Nets Are Not the Only Answer

by Tigaiza Arnold and Clare Killian, Interns, Ituba A Village

Arnold and Clare with Mr. Kintu Sam, his mother, and his wife

She welcomed us into her humble home with a sweet and soft “Tusangaire!” (you are welcome) and we sat down on the couches. The survey went smoothly, and as we conversed with her, a middle aged man, who we later discovered was her son, was seated adjacent to us. Throughout the duration of the survey, we thought the man was resting, not paying attention to the activity happening nearby. Little did we know, not only was he paying attention, but he would end up sparking a conversation emphasizing malaria and its detrimental impact on the people he loves dearly. The impact of this conversation would last much longer than the time they spent in this man’s company.

When we completed the survey and thanked the woman, the man immediately cleared his throat, sat up, and addressed us somewhat aggressively at first, asking our names again. We answered quietly with a smile, unsure of what this man was going to say. He then launched into a conversation, almost a lecture, about the complex issue of malaria prevention. According to him, the long-standing prevention methods focused on manufacturing and providing mosquito nets is absolutely crucial and important, but is only a secondary and incomplete line of prevention. Nets alone will not eliminate mosquitos and malaria.  Nets alone will not prevent people from getting bit by malaria-carrying mosquitos; the majority of life in Ugandan culture is lived outside and sleeping is one of the only indoor activities.

Mosquitos are most prevalent from dusk until dawn, but almost no one goes to bed before dusk and stays in bed until after dawn, especially in village communities. “These people are vulnerable when they are not sleeping, and that time period has not been accounted for in malaria prevention efforts.” he said. He discussed how malaria prevention must account for all the different lifestyles lived by people affected by mosquitos every single day. Communities deserve individualistic and culturally relative approaches to preventing this disease, something that large, governmentally funded organizations and efforts tend to lack. His passion for this issue was contagious and very evident. He expressed his disbelief about how this debate has been going on for years in the academic and political community, but almost nothing has been done in the field other than education and mass distribution of mosquito nets.

             

Arnold and Clare with Mr. Kintu Sam

We intently listened to him, agreeing wholeheartedly with his statements. Unable to give answers to his important questions and opinions, we struggled internally with this, feeling helpless in that moment. We assured him that they would share his story, continue the conversation, and work within their capacity to further the progress on malaria.

Weeks later, with our previous discussion with him still nagging in our thoughts, we decided to go return to this man and talk to him more. When they arrived at his home again, he was joyous to see them, welcoming them feverishly, and eagerly sharing more information regarding his life and opinions. Once again we enjoyed an engaging conversation with him. The time spent at this man’s home with him and his family was wonderful, a new relationship blossoming between us.  

People, such as this man, can change the world. We were so fortunate to meet him, hold an unforgettable conversation, and continue to foster our undeniable conviction that every individual human life matters. Every life changed is significant and people are not solely statistics, not only numbers in a global epidemic. People are individuals and deserve to be treated as such. You never know what impact you could have.

The Welcome We Weren't Expecting

by Alex Mulyowa, Trevor Bishai and Margaret Nabukenya, Interns, Kinu Village

The football game outside the Kinu house.

Most evenings around 6 p.m., the area outside the front of our house becomes the venue of a spirited game of pickup soccer. As the sun sets over the dry patches of scattered grass, a group of energetic children and teenagers from the neighborhood fill the air with excited shouts, kicks, and cheers. Four small bricks are the goalposts, and because there isn’t quite enough space between our house and the house across the path, the pitch bends a little bit to the right side of our house. The older boys usually have the ball, while younger children spend their time either chasing after it or doing cartwheels. The games begin when we return from working around the village and continue until the sun sets; a crowd of spectators both young and old add a distinct jubilant atmosphere.

Team Kinu during a planning meeting.

But these evening soccer games are not any sort of longstanding tradition here in Kinu. They began just a few weeks ago, on one of our first days here, when we started kicking a ball around outside our house. When our international team leader, Shannon, decided to pack a ball in her luggage, little did she know that it would become the source of such a fun tradition in the village, and one that signifies our brand-new presence here.

One evening, we chatted with some of the regulars on the teams to get to know them better. When speaking with Yosamu, a 17-year-old young man from the village, I was surprised at one of the reasons he gave for why he likes to come play at our house. He told us that he and his friends like playing soccer here because they “want to show love to the visitors.” Even though soccer is his favorite sport, and he likes to keep practicing regularly, coming to our house to play is his way to show us that our presence is genuinely appreciated. He is playing a part in incorporating us into the broader community of Kinu by just showing up to play. A building of mutual understanding and appreciation is taking place: while we are always happy to see the large group of kids outside, the kids themselves are evidently just as happy to have six new friends, ready to play.

Interns practicing their football skills during orientation.

We have dedicated much of our first few weeks here to building relationships within the community, and we have done this in a variety of ways. Formally, we have met with VHTs and held introductory meetings in local places of worship. Less formally, but just as importantly, we have been playing soccer. Building relationships has been an important goal for our team, because at the end of the day, strong relationships form the foundation of successful public health projects. Public health depends on mutual understanding, learning, and growing together. While we work every day to build relationships around community health, nightly soccer games are one of the ways that the community extends its welcoming hand back to us.

Recognizing the Hero Inside Myself

by Tess Waldrop, International Internship Coordinator

Women from the recent cohort of UVP's reintegration program
practicing their tailoring skills.

Laughter and singing echoes over the gate as we walk down the familiar red dirt road that leads us to our destination on a sunny morning in Iganga Town. As we cross the threshold of the house, I admire the numerous classic foot-powered Singer sewing machines that occupy the light filled space, where scraps of colorful kitenge litter the floor, vibrant hand sewn garments hang from the ceiling, and delicious savory smells waft down the hall. With the obvious joy that is emanating from the occupants that fill these rooms, one would be surprised to learn that their recent pasts might not match the bright smiles which now adorn their faces.

Loy and a program participant discuss UVP's
work at the International Day to End Fistula in
Mbale, Uganda.

Only months earlier, the women residing here were all suffering from obstetric fistula, locally referred to simply as “leaking.” Often ostracized by their communities, left by their partners, or even told they would never be cured, the women who now surrounded me had reached their momentous UVP Fistula Reintegration Program Graduation day. An ever-evolving and expanding program done in close partnership with various experts and community based organizations, the UVP Fistula Reintegration Program provides an opportunity for those living with fistula in eastern Uganda to receive screenings, counseling, surgical repairs, and vocational training skills. The average time UVP’s patients have suffered from fistula is an unimaginable 11 years - for most of us, it is hard to conceptualize the true weight of living with incontinence for such an extended period of time. Thus when invited to assist with conducting exit interviews with the graduating participants of this cycle of the program, my colleague Maria and I jumped at the chance to hear more about their stories and celebrate their new found health.

Evelyn and a participant from UVP's reintegration program
enjoy the festivities at the International Day to End Fistula
in Mbale, Uganda.

We sit down one on one with each woman, asking them about their experience with fistula, what they had learned while spending time with UVP, and how their dreams for the future might have changed over the course of the past two months. It may come as no surprise that these sessions were filled with many tears and hugs. What might be surprising, however, is that these were not tears of sadness or hugs given in order to console those we were interviewing. These tears were tears of happiness; these hugs were initiated when recognizing the optimism and courage displayed by some of the strongest women we undoubtedly had ever met. Identified through UVP’s Fistula Ambassadors with guidance from our Fistula Coordinators Loy Tumusiime and Evelyn Nabwiire, it quickly became clear that the support given by these two dedicated colleagues of mine was paramount in our new friends’ lives in a way I could only begin to understand. This observation was confirmed when, after one particularly long interview and soggy hug with a survivor, she turned to look at us and poignantly said “Thank you for helping me to recognize the hero inside myself.” To me, this woman had summed up in 11 words what all of us should be striving to achieve and what UVP works to do every day. Loy and Evelyn have plainly made it their job to not only make sure that they are assisting their patients in recognizing the power and opportunity which exists inside themselves, but more importantly helping them recognize that it is up to them to seize that power and opportunity and never let it go. Though many of the patients were older than my colleagues by many years, it was clear the patients looked up to Loy and Evelyn, and were ready to begin their lives anew and make their mentors and families proud.

Upon completing the program, the participants
dance with excitement to return home and start
their new businesses.

 At the end of a long day of celebrating with mounds of matooke, lots of dancing, pictures galore, and smiles from to ear to ear, we presented the survivors with the mantras which they themselves came up with. Mantras which would help them to find motivation in the days ahead and remind them of just how powerful they are:

··· “Believe in yourself!” ··· “Never give up!” ··· “Be strong, be patient, and work hard to achieve your dreams!” ··· “If you love something, you can achieve your goals.” ··· And my personal favorite, “Work with happiness every day!”

Yesterday, a Tippy Tap. Today, a Kitchen!

by Patrick Tulibagenyi, WASH Program Manager

Mutesi mixing the sticky dirt
to lay the bricks.

She is mixing the mud and he is laying the bricks. One by one, together, they build a kitchen. As the final sanitation facility left to build, Mutesi and her husband Hatim glow with pride when they talk about the progress they have made over the last several months. Making time and saving money can be a slow process, but they worked diligently to make this a reality.

“My husband has been supportive every time I tell him about what we learn from the sensitizations,” says Mutesi. From educational sessions conducted by the VHTs and UVP staff the family has learned the benefit of having proper sanitation facilities. Just yesterday, VHT Shaban helped them construct a tippy tap (hand washing facility) just outside their latrine. When I passed by, it was full of water, had a full bar of soap next to it, and water on the bricks below: it had been used very recently.

Hatim using his skills
to expertly lay brick.

Before the sanitation campaign, Mutesi says, “We were not bothered and no one cared about the sanitation facilities, but after seeing what our neighbors were doing and the support of the VHTs, we had no option but to join the campaign.”

Although the kitchen was the last facility to be constructed, that doesn’t mean it was the least important. Without a kitchen, there was nowhere to cook when it rained, leaving the family hungry or to cook in the house, neither being a healthy option.

Twekembe! (Teamwork!)

Making healthy changes takes time: Hatim took time away from his job to help Mutesi construct the facilities. He sees the time away not as a loss, but a gain for his wife and their four children. He sees their health as his duty.

As residents of Bukakaire, Mutesi and Hatim have seen UVP around for three years, but changing behaviors takes time. With the support of their VHT, Hatim and Mutesi intend to maintain their sanitation facilities as a reminder their neighbors to take their own health seriously. Hatim concludes, “I would feel terrible if I had a guest visit my house and no latrine for them to ease themselves. That’s no way to appreciate your visitors.”

Mutesi shows the previous 'kitchen'.