Courtesy of Meera...
http://picasaweb.google.com/meerachary/
BlumCenterICTImplementationGroupPhotos?authkey=bYnloQ0-8fo
(for funny photos, email us!)
Wednesday, June 20, 2007
Monday, June 11, 2007
Until next time...
I hope Meera and Ali have returned home safely. Amanda should now be in Tanzania, enjoying the sun and water. I miss the rest of the team already! The past 3 weeks have simply flown by.
Last Friday, both teams presented findings and recommendations to the Ministry of Health, the Uganda Communications Commission, and Microcare. The meetings lasted 2 hours, with plenty of time for discussion, and the Ministry seemed genuinely interested in what we had to say. They were especially surprised by our reports on the conditions in Nakaseke; at the previous meeting, they expressed their belief that Nakaseke was "ok" and were shocked to learn that there was only spotty network, inconsistent electricity, poor roads, and a lack of supplies and staff. George Sharffenberger, Executive Director of the Blum Center, also presented on the Blum Center for Developing Economies and its role in this project. Afterwards, we met with the Member of Parliament for the Nakaseke District, who also happens to be the Minister of Gender. For the most part, it seems like everyone is interested in continuing to support the work that is being done and the next steps for us are to continue information and document retrieval and hold "healthy discussions", a favorite term of the Celtel COO, with potential partners about the possibility of a pilot. I am sad that the on-site part of this research project is over so soon, but as Meera said, who knows what opportunities will arise going forward. We will keep in contact with all the wonderful people we have met and maybe one day we will get a chance to come back.
I wish I had some more pictures to post, but unfortunately my camera was spoiled, as they say here, before I left Berkeley. Rest assured, though...the rest of the team will be uploading all the pictures soon and we will post a link on this blog. Stay tuned!
Last Friday, both teams presented findings and recommendations to the Ministry of Health, the Uganda Communications Commission, and Microcare. The meetings lasted 2 hours, with plenty of time for discussion, and the Ministry seemed genuinely interested in what we had to say. They were especially surprised by our reports on the conditions in Nakaseke; at the previous meeting, they expressed their belief that Nakaseke was "ok" and were shocked to learn that there was only spotty network, inconsistent electricity, poor roads, and a lack of supplies and staff. George Sharffenberger, Executive Director of the Blum Center, also presented on the Blum Center for Developing Economies and its role in this project. Afterwards, we met with the Member of Parliament for the Nakaseke District, who also happens to be the Minister of Gender. For the most part, it seems like everyone is interested in continuing to support the work that is being done and the next steps for us are to continue information and document retrieval and hold "healthy discussions", a favorite term of the Celtel COO, with potential partners about the possibility of a pilot. I am sad that the on-site part of this research project is over so soon, but as Meera said, who knows what opportunities will arise going forward. We will keep in contact with all the wonderful people we have met and maybe one day we will get a chance to come back.
I wish I had some more pictures to post, but unfortunately my camera was spoiled, as they say here, before I left Berkeley. Rest assured, though...the rest of the team will be uploading all the pictures soon and we will post a link on this blog. Stay tuned!
Tuesday, June 5, 2007
Back in Kampala
After two weeks in Nakaseke, the two Blum Fellow teams decided to meet up for a weekend of debriefing (and, yes, relaxing!) at the amazing Murchison Falls National Park in Northern Uganda. We saw the view from the top of the falls on Friday, and went for a pre-dawn game drive on Saturday morning. This is the African landscape you see in the movies-- sprawling Savannah, wide trees, cavorting cob and waterbuck... it was beautiful! We saw everything from hippos and warthogs to the elusive leopard and lions. An afternoon boat ride brought us close to hippos and (yikes!) crocs, and to the bottom of the falls. It was a great weekend.
Between the game drives and boat rides, the two groups had a chance to meet and exchange what we had learned and saw so far. What we found is that the two groups had vastly different experiences. This was partly because we were working in different regions, but mostly because we had different objectives and thus went into our interviews asking different types of questions. The other group was focused on a sophisticated smart-phone technology that would make data collection and dissemination digitized. And in the districts that they visited, people some health centers were already using these types of devices, to varying degrees of success. The group was excited to see what smartphones could do for Nakaseke.
Our group's optimism was a bit more guarded. Because we saw a number of technologies in Nakaseke that failed due to lack of maintenance, we are not convinced that putting smartphones in the hands of village clinics is the best idea right now. But we are excited to see what the smartphone group learns this week in Nakaseke district.
We, on the other hand, are camped out in Kampala for a week of meetings on the backend side of things. We've been to the field and seen how things are, and now we want to talk to the people who can change things at an institutional level. Thus far, we have talked with representatives from the Uganda Communication Commission (which plays a role similar to the FCC in America), Celtel Uganda (one of the major cellular/broadband/landline providers), MTN Uganda (another cellular provider), and SEVO (a national volunteer first-aid/ambulance service organization). These meetings have been incredible, and at times I wish we had had them at the beginning of our research.
All of these stakeholders are interested in the type of project we are considering, and all of them had both insight and advice to contribute. More importantly, many of these entities are ready and willing to partner with us to provide service or support. For example, the Celtel COO said that they would be willing to discuss providing subsidized rates for an emergency health hotline in Uganda (think 911), which could link patients to the services that currently exist but are underutilized due to lack of access and awareness.
We have more meetings like that this week, culminating in our final meeting with the Ministry of Health on Friday, where we will present our findings and recommendations. Let us clarify, by no means do we think these recommendations will be final or complete. They are simply another step in the long road towards improving health care in Nakaseke and Uganda in general. But we do hope to shed new light on the situation to the Ministry Officials who will be working on this going forward, and also to guide further research by other Blum Fellows. Who knows? We've all expressed an interest in continuing our own involvement with this project-- perhaps our adventures in Uganda will not end so soon after all?!
Between the game drives and boat rides, the two groups had a chance to meet and exchange what we had learned and saw so far. What we found is that the two groups had vastly different experiences. This was partly because we were working in different regions, but mostly because we had different objectives and thus went into our interviews asking different types of questions. The other group was focused on a sophisticated smart-phone technology that would make data collection and dissemination digitized. And in the districts that they visited, people some health centers were already using these types of devices, to varying degrees of success. The group was excited to see what smartphones could do for Nakaseke.
Our group's optimism was a bit more guarded. Because we saw a number of technologies in Nakaseke that failed due to lack of maintenance, we are not convinced that putting smartphones in the hands of village clinics is the best idea right now. But we are excited to see what the smartphone group learns this week in Nakaseke district.
We, on the other hand, are camped out in Kampala for a week of meetings on the backend side of things. We've been to the field and seen how things are, and now we want to talk to the people who can change things at an institutional level. Thus far, we have talked with representatives from the Uganda Communication Commission (which plays a role similar to the FCC in America), Celtel Uganda (one of the major cellular/broadband/landline providers), MTN Uganda (another cellular provider), and SEVO (a national volunteer first-aid/ambulance service organization). These meetings have been incredible, and at times I wish we had had them at the beginning of our research.
All of these stakeholders are interested in the type of project we are considering, and all of them had both insight and advice to contribute. More importantly, many of these entities are ready and willing to partner with us to provide service or support. For example, the Celtel COO said that they would be willing to discuss providing subsidized rates for an emergency health hotline in Uganda (think 911), which could link patients to the services that currently exist but are underutilized due to lack of access and awareness.
We have more meetings like that this week, culminating in our final meeting with the Ministry of Health on Friday, where we will present our findings and recommendations. Let us clarify, by no means do we think these recommendations will be final or complete. They are simply another step in the long road towards improving health care in Nakaseke and Uganda in general. But we do hope to shed new light on the situation to the Ministry Officials who will be working on this going forward, and also to guide further research by other Blum Fellows. Who knows? We've all expressed an interest in continuing our own involvement with this project-- perhaps our adventures in Uganda will not end so soon after all?!
Thursday, May 31, 2007
Take-Aways to Date
It’s quite remarkable that after only 10 days of working within Nakaseke District, our team has really come to understand how the health care system works.
Well, sort of.
We’ve visited multiple health centres, Village Phone Providers, and traditional healers in each of Nakaseke’s 8 sub-counties. We’ve toured the district hospitals and spoken with countless nurses, doctors, clinical officers, and midwives. We’ve seen disease incidence reports and noted drug inventories. But as Amanda mentioned, we are constantly plagued by contradictions and inaccuracies in our data collection. More importantly, we struggle at times to actually define what the core issues are.
Somewhere along the dusty roads, however, we have come to a few realizations:
- Communication, in and of itself, is not a silver bullet here. Any communication solution needs to address correlating issues: lack of cellular network, lack of transportation and poor road conditions, understaffing, etc.
- Sustainability and local ownership is the key to any solution. We have seen far too many Western-funded projects here that have fell into ruin due to poor maintenance and expensive ongoing costs. Any community project should use already-identified local leaders, such as the community health mobilizers that are attached to the Health Centre IIIs and who are already doing great work.
- Culturally, communication means different things to different people. This applies to both the difference between communication here and in the West, where a patient may feel comfortable calling a physician to ask for medical advice. It also applies to the difference between urban and rural areas in Uganda, where communication plays differing roles to different people. Physicians at Kiwoko hospital wanted internet access. But for a rural health care provider at the village level, communication meant simply being able to easily access the bigger hospitals with transportation such as motorcycles or pickups.
While these impasses are great, our team sees promise and potential in the health care system here. As infrastructure improves, more health care providers will move to rural areas to live and work. Improved roads will give poor villagers better access to health care in district hospitals. And most importantly, the beautiful and motivated people we have met along the way will continue to work hard to improve the health care system in Nakaseke and Uganda as a whole.
Well, sort of.
We’ve visited multiple health centres, Village Phone Providers, and traditional healers in each of Nakaseke’s 8 sub-counties. We’ve toured the district hospitals and spoken with countless nurses, doctors, clinical officers, and midwives. We’ve seen disease incidence reports and noted drug inventories. But as Amanda mentioned, we are constantly plagued by contradictions and inaccuracies in our data collection. More importantly, we struggle at times to actually define what the core issues are.
Somewhere along the dusty roads, however, we have come to a few realizations:
- Communication, in and of itself, is not a silver bullet here. Any communication solution needs to address correlating issues: lack of cellular network, lack of transportation and poor road conditions, understaffing, etc.
- Sustainability and local ownership is the key to any solution. We have seen far too many Western-funded projects here that have fell into ruin due to poor maintenance and expensive ongoing costs. Any community project should use already-identified local leaders, such as the community health mobilizers that are attached to the Health Centre IIIs and who are already doing great work.
- Culturally, communication means different things to different people. This applies to both the difference between communication here and in the West, where a patient may feel comfortable calling a physician to ask for medical advice. It also applies to the difference between urban and rural areas in Uganda, where communication plays differing roles to different people. Physicians at Kiwoko hospital wanted internet access. But for a rural health care provider at the village level, communication meant simply being able to easily access the bigger hospitals with transportation such as motorcycles or pickups.
While these impasses are great, our team sees promise and potential in the health care system here. As infrastructure improves, more health care providers will move to rural areas to live and work. Improved roads will give poor villagers better access to health care in district hospitals. And most importantly, the beautiful and motivated people we have met along the way will continue to work hard to improve the health care system in Nakaseke and Uganda as a whole.
Friday, May 25, 2007
Kampala and Nakaseke
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
Sunday, May 20, 2007
Day 1 Kampala
Ali and I met up at the airport and cabbed together to meet Meera at our hotel. It's an amazing place and we don't want to leave, but many others seem to know of its beauty and there are no rooms for tonight or tomorrow night. Hopefully we can stay here again after our time in Nakaseke district.
We are currently relaxing under a tree in the courtyard reading books and getting acclimated to the heat of Uganda. Kampala's not like I thought it would be. There's a huge mall complex with a gym and bowling alley and more developed buildings than I expected. Jessica arrives in about an hour and then we're going to run errands and get ready for the week. Tonight we're having dinner with Dennis and Harriet, two colleagues in Uganda, at a local fast food place. I'm intrigued by the idea of local fast food.
Hope all is well!
Saturday, May 19, 2007
Village Life....
Before I start with ICT information, I must digress into talking about my visit to my old village-- I found that it, too, relates to our project...
The 8 hour bus ride to Bunena quickly squelched the utopian vision I had of Uganda-- after two hours of waiting in the bus park, we finally ambled off for the dusty ride, complete with the requisite snake oil salesman peddling his wares and giving his (apparently convincing) salespitch for the first 20 minutes of the ride (he had at least 10 takers!) However, arriving in the village erased all memories of the bus ride-- I was greeted by Stella (my best friend in the village from Peace Corps) and her (now enlarged) crew of about 15 kids! It was great. The neighbors came over and we ate all of my favorites-- matooke, beans, groundnut sauce, millet, rice... the even baked a cake! (Surely a double gesture, for I had taught them how to bake cakes during my stay there.) That night, after a warm bucket bath under the stars, I slept well.
The next day was not so joyous, however. We woke to the news that a local boy had died, not 200 meters from the house, while cutting a tree that fell on him. We watched the parade of people troop to the site of the accident, including his mother, who was wailing as she walked down the path. We heard that the parish priest, upon seeing the boy, had collapsed himself, from shock at the site. It was really a bad morning. People spent the day talking about what a good boy he was, what good prospects he had in his future. "It was his day." or "It was God's will" was the familiar refrain... I heard that a lot in my two years there...
But, as is common in life, there are opposing forces. There were as many new lives in the villages as passings, and I saw so many babies that weren't there when I left. Even the boy's funeral was a surprisingly upbeat occasion, as I saw so many old faces who I wouldn't have seen otherwise... People talked about the boy's life, and the mood, although somber, was one of community and faith.
I spent my last night at the home of Kandole and Kobusingye, one of my favorite families in the village. They are a hard-working couple, both teachers, with (I think!) 7 kids, from 16 to 2 years in age. They really value education and their children, and they also visibly love each other, which is rare... I love being in their home, it is always a pleasure. However, even misfortune had overtaken this house. Recently, Kandole had been bitten by a snake, rendering his right leg useless. He recalled the incident, saying that it was so difficult to travel to the hospital just to get antibiotics from the clinic. So enters ICTs into the picture. Had Kandole been able to merely call a nurse and explain the situation, he may have saved himself and his family the time and money it took to travel to town to see the nurse. I explained my project to my friends, and everyone agreed-- if they just had someone they could CALL and talk to about their health issues, a lot of time and money would be saved.
Cell phones are ubiquitous in the village. Everyone has one, and those who don't can use the ever-present "Village Phones" located in almost every shop on a fee-per-use basis (even Stella has one). This is one of the biggest changes I see in the village-- it is so easy to connect to the outside world. Our project seeks to provide someone they can connect TO.
Two of the teammates (Ali and Amanda) have arrived in Kampala now. We are awaiting the last (Jess) tomorrow. Then our real research begins!
Until then,
Meera
The 8 hour bus ride to Bunena quickly squelched the utopian vision I had of Uganda-- after two hours of waiting in the bus park, we finally ambled off for the dusty ride, complete with the requisite snake oil salesman peddling his wares and giving his (apparently convincing) salespitch for the first 20 minutes of the ride (he had at least 10 takers!) However, arriving in the village erased all memories of the bus ride-- I was greeted by Stella (my best friend in the village from Peace Corps) and her (now enlarged) crew of about 15 kids! It was great. The neighbors came over and we ate all of my favorites-- matooke, beans, groundnut sauce, millet, rice... the even baked a cake! (Surely a double gesture, for I had taught them how to bake cakes during my stay there.) That night, after a warm bucket bath under the stars, I slept well.
The next day was not so joyous, however. We woke to the news that a local boy had died, not 200 meters from the house, while cutting a tree that fell on him. We watched the parade of people troop to the site of the accident, including his mother, who was wailing as she walked down the path. We heard that the parish priest, upon seeing the boy, had collapsed himself, from shock at the site. It was really a bad morning. People spent the day talking about what a good boy he was, what good prospects he had in his future. "It was his day." or "It was God's will" was the familiar refrain... I heard that a lot in my two years there...
But, as is common in life, there are opposing forces. There were as many new lives in the villages as passings, and I saw so many babies that weren't there when I left. Even the boy's funeral was a surprisingly upbeat occasion, as I saw so many old faces who I wouldn't have seen otherwise... People talked about the boy's life, and the mood, although somber, was one of community and faith.
I spent my last night at the home of Kandole and Kobusingye, one of my favorite families in the village. They are a hard-working couple, both teachers, with (I think!) 7 kids, from 16 to 2 years in age. They really value education and their children, and they also visibly love each other, which is rare... I love being in their home, it is always a pleasure. However, even misfortune had overtaken this house. Recently, Kandole had been bitten by a snake, rendering his right leg useless. He recalled the incident, saying that it was so difficult to travel to the hospital just to get antibiotics from the clinic. So enters ICTs into the picture. Had Kandole been able to merely call a nurse and explain the situation, he may have saved himself and his family the time and money it took to travel to town to see the nurse. I explained my project to my friends, and everyone agreed-- if they just had someone they could CALL and talk to about their health issues, a lot of time and money would be saved.
Cell phones are ubiquitous in the village. Everyone has one, and those who don't can use the ever-present "Village Phones" located in almost every shop on a fee-per-use basis (even Stella has one). This is one of the biggest changes I see in the village-- it is so easy to connect to the outside world. Our project seeks to provide someone they can connect TO.
Two of the teammates (Ali and Amanda) have arrived in Kampala now. We are awaiting the last (Jess) tomorrow. Then our real research begins!
Until then,
Meera
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