Malaria

Greetings from Uganda! This blog post comes to you from the back row of a bumpy and breezy bus ride back from our safari experience at Lake Mburo National Park. Do you see the longhorn cattle up ahead of us?

 

 

 

After passing zebras, antelope, baboons, water buffalo and this precarious cattle traffic jam, we feel compelled to ensure you that no animals were harmed in the writing of this blog post.

 

 

 

 

 

Two mornings ago, after a night of making farewell speeches, dancing, and exchanging gifts, we woke in Kalisizo town in rural Rakai province to the call of a stubborn rooster. After packing our bags, navigating a final bucket shower, and taking a last walk through the compound garden, we prepared to say goodbye to our host families. Throughout our time in Rakai, the abundantly welcoming culture of our host parents, brothers and sisters, and extended family facilitated our immersion and integration into daily life as a rural Ugandan. Understanding the activity of a rural family provided valuable context for our studies in malaria and childhood illness, especially in terms of how daily life and perception of medical care might explain or indicate trends in population health.

To explain a bit about life in rural Uganda, as seen through our homestay experience, the majority of our families were subsistence farmers and maintained vibrant gardens with a wide variety of produce including eggplant, pumpkins, matooke, bananas, wheat, maize, Irish potatoes, and sugar cane. After chores, which were divided among the children of the house (ourselves included), and cooking, which was typically prepared by the women and girls of the household, members of the family engaged in income generating activity such as harvesting ground nuts, raising hens, goats, pigs, and cattle, or weaving handicrafts. As residents and guests, we learned to peel matooke, Irish potatoes and yams, to cut sugarcane, to weave mats, and to make simple dishes, among other activities. Many of us also diligently sought vocabulary lessons to retain phrases, songs, or greetings in Luganda, which was the local language spoken by most of the residents.  After beginning each morning washing utensils, drawing water for bathing, stroking the fire for the first meal preparation of the day and ending each evening after taking tea with laughter, games, dancing, and a traditional meal of matooke, rice, beans, or posho, we grew a distinct appreciation for the hard work of our host families.

Each night at our homestay we slept under Insecticide Treated Nets (ITNTs) to prevent mosquito stings since female anopheles mosquitoes, carriers of the malaria plasmodium parasite, are most likely to sting at night. We noticed, however, that some of our host siblings and parents slept without nets and explored the topic later with the Coordinator of Malaria Studies at the Rakai Health Sciences Program (RHSP) center, Mr. Baghendaghe Enos. He told us that the diagnosis of malaria in most of the health facilities is done by the use of Rapid Diagnostic Tests (RDTs) and microscopic examination of the plasmodium parasites in blood samples.  During our conversation, the coordinator noted that 20% of hospital admissions are due to malaria, of those admissions the illness contributed to 9% of In-Patient Deaths (IPDs). While residents received free nets through government programs, many would sell their nets or use them for other purposes such as carrying, sponges or fish nets. Further exploring the coverage of the bed net intervention, we visited the Kalisizo hospital general wards and children’s wards and did not find a single net in the ward. After discussing the situation with a hospital physician, he noted that although the hospital had bed nets at one point, patients thought the net was theirs to keep when they were discharged and then took the net with them upon departure from the ward. The hospital was financially unable to replenish stocks of mosquito nets, and therefore nets are no longer provided in in-patient wards. Observing thick bush around the children’s ward, which are potential breeding ground for mosquitos, and split window screens and frames, which enable mosquito entry to the ward, we confirmed with agreement of the director of the children’s ward that it was possible for children to contract malaria in the hospital. 

 

 

Besides malaria, respiratory infections – including pneumonia, asthma, and corhizza - are also some of the most common community diseases. Although immunization service for pneumonia using the Dip+HepB+Hib vaccine are often offered at the hospital, very few mothers make it a point to take their children for immunization which predisposes them to the illnesses. My two year old host sister Zaharah, for example, cried all day when we arrived. She had a running nose, cough, and had been diagnosed with pneumonia a few days prior. For Zaharah, it took her mother a few days to decide to take her to the hospital; however she recovered quickly thereafter. 

On Saturday of our homestay, we engaged in a service activity to paint the interior of two classrooms at one of the local primary schools in Kalisizo called Matale Church of Uganda Primary School. After painting and learning that primary school boarding is more frequent in Uganda than the US, we found that the dormitories of primary boarding school are often cramped living quarters that do not meet public health standards. When we spoke with Mr. Enos, we learned that skin infections including ringworms and mites in mattress were very common among school-aged children as a result of the living conditions.

Since we are visiting during the longest holiday period in the Ugandan school calendar, we had the opportunity to observe the lifestyle of children while we were visiting the Musana Music Center and Toruwu in Kampala, as well as during our homestay in Rakai. In both the urban and rural setting, families seem to have many children (the fertility rate in Uganda is about 6 children per woman) and children seem to move freely about the town from one house to another caring for younger siblings and joining in large groups to play games. Their frequent daily movement, and cramped living quarters at night, often with more than one child in the same bed, could contribute to the spread of infectious disease, according to Mr. Enos. We also thought this may be a potential indicator of why the director of the children’s ward noted that July, December, and January consistently registered the largest volume of patients since the months coincide with the school holiday calendar.

The cramped quarters of the children’s ward at the Hospital in Kalisizo seemed to our group to potentially exacerbate the same pattern of infection spread due to the thirty beds in the 30 square meter ward. When asked about challenges that the ward faced in providing care to patients, the director emphasized a lack of capacity to meet the needs of the community in terms of the number of staff, pharmaceutical drugs, beds, and facilities including monitoring devices. The director also noted that their care and diagnostic process follows clinical guidelines from the World Health Organization that is outdated and that they consistently have a poor supply of drugs to manage illnesses aside from common infections. Despite the challenges faced by the ward, the director seemed optimistic that emphasis on public sanitation in the community, increased drug supply, and improved access to monitoring facilities could improve the quality of care that they are capable of providing to patients.

 

 

Nutrition

Nutrition Blog Post

Manning Sarah, Neikoba Enid, Zuo Linda

               

                Before being a part of this experience, we all had very different ideas of what a balanced diet should look like relative to the three different countries that our group members are from and the foods available in each. As we near the two-week milestone of our time in Uganda our perceptions of “proper nutrition” have changed.

                On our first full day together we traveled to Owino in Kampala, one of the two major markets in the city. It was both an overwhelming and enlightening experience. The market itself is a maze of stalls; so many people both buying and selling hundreds of products. It was the meat and fish that grabbed our attention most, even for those who are not focusing on nutrition as a study. There was no source of refrigeration to be seen as chunks of raw meat where hanging from stalls and piled on counters. Though it looked relatively fresh, it was unclear how long it had been out. There was a similar situation with the fish being sold. While the majority of that available had already been smoked in order to preserve it, the fish were still left out, allowing them to come into contact with flies and any other type of insect that may have been living around that area. These conditions began to bring up questions regarding the impacts of sanitation on nutrition, among other things.

                Our homestay experience in Rakai highlighted some of the major staple foods of the Ugandan diet: matooke (mashed/pressed boiled plantains), Irish potatoes, groundnuts, and rice. Other important foods also include: sweet potatoes, cassava, maize, and pumpkin. Most meals served in Uganda are generally heavy in carbohydrates but also do not have added sugar like many of the foods from other countries. Most of these products are grown at each family’s home with some exceptions.

 

                One morning we went on individual group outings to different locations near the Rakai Health Sciences Program (RHSP). We spent this time at Kalisizo Clinic and had an extremely informative interview with one of the nurses there, Grace Nambooze, who explained to us how the topic of nutrition is introduced to patients every day. Although Kalisizo does not have a nutrition department, the clinic requires all outpatient cases to complete a health education discussion before they receive care.
 

She began by explaining the different levels of malnutrition: mild, moderate, and severe. Severe cases are typically referred to a different hospital that can specialize in that treatment, but Rakai has not seen a situation that serious in at least four years. Principal Nurse Nambooze went on to mention the importance of education of a balanced diet of proteins, fats, carbohydrates, greens, and minerals out of local foods that can be easily and affordably obtained by those living in the area. If food is too expensive or difficult to grow, it is unlikely that many will be able to buy or cultivate it sustainably. The clinic asks families to bring samples of their plantations and health care providers offer lessons on how to prepare nutritious meals.

 

                Principle Nurse Nambooze also explained factors that can exacerbate malnutrition. Before speaking with her, we had been under the impression that malnutrition is largely synonymous with starvation. This is not necessarily the case though. Co-infectious diseases such as malaria, TB,HIV/AIDS and diarrhea, are those that impact immune systems. These create dangerous situations in which patients can easily become malnourished as their bodies are in weakened states trying to fight the disease and often do not fully utilize nutrients being taken in. TB patients, for example, experience a loss of appetite. Even if they have food available to them they will not be taking in the amount that their body needs simply because they do not want it.

 

                Our original perceptions, especially in the early days of the homestay, were that meals here were not as “nutritious” as we had expected. Upon further reflection, though, the carbohydrate-heavy diet consumed by most Ugandans fits perfectly with their very active and work-intensive lifestyle. Beginning with some of the very first meals that we have been served here, it has constantly come into question whether or not we are really experiencing the “true” Ugandan diet. The general consensus is that our experience has been of the Ugandan food but at much higher quantities and with much greater variety than most would have. This assertion was backed up today when we talked to the youth representative of the Ugandan parliament who listed malnutrition as the second direst issue that Ugandans currently face. We look forward to continuing our research here in urban Kampala in order to get a more holistic picture of this topic.

Maternal Health Blog Post

Danait Yemane, Jessica Namata, and Victoria Buckman

Maternal Health Blog Post

18 January 2015

Uganda has an astonishing maternal and infant mortality rate. This poignant fact is what ultimately sparked our group’s interest in maternal health. We chose to research this topic here because we wanted to further explore the status of maternal health from a public health perspective. We began our research by hypothesizing about the cause of such notable statistics, their impact on expecting mothers and their communities, and discussed possible solutions that could help better the status of maternal health. To find the answers to our questions, we met with medical professionals from both urban and rural locations, such as midwives from Kampala and Rakai District, traditional birth attendants, and OB/GYNs to learn about each of their unique perspectives regarding maternal health in Uganda. Our hope is that after synthesizing our findings from these interviews and site visits, this information will help us illustrate a clearer image of what maternal health is truly like in Uganda.  

            During our trip to Matale in the Rakai district, we were given a wonderful opportunity to spend five days with a home-stay family. In conjunction with our homestay, we were also given tours of the Rakai Health Sciences Program and the Kalisizo Hospital. At the hospital, we were able to interview a knowledgeable midwife who gave us information on the hospital, its medical professionals, and patients. We learned about the antenatal care process, which includes HIV testing, full body examination, and obtaining medications. Additionally, we learned about what happens during labor and delivery (high concentrations of c-sections), and post-natal care (follow up visits with the midwife as needed depending on the birth). After meeting with the midwife, we toured the facility and learned about some of the practices that take place in the labor rooms (collecting extra money for “higher quality” care) and observed the overwhelmingly crowded holding rooms and lack of sanitary equipment necessary for having safe deliveries.

Once we completed our tour, we learned about other individuals who assist pregnant mothers with giving birth: traditional birth attendants. These birth attendants use natural remedies and produce their own medications for patients to use for a variety of illnesses such as malaria, diarrhea, ulcers, etc. We were fascinated by the idea of a woman assisting mothers with the delivery of their child simply through natural methods so we decided to pay one a visit. With the help of Victoria’s host brother, Moses, we interviewed a birth attendant at her home and were given a tour of her herbal garden. She explained how she learned her techniques from other birth attendants and family members, showed us various types of herbs, which she uses to cure some of the illnesses mentioned above, and described how she assists between 10-12 mothers per week with giving birth with few tools and remedies. However, if the delivery has complications, she refers the patient to the hospital for professional help.

After our trip to Rakai, we returned to Kampala and visited Mulago Hospital.

Mulago hospital is the largest hospital in Uganda. It is a national referral hospital divided into two parts: Upper Mulago (old) and Lower Mulago (new). A midwife gave us a tour of the facility. First, she took us to the maternal care service reception where pregnant women are received, registered and then tested for HIV. In addition to this, the mothers are divided into counseling groups. All of this is done in a single shelter divided into compartments by desks. Depending on their HIV status, the mothers are then given private counseling from the doctors. Next, we went to the labor ward, which is composed of a single room divided into compartments by curtains for privacy purposes. After birth, the women are taken to the ward for recovery depending on the post delivery complications of the mother and baby. Next, the baby is tested for HIV: if the results are positive, the mother is advised to bring the child for another test. If the results are positive for this as well, and at 18 months, it is determined that the child has HIV. Once they have been confirmed as HIV positive, the child is connected to Bayler Uganda for medication and a follow up. At Mulago there is a follow up room where HIV positive women are registered for their health and medication free of charge.

Our group led a reflection session on January 17^th. During this discussion, everyone was given an opportunity to share their most memorable experiences (the good and bad) along with what they are looking forward to in our last week. A number of students were excited about the presentations and going to Jinja. Next, we played “Maternal Health Jeopardy” in our respective research groups and answered questions regarding ante-natal care, labor and delivery, post-natal care, traditional birth attendants, and miscellaneous topics from our trip so far. At the end of the reflection, we had a discussion on maternal health issues in Uganda and the US, such as abortion, contraception, prostitution, and natural medicine. Overall, the reflection session was very informative and all of the groups actively participated.

            Within the past two weeks, our group has gained a greater knowledge of the status of maternal health in Uganda. Through our home-stay, interviews with health professionals and traditional birth attendants, and detailed tours of health institutions, we believe that we are equipped to give an insightful presentation to our fellow peers and Makerere University staff. After our presentation and upon completion of this course, we expect to take the information that we have learned about maternal health in Uganda and apply it to certain aspects of American maternal health. We think that there are more similarities than differences between our two countries, as America still struggles with health disparities that impact expecting mothers of low-income families and other demographics. We look forward to sharing what we have learned about maternal health with our communities once we return home. 

ORPHANS AND VULNERABLE CHILDREN

  ORPHANS AND VULNERABLE CHILDREN IN  UGANDA

 

Throughout our time in Uganda we have found several things that have sparked our attention to our topic of Orphans and Vulnerable Children (OVC) as we traveled around Kampala and later Rakai.  As we began our first days touring Kampala, we were exposed to two great youth programs including Musana Music Centre, a full brass band that practices frequently.  While we are fond of the program’s developmental aspects, we also noticed haggles of children running after us or around a corner, often without parental observation. While walking down to the Centre it was concerning to see a baby squatting on the front porch of a house and defecating while sitting in it. We were startled by the unsanitary situation of youths throughout the village. Young children around 5 years old carrying another two year old on their back seemed to be the norm as kids were looking after each other.  We thought this excessive responsibility robbed the children of their right to play and be a child. However, given the fact that Ugandan culture seems to emphasize the importance of the family and the community over the individual, the kids may not see this as a burden but rather as a natural part of being in a family.

 

 

Perhaps one of the most informative and interesting experiences that allowed us to dive into our study more in depth, was the time we spent Friday morning with Joseph Rutaraka, a Rakai Health Sciences Center employee and founder of the Rakai Orphans Hope Projects (ROHP). Through Joseph’s lecture we learned much more about Uganda and specifically Rakai related to OVC.  There were things that we expected to hear that contributed to the burden of the issue in Rakai including the high rates of poverty, abuse, malnourishment, disease and disability. We found that one common way a child might be orphaned is if their parents cannot support their basic needs due to economic hardship, shame, or cultural issues. 

We were surprised to find some of the other conditions surrounding a child’s entry into OVC. It’s shocking to hear of parents having to abandon their children due to complications in relationships and other controversial topics. Armed conflict also resulted in OVC whom may have been involved with groups condoning murder or cannibalism. In Rakai specifically, HIV is the leading cause of orphaned children. In Uganda there are 2.5 million orphans and of them 1.2 million are orphaned by HIV/AIDS. We also learned about some of the positive interventions and programs targeted at OVCs. Compassion International is one of the leading organizations supporting child programs in Uganda and throughout the world. We had the opportunity to visit one of the Compassion International sites in Rakai. The place was beautiful; the church was painted very colorfully with scenes from the Bible around the outside. As the program directors gave us a tour of the office, we could hear the children singing gospel songs inside the church as part of Compassion’s day program.

 

After opening our eyes more to the situation and state of orphans in Rakai district, Joseph shared with us the driving force behind his passion for working with orphans. At the age of 10, after his parents died of HIV/AIDS, Joseph became the head of his household and became responsible for his younger siblings. Thankfully, Joseph and his two siblings were all born HIV-negative, and they were able to enter a child sponsorship program through Compassion International, which gave Joseph the opportunity to attend not only primary and secondary school, but university as well. After university, Joseph moved to Rakai District to do research at the Rakai Health Sciences Center and has continued supporting ROPH.  We were so honored to hear this story and though it truly encompassed the success and benefit we so deeply hope orphans and vulnerable children can achieve.

In conclusion, the major cause of orphans in Rakai district and Uganda generally is death of parents as a result of being infected with HIV/AIDS, but it’s a relief to know that many approaches are being put in place to reduce the incidence of the disease in Rakai district. For example, the Stylish Living campaign by the Rakai Health Sciences Center, in which a van is used for “edutainment” (educational entertainment) and people of both sexes are encouraged and advised to make better, healthier choices, for example through circumcision, avoiding multi-sexual partners, use of condoms, and testing to know one’s HIV status. We were so excited to hear about and see all the efforts on behalf of the local people of Rakai to improve the lives of its children, particularly those affected by HIV/AIDS, and feel blessed to have been able to see these incredible initiatives firsthand!

 

 

HIV/AIDS in Uganda

 

Rolling through the dusty roads of suburban Kampala in the Ugandan school bus, the HIV/AIDs prevention signs seemed a bit out of place among the open-faced strip malls selling hand-woven mats and basic cooking supplies.  “375 Ugandans contract HIV every day,” one sign read, baffling us American college students. Several prevention methods have been identified apart from the public advertisements, each aimed at reducing the incidence of HIV, whether it be through education, calls to action, or acknowledgement of future circumstances.

 

We have spent our past few days at the Rakai Health Sciences Program (RHSP), an HIV research institute in the Rakai district of Uganda. RHSP does important prevention and research work in the area. RHSP has been working to stop the spread of the virus since its appearance in 1982. Rakai is still home to a high infection rate. The overall rate of infection in Uganda is 7.3%. This rises to 12% in Rakai. Rakai is a rural district, home to many small farming villages. Through our time here and with our homestay families, we have seen that educating the community about how HIV is spread and how to prevent infection has been vital in the fight against the virus in Rakai.

 

Health education is one of the most effective prevention methods RHSP has implemented. RHSP staff travel to different parts of Rakai to teach better health practices to small groups of residents. They have found that theater and drama troupes are the most effective in promoting their educational messages. Men seem to be the hardest group to reach, but they respond well to the scripted dramatizations of various HIV health topics. The clinic at RHSP also has a health education presentation every morning for the patients. Each month focuses on a different topic such as family planning or condom use. We were lucky enough to be able to spend some time at the clinic and see one of these presentations firsthand. The session was greatly attended and informative. A lot of what we learned from the Dr. Alice was also presented to the attendees.

 

RHSP’s biggest innovation in health education, however, has been their “Stylish Living” event. This fair-style event brings HIV education to the community through dancing, live performances, and competitive games. They are even able to offer prevention methods on site. These include male circumcision, family planning counseling, couples HIV counseling, and HIV testing. The event is highly attended and considered a huge success. We saw the “Stylish Man Van” firsthand and all agreed that the event would probably be a fun and educational experience.

 

Another strategy towards HIV/AIDS prevention in Rakai and elsewhere is condom use. Doctor Alice, a health worker at the clinic narrates, “Free condoms are given to the female attendants to use in their households but feedback from them shows their husbands or partners find this inevitable, opting for unprotected sex.” She also adds, “In most areas in Uganda, certain brands are free of charge, though a lot of youths fear being noticed picking them up from conspicuous places.” There is a lot of cross generational sex, during which the adults in respect of “experience” don’t want to use condoms. In some areas they don’t know the proper use of condoms due to illiteracy, so they cannot read the public advertisements or educational material. Most pregnant mothers only learn that they are HIV/AIDS positive when first tested in the clinic, which is mandatory for every pregnant woman in Uganda. In this case, they do not want to be noticed and do not disclose this to anybody, because most fear being pregnant. The challenge is that implementing the eMTCT  (elimination Of Mother To Child Transmition) strategy could turn out to be ineffective due to lack of follow up for the identified HIV/AIDS positive cases. The doctor also thinks interventions like this being passed on billboards would be most effective in literate urban populations but not in rural areas in Rakai.

 

                Circumcision is another strategy used to reduce HIV/AIDS. Circumcision reduces the risk of HIV infection by 60%.The government has strived to get the male population involved in safe male circumcision through different mobilization channels (drama/film shows, village meetings, soccer) where different circumcision messages are passed to the community members. Free circumcision services are also given to the community members at different health centers. The circumcision rate in Uganda is low due to different fears and misconceptions.  For example, women usually complain that men no longer meet their sexual demands once circumcised; while others think their men will have many sexual partners since they believe they are safe from HIV/AIDS.  However, the Rakai health center has plans and strategies, such as the mobile circumcision camps and the health campaign, to increase circumcision rates and to reduce the different perceptions on circumcision.

 

     The first HIV/AIDS case in Uganda was in Rakai in 1982, and HIV/AIDS was referred to as “slim disease” since most people with HIV lost a significant amount of weight. Furthermore, the hospital recorded at least 5 HIV/AIDS cases every day. Increases in prevalence since the virus’s appearance are attributed to poor attitudes on condom use, illiteracy (some people can’t interpret the different health education messages), many sexual partners, and poverty. Poverty can lead people in the area to become involved in commercial sex. The incidence is much higher among the truck men, fishermen, and business people who work in bars.

 

                An important aspect of the public health intervention on HIV is the social balance between prevention and clinical treatment, and the allocation of funds dedicated to the cause.  A notable circumstance is location: the balance may be different in the United States as compared to Uganda.  To reiterate, the prevalence of HIV in Uganda is 7.3 percent, so the government will spend a larger percentage of time and resources on the intervention as a whole.  As to what the balance should be in Uganda, the answer is largely subjective.  Some people we have spoken to argue that prevention should be the main focus, as it will eventually lead to less necessity for treatment anyway.  On the other hand, some prevention methods are not effective, so the focus should be on reducing the negative impact on the lives of those already affected by HIV/AIDs and increasing their lifespan.  Dr. Alice told us that clinical treatment is funded in the Rakai district of Uganda by a grant from the United States, and other districts by other countries. Luckily, this allows prevention to thrive as well as treatment. The circumstances in Rakai breed necessity for both prevention and treatment, which is why both are essential in a society as riddled with HIV as Uganda.

 

                Please continue to check for future blog posts from the Hopkins/ Makerere study abroad group. Happy New Year!

Initial Days in the Program

 

We have just finished our second full day in Kampala.  We arrived Sunday afternoon after an hour delay in Addis Ababa to find a public health screening and then a long line for immigration, so it took several hours to get out of the airport.  The upshots were that that we saw a cute monkey and baby in the parking lot and that we arrived at the Ndere Center very close to dinner time!  After quick introductions between the Hopkins and the Makerere students, we attended Ndere’s world famous Sunday evening performance and buffet.  For many of the Hopkins students this was their first taste of traditional Ugandan food, although most choose the Ugandan barbecue over the traditional buffet.  The students very much enjoyed the show, which included traditional music, song and dance from different regions of Uganda as well as neighboring countries.

 

Monday we had a chance to sleep in a little bit before a big breakfast and then a few hours of team building.  Then, after lunch, we headed into downtown Kampala to visit the Owino market.  This also entailed out first experience of Kampala traffic, which allowed us to get to know one particular block of a main road quite well!  The students divided into teams and explored each section of the market.  They had assigned tasks in each section--from finding a food they had never seen before and asking how to prepare it, to finding the most expensive artifact.  Afterwards we returned to Ndere for debriefing and dinner.  Sunday evening we were joined by several public health and development professionals who talked about how they came to be in their current jobs and then took questions from the students.

 Today was another full day, with a welcome from Dr. David Serwadda (former Dean of the Makerere School of Public Health and founder of the Rakai Health Sciences Program) over breakfast followed a visit to the Musana Music Center.  After being welcomed by their brass band, the students spent time discussing topics that had been generated by the youth from Musana, and then ultimately ended up sharing songs with their new Ugandan colleagues before lunch. In addition to youth development through music, the youth there demonstrated what they call a tippy-tap: a device they have developed that allows one to wash hands after using the latrine without needing to touch anything.  They plan on building more of these and sharing them their neighbors. Some of the band members took us into their homes. Here is a picture of Jessica, who welcomed us into her home and talked passionately about how much she respects her mother's efforts for the family.

 

 

 

 

 After lunch we were invited into the homes of a few of the youth. We had the opportunity to learn more about the lives of youth and youth development in the Kampala area.  We then headed for a visit to the program Training of Rural Women in Uganda, or TORUWU.  We were welcomed by a second brass band and then had an opportunity to learn about their programs: making wine and crafts, cultivating mushrooms, handicrafts, sewing, and another brass band.  We spent an hour or so playing with neighborhood children and chatting with the youth before sharing dinner with TORUWU organizers and participants.  Finally, we returned to Ndere for our first reflection session.

 

During the reflection session students discussed their struggles with confronting stereotypes about Africa, poverty, the role of aid, and their perceptions of U.S. and Ugandan culture.  Many were surprised at the level of development they have seen.  The TORUWU project was cited as exemplifying the “triple bottom line” of demonstrating economic, environmental and social sustainability.  Both the Ugandan and American students have been struck by both similarities and differences between the U.S. and Uganda and between their cultures.  We split up into 5 teams to discuss public health topics of particular relevance in Uganda: Orphans and Vulnerable Children, Maternal Health, HIV, Nutrition, and Malaria and Childhood Illnesses. We ended the evening by hearing each of the theme teams talk a bit about what they had seen so far related to the five themes. Each of our next blog posts will be written about each of these five topics as we see them in more depth.

 

Tomorrow morning we leave for our homestay in Kalisizo, Rakai district.