Stories from the Field: Fistula Patient's Success

By Maureen Nakalinzi 


As we approach her house, we find her waiting for us at the door. She informs us she was going to her stall in the trading center when Loy called, informing her of this follow-up visit. N. Maliza attended the fistula camp last year in December and luckily for her, the repair was successful. When she left the camp, she got a small loan from her friends at the trading center and restarted her vegetable selling business that she was forced to close down when she got the fistula. She says, “Every day when I wake up the morning to a dry bed, and when I pack my vegetables to go to the market, I thank God and Uganda Village Project for giving me a new lease of life and for reaching out to me when I had lost all hope."

Final Thoughts on the Summer - Kazigo A

By Derek Bunch

The final week in Kazigo A brought about a mixture of tears and smiles. The last week was dedicated to celebrating with all of the village members who had generously helped our team this summer.  This appreciation was extended to our Village Health Team (VHT), The Kazigo A drama team, and our wonderful cook, Harriet. For each event we cooked the entire meal and surprised our guests with such things as guacamole and mango salsa, which was a first for many. Our dinners with the drama team and Harriet ended with the sound of drums, and some local traditional dance. The drama team was very helpful in teaching Lindsey, Sara and I to “move our hips.” This basically consisted of them grabbing us by the waist and twisting our hips for us while the onlookers cheered on our efforts. The most meaningful aspect of all of these dinners came from the immense amounts of love and appreciation that the villagers showed us. This final week was an encouraging indicator of the positive influence our team had made in the village and on the village residents.  Tears were not only shed by us but by the villagers as well. Our Village Health Team dinner was particularly emotional. Muzungu our very long-winded VHT member told a story comparing our relationship to a wedding ring given to a lover and how that ring will always belong to the owner and if that person asks for it back then you must give it back even though you still love the person. He explained that even though they love us and want us to stay, that they must let us leave, or in turn “give our ring back”. 

Our team had a very successful summer in Kazigo A. By the end of the summer we had held sensitization events on malaria, family planning, safe water, sanitation and hygiene, and eye care. In addition to these activities we hosted an HIV/STD drama and testing day and coordinated a borehole cleanup day among the community. Our team sold 210 insecticide treated bed nets, sold 40 tablets of Waterguard, and distributed four boxes of condoms. Our sanitation push was a success in constructing 47 tippy taps, 9 plate stands, and 10 latrine covers. We also helped to improve 5 tippy taps, 3 trash pits, and 3 plate stands. However, our most important accomplishment this summer were the strong relationships we built with the community and the positive name we made for the Uganda Village Project.

I speak on behalf of the entire Kazigo A team when I express my appreciation for the people, the residents, our friends in Kazigo A. The lessons we bring home with us will be with us for the rest of our lives. The friendships and relationships we built and the experiences are unforgettable and will provide a framework for any of our future endeavors. I want to say thanks to the entire Uganda Village Project in-country staff for all of their help this summer. We hope that our work this summer will enable them to continue the positive progress in Kazigo A. Lastly, I want to say thanks to the entire Kazigo A intern team. I had the pleasure to have worked with some of the most amazing individuals I have met in my life. This experience was unique, in that not only did we work together everyday for ten weeks but we also lived together in a house the size of many people's living room. Our team came together to accomplish a huge number of tasks this summer and we had fun in the process. With Sara’s acrobatics for the kids, Lindsey constantly trying to explain that her name was not Sharon, Naomi’s amazing cooking, and Felix’s computer, we never had a dull moment in our village. So thank you again team for an amazing summer, and thank you Uganda Village Project for enabling us to have this experience. Keep up the good work.

Community Total Lead Sanitation Update

                                                                                                                  
By Titus Obbo

This summer UVP developed a new approach for community involvement in the Community Total Lead Sanitation (CTLS) program. Kidaago B is experiencing a new way in the community life. UVP interns this summer helped out to clean the bore hole together with community members. The Village Health Team and Water User Committee have set up the calendar for hygiene and sanitation in the community and defined the governing rules intended to phase out poor facilities and install hygienic ones in households. In particular, dirty jerri cans and buckets will not be allowed for use of collecting water at the well. 

Collaboration with UVP has resulted in a cascaded effect down to the households where members have waged a war against open defecation by digging pit latrines. The village has clustered households in groups of ten to help each other build a good pit latrine that can last for at least more than 15 years given the nature of the soil texture.


UVP would like to thank its interns this summer as well as donors and broader UVP family for their hard work and support!

Titus Obbo is UVP's Safe Water and Healthy Villages Program Coordinator. Titus is a graduate of Makerere University with a degree in Human Resource Management. 

The Eye Camp

By Maureen Nakalinzi 

It is 8am in the morning as I make my rounds around four villages in a taxi (Nakamini, Bunio, Butongole and Bulamagi) to pick up patients who will be going for eye surgery at Iganga Hospital. In all the villages, I find them seated outside together with their families waiting for me. One of them actually tells me, “I am not late today, I have kept Mzungu time and you have kept African time because you are 10 minutes late." During the taxi ride, most of them are quiet -- probably wondering what will happen during surgery -- and for those who were completely blind, probably pondering the prospects of seeing again.


We reach the hospital after a few minutes and it’s a sea of people outside. They are people surrounding every corner of the eye clinic waiting for their chance to see the doctor. The eye clinic is a very small room inside the antenatal ward which can only fit two patients and two doctors at a time. Luckily for me, since UVP has an agreement with Sight Savers International (the organization that sponsors the eye camp) and Iganga Hospital, my patients where already screened and diagnosed, so we are spared waiting in the long lines outside and asked to join those that are waiting for surgery in the next building.

The surgery room is a small room inside the maternity ward and while my patients sit on the ground in the corridor waiting for the surgeon, throngs of women in labor pass by and my patients pray silently for good outcomes for themselves and for those women. The doctor arrives at 4pm and we have been seated waiting in that corridor since morning. She apologizes for coming late and announces that she can only perform four cataract surgeries and everyone else can wait until tomorrow. Since my patients are among the first four people, they will be asked to enter one at a time for the surgery.

After 15 minutes, the first patients walk out of the tiny room. I am asked to get one of the patients a place to rest in the male ward. Unfortunately since the hospital is a very small place, there are not enough beds for every patient to sleep. Just as I try to get a bed, the doctor politely asks me to give it up because there is a patient in a more critical condition. The patient ends up sleeping under a mango tree after surgery and in the evening after all the women in the antenatal ward have been attended to, we convert this ward into “the after surgery ward” for eye care patients. Every patient that comes into that ward to rest can’t wait for the next morning when they will remove the bandages on their eyes and they will be able to see again. They keep telling me, “we don’t care about sleeping on papyrus mats for tonight, tomorrow will be a new day in our lives.”

Maureen is a Uganda Village Project Program Coordinator who works on the ground in Iganga. 

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.