Periods: Ending a Sentence, Not an Education

by Audrey Foxx & Erika Hernandez: Idinda Village

With downcast eyes and a voice no louder than a whisper, Sharifa, began detailing how the convergence of poverty and menstruation served as a barrier for keeping girls in school within her community. A fourteen-year-old student at Idinda Primary School in Eastern Uganda, her tangible discomfort personified the experience of young girls globally when discussing menstruation- with observable hints of fear, shame, anxiety, and taboo. With gradual coaxing from the notably progressive and supportive Headmaster, Robert Nabe, Sharifa explained how poverty holistically amplifies struggle for rural Ugandans, and menstruation was no different. “I am lucky that my mother can afford sanitary napkins, but that is not common here. Many of my friend’s fear coming to school, or just don’t bother because they don’t have the proper materials”. This stark reality is the case for many young girls within Idinda, where tampons and other menstrual products are nonexistent. In a village where the weekly household expenditure averages 10,000 shillings (about $3 USD) the price for a pack of 7 pads (3,000 shillings) is a financial luxury families just can’t afford.

Globally, educational attainment serves as one of the most powerful drivers for economic achievement, and positive health outcomes across the life course- especially for young girls. Educated women are less likely to enter into child marriages or experience domestic abuse, and have a higher likelihood of having fewer and healthier children; these children are then in turn, able to receive an education and avoid a life of poverty, inequity, and disenfranchisement. While gender roles, civil unrest, and conflict are often recognized as barriers for keeping girls from school- menstruation is commonly overlooked and under addressed. Misconceptions and taboos that perpetuate myths of impurity in many countries around the world teach girls to feel shame about their bodies, and give others the space ostracize women and perpetuate these narratives.

             

For young women in Uganda, sanitary napkins aren’t financially feasible explained Headmaster Robert. “Most young girls here resort to using cloth, which is both unhygienic and an unfit substitute for sanitary napkins” His authenticity palpable, he went on to explain that with school hours stretching from 7am-5pm, school is truly a second home for these girls. Headmaster Robert has even gone as far as purchasing sanitary napkins and spare uniforms for the girls at school, but it’s a small drop in the bucket in terms of sustainable solutions. “Schools need to be doing more, but we are not financially equipped to tackle this problem alone- we need support”. When asked what he believed would be a long-term solution, he alluded to funding for necessary facilities like a washroom or a changing room. He continued by emphasizing the importance of normalizing menstruation and empowering young girls. “This is so often seen as a silent problem where girls suffer alone, we as a community need to be talking about this, and doing more”.

You can make a difference by contributing to UVP to support reproductive health education to fight menstruation stigma. Join the movement! Sharifa's story has been shared with her permission.

Becoming an Expert

by Jason Maples, Intern, Bulugodha Village

“Where to?”

This is an innocent question from a smiling man. We know to expect this question every time we pass Ivan’s home. This question may be innocent, but it has a purpose. Ivan inquires because he plans on coming with us. Travelling long distances, even to other villages, all when he wasn’t told he was needed. Ivan is always welcomed, though. His contagious smile infects all of us and leaks into the rest of the community.

To me, he is the hope of the community. Ivan’s overwhelming cheerfulness comes in spite of a challenging childhood. When he was young, he went to work in his uncle’s sugar cane field, leaving his home in Bulugodha, and even sacrificing his pay to send himself to school. His father’s death was the only thing that could force him home, but it couldn’t stop him. 

Ivan started a successful shop that he ran for years before he became a VHT. Ivan’s characteristics of determination, resilience, and joy were all major reasons that the community selected him as a VHT, but the biggest is his hope. The chairman saw it, the community elders saw it, and now I see it.

When Ivan first took his position, the latrine coverage was very poor, but now almost every household has access to a latrine. This is just one example of how his determination has improved his community. He loves being a VHT because it allows him to continue his search for knowledge. Absorbing all the information from the VHT education sessions, Ivan has become an expert on malaria. He is further able to improve the health of the village this way.

I’m convinced that he could make a difference with just his smile, though. It has made a difference in me. The hope that Ivan has bestowed upon us leads all of us in Bulugodha village to believe that change can happen. I believe this village will live healthier lives thanks to Ivan.

Be a change-agent like Ivan by supporting UVP today - share this story with a friend!

Empowerment Through Health Access

By Josephine Asio, Program Coordinator

Life in the village can be complicated. In partnership with our supporters, Uganda Village Project offers access to education, services, and tools to make it easier to create a healthier future. Sometimes that comes in small steps, like a woman who can choose to control her own decisions to stay healthy and informed, even if those around her are not taking advantage of the same services.

Jane, a mother of three, who recently attended an HIV outreach shared her story:

"I would like to thank Uganda Village Project for bringing these services closer to our communities. Our village is far away from Namungalwe health center III (where she could receive services). My husband is married to two women, and being the first wife, I am not sure about my co-wife's HIV status. We all live in different places, making it impossible to encourage one another to come for testing. I have always encouraged my husband to come for testing but he does not want to do so. Because of the constant worry, I go for voluntary counseling and testing services whenever I get a chance to do so. Throughout the time UVP came to work in our village, I and my kids have benefited from all the services offered.”

Your support empowered Jane to take her health into her own hands. Thank you to all those who support UVP from near and far. Jane appreciates you!

Are you proud of the work you support? Share this email with someone to let them know you support access to health services for Jane!

Seeing Tears Turn into Smiles

by Loy Tumusiime, Reproductive Health Program Coordinator

It had been a boisterous day filled with stories and camaraderie. The UVP office was filled with all of our Fistula Ambassadors. It’s one of my favorite activities because I get to hear many stories about successes; our Fistula Ambassadors conduct educational outreaches in faraway places. They cover about 4,000 square miles in eastern Uganda. Today, I got to catch up with Aidah who made the trek to Iganga even though she is expecting her baby any day. As a former fistula patient, Aidah has been reflecting on her previous birth experience.

After a prolonged labor, Aidah left the hospital with what turned out to be a very complicated fistula. Her first husband, distraught by the loss of the baby and his wife’s health condition, left. After one year of living with fistula, Aidah attended a UVP fistula camp and received treatment that resulted in the successful closure of the fistula. She was so grateful for the services, she started conducting informal educational outreaches – before UVP established the Fistula Ambassador program. Once UVP partnered with The Fistula Foundation and established the Fistula Ambassador program, Aidah didn’t have to think about the offer to become a Fistula Ambassador. Her passion for educating women on how to avoid fistula shines brightly six years later.

Now remarried, Aidah is expecting her baby any day and she and her husband have prepared very well with a small savings that will provide them transport to the health center and supplies needed to support a healthy and safe delivery. When I asked Aidah what inspired her to keep acting as a Fistula Ambassador, even traveling in the final days of her pregnancy, she had this to say: “When I see a woman leave the village crying only to return with a smile on her face, I know her life has been changed, just like mine was.”

To find out more about UVP’s fistula program, visit our website. You can support Aidah’s work to educate women in remote places by making a contribution to reproductive health programming!

The Connection between Health and Wealth

by Josephine Asio, Program Coordinator

“Having a pit latrine in my village was considered a luxury,” Harriet laments. Based on this comment, it doesn’t surprise me that she scoffs when she tells me that her neighbors used to think that it was witchcraft that made children fall sick. Harriet knows it was the poor health conditions of the village.

But now, three years later, Harriet is pleased with the changes she has seen in Namufuma. She says that seven out of ten neighbors now have latrines and many more people sleep under mosquito nets. These numbers were confirmed by the graduation survey in the village – there was a 20% increase in latrine coverage and a 10% increase in knowledge of how malaria spreads and is prevented during the three years.

One notable thing Harriet shared with me was the difference in how the community members saw the government health workers. Prior to UVP working in Namufuma, the sub-county Health Assistant was known for arresting people who did not have a proper latrine. Although that practice had been outlawed nearly ten years ago, community members still feared a visit from the Health Assistant. The VHTs and UVP staff visited the village many times with the Health Assistant to provide valuable education and slowly debunked the myth that those without proper facilities would be arrested.

She finishes our conversation by making a bold statement: “A healthy community is a wealthy community.” I pondered this statement for a while, wondering why she so clearly understood the relationship between health and poverty, but that others still seemed far away from this revelation. I came to a conclusion I’ve had before: behavior change is a slow process and we must be patient and persistent.

Do you believe that health and wealth are intertwined? Learn more about UVP’s Health Villages program by visiting our website.

The Many Weights of Disease

by Josephine Asio, Program Coordinator

Sarah in Mwendanfuko knows that diseases do not only affect your health; they affect you physically, financially, and emotionally.

I met Sarah while conducting house-to-house education with the sub-county Health Assistant. Sometimes people are afraid for us to visit them because they do not have the proper health facilities in place, but that was not the case with Sarah. When we found her, she was with her six-week-old baby and her mother in law, and she was confident that she had the proper facilities because she had experienced tragedy in her family that she never wanted to experience again. In fact, it was such a traumatic experience, that even years later, Sarah became quite emotional while telling her story.

When Sarah’s sister was three months pregnant, she began to bleed. Because of financial constraints, her sister was not able to be taken to the hospital immediately. The next day when they were able to seek treatment, they learned that Sarah’s sister had malaria; while the health care providers did what they could, they were not able to save her, and her sister passed away while in Sarah’s arms.

Because of her traumatic experience, Sarah sought antenatal care early in each of her four pregnancies and heeded the recommendations of the health care providers. Every member of her household sleeps under an insecticide treated mosquito net and they seek care immediately after symptoms arise. In addition to ensuring preventative measures are in place for her family, Sarah also encourages her neighbors to purchase mosquito nets from UVP to keep their families healthy and to avoid tragedy.

Sarah’s story is being used with her permission. If you would like to learn more about our malaria program, visit our website.

The Realities of Inequity

by Becca Rose, Ryan Blake, and Nikki Johnson, Interns, Naluko Village

On our first full day in Naluko village, we met with our Village Health Team members (VHTs). These five community leaders are tasked with promoting general health within the community, despite access to scarce resources and no formal medical training. About an hour into our meeting, a voice called at the door, “Kodhi!” ‘Knock Knock!’ A man popped in and called one of our VHTs outside.

A couple minutes later, the VHT returned, exchanged words in Lusoga through choked tears, and left. Our Ugandan team leader, Sarah, translated, “Her father has just died.” It’s culturally expected that relevant members of the community attend funeral ceremonies, and so we learned that all of our VHTs would be absent two days that week, traveling to attend the burial. We expressed our condolences to the family and resolved to visit her upon return- as per custom, but then exchanged concerned glances, wondering what this would mean for our work.

The meeting continued and our excitement slowly rekindled. We learned more about our community and began to discuss our ideas. Then, we got to the chairman. The chairman is the head political leader in the village, and holds significant influence with community members. Initially, we planned to make personal contact with the chairman immediately, and request he set up a community meeting for us to introduce ourselves. The VHTs informed us that his wife was sick, but because the nearest health center was in Iganga Town, a far distance from the village, he wouldn’t be available to meet with us. Another obstacle. Yet again, we were called to be flexible, and adapted appropriately, resolving instead to meet with the vice-chair and other prominent leaders.

That evening, the woman we hired to assist with our food informed us that she would not be able to cook for us because her son was sick and she would have to attend to him. For the third time that day, the consequences of the health challenges we were tasked to address were directly inhibiting our ability to make progress.

Just as with most systemic inequity, the cycle begets itself. The lack of public health resources within the community was directly inhibiting our ability to provide public health resources to them. Western powers often adhere to toxic false notions about the realities of life, overlooking the complexity of solutions in low-resource contexts, especially in sub-Saharan Africa. Many people believe that healthy practices, such as washing hands or using hygienic waste management practices, are simple obvious truths with simple obvious solutions. This reductionist thinking fails to account for the cyclical nature of these issues. Interrupting a cycle is tricky business, involving active accounting for the consequences of the issues, while simultaneously preventing their recurrence. With a nuanced and relevant understanding of the issues at play, our team is excited to take on the challenges that lay ahead, regardless of the obstacles along the way. After all, this is what we’re here for.

Learn more about UVP's public health internship by visiting our website.

 

The Strengths and Weaknesses of Our Village

by Julia Chodyla, Intern. Namunkanaga 2 Village

With broad smiles reaching ear to ear, the children of Namunkanaga 2 walk past our new home singing the song we taught them about washing their hands after using the latrine. This melody is a clear indication that we have started to leave our mark; we have started to inspire healthy living. 

After assessing the strengths and weaknesses of the community through a SWOT analysis with our Village Health Team members (VHTs), we are shocked and impressed with the village’s proactive approach to family planning. From what we are told by our VHTs, girls as young as 13 are getting the implants and are regularly renewing them every three years once they expire. And despite the strong religious devotion in the community, the men are taking their wives and daughters to get contraceptives, actively supporting them every step of the way. That being said, we still find a disconnect between this information and the sea of children that crowds each household and crams into the school benches. Hopefully when we visit house to house the next two weeks conducting our baseline surveys we will be able to investigate the reasons behind this phenomenon. 

This leaves us to assess one of the main challenges of the village: sanitation. Our initial impression is that drinking water is rarely treated or boiled and there is a lack of hand washing after using the latrine. In households without latrines, community members oftentimes urinate or defecate in the bushes or the sugar cane fields, and even if a latrine is available, it is not smoked or scrubbed due to its mud structure allowing an infestation of flies that spread diarrheal diseases. Malaria is another area of concern: although the government distributed nets a few years ago, education surrounding their proper use was not provided and some people are convinced that malaria is contracted by eating mangoes. While it may be a strong statement, we believe it is a true statement- there is a severe lack of education- education about the contraction of diseases, education about the prevention of diseases, and education about the access to treatment. 

According to the VHT’s, one thing that cannot be argued is that the people of Namunkanaga 2 are yearning for information and are ready to make large strides towards healthier lives. We extend our utmost gratitude for the warm welcome, hospitality, and encouragement Namunkanaga 2 has given us. We know that a healthy life can be a reality by working together to create a sustainably healthy village that is given the tools and education to keep independently improving.  

Learn more about UVP's 2019 intern cohort by visiting our website.  

Your Feedback has Profound Value

Your Feedback has Profound Value

We eat, sleep, and breathe UVP. We know what programs look like on the ground and the names of all the VHTs. We see the same faces when we go to the village and we have relationships with staff members at all the local health centers and the Iganga District offices. We’re embracing UVP all the time, so there are things we take for granted, things we intrinsically know because of our intimacy with the work. It’s called the curse of knowledge – once you learn something, it’s hard to remember how it feels to not know.

The survey that many of you took last month helped to illuminate ways we could talk out the work of UVP, the work you support, to promote better understanding of what exactly is going on in villages in Iganga. Here’s a couple tidbits we received from you.

Yes, you got all the questions right! If you ticked the box indicating that trachoma education is one of UVP’s programs, that tells us that we need to do a better job at highlighting program changes (we used to implement trachoma awareness programming, but began focusing on our other programs in 2009).

Most respondents to the survey know that UVP provides education in clean water (83%) and sanitation & hygiene (77%) and clean water access (75%). What surprised us is that most people don’t know that, in addition to malaria education, we provide malaria testing and treatment (only 35% knew this). And while many people (68%) know UVP provides HIV education, less than half (47%) know that HIV testing and counseling coincide with that education.

We learned that the term ‘public health’ is ambiguous and broad – it can mean many different things to many different people. The largest majority of people categorized it as required, useful, or necessary (23%), followed by a community concern (17%), and finally as general health or non-descript health terms (15%). We could do a better job at painting a picture of what public health means, particularly in rural Ugandan villages.

We also learned that it is difficult to determine what UVP is directly responsible for due to our close ties with other organizations. So, our job is to better communicate those things to you! While we’re making adjustments in our communication, feel free to reach out to us if there is something that you really like, something you learned, or even something that left a bad taste in your mouth (something you didn’t like). Please be gentle, we really do take your comments to heart!

And finally, a heartfelt thank you! Because you took the time to provide us with your input, we can provide better education about what public health looks like and the real impacts it has to rural communities in Iganga.

Hugs,

Kelly Child

Executive Director

Now the Baby is Not Just Her Responsibility

by Maria Gorret Nampiima, VHT Program Coordinator

Sometimes, health education requires tenacity and creativity.

I met Sarah in Ituba A while the VHTs and I were conducting house-to-house visits focusing on reproductive health education. Because of the sensitive nature of reproductive health, these visits are different than our outreaches; community members feel more comfortable to share their personal stories and ask detailed questions. Sarah was no exception.

At five months pregnant, we were astonished to learn that Sarah had not gone for antenatal care yet. It can be easy to make a community member feel ashamed and guilty, so we kept our surprise reactions to minimum; after all, Sarah isn’t the only one responsible for seeking antenatal care. She expressed to us that she knew she needed to go and was worried – she had experienced birth defects in previous pregnancies and wanted to check on this baby, but didn’t have the funds to transport herself to the health center.

Sarah shared her challenge in seeking antenatal care with the VHTs during our visit, and after some discussion, she asked for the VHTs help to encourage her husband to better support her health care in pregnancy.  Although family counseling is not typically a role VHTs embody, they were supportive of her request and our next stop was the trading center.

Upon arrival, the VHTs quickly located Sarah's husband and, after greeting him, asked several questions about his wife’s health. As the VHTs discussed with him the importance of antenatal visits, his face changed from confusion to determination. Since he had not been to any of UVP’s reproductive health outreaches for men because he works outside of the village during the day, he wasn’t aware of the importance of antenatal visits. As the education provided by the VHTs sank in, he became more understanding and accepting of his role in the pregnancy part of raising his child.

Fast forward two weeks: we’re back in Ituba A and visit the trading center again, looking for Sarah’s husband. The moment he sees us, he smiles widely. He is happy to report that Sarah has been to the health center for an antenatal visit and she and the baby are doing fine and growing well. He is proud of his healthy family, and we left him at the trading center sharing his story with his friends.

It’s amazing what a little education can do!

Education and access are a powerful team! Learn more about this influential program and ways you can support life changing education by visiting our website. We are sharing Sarah's story with her permission; her husband has asked to remain anonymous.

“I Pondered on Taking Poison”

by Loy Tumusiime, Reproductive Health Program Coordinator

After almost two hours, Jamira realized that labor had started, but her husband and other family encouraged her to wait until morning to go to the health center. After all, these things can take time.

In addition to the family’s influence, “it was the long distance [to the health center] that kept me from seeking treatment early,” Jamira remembers. Unfortunately, the baby did not survive. Upon discharge from the hospital, Jamira went to her grandmother’s home; Jamira did not want to go back to her husband until she figured out why she was uncontrollably leaking urine. After one month, her grandmother couldn’t take the smell and built Jamira a shack made from banana leaves behind the house. In addition to being isolated, Jamira was in pain. “I pondered on taking poison,” Jamira says as she recalls those dark days 12 years ago.

Jamira’s first flicker of hope happened when her sister-in-law heard one of UVP’s Fistula Ambassadors giving an educational talk at the nearby health center. It wasn’t until Jamira reached Kamuli Mission Hospital and saw all the other women in the same condition that she embraced that hopeful feeling. “Fistula is a treatable and preventable disease, but when you are out there you can’t know that.” Living in a rural area limits the education that women are exposed to, making UVP health outreaches by staff and Fistula Ambassadors some of the only education women receive.“When urine flows, it washes away all the brain and stops you from thinking abroad,” she says.

Despite being shunned for 12 years, Jamira’s spirits are high as she readies herself to leave the hospital to participate in UVP’s reintegration program where she will learn a trade and continue to heal in a supportive environment.

A fistula patient today becomes the Fistula Ambassador of tomorrow. One woman at a time, UVP’s Fistula Ambassadors find those who have been neglected for years, suffering in silence - women like Jamira.

You can support our Fistula Ambassadors to reach women like Jamira with life-changing treatment by making a contribution today! We are sharing Jamira’s story with her permission.

Beginning a New History with UVP

by Patrick Tulabagenyi, Program Manager

People passing by see us and stop to ask questions. And our group grows with each passerby.

We are in Namunkanaga village holding a community meeting to discuss some of the health challenges facing the village – conducting our due diligence before we commit to working in a community for three years. The community discusses several health concerns and asks many questions about how UVP works. It was at this point that Banuli stands to speak.

Nearly ten years later, UVP’s work in Luuka District still stands out in Banuli’s mind. As a former leader of a village in Luuka District (formerly Iganga District), Banuli worked directly with UVP to improve his village’s health, specifically through safe water. As he spoke, it was clear to me that he was well-respected in this village.

Banuli narrated to his peers about the positive relationships UVP forged in his previous village, relationships that affected many positive changes. He noted the new shallow well and the reduced prevalence of diarrheal disease. He smiled wide when he mentioned seeing many new tippy taps in the village as a result of the education his community received.

Namunkanaga is eight kilometers (five miles) from the nearest health center. Transport costs can keep a family from seeking medical treatment, so preventing illnesses is of utmost importance. Namunkanaga’s chairman stood up and stated that he felt the community would greatly benefit from educational sessions. The crowd nodded. The vote that followed was overwhelmingly in favor of working with UVP.

Following the meeting, the chairman showed us the proposed house the interns could live in. The community is very excited to work with UVP and pulsing with energy to welcome their visitors in June!

The interns are coming! In June, UVP and Namunkanaga will welcome our new intern cohort. Like us on Facebook and Instagram to see their adventures!

Not All Things are Sweetened by Sugar Cane

by Josephine Asio, Program Coordinator

At the time, she didn’t know that sugar cane could be deadly.  

As Ms. Kagoya and I chat on her recently swept veranda, we watch her two year old son playing under the mango tree. I sensed a bitterness arising as we begin to discuss her experiences with malaria more in depth.

Early in 2017, before UVP started working in her village, Kamira, Ms. Kagoya experienced complications during pregnancy. She was about 16 weeks along when she began bleeding. Because it was early in her first pregnancy, she had not yet had her first antenatal visit, so she thought the bleeding was normal, especially because she didn’t feel sick. “It all happened so fast that I didn’t know how I got to Bugono Health Center,” she says. She woke up at the health center to find out she had lost the baby. The nurse told her that she had high levels of the malaria parasite in her blood and that is what caused the miscarriage. The nurse also told her that she could still have more children, but she would have to change her habits.

Upon returning home, Ms. Kagoya and her husband began clearing the space immediately surrounding their compound. Sugar cane had been planted to the edge of the house and closely surrounded the compound, but after talking with the nurse, Ms. Kagoya now knew that sugar cane was a popular breeding ground for malaria. Because sugar cane is a lucrative crop, it is unheard of for a farmer to clear some area of the crop.

In addition to clearing the sugar cane and standing water, Ms. Kagoya and her husband located their mosquito nets and hung them. When the government distributed mosquito nets nationwide, there wasn’t much education to accompany them. It can be hot sleeping under a mosquito net, so Ms. Kagoya hadn’t taken the government distributed nets seriously.

The bitterness I sensed at the beginning of our talk dissipates to hope and passion. She doesn’t want others in her community to experience the tragedy her family did, so she encourages others to take the education UVP provides seriously. She doesn’t want a mother to lose her unborn baby because of a lack of knowledge. “Lack of information can be very fatal,” Ms. Kagoya tells me. And she’s right.

We are sharing Ms. Kagoya’s story with her permission. If you believe that prevention is the key to better health, join us in addressing key program areas in rural communities!

A Father's Perspective

by Patrick Tulibagenyi, Program Manager

The phone rings – once, twice. And a third, long ring before he answers. I wasn’t sure how David would react to my phone call, so when he finally answered, I held my breath for a moment, hoping he would be open to discussing his daughter’s situation. 

It’s not often you get the story of a father affected by fistula, which is why I wanted to speak with David. He believes that education is of utmost importance, so he has fought to keep all of his children in school. So it is understandable the devastation he felt when his teenage daughter, Agnes, told him she was pregnant. Traditionally, when a woman becomes pregnant, it is time to marry the father of the baby, which is what David demanded. So, at 17, Agnes married the father of her child, left school, and went to live with him. And that’s where things turned sour.

Agnes’ husband was not supportive of the pregnancy, which resulted in poor care for Agnes. Due to the lack of support, there were few options for Agnes when she went into labor. With the help of her father, she was able to seek care at a local health center, but the challenges continued. Her ordeal resulted in a stillborn baby and a fistula.

Knowing his daughter would not be well cared for by her husband, David brought Agnes home. He wasn’t sure how to treat her condition, in fact, he wasn’t even sure what her condition was called. While he was trying to figure out what to do, he heard a radio announcement about a camp at Kamuli Mission Hospital to treat a condition that sounded similar to what Agnes was experiencing. Not knowing what to expect, David sent Agnes to the camp with a caretaker. Not only did Agnes receive care, her surgery was successful. The family was elated!

To ensure Agnes healed completely, and because he was an advocate of education of any kind, David suggested she join the extended reintegration program and learn a trade. So she did. Agnes completed UVP’s reintegration program in 2018 and then returned home. But only for a short time.

The next time I saw Agnes, she was walking through the gates of Top Care Secondary School in Iganga where she was resuming her studies in level Senior 3. Unlike before, the day she returned to school she was confident and full of hope.

David’s support meant a different outcome for Agnes, which is why UVP’s Fistula Ambassadors work to educate men also. Good health is not just for one person; it is most impactful when it is a group effort.

See Agnes’ full story here. We have 30 former fistula patients that serve as Fistula Ambassadors who conduct outreaches throughout the year in rural communities. In 2018, UVP’s Fistula Ambassadors reached more than 49,000 people with education about preventing fistula and battling stigma. Photos by Ben Blankenship.

What Ownership Looks Like

by Nampiima Maria Gorret, Program Coordinator

Photo by Ben Blankenship

I was walking through Bufutula A with the VHTs visiting individual households answering questions about sanitation when we came across Kawanguzi* and his 16 year-old son digging a hole. Or more appropriately, digging a pit.

When I first saw Kawanguzi, he looked so serious. His bold features did not give any indication to the feelings beneath them, so I began asking the quiet man some questions. I wanted to learn his story.

A month earlier, Kawanguzi’s latrine was washed out in the severe rains. It undermined the foundation and filled the pit with mud. The roof was no longer secured and the door was missing. Oftentimes latrines are constructed out of local materials such as trees and mud, so severe rains have detrimental effects. It is typical for a family to start practicing open defecation once their latrine is destroyed, but Kawanguzi was determined to avoid that.

Talking openly about sanitation is not common, but as I chat with Kawanguzi, he does not seem shy despite the small crowd of neighbors and children that has formed around us. He answers my many questions with confidence because he clearly knows the importance of sanitation. Kawanguzi tells me that most people think that building a latrine is work reserved for women, but he doesn’t agree. “It is my responsibility to provide the right facilities to my family. It is my responsibility to show my young son the right habits.” That’s why Kawanguzi was enlisting the help of his 16 year-old son: to teach his son the habits Kawanguzi learned from interns Jake, Debbie, Bridget, Kirsi, and Kennedy in 2016. In addition to the shallow well that UVP built with the community, the interns conducted educational outreaches discussing the importance of handwashing and using a latrine to ‘ease oneself’.

Photo by UVP staff

As we finished our conversation, I matched Kawanguzi’s feelings of appreciation. He thanked me profusely for the work UVP has done in his village. And I thanked him extensively for acting as a change agent in his community and showing his son how to take ownership of his responsibilities and serve as a dependable citizen to Bufutula A.

Behavior change does not happen overnight. The seeds our interns sew and that UVP staff continuously care for over the years take time to flourish. There are many people involved in this slow process, but the most important ones are the community members who take ownership and responsibility to keep their family and community healthy.

*To respect his privacy, Kawanguzi's name has been changed.

A Second Chance at Secondary School

by Nampiima Maria Gorret, Program Coordinator

Despite the fact that she’s the youngest member of her cohort in the reintegration program, Agnes is confident. Energetic, yet soft spoken, Agnes treats everyone with the utmost respect.

When her water broke, Agnes knew she needed to go to the clinic, just like she had learned during her ANC visits. She took the little money her family had saved, and made her way to the nearest health center riding on the back of a motorcycle. Once there, the clinic staff felt her situation was beyond their ability and sent her to another health center. Again, she travelled by motorcycle to her next destination. Upon reviewing her condition over several hours at the second health center, Agnes was once again referred to a different facility. And once again, she rode on a motorcycle to seek the care she needed. Finally, at Rubaga Hospital in Kamuli District, she learned that she needed to have a cesarean section to deliver the baby. Unfortunately, it was too late. Having been obstructed in the birth canal too long, the baby was stillborn. Agnes recalls that day she had to take on two bitter realities: she lost her baby and had begun leaking urine uncontrollably.

After returning home, she was traumatized, despite the support she was given by her care takers was broken by the fact that her friends made fun of her situation and spoke ill things behind her back. Agnes began to feel despair, thinking there was no way for her to live a normal life again. But upon meeting a Fistula Ambassador in her village, she started to feel more hope, a feeling that continued to grow through surgery and all throughout the reintegration program, particularly from the support of the other women in her cohort. With all the hope you felt, Agnes began making plans for the future: she was going to return to secondary school.

The Malaria Revolution

by Josephine Asio, Program Coordinator

On a quiet afternoon, I meet Ivan in a neatly swept compound in Bulondo village. Although it isn’t immediately obvious, Ivan is part of the transformation happening in Bulondo; the revolution of how community members understand and prevent malaria. You see, this four year old boy is so committed to preventing malaria that he insists on sleeping under his mosquito net at all times, even in the middle of the day. And that’s where I find him, waking up from his afternoon nap under his carefully tucked mosquito net.

Ivan’s mother, Sarah, recalls long stretches where Ivan was at the health center to treat malaria every month, sometimes more. On more than one occasion, Sarah wasn’t sure if Ivan would leave the health center alive. Because their home is situated next to a sugar cane field, Sarah felt hopeless at avoiding malaria. Until she learned more about it.

Last August, Bulondo VHTs visited Sarah’s house and encouraged her to purchase a mosquito net. The VHT knew Ivan and others in the family had been sick recently and asked Sarah how much she spent traveling to the health center and for treatment. She blushed slightly and admitted nearly 30,000 shillings. The VHT asked her to make an investment in her family’s health that was a fraction of the cost: for 3,000 shillings, she could by a mosquito net. And she did.

Since then (nearly 6 months ago), Ivan hasn’t visited the health center at all! Ivan says, “When will it by my time to go to school?” a question he frequently asks. “Soon,” Sarah says with a chuckle. She turns to me and says, “Sometimes we overlook everything we are taught about how to live a healthy life, and only remember when you are directly faced with it. I now know that prevention is much cheaper than a cure.”