The Next Four Months

By: Orrin Tiberi, Global Health Corps Fellow

Where did the last 8 months go? I keep asking myself that question each time I consider that Julius and I, the first Global Health Corps Fellows at UVP, only have four more months left with this great organization.  I suppose part of it went to continually following up with the Uganda National Council for research approval, and another part editing the goals and objectives, and probably another part to data collection.  When I look at each of the goals Julius and I have accomplished over the past 8 months I wonder how we had time to do them all, but looking at the time overall it has flown by.  I hear that is pretty standard though, and am content with our work and looking forward to the next four months.

As many of you know, Julius and I conducted an impact evaluation of the villages where UVP does the majority of their work.  The rest of April will be taken up by entering that data (approximately 5700 individuals were captured in the data), and also collecting more data from the villages we are graduating in May: Namunkesu, Kidaago A, Kidaago B, Kazigo A, and Kazigo B.  We will use the data from the graduation survey, as well as the data we just collected in the 5 year Healthy Villages Survey, in order to gauge the level of progress those villages have made in the past 3 years.  Their graduations are in mid-May, which will be just enough time to enter and analyze all the data.

Just a few weeks after the graduation fairs in June, Julius and I will be introducing the brand new summer 2015 interns to the M&E tools that we have created and the M&E framework of the organization. We hope to be able to provide guidance for the interns as they embark upon a life-changing summer out in the communities.  We have also created a survey tool for the new villages that the intern teams will be able to use to get a picture of the health of the village.  Julius and I are both excited to see the results of that comprehensive data collection!

Our contracts end in July, but before we go we will have the chance to work directly with our replacements from Global Health Corps.  This model, having two weeks together with the old fellows, helps facilitate institutional memory for the fellows and we hope will provide the new fellows with some great jump-off points!

It has been a great experience so far, and I know I can speak for Julius when I say we can’t wait for the many experiences we will have in the next four months!

Combatting Obstetric Fistula

By Julius Kirya, Uganda Village Project Global Health Corps Fellow

Obstetric fistula is one of the most devastating and serious of all childbirth injuries, yet it still remains one of the most neglected issues in women’s health and rights. There are also many misconceptions around fistula, particularly in more developed nations. One friend from china thought it was “one being dirty”, whereas an American colleague understood it as “abnormal connections between various parts of the body”.

    Obstetric fistula is a hole that forms between the bladder and the vagina or between the rectum and the vagina as a result of prolonged obstructed labor. The constant pressure during labor cuts off the blood supply to these tissues, causing the aforementioned hole, leaving urine and feces to leak continuously and uncontrollably through the vagina. In 90% of cases of obstetric fistula the baby dies.

Young, poor women living in rural areas account for most cases of obstetric fistula. These women are at high risk because they have limited power in making decisions that pertain to their reproductive health. Having children before the pelvis is fully developed, coupled with malnutrition, small stature, and generally poor health can all lead to obstructed labor.  Older women who have delivered many children are also at risk. 

If left untreated, fistula can lead to serious consequences such as frequent ulcerations and infections, kidney disease, and even death. Some women drink as little as possible to avoid leaking and become dehydrated. Damage to the nerves in the legs can leave some women unable to walk. Such medical consequences compound social and economic problems and ultimately contribute to a general decline in health and well-being. Misinformation and ignorance create stigma that often leads women with obstetric fistula to be ostracized from their homes or communities.

UVP has addressed this issue and significantly improved these women’s quality of life by organizing three fistula camps a year. This tireless effort has reached over 250 patients who have received fistula repairs, and seeks to reach all women identified with fistula within rural eastern Uganda. The program coordinator stays at the camp and provides support, counseling and guidance.  

UVP fistula program coordinator giving final instructions to patients before returning home after surgery

A fistula patient undergoing surgery

With funding from the Fistula Foundation, UVP supports the patients at the repair camp by providing food for them as well as their care-takers. After surgery, UVP transports the women back home  -which is crucial, because if they return home by motorcycle, bicycle, taxi or walk long distances they risk re-opening their healing fistula.

Patients after undergoing Surgery at Kamuli Mission Hospital, Uganda

In order to increase the probability of a patient completely healing, the Fistula Program Coordinator follows up with the women after the surgery to check on their healing and social integration as well as monitor for surgical complications. UVP also trains fistula survivors as Fistula Ambassadors who spread the word at the grass root community level, by mobilizing and conducting education sessions, a venture through which more patients are identified.

Fistula is a highly preventable medical condition and its prevalence is easily reducible. Making family planning available to all who want to use it would reduce maternal disability and death. It is also best for pregnant women to always attend antenatal services and give birth in the presence of a qualified medical professional. Emergency obstetric care should be available to mothers who suffer complications during child birth. We should address social issues in the communities where we come from, especially those that endanger women. 

David Kyato: working beyond drug shortages

April 5 – 11 is International Health Worker Week. Every day, dedicated health workers around the world spend long hours—often for very little pay—to keep their communities healthy. For the next week, UVP will be highlighting a few of the health workers we partner with who ensure good health for all Ugandans.

By Kait Maloney, UVP Managing Director

David is a lab technician and nurse who works in a government health clinic in Iganga town. He also works with Uganda Village Project (UVP) to do quarterly community reproductive health outreaches in the rural areas of Iganga. He partners with UVP staff to provide education sessions about family planning and reproductive health. Then, he counsels women and distributes contraceptive methods to those who want them. One of the major challenges he sees as a health worker is the drug stock outs at the health facilities. Because of lack of drugs, people travel to seek treatment but cannot get the services or drugs that they need. Through his work with UVP, David is able to ensure that women have access to the contraceptives that they want.

When asked about his work in the rural communities he said, “I enjoy going out to the communities to offer very urgently needed family planning services to the women because most of them want the services, but can either not afford transport to the health center or their husbands don’t give them permission to go.”