Final Thoughts: Potential for Change

By Matt Cognetti

Surveying and traveling to 5 different villages around Iganga, you begin to notice obvious patterns, especially a high prevalence of child measles. On about the fourth day of surveys, I couldn’t take it any more. This was about the 80th kid with measles. I just put my head down about ready to give up and cry.

“What are these people doing, why don’t they take their children to the health center to get their free vaccination,” I said.

“Matt, they’re going to be alright, they’ll figure this out. Don’t worry so much, the potential to help themselves is there,” one of the Ugandan interns explained.

That was in the middle of July, it is now August 16, a week after my internship program and now instead of giving up. I feel like I need to go back.

Basically to sum up my time there: I received some valuable leadership experience, got sick multiple times, and learned about public health and nutritional challenges. Besides living and working among the villagers my favorite experiences include, having the opportunity to listen, observe, and collect information, directly from the people. Even though language was the biggest barrier, everyone had an opinion to share, and was happy and eager to share their problems and solutions.

The opportunities provided by the Uganda Village Project were amazing. Working with the nutrition team allowed me to begin to effect change for the people of Iganga. Unfortunately though, many big changes could not be accomplished. There is so much promise in Iganga Town, and two months does not allow us interns to do more than really observe. That’s what makes me want to come back, the numerous insights I learned, and the great potential for growth.

Working with the UVP gives all interns a taste of public health work, and believe me a few found this type of work wasn’t for them. Overall this is a really amazing working opportunity that gives interns a chance to positively effect people’s lives.

Matt was a member of the nutrition team this past summer, interning with UVP. 

UVP's Obstetric Fistula Program

By Rashad Turan Korah Thomas

Virtually unheard of in wealthier nations, obstetric fistula (Latin for hole) is an affliction of the very poor, and is predominantly caused by neglected, obstructed labour. The prolonged impaction of the baby’s head against the mother’s internal tissue results in a severe medical condition in which an opening develops between either the rectum and vagina or between the bladder and vagina causing persistent incontinence and rank odour. Though a simple surgical repair can mend most cases of obstetric fistula, most women go untreated, unaware of what it is, afraid to admit to the condition if they do, or too poor to afford the repair. Because of the impoverished, rural demographic most affected by fistula it has historically been difficult to collect accurate statistics.

In addition to the physical damage done to a woman’s body there are other ramifications of the condition. Misinformation leads to stigma that often leads to women being ostracized from their homes or communities. Relegated to the periphery of community living, these women are, effectively, removed from engaging in society and at the same time are limited in their ability to care for themselves.

Up to June UVP, in partnership with UK-based Uganda Childbirth Injuries Fund (UCIF), helped facilitate surgical repairs for 12 women from 4 different districts at the two repair camps this year. The partnership allows UVP and UCIF to remain faithful to their strengths for the greatest impact. UVP identifies women with obstetric fistula though village outreaches, health centre referrals, radio shows, and simple word-of-mouth between women. UVP then transports women to “repair camps” at Kamuli Mission Hospital, where they are repaired by surgeons from UCIF. UVP also transports one attendant for each patient and after surgery; UVP transports the women home (an important step, because if they go home by motorcycle taxi, or walk long distances, they risk re-opening their healing fistula).

Our fistula program staff then follow-up at the women’s homes to check on the repair’s success, to monitor for surgical complications, and to assist the women with further steps in the cases where the repair was not successful.

To donate to UVP and the obstetric fistula program, check out our donations page here.

Rashad Turan Korah Thomas currently serves as UVP's Country Director and is located in Iganga town. This article was taken from UVP's Semi-Annual Report for 2012. 

Stories from the Field: "Tragedies" in Kazigo B

By Gloria Tran



On Thursday, July 26, two tragedies occurred simultaneously under the roof of Kazigo B.

It was a dark, but not so stormy night. Well, dark because there's no electricity of course. Four members of Kazigo B huddled in the living room around the light of a single kerosene lamp.

Simon Peter wasn't feeling well; he was thinking he had malaria. Emily and I exchanged glances: it was time to break out the malaria test. After reading the picture instructions by the light of our phones, we donned on latex gloves, alcohol-prep his finger and stabbed him with the little blue lancel needle. Poor SP needed to be stabbed twice to get enough blood. Then, we waited 15 min for the blood to migrate across the test applicator.

Meanwhile, Em visited the latrine. Suddenly I heard a shout from out in the yard. Wide-eyed with terror, Em ran in, asking if she could borrow my phone. When I asked her what was wrong, she replied, "I think something terrible just happened," and bolted back out the front door, clutching my phone as a flashlight. Dan yelled after her, "Snake bite?"

We then glanced at the white plastic malaria test piece to check its progress. With abated breath, we squinted as the fluid cleared the second line. Two strips, it's malaria! Sorry, SP!

A few moments later, Em returned with news of her own tragedy: her phone slipped out of her headband and dropped into the latrine pit. The phone had cracked into two pieces when it landed on the floor. Only the battery and cover had survived the accident. We mourned when the worst part of the tragedy suddenly dawned upon us all: we wouldn't be able to call the phone and have it ring suddenly while someone used the latrine! Noo!

 The rest of the week was the usual mix of the positives and negatives of community work.

On Monday, Tuesday and Wednesday, Kazigo B teamed up with Kazigo A to help them with their sanitation push, where we went around helping as many households build Tippy Taps, plate stands, etc. as possible.

Because we only had a couple of days, we only perhaps reached 80 houses, just to get things started in the community. Despite that, I am still so impressed by Kazigo A's commitment and cooperation. That's really the thing that made the push the most successful. They must have responded to the baseline survey, community meetings and sensitizations and the hands-on workshop with the VHT... and decided that they wanted to be a part of this huge sanitation improvement campaign. I saw giant swimming-pool sized trash pits, fortified sturdy perfectionistically perpedicular plate stands (better than ours!), Tippy Taps galore! What a feeling!

Thursday, we planned for a safe water sensitization using answering Jeopardy questions as a interactive way of teaching. No one showed, apparently due to it being rice harvest season. We were disappointed, yeah, but I think we understood that mobilizing for community education is always hard work.


On Friday, we enlisted Maureen's help to talk to our community members about Family Planning. Our group of women were attentive, but also really talkative and giggly. Nice to see that women can bond about their sexuality in rural Africa as well! A question was raise about where the Implanon implant should go, and an old woman (our most loyal attendee) said "Eh! (Psh!)" raised her arm to point at her tricep, as if it were the most obvious thing in the world.

Stories from the Field: Turtles in the Borehole Pool

By Derek Bunch


The main focus this week was our sanitation push. It was pretty successful, we travelled to many different houses. One thing we were pleased to see is that many people, since our baseline surveys, have attempted to create what they didn’t previously have. We found new trashpits, plate stands, and tippy taps all over the place! We were very impressed.

On Thursday, we had our family planning sensitization. Maureen and Rashad both showed up and we split up the men and the women. At first, no one showed up at all, but after a couple hours, people started trickling in and we eventually had a good number of people show up (about 85 in total). For the women, there was this old woman who was very, very interested in the female condom demonstration, and we all thought that that was really funny. For the men, our VHT asked a question, where he made an analogy to fighting. He was talking about how some men like to fight on and on for hours and he asked if the condoms were strong enough to last that long! Everyone was laughing at that question.

On Friday, we started our bore hole clean up in the town center. As we started draining the huge, smelly, mucky pool of water, we saw some movement in the sludge. Turns out, it was a baby turtle! We asked the kids to run and bring us a container and we put the turtle inside. We ended up finding 17 turtles in the bore hole pool! We kept them overnight and then returned them to the swamp the next day. I believe this was UVP’s first turtle rescue mission!

Derek is interning in Kazigo A village this summer. 

Safety Briefing: Ebola Outbreak in Western Uganda

Those who follow the news from Uganda have likely been concerned by the reports of an outbreak of the viral hemorrhagic fever known as the Ebola virus which was first reported as resurgent in western Uganda about three weeks ago, but the outbreak was not confirmed until July 27th. (1,2) There have been about 20 cases and 14 confirmed deaths from this outbreak, most of these cases were from the same household in a village in the Kibaale district in Western Uganda, which is about 125 miles west of Kampala, a day's travel from the Uganda Village Project offices in Iganga District. Uganda has had three major outbreaks of Ebola virus in the past 12 years, the largest one in 2000 was associated with several hundred deaths. (1)

The Ebola virus is a dangerous infection that can cause symptoms of headache, vomiting, and fever, and the mortality rate for those infected by the virus is high. Because the early symptoms are quite similar to other common infections such as influenza and malaria, fear levels can be high during an outbreak. however, transmission of the virus is through direct contact with bodily fluids such as saliva or blood. Therefore, risk of transmission without close contact is low. (3)

There are no travel restrictions in effect for Uganda because of this outbreak, and we are not planning to modify any of the internship activities for Uganda Village Project based on the outbreak. Although a case has been reported in Kampala and several others are being watched there, these are patients who traveled from western Uganda to seek treatment at Mulago, the nation's largest public hospital. The infections did not occur in Kampala. Travel through Kampala for departure at the end of the internship program is not risky. The Ugandan government has encouraged people to limit contact such as handshakes, even though these are unlikely to spread the disease - Uganda Village Project also supports that stance as a good way to prevent transmission of many different types of infectious diseases.

Any friend of Uganda Village Project or the internship program is welcome to contact me at any time regarding the Ebola outbreak with any questions.

- Alison Hayward, MD
Executive Director
Uganda Village Project

__________________
Resources:
1) BBC News: Museveni Warns of Ebola Threat. 30 July 2012.
2) Reuters: Ebola Outbreak Kills 13 in Uganda. 28 July 2012.
3) U.S. Embassy. Confirmed Case of Ebola Virus in Uganda. 28 July 2012.
For those interested in syndromic surveillance:
Searches for "ebola" on Google Insights in the past 30 days

Stories from the Field: Final Weeks in Kazigo A

By Naomi Muyanga

Sara and I finished the baseline surveys on Monday. Then Tuesday was the eye care and WASH sensitizations and it so happened that the VHTs did not mobilize and we had to walk around the village home to home mobilizing (I even rolled a piece of paper to act like a microphone and moved around at the last minute), but irrespective of our efforts, not more than 50 people turned up for the sensitization which was so irritating, but we had to bear it.

Wednesday and Thursday were sanitation pushes – hands on at VHTs homes from Kazigo A and B respectively. Both teams worked together to accomplish the last though it rained heavily on Wednesday and it seemed like we won’t work, as UVP staff also just dropped the materials and left but later in the evening, we started vigorously and managed to complete the task.

The community meeting where the survey results were released was a success, but still after an intensive mobilization on that very day. Titus and Patrick did a demo on safe water which was so fun where they put cow dung to mean faces into drinking water and asked whether any of the community members could take it!

Crazy, but true! - “What fun was in the blog this week?” I asked Derek, but he responded with “time’s new roman? Calibri?” I said, “What language are you speaking?” “The font was times new roman, that’s what I said!” He repeated only to realize it was a misperception of the word fun for font, everyone in the house giggled for over a minute.

Stories from the Field: Borehole Improvement Day

By Lauren Smith 


Friday morning kicked off bright and early with the first Kazigo B borehole improvement day.  Approaching the borehole, shovels, pick-axes, hammer, and sunscreen in hand, we were pleasantly surprised to find the caretaker there and ready for action.  First task: dig trenches to drain the nasty puddle at the end of the borehole and clear away the brush.  Armed with enthusiasm and total confidence in our tool wielding abilities, all four of us mzungu ladies stepped up to the borehole for the first swing.  Shovel digging skills, Gloria and Emily, check.  Hoe swinging skills…well, Lauren found those could use some work.  Turns out that while the caretaker (who is most likely twice our age) could effortlessly dig a trench in a few graceful strokes, us mzungus were in need of some serious practice.  After a few amusing swings, resulting in laughter and raised eyebrows from the Ugandans present, the Ugandans took over trench digging duty.  But, while we may be in need of some lessons in the art of swinging a hoe, we can collect and place rocks like pros, shovel and swing a machete with the best of them.  SP took on fence building, and Dan played paparazzi, documenting the event with four cameras dangling from his arms at a time.  We had a great turnout. Three of our VHTs came to help, and in total, about 15 community members participated in the improvement day.  In a few short hours we’d successfully transformed a dirty and overgrown borehole into a model borehole.  Trenches dug and lined with stones, brush cleared, pedestal cleaned and fence constructed, everyone was in good spirits, proud of the results, and covered in mud.  He who is the dirtiest had the most fun!

Lauren is interning in Kazigo B village this summer. 

From Iganga to Arkansas: Former UVP intern brings Ugandan health into the high school biology classroom

By Jennifer Jehnsen

I was a Team Leader for the Uganda Village Project’s Healthy Villages Initiative in summer 2009. In Nabitovu village, we focused on education outreach about insecticide treated mosquito nets and Waterguard as well as distribution of these at a subsidized price. We also focused on training the Village Health Team with knowledge about First Aid, HIV/AIDS, obstetric fistula, and malaria. These would become the leaders of the village in terms of health. Our day to day involved planning community meetings with village, district, and church leaders and doing community outreach at health centers and at schools. My biggest challenge was getting community members to come to outreach meetings. It was hard to have any sort of advertising in terms of when these were going to take place, so we really had to rely on word of mouth for the location and times of these community events. 

UVP solidified my interest in global health, particularly in rural health, because I witnessed the lack of resources for healthcare in rural areas, specifically for primary care. I saw the health centers without medicine or doctors, the clinics with one nurse and thirty people waiting in line. I've seen similar issues in rural areas in the U.S. and believe that the lack of adequate access to primary healthcare in rural areas needs to be addressed.

Currently, I am a high school biology teacher in McGehee, Arkansas. This summer, I am teaching at the Arkansas Governor’s School, a 4-week gifted and talented program that provides students an incredible opportunity for intellectual growth and social interaction while living on a college campus. I am using the knowledge and skills that I gained from being a Team Leader to educate my students about the public health approach toward tackling neglected diseases found in the developing world. I love talking about my experience in Uganda with my students. They usually have a lot of questions about what the people are like, what the buildings are like, and what the schools are like. I like to incorporate the health issues that I worked with in Uganda into my lessons so that my students can make real life connections about the relationship between biology and health.  I share with them challenges and successes our team encountered while setting up programs to prevent malaria, HIV, and waterborne diseases in Uganda. We also discussed the importance of community educational outreach and sustainability when implementing public health programs. 

 The students created skits for educating people about malaria prevention, and designed prototypes of sand filters that will not only filter pathogens out of the water but also provide a way to dispense water without recontamination. We had discussions about the stigma attached to HIV/AIDS and its affects on prevention, treatment, and testing. The final project will involve the students designing a budget and project proposal for a public health initiative that will address a tropical disease found in a developing nation. 

The main focus of my class is that epidemics of neglected diseases are not caused solely by the virus, bacteria, or protist; economic, social, and cultural factors also contribute greatly to the spread of the disease. My goal for the students is to understand the complexity of the issues in international health and that the spread of these diseases cannot be stopped simply by distributing free medications. I hope that my students will spread awareness about the issues people are facing in Uganda and like a chain reaction, more and more people will become advocates for people living in the developing world.

Jennifer Jehnsen interned with UVP in 2009 and was a team leader. She currently serves on UVP's internship task force. Since attaining a BS in Environmental Sciences and minor in Global Poverty & Practice from UC Berkeley, she has been working as a high school biology teacher in McGehee, Arkansas. 

HIV and UVP: Healthy Village Teams work to combat HIV in Iganga

By Gwendolyn Wernersbach 

HIV rates in sub Saharan African remain a major public health concern globally.  Uganda in particular is considered by many to be among the world's earliest and most compelling national success stories when it comes to combating the spread of HIV.  In recent years, Uganda experienced a decline in HIV prevalence, however, new reports show that the HIV prevalence rate has increased slightly, and that women are disproportionately affected compared to men.    

The HIV prevalence rate in Iganga is estimated to be higher than the national average by about eight percent.  Rural populations are most affected, as access to HIV testing, counseling and treatment are more difficult to come by in remote areas.  According to the Ugandan Ministry of Health, 85% of the population of Uganda does not know their HIV status, which demonstrates the impact and importance of these services.  Access to HIV counseling and testing is compounded by the fact that AIDS-related stigma and discrimination remains the single most important barrier when it comes to behavior change and public action. 

The Uganda Village Project (UVP) is helping to combat rates of HIV in rural areas of the Iganga district by providing HIV counseling and testing services through our Healthy Villages Team program.  The Village Health Teams work with local partners, including St. Mary’s, to conduct culturally appropriate outreach activities to educate communities about basic HIV prevention methods, and often incorporate dance, drama and music performances in to their messaging.  Additionally, UVP is actively involved with distributing condoms in collaboration with partner NGOs, and also administers voluntary HIV testing for villagers as a way to eliminate fear, stigma, or costs associated with travel to a clinic. 

Meet our friend Naigaga Sarah of the Nabitovu village.  Naigaga Sarah is a 34-year old mother of three children, and a proud member of the UVP Nabitovu Village Health team.  She is pictured below holding her youngest child as she waits to speak with the counselor about her results following a routine HIV test. 

Naigaga Sarah comes from a polygamous marriage, she is wife number three and the youngest wife in the home.  "We all came to test today," she said smiling.

"Since Uganda Village Project came into the village, my co-wives, my husband and myself have been testing for HIV at least once and sometimes twice every year.  As a Village Health Team member I encourage others to come for testing and mobilize the village for the HIV education sessions as well. I am happy for the opportunity Uganda Village Project and their donors have given us, by bringing testing right to the village level.  They test at the health centre as well, but it is far and walking there can sometimes be tiresome, therefore bringing testing to us is good and we are grateful."

In 2011, 1,421 HIV tests were administered in nine villages.  So far this year, as of July 2012, 1,623 HIV tests have been administered in eleven villages.  For those that test positive, they are referred to The AIDS Support Organization (TASO), their closest health center, or Iganga district hospital for follow up care and treatment.    

In these ways and many more, UVP is helping to reverse the trend of HIV in Iganga district.  We can only continue to do this important work through your help, generosity and support.  Learn more about how you can make a difference by supporting UVP’s HIV prevention efforts in Iganga here.   

Gwen is passionate about global public health and humanitarian relief efforts, both domestically and internationally. She has worked in the areas of HIV prevention, refugee health, nutrition, fitness, water and sanitation projects, and public health emergency preparedness. Gwen has served as a Peace Corps Volunteer in Lesotho, and holds an MPH from Emory University in Atlanta. She currently works with the American Red Cross and serves on the board as a Member At Large for UVP. 

Stories from the Field: Baseline Surveys, WASH Sensitizations, and HIV Drama Group

By Lindsey Anderson

On Monday, after the team leader meeting, Derek, Felix, and I arrived home and Naomi and I left for a few baseline surveys on the complete opposite side of the village. Our goal was to get as many as possible and then head home to help with our group dinner with Kazigo B before dark. We ran into one of our VHTs and he kept taking us to more houses… As dusk began to arrive, he said we only had 10 more houses for this side of the village, so we thought: why not? By the time we finished the last house, it was almost completely dark and we had no phone and no light, and our VHT left us…so we had to start the 25-30 minute walk back home. After about 5 minutes, it was pitch black. Naomi kept trying to scare me because she was saying there was someone following us and she kept grabbing my arm. Finally, we ran into Dan and Simon Peter from the Kazigo B village and they helped guide us the rest of the way home.


On Tuesday, we had our WASH sensitization at the secondary school in Nabitende. It was not as successful as some of our other sensitizations. High school kids in Uganda are very similar to high school kids in the United States. If they decided they already know the information (or just don’t want to listen), they aren’t going to hear anything that we tell them. But, I’m sure the information came across to a select few...


On Wednesday, we had our HIV sensitization with the God’s Messengers drama group, who arrived 5 hours late because of a diver mishap. When they finally arrived, Sara and I got into the back of the pickup truck (with about 20 other people crammed back there) and drove around the village mobilizing. It was a crazy experience!! We were shouting, dancing, and I even beat on a drum for a few minutes. It was a lot of fun. Once we got back, we all got together to entertain the audience by participating in the local dance! Every single one of us got the chance to tie a scarf around our waists and shake our hips to the beating drums. The audience had a lot of fun watching us, and we had a lot of fun dancing for them! 


Lindsey Anderson is interning and living in Kazigo A village this summer.