Eye Care Training for Village Specialists

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

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

Here are some of the topics covered during this workshop:

Day One

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

Day Two

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

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

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

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

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

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

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

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

Here's how you can help:
Any Facebook users can join our cause and make a $10 or more donation starting at 3pm EST 10/26
http://apps.facebook.com/causes/16315
Non-Facebook users can make a donation directly at causes.com
http://www.causes.com/causes/16315
Anyone is welcome to watch the Challenge rankings board and see how we do - daily contest runs to 3pm 10/27
http://www.causes.com/agc/today
Please pass this on to anyone you think might be interested in helping.

UVP Attends a Hygiene and Sanitation Conference

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

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

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

Mod Pots Featured in Article

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

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

Read the full article at:
http://nature.berkeley.edu/blogs/news/2009/10/cnr_student_helps_keep_water_f.php

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

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

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

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

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

Uganda's misplaced health millions - BBC Oct. 4

Below is an article from BBC, describing many of the issues that we face in Iganga daily. As described, our local health centers (around which the Healthy Villages are placed), are sadly lacking in both durable and non-durable supplies. Patients are often neglected for hours or days before receiving any treatment, and may be charged, in the end, for medicine which ought to be free. As described in the article, much of the international funding for health in Uganda goes to HIV/AIDs programs. Through Healthy Villages, however, UVP address the health issues which are most pressing in the village, instead of the 'trendy' issues or the issues which happen to fall under media spotlight. Diarrheal diseases, as mentioned in the article, are one of the most dangerous but unaddressed health problems in rural Uganda. Through the construction of shallow wells, through education about waterborne diseases, through training Village Health Teams on the safe water chain (from source to point), through working to increase latrine coverage, and tangentially through many other programs, UVP is seeking to lower the rate of diarrheal diseases in our Healthy Villages. Uganda's misplaced health millions

This health centre lacks even the most basic equipment By Jeppe Villadsen BBC Focus on Africa magazine, Nairobi On a sun-drenched Sunday after a weekend in the country with his wife and two colleagues, Diego Angemi drives from the Sipi Falls in eastern Uganda towards the capital, Kampala. He has travelled this stretch of road many times before but this time there is a dramatic turn of events. A hit-and-run accident has left a boy lying unconscious at the side of the road. They rush the boy to a regional hospital in Mbale, a village about 200km north-east of Kampala, in the hope that they can save his life. Their hopes are soon dashed. In the hospital's emergency room, apathetic staff must be persuaded even to investigate the boy. "Unbelievably, the doctor seemed almost annoyed by the fact that we had brought the boy in," Mr Angemi recalls. The reason for the staff's apparent numbness, however, soon becomes clear. In contrast to the health centre, this research centre is worth millions There is no equipment in the department, not even for basic resuscitation procedures. The emergency room has neither oxygen nor equipment for monitoring blood pressure. There is not even a simple penlight to investigate eye movement. "While we sat waiting and hoping that the doctor would take responsibility we realised that the boy's hands were turning cold and that his pupils were dilating. He died right there in front of us," Mr Angemi says. Huge imbalance Although the emergency room of this local hospital is dysfunctional, right next door is a newly-erected building belonging to Taso, a Ugandan Aids support organisation, which houses medicine and hospital equipment worth millions of dollars. Nearby is an arm of the Joint Clinical Research Centre (JCRC), the self-governing state institution which researches HIV and Aids. JCRC is the largest provider of anti-retroviral (ARV) medicine in sub-Saharan Africa. Why then should foreign donors continue to multiply Aids spending but use small change on projects which, for example, provide safe drinking water? Daniel Halperin, Harvard University Both these organisations are recipients of multi-million dollar support from the US. One of the main American funders is Pepfar - the President's Emergency Plan for Aids Relief. In 2008 alone, funding from Pepfar reached $283.6 million - an amount which easily exceeds the entire annual budget for Uganda's ministry of health. "It makes you wonder whether this assignment of funds is justified when the most frequent cause of death in Uganda is, in fact, malaria," says Mr Angemi. The Ugandan health ministry acknowledges the imbalance. "Since ARV medicine is very expensive and HIV testing equally so, expenditure on HIV completely overshadows what is otherwise available in the health system," says the state's head pharmacist, Martin Oteba. After many trips throughout Africa, Harvard's Daniel Halperin, who has been researching the disease for 15 years, has made the same observations. "Many people in the West believe that all Africans are impoverished and infected with HIV. Yet the reality is that many countries have stable HIV statistics of under 3%," he says. But in spite of this, the vast majority of support, particularly from the US, is given specifically to the war on Aids. "This is because it is a disease that we ourselves have dreaded and have therefore placed it at the top of the global agenda." Multitude of diseases Sometimes African health ministries become over-burdened with the huge deliveries of ARV medicine which they do not have the time, finances or manpower to distribute. DEATHS IN UGANDA Aids: 94,000 Malaria: 41,000 Diarrhoea: 30,000 Tuberculosis: 15,000 Measles: 7,000 Tetanus: 7,000 Source: World Health Organisation, figures from 2002 "The healthcare systems cannot keep up," says Esben Sonderstrup, chief health consultant for Danida, the Danish international development agency. "Then, there is the serious risk of medicine expiring and becoming unusable." For Mr Halperin, it is completely mindless to target aid with such a narrow focus on a single disease. "Why then should foreign donors continue to multiply Aids spending but use small change on projects which, for example, provide safe drinking water?" he asks. Last year, according to Mr Halperin, the US spent $3bn on Aids programmes in Africa but invested a mere $30m on safe drinking water. Mr Halperin cites other examples. One fifth of the world's diarrhoea-related deaths occur in just three countries: the Democratic Republic of Congo, Ethiopia and Nigeria, all of which have relatively low HIV statistics. Yet diarrhoea, which is relatively straightforward to combat, is largely ignored by donors in favour of Aids programmes. No-one turned away At the main Taso centre in Masaka, southern Uganda, there is a new building with a bright, newly furnished office stocking an excess of campaign materials. We are always able to offer the right medicine to our patients. It has never been necessary to turn anyone away Martha Nakayma, Taso Martha Nakayma, a 26-year-old public-relations assistant, relays the demands of a district which has an estimated 80,000 HIV-positive inhabitants. Already more than 25,000 people have received help from the centre. Aside from doctors, nurses and social workers, personnel at the Taso centre include nine information technology assistants and two marketing people. Pepfar is Taso's main donor, providing approximately 60% of the funding. "We are always able to offer the right medicine to our patients. It has never been necessary to turn anyone away," says Ms Nakayma. She explains that one day each week is reserved for home calls to those who live far away. A skills development programme for patients means the hum of sewing machines is often heard. In addition, there is a theatre group for productions on HIV-related topics. "We also offer massage and special aromatherapy which can help to alleviate pain," she says. Elsewhere, there are local general medical clinics like the Ssekiwumna Health Centre situated on a dirt track off a main road outside Kampala. On an average day, up to 30 patients visit the clinic, typically with conditions like malaria, skin infections or diarrhoea. Its annual budget is just $3,500. No apologies One of the biggest problems in institutions like this is the unreliable delivery of medicine and the lack of transport facilities, says Charles Mugyenyi, a health worker at the centre. His dream is to purchase a motorcycle for the small clinic. African leaders recently announced a joint bid to tackle malaria All this stands in stark contrast to the large sums pumped into Aids' centres by international donors. "Of course a lot of money goes to HIV/Aids because it is a terrible illness, but more should go to programmes like vaccination campaigns, tuberculosis and family planning," says Mr Mugyenyi. So what do the representatives of Pepfar make of the criticism? Premila Bartlett, Pepfar's coordinator in Uganda, says they have nothing to apologise for. She argues that, unlike many other international organisations which had "lofty goals" to get people on treatment, Pepfar has actually committed resources to the disease and in doing so has made things happen. Pepfar, she says, is certainly not trying to undermine the existing system but rather to repair something which "in many cases is in pieces". One of the problems is government commitment. "If that isn't there, the system isn't going to get fixed and the people won't get the services they need." From: http://news.bbc.co.uk/2/hi/africa/8275713.stm

UVP Health Clubs, Coordinated by Julius Mbabani

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

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

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

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

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

Eye Care

We have now chosen 2 of our to-be-trained “Village Eye Specialists.” In each village, we hold a large meeting with all political and opinion leaders, and a bunch of VHT members. Abdul, the representatives from Sight Savers International, sensitizes the village leaders about eye problems, and about issues of rehabilitation and learned mobility for those with eye problems. Then the group chooses a villager to be trained as Eye Specialist.

In Bulumwaki the village leaders chose Faith, our VHT chair, but then Faith moved out of the village. Last week, the village leaders elected another VHT member, who is young and fairly educated and who had sat through Abdul’s entire previous sensitization on eye problems.

In Bugabula, the village leaders chose Mugaya, the VHT chair and the Village LC-1 chair. Bugabula appears to have a much higher rate than normal of eye problems, and so Abudl is going, today, to speak with the SSI surgeon in Iganga, to ask him if he might be able to do eye surgeries at the nearby Kinyunga Health Center, rather than us transporting a ton of Bugabula villagers all the way to Iganga Hospital in town. (Bugabula is 75 minutes from town by motorcycle, and about 2.5 hours by public transport.)

We shall be going to Walukuba today, to choose the eye specialist… I’m going to hazard a guess that the village will choose Samwiri Kambuzi, the VHT chair. I’ll update this blog to let you know if I’m right – and I’ll take a picture of the sensitization also, to post!

We are yet to get to Butongole, and Nabitovu shall be next Tuesday.

The Community Map of Bugabula

At the bottom is a full picture of the community map of Walukuba, and then in the middle is a close-up bit of map and key, and at the top is a close-up map of a cluster of houses without latrines (the ones in red). This is the map that i traced and then colored from the map that the VHT members themselves drew.

The Last VHT Trainings - Bugabula and Walukuba

We have now completed teh training of all five Healthy Villages Village Health Teams (VHTs). Red Cross trained each of them in a two-day training, encompassing: malaria, HIV/AIDs, the “Safe Water Chain” (from source to drinking point, how to keep water safe and clean) and waterborne disease, immunization (schedules, and its importance), some nutrition, sanitation and hygiene and the diseases that stem from a lack therein, and probably a couple other things that I am currently forgetting.

In addition to these issue-particular topics, they receive training on how to be health workers – the best way to talk to ask questions and relay information, how to advise people to seek further medical help, where they ought to advise people to go, etc.

The trainings also lay much emphasis on acting as model citizens to the community. The VHT members are given a laundry list of small, feasible sanitation and health measures to implement at their own house: an outside dish-drying rack, a large, protected trash pit, a tippy-tap outside their latrine, etc. Having implemented these measures themselves, (ensured by Red Cross and UVP follow-up), the VHT members shall then concentrate on spreading the gospel to their neighbors.

Something awesome: Red Cross also, during the course of the two latest trainings, had VHT members create a “village map.” The maps indicate households, important landmarks, crops, etc. Importantly, the maps also indicate which households do not have latrines, and how many children under 5 live at each household. These maps will be really helpful to us, and to the VHT, in the course of this next year’s work. Even now, we are working on a latrine campaign, in partnership with JIDDECO, and because of these maps we know now precisely which households need to build latrines, and can focus our efforts accordingly.

An anecdote: It was really wonderful to see the Bugabula team creating their village map. (I missed the creation of Walukuba’s map!) They first did a small version in the dirt, everyone working together – and arguing together – over the precise areas of road intersection, location of trees, whether the church was closer to this well or that mosque, etc. Then they did a much, much larger (about 15 feet lengthwise, 10 feet across) map in the dirt again, and this time used little yellow fruits to mark the each house, and even smaller green fruits to mark latrines. Mugaya, the VHT chair and also the chair of the village, was instrumental in this phase; he knew exactly who lived in each house, their names and their children’s names, if they had a latrine, which household might or might not share their latrine, and seemingly all other details of each household’s life and family. Finally, having completed this huge, dirt version of the map (outlined in fine, light gray charcoal ash, which contrasted beautifully with the red-brown dirt – im sorry I have no picture), a smaller group of VHT members copied the details onto a large paper map of the village. I then took this map home to copy out a UVP-version, before returning theirs.

The top right picture in this blog is from the Walukuba training.