Week 4

07/06/2010
I miss good sleep! It was cool enough last night, but the traffic outside our windows begins promptly at 4am. Every driver also has an obsession with the horn and taxis beep every 3 yards to gauge pedestrian’s interest in their services as if they would not simply raise their hand or wave. There is also a night club on the next block and the music is blaring all night long. I will be glad to get out of the city and into a more rural area.
Today, we met with David. David is one of the founders of the clinic that we will be working with in Pallisa. Interestingly, he is also a politician who is running for parliament. He had a lot of good information for us about the basic operation and population served. The clinic is funded by the Ugandan government and through some charitable work through other sources. According to David, the clinic serves 12 sub-counties and about 50k people overall. He mentioned malaria, HIV, and cholera among the top health issues. He also said that the staff also organizes education within the community and especially in the youth. He also introduced us to Simon, who is the founder of Young Uganda. His organization is Christian faith based and they work on education of youth. We still have a lot of questions that we all agreed would be better answered by the medical staff at the clinic. We agreed that we will travel to Pallisa on Wednesday. We plan on visiting his home in Kampala tomorrow to meet and have dinner with him and his family.
After our meeting, we walked to a nearby tourist market that we have visited before. We were there for a few hours browsing and then chatting with some new friends that Julisa made, Faith and Suzan. We then crossed the street and hung out at 1000 cups, which is a coffee shop that is makes Ugandan grow coffee and also provides tours of their farm. Visitors get to grind their own coffee and take it with them. It seems like a neat experience. We then decided to head to a Bahai Temple that is on the outskirts of Kampala. Bahai, from what I understand is a very broad religion that incorporates the beliefs of many religions as being similar. I only know what Julisa explained, but I am interested to read up on it. After a long taxi drive through some very poor areas and bad roads we arrived and it was closed. We headed back to meet with Dustin. Dustin was finally able to coordinate internet access. We spent some time setting up our computers and then went to have dinner. At dinner our group all expressed that we have some concerns about the expectations of the clinic, medical staff, and the population. Dustin’s contact who has worked in the area said that it will be difficult to convey that our role is to do assessment and not provide care and medications. She said that the population has become accustomed to receiving aid and particularly western medicine. She feels as though they have abandoned good traditional practices that work for the western medicine that is pushed by the religious medical groups that have provided aid in the area before. The plan for tomorrow is to get some last minute supplies that we expect will not be available in Pallisa and to have dinner with David.
08/06/10
We went out into town again to try to find some other things that we think will not be available. It is still a little unsettling that we do not know much about Pallisa, where we are going. We got back to the hotel in the afternoon and then later went out for to a few other local night life places. We went to a place called Kicking It, which is a sports bar and restaurants. Getting there was a little scary. We took bodas, the motorcycle taxis, three to each including the driver. We had ridden these once before, but it was very late when there was no traffic and we were buzzed. This time it was still rush hour and we were sober. I had a really hard time trying not to control which way we leaned as we squeezed in between cars and I thought for sure we were not going to make it there without at least getting into a fender bender. None of the drivers knew the place by name so Dustin was leading the group. The two groups that were following Veronica and I on one and Chris and Ciara on the other were separated from the leading boda which Dustin and Janessa were on. We ended up going to far and then Dustin reached Chris by cell and guided them and or driver followed. We met a few friends of friends of Dustin’s contacts. While we were there Carol the site leader for Embarara, where Janessa and Ciara will be going, arrived. She had just arrived a few hours earlier, dropped her bags at the hotel and came out to meet us. After we ate there we headed to another place, Cayazze, another restaurant/bar/club that is part of a hotel. It was a nicer place and it was clean and the music was pretty good. I was feeling pretty miserable though. I had taken my Lariam and I was feeling the adverse affects. I was nauseas, anxious and just feeling generally lousy. I didn’t feel much like dancing and I just watched everyone as the group did. I felt bad about not participating, but I really wanted to be in bed. After a while, I threw up and I felt a little better. I danced a little bit after that and then we headed back to the hotel with Jude, Dustin’s friend who had his car. David came with us back to the hotel and there he headed to find a boda to take him home.
09/06/10
Today we are leaving to Pallisa and I woke up a little nervous. We didn’t pack last night, we had about 2 hours to get ready and eat, but I was hopeful that David (from Pallisa) would be on Uganda time. No such luck though, he arrived at 930hrs, thirty minutes early. Simon also planned on traveling with us, but he did not fit, so he said he would meet us later in Pallisa. Simon is the founder of Young Life Uganda. He works with David in coordinating efforts to find resources for assisting the clinic and also an NGO for the education of children. We were ready a few minutes later, but Dustin and Chris had not started to pack. At least it wasn’t Veronica and I he was waiting for. We packed our entire luggage to the ceiling of the Land Rover and we were on our way to Pallisa about 1030hrs for what David said would be a 2 ½ hour drive, except we had to stop at the cell phone store to try and fix our internet modem. I guess the anxiety was getting to me because even though I knew that it was not going to be quick, I couldn’t help getting inpatient as they tried to fix the problem. About 2 hrs later we were back on the road. The back windows would not go down and it was miserably hot with three of us sitting in the back. I think we all fell asleep for a while. About 2 hrs later we reached Jinji, a major town on the way to Pallisa, and stopped for lunch and a break. It was already nice to be out of the big city. The air was cleaner. David received a call from the clinic requesting IV fluids, so he said we needed to eat quickly so that he could stop along the way and get some. We ate in about 30 minutes got back in the car. The rest of the drive was trough some farming areas with a few small towns/villages sprinkled in between. We reached Pallisa town in about another 2 hrs and stopped at a Pharmacy as we entered the town. David picked up what he needed and we were on our way again. I thought it would only be a few more minutes down the road because the roads had been good so far and we were already in Pallisa, but that was not the case. We turned off the main road onto a dirt road, which seemed to get worst and worst. The boxes of IV fluids started shifting and soon Chris and I were struggling to keep them from falling forward on top of us as we bounced around. We made it to the Country Inn, home for the next two months, about 30 minutes later. Simon was already there. It turned out to be a very nice place by Ugandan standards for Rural accommodations and I certainly felt better here already then I ever did in Kampala. It was cleaner and better maintained. We headed out to Agule clinic to meet everyone there and introduce ourselves. It was about another 15 to 20 minute drive down a very rough dirt road to get to the clinic. We arrived and were introduced to everyone. We talked a little about what we would be doing and briefly on some of the expectations. We explained that our role is research and that our work would serve to access the needs of the community so that resources could be allocated and, potentially, funding could be sought. Although they acknowledged this idea, the conversation seemed to always come back around to what we could do hands on, or so it seemed. We went back to the hotel had dinner and went to bed. Everyone was exhausted.
Interesting quotes by Simon;
It is better to be like the snail, travel a short distance, but leave a mark.
Blessed are the flexible, for they will not break
10/06/10
The plan was to introduce ourselves and research to the local authorities. We started fairly late under the guidance of Simon, because he said that it is rare for a government official to be in the office before 10am. He also mentioned that they take 2-3 hour lunches. We met with too many officials to remember all the names, but basically we met the representative to the president on behalf of the people, the head of the ministry of education, the head of security (does not mean what it sounds like, but I don’t have a clear understanding of their duty), the sheriff, and the head of the ministry of health. Simon basically introduced the group and some background on our research and we had brief meetings with each area and requested support from them in our efforts. I gathered though that their support would be vicarious as really what we were there for was just to inform them that we are here and that if anyone called to inquire about us that they had knowledge of us and our project. We were done with the meetings and a walk around town to get oriented about midday. We walked back to the hotel for lunch and Simon and Charles, our driver and camera person went off to take care of some errands. They said they would be back at 3pm to take us to the clinic to try and iron out some plans with the doctor and staff for the “outreach” events. We had lunch, which has been consisting of rice, matooke, chicken, some kind of meat, and a drink. Before we left our team sat down to sort out how the meetings should go, because we were all feeling like there had been some miscommunication and there was some misunderstanding between what our roles would be and what the Agule administration and Simon expected. We headed back to Agule at about 3 to discuss our plans further with the clinic administration, with the understanding that we needed to continue to affirm that our roles were to conduct research and not provide treatment. The meeting revolved around the number of “outreaches” and what we were going to provide to the community. The meeting was a little tense and we agreed that before we could make any concrete plans we needed to get cost of supplies/medications. They were focused on how much money was budgeted and Simon on several occasions had already inquired as well. We were not on the same page. The intent of the program was to provide some consumable goods to the community, but the focus is the qualitative research. We debriefed at dinner and we all agreed that we needed to continue to emphasis this. The plan for tomorrow is to visit Gogonio Village to inform the village government that we plan on conducting some activities in the village on Friday.
11/06/10
We headed out to Gogonio with the four of us, Simon, and Charles (our driver). Gogonio is a peninsula into the area’s largest lake and the area identified by the clinic staff as the area most affected by mosquitoes. We drove about 5-6 kilometers and arrived in Gogonio about 30 minutes. The meeting with the govt officials started out well and then Simon suggested that Veronica and I speak with the group that was sitting outside. I was irritated by this because Simon had overstepped his role and was starting to direct the work, research, that we were doing. We reluctantly went out and started to superficially explain what we would be doing and asked some broad open ended questions about health. It could have gone worst, but it did not go well. Simon communicated to them that we would have testing and anti-malarials, but we have no information on cost or if it’s even going to be possible. He is putting us in a very bad place with the community. I was looking forward to leaving after that but we had to visit the Health Center. We met there again with who had been introduced in Pallisa as the area statistician. He actually runs the clinic in Gogonio, which makes it easier to understand why there is no updated statistic information for the past ten years. After a brief meeting, since he knew what we were doing already, Simon insisted that we go see how bad the mosquitoes were further towards the lake. As we were leaving the clinic, the nurse asked if we would take a mother of twins in the direction we were going. She had come to the clinic to get treatment for the babies, who were thought to have malaria. She had gone to the clinic in Opeta, but they did not have any malaria medication. She paid for a boda boda (motorcycle) to bring her the 3km to Gogonio, but there was no medication there either. She had riden there with two newborn twins and her other child, who looked about 10yrs old, on one motorcycle! We squeezed a few people in the back of the SUV and took her and her children as well as the area security representative with us. We made it to where we could see the water and then we drove parallel along the shore until we reached an area where there were a few mud huts. Charles drove right up into the village and parks in between them. This was not a good thing and we got some not so happy looks. Simon immediately started to communicate to the group and even though I don’t speak the lanquage, I could tell that he was going the schpeal that he had gone through the in Gogonio. We were feeling very uncomfortable. We rolled into these peoples home, uninvited in this big SUV, and we were telling them what we were going to do. We told Simon that we wanted to go, but Charles had disappeared. When showed back up, he told us that the people a little further down wanted to say hi. Actually he was apparently going over the same stuff that Simon was. This was disastrous. It is going to be very difficult to reenter this community in a non-intrusive way and to talk to people, and get objective opinions. We went to say hi to the people further in so that we would not go against what our hosts wanted. We left there feeling miserable about what just happened. Not only did we damage our possibilities for good research, we entered their community like elitist dictating what was going to happen. We wanted to get back to the hotel as soon as possible, but Charles had made plans with a finger piano group to perform for us. We found out that this group had traveled to Gogonio just for this and had been there since the morning, waiting for us. Again we were put in a very uncomfortable situation. The group performed just for us four and the group leader made it obvious that he was looking for sponsorship. On the positive side the music was good and they put on a good show. It just would have been nice if it was not so contrived. We felt so bad about them spending all day there waiting for us that we all gave them more than just tips for their performance. When we got back to the hotel everyone was mentally exhausted and we all agreed that we need to take a nap and then meet later to discuss what had happened. When we debriefed, we all expressed the same frustrations. I was sure Dustin already knew, but he asked my opinion, so I told him he needed to talk to Simon about this even though it would be difficult and a sensitive topic. We all also acknowledge d that the way we entered the community was not the way to continue and not the way to get real feedback from the community. The next day was to be devoted to getting familiar with the operation of the clinic and to divulge how much is available for the “outreaches” and to try to finalize the plans.

12/06/10
On the way to the clinic we received a call from Simon asking us to turn around and pick up a student from his school, who was feeling ill. So we made it to the clinic about 1030 am. We didn’t miss much since the doctor had not arrived. We spent most of the morning getting familiar with the clinic, shadowing staff, and playing with the kids. The kids were pretty dirty, they run around bare foot, their clothes are in tatters, but most appear generally well nourished and happy. There a few concerning practices at the clinic that I encountered. When talking to the midwives I inquired about prenatal vitamin distribution, because I had seen a stock in the pharmacy. It turns out the standard protocol s to give pregnant mothers one prenatal vitamin during pregnancy. Also, for pregnant HIV positive mothers who should not breastfeed, they are told to feed their infants cow or goats milk as an alternate. There is no formula. The doctor called me into his office to palpate a patients liver. I found out later that the woman was 55years old. I would have guessed that she was in her seventies by her appearance. He called me in, since he said I would probably never see a liver so enlarged in western medicine. He was probably right the patient’s liver extended about 3inches below the costal margin, bulged out slightly, and was hard. He thought it was a late stage cancer. She had not been to the doctor before now.
Deborah, the administrative person at the clinic made lunch for us and we sat and ate with the doctor. After lunch we had a meeting with our group, the doctor, and the clinic chairperson under a tree on the property. So it started out again with how much money was available. Dustin let them know that there was only $800 as the memorandum of understanding stated, which was known to them prior to the start of the project. So after so back and forth trying to figure out what was possible with the funds available, we settled on a plan. We agreed that we would not us the doctor or the clinic staff, since there would not be any medication distributed. Instead of doing “outreaches” we would go door to door and use the funds to purchase only mosquito nets. The nets would then be distributed after we had completed our conversations with individuals as a token of appreciation, if they fit the population of vulnerability to malaria. We all felt relieved after the meeting that we were all on the same page now. So from now on we will be on our own for the most part, without Simon and Charles. Simon will also be busy with another group that is coming in through his NGO, so he should be out of our hair. Dustin heard from Julia that the leader of that group is a rougue ex-MHIRT student that never returned from his site and stayed here and has been coordinating aid and preaching. They say he’s very overzealous, so we are concerned about his activities and we want to stay clear of him and not be associate with his efforts in the eyes of the community.
Dustin was driving the car now. They left us with the vehicle to use. On the way back to the hotel we came across a chicken in the road that at first looked like it was sitting there, but as we got closer it was apparent that it had been injured somehow. Dustin tried to avoid it but it didn’t move out of the way quickly enough and we think the back tire ran over it. We talked about stopping and going back, but we didn’t. We talked about maybe stopping and finding out about whose it was and buying them another. I’m not sure it’s funny, but it’s the ongoing joke now.
13/06/10
Today was just a day to get caught up on our journals and work. We walked to the supermarket to get a few things and came right back and have not gone anywhere else. We did meet to peace corp workers that live here and teach at a school a few kilometers away. One of them, Joe, may join us when we do our getaway in the beginning of July. We have plans for later tonight to go watch one of the World Cup games at a local restaurant.