhold the treatment to finish up their research project for an undetermined amount of time.  The study continued for thirty more years, until in 1972 when the story became a huge scandal for the blatant disregard for human suffering.  The idea of IRC, or IRB, approval was born from this episode, now known as the Tuskegee Syphilis Experiment.

Today, in order to conduct any kind of research with human subjects the research team needs to be able to provide evidence that they will not be harming the participants in any way.  Beyond the physical harm of potential participants, IRB also mandates that the research team proves that they will not be collecting any data that could potential be harmful to the participants, or de-identifying the data sufficiently that it cannot be traced to the original participant.  This clause is extremely relevant to Uganda Village Project as many of the questions on our survey ask about health status and sexual history.  In our IRC proposal, we had to explain the process of protecting participants from any information leakage that could result in their detriment.  For example, one question is about sexual activity.  If an unmarried 18 year old responds positively and the mother comes across the study, there could be problems.  Another question asks about current health problems such as HIV or cancer.  A family finding out a relative is HIV positive through a survey is not appropriate and could put that family member in real danger from their families’ reaction.  UVP’s solution to these issues is to destroy the location information directly after the survey is validate and check for completeness.  We will also be storing the paper copies in a secure location on the compound.

The main objective of the research project, as you may have guessed, is to evaluate the effectiveness of the Healthy Villages program and looks for bright spots in the Healthy Villages. Bright spots are villages or people that have excelled in any section of the program, and appropriately are the areas that we will be concentrating on in our focus groups to see the driver of such positive change. Hopefully we will find some that can be replicated in other villages with not as good performance. Besides evaluation, the Uganda Village Project also hopes to be able to publish academic manuscripts from the research project.  This is another of the IRC oversights and we will be working directly with the board as we write publications.  As I said in my last post, it is going to be a busy, and exciting, year!

Orrin is one of Uganda Village Project's Global Health Corps Fellows this year. You can find him on Twitter @otiber or on Instagram @ofteted. Any questions or comments you may have can be directed to his email orrin@ugandavillageproject.org.

Population Growth - What Can We Do About It?

In the next 35 years, the population of Uganda is expected to grow 160% -- from 40 million next year to 104 million by 2050. Uganda Village Project works in several areas that address the effects of population growth: we help women choose when and if they give birth by providing accessible and user-friendly contraceptive services, we work with communities and local government to build shallow wells to ensure infrastructure is in place to meet the needs of growing populations, and we educate about infectious and other diseases that can plague over-burdened health systems and spread quickly when populations swell.

In the Global Health Corps blog, our very own Orrin Tiberi wrote an article about population growth in Africa and the changes this will bring to growth and development on the continent. Check it out at
http://ghcorps.org/whats-love-and-health-got-to-do-with-it/.

Stella: two years later

In 2012, we wrote on this blog about one of our Orphan Support Program students, Stella Nangobi. She had won a scholarship to secondary school because of her hard work with a Children’s Rights and Responsibilities Club, and she was top in her class in her final exams. Stella has continued to impress us over the years. She won a placement in a government university—meaning her tuition is covered—because of her academic performance. For the past several years, she’s been studying to be a teacher so she can continue helping children.

When Stella was 10, she was evicted from the home she was living in by herself. Uganda Village Project staff and board felt that the next decade of Stella’s life should be different, and thanks to some generous donors, we’ve been covering her housing costs while she’s in university. 

Our Orphan Support Program will be phased out at the end of this year so we can focus on our core mission of public health work in rural villages. However, we plan to continue helping Stella with her living costs for her last year of university. She has been a wonderful example of success, and we’re glad that you’ve been on this journey with us and with Stella. We are so grateful for all of the donors who provided scholarship funds over the years to keep Ugandan students in school. Although our direct support for the students is ending as they graduate from their courses, we will continue to follow their progress. We’re so proud of Stella’s hard work, and know she has what it takes to make a difference.

Why Monitoring and Evaluation Matters in Everything

By Orrin Tiberi, Global Health Corps Fellow at Uganda Village Project

Hello from the sunny Iganga, Uganda! For those of you who have not heard of me before, I am the recently arrived Global Health Corps volunteer who will be working in Monitoring and Evaluation for our favorite NGO here in Uganda!! (That would be Uganda Village Project, in case you forgot.) Tuesday the 26th of August marks five weeks that I have been in country, and what an incredible five weeks it has been! I have participated in shallow well clean-ups, malaria sensitizations (which I came to learn was a presentation, not a method of making malaria more sensible), spent a night in the communities, and learned a TON about Uganda Village Project (UVP). You all have participated/supported/championed/been part of an organization that really is having an impact in the Iganga District of Uganda and I am here to help show that impact. We have 8 main goals for the coming year, and probably time for 6 of them, so it is going to be a busy, yet amazing, year here!

This brings me to the topic of Monitoring and Evaluation. I thought in the interests of clarity I would go back to our beloved Oxford Dictionary and define both of these words so we can have a collective understanding of what they mean. According to the Oxford Dictionary, Monitoring is to “observe and check the progress or quality of (something) over a period of time; keep under systematic review”. Uganda Village Project, as many of you know, has been great about keeping track of all their health programs. They can tell you exactly how many hand-washing presentations have been done in a village or what percentage of malaria nets are hung correctly. This is the first step to monitoring: reliably collecting the outputs of an intervention. What Julius and I will be working towards in the coming year is being able to more reliably monitor the current programs of UVP, as well as creating a method for the continuous monitoring of the outcomes of their work. It is great that UVP knows that 70% of the households in the Healthy Villages program have bed nets and have been sensitized to malaria, but how does that affect their health? Are there decreases in symptoms of malaria? Is there an increase in the knowledge base of signs and symptoms of malaria for children? These questions are the type that we aim to be able to measure after this year. By answering these questions, UVP can more accurately represent its work to local partners, international friends of the organization, and in grant applications. Reliable data on these indicators will also allow UVP to continue to make informed decisions about what programs are effective, an essential step if we hope to continue growing in the coming years.

Evaluation is “the making of a judgment about the amount, number, or value of something; assessment”. Whereas monitoring is to make sure the process of an intervention is sound, and to measure some proximal outcomes and outputs of work, evaluation is a measurement of the outcomes and behaviors that may have been influenced by the intervention. This is incredibly important when showing the impact that an organization has had. A thorough evaluation is the way that any organization can say for sure that they have changed the situation for the better.  Monitoring helps with this of course, but as it is run concurrently with the intervention, it is hard to say for certain if the changes seen in the data are going to be long-term changes or just a blip in their behavior.

Uganda Village Project has been very proactive in this area as well. One of the main tasks that Julius and I will be working in this coming year is an evaluation of the impact of UVP’s work on the 88 villages that had been selected to be a part of the Healthy Villages Initiative. Currently UVP has intervened, or is currently in the process of working with 24 of these villages. We will use the rest of the villages as a comparison to evaluate the impact on overall health that UVP has precipitated. Currently we are in the proposal stages of this evaluation, gathering the necessary documents that are needed to receive Institutional Review Board approval for working with community members. After this is achieved, we plan to start with data collection in early 2015. As I said before, it is going to be a busy year!

Monitoring and Evaluation are sometimes criticized upon for not valuing the individual. It is easy for a single person to get lost in numbers, but with numbers we are able to tell so much more than what can be seen on an individual level. This year Julius and I hope to be able to bring the bigger picture into clarity, while not forgetting the amazing people and stories that are present in our analysis. We both look forward to a life changing year, and hope to share more of it with you in the upcoming months.

If you want to see more of the day to day life in Iganga, please follow me on Twitter @otiber or on Instagram @ofteted. Any questions or comments you may have can be directed to my email orrin@ugandavillageproject.org.