Drama Competition at Rymiyonga

For weeks the Volunteer Health Teams have been practicing for the drama competition. The first round winners were three and with their Trainers they have been hard at work including role plays, songs, traditional dances with drumming and even making their own scenary. HIV/AIDS features in the presentation as does traditional medicine.

There is one member of the large Vesico-Vaginal Fistula team, a O & G resident, from the US staying at the flat to guide the last cases though their convalescene. They have spent all their time at the hospital,getting a rather trucated version of life here in Uganda, so I have invited her to join us. One of the groups has arranged for a mammoth community feast.

Friends, relatives and well-wishers will be attending. Cash prizes will be provided for the winners. Save the Children personnel have come to make the presentations.

The groups have done so many different songs and plays that each presentation goes on for at least a half an hour. The church is huge with walls stretching high into the ceiling, likely meant to be a cathedral when complete. The floor is mud and the windows without casings or glass but the idea is definitely grand. Chairs and benches have been brought in for us. The light is poor inside so I ask the puppeteers to bring their puppets outside where I can better photograph them. They seem proud to be asked as they have made the puppets themselves.

It is a joyous celebration. The groups well prepared and shining with delight. Wonderful really to see all the VHTs in their T shirts filling the place. This brings all the kids over to watch again, they can't get enough. I love the big foam faces and their matching curtains for the box.

Photos: Traditional healer drama; VHVs in their T shirts; kids watch; puppet show.

Ruhungu Volunteer Health Team Training

At 8 a.m. when we set off for Ruhungu parish in SW Uganda for the Volunteer Health Team training workshop, the roads are already full of traffic. In the road to the village, we pass the milkmen on their bicycles carrying cans lashed on the back with strips of rubber inner tires selling the days milk along the way. Heading out from the community we pass bicycles heavily laden with huge bunches of matooke, a green cooking banana which forms the basic staple in the area. For people in Ruhungu, matooke is not only their staple food but also a source of income. The fields are bright green, glistening from the recent rains.

We are the first to arrive. I am travelling with an interpreter these days which is helpful for following in detail the training and also with a pediatrician on a short visit to the area as part of her London School of Tropical Medicine course. She is Portuguese and makes a connection between what we are trying to do here with what is needed for African migrant populations in Lisbon.

Surprisingly enough, she was, prior to coming here, totally unaware of community-based child health program and their potential for getting health education and prevention efforts mobilized in rural areas. Her enthusiasm is contagious allows me to see it with fresh eyes.

Once again we are training without manuals. This doesn't seem to diminish the effort that participants put into training however. To put across the health messages and make them more memorable and thus more easily recalled, participants are encouraged to report back using drama, songs and poems. The whole group so likes the immunization song that it is repeated several times until I too am able to catch the Runyankole words.

After the session about diseases, the whole class moves to the front of the darkened room, to copy into their scribblers, the key points the facilitator has written on the newsprint posted at the front of the room. Electrification, which was such a game-changer in rural Canada in the Fifities, has not yet reached these rural parts of Africa, more than 60 years later.

During small group work after tea, huge thunderheads unload a torrent of wind and rain on the tin mbati roof of the small hall. The cacophonous hammering makes it impossible to hear a person yelling in your ear, yet through it all, the participants stuggle to hear and make themselves heard. There are very few places left where one still sees such dedication to learning.

The pediatrician is amazed at this. I realize I am no longer even surprised. Such is the desire for learning here in the rural areas that training is almost always given as a top motivator for the volunteer health workers.

The dense rains has been expected so the mid day meal preparation has already begun indoors when we arrive. The woman organizing the huge sikiri (tin pot) full of banana leaf-wrapped matooke can hardly be seen thru the smoke eminating from her fire atop three stones inside the small room. She sits happily on her small stool with groundnut stew in one corner and the huge mound of matooke covered with banana leaves in the other. We have not yet even addressed the indoor air pollution as a cause for ill health, so busy are we with infectious diseases. Another challenge!

Here at the village level one thinks how interrelated things are. I suspect if we were able to reduce the level of air pollution /smoke that women and especially children are exposed to in these closed spaces we would see a great reduction in the pneumonia.

I am pleased to see the woman has sent her small child outside, away from the heavy smoke in the room at least for now before the rains come down. I am only able to tolerate the smoke long enough to take a quick photo. But it is a lovely photo even thru the dense smoke.

Photos: man with matooke on bicycle; parish room; windstorm beats matooke trees; VHTs copy down notes; cook with matooke on 3 stones

Rubber Necking in SW Uganda

Catching up on the Volunteer Health Team VHT training going on in our rural areas has me travelling to distant places in the districts of the South West of Uganda 4 days a week, each day a different set of trainers and a different community. Most of our original CORPs (Community Owned Resource Persons) have been incorporated into the VHT, and our facilitators have been leading the training in our own area, so it is nice to see how well they are doing. There are the usual issues of the training material has not been translated so manuals and teaching aids are not ready for participants and the record books they are to register people in are not yet available.

The great thing about travelling to the field is the wonderful rubber necking one gets to do as many of the villages where we train are deep in the rural countryside. Intensive tea plantations have been built on the road to Queen Elizabeth National Park. We found large groups of workers picking tea. It was also the first time I have seen them do it with mechanical pickers which sheer off the top of the bushes. Groups of workers collect the tea leaves in large plastic rice bags by the road for transport to the kilns for drying.

Uganda tea, even the cheapest kind available, is lovely. I am not clear about what is needed for great tea, but the cool high, fertile land here in Western Ankole seem to be just the ticket.

Near the forests in the same direction last week there were men sawing huge logs on a platform, one man below and the other on top, to hand cut planks. I had never seen this done by hand before except in historical photos of the early felling of the Pacific Rain Forest.

Towards Lake Victoria, high in the hills we come across a couple of children collecting water from a protected source. The enclosure for the pump is made out of a rapidly growing cactus-like plant which will over time weave together to form a barrier to the cattle. There was a younger child, only four or five years old with the two boys. Even he has a small plastic bottle to fill.

Small children often participate actively in the collection of water. These kids seem to be having a good time of it. The smallest child started to cry when he first saw me, perhaps his first time to see a white person, but the others soon reassured him. But he does not appear very happy in the photo. Life in rural areas tends to require the participation of the whole family including small children. But the good thing is that they have access to clean water.

FPHC Begins Reconstruction Activities in Flood Areas

Sorry for the delay in communicating with you. We have been really overburdened and it continues. even now. The staff is working longer hours than routine, even the office staff.

Because our geographical area is prone to emergencies and we have needed to respond quickly in the past to earthquakes, floods and massive IDP migration, this past January we opened a special bank account to create emergency response fund. This also has helped us to track the emergency funds we received better. We had a small amount in this account when the floods hit that allow ed us to jump right into relief services at the end of July, 2010.

The need for medicine and supplies, even at the beginning, however was very big as whole families and communities had run from their flooded homes with only the clothes on their back. So we were very glad that you were able to raise and send funds to us so quickly.

Our early and effective emergency response was acknowledged by the government authorities, who put us on their official list. This helped as we then received some local donations from philontherapists and organizations. International groups such as UNICEF, WHO and UNHCR also came forward to assist us with supplies. In addition, we had realized some unspent funding in ongoing projects in the tribal areas and got approval from UNICEF for utilization of those savings in flood affected areas.

Along with the donations sent by Society of Rural Physicians of Canada, Hillman Medical Education Fund and Rose Charities we have been able to continue our work since the floods began.

Recently we have been chosen by UNHCR for an emergency grant to set up two static health care centres in government health facilities in Nowshera and Charsadda districts for the flood-affected people. Each of the static centers supports by six mobile teams. The static centre consists of LHV, 1 MCH Assistant and 1 Male Social Mobiliser. . Each of the six mobile teams supporting the static centre consists of 2 Medical Doctors, 1 Medical Technician, 1 Laboratory Technician, 2 LHVs, 2 MCH Assistants, 2 EPI Technicians and support staff. So this totals more than 50 additional staff members as well as the necessary medical and non-medical equipment, rented vehicles and medicine. As part of this UNHCR project we are also rehabilitating 12 health facilities, including several FPHC centers, that have been affected by the heavy rains and floods.

We expect to hear shortly from UNICEF regarding a possible six month Nutrition Project for flood affected people that is planned to start middle of October. Under this project FPHC will be providing Nutrition Services (specifically provision of ready to use micronutrients and nutritional information) to women and children in at least 10 Union Councils . A Union Council is an administrative unit like a big village.

In recognition of our activities, FPHC is now an established part of the the Nutrition Cluster at Country level and coordinate regularly with UN Office for the Coordination of Humanitarian Affairs (UNOCHA) and National Disaster Management Authorities. Thank you to all our generous donors for helping not only flood-affected people in Pakistan but also for assitsting all the staff of Frontier Primary Health care to build capacity in responding to these humanitarian emergencies.

from Dr. Emel Khan and FPHC

Photos: Flood relief 2010