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.