Month: January 2015

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I got so much trouble on my mind

This nagging feeling is a confusing one. It sits between bereavement and astonishment. It engulfs. It depresses. This feeling rears itself as I scroll my Facebook newsfeed and hear the narratives of our clients at HIPS. Statistics are staggering but the autobiographical narratives reveal the dire straits of our people.

Let’s look at our current dilemma:

  • Racism is dead, right? Well, let’s not be naïve. Racism – whether overt or covert – is inherent in our everyday lives. If you think the U.S. has moved beyond demonizing, brutalizing, and criminalizing African-Americans based upon their racial classification, let’s recall Trayvon Martin, Jordan Davis, Marissa Alexander and Renisha McBride. These are not ancient examples, mind you. Some of the most recent names include Vonderrit Myers, Eric Garner and Mike Brown.
  • Look at mass incarceration. Black men are more than six times as likely as white men to be in prison, according to the Pew Research Center. Take a moment to think about the intended and unintended consequences of this inhumane justice system.
  • Look at health disparities from HIV/AIDS, breast and prostate cancer, to practically every disease in the U.S. For one, African-Americans make up 44 percent of all new HIV infections. This problem is not only about transmission but also about access to health resources and stigma. Health is a right, not a privilege, yet these numbers tell a different story.
  • Washington, D.C. and many U.S. cities are experiencing an influx of college-educated, gainfully employed residents. Thus, gentrification is in full effect. Cities are changing. Potholes are resealed, condominiums are erected, property values skyrocket, and poor people are displaced. Remember Boyz In The Hood? Moreover, the social services for the poor see their budgets cut and go elsewhere. So while the D.C. Mayor’s Office proudly announces record-high population increases, close to 12,000 people are homeless. Worse yet, affordable housing is not flourishing, leaving thousands of people on a citywide waiting list for years before they can move into a place.
  • Where’s immigration reform? With 12 million undocumented immigrants in the U.S., there is still no sense of urgency to tackle comprehensive immigration reform from our trusted public servants in Congress. Meanwhile, deportations are plentiful. And who hangs in the balance? Hardworking, taxpaying Americans – the ones called “illegal aliens.” You mean to tell me racism, mass incarceration, and economic justice do not play roles here?
  • Women’s rights are not recognized as human rights. At least, that is how it appears. Women’s sexual and reproductive rights are up for debate every campaign cycle or Supreme Court session. Equal pay seems too difficult to guarantee but sexual assault appears omnipresent. Frankly, if a woman is not guaranteed her human rights, we all suffer an injustice to our communities.
  • The same applies to our LGBTQ Family, especially Transgender folks. Kudos to the feds for banning discrimination of transgender and non-gender conforming persons. That’s a great move, yet this does not negate the discrimination faced by so many. The National Center for Transgender Equality’s discrimination survey reports unemployment twice as high as the general public. Furthermore, with a disproportionate number of homeless transgender folks, homeless shelters are ill equipped. Staff members are lacking cultural competency and shelters are not safe spaces for transgender people.
  • And as I listen to the most recent album from Pharoahe Monch, I can’t help but to think of how barriers remain endemic in mental health access and drug use treatment.

This feeling still leaves me stewing in frustration while in my quiet loneliness. This feeling also solidifies my determination somehow. Policies and red tape have to be revisited and re-evaluated and removed. My cries must join your cries to be amplified. Yes, none of these aforementioned issues exist within a vacuum. The hearts and minds of our neighbors in our communities have to be touched.

We must move beyond the colorful rhetoric and transform whatever good intentions we have into action. Your struggles are not far-removed from mine. Racism should not have a host, and affordable housing should not sound foreign to city planners. We have to become a community; an inclusive, compassionate community that supports, empowers, and respects one another.

When “i” is replaced with “we”, even illness becomes wellness.” — Malcolm X

 

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GHC Staff Uncategorized

Superhumans

One of my main reasons for applying for a Global Health Corps fellowship in Uganda was to be closer to the work I was supporting. Before GHC, I worked at the US headquarters of a global health nonprofit organization. I loved it there: interacting with donors, writing about projects I believed in, and learning about global health equity every day. One of the most inspirational parts of my job was the opportunity I had to interact with field-based staff. I relished every chance I got to collaborate with them on proposal development, data collection for donor reports, and donor site visits. Yet these interactions were almost always remote, through email or over a staticky and unreliable phone connection. I wanted to work with them, and learn from them, more directly – in person and on a daily basis. I wanted to witness the work they did first-hand.

Since being in Uganda, I have been consistently impressed by the competence, knowledge, professionalism, and commitment of my colleagues. Like most nonprofits, Baylor-Uganda is stretched thin in terms of staffing, and everyone is required to do work outside of their job descriptions. Based on the amount of work they handle and the daily challenges they face, I have basically come to believe that the Baylor-Uganda staff are superhumans. When they aren’t seeing patients, doctors are writing grants; when they aren’t analyzing program outcomes, M&E managers are gathering impact data to share with donors. Most people here are responsible for the work of at least three full-time positions. And although stress can be high at times, people rarely complain; they just do their work with positive attitudes and unmatched dedication. And from the Quality Improvement Officers obsessing over improving program efficiency to the Play Therapy Specialists bouncing basketballs with tiny HIV-positive toddlers, it is obvious that they love what they do. Their passion for their work is palpable and inspiring—if everyone loved their jobs as much as Baylor-Uganda staff seem to, the world would be a happier and more meaningful place.

This may sound overly optimistic and, of course, Baylor-Uganda has its problems like any other organization. Perhaps I am being excessively sentimental as my time in Uganda comes to an end. But overall, I can honestly say that it has been an honor to work with such impressive people. Their dedication has been, for me, the top motivating factor to do my work. They are capable of doing great things—and the least I can do is try to raise funding and support so that they can.

Melissa and Baylor-Uganda colleagues cutting a cake after winning a grant
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GHC Fellows and Alumni GHC Staff

If we can’t talk about it, we can’t end it: Playing your part to end violence against children

In my first week at Together for Girls, I learned very quickly that experiencing sexual assault doesn’t make a person a victim, but a survivor; that there’s a difference between coerced and forced sex; that pairing photographed faces of young people next to data on the issue of sexual violence against children is a unanimous no-no, violating their rights and putting them potentially at risk. I’ve learned that in the countries where Together for Girls is working, more than 50 percent of children experience physical violence before turning 18, and that for 25 percent of girls in many countries, their first encounter with sexual intercourse is unwanted.

And unfortunately, there are many more stats like these for me to learn.

I’m in the second quarter of my one-year Global Health Corps Fellowship—my very first experience working in global health (or any health for that matter)—at my small yet mighty placement at Together for Girls in Washington, DC.  Together for Girls is the private-public partnership that brings together five UN agencies, the US government (and as of just recently, the Canadian government!) and the private sector to end violence against children, particularly sexual violence against girls.

“Wow, why did you jump to such a terrible issue to begin your career in health?” say many palpably uncomfortable people upon learning my answer to the standard “so what do you do?” question. But little do they know, they’ve started a conversation that should be taking place the world over:

Why aren’t we jumping to address the issue of violence against children?

Sexual violence against girls is the elephant in the room sitting on the edge of global health concerns, and is just now beginning to be recognized by the public in a bigger way—“thanks” in part to the bravery of public-facing young women like Peek.com founder Ruzwana Bashir and Columbia University’s Emma Sulcowicz. But despite highly publicized cases and public remarks across the world, the most marginalized groups of women and girls are still excluded from many of the advances that we assume as norms today. They are often more vulnerable to violence and have greater trouble reporting and accessing services if violence occurs.

I get it though; talking about violence against children is unpleasant. And talking about sexual violence and girls is pretty much unbearable. But when do the numbers get big enough that we’re forced to have a conversation about it? The CDC estimates that one billion children a year experience some form of abuse.  The recent UNICEF report “Hidden in Plain Sight” details the miserable extent of physical, sexual and emotional abuse against children across 190 countries, citing that globally, about one in 10 girls (about 120 million) under the age of 20 have experienced forced intercourse or other forced sexual acts. The report also mentions that one in three ever-married adolescent girls aged 15 to 19 years (84 million) have been victims of emotional, physical or sexual violence committed by their partners or husbands.

And to make things worse, data from the Together for Girls partnership shows that girls who experience violence have a higher risk of negative health conditions later in life. In Swaziland alone, girls 13-24 who have experienced violence are 3.7 times more likely to contract HIV and 3.5 times more likely to experience complications with pregnancy compared to those who haven’t been exposed to violence. And to make things even worse, the UNICEF report shows that many instances of violence happen in places where children are supposed to feel safe—their homes, schools and communities. Bottom line, the issue of violence against children is truly “hidden in plain sight.”  And of course, if a girl lives in a wealthy country with access to education, rule of law and respect for human rights, she is far from immune – just ask girls on any college campus in the US where it is estimated that one in five will likely graduate with more than just a degree, but also a history of rape.

Playing your part to end violence against children

Obviously, there’s no clear-cut solution to this issue, which really takes shape as the complex beast that it is once you factor in the culture of victim blaming, as well as the many forms of violence that sit deep in traditions, like child marriage, beading, female genital mutilation (FGM) and many more. But if we don’t start acknowledging the significance and the breadth of the issue and the silence that too often surrounds it, real action globally and locally just won’t happen.  We know there are interventions that can help survivors recover and–even more importantly–that violence can be prevented. But we have to lift the silence.

So let’s start talking about it. Together for Girls just launched the second issue of Safe—the first-ever digital magazine focused on the global epidemic of violence against children. Launched in 2013 during the 16 Days of Activism Against Gender-Based Violence, the inaugural edition focused on sexual violence and highlighted inspiring survivor stories, the hard work being done by organizations and individuals to combat the issue, and celebrated the many positive steps already taken. With issue II, we’re shifting gears and connecting the dots between health and violence through TfG data, stories from HIV-positive survivors, interviews with change-makers leading the fight, and a world-spanning list of heroes who are using innovation and grit to end violence.  We want Safe to be a tool to advance the conversation surrounding violence against children, and not just the uncomfortable part either – the solutions part.

There are incredible organizations all over the world (like this one and this one and this one) that are using empowerment frameworks, recovery centers and the voices of girls to challenge the culture of violence, proving that progress is being made. But the organizations working on this issue need the voices of the public to help bring this issue into the light, to remove the barriers for advancement that are rooted in every society.

So learn about the issue. Question behaviors that silence survivors. Call out people or organizations perpetuating violence. Join a campaign working on the issue. It takes a global village to end violence again children—so let’s start getting comfortable with talking about it.

Learn more about Together for Girls and read issue II of Safe magazine here.

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GHC Staff Uncategorized

DREAMers in Limbo: The Federal Decision to Delay Action on Immigration Reform

June 15, 2012 was a great day in the United States. President Barack Obama issued a ruling that would grant reprieve to hundreds of thousands of undocumented young adults who came to the U.S. as children. Immigrants were finally able to live and work in the U.S. without the threat of deportation and the possibility of renewing their deferred action status after two years. Although deferred action is not a pathway to citizenship, it does elicit a measure of good faith and a reminder that America is a country whose history was built by immigrants.

In early September 2014, it was widely rumored that President Obama would once and for all use his executive power to deliver comprehensive immigration reform, a motion that has been lobbied for by many advocates for years. Unfortunately, it was politics as usual when the President decided to delay reform until after the midterm elections in November. It is obvious that his decision was made to placate several Democratic senators seeking re-election in a competitive Senate rate. Immigration reform is too “controversial” of a topic and if reform was pushed too early, many Democrats could end up losing the votes.

The consequences of yet another delay in immigration reform are many. Because of this inaction, initial estimates show that at least 60,000 immigrants will be deported between the date of inaction on September 5, 2014 and Election Day on November 4, 2014, which is consistent with the rate of deportation in 2013. However, the difference here is what you get on the flipside; the implementation of administrative action would ultimately protect millions of people – potentially including parents of U.S. citizens, parents of the young immigrants who’ve already qualified for deferred action, and/or spouses of U.S. citizens or permanent residents. Families would no longer have to live in fear of being torn away from loved ones. Protections such as these constitute inalienable rights that government must act now to provide.

Additionally, these federal protections are vitally important to a country that seeks to revitalize its weakened economy. Not only does granting work permits to eligible undocumented individuals mean the U.S. will see a boost in payroll tax revenues, but it will also mean that many of these immigrants will begin to assume some of the more low-wage, low-skilled jobs, lifting American citizens out of those positions and presumably up the company ladder. Although, it should be noted that undocumented workers currently are nearly three times more likely to experience wage theft than legal workers. However, the glimmer of hope is that immigration reform would inherently engender accountability and standard measures among employers.

Granting temporary work permits for undocumented workers will inevitably maximize their earnings potential and create a pathway towards economic security. Additionally, through executive action, the President can focus enforcement resources on high-priority targets, such as major criminals and those who threaten national security. And as Americans wait for the Administration to announce which executive actions on immigration it will take, they should keep in mind that a step toward fixing the immigration system is a step toward greater financial security for everyone. Further delay in reforming the American immigration system can no longer be an option.

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GHC Fellows and Alumni

The Global Health Web

Nearly three month ago I found myself siting on an Adirondack chair on Broadway Triangle. Beauty drew us to this section of town. It was one block from Pierson College, where I along with other global health advocates, were residing. A nice gentle breeze was blowing from Elm Street, carrying with it a tantalizing aroma from Maison Mathis and Bistro Noodle. I switched my attention from the expo summer camp students who were enjoying their Hummus dip at Maison Mathis, and to my far right, I could see techie individuals swiping the tip of their fingers on Macintosh gadgets inside the Yale Apple-Store. Siting right on the middle of a Y-junction, I admired the automobiles passing through both ends of Broadway Street. It was not the busy street full of Azungu pedestrians that caught my attention, nor the wonderful trees along the road that pulled my guts or the interconnection of the world around me. It was the interplay of all these facets of life that were at hand. Their interconnectedness is what struck my attention. It was how the health food business could use the electronics products from Mac to account for their products; it was how the fresh air produced by trees along the road absorbing carbon produced by the automobile traffic which was the focal topic of the Expo summer camp students visiting the magnificent Yale University.

I sat there relating the idea of interconnection to the disciplines involved in global health. It was with this thought in mind that my co-fellow and I tried to outline our contribution to global health and map out our journey that was about to begin.

The equation to building health equity is not only good hospitals, anatomy books, physicians and nurses. Rather it is the collaborations between nations that bring together facets of research and action to build health care that is accessible and effective for all. It is the contributions of different types of professionals and expertise that will build sustainable health equity. It is the contribution of food nutrition, top notch architect designs, supply chain analysis, technology, finance and monitoring and evaluation that makes the whole health field able to grow and succeed. This is what global health is all about, and bringing these professionals and their varied skills to the problem of health equity is what Global Health Corps does.

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Happiness Toolkit

Living and working in Uganda isn’t easy. Picture this: you’re working in a country that has totally different customs, languages and cultures (yes, multiple) from your own. So you’re trying to wrap your head around the incredible diversity around you while picking up words in the various languages you hear. You’re trying to learn when people eat, what they eat, how they eat it. You’re searching through every grocery store in your vicinity to try to find some food items that look familiar and trying to figure out how to get that gas tank connected to your two-burner stove-top (kind of feels like camping in your kitchen). You’re struggling with this bucket-laundry thing; you put the soap in and make frantic ‘laundry-machine motions’ with your arms (which makes your neighbors laugh) and haphazardly scrub only the ‘important areas’ because your back starts to hurt from being hunched over. And you’re doing all of this while learning the layout of a new city and discovering how public transportation works (but wait, it’s different in every city so don’t get too comfortable). It’s all very exciting and interesting and sometimes frustrating.

When I stopped to think about it, I realized that I was completely re-learning how to take care of myself. I was undoing years of thinking that I was a self-sufficient, independent young woman capable of caring for myself. Suddenly I was left asking, “How do I pee into that?” while pointing to a hole in the ground in the back corner of a pit-latrine. My amused colleague explained how to pee while standing; something I never imagined possible for women (full disclosure: it was a disaster but I’m determined to figure out how she did it!). Learning how to be an independent person in a foreign country has taught me two things: 1) I have learned what I really need to be happy and stay sane, and 2), turns out I’m not as independent as I thought I was, but there’s something comforting about that.

Staying happy and sane is crucial. How can you lightheartedly laugh at the incomprehensible things people say to you if you’re in a bad mood all the time? [Ex. “I’m going to take a short call.” Ok, sure, I don’t really care how long you’re on the phone for – turns out that means going pee and long call…well you get it.] To me, staying positive and happy means cooking healthy foods for myself, exercising regularly and having a group of close friends around to laugh with. Luckily, I’ve learned where the fruit and veggie market is and have my veggie lady, Alice, who excitedly tells me whenever she has beets because she knows they’re my favorite. And I have James, the street-food vendor who I can call whenever I want my “Chiara Special” which consists of torn-up chapatti, beans, cabbage and tomato (called Kikomondo) and a two-egg omelet on top (that’s the special part).

I also run most mornings before work. At first I was afraid because running is not very common in Kasese. I’m usually the only runner on the roads and get lots of curious stares. I have found that people, especially children, love to call out to me, wave, smile and even chase me from time-to-time. Now it’s a game; sometimes when I’m chased I’ll turn around and make scary faces and scream really loudly while chasing after them. They scream and bolt off the road into the fields, but as soon as they realize it’s a joke we laugh together until tears come to our eyes. I keep going, and they keep chasing me. But I treasure these moments, running into the sunrise over the beautiful valley that I live in. It makes me realize everyday how lucky I am.

So, after learning that I needed healthy food, my morning runs and my amazing friends (friends from home as well as friends who came built-in with this incredible fellowship experience), I slowly began to realize that I’m not as independent as I thought. I rely heavily on my co-fellow to help me navigate Kampala, understand office politics and translate things when people are speaking one of the six-plus languages she speaks.  I rely on my colleagues to help me understand the communities that my organization, ACODEV, reaches. I rely on strangers sitting next to me on the bus to tell me if I’m actually going in the right direction (it’s easy to be coerced onto the wrong bus if you’re not careful!). I rely on my friends who are a Whatsapp message away, willing to listen to me vent my frustrations about work and about the time I got on a bus that was about to leave, but, 2 hours later we had not left the bus-park. I’ve learned that being a hyper-independent individual doesn’t work here because being a part of an interdependent community is what keeps everything going. It’s such an admirable social quality that, in my opinion, we downplay the importance of in the US.

Most importantly, I’ve re-learned how to take care of my basic needs so that I can be a happy, healthy, productive member of my new community and my organization. There were some ups and downs, and there are continual frustrations, but now that the growing pains of settling in have passed, I feel fully equipped to take on the year ahead with my “Happiness Toolkit”!

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Rethinking Incentives for Midwives

According to The State of the World’s Midwifery 2014 Report, there is only an estimated 27% met need of the workforce (midwives and physicians) available to provide midwifery services in Uganda. How do we address the unmet need? Incentives!

“What are the incentives? Think about the incentives.” These are phrases I have heard so often in regards to motivating midwives and reducing the rate of attrition. When we talk incentives, many times we are referring to financial incentives. Financial incentives have proved successful but the biggest challenge with this has been sustainability of such reward systems.

Incentives are classified as financial or non-financial. However, according to the World Health Report 2000, incentives for health workers are “all the rewards and punishments that health workers receive as a result of the organization in which they work, the institution under which they operate and the specific interventions they provide” (WHO 2000). As we look to double the number of the workforce available to provide midwifery services by 2030 there is need to design incentives that are specifically targeted to:

• Encourage health workers provide midwifery services
• Support staff recruitment and retention
• Enhance productivity and quality of services

Whether financial or non-financial it is important to recognize that health workers will respond differently to these incentives depending on the level at which they are in their career.

On a recent visit to Isingiro in South-Western Uganda, I met with Godwin, an enrolled comprehensive nurse who had just started working the previous year at Rushasha Health Centre III, which is approximately two hours away from Isingiro town. An enrolled comprehensive nurse is a nurse able to provide midwifery services. In the absence of the midwife in charge, Godwin is providing antenatal care to expectant mothers. A queue awaits him outside as it is a Tuesday- a day dedicated to antenatal services. Godwin expressed his happiness at being able to step in for the midwife and offer these services. He said it gave him the opportunity to practice his skills and the more he did it, the less likely he was to forget. When asked what motivates him to keep doing this, he remarked that when mothers go away happy and bring in other mothers he is happy because it shows he is doing a good job. He was also encouraged by the support supervision and in-service trainings he had received through Jhpiego’s intervention.

For Godwin and others like himself, who are at the beginning of their career, the motivation sparked by financial incentives is not as important as non financial incentives like support supervision, continuous learning that can guarantee growth and progression in their career.

The ideal scenario would be that by 2030, the number of midwifery graduates and physicians would have doubled from the current 29% to 48% (The State of the World’s Midwifery Report 2014). If we are to achieve this goal, I think it is necessary to rethink incentives and how we award these. Let us not only look at the financial incentives but also consider the merits and appeals of non-financial incentives.

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GHC Fellows and Alumni

The Whole Person

Through my consistent experiences with patients at the Joint Clinical Research Centre (JCRC), a HIV/AIDS care and research facility just outside of Kampala, Uganda, I am reminded of how complex a patient’s experience can be with a chronic illness, especially when it involves pain.

The pain of living with HIV is not often a story solely rooted in the physical effects of the virus, even if a person appears on the surface to have a primarily physical ailment. There are wide-reaching implications often overlooked by healthcare providers that include the emotional, psychological, spiritual and social consequences of having the virus.

One of the ways JCRC supports this all-encompassing approach to patient care is through weekly “CMEs”, or continuing medical education talks, generally presented by health professionals. Recently, I have really enjoyed presentations by hospice nurses at Hospice Africa Uganda and Dr. Seggane Musisi, a psychiatrist/researcher from Makerere University in Kampala. Although they come from slightly different perspectives and backgrounds, all unwaveringly emphasized how we need to look at the whole patient and utilize a more integrated care model that addresses the core of a patient’s imbalance. As a nurse and future physician, I truly believe that this is the foundation of the highest quality patient treatment. My experience has shown me that patients will not optimally function if all of these aspects of their lives are not in balance. This is especially important now for patients with HIV because a HIV diagnosis is considered more of a chronic illness and people are living much longer than before.

Dr. Musisi mentioned that one must truly be thorough when assessing a person, especially when it comes to pain. A good starting point, he shared, is asking a patient an open ended question such as, “What are you experiencing right now?” This opens up the avenue for patients to discuss their subjective experiences and allows for more fluid dialogue. Perhaps stigma is something that bothers some patients the most. Patients, especially those with tuberculosis, may feel abandoned on the outskirts of society. Tuberculosis is something we see more often here in our patients with HIV as compared to the general population because of their compromised immune systems and the synergistic workings between HIV and tuberculosis. Or maybe patients with AIDS serving as primary breadwinners are suffering the most as they wonder how their families will fare when they pass.

In general, this is a call to get to the core of any dissonance of a person’s firsthand experience as this is the person’s reality. Even if we are not involved in direct patient care, we must remember that quality healthcare will dig a little deeper in order to really address the greatest challenges of the human experience and to assist people in achieving optimal wellness as they define it for themselves.

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GHC Fellows and Alumni

Holistic Health

Global Health Corps is an organization that promotes health equity for all. What does it mean to be well? How does one not contract a disease? Is health just the absence of disease or does it mean more than that? The World Health Organization goes a step further and defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The WHO definition includes many aspects of one’s well being in order to be a healthy person, and rightfully so.

Take the example of Tukahirwa Alice. She is a 54 year old widow. She lives in a small village called Nyakageyzi in southwestern Uganda. In her village, there are few people with access to power or running water. She is a subsistence farmer growing bananas, beans, sweet potatoes and a few other crops to feed her family. She lives in a mud hut and uses a pit latrine. Many of her children have died and she is left caring for 4 of her grandchildren. On top of that she is HIV positive and needs to take ARV’s (antiretroviral) treatment to slow the progression of HIV.

Alice and her family

This story is not uncommon for this area of Uganda and other parts of the world. So how do we provide grandmothers like Alice with the tools and ability to create a more healthy life? That is where Nyaka AIDS Orphans Project comes in.

Nyaka believes that it is important to provide a holistic approach to development. The organization believes that in order to create a healthier, thriving community we can’t just focus on education or health care or sanitation or any one aspect alone. The approach must be integrated. Fixing one problem won’t raise a community up out of poverty. We need to continue to address all factors that challenge people from living a healthy and fulfilling life.

Since I am a fellow at Global Health Corps, I am particularly interested in making sure that ones health does not stop someone from living the life they want to live. In order to improve someone’s health that person needs access to health care, but not just any health care, quality health care. The individual must be able to access health services and also receive drugs. These basic services must be affordable and available to every person regardless of their income and where they live. Access to doctors, nurses, dentists and medicine though, does not ensure that a person is healthy.

In order to be healthy we all need a safe places to stay. Some place where we don’t fear the roof or walls of the house collapsing. We also need a clean place where the surroundings are free from tall grass, garbage and feces. We need a place to go to the bathroom and a place to bathe. We need a place where there is room for all family members to sleep inside. We need to have a house within a sanitary environment to live in order to prevent diseases in the first place.

We also need water. But not just any water, we need water free from parasites and bacteria. We need water that does not cause diarrhea when drunk. We need safe and clean drinking water. The same goes for food. We need food that is cooked properly so that we don’t get sick from eating it. We all need to eat. We can’t just eat boiled plantains everyday with a spoonful of beans. We need a variety of foods like mangoes, green vegetables, chicken, milk, nuts, tomatoes, milk, and onions. We need to eat foods that will help boost our immune system and keep our bodies healthy and strong. We all need this, whether we are 2 months old or a 102 year old.

A grandmother preparing a variety of foods

We need education. We need to provide children with the ability to attend school. To learn, to gain a better understanding of the world and to be given a chance to succeed. We need to teach guardians how to keep there children healthy and how to keep themselves healthy. We need to teach pregnant women how to take care of themselves before, during and after birth. We need to teach farmers how to produce food more efficiently. Knowledge truly is power.

We need something to hope for. We need to make sure that grandmothers and grandfathers have something to live for. We need to make sure that children have the ability to go to school and dream of being a teacher or pilot or doctor. We need people to have something to look forward to, to strive for. We need people to believe in the ability of making a difference and creating a better future.

Perhaps, the most important thing that we need is each other. We need friends and family. We need support and the feeling that we belong somewhere. We need someone to help us take care of our children, cook and clean when we are too sick to get out of bed. We sometimes just need someone to complain to. We need someone to celebrate with us during happy times and someone to lean on when the going gets tough. These interactions can influence our physical, mental and social health. We all need human interaction.

There are many things that we need to be healthy which brings me back to Alice and the work that the Nyaka AIDS Foundation does. Before Alice joined a grandmother group affiliated with Nyaka, Alice was struggling. She could not afford the services and drugs offered at the nearest government hospital; her pit latrine and kitchen were in rough shape. She struggled to pay the school fees for the children she was caring for; her HIV was affecting her life.

Alice became involved with the Granny group, where grandmothers take advantage of micro-finance loans and are able to discuss challenges they are having in their life and provide each other with solutions. This support from other grandmothers with experience with similar problems caring for orphans is a great way to spread knowledge and make that one another know that they are not alone. Nyaka also provides new houses, kitchens and pit latrines to grandmothers. Within these groups grandmothers determine who is in the greatest need of one of these structures. Alice was chosen due to the dilapidated state of her own facilities. The knowledge that she now doesn’t have to worry about these structures falling down thus reducing some of the stress she feels.

Alice also utilizes the Nyaka clinic for free healthcare and medications. She no longer has to worry about having enough money to pay for health services and drugs. She also attends health talks to learn how to better care for her family. Her use of the clinic has reduced her burden of living with HIV, in fact she now looks strong and healthy while talking her ARVs and accessing the services at the clinic.

Alice’s daughter and granddaughter receive sponsorships from Nyaka to attend secondary and primary school, respectively. The students receive two balanced meals a day. The knowledge that she has given her family a chance for a better future is one that she says is keeping her alive.

Nyaka enables individuals to provide a better life for themselves, while securing a better future for their children by providing a holistic approach to health. Imagine if this success could be replicated for all of those women who were living like Alice. By providing individuals and communities with programs and services addressing not one challenge, but many that affect their health we could transform communities. After all, many different things impact health.

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Information Systems: the Secret to Solving Uganda’s Health Problems

It’s interesting how so many ideas have been documented and visualized about improving the health sector in Uganda, while ignoring the fact that an improved health sector starts with health providers being able to work more efficiently and effectively.

This involves proper documentation of patient records, proper data storage, and proper feedback mechanisms in order to create a smooth information flow.

Most of the current processes are often manual and more laborious than they need to be. This causes greater inefficiencies, longer turn-around time, loss of revenue due to inaccurate compilations, inability to archive data for future use, and poor allocation of resources.

Well developed health information systems that are based on the idea of sharing critical information can assist areas of operation in the health sector. I am currently working as an IT systems fellow at Joint Clinical Research Centre (JCRC), a non-profit organization that was founded in 1991 to address the challenges of HIV/AIDS in Uganda. JCRC is one of the largest antiretroviral therapy (ART) centers in Uganda. Currently, it has the most advanced reference laboratory for other HIV/AIDS partners in the country with capacity to do sophisticated tests required for ART monitoring and detection of resistance to antiretroviral (ARV) drugs.

In order to achieve the success that it has, JCRC embarked on upgrading of its health systems and boosted its capacity to handle as many clients as possible. As a fellow I am proud to be a part of the team; creating a positive change in the Ugandan health sector.

It was quickly realized that these new health systems assist in keeping track of patients, clinic productivity and patient adherence to scheduled appointments. By keeping track of this information, it is easier to develop an overview of the patient population and an understanding of the finances of both patients and the clinic.

These systems also provide data regarding quality measures because services such as vaccinations and procedures performed within the practice can be tracked easily. Clinicians and doctors are also able to enter their notes into the system and to be able to document procedures and interventions performed in the office. Additionally, prescriptions may be written within the system and sent to pharmacies electronically, tests may be ordered, and test results may be received electronically for clinician review and action. Paper documents often can be scanned into the system so that hard copies of outside reports can be included in a patient’s medical record.

Outlining Health Personnel Performance Measures and Quality Improvement Plans are key to developing strategies to improve care, administrative work, and reduce variation in the delivery of care and services.