A Gift Received

by Tumusiime Loy, Program Coordinator

Judith and I cannot sit inside her rented one-room home on the edge of Iganga Town because the day is too hot, so we sit on the veranda on a woven banana fiber mat.  I came to meet Judith several months ago when one of UVP’s Fistula Ambassadors contacted me about a potential fistula patient. That’s what brings me here today: to hear Judith’s story.

With the passing of her father, her entire family began to struggle. Judith could no longer attend school because her family could not afford the fees; even food became scarce for the family of seven children. At just 17 years old, and against her family’s wishes, Judith married Seifu. She couldn’t see any other way to support herself and no longer wanted to feel like a burden to her family. For a few years, things were fine.

 Then, a friend told Judith that she should stop taking her contraceptive because it would cause health issues and keep her from having children at all. Shortly after, at 22 years old, Judith became pregnant with her first child. She stayed at her family’s home in the village while Seifu worked to make accommodations elsewhere. Finally, at nine months pregnant, Seifu came to help move Judith to their new home. About two hours after arriving to their new home, Judith went into labor. Since this was during the lockdown in 2020, transportation was very difficult, so Judith remained in the village in labor for two days, receiving help from neighbors. Finally, Judith delivered a stillborn baby and immediately began leaking urine.

 “I was advised to leave her and marry another woman, but I didn’t listen because if it weren’t for me Judith wouldn’t have gotten fistula,” Seifu says solemnly. As a school teacher, Seifu’s salary disappeared over night when the government closed the schools, which put them in a tough financial position. He resigned himself to helping her get healed and began reaching out to every person he knew to see if they could help. Then, a friend directed him to UVP and Seifu received the gift he was looking for. He accompanied Judith to the fistula camp where she received a successful repair surgery!

Despite being a rather quiet person, I can tell she is still extremely happy, floating on cloud nine after her successful fistula surgery. Judith recalls, “I used to use three bars of soap per week washing because of the leaking, which is very expensive, especially when Seifu wasn’t receiving his salary.” At the end of her story, I notice that several of her neighbors have gathered around to listen. Judith says that she doesn’t mind the crowd because every person who hears her story is one that now knows about the mystery of fistula and how it can be prevented.

Judith's story is being shared with her consent. You can provide life-changing treatment to women like Judith by supporting UVP’s fistula program. You can change a life TODAY.

Intern Dispatch: Mwendanfuko

by Solome, Brenda, Sheridan, Carmen, Sami, Megan

Mwendanfuko Village Health Team

The day was reaching 2:00 p.m. as our team finished lunch with UVP’s managing director and began prepping for our Village Health Team (VHT) meeting. As we anticipated the arrival of the VHTs we reviewed the different topics we wanted to cover with them—it was going to be an information packed meeting. To little surprise, at 2:30pm Mr. Bumali was the first to arrive. Our team sat outside with Mr. Bumali and decided that as we waited for the other VHTs to arrive, an easy way to pass time was to play a card game.  We decided on UNO and began teaching Mr. Bumali how to play. First Megan explained the rules of the game to Brenda and Solome so that they could then translate the instructions to Mr. Bumali into Lusoga.  With everything translated and with all of the cards dealt, we were ready to play. The game began slowly as people acclimated to the rules and processes. Soon the competition picked up, and as more VHTs began arriving, the game became very fun and exciting for everyone. Each VHT that arrived was equally entranced with the game and eager to join in. After seeing our VHTs laugh and joke over a simple game of UNO, we quickly realized that we had developed a new fondness for laughter and down time with our VHTs beyond working hours.

The next morning, we held a reproductive health day at the primary school.  Our teaching was aimed at the upper levels at the school and therefore focused on the importance of staying in school and abstinence, while also raising awareness about obstetric fistula. As we planned for the day we were anxious about how the students would engage with the topic?  Would they be rowdy? Awkward? Embarrassed? Throughout the day we were happily surprised, the students listened intently and, although shy at some points, were engaged and involved in discussion.

This sensitization helped us to realize the ways in which children are sources of change in their community.  They are very eager to learn, ask questions, and share the information they learn with family and friends.  It is so important to educate children within the community as they are one of the strongest channels to the education of the entire population. We also learned more about the importance of cultural context, as the sex education that we provided at the primary school in Mwendanfuko is very different from that which the international interns would provide or receive in the United States, or many other countries.  In designing this sensitization, our team discussed the importance of recognizing the cultural expectations of a society and taking different perspectives into account when determining how to educate about and address specific issues.

Later that day, we headed back to the school to hold a malaria sensitization for the community. While walking towards the school field, we felt the first drops of rain and quickly sought shelter under a mango tree as buckets of water began to fall from the sky. “Maybe it will go away soon?” we wondered as we saw lightning flash across the field. With the acceptance that the sensitization we had planned and mobilized for all week would not be held that day, we gathered in a classroom to wait out the storm.

Having made friends with a 12-year-old girl named Shanitah, Carmen decided now was a good a time as any to embarrass her in front of all of her friends. Carmen grabbed Shanitah from under the classroom’s protective overhang and pulled her out into the pouring rain.  Using the limited Lusoga she had learned, she challenged her mukwano gwange to a race across the school field. To the amusement of the hundred or so children gathered, Carmen and Shanitah took off at breakneck speed in an Olympic-worthy example of athleticism, which ended with Carmen slipping in a puddle.  Needless to say, the afternoon, while different than originally planned, was a huge success.

After having decided to postpone the malaria sensitization due to the rain, we trekked back to our muzungu house in the rain – shoes in hand and toes covered in mud.  Feet were cleaned, shoes were washed and the few warm clothes we had packed were dug out from our suitcases as we settled in to our cozy house, listening to the rain pattering on the tin roof. As night drew closer and the lanterns were lit, Sheridan decided that it was an ideal time to execute something she had been talking about for weeks – a hair cut. Walking out to the front veranda with our one pair of small safety scissors, she announced that the time had come for Solome to cut her hair. Solome had no experience cutting any hair, let alone muzungu hair, but declared she had a gut feeling that she knew how to do it. So there it began, the Mwedan-salon was in full swing, and as the community members huddled around to see the muzungu cut her strange hair, Solome’s true hairdresser potential was realized.

During the hair cutting process, we hosted three girls at the muzungu house who happen to be daughters to our next door neighbor. They were so amazed to watch muzungu hair being cut and were wondering why Sheridan had decided to cut her hair short. During their stay at our house we taught them how to play UNO; they caught on quickly, pointing out that UNO was similar to the Ugandan card game called MATATU. We started playing UNO at around 7:30pm and didn’t finish playing until two hours later.  The games were long, exciting, and interesting and after the final round every was feeling happy but tired.  Our guests left the muzungu house very happy and looking forward to playing more UNO.

Our sixth week was full of both challenges and successes in the village. We continued to learn more about the restrictions of our abilities in our work, as well as the strengths of our team and our community. As the summer speeds by, we hope to get as much done as possible and continue to empower our community and VHTs to carry on our work after we leave.

Family Planning Success Stories

By Maureen Nakalinzi

The following are four success stories about UVP's family planning services. 

For Our Children

Forty-eight year old Nabirye Alizikyi lives in Nakamini village in Iganga District. She is a mother to 10 children and she recently decided with her husband’s support to have a tubal ligation procedure done. When asked for the reasons why she had this procedure, she said, “I am disabled so I am afraid I won’t be able to look after my children very well if I continue having more children and my husband doesn’t make enough money. We also want our children to get an education hence we will concentrate on the children we have now." She was grateful for the support given by Uganda Village Project towards this accomplishment.

The Breadwinner

"I am called Naibira Zabina and I am 30 years old. I live in Nabukone Village in Iganga District.  Although I am married, I am the breadwinner of my home because my husband has three wives and he doesn’t earn enough to provide for all our basic needs. I have also always had difficulties with all my pregnancies hence the doctor counseled me and my husband to not have children any more. At first my husband did not support my choice of method, however after we were counseled by a UVP family planning services provider about the benefits of family planning, my husband gave me permission to go and have a tubal ligation procedure done. I feel happy because I will be able to plan for my family efficiently as I will not be worried of getting pregnant again." 

Spacing Our Children Out

"I am called Nakanda Jenny and I live in Nawansega village in Iganga District. I am a mother to five children. My husband and I are both farmers and we both understand that much as we want to have more children, we need to be able to plan for them and properly care for them. After we were counseled by a UVP family planning service provider, we both agreed to use the Norplant and we are both happy that we will be able to space our children very well and also meet their needs without the risk of unintended pregnancies."

Making an Informed Decision Together

Nabirye Loy is 30 years old and lives in Nakamini Village in Iganga District. Although she had planned to have six children, she now has nine children, a factor she attributes to not being able to access correct knowledge about family planning. As a result, she became afraid of using any method. But recently, thanks to the presence of UVP in her village, she was taught about family planning methods and later together with her husband; they made an informed decision to have a tubal ligation procedure done. 

Maureen Nakalinzi works as UVP's Health Villages Program Coordinator on the ground in the Iganga District.

Deceptively simple science aims to save premature babies

By Kathleen Bongiovanni, MIPH, MS; Photographs by Seattle Children's Hospital

Kathleen Bongiovanni serves as a Member at Large with UVP. She works as a Program Manager in the Center for Developmental Therapeutics at the Seattle Children’s Research Institute. She holds a Masters in Genetics and a Masters in International Public Health. Kathleen recently won the Gates Challenge Explorations award funded by the Bill and Melinda Gates Foundation. 

Sometimes even a simple idea can make a difference in people’s lives.  In my case, I hope that the creative adaptation of a simple science concept will one day save the lives of premature infants in the developing world.

As a program manager in the Center for Developmental Therapeutics, I support researchers working in the realm of preterm birth and neonatal health.  So far, the main focus of that work has been on treatment options for premature infants, including the development of the Seattle Children’s Positive Airway Pressure ( Sea-PAP) device, an easy to use respiratory support device for preemies.

The aim of my new research project is to investigate new ways of easily and inexpensively diagnosing lung immaturity in premature infants.  Premature birth is a leading cause of neonatal death in the U.S., but not many people realize that it is also a huge issue in developing countries.  New research has shown that 15 million premature babies are born each year, and helping preterm infants everywhere lead long, healthy lives is an important goal of my research.

In developing countries, especially in Uganda—which is where part of my research will take place—many mothers choose to give birth at home, and fewer than fifty percent of births occur with the assistance of a trained health care worker.  Premature infants are born with immature lungs that often lack the ability to make enough surfactant, a surface tension lowering fluid that opens up airways and makes it easier for us to breathe.  Without surfactant, a baby’s lungs are prone to collapse and the baby as risk for developing respiratory distress syndrome.  If problems go undetected and are not treated quickly, this syndrome can lead to death or lifelong disability.

Mothers in resource-limited countries may not be aware that their infant is born prematurely and may not recognize the danger signs of lungs immaturity, placing these infants at risk for developing respiratory distress syndrome.  About 50 percent of deaths that occur within the first 30 days of life are due to delays in problem recognition and care-seeking.  If a mother or trained health care worker is unable to recognize the danger signs of respiratory distress syndrome, the mother or family won’t know to take the infant to a health care facility.  The resulting delay in care, sometimes up to 3 days, can have a devastating impact on the health outcome of the infant.   

Tests for lung immaturity are available in the U.S. and other developed countries, but these tests are complex and expensive, and require invasive amniocentesis or gastric aspiration.  Alternative lung immaturity tests that are appropriate for use in developing countries do not yet exist. 

My research project revamps an old test that was originally developed in the 1970s.  I characterize it as being “deceptively simple,” and thanks to the newer, fancier tests, many people have overlooked it.  The test is called the foam stability test, or shake test.  It works by mixing amniotic fluid with ethanol and shaking the mixture by hand in a vial, then letting it sit for 10 minutes.  You then look at how many bubbles are in the vial.  Lots of bubbles means that the amniotic fluid contains enough surfactant to support an infant’s breathing- no respiratory distress syndrome.

Amniocentesis is not readily available in developing countries, and would be too expensive to implement.  My idea is that the foam stability test should work by taking and saving the oral fluid that is routinely suctioned out of an infant’s mouth right after s/he is born.  This fluid is similar to what you would collect through amniocentesis, and should perform well with the foam stability test.  Oral fluid can be collected noninvasively, and ethanol is not expensive.  The test is simple and can be conducted by someone with minimal training, making it perfect for use in developing countries. 

Right now, I am working with clinical colleagues at Texas Children’s Hospital to plan clinical studies that are necessary to assess the efficacy of this diagnosis technique. I am also traveling to Uganda in June, and will work with my collaborators there to hold focus groups and interviews with women and clinicians in rural settings. Our goal is to gain a better understanding of their feelings on suctioning and testing infant oral fluid, and how amenable they would be to the lung immaturity diagnostic test.

In addition to my work at the Seattle Children’s Research Institute, I am also a member of the board of directors for the Uganda Village Project. One of the reasons that I am conducting part of my research in Uganda is that the rate of preterm birth and infant mortality there is very high, and I believe that simple interventions can make a big difference. Uganda Village Project has a Safe Motherhood Program that provides education and improves access to appropriate medical interventions to people in rural areas, who would not otherwise be able to access these life saving services. As a board member I have the privilege of helping to shape UVP’s strategy and programs, and actually met one of my research collaborators, Dr. Peter Waiswa, through our mutual work with UVP. While in Uganda for my research project I also plan to visit the UVP offices in Iganga, and finally meet some of the people I see at our monthly teleconferences!

My research project  is possible because I won a Grand Challenges Explorations award, a rapid grant making initiative funded by the Bill & Melinda Gates Foundation.  Grand Challenges Explorations (GCE) provides funding to individuals worldwide so that they can explore ideas that break the mold in how we solve persistent global health and development challenges.  

Read more about Kathleen's work here: http://bit.ly/IQiM5B
Learn more about UVP's Safe Motherhood Program here: http://bit.ly/xD6Iaz

Reproductive Health News from Iganga

Interesting article from AllAfrica.com - Iganga District in the news.

Iganga Stores Full of Contraceptives

Comments from UVP staff or locals?