Filling important roles in communities

Uganda Village Project’s reproductive health outreaches are for women to learn more about safe pregnancy and child spacing, and receive contraceptives if they would like. Why would a woman who had gotten a tubal ligation years ago come to an outreach?

That’s the question we asked this month when a woman showed up at the outreach in Nabirere A village. The answer was that she was sick, she had nowhere to go, and she trusted UVP. The nurse who accompanies Maureen on family planning outreaches examined the woman and declared she needed to go to the hospital. She was sick and she desperately needed a blood transfusion. Everywhere you would expect to see blood vessels running under the skin, she was simply pale. Ultimately, she decided against going to the hospital, although we were prepared to take her in the UVP car as we left the family planning outreach. She wanted to get her household in order before leaving, and we reluctantly left without her.

UVP works on education, access, and prevention. We don’t provide clinical care and our role is to refer people to treatment instead of provide medical advice. The simple fact is that we are a small organization, and we have to choose where to place our focus because we can’t do everything. This story could be about the gaps this creates, but instead it highlights the broad impact we have in rural communities.

First, the Village Health Teams in this community are clearly doing a good job at spreading awareness about the outreaches. This woman wouldn’t have been seeking out information on reproductive health, since she’d had a tubal ligation, but she still heard about the outreach and arranged to attend. Second, communities trust us. It’s hard to admit when you’re sick and seek help, but this woman made an effort to come see us and ask what she should do. Our goal is to pass on this role to the Village Health Team members so they can continue to be referral points in their communities. Third, we can’t do everything, but we provide a crucial link to additional services if we don’t provide them ourselves. In this case, we referred the woman to the hospital and we are following up with her to make sure she gets herself treatment. We do similar things when we pass on information to villages about traveling clinics for eye diseases or connect households with places to buy water filtration systems.

Access, education, and prevention. These words focus us, but they also encompass a wide variety of roles we play in rural villages. They are roles that we are glad to fill as we work with partners to ensure that communities have the opportunity to improve their health and well-being.

A conversation about fistula

Last year Rachel Bridge, one of UVP’s Global Health Corps Fellows who is working as our Fundraising and Partnerships Coordinator, went to the pre-screening site before a fistula camp. While she was there she talked with Loy, our Fistula Coordinator, and with Nalwoga Annunciata, a nurse at the health center we’ve used to refer patients since the early days of Uganda Village Project (UVP).

Rachel: I would love to hear more about your work with UVP’s Fistula Program.

Nalwoga: I started with Julius (Ntalo) in 2003; it has been a long process. Moving slowly slowly. There is nothing bad in this world like a fistula...We have been working so hard here, going slowly, slowly. And Loy has done a good job. 

When I went with Julius to collect the clients the ladies were hiding. I remember one woman so vividly. She was hiding, like a snake coiled up. She had been living with fistula for such a long time. Fistula always means broken marriages, no help, no support system, community denial, isolation, no income generating activity...the smell repels anyone in the house. That woman was alone in the house. Her husband had left, her family had abandoned her. I remember we finally convinced her to get the surgery, Julius guided her out. After the repair of the fistula that woman looked very well. She uncoiled.  

These women: how much they suffer from fistula. But we have worked with so many women and the work has been successful. Now they live such full lives, they marry, and they are all so beautiful. Just look at Loy, look at how beautiful she is! She once suffered from fistula and now she is running this entire program and doing such a good job.  

Others come here when they have lost hope. They say it is a curse, they say it is bewitching. They don’t know the cause, they don’t know it comes from obstructed birth. A young girl from Namayemba, she got pregnant when she was very young, 13 maybe. She was giving birth at a traditional birth attendant. She had a big baby and they made her push. As she pushed she got a fistula. She traveled 4 hours, can you imagine, 4 hours as she is in labor, to get medical care. But the baby passed away before they could reach the health center. Can you imagine?

Loy: We are always lucky with Nalwoga (who is a nurse at that health center) because we have never gotten a fistula from here.

Nalwoga: Never. We have never gotten a fistula from this health center because we refer early. We always have early referrals and safe deliveries.

(Rachel, Loy, and Nalwoga started talking about the upcoming camp, where the first stop is the pre-screening at Nalwoga’s health center.)

    

Nalwoga: I always receive them (the patients) here, and you have to make them very happy and very jolly.  

Rachel: I am sure you are the jolliest welcomer.

Nalwoga: I am!  We sing and welcome them. There is even dancing! You will see!

Nalwoga: We have saved so many lives. I don’t want people to die from here.  

Loy: Many women prefer health centers to hospital because the midwives in the hospital, they are abusive.  

Nalwoga: In midwifery you must be kind.  

Loy: When I was giving birth I was referred in time but they made me wait. So when I came and waited, it then caused the fistula.  

Nalwoga: Those who have been taken for fistula repair, those doctors have done good work for our clients. And now people have started coming out. There was a woman in Tororo, Loy, tell her about it.

Loy: Amor Margaret. The woman had a fistula for over 30 years and she was abandoned by her husband and family. She went back to her parents’ home and they gave her a tiny part of their land to build a small house and live alone. A man got my contact to help this woman. The first time I saw her I thought she was (mentally ill). But in reality, she wasn’t, it was her fistula and her situation that made her (mentally ill). The abandonment. The isolation. I brought her to the camp and, God’s mercy, she was repaired. And when we came back everyone wanted to see the woman who had cured her. When I was there was a big crowd of people to see who I was. There was such a feast! They prepared me chicken, matooke, drinks. And after, they packed me take away for everything. She told me “whenever I look at you, I see my life.” She asks for me to come to her every month. She is now accepted by the family members. She is social in the community. She is now one of our Fistula Ambassadors and she has identified so many patients. Ah, Margaret.