Tuesday, May 7, 2013

It's Natural To Be Afraid



As I am trudging through (only) my fourth resume and cover letter, I have been listening to the album All of a Sudden I Miss Everyone by Explosions in the Sky.  One of my favorite songs is It’s Natural to be Afraid.   And to be honest, I am afraid; of not getting a job, feeling out of place, being a spinster (think Homeland where Carrie realizes her job in the CIA isn’t conducive for a relationship and says to Saul, “I’m going to be alone the rest of my life aren’t I?”), not knowing where I’ll be living, regretting that I’ve not done enough here, missing Uganda, and always wanting to be somewhere else. The list goes on.

I’ve sat here and just thought how I would just love to be a travel blogger about or a free-lance writer about global health.  I love to write.  But I’m pretty lazy about it.  Most evenings when I get home I just want to watch whatever TV series I just downloaded.  For the past two hours I’ve been resisting the urge to go watch Girls.  Going back to Homeland, there’s a scene where Carrie and Brody are walking through the woods and she says “Growing up this is what I wanted.  I never dreamed of the corner office in New York, but of Uganda or Nepal.”  Agreed.  Is it ironic that I’m in Uganda applying for a job in New York?  At least international travel is required. 

*The following section was written mostly back in January.  I might be lazy, but at least my obsessive saving paid off!* 

Over the past few months, I’ve realized there’s been a certain rhythm to my life.  I go abroad for a few months or years, and then I live in the states for a few years.  For years I’ve been thinking that some day I’ll have to give it up and finally “settle down” in the US.  But then the other day, it hit me that I don’t.  Why do I have to give up anything?  Who says I have to one or the other?  If this works for me and makes me happy, then why shouldn’t I continue it?

I realized that my life in the US and abroad don’t have to be mutually exclusive.  I don’t have to give up one to have the other.  I know in my heart that I will never be able to totally give this up. It would be a disservice to myself, the work I’ve done, and everyone who has supported me.  A part of me will always want to be abroad.  I can’t and won’t pretend to be something I’m not.

A Peace Corps staff member emailed me today asking if they need to start for another PCRV (Peace Corps Response Volunteer) to replace me.  Wait a minute!  I can be replaced? I won’t be the newest, hottest thing on the block anymore?  I knew that I wouldn’t stay here forever.  But I instantly felt a pang of jealousy for whoever might be my predecessor and all the hope, excitement, uncertainty, and expectations they feel in the next few months of applying and preparing for their journey here.

*Back to the present.*

Who knows?  Maybe I will get that corner office in New York and love it.  Or hate it.  Maybe I will “settle down” after finding that dreamy guy who embodies the qualities of the following men: 

  • The confidence of Don Draper minus the mysgony 
  • The drive of Jack Donagy minus the conservatism
  • The charm and versatility of Ryan Gosling
  • The folksiness and sensitivity of Fleet Foxes
  • The wit of John Stewart and Stephen Colbert
  • The humor of Conan O'Brien

*I worked pretty hard for a half hour on putting this into a really cool pie chart, but failed to correctly copy and paste it.   I’m clearly going to need Jack Donaghy to help me master pie charts. But am I asking too much?*

Maybe everything I want right now won’t matter when I get back to America. That’s happened to me before.  Either way, I’ll be alright.  

Since March, I have felt torn about living in Kentucky where I can be closer to friends and family or living on the East Coast, where I would have more options to continue a career in global health.  I remember riding my bike into town and feeling stressed about this.  But then I realized I have options. I thought about all the women in Uganda (as well as the developing world in general) who have very few options about where they live, how many kids they have, who they can marry, how much education they get, and whether they can get a job.  And here I am whining about how hard it will be to choose where I want to live.  At least I can choose.     


Thursday, May 2, 2013

World Malaria Day



On Thursday, April 25th we held a World Malaria Day Event here in Soroti.  It’s been one of the most rewarding experiences of my Peace Corps service, including my two years in China, not just my year of Response here in Uganda.  People at the district and Stop Malaria kept thanking me for making it happen.  But all I really did was secure the grant and keep track of the money; they were the ones who did all the hard work.  

World Malaria Day is in late April, but the planning started way back in February. I almost didn’t apply for the grant that would fund the event.  To be honest, I was pretty intimidated by the grant application process.  I also assumed that my organization would start planning and funding the event, but only national level events are supported by the central office.  My coworkers, Ruth and Fred sat down with me to make the detailed budget.  They were on the phone all morning getting prices for tent rentals, medicines, gloves, you name it.  It was then that I realized that how much people were actually counting on me to come through with this grant. While I was in Kampala for a meeting, they were getting signatures from district health officials to make sure we submitted it by the deadline.

We started having planning meetings with the district and other NGOs in late March.  A month or two before that, I briefly met with a district health official, who would later become chairman of our committee.  When I told him my name, he said it was difficult to pronounce and asked what my Christian name was.  After telling him my last name and that my middle name was Elizabeth, he said “Elizabeth! That is a good name. I will call you that!” Despite explaining that no one ever calls me by that name, he insisted on calling me Elizabeth.  I said “As long as you help me with World Malaria Day, you can call me that.”  For months, I’ve been wincing every time he called me Elizabeth and gave his big-man (I don’t mean fat, “big man” is a term here in Africa for men in leadership positions) laugh afterwards.  But hey, sometimes you have to give up things up to make something happen, even if it’s your identity.

At the first meeting, the chairman proposed that we combine World Malaria Day with World TB and World Health Days.  I wasn’t crazy about this idea (and neither were my coworkers), but we went along with it.  Usually, there weren’t many people at the start of each meeting, which was very discouraging and frustrating to me. But as more people filled in by the end of each meeting, I had renewed energy. 

As part of our grant disbursement, for some reason I was designated to receive money for three other PCVs.  I didn’t know this until the day before.  When I checked my bank balance, I had over 25 million shillings, almost $10,000.  I have never had that much money in my bank account (but hopefully will someday when I get a fabulous job) and it made me very nervous.  The next day, I immediately transferred the money to the other PCVs.  It’s probably the only time in my life I will ever be able to handle millions of any currency! The next day I was actually able to order the nets and have them delivered to our Kampala office, which was really exciting to see them arrive just a few days later here in Soroti.

Two weeks before the event, I was actually travelling through the southwest of the country.  It wasn’t the ideal time to go on leave, but it was the only time I had an opportunity to travel before my COS (Close of Service) date. Most of the rentals and services were already reserved and paid for before I left.  But the SMP team was still working hard while I was gone…Ruth was working on the t-shirts, Benjamin was buying RDTs (Rapid Diagnostic Tests), and Fred attended the district meeting.     

The day before the event we were all busy running around; picking up and sorting t-shirts,  copying and delivering over 80 letters of invitation, and buying last-minute supplies. The municipal health educator and our driver, Ronald spent a long time labeling and stapling those letters.  Fred and I were so rushed that we were sorting and stuffing envelopes out of the back of his van at the district headquarters.  But, everything was coming together and I felt like a little kid on Christmas Eve.

On the big day, we started arriving at the office around 7:00 am. The sound system and the tents arrived several hours later than expected. There was a lot of “town running” between the SMP truck and Fred’s van.   The first school group to arrive was Nakatunya Primary School. They had marched onto the sports ground looking smart in their navy uniforms and even had a homemade banner.  That’s when I started getting emotional.  For those of you that don’t know me well, I am very emotional.  As hundreds of primary school students lined up for the parade, the marching band (comprised of several blind and visually impaired students led by their friends) warmed up, and finally seeing the banner with the Stop Malaria Project and Peace Corps logos, I got tears in my eyes.  Thankfully I had on dark sunglasses! It just overwhelmed me that so many people from different organizations cared so much about not only being a part of this event, but also worked so hard to make it happen. Although my contribution was small, I finally felt like I had contributed something.

The parade was definitely the best part of the day.  Ruth, Badru and I were at the tail end of it, followed by the SMP truck.  A policeman on a motorcycle was in front to stop traffic.  Two others walked with us.  As we walked up and down Main and Market Streets, people were out on their shop sidewalk and home balconies to see what was going on.  

After we got back to the sports ground, the performances by the school groups started.  Most of them sang songs and recited poems about malaria.  Let me tell you, they know their malaria stuff!  Little kids were talking about plasmodium falciparum, anopheles and fansidar.  I dare you to find an American kid that has such a high medical vocabulary!  In one poem, Uninvited Guest students talked about how malaria struck unexpectedly when you least expect it, like Al-shabab.  Impressive! The TASO (The AIDS Support Organization) drama group was comprised of several people who were HIV positive.  They performed skits about malaria and sanitation. Several speeches were also given by local government officials.

At least 300 people were tested for malaria.  That was just in one tent, which had health workers from Western Division Health Center.  UHMG (Uganda Health Marketing Group) also performed tests in their tents.  We distributed nets later to those who had tested positive for malaria.  As people lined up to receive their nets from the guest of honor, we noticed about five or six little girls from a dance troupe with matching costumes were also in line.  All of them had malaria.  Another woman and I looked at each other in astonishment.               

We also gave 20 nets to Amecet, or Youth with a Mission.  This organization is a shelter for young children (mostly infants and toddlers) whose parents have died or our too ill to care for them.  Many of them are HIV positive.  When Fred and I visited them earlier in the week, they showed us a wall of photos of all the children that have passed through there.  Several photos had stars on them, indicating that the child had died.  The Amecet staff came to the event for a few hours with several of the children, even setting up a crib in one of the tents.

After the ceremony ended, there was a women’s football match between SODAN (Soroti Development Network) and Uganda Red Cross.  Fred and I watched as Red Cross eventually won during penalty shots. The district had arranged for the winning team to receive a goat (for slaughtering and roasting) as a prize.  They were so excited about winning that they practically dragged the goat around the field and eventually picked it up and carried it around like it was the star player.  The district health official (whom called me Elizabeth) insisted I hand over the goat to the winning team.  So, I made a little speech about preventing malaria, hypertension (the theme of World Health Day), and TB.  But I also used it as an opportunity to encourage women and girls to continue playing sports.

It was an 11 hour day and I was exhausted and sore by the end of the day. But it was worth it.  I want to thank all of the organizations which helped make this day possible: Stop Malaria Project, Soroti District Health Office, Amecet, The AIDS Support Organization, Charity Women’s Association, Uganda Red Cross, World Vision, Pilgrim Africa, Uganda Health Marketing Group, Soroti Development Network, Child Fund, Compassion, Penecostal Assembly of God, SARUDA (a Soroti-based NGO).  Of course, none of this would have been possible without the months of planning and hard work from the Stop Malaria Staff:  Fred, Benjamin, Ruth, Badru, Helen Betty,  Ronald, Sarah, and Robert.  Eyelama! Thank you! 

I have to give a special shout out to Joanna Groepper, my friend and fellow Soroti PCV, for coming to the event and helping us out!     
  

Tuesday, April 9, 2013

Stop Malaria Project Interview: Badru Gidudu Walimbwe



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.

Badru Gidudu Walimbwe is the Technical Team Leader for the Teso Region at SMP.
  
A: Where are you from?
B: My original district is Sironmko, near Mbale, but my family lives in Kampala. 
 

A: What did you study?
B: I received a diploma in medical entomology and parasitology at Mulogo paramedical School. Then, I got another diploma in health services management from Uganda Christian University. Then, I got my bachelor’s degree in social work and social administration.  I have a master’s degree in social sector planning and management from Makere University.

A: Where have you worked before SMP/MC?
B: Before SMP, I was with AMREF (African Medical and Research Foundation) as a project assistant. The project was integrated for Malaria, HIV/AIDS and TB in two central districts. I worked in Rukingiri as a vector control officer at their district health office.  Throughout those jobs, I worked at the community level in home based management of fevers, net distributions, and IRS (indoor residual spraying). Rukingiri is a highland district where malaria was really low, but now those areas are prone to epidemics, maybe due to climate change. That’s why we had to do IRS there, which helps reduce epidemics.   

A: Why did you want to work for SMP/MC?
B: All my initial experience was in malaria since school, and then comes SMP, in so many districts. I thought wow…this is the best opportunity for me to make a contribution to the malaria world. That time in the beginning we were targeting 45 districts, but then we reduced to 34.  The fact that it was going to work through the national health system and local government level, I understood all the dynamics and interventions, I was excited to be able to make an impact.  It was a good opportunity for my career to grow and make a contribution to the community.       

A: What drew you to work in public health?
B: When I was little, I knew I wanted to be a health worker. Most of the interventions in health need to be more focused on prevention. It’s more rewarding to me to put more effort in prevention, than to seeing someone ailing in the hospital. Working with the small rural communities is easier and more rewarding than urban communities.  The response is better.  You have more success in rural areas in public health interventions than in urban settings.       

A: What do you like most about your job?
B: The most interesting thing is that you are acting like a broker.  You have this health worker, a community, and someone who has a little money to offer help.  So it’s exciting linking them; someone who needs support and someone who can provide it.  When people give testimonials about how nets have reduced the number of malaria cases in the wards, it’s rewarding.  It’s exciting to make a contribution and the result is positive.  It’s exciting to think you are reaching the whole health system and all those health centers.    

A: What do you think is the biggest challenge in malaria eradication?
B: The main challenge is that many people are intervening, but things seem scattered. 

A: What do you think could be improved in the malaria eradication campaign?
B:  We need to repackage the interventions so it’s not one intervention at a time.  We should do everything at the same time; IRS, nets, treatments, and community sensitization.  Very critical monitoring indicators should be followed closely to see if you’re really making progress. We need to work as team, with the districts, SMP, and have everyone on board.  We could start on a small scale then make it large.  The outputs need to be monitored.  We need to see what needs to be done at facility level, and community level. If we do immediate case management, you are reducing the number of parasites in the community. We need to promote early early early treatment! In principle, you can have mosquitoes. But if you don’t have the parasites, then they’re not a problem.   

A: After SMP ends, what would you like to do?
B:  Having gained all this experience, for me this is another opportunity to go to the next level to repackage this experience and make a significant contribution to malaria control and prevention, whether it’s a malaria organization or consultancy.  I think working in a big malaria organization would be the best.

A:  Can you share a memorable experience from working at SMP?
B:   In Serere (pilot net distribution), we have this huge thing that everyone is looking at; PMI (President’s Malaria Initiative), and the district are expecting a lot with logistics and administration. We need results, quality results, big teams in the country, district, even outside the country are seeing what your output will be.  You’re not trained in logistics, but you have to implement to make sure the activity is successful.  But you’re not in control of everything.  Someone else has to order the nets, deliver them, and they don’t’ come at the time you want.  It was a really interesting challenge.  There was no 8 to 5, we were having meetings through the night.  You have to balance being tough and soft otherwise, things won’t shift. The Distribution was a memorable experience. I was excited when I did the report.  Joslyn (Meier, the deputy director of Malaria Consortium) said it was the best report she’d read in Uganda.  You have to work under pressure to get that final thing.     

Stop Malaria Project Uganda is one of many organizations that host a Peace Corps Volunteer in partnership with the Stomping Out Malaria Initiative 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/.     


Stop Malaria Project Interview: Ruth Enyimu



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.

Ruth Enyimu is a behavior change communication assistant at SMP.
  
A: Where are you from?

R: I’m from Kaberamaido.

A: What did you study?
R: My first paper was a diploma in secondary education. My bachelor’s degree is in adult and community education from Kyambogo University in Kampala.  I am now going for my master’s degree at Mukono Christian University in public health.  

A: Where have you worked before SMP/MC?
R: I first worked with World Vision in the children’s department where we looked at the beneficiary child, its family, health and education.   I worked there for about four months as a volunteer.  My second job was with Save the Children. I was supposed to work in Sudan in a rebel camp.  After the training, I remained working online.  But when the time came to go to Sudan, the rebels went to Central Republic of Africa.  I held my appointment for about 5 months, and then went to AMREF (African Medical and Research Foundation).  There, I was a project assistant for Malaria, HIV/AIDS and Water and Sanitation.

A: Why did you want to work for SMP/MC?
R: The project I was working for in AMREF came to an end.  One thing that excited me about SMP was that I already had experience.  It’s all about behavior change, not just treatment. That’s why I applied for that position.  I felt like if the community takes on the responsibility of prevention, there’ll be no cases in the facility.  I wanted to continue the work I had started with AMREF to work with VHTs (Village Health Teams). This was an opportunity to create sustainability for both projects.      

A: What drew you to work in public health?
R:  Most of the health issues are preventable diseases.  But they are ignored; people don’t have knowledge.  I believe public health will give me a lot of insight into community health.  I believe that will really help me change the lives of the community; but with their help, I can’t do it alone.  Generally, I don’t like to be office-based.  I really want to be deep down with the local person who has a problem.  Public health will directly take me there.  

A: What do you like most about your job?
R:  It really makes interact with the local person.  I get to interact with different people. Without SMP I wouldn’t have met you.  I’ve got to meet and train many Peace Corps Volunteers.

A: What do you think is the biggest challenge in malaria eradication?
R: It’s the attitude of people and the allocation of resources.  There are more resources for treatment instead of believing that prevention can succeed. There is also a knowledge gap of the local person.   

A: What do you think could be improved in the malaria eradication campaign?
R: The sensitization that we are doing is broad; we think the same sensitization will work in every region. It should be zeroed in what the community needs.  For example, if I was in charge of nets, very few would be allocated to regions where the burden isn’t high.  Areas with a high burden should be focused on.  Small community and village groups like SACCOs (Savings and Credit Co-operatives) should be taught the benefits of health and changes will occur.  Most of our sensitization is radio based and not every person will interpret what they hear on the radio.  Our IEC (Information Education Communication) materials for each region (holds up a poster) should show have real photograph of an actual family in the community that everyone knows.  These are just cartoons.  But with a real photograph, people would think “even I could do this.”  The health education in the facilities should focus on individuals or households, and should be followed up.  No one bothers to make follow- ups to see what the problem is from the grassroots. Instead, they wait until they go to the facility.  Like other outreaches are done, with immunization and TB programs, why not do outreaches for malaria treatment and testing?  

A: After SMP ends, what would you like to do?
R: I would really still wish to work with another organization that is handling malaria issues.  It’s a big burden for the country.  

A: Can you share a memorable experience from working at SMP?
R:  We had a radio talk show which I initiated brining a local person, a couple who went for IPTP (Intermittent Preventive Treatment in Pregnancy) for four doses, and got treatment within 24 hours.  I realized that was very educational, but very brief.  When you bring in a local person, you get many callers, and educate others on the real experience.  Another morning, I decided to listen to the radio.  One of the LC3 (local councilor) from Kaberamaido discussed how people were using (bed) nets for fishing.  So, I got the driver and decided to go up there.  I saw nets in the swamp used for fishing.  I fear water, so I couldn’t remove them.  And I knew that if I removed them, it wouldn’t help.  So I got the community together and asked them to be sincere and march to the water to remove it.  I said, “Let’s go and remove them and we’ll talk.”  The only one that remained was because the owner isn’t there, but he refuses.  I said, “this one doesn’t have an owner, he doesn’t want to use it, and doesn’t think it’s important”.  We removed it, and had a meeting and gave them proper education on net use.  I asked them “how much does this fish cost?”  A kilo of the tiny fish was 2000.  “How much do you spend on treating malaria in your household?” They said at least 20,000.  I told them “let’s put this in a weighing scale”.  I used a stone to represent the cost of treatment and the other side was sleeping under a net.  We agreed that we should all we be watchmen, and signed an agreement that if someone uses a net for fishing, they would be arrested.  And today, there is no fishing with (bed) nets.   They realized that if you misuse something you are given for free, then you lose it. 

Stop Malaria Project Uganda is one of many organizations that host a Peace Corps Volunteer in partnership with the Stomping Out Malaria Initiative 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/.