Monday, April 8, 2013

Stop Malaria Project Interview: Benjamin Omagor



As part of BAMM (Blog About Malaria Month) I will be featuring brief interviews with my coworkers at Stop Malaria Project (SMP) and Malaria Consortium (MC) in the Soroti office.
Note: SMP is implemented by MC, which provides technical assistance to the project.
 
Benjamin Omagor is a technical assistant employed by MC to work in SMP. 

  
A: Where are you from?
B: I’m from Soroti, in Arapai subcounty, Onyakai village.

A: What did you study?
B: I received a diploma in clinical medicine and community health from Mbale School of Clinical Officers. Right now I’m studying for a bachelor of science in health services management at Islamic University in Uganda in Mbale.  Afterwards, I will pursue a master’s degree in health economics or public health.  If all goes well, I’d like to do it at Johns Hopkins University, or study in London. 

A: Where have you worked before SMP/MC?
B: I was working as a clinician at Louis Memorial Medical Center in Kampala.  I was also working as a buffer trainer for Malaria Consortium in a project called ICCM (integrated community case management) which involves treatment of malaria, pneumonia, and diarrhea at the household level implemented by VHTs (village health teams).  Working those two jobs gave me a clear understanding of the difference of health service delivery between the elites and the rural poor.  

A: Why did you want to work for SMP/MC?
B: I have this enthusiasm to implement community based projects.  I realized that I could be of use based on the experience that I gained from working in a well-facilitated health facility.  Now during supervision, I see myself trying to create an improvement in rural facilities.  The job also brought me back home.  Since the facility I was working in had patients with health insurance, I began to think “is it possible for me to come up with an insurance package for the rural poor?” Coming back to Soroti made it easy for me to think how I can implement that, even though it’s still just an idea.  Slowly, I’m starting to see how I can kick-start that project.  The point is to help people that are really poor.  I’m also involved with a chicken project to help generate income for poor households.      

A: What drew you to work in public health?
B:  As a clinician, I was seeing people come with different illnesses to a facility. The fact that there is a possibility to prevent a disease drew me to public health.  Why does someone have to wait until they are sick to come a facility?  We can attack malaria from all fronts, from prevention to management.  It’s all connected.  The fact that I can work with communities and crowds also drew me in. 

A: What do you like most about your job?
B I’m really involved deep inside the fight against malaria.  It helps me also move to places, meet different people and study different aspects about human beings. 

A: What do you think is the biggest challenge in malaria eradication?
B: The biggest challenge right now is the eradication of the mosquito itself. We are now encouraging people to use barrier methods, like sleeping under nets.  In our environment, it is almost impossible to eradicate the mosquito with so many swamps, especially here in Teso, with all the fingers of Kyogo Lake.  You can’t drain the swamps and a mosquito can fly over two kilometers.  But we have gained a lot success in preventing deaths from malaria.   

A: What do you think could be improved in the malaria eradication campaign?
B: I think we need to take curative measures nearer to the communities.  More research should be done on sterilizing mosquitoes.  If you can’t do without the mosquitoes, at least stop it from carrying the parasite and transmitting malaria. Introducing scaling up of ICCM should also be done. Drugs should always be available and recruit enough health workers to treat children with malaria. Drugs are useless in the facility if no one can dispense them.

A: After SMP ends, what would you like to do?
B: I would like to work with health projects for about five years.  But, if it doesn’t come my way, I will do poultry or other business.  Or I could volunteer in rural health facilities as a clinician.  And of course, I want to pursue my master’s. 

A: Can you share a memorable experience from working at SMP?
B: When I did clinical audits in Ngora hospital, we discovered they didn’t have an emergency room in their OPD, or Outpatient Department. (Clinical audits are a way for health professionals to be assessed through clinical performance.  It involves setting standards, and the audits compare the reality to the standards.  It identifies gaps that need to be addressed.)   So, for the first time, I saw that the administrators took it seriously.  Before I left, they identified a room to be set up for the emergency room.  It impressed me that they took it very seriously.

Stop Malaria Project Uganda is one of many organizations that host a Peace Corps Volunteer in partnership with Stomping Out Malaria in Africa. The initiative mobilizes and connects over 3,000 Peace Corps Volunteers in 23 countries in sub-Saharan Africa to work together to eradicate malaria from the continent. To learn more, please visit: http://stompoutmalaria.org/.     


Photo of Fred (from last interview)





                                                
 

Friday, April 5, 2013

Stop Malaria Project Interview: Fred Akol



As part of BAMM (Blog About Malaria Month) I will be featuring brief interviews with my coworkers at Stop Malaria Project (SMP) and Malaria Consortium (MC) in the Soroti office. Photos to come later!

Fred Akol

A: Where are you from?
F: Soroti District

A: What did you study?
F: Social Sciences for Bachelors’ degree, Public Health for Master’s degree, and a diploma in Project Planning and Management.

A: Where have you worked before SMP/MC?
F: AMREF (African Medical and Research Foundation) as a project officer for HIV/AIDS, TB, and Malaria. Before that, the Landmine Awareness Trust in Soroti.

A: Why did you want to work for SMP/MC?
F: I saw the activities for fighting malaria which is the main killer disease for the region and country.  Secondly, it takes me deep in the community. 

A: What drew you to work in public health?
F: I love working with communities and health is a big issue in communities.  People need to be supported on issues of health and public health. I like the practical work, being active within communities, and being able to interact with real people.

A: What do you like most about your job?
F: Exposure to different stakeholders in different offices and being open to learning on the job.

A: What do you think is the biggest challenge in malaria eradication?
F: People’s attitudes towards prevention methods.

A: What do you think could be improved in the malaria eradication campaign?
F: Methods for prevention; promote IRS- it's expensive, but it’s the best.

A: After SMP ends, what would you like to do?
F: I will still work with public health partners which are still in health field because I feel I need to do much of the same thing.

Thursday, April 4, 2013

The Real Malaria



Last night I was watching a clip of the documentary about the book Guns, Germs, and Steel, which follows the author, Jared Diamond, around the world in his quest to discover how such huge inequalities emerged between the developing and the developed world. In other words, why are some countries so rich and others so poor?  While in Zambia, one of the poorest countries in the world, with an average life expectancy of 35, he visited a hospital and talked to a health worker about the burden of malaria there.  Dozens of children were lying in beds in one ward, one of which barely had her eyes open, unblinking.  Then, the camera panned to Mr. Diamond, who had to cover his face because he started crying.  He said, “There’s a difference between understanding something intellectually and experiencing it firsthand.” I immediately teared up, not just from seeing this older, world-renowned author becoming so upset about a problem that is so far removed from most of us, but also because I had an almost identical experience about six weeks ago. 

In late February, I spent a few days in neighboring Amuria district to help out with Integrated Support Supervision (ISS).  During ISS, we visit a range of health facilities to get data related to malaria.  On our second day, we visited St. Clare Health Center III.  In Uganda, there are four levels of health facilities, with one being the lowest, according to size and services offered.  Although St. Clare was a level III health center, it operated like a level IV, according to Ann, a local nurse, who was helping us with ISS.  St. Clare is a private hospital funded by the Catholic Church, and has a few mzungus or foreigners working there. Amuria is less developed than Soroti, and here “in the middle of nowhere” (not my words, but those of our driver, Ronald) on a small hill was a pretty impressive facility on a beautiful campus.  Besides the hospital, church, and school, there weren’t even huts around this area.  It was nothing but trees and scrubby bushes as far as the eye could see.  

My part of the ISS was to get data from the Antenatal Clinic (ANC).  To get to the ANC, I had to pass through the children’s ward.  As I was waiting in the hall outside the ANC office, Ann came in telling one of the nurses that a child had a very high fever and needed immediate attention.  I could see several people huddled around one of the beds.  Curiosity got the better of me, and I went over to see what was happening.   

It was a four year-old girl who was naked, with her eyes closed, arms bent and fists clenched near her face. She kept making an involuntary whimpering sound over and over.  This sound still haunts me.  Ann said that her malaria test result was a 3+, which means she had an extremely high density of malaria parasites in her blood.  This, combined with a fever of 104 and convulsions, led to a diagnosis of severe malaria.  Ann instructed the nurses to give her an I.V. (of what I can’t remember, but should know) to bring the down fever.  They also kept crushing up some pills and gently sprinkling it in her mouth.  Besides the fact that a little girl was in so much pain from a completely preventable disease in such an efficient hospital, so much seemed wrong; the colorful, cheerful paintings of biblical scenes on the walls, nets on every bed (which is rare in most health facilities), and the fact that I felt helpless and ashamed that I wasn’t doing enough.  All of this was just too much for me, and I had to leave the ward with tears in my eyes.  

It’s like Jared Diamond said, intellectual understanding can’t make you ready for first-hand experience. No matter how many case studies I read in grad school, days of training and workshops I’ve completed here, none of it could have emotionally prepared me for seeing malaria up close and personal.  When I came back later, Ann was still with the little girl.  Her fever had come down, and her body looked a little more relaxed.  I’m not very religious, but I believe in prayer.  So, I said a prayer for the girl and her family.  She was still alive when we left St. Clare later that afternoon and I can only hope and pray she is still alive today.     

To be honest, I can barely get through writing this without crying.  Look, I know there are countless sad stories out there about sick kids in Africa, but I still feel compelled to share mine.  We’ve all seen the stereotypical images on TV commercials or the news.  I’m not trying to be trite, pull at your heart strings or make you feel guilty.  But this problem is real.  It doesn’t go away when the commercial ends or after I leave Uganda.  It won’t go away without a lot of sacrifices of our time, efforts, and yes, money.   I know that my one year service here isn’t enough to make a huge impact and at times I should have taken a lot more initiative.   But, if by reading this story, you start paying more attention to malaria and hopefully help raise awareness about it (or development or global health) then at least I’ve made a small dent in this gargantuan epidemic.  You can start by sharing this blog entry with your friends, family, colleagues, or students.  Changing your cover or profile photo on facebook to one of our Stomping Out Malaria images (found on my facebook page) for the month of April is also a simple, easy step to help our movement gain momentum leading up to World Malaria Day on April 25th.  Thank you.

When I was a history major at Western Kentucky University, Jared Diamond’s book was discussed and lauded by several of my professors.  He actually came to speak at WKU, but for some reason, I didn’t go to his lecture and I’ve always regretted it.  Now that I’ve seen how emotionally invested he is in development, Guns, Germs, and Steel will quickly move up my reading list.  After all, he inspired me to finally share this experience. 

   

Thursday, January 10, 2013

The Bluegrass and the Pearl



For nine days in December, I was lucky enough to have my mother come visit me in Uganda. Queen Elizabeth National Park in the southwest and Murchison Falls National Park in the northwest were the highlights of our tour around the “Pearl of Africa”.  It’s rumored that it was Winston Churchill who first gave Uganda this moniker.  Whoever said it got it right.     

Our first destination was Queen Elizabeth in the southwest. As we wound our way through Bushenyi, I couldn’t stop taking photos. I kept clumsily leaning over Mom or steadying the camera out of my own window to capture the landscape that so was vastly different from the plains of Eastern Uganda. We were trying to reach Mweya Lodge before dark with enough time for an evening game drive, so we only made one or two quick photo stops.  Paths crisscrossed the hills blanketed by tea bushes that glowed almost fluorescent green in the late afternoon sun. Huge leaves of banana and matooke trees leaves dotted the mountains just before we passed an alpine lake.  I was in awe.  But it couldn’t prepare me for what was just around the bend.

After rounding a curve, we were suddenly overlooking an endless plain.  As far as the eye could see, it was nothing but acacia trees covering the savanna.  It was magnificent.  The waters of Lakes George and Edward were silver on the horizon.  Although it’s cliché, I couldn’t help but think “Wow! This is just like what I’ve seen in the movies. Only this is better because it’s real life!”  After stopping for a few minutes to take it all in, we descended through hairpin turns and finally entered the park.  I was glad that I had sunglasses on because I had tears in my eyes.  Seeing the acacia trees and tall grasses at ground level was just as breathtaking.

With the Kazinga Channel to our left, cactus trees flanked the road between the gate and the lodge.  Within five or ten minutes, we were lucky enough to spot a family of elephants less than 50 feet from our van.  As I was taking pictures, the mother elephant looked right at us, fanned out her ears, and took a few steps in our direction.  Mom got concerned and said “Umm, I think she’s coming over here. She doesn’t look too happy.” A few minutes later we climbed up the peninsula to Mweya Lodge just as the sun was setting behind pink and orange clouds.  Everything I had seen in the past hour seemed too good to be true. 

The next morning we set off for a game drive before the sun came up. The convertible top on our van was raised so we could stand up to have a better view.  We were lucky enough to have a wildlife guide accompany us.  The first animal we saw was a “loser” male water buffalo that had lost a fight with a younger male, and as a result, was pushed out of the herd.  Throughout the morning the guide kept calling out “loser”! Uganda cobs, which are similar to gazelles or impalas, were all over the savanna.  But I never got tired of seeing them.  Water bucks paused by the side of the road as we passed.  We stopped at a village next to the lake where hippos were dangerously close to the shore, but the locals paid them no attention.  Cattle, goats, and marabou storks wandered around the mud and trash.  On the way back, I spotted three large birds in front of some old abandoned buildings.  When the guide told me they were crested cranes, I said, “Oh my god”! I had wanted to see the elusive national birds as soon as I saw photos of them on the internet back in June before I left the States.  Abby, our driver, slowly went towards them so I could get some pictures. I can’t believe that I’ve turned into a birdwatcher like my Mom and brother, Eric!  Trust me; I’ve fought this aspect of my genes for years.   

That afternoon after lunch, we saw some warthogs hanging around outside the lodge in the rain.  I seriously couldn’t help but think of the character from the Lion King.  With about six European tourists, we boarded a small pontoon to cruise the Kazinga Channel, which connect Lakes Edward and George.  Directly across from the launch site, we saw elephants, hippos, and a crocodile slip into the water.  Most of the time was spent hovering close to the tree-lined banks to see birds: eagles, pelicans, herons, storks, cranes, ibises, and kingfishers.  Ah, the kingfishers!  The black and white pied kingfisher would flutter high above the open water before quickly swooping in to catch fish.  But the most spectacular bird we were lucky enough to see was the malachite kingfisher.  Slightly larger than a hummingbird, it had a purple body and a neon orange beak.  It was during our pursuit of the malachite that I started to feel some serious camera envy.  Some of the guys on our boat had huge lenses.  Although my six year-old Sony Cybershot takes great pictures, I will have to zoom in about a million times on Instagram to be able to identify a lot of the wildlife. Upon spotting a “loser” water buffalo, Mom said one of the funniest things I’ve ever heard her say.  “So his new job is modeling?  He just stands there and lets us take pictures of him”.  As we drew closer to the end of the channel, some young elephants were jousting in the water.  It was incredible to see them splash around with their trunks and tusks raised up at each other.

On our last day in Queen Elizabeth, we were scheduled to go chimpanzee trekking. After driving on the paved road for about ten minutes, we turned off onto a muddy road towards the top of Kyambura Gorge.  The gorge, which is only 1 km across, 100 meters deep, and 8 km long, is almost a completely different ecosystem.  It’s basically a rainforest in the middle of the savanna. 

There were six other foreign tourists going on the hike with us. Our guide was a woman named Petra, who told us that we would be trekking a community of 20 chimpanzees, but couldn’t guarantee that we would see any.   She also explained that occasionally they see lions near the river at the bottom of the gorge.  Petra warned us, “If we do see one, just move on and act like we didn’t see it.  Don’t take pictures or it may charge.  But don’t worry.  That is why Albert (the other Uganda Wildlife Authority ranger) has a rifle”.  Great.  I’ve wanted to see a lion my whole life, and now if I do, I can’t even look it or take a picture and it might get shot?!  It had been raining heavily that morning and the top of the trail was steep and slippery.  Mom decided to stay behind and do some bird watching with our driver. She even got to see some black and white colobus monkeys.

After about five minutes, the trail leveled off at the bottom of the gorge.  We could hear hippos snorting and spotted one at a wider part of the river.  Petra kept looking for and pointing out animal prints and poop on the trail. Specifically, she was looking for the knuckle prints of the chimpanzees.  Even though we didn’t get to see a hyena, it was pretty cool to see its tracks.  We got to see a few olive baboons (through binoculars) pretty high up in the trees.

Eventually we reached a boardwalk that stretched across the river where we stopped there to look at a tree on the other side.  Wouldn’t you know it, there was a chimp sleeping! Now, at this point, I felt pretty satisfied that I even got to see one.  Petra told us in the beginning that it’s only luck if we get to see any chimps at all.  She also apologized to us in advance that we might have to cross water because of the heavy rains.  To reach the boardwalk, we would all have to take 3-4 steps through the river.  All I could think about was getting schistosomiasis. I was wearing my Earth tennis shoes that I had worn barely twenty times since I bought them in May.  I knew I should have packed my gum boots! But I didn’t want to miss anything, so like everyone else, I got my feet wet, literally and figuratively. I thought our wading was over at the end of the boardwalk, which was only about 30 feet long.  But then we were knee deep in what looked like a mangrove.  We saw another chimp that was really high up, but it was difficult to see through binoculars in the thick, dark forest canopy.  As it started to rain, Petra decided we should go back as our chances for seeing more chimps were getting slimmer.  I realized how unprepared I was when everyone else was wearing rain ponchos as I fumbled around with my plaid umbrella in the middle of the rainforest.  After we regrouped on the other side, Petra was telling us more about the life of chimps.  Then, we heard some of the females make a distress call.  Upon hearing this, Brutus, the alpha male swung down out of that first tree, just like a scene out of Tarzan.  I still can’t believe I got to see something so rare.  Not being able to top that, we made our way back up to the top of the gorge. 

Mom got to see the more “human” side of Uganda in transit between the parks. After spending one night in Fort Portal, we had an eight hour trip over dirt roads to Murchison Falls.  The scenery was beautiful.  A few hours into the drive, we saw a group of kids playing and bathing near a pool of water beside the road.  One boy had his back to us and it looked like he was doing a little dance.  Both of these are pretty common sights here.  When he turned toward us, we saw that his pants were down.  But he kept dancing for us despite his lack of underwear.  Mom and I just died laughing.  A few days later, after we left Murchison Falls, we passed through a small town at about 10:30 am.  We noticed there was a man lying in the road behind a parked bus.  Then, as we got closer, we noticed he had a beer in his hand that had spilled all around him.  Another man dragged him across the road, and when they got to the other side he slapped him across the face!  But the drunk guy just smiled and laughed at him.  I don’t know if we were more disturbed or amused.  But again, we couldn’t help but laugh.

Late in the afternoon on Christmas Eve, we arrived at Murchison Falls.  But first we had to cross the Nile River on a ferry.  I’ve crossed the Nile at least ten times on the Owen Falls Dam in Jinja (which I still marvel at), but to be standing just a few feet from it was something else.  A lone elephant stood on the opposite bank and a hippo bobbed in the water not far from the ferry.  After waiting about 30 minutes, about 10 cars tried to outmaneuver each other onto the ferry, resulting in a minor fender bender. I noticed an older gentlemen standing around a vehicle with his family.  A few days later our driver told us that it was Sudir, an Indian who is one of the wealthiest men in East Africa.  He owns Crane Bank, Munyonyo Resort, and several buildings in Kampala. 

On Christmas morning, we sat off on another game drive before dawn.  I thought that the landscape of Queen Elizabeth would be hard to match. But the rolling hills and winding roads of the savanna in Murchison Falls were just as, if not more beautiful.  We were really able to see all the colors of the sunrise as oribis (small gazelles), Uganda cobs, and Jackson’s Hartbeests peeked through the grasses on both sides of the road.  I really became fascinated by Jackson’s Hartebeest, which are only found in Uganda. They are like a hybrid between a deer and a wildbeest, with long, odd faces, graceful bodies, and slender horns.

We wound our way through a small but picturesque grove of acacia trees and saw a few random giraffes which was pretty exciting.  As it got lighter, we arrived near the banks of the Albert Nile where we saw water bucks and several different birds.  We kept seeing the odd giraffe here and there until we saw several cars parked on the road.  There were about 25 giraffes near a watering hole.  It was surreal.  Mom said it looked the wind was pushing their necks in the same direction.  There was one who was alone on top of the ridge and rays of light streaked behind his silouhette.  I thought “Come on! This can’t be real!”.   

For those who don’t know me well, I’m a cat lover.  This includes big cats.  At the prospect of seeing lions for the past few months I was anticipating a lot of emotions for the moment when I actually got to see one.  Honestly, I thought I would cry the same way that Kristen Bell did when her husband surprised her with a sloth.  Look it up on YouTube.  It’s hilarious.  But I have to say that the giraffes topped the lions.  Near the end of our game drive, we again saw several cars stopped.  There were two elephants munching on some shrubs.  But then I noticed two beige dots at the edge of the thicket.  I suspected they were lions and when Abby confirmed it for me, I grabbed the binoculars.  I could feel a grin of satisfaction spread across my face at seeing the two females stretched out next to each other.  Between the elephants and the lions were a few Jackson’s Hartebeests grazing.  Again, I thought “Seriously?!  Are you all working for a postcard company?!”       

After returning to the lodge for lunch, and some lounging around the pool, we boarded a double-decker boat named the “African Queen” for a Nile River cruise.  One of the most interesting things we saw were tiny holes in the side of a cliff that served as homes for beecatchers.  The tiny birds shone iridescent green with hints of red as the flew around the tan cliff, resting on tree branches.  As we got closer to Murchison Falls, we spotted some black and white colobus monkeys. Unfortunately, we weren’t able to get close to the falls because the river became shallow and rocky.  Murchison Falls is supposed to be the most powerful waterfall in the world, which was still incredible from a distance.  As we headed back towards the lodge Mom and I split a Nile Special beer, which has become my favorite here in Uganda. 

That night, all of the tables were placed outside around the pool for dinner.  After getting properly stuffed, we were treated to a performance by Acholi traditional dancers.  The Acholi are one of the larger tribes in Northern Uganda.  The men sported white feather headresses.  The women performed one dance where they placed small red pots on their heads on certain drum beats.  I don’t’ know if I’ll ever have a more memorable Christmas. 

The next morning we left Para Lodge to make our way to Soroti.  Instead of turning left towards the Nile, we turned right to make our way out of the Northeastern gate of the park.  Only meeting about five other vehicles, it felt like we had this whole area of the park to ourselves, which felt kind of magical.   Palm trees were everywhere, a stark contrast against the golden savanna.  Abby told us that elephants brought the palm trees as they migrated down from Ethiopia.  We were lucky enough to see elephants, Jackson’s Hartebeests, black hornbills, and giraffes one last time .  It still blows my my mind that I got to see all those animals on the same day that we arrived in Soroti.   
     
After spending two nights in Soroti, we spent the afternoon in Jinja, where we took a boat ride to the source of the Nile River.  The next morning we took Mom to the airport at 2:30 a.m..  I took two busses back to Soroti, one of which almost tipped over in a ditch.  I won’t go into the details, but it’s the most scared I’ve been travelling here. It was a a really bizarre ending to such a wonderful trip where we only had a few minor glitches. TIA!   

I just have to acknowledge how incredibly grateful I am to have a mother who was willing to spend almost 48 hours on a plane to spend only eight days with me.  She has a sense of curiosity, adventure, and humor that transcends any age. I can only hope that I will be half as extraordinary as her as I get older.  We have travelled in Europe, Asia, and Africa together.  I can’t wait to see where life will take us next…