• This is the blog for students participating in DukeEngage - Uganda 2011. Join us as we share our thoughts and experiences throughout our stay in Mbarara, Uganda.
  
  For a full description of this program, please visit the DukeEngage in Uganda page.

With the end of the trip less than a week away, I can’t help but reflect back on the events of the last two months through a bittersweet lense. I arrived in Uganda not completely sure what to expect. From the moment the plane landed on the single strip runway, I knew I was abandoning all the western comforts I have grown accustomed to. The first night I took a cold shower I couldn’t help but think “what did I just get myself into?” All the worst possible scenarios pulsed through my head for the first few days as I imagined myself getting mauled by a lion walking through town or getting strangled to death by the 20 foot python we ran over driving from Kampala if my bed net didn’t beat him to me.

Need not be said, these irrational fears of the unknown quickly faded to feelings of pure excitement as I interacted with the real Uganda; the Uganda where the only real danger is missing out on everything around you. I went from waiting minutes to cross the busy roads of Mbarara to dashing between boda bodas and honking cars as if they weren’t even there. I learned how to avoid being given the Mzungu price for passion fruit in the Central market (sort of) and how to make Ugandans crack a smile with my poor attempts at Ryankole.

In the village, I discovered more than pigs on hilltops or amazing spicy red peppers; I discovered a new found courage and sense of adventure I never knew I had. You would be amazed by what lies within the vast matooke fields deep in the villages of Kashongi. I stumbled upon the rare domestic pigs of Uganda in Kitabo and the avocado trees of Rwenmamba. With each water tank committee interviewed I learned the generosity of the Ugandan people. Mark and I gladly accepted gifts ranging from 20 avocadoes and papayas to a one month old kitten appropriately named CHLO-WEE after the infamous Ugandan radio commercial.

Although I learned a lot during the trip concerning the importance of clean water and the proper functioning of a water tank, the best lessons came from the people I interacted with everyday. The less successful tank committees taught me the importance of cooperation in group activities. My village host family taught me the importance of family in overall life satisfaction. But most importantly Ugandan taught me the importance of laughing. I have never spent so much of my time laughing than I have here. You can just look around and see the influence it has the people here from the rolling laughter of my village host mother to the addictive laugh of one of our translators. Despite the poverty and looming shadow of an early death around every corner, the Ugandan people are happy. That is something that will stick with me for years to come.

Lisa and Me with our little artist Nixon during a Committee Meeting

Carrie on her field day field trip into the Matooke fields

Gifts from a water tank committee

-Genny

It’s hard to believe that we have already spent seven weeks here in Uganda and that by this time next week, we will be on the other side of the Atlantic Ocean, on our way home. I feel like I have just begun to become familiar with the surroundings and culture here, but there is still so much more to learn and experience.

The past week has been a particularly enriching one, through both our fieldwork and our cultural experiences.  Now that Katie and I have finished facilitating focus group discussions about child health issues in Kashongi, we are conducting follow-up interviews with noteworthy participants whom we met during the past several weeks.  The interviews have allowed us to delve deeper into child health topics such as access to medical services, attitudes about health facilities, and care-seeking norms.  They have been extremely informative, though we keep on discovering essential details about our interviewees – for example, that one happens to be a member of the village health team – halfway through the interviews.  These little surprises have definitely kept us on our toes and tested our improvisation skills, as we’ve had to modify our interview questions on-the-spot according to the interviewees’ roles in the community.

Over the past four weeks, Katie and I have also led focus groups to evaluate the impact of rainwater harvesting tanks installed throughout Kashongi in 2010.  I have been struck by the correlation between the ability of a tank to deliver clean water and the effectiveness of the tank’s oversight committee, which is composed of community members responsible for the maintenance and usage of the tank.  Through our focus groups, we have encountered communities where the tank committees successfully managed the provision of clean drinking water to a large number of nearby residents, but we have also visited communities where tank committees were inactive, tank water was wasted, and tanks were damaged, with no plans for repair.  Learning more about the tanks has also helped to quell my woes about the dreary weather here in Uganda. With the advent of the rainy season this past week and the havoc that the daily rains have wreaked on my laundry-drying plans, I have found a silver lining to the storm clouds – at least I know that the rains are filling the tanks with clean water for the communities.

A building outfitted with a rainwater harvesting tank.

Katie’s and my time in Kashongi last week wasn’t been entirely devoted to our fieldwork; along with most of the other DukeEngagers, we did a homestay overnight in a village in Mooya parish.  It was a nice change of scenery from our usual nights tucked away in Mbarara and a fantastic, though brief, opportunity to become immersed in rural Ugandan culture. Katie and I were hosted by Jennifer, an amiable drug shop owner who lives right outside of a trading center.  During our stay, we searched for hyraxes in a stream, helped milk a cow, accidentally contributed to the untimely death of a chick (I’ll forgo the details), prepared matooke, and brought goats out to pasture.  This has been one of my favorite experiences of the summer, as it has been such a pleasure to witness the daily lives of the community members with whom we do our work.  With that said, I’ll end the post with a picture of Katie holding one of Jennifer’s baby goats.  Let the aww’s commence…

What is in a word? What we make of it. There really cannot be a context without content.

Standing in the maternal ward of Mbarara Regional Referrral Hospital (MRRH) on Friday, I could not fully comprehend the ease with which the midwives, doctors, and assistants referred to the unsettled mother laying on the first bed of the delivery room. With two fully robust expectant mothers just two beds away from her, there had to be something wrong if this young mother was laying on the hospital bed, ready to “deliver,” yet looking to be only about five months pregnant.

One thing I learned this past Friday is that abortion seems to have two distinct connotations in the United States and Uganda. While in the United States an abortion refers to the early termination of a pregnancy by choice, in Uganda, an abortion is a spontaneous act of the body, when a mother begins having contractions and signs of delivery too early in the pregnancy – in this case, at 25 weeks. I wasn’t sure if my heart could bear to watch a young mother lose her child that Friday when the doctor told me they were about to deliver a baby that was most nearly aborted but fortunately, my inquisitive mind, mostly out of shock and fear, was forced to question and further investigate the purpose behind the procedure. I was overcome with a deep sense of sympathy and mental persecution for the mother as the doctor laid out her medical history. Not only did she have to undergo this spontaneous pregnancy, she also had a low-line placenta, meaning the placenta is presented first at the cervix, instead of the baby’s head. That’s two complications. To top it off, this woman already had two spontaneous abortions in her past, all resulting in miscarriages!

Although it was such a wonderful experience to witness two healthy deliveries that morning (Carrie and I held and weighed two beautiful baby boys – one at 3.4 kilograms and another at 3.6 kilograms), it was nearly disheartening to learn about the several complications that can occur during pregnancy. From malaria to spontaneous abortions, low-line placenta to internal bleeding (thanks to the Maternal Health Team for all the research), I can clearly see just how important our work this summer will be, especially as the Safe Motherhood Initiative begins this September.

The fence that separates Mbarara Regional Referral Hospital, where we shadow on Fridays, from Mbarara University for Science and Technology.

The maternity ward at the Kashongi Health Centre III, where the Safe Motherhood Initiative will be monitored.

The purpose of the Safe Motherhood Initiative is to ensure that all pregnant mothers deliver at a health centre, starting with the Sub-county of Kashongi. Carrie and I have been working on the medical records system, a program designed to provide a faster and more efficient form of collecting and storing patient information. After five weeks of research, preparation, and anticipation, it was quite the sight to watch Village Health Team (VHT) members from Kashongi come to an understanding of our mission and look forward to helping us reach our goals. While creating the training manuals, we had some form of trepidation as to whether or not the VHT members would find it difficult to integrate technology into their daily workflow, but I must say, the fervor, enthusiasm, and determination we witnessed during training leaves me no doubt that the community health workers will be able to successfully follow-up with expectant mothers in the field, enter information into the FrontllineSMS application on their cell phones, and send forms to the computer at the health centre. We both look forward to training the midwives this week before piloting the entire system within our last few days here in Uganda.

The medical records system computer and cell phones for the VHT members to use in the field.

A pair of VHT members practicing for follow-up visits in the field.

-Joan

Over the past few weeks, I’ve learned a lot about the biggest health challenges in Kashongi.  Helen and I have conducted child health focus groups and interviews with community members, health workers and officials, and traditional healers.  It has been really interesting to see the different health issues from completely different perspectives.  From the community members, we have learned that the most prevalent diseases for children are malaria and diarrheal disease.  While the women, who are the main caretakers of children, know to seek care from a health center, they consistently reported that the distance is too far and transportation is not available.  This has contributed to their continued patronage of traditional healers for treatment.  When they do make it to a health center, they are often referred to a higher health center (e.g. a hospital) because the lower health centers do not have the proper supplies or equipment to treat many diseases.  Another primary concern for the women is that many health centers have no way to diagnose malaria other than symptomatically, so they distribute antimalarials for a wide range of symptoms that are not always malaria.  This lack of close and accurate diagnosis, lack of supplies and difficulty finding transportation has decreased their willingness to seek care from health centers.

Me, Anastasia, Helen, Becky, and Lisa with community members in Rwenjubu.

Our conversations with health workers and officials showed the other side of the story.  The health centers receive supplies from the government every three months, although in the recent past they have gone an entire year without receiving any supplies.  These supplies consist of whatever the government decides that they need, regardless of what the health center requests.  They run out of many of the medications in under a month.  Because of the lack of supplies, it is incredibly hard to encourage the community members to seek care from the health centers.  When they go to seek care and they cannot be treated, they are unlikely to return.  There are several health education initiatives in place, mostly centered at Kashongi Health Center III, though there are some outreaches to the villages.  They hope that this will encourage seeking care from health centers and the proper preventative practices.

Preparing for a focus group discussion in a classroom in Mooya.

Outside of work, we have been keeping ourselves quite busy.  On July 25th, we attended “Christmas” at Becky’s church.  The church was strewn with red and green cloth, complete with a decorated Christmas tree on stage.  To celebrate, we sang Christmas carols and had the most delicious Ugandan food we’ve eaten to date.

Seth, Joan, and Carrie at Christmas!

This past Saturday, we went Chimpanzee tracking at Kalinzu Forest Reserve.  It was really fun, even though we had to wake up at 5 to get there in time to see the Chimps.  We split up into two groups.  My group saw a red-tailed monkey, black and white colobi, and L’hoest monkeys.  At the very end, after hiking for over four hours, we finally got to see the chimps.  It was amazing.  Being in Uganda is quite the adventure!

Joan, Mark, Helen, Adrienne, and Genny trekking through the jungle.

-Katie

So last weekend we went to Lake Mburo National Park. Not a bad experience..not bad at all. Let’s name all the animals, and I hope I don’t forget any: zebras, impalas, water bucks (a type of antelope), water buffalo, hippos, crocodiles (one REALLY big one), eagles, warthogs, these little squirrel-like mammals (only those of us who took the long route home), baboons, and monkeys. As a Bio major and someone who just flat out enjoys him his nature, I had quite a good time. Fun was had, Adrienne got stuck in the mud not 50 yards from where a water buffalo had died from being stuck in the mud, and we all had to yell at Max to not scare off all of the animals. I believe it is worth mentioning that some new nicknames also came out of the last weekend, mainly from the bakery but also from the shirts of our armed guides at the park. The ones that I can remember are Eddie “Carrot, M.D.” Zhang, Carrie “G’nut Cockies” Ho, Katherine “Rock Maffins” Donato, and Adrienne “Riffle Champion/Blackfoot” Niederriter.

On a different topic, I’m not really sure whether anyone else has mentioned this before me, but as I write this it nears 10pm, and the power from the grid turned off at around 7, meaning we’re currently on generator power; unfortunately, that power goes out at 10, and suddenly as it becomes pitch black the incentive to go to bed early grows exponentially. It kind of sucks having to plan stuff out sometimes based on whether or not you will have electricity, something that we take for granted so much in the developed world. But, on the bright side, I am getting plenty of sleep. Can’t say it’s difficult to go to bed when it’s either that or operating by flashlight. Especially because when you turn on the flashlight and become the only source of light in the room, bugs are suddenly drawn to you. Another positive thing is that my group’s work is almost entirely in Kashongi, aka out in the field, where we really don’t need electricity (they don’t actually have electricity in the village. Problem solved).

I know that this may change soon, but I would like to mention that as of right now the water tank group has, without asking, gotten two different gifts of amazing fresh fruit straight off the tree. Last Thursday the vice-chairman (chairwoman?) of the last tank committee we (Genny, Seth, and I) visited took us to her house, which was right behind the school we were at, and gave us about 20 gigantic avocados. Good thing I like avocado. Our other gift of fruit was from earlier, when we received two large papayas from a different primary school. I like this deal.

I would like to close with some words from the wise….some lovely Ugandanisms. Credit to Becky for “When two elephants fight, it’s the grass that suffers”, with reference to the fact that when adults fight over access to water from the rainwater harvesting tanks, the children are the one whose health suffers. Another one is that “when a family’s cow gets sick, they are more likely to nurse it back to health than if it were someone else’s cow” — in reference to the idea that people will be more likely to take care of the water tanks if they feel like the tanks belong to them. Not going to lie, Genny and I probably couldn’t have come up with such culturally relevant analogies in a million years.

-Mark

Ducking my head and hoping not to bump my head on the top of the car, I fell asleep as we traveled from Mbarara to Kampala Saturday. We were all excited to go to Kampala for some Western food. The food in Uganda is very bland and we are almost assured four types of starches each meal. Garden City was bigger than I imagined. It had 6 floors and there were a playground and even a go-cart place. I was really excited when I went in the mall and saw what I perceived as a Pizza Hut. I turned out be a Pizza Hot, but the logo was exactly the same. I almost jumped out of joy. As we first explored the mall, we also saw an ice cream and cake shop on the top floor. As we came down to get pizza, there was also a smoothie place called Mr. Fruit. The banana strawberry smoothie tasted exactly like the way it did in the States. We are able to buy a lot of fruit here actually: bananas, pineapples, apples, papayas, watermelon, mangos, and passionfruit. You will only miss something once it’s gone, such as strawberries. I had never thought I would miss the food back home this much. For people planning to go next year, make sure before you go to Uganda, spend a week eating your favorite food. By the time the pizza finally came, I was famished. The pepperoni pizza was like a slice of heaven. Besides the food, there was also shopping in the mall. As a result, we were able to look for gifts for friends and such. As we wandered around the city afterwards, I was really excited for the dinner with President Brodhead.

From what I saw out the window as we approached the gates of the hotel, I could tell it was very impressive hotel. When we stepped in the hotel to change into more formal attire, the first thing I noticed was that the hotel had AC. When most people think about countries lying on the equator, they assume that it would be extremely hot. This is not case in Mbarara, where we stay for the summer; it is quite chilly in morning and at night. After we changed and went in the lobby of the hotel, I realized that my first impressions actually paled in comparison to what I saw inside. There was a waterfall in the main lobby of the hotel. The staircase looked as though it was designed during the Glided Age for debutante balls. It is quite remarkable the contrast between the city and the villages in the subcounty, Kashongi, where we provide basic health services. In the villages, simple facilities that we take for granted in United States are not there including clean running water and electricity. It’s difficult to see such a disparity between worlds. But that’s why we are here. We are here to do our best to make sure the water tanks we build are functional, provide education materials for Community Health Workers to better educate pregnant women on the importance of delivering in a health center, and possibly incorporate computer technology to better track pregnant women so they come for their antenatal visits. This weekend trip to Kampala has shown me how lucky I am to be a Duke student to have this opportunity to come Uganda to hopefully make a difference, how matter how big or how small.

This weekend has truly felt like a vacation: eating pizza at the mall, meeting President Brodhead, who was very sincere and candid, and going to Jinja, the source of the Nile River. Finally but the least, the blueberry ice cream for dessert at dinner was indescribably delicious, making me forget about every bump in the road from Mbarara to Kampala.

-Max

When the shock/excitement/newness of all that Uganda brings goes away we are left with what is important, good or bad.  Amongst the bad things, one that particularly stood out to me was there actually are millions of hungry, dirty, and sick children.  This is not to say that the people are beatan down and unhappy as I might have expected, but they are generally malnourished and lack adequate health care and clean water.  The infrastructure is a mess – roads, electricity, general government oversight.  Still people accommodate when they can and spirits are reassuringly high.

In essence, the first few weeks here have helped me realize 2 important things:

1. What we are doing as part of DukeEngage is fundamentally important.

2. Constraints that do not exist in the States will be the primary obstacles to widespread impact.

-Stephanie

This is our second week.  We’ve divided up into 6 teams, each with a separate project, aiming to improve health and health services in rural communities an hour from Mbarara.  Yesterday the power went off in the morning, and did not come back on until an hour after dark.  Today everything is running smoothly, so everyone is eagerly intent on finally making some concrete steps forward on their work after a first week of meetings, site visits and orientation talks.

Since everyone is productively occupied, I’ll share a couple stories before passing the journal on.

First this great photo, courtesy of Carrie, which tells most of the story by itself.

It was Anastasia’s birthday last week, so we decided to surprise her.  With a jackfruit.  What better way to celebrate in a memorable way, that to try a massive, spiky fruit that you have never seen before?

A group of use set out for town in the afternoon.  We located the central market, but as we explored the stalls we saw homemade clothes hangers and mousetraps, large papyrus mats, walls of stacked jerrycans, bags of ghee, live chickens, piles of cassava, cask upon cask of matoke bananas, large papayas, sacks of mangoes and green oranges… but no jackfruits!

Genny asked someone if there was someplace we could find jackfruits, and after some confusion we soon learned they are called fene here.  Another word for our Runyankole vocabulary list!  Eventually a woman energetically motioned for us to follow her.  She led us out of the market, across the street, and down one of the many narrow side streets in Mbarara’s bustling little city center.  We turned into a large courtyard with a dozen women  preparing bananas, more bananas…  and fene!   We’d finally hit the jackfruit, er jackpot!

I asked the price of a medium sized one.   10,000 Shillings, or $4.  A woman across the courtyard asked what price the woman dealing with us had quoted.  When she heard, she tried to suppress a smile.  Clearly an inflated price for bazungu.  I began negotiating slowly and with little success, when all of a sudden Joan materialized at my side, animatedly haggling in what sounded like a very fluent and effective mix of Luganda, her native Lugisu, and the local Runyankole.   It was a fun exchange to witness and it brought a smile to see the transformation from her usually quiet and soft spoken bearing.   In no time, we were walking back, only 6,000 Shillings poorer, and one heavy jackfruit richer.

We took turns carrying our prize back towards our home on the hill.  Apart from its significant weight, the thick rind is studded with points that uncomfortably dig into your arms.  When my turn came, I happened to spot a discarder disc made from banana palm leaves, that Ugandans use as a stabilizing cushion when carrying objects on their head.  On a whim, I decided to try it out.  I was unable to carry the fruit more than a step or two without a steading hand to balance it, but the weight was remarkably easy to carry, and made walking much less strenuous and more comfortable.

Needless to say, as you can tell by the photo, an greatly amused crowd had soon gathered to witness my attempts.  As we walked home, every single person on the busy street, broke into wide grins of disbelief as soon as they saw me.  Most exclaimed in surprise, and turned to look and chuckle after they passed me.  My friends tell me that many pulled out phones and cameras to try to sneak a picture of this most unusual sight.  School was letting out, and some children burst out laughing out loud, and were so tickled they couldn’t stop, as they followed from a distance.

I didn’t set out to draw attention, but at least I gave many Mbararans a story to tell, and brought a smile to many lips.  In my own small way, a tiny contribution to the world.

-Seth

As coordinator of DukeEngage’s Uganda team, I arrived in Africa with lofty aspirations of instituting some form of personal autocratic regime.  Well, it seems that the free winds of the “Arab Spring” have been blowing also through our group:  when I sought a volunteer to pen our first journal entry, I soon found that the tables of power had been turned already within the first week, as the group united to assign the task to me.   Clearly I must pragmatically accept the new reality and seek to appease the masses…  so here I go.

We have been together in Uganda just 4 full days now, but have already had a few adventures and it feels like we have been here much longer.  It is always interesting how time seems to stretch like that when every day is full of brand new sounds, sights, aromas, questions and impressions!

One of my amusing memories from the week is leading my teammates through the roadside churning of a Kampala street the first night, on our way to find a restaurant for supper.  We wove around parked boda bodas (motorcycle taxis), hopped over a ditch, avoided stepping in the gutter, sidestepped a matatu van slowing to let off passengers…   A bike zipped by going the wrong way without lights.  The smells of roasting corn and grilling goat kabobs mingled as music thumped from streetside restaurants.  Chaotic, but exciting!  It really felt like we were immersed in Uganda now.

Then I looked over my shoulder and couldn’t help chuckling: stretching out behind me there were 13 bazungu in a long single file line, weaving with me through a sea of Africanness, following my every move.  We formed quite a procession!

The same happened today on the way to Mayanja Foundation, with whom we will be partnering this summer.  There was my bazungu line, curling its way faithfully in my footsteps down the meandering hillside trail.

We decided to christen our group the Bazungu Train.  We’ll see if it sticks.  Eddie suggested we promote it as the new Ugandan reality TV show!

So what are we learning so far?  To adapt to the soft spoken Ugandan accent and to cross the street with confident ease…  well maybe not quite yet, but we are well on our way.

We know that bananas are yellows, potatoes are irish, and peanuts are G-nuts.  We pick someone from their home (no picking UP here) and we raise our friend on the phone.  When we relieve ourselves, we take a long or short call, depending on the need.  We also were surprised walking into the restaurant that first evening, to learn that they do not sell any food… just meat, chicken and fish!  I still don’t have it all figured out, but I think “food” refers to any of the main starchy foods that form  the base of the Ugandan diet.

So far the group has been great.  They are adapting fast and are fun to be with.  Our residence for the summer is basically a private Ugandan dormitory.  With two long hallways of rooms with shared bathrooms and showers, it feels rather like being on campus – minus the gothic architecture, of course).  I’ve quite enjoyed the feeling of being back in a dorm, talking and laughing in the hall with fellow Dukies.  Community and camaraderie are great in life.  And that’s something I’ve found to be true the world over.

-Seth

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