Interlude to a Travelog

I just stopped at the local supermarket on the way home and quite a few people were gathering. I ran into my World Education colleagues Inbal and Pierre in the parking lot who said that they were there to check out “the happening,” sponsored by the Alliance Francaise. A few local musicians were playing and a kid was breakdancing. I thought no more about it and ran into the store.

I emerged from Shoprite and heard Edith Piaf on the loud speakers. Many more people were gathered, but I didn’t want to keep Victor, my driver, waiting. I found Victor but from the corner of my eye saw a giant backhoe moving—and then noticed someone hanging from the backhoe. Not hanging, but dancing. Ballet dancing with a giant backhoe to Edith Piaf.

It was an amazing, uplifting, wonderful little interlude in downtown Kampala.

Meeting a Client in her Home

Day 3 continued

After leaving St. Stephen’s School, we drove to a local clinic and picked up a community health volunteer, Mama Agnetta, as well as the local government community health extension worker (CHEW) named Steven and drove to visit a client.

The roads we were driving on got smaller and smaller until it was essentially a path between fields growing corn and beans. When we got to a little shop, we parked and began walking. It was about 10 minutes to Evaline’s house, down paths between more fields—this part of Kenya is quite lush and all the fields had corn reaching about 2 ft high, with beans planted in between the corn. The house was larger than many I’d been to. It had a relatively big sitting room—which I suspect had extra chairs brought in for our visit—and a bed room, a packed dirt floor swept clean. And small windows that opened for ventilation.

[walking to Evaline's compound]
Mama Agnetta had heard that there was a woman who was house-bound when was visiting other people in the community about 2 years ago, and she came by to pay her a visit. Evaline says that her husband was living in Nairobi and her family had abandoned her when she became sick. Her . Mama Agnetta helped get Evaline to the Matibabu Clinic in Ukwala and advised her to get an HIV test while she was there.

When the test showed that Evaline was HIV positive, Mama Agnetta counseled her and talked about how to take care of herself and the importance of good nutrition. She arranged for Evaline to get multivitamins and other nutritional supplements and to get regular check-ups. When her CD4 count reached 120, Mama Agnetta helped Evaline go to the government's Community Care Clinic, across the street from Matibabu’s clinic, to get her antiretroviral drugs (ARVs). Today, Evaline credits Mama Agnetta with saving her life.

[Evaline says that Mama Agnetta, right has saved her life]

Visiting Evaline was very inspirational, and it was particularly interesting to hear how Mama Agnetta feels supported by Matibabu and how she’s seen the community change since CHWs began working in force. For example, the Kenyan District Health Office labels this area as prone to cholera. But in Ukwala, since the CHWs have been trained, there has not been a single case of cholera.

Mama Agnetta was a traditional birth attendant (TBA) for many years, and was even trained by the CDC as a “TB ambassador.” But as a CHW she is better able to address holistic needs of people in the community. She gives basic health information on health concerns ranging from diarrhea and worms to malaria and HIV, but more importantly, she knows when to refer someone to the health facility and can help clients negotiate what’s needed once they get there.

When asked what she thinks CHWs need, Mama Agnetta was quick to respond. “We need more CHWs who are trained [currently each CHW has about 20 households s/he is responsible for], and we should be more deeply trained in key areas.” She knows they can learn more—even though many of her colleagues are illiterate. Mama Agnetta also said that the CHWs need transportation—a bicycle—so they can get around more easily. All CHWs do their own chores and work in the mornings, in their home or on their farm, and then volunteer in the afternoons. A bike would certainly make their job easier. But few donors want to give funds for that kind of purchase. Philip is trying to find a way to help—though his hands are often tied, too.

Days 2 and 3 in Kenya

Wednesday, October 6, 2010

Our first work day here in Kenya was dedicated to a key message development workshop. The consultant Sarah used a process similar to one I’ve done in the past, whereby participants work to define who the organization is, its key differentiators, and the impact they’ve had on their clients. All this is designed to help Matibabu position itself to partner with other groups and do fundraising once the U.S. PEPFAR funding ends next year.

It was a long day with the staff very engaged in the process—though we never did get to the actual key messages because there was so much other discussion around other issues. (And frankly, I was glad to see that I wasn’t the only one who finds it difficult to reach this point!)

We again met with Amanda and Andrea over dinner. Mel had been with them all day taking photos in the clinic—mostly kids with malaria, she reports. (I made sure I started taking my anti-malaria Malarone once we got there!)

The second day gave us a chance to get out to visit clients, a youth group, and talk with community health workers.

[Bikes lined up outside St. Stephen's Siginga School]

First stop, an “Anti-AIDS Club” at the St. Stephen’s Siginga Secondary School. The Club was formed in 2009 after Matibabu worked with the school guidance counselor to conduct information and behavior change sessions with students. About 70 students, aged 14-20, participated in the information session and 69 of them ultimately got an HIV test (all negative!). From there they formed the club, which gives them a venue to talk openly with each other about issues that might be concerning them. The guidance counselor, Charles, leads the sessions.

Charles said that they all recognized that as western Kenya has the highest rate of HIV in the country (estimated to be 40%), that behavior change needed to start with youth. The club also works to build kids’ self-esteem and enable them to delay sex and “just say ‘no’!” And, in fact, in 2 years the pregnancy rate among girls has gone down, from 10 girls (of 200 students) to 4 this year.
[at right: Charles introduces us to the kids]

After meeting with Charles, we had a chance to meet and talk with the students (who were pulled out of class to meet the special visitors out on the lawn!). We asked a few questions of the kids, like what did they discuss at their last meeting, what do they tell a friend who might be getting into trouble. Philip, our project director, asked if they were able to pass along information they learn in the club—thus informing others of the factual information they've learned and hopefully help change others' behaviors, too.

[Philip fielding the difficult questions!]

The kids were then given a chance to ask us questions. One boy asked whether we had any advice on how one can approach one’s parents or aunts and uncles because it’s difficult. I piped up that as a parent of a 16-year old and an 18-year old, there have been times that they’ve come home and said “this is what I learned at school today…” so the issue is approached from the side, as opposed to directly telling an adult what to do. Not sure the advice resonated with him, but I tried! Other questions posed were more difficult to field—like “why don’t we lock up everyone who has AIDS” or “what do you say when a pastor says it’s a curse from God?” I did not have to respond, luckily, but these are some of the moral issues the kids are clearly thinking about—and at 40% prevalence (even though many people still don’t know/admit to being HIV positive because of fear of stigma) almost every kid there likely has had a family member infected… they are all affected even if not infected.

more on the other community visits soon...

Back on the Road - Uganda and Kenya

Monday, October 4, 2010

I landed in Kampala on Sunday morning, had a day at the hotel meeting with my colleague and friend Barbara Durr who was in from Nairobi. I wasn’t at the hotel long, though. Monday morning I checked out, went to the office, and we quickly left for Kenya. Our project director, Philip, did the driving (a first! Typically projects have hired drivers who cart us all around), ably dodging potholes and shepherding us through the crush of the border, where hawkers descend on the car offering to change money for you, hand you forms you may need, showing you what’s what. You get to do it all twice, as you leave Uganda and, 100 yards later, as you enter Kenya. It was quite the scene—a well coordinated chaos, it seemed!

Along for the trip was another communications consultant, Sarah, an American living in Kampala, and Mel, a British photographer visiting Uganda.

It was about a 6 hour drive all told. We landed in Western Kenya, in Uganya district, at a surprisingly nice hotel. Frankly, I was prepared for the worst, but the Hotel Camunya isn’t at all bad, all things considered.
(hotel Camunya at right)

After checking in, we drive the 20 minutes to the Matibabu Clinic. Matibabu is a small local NGO that JSI is working with through the Technical Assistance to the New Partner’s Initiative project. Matibabu received a direct grant from the CDC under the New Partner’s Initiative and JSI has been asked to help strengthen Matibabu’s management systems—along with about 15 other organizations. We just took a quick tour of the clinic and met some of the people working there and made plans for the next day, when Sarah would be conducting a workshop on key message development.

It turns out that while Matibabu is “homegrown,” they were founded and are extensively supported by a group of doctors from San Francisco--now called the Tiba Foundation. We found this out at dinner, when two Americans came into the hotel restaurant; one we had seen at the clinic. Amanda and Andrea are doctors who have volunteered for two weeks at Matibabu. Amanda, a pediatrician, has been involved since day one and volunteers twice a year. This was Andrea’s first trip—she’s an intensive care pulmonologist who’s known Amanda for years and was persuaded to come to Kenya by Amanda’s enthusiasm!

Matibabu Pharmacy window below