Access to Healthcare

Last Monday I visited Virika Hospital which is the second largest of the three hospitals in Fort Portal. Lucy, the nurse at the local clinic accompanied me as well as a Boston College nursing student and a doctor who are staying at the field station to the hospital. Like many hospitals in Uganda, Virika was religiously affiliated and the head administrator was a nun. Also typical of Uganda, the nun welcomed us, had us sign a visitors book, and quickly found someone to show us around. After touring the wards of the hospital (maternity, medical, pediatric, and surgery), I mentally rated the facility as “very nice.” Later I was thinking about how skewed my rating of quality health care is Uganda. In America, wards with 3 sections each with 8-10 beds would not be considered “very nice.” In the public wards each patient had a small, basic bed with a mosquito net, but there was no privacy . The private wards had two beds in a small room, but only wealthy patients could afford them. Not surprisingly, the private wards were almost empty while the public wards were crammed with patients. The pediatric unit was the busiest, which is not surprising considering the number of children in Uganda, but it was the surgical department where I saw the most lag with modern medicine. For example, one of the people I worked with for at Makerere University needed gallbladder surgery. The same procedure could be performed as a laparoscopic procedure in America, but would require invasive surgery in Uganda because the surgeons do not yet have the technology. At Virika, there was only one surgeon and then a minor surgeon whose job was to suture and perform small procedures (as there is no sort of emergency department).

Room in Private Ward of Virika Hospital

Library at Virika Nursing School

Yes, there are ways in which we can improve health care in our country, but this visit reminded me not to take for granted the cutting edge medical techniques and technology we have access to in America. The clinic Lucy works at, like many other clinics, has no access to labs, x-rays, or other basic tests and uses only symptoms to diagnose patients. A quick visit to the Nursing School affiliated with Virika made me value the resources I personally have access to just as an undergraduate university student. The Virika nursing library consisted of four bookshelves each with a few textbooks per nursing category. One part of the small bookshelves contained popular novels including the complete Harry Potter series. Last time I checked, Harry Potter is not quite relevant to learning to be a nurse.

Living in Kibale Forest

I arrived at the field station in Kibale Forest National Park this past Tuesday. 5 hours east of Kampala, Kibale Forest boasts the most variety of primates in East Africa. It had been surreal to see red colobus monkeys and baboons (among others) as I walk around the grounds of the field station. When I walked up to my room yesterday, I had to wait because a baboon tried to open the door next to my room and then sat on the windowsill beside my door for fifteen minutes. I guess I will have to get used to giving the baboons the right of way as Kibale Forest is my home for the next two weeks.

As serene as the national park may be, I did not realize leaving Kampala would mean the end of my independent experience in Uganda. The fieldstation feels like a mix between summer camp and a relaxing vacation as delicious breakfast and dinner are served at 7am and 7pm respectively, lunches are packed for the day, and tea is ready when we return. There are planned activities including chimp trekking, one-day safaris, and walks though the crater lakes as well as education presentations about the 20 year old chimpanzee study that takes place in Kibale Forest (by the director of the Kasiisi Project’s husband). We have latched on with group of educators and administrators from Weston, MA, who are working with the Kasiisi Project in the schools for the next two weeks). Latching on with a group of Americans means beginning to adjust back to western culture. The changes are small but still take some adjusting. For example, after adjusting to the quiet voices of most Ugandans, I forgot how loud groups of Americans can be. However, by starting the adjustment process now, it will ease the adjustment period when I return home.

Part of the Weston educators visit includes attending the large welcoming ceremony at the Kasiisi school. It was humbling to be welcomed by the primary school students through song, dance, poetry, and drama interludes. The six hour ceremony included students from all 5 schools associated with the Kasiisi Project and over one hundred parents and local community members. As the teachers and administrators participate in a cultural exchange-type program, Alice and I also have a schedule of our own which expands on our internship with MakaPads. My and Alice’s goal in the Kabarole district is to get feedback on student peer educators whose role is to provide information and support about girl’s reproductive health in the school. I will update you all more the next time I travel to Fort Portal, the main town, for internet!

Living in the MakaPads World

Processed papyrus paper mixed with water

Sun-dryed white paper waste

Although it is hard to believe a month has passed, I am leaving Kampala tomorrow. My internship with MakaPads had come to an end  but I was lucky to work with MakaPads during such a critical period as MakaPads is in the process of moving to the commercial market. Over the past month, we had the opportunity to see the many stages of production including the full production plant at Kyaka, the Congolese refugee settlement, the different production sites in women’s homes around the slums of Kampala, and the central office and workplace at Makerere University. Here is a quick overview of the production process (see above photos). First, the papyrus is cut from the swamp. Then the fresh-cut papyrus is mixed with water and white paper waste (shredded office paper) to form the absorbent. A second absorbent layer is made from only paper waste and water. Both absorbent layers are left to sun-dry and after, they are softened together. The absorbent layers are covered with an imported synthetic material and  lastly, the pad is sealed. A final quality check is performed at Makerere University, the sanitary pad is packaged, and packaged product is sterilized. This is the production process of the only organic, locally produced sanitary pad in Africa.

Dr. Musaazi of Makerere University invented MakaPads as an affordable solution to lack of sanitary towels for school girls. To keep the cost of the pad low, organizations need to donate the white office paper waste. In order to scale up production to prepare for moving to the commercial market, MakaPads needs more donated paper waste. As a result, Alice and I found ourselves visiting` banks, NGO’s, and embassies. Essentially working as a marketing intern for MakaPads and meeting with the various above organizations was a wonderful way for Alice and I to become familiar with the city of Kampala during our month here. Throughout our work with MakaPads, we visited various large organizations (both local and international), spent many days at Makerere University, one of the foremost universities in east Africa, and we saw the slums of Kampala when we visited the different MakaPads production sites.  We really got a small taste of the many parts of Kampala. But now our time in the city is up and we are off to the village…

Adjusting to “Africa Time”

Abseiling down Sipi Falls

As a Ugandan friend said today, “no one here is in a hurry.” I really thought I had adjusted to “Africa time.” I bring a book with me everywhere I go… meetings, lunch plans, taxi rides, weekend trips. But no experience better explains this cultural difference better than my and Alice’s weekend trip to Sipi Falls.

7:15 am – Buy tickets for 8:00 am Post Bus
7:50 am – Post Bus arrives
8:12 am – Post Bus departs

Not Bad. For “Africa time.” The bus trip began smoothly, but somehow this 4-5 hour trip turned into a 8 ½ hour adventure? Well, Ugandans may move at a slower pace, but they still know how to multi-task. Never was this more true than with the Post Bus. How were we supposed to know that this bus literally delivers the mail to every post office between Kampala and Mbale. Yes, we stopped at each and every post office along the main road. So once we realized we were riding around in giant mail truck, I decided to get comfortable and take in the many interesting things the post bus transported – a list that includes post mail, people, chickens, and human transplant organs. Yes chickens and human organs. At one stop a women sat in the empty seat beside me and placed a bag at her feet. Then the bad started to move and I realized she was carrying around a live chicken. Then there was the cooler with the human organs that had a paper attached that read “ transport immediately.” If only in America, immediately meant within 5 hours (give or take).

And this experience would not have been complete without the people. Catherine, who sat next to me for the last hour of the ride and talked about family, work, religion, and travels. She told me the name of each town as we passed through and how far we were from our destination. She told me how we choose the safest bus with the least number of accidents (at least we had that going for us). And, when we finally arrived in Mbale, she walked Alice and I to a taxi, made sure the driver spoke English, and gave him a stern speech (in Lugandan) about transporting us safely. Thanks to Catherine we arrived safely, in time for a fresh cooked dinner; we woke up the next morning for an amazing day of abseiling down the 100m high Sipi Falls and then climbing back up the waterfalls. The good news is the ride home was a quick four hours… complete with many more chickens.

At the Beginning

Menstruation is Healthy and Normal

As the world becomes smaller and more connected, opportunities to participate in global education experiences continue to grow. As a Human  and Organizational Development major with a concentration in Health and Human Services, I knew that a large number of service and research experiences would be available to me as created my summer project. I also knew I wanted to be involved in a global health related project that focused on a lesser known but vastly important health issue… a project focused on female menstruation in the developing world seemed to qualify in the “lesser known” category.

My summer project is a smart combination of working with the Kasiisi Project, an established U.S. based non-profit, and doing research with Technology 4 Tomorrow, a Ugandan based company. For four weeks, my Vanderbilt classmate Alice and I are living in Kampala, Uganda. We are conducting research for MakaPads, a Technology 4 Tomorrow sustainable development project that creates organic and locally produced sanitary pads for women and girls. We are helping research the socioeconomic effect that MakaPads production has on Ugandan communities and those employed by the company. Then Alice and I will travel to the Kabarole district in western Ugandan to work with a branch of the Kasiisi Project called the Girl’s Support Program. We are visiting the schools benefited by the Kasiisi Project and performing baseline research for development of a Girl’s Support Program in those schools. The purpose of the Girl’s Support Program is to develop peer educators who mentor their female classmates on feminine hygiene and health education issues. Ultimately, Alice and I wish to further ties between MakaPads and the Kasiisi Project, so that a MakaPads production plant could be created in the Kabarole district in the future.

This project has allowed me the unique opportunity of working firsthand with a global health-related project from both the perspective of a  American non-profit and a local Ugandan organization. This experience has already further sparked my interest in the global health sphere, and I realize that I want to take more classes not only on health delivery, but also on international development and health policy.

In the time I have been in Uganda, I am enjoying the adventure of learning about a new international city and culture. In one short week, I have discovered much about independence and self-sufficiency.  I realize that a gap exists between living independently in a university setting and life outside that self-contained community, However, I am excited by the memorable experiences that arise from the exploration of the unknown. In my 10 days in Uganda, I have already settled into my apartment in the bustling capital city of Kampala, visited Kyaka, a Congolese refugee settlement, and whitewater rafted class 5 rapids on the mighty River Nile. With 3 weeks of exploration still to come, I can only imagine what more lies ahead…