Monday, August 2, 2010

Health Coach Training in Uganda

I have uploaded a couple of pictures here:

Check out this video I made about VHT Trainings in Uganda:

Since I arrived in Uganda a month ago I have been wondering how such a dry place could have such richly green vegetation. By the end of my half-hour walk into the office each morning my clothes, skin, face, and mouth would be coated with dust kicked up by the trucks. We remarked how the weather was perfect -- hot but not too hot during the day and cool but not too cool at night, and an occasional sprinkle one or twice a week at the most, not enough to even wet your clothes. I could not understand how a place that seemed so dry could sustain a sort of jungle vegetation not so different from the rain-forests of Ecuador.

The paradox was resolved three days ago when we were walking home from the office for lunch and the skies opened up in a downpour, turning the dusty dirt road to wet clay and mud. This event has repeated itself at least once a day since then, and brings the days activities to a halt each time. It is on such a rainy morning that I take advantage of some remaining battery power in my laptop to write this.

The program that I am working with here is a remarkable one -- a local NGO called Volset is partnering with a US NGO called OmniMed and the local government to train "village health teams" with one community health worker for every 20-30 families. After a week's worth of training, these "VHTs" go back to their villages and start visiting the homes of their neighbors to collect information about the health status of their communities (how many families have latrines, handwashing places, plate drying racks, how many children are immunized, how many cases of malaria there are, etc). They collect this information to give to the local health centers but also work to educate their neighbors and encourage them to fill in the gaps in order to prevent disease and promote health. It is interesting to be a part of a program in this stage of "scaling up" and interesting to see the tradeoffs of training more and more VHTs versus ensuring good support for the ones who already have been trained.

Most of our time here involves working directly with the VHTs -- training them and following-up with those who have already been trained. And these VHTs are amazing, inspiring people, who do all this work with absolutely no reward except the knowledge that they are making a difference in their communities. They are all proud to tell us about how they are seeing their neighbors boiling water, building latrines, taking children for vaccinations. But it is not easy work. How do you insist that an old woman with several young grand children to take care of dig a latrine? How do you tell your neighbors to go to a Health Center when they are sick when more times than not a person will go to a health center, wait through a long line to see a doctor, be told that they have malaria, or TB, but the health center will have run out of medications so they will have to go to a private pharmacy to buy them. The result of this, of course, is that people begin to go directly to the private pharmacy, where they buy medication based on a self-diagnosis or the diagnosis of a nurse who runs the private "clinic" and save all the time and transport cost that a visit to a health center entails.

Which brings me to the bigger picture -- how can a country like Uganda, with all of this foreign aid, a stable government with strong US support not have medicine in their government health centers? People talk about how most of the money stays in the government for internal workings / kick-backs, which I am sure is a big part of the problem, but there is also a greater context. Most obviously and importantly is the legacy of colonialism which shapes so much of the way people think and the way things work. Then there is the fact that the Ugandan government spends so much money on security (sound familiar?) -- both for defense forces within Uganda and the troops they have sent to other countries like the Congo, Rwanda, Burundi, and Somalia. I actually wound up talking about all of this late at night by candlelight with one of the VHTs in his house. Under a roof made of papyrus and sheet plastic, this man listens to the BBC on a radio powered radio and gets a Kenyan newspaper once a week to stay up on what is going on in the world. He explained that the reason that Uganda has been intervening militarily in other countries is that the United States is using Uganda.

Crazy as it seems, I actually have less than 3 weeks left in Uganda. It is always a sad moment to realize that my time is drawing to a close and that I will be leaving behind all the friends I have made here. I do want to stay in touch and involved to the extent that I can, and one thing I've decided to do is find sponsors for one of the amazing young women I have met here, an 18 year old named Saida, to go to nursing school. I'll be going to Kampala with Saida tomorrow to visit nursing schools and find out all the details, but I think it is going to come out to about $100 a month for tuition, room and board for the three years of nursing school here. A substantial amount of money, sure, but it will transform her life and give her the skills to make a real difference in her community. Let me know if you or someone you know might be interested in contributing.