First, apologies for the delayed mass entries—we have been out in the villages with no phone network or internet connection! Here are some updates from the past few days (pictures will be posted tonight!):
Uganda, the Pearl of Africa
May 24, 2007
The people here are warm, open, and inhumanely patient with my American English and limited Luganda. It has been immensely helpful to have Meera and Dennis translate for us. Ananias, the Secretary of Science and Technology to the President, has also been a knowledgeable and well-connected guide. He is from the Nakaseke district so he is familiar with the people and has access to influential leaders, but he also works for the government, which brings a different dynamic to our visits.On Wednesday night, we stayed at the home of the LOC IV Chairman who oversees Nakaseke County and helped his family prepare a traditional dinner of ghee, beef, cabbage, groundnut sauce, and matoke (plantains). Our driver, Silver, demonstrated how to properly peel the matoke, a task that is much harder than it looks. All of us were given local nicknames: Meera is Kembabazi ("one who has grace"), Amanda is Kabirungi ("she who is beautiful"), Ali is Kirabo ("gift"), and I am Kente ("as lovely as a cow").It is interesting to see the differences between this society and our own. Cattle are greatly treasured here because they are the main source of livelihood and also culturally symbolic. Humans live off of cow’s milk after we are too old to breastfeed, and also rely on cows for meat, clothing, and many other things. The head of security in the county explained to us that he would prefer to receive a cow as a gift over any large sum of money. The Chairman gave Ananias a beautiful pregnant cow as a wedding gift.Family is clearly a top priority, as many people provide for not only their immediate family, but also their extended family and in-laws. The men are expected to carry active lifestyles and stay physically fit, while the women are expected to care for all the children and complete all domestic chores. There are also many women entrepreneurs here. We interviewed a woman named Violet, who ran a shop and a village phone in addition to her household duties. Women in the villages are not supposed to sit on the ground, as we quickly learned after being laughed at a couple times. People here laugh whenever something unexpected happens though; it is not necessarily because they are making fun of us. They even laugh whenever Meera impresses them with her fluent Runyankore.The children have the most beautiful smiles and like children everywhere, love sweets. Most of the children are currently in school. Their parents either send them to boarding school, or they attend the schools in the subcounty. The government is now aiming for universal secondary school in addition to universal primary school. Dennis told us that after secondary school, approximately 98% of the students are qualified to continue on to university-level education, but due to lack of funds only about 10% of the students actually get to attend.
ICTs
May 24, 2007
On Tuesday morning, our team, along with our Ugandan counterparts Ananias, Harriet, and Richard, had our first meeting with representatives from the Ministry of Health. We went in with few expectations, as we weren’t sure who was going to attend the meeting or what they knew about the project. The 9:30am meeting started at 10:30am (Uganda Standard Time!); the attendants included the Assistant Commissioner for ICTs for the Ministry of Health (Dr. Mukooyo Edward), the head of Clinical Services, and 4 staff members who work in data collection and records. The minister himself was supposed to attend, but he was delayed by a trip to Geneva where he was meeting with WHO. To spare you the details of the meeting, I can just say we were greeted with guarded skepticism about the project, particularly about the Smart Phone group’s project. The Ministry of Health is a highly performing sector of the government; therefore, they are very careful about endorsing just any new initiative. Understandably, they were critical about the project; but ultimately, they gave us some helpful words of advice. Namely, they told us that Ministry/government buy-in was critical, that sometimes the most simple technology can be more useful than a complicated one, and that any project should be practical and scalable. We had these criteria in mind before the meeting, but it was good to hear them reiterated by the Ministry. One main criticism we received was regarding our choice to study Nakaseke District for our project. Why, the Ministry representatives asked, were we going to Nakaseke when it was a perfectly well-off district? They wanted to know why we weren’t going to the north or the east. We explained our reasoning (that we had connections in Nakaseke, that we wanted to start in a place where we felt we would have the most initial support, etc), and eventually, the representatives reluctantly accepted that we would start in Nakaseke district. One dynamic I must mention regarding the project is cultural; our team is one of 4 women from UC Berkeley; the Smart Phone team (the other team from UC Berkeley) has 2 women and two men. The Assistant Commissioner made sure to point this out at the meeting. In addition, he asked Harriet (one of our counterparts who comes from the private sector and has no affiliation with the Ugandan government) to take the meeting notes, which perhaps is the job that goes to a meeting secretary. It was a strange role placement, and not one that went unnoticed by all meeting attendants. After the official meeting, Dr. Mukooyo gave us a tour of the MoH facilities; ICTs are definitely playing a burgeoning role at the national level—we would soon see what role they could play at the district and grassroots later…
Deliver us!
May 23, 2007
Today we had the most incredible experience while visiting a Traditional Birth Attendant (TBA) in Ngoma parish named Prossy Katate. A young girl (only 15 years old) was delivering her first child and Prossy invited us back into the "delivery room" to observe. The girl, Fiona, gave birth to a son just before we entered the room and Prossy was massaging the baby’s chest as he was having difficulty breathing. We all squished into the room and I continued to massage the baby’s chest where he lay at the end of the bed and Meera held Fiona’s hand as Prossy helped her to deliver the placenta (Amanda assisted by passing cotton swabs while Jess presided over the whole operation) - quite the hands-on experience! J Fiona, as do most women in the village, delivered without any pain medication (despite needing an episiotomy) although Prossy informed us that she does have drugs for which she charges extra. Prossy runs an efficient and busy practice and while we waited to speak further with her about her work she delivered yet another baby and two other women sat in a side room in the early stages of labor. I was impressed not only to see Prossy using latex gloves throughout the earlier procedure but also that Fiona received fluids from an IV drip of saline hung from the window. Perhaps most amazing though was that each woman delivered her child in complete silence (talk about a high pain threshold). Interestingly, we later learned that one reason so many women visit Prossy is that she does not make them take the HIV screening test required by the local health center in order to deliver at those facilities. Prossy indicated that one of the greatest challenges she faces is a lack of assistance and equipment (e.g., forceps, cotton, suction balls to clear a baby’s nose, etc.) particularly since her method of sterilization is to boil things in water which takes time. For example, he has a limited number of forceps and if she sees many clients in one day it is difficult to sterilize the equipment in between each visit. I have to admit that when we visited another facility at a higher level and I saw a number of forceps lying around I had to resist the STRONG urge not to pocket one to send back to Prossy. In the past few days we have seen a wide range of health services ranging from a traditional village healer who uses herbals remedies to treat various conditions to a level 4 health center with a fully equipped operating theater and maternity ward. Unfortunately, the operating facility has not been functional for six months as the doctor left the health center and the maternity ward is not yet opened due to additional staffing issues. Overall, the main issue we have come across is that people are primarily dealing with malaria, cough and HIV although malaria truly seems to be the most pressing concern. Access to reliable emergency transport is clearly a need as well and this is further compounded by the inconsistent care available at different health centers.The greatest finding thus far is that the lack of network (or a consistent connection) is the first barrier to promoting positive health outcomes and that this must be established prior to further work in developing a plan for communication for health improvement.Thus far, we have had a truly eye-opening experience and people have been so welcoming and friendly. They are always willing to speak with us and share their stories even when we are asking for personal information. Later in the week we are off to some higher level facilities where we anticipate that our discussions about communication and opportunities for mobile phones will be fruitful.We’ll keep you posted about our further hands-on health escapades – I heard mention of a surgery later next week!
Who said Nakaseke was "ok"?
May 24, 2007
The Assistant Commissioner Health Services of the Resource Centre (Health Info and ICT) for the Minister of Health said that health issues and connectivity in Nakaseke district was all "ok" (See Meera’s posting about the meeting). We found something very different in the field. After a somewhat nerve-racking journey three hours into the bush we arrived in a remote trading center, Ngoma. There is network (cell phone coverage) there, but only under a certain tree in town.
During the next few days we found that every parish that we visited had either no network at all or only in certain places and at certain times. The main concerns at the different health clinic levels were transportation and supplies, not connectivity. Most villages had a village phone operator (not the Grameen foundation type since most were men) who sells airtime to people that need it. They purchased a cell phone with a cable and antenna that picks up the faraway network. We stood next to the village phone with our phone and found no service, but the village phone often had perfect service. Unfortunately, the health workers feel that it is not cost-effective to use the village phone. One minute costs $0.25. A quarter in the rural areas is a lot of money and that is only for one minute. The health workers would rather travel to the district hospital or Kampala directly than pay for phone calls that are expensive.
Again and again we’re finding the same information in these areas. The telephone companies need to expand into this region and provide network before mobile phones can be implemented here. We’re now focusing our research and time in areas of Nakaseke with network. It’s only a matter of time until all places here have network, though, and the plan we develop will be scalable to all places of Nakaseke.
On a lighter note, my name, Amanda, means "charcoal" here and as we were passing a truck full to the brim of charcoal Meera had a vision of us atop the charcoal in the truck seizing my destiny.
~Meera, Ali, Jess, and Amanda
Uganda, the Pearl of Africa
May 24, 2007
The people here are warm, open, and inhumanely patient with my American English and limited Luganda. It has been immensely helpful to have Meera and Dennis translate for us. Ananias, the Secretary of Science and Technology to the President, has also been a knowledgeable and well-connected guide. He is from the Nakaseke district so he is familiar with the people and has access to influential leaders, but he also works for the government, which brings a different dynamic to our visits.On Wednesday night, we stayed at the home of the LOC IV Chairman who oversees Nakaseke County and helped his family prepare a traditional dinner of ghee, beef, cabbage, groundnut sauce, and matoke (plantains). Our driver, Silver, demonstrated how to properly peel the matoke, a task that is much harder than it looks. All of us were given local nicknames: Meera is Kembabazi ("one who has grace"), Amanda is Kabirungi ("she who is beautiful"), Ali is Kirabo ("gift"), and I am Kente ("as lovely as a cow").It is interesting to see the differences between this society and our own. Cattle are greatly treasured here because they are the main source of livelihood and also culturally symbolic. Humans live off of cow’s milk after we are too old to breastfeed, and also rely on cows for meat, clothing, and many other things. The head of security in the county explained to us that he would prefer to receive a cow as a gift over any large sum of money. The Chairman gave Ananias a beautiful pregnant cow as a wedding gift.Family is clearly a top priority, as many people provide for not only their immediate family, but also their extended family and in-laws. The men are expected to carry active lifestyles and stay physically fit, while the women are expected to care for all the children and complete all domestic chores. There are also many women entrepreneurs here. We interviewed a woman named Violet, who ran a shop and a village phone in addition to her household duties. Women in the villages are not supposed to sit on the ground, as we quickly learned after being laughed at a couple times. People here laugh whenever something unexpected happens though; it is not necessarily because they are making fun of us. They even laugh whenever Meera impresses them with her fluent Runyankore.The children have the most beautiful smiles and like children everywhere, love sweets. Most of the children are currently in school. Their parents either send them to boarding school, or they attend the schools in the subcounty. The government is now aiming for universal secondary school in addition to universal primary school. Dennis told us that after secondary school, approximately 98% of the students are qualified to continue on to university-level education, but due to lack of funds only about 10% of the students actually get to attend.
ICTs
May 24, 2007
On Tuesday morning, our team, along with our Ugandan counterparts Ananias, Harriet, and Richard, had our first meeting with representatives from the Ministry of Health. We went in with few expectations, as we weren’t sure who was going to attend the meeting or what they knew about the project. The 9:30am meeting started at 10:30am (Uganda Standard Time!); the attendants included the Assistant Commissioner for ICTs for the Ministry of Health (Dr. Mukooyo Edward), the head of Clinical Services, and 4 staff members who work in data collection and records. The minister himself was supposed to attend, but he was delayed by a trip to Geneva where he was meeting with WHO. To spare you the details of the meeting, I can just say we were greeted with guarded skepticism about the project, particularly about the Smart Phone group’s project. The Ministry of Health is a highly performing sector of the government; therefore, they are very careful about endorsing just any new initiative. Understandably, they were critical about the project; but ultimately, they gave us some helpful words of advice. Namely, they told us that Ministry/government buy-in was critical, that sometimes the most simple technology can be more useful than a complicated one, and that any project should be practical and scalable. We had these criteria in mind before the meeting, but it was good to hear them reiterated by the Ministry. One main criticism we received was regarding our choice to study Nakaseke District for our project. Why, the Ministry representatives asked, were we going to Nakaseke when it was a perfectly well-off district? They wanted to know why we weren’t going to the north or the east. We explained our reasoning (that we had connections in Nakaseke, that we wanted to start in a place where we felt we would have the most initial support, etc), and eventually, the representatives reluctantly accepted that we would start in Nakaseke district. One dynamic I must mention regarding the project is cultural; our team is one of 4 women from UC Berkeley; the Smart Phone team (the other team from UC Berkeley) has 2 women and two men. The Assistant Commissioner made sure to point this out at the meeting. In addition, he asked Harriet (one of our counterparts who comes from the private sector and has no affiliation with the Ugandan government) to take the meeting notes, which perhaps is the job that goes to a meeting secretary. It was a strange role placement, and not one that went unnoticed by all meeting attendants. After the official meeting, Dr. Mukooyo gave us a tour of the MoH facilities; ICTs are definitely playing a burgeoning role at the national level—we would soon see what role they could play at the district and grassroots later…
Deliver us!
May 23, 2007
Today we had the most incredible experience while visiting a Traditional Birth Attendant (TBA) in Ngoma parish named Prossy Katate. A young girl (only 15 years old) was delivering her first child and Prossy invited us back into the "delivery room" to observe. The girl, Fiona, gave birth to a son just before we entered the room and Prossy was massaging the baby’s chest as he was having difficulty breathing. We all squished into the room and I continued to massage the baby’s chest where he lay at the end of the bed and Meera held Fiona’s hand as Prossy helped her to deliver the placenta (Amanda assisted by passing cotton swabs while Jess presided over the whole operation) - quite the hands-on experience! J Fiona, as do most women in the village, delivered without any pain medication (despite needing an episiotomy) although Prossy informed us that she does have drugs for which she charges extra. Prossy runs an efficient and busy practice and while we waited to speak further with her about her work she delivered yet another baby and two other women sat in a side room in the early stages of labor. I was impressed not only to see Prossy using latex gloves throughout the earlier procedure but also that Fiona received fluids from an IV drip of saline hung from the window. Perhaps most amazing though was that each woman delivered her child in complete silence (talk about a high pain threshold). Interestingly, we later learned that one reason so many women visit Prossy is that she does not make them take the HIV screening test required by the local health center in order to deliver at those facilities. Prossy indicated that one of the greatest challenges she faces is a lack of assistance and equipment (e.g., forceps, cotton, suction balls to clear a baby’s nose, etc.) particularly since her method of sterilization is to boil things in water which takes time. For example, he has a limited number of forceps and if she sees many clients in one day it is difficult to sterilize the equipment in between each visit. I have to admit that when we visited another facility at a higher level and I saw a number of forceps lying around I had to resist the STRONG urge not to pocket one to send back to Prossy. In the past few days we have seen a wide range of health services ranging from a traditional village healer who uses herbals remedies to treat various conditions to a level 4 health center with a fully equipped operating theater and maternity ward. Unfortunately, the operating facility has not been functional for six months as the doctor left the health center and the maternity ward is not yet opened due to additional staffing issues. Overall, the main issue we have come across is that people are primarily dealing with malaria, cough and HIV although malaria truly seems to be the most pressing concern. Access to reliable emergency transport is clearly a need as well and this is further compounded by the inconsistent care available at different health centers.The greatest finding thus far is that the lack of network (or a consistent connection) is the first barrier to promoting positive health outcomes and that this must be established prior to further work in developing a plan for communication for health improvement.Thus far, we have had a truly eye-opening experience and people have been so welcoming and friendly. They are always willing to speak with us and share their stories even when we are asking for personal information. Later in the week we are off to some higher level facilities where we anticipate that our discussions about communication and opportunities for mobile phones will be fruitful.We’ll keep you posted about our further hands-on health escapades – I heard mention of a surgery later next week!
Who said Nakaseke was "ok"?
May 24, 2007
The Assistant Commissioner Health Services of the Resource Centre (Health Info and ICT) for the Minister of Health said that health issues and connectivity in Nakaseke district was all "ok" (See Meera’s posting about the meeting). We found something very different in the field. After a somewhat nerve-racking journey three hours into the bush we arrived in a remote trading center, Ngoma. There is network (cell phone coverage) there, but only under a certain tree in town.
During the next few days we found that every parish that we visited had either no network at all or only in certain places and at certain times. The main concerns at the different health clinic levels were transportation and supplies, not connectivity. Most villages had a village phone operator (not the Grameen foundation type since most were men) who sells airtime to people that need it. They purchased a cell phone with a cable and antenna that picks up the faraway network. We stood next to the village phone with our phone and found no service, but the village phone often had perfect service. Unfortunately, the health workers feel that it is not cost-effective to use the village phone. One minute costs $0.25. A quarter in the rural areas is a lot of money and that is only for one minute. The health workers would rather travel to the district hospital or Kampala directly than pay for phone calls that are expensive.
Again and again we’re finding the same information in these areas. The telephone companies need to expand into this region and provide network before mobile phones can be implemented here. We’re now focusing our research and time in areas of Nakaseke with network. It’s only a matter of time until all places here have network, though, and the plan we develop will be scalable to all places of Nakaseke.
On a lighter note, my name, Amanda, means "charcoal" here and as we were passing a truck full to the brim of charcoal Meera had a vision of us atop the charcoal in the truck seizing my destiny.
~Meera, Ali, Jess, and Amanda
2 comments:
Hey, meera (and everyone else!). Your blog is really interesting...We'll keep checking on it. Hope you're doing well--the pics of Patience are adorable. We are in Zanzibar now, heading to the east coast (Uroa) tomorrow after spending last week in Kenya, the Masai Mara mostly. Have fun! -Aarthi and Brian
Hey Jess! Glad to see you made it - the last posting that had "Jess should be here in about an hour" was relieving. Uganda sounds like people are very lovely and, well, human. Don't catch any nasty diseases, dearie!
Mags
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