Day: April 6, 2015

Storytelling for Change

  • Apr, 06, 2015

Globally, there are many societies still holding on to laws that are implemented abusively towards women. Although advocates of women’s rights generally combat this through persecution, women continue to face discrimination due to traditional beliefs and practices. Every February, since it launched on Valentine’s Day in 2012, the One Billion Rising campaign brings together people from all around the world to rise against the injustices that women and girls continue to face. More so, it sheds light on the detrimental impact of violence against women not only on the social level but on economic, environmental, gender, and health equity. The theme for this year’s campaign is One Billion Rising Revolution.

Let us rise together, let us allow our feet to move to the drums and dance our way to changing the status quo. I am rising to join the Revolution against Female Genital Mutation (FGM).

The Rite of Passage – A fictional short story 

“Huntor sukabeh beng? Mamah mung ari. Yalteh me ndara ung…”

(Translation from Fulani: Where are the children? Your grandma is here, come out let me see you)

The singsong voice of my Fulani grandma called out to us as she walked back home from the market. Every morning, Mamah Bwiam, as we fondly called her would wake up before dawn and march to the nearby market where she sold Latchiri (Fulani maize couscous), Kossan (Sour milk) and Deggeh (Peanut butter). By 10am, she was back carrying her empty lekett(s) (Calabash/ Gourds) with her. Years of posture training taught her how to balance a lekett on her head while walking. Zainabou always watched in awe, she had never once heard or seen a lekett fall off Mamah Bwiam’s head. She hoped not, because a broken lekett was a bad omen. Two summers ago, a woman who lived behind the bantaba (equivalent of a gazebo) had dropped hers and from what she heard, the woman had become mentally ill!

Mamah Bwiam was a tiny woman, short and bony. Her skin the color of polished coal was too dark to be considered Fulani. But her hair, fine and curly, like that of her Berber ancestry belied any doubt of her heritage. Although life, early marriage and bearing children in her early teens, had aged her drastically, she still maintained youthfulness about her. By the age of 28, she had been left a widow caring for five of her children and two of her late husband’s other children. Through the throws of poverty and helplessness, she struggled to make ends meet, feed and afford her sons a high school education and her daughters a primary school one. It was perhaps only her eyes, jaded from a painful past that let on that deep inside the youthful demeanor lived an old soul. Now at 50, it was hard to tell, that this beautiful woman with skin as rich as dove chocolate and a smile so radiant had lived through the pain of death, and was now struggling to overcome undiagnosed liver cancer.

“Huntor sukabeh beng? Mamah mung ari. Yalteh me ndara ung… ko haywe? kerreh ko BalaSasa (fabled monster) nangi mung? BalaSasa oooh, BalaSasa oooh… Huntor sukabeh beng?”

(Translation: Where are the children? Your grandma is here, come out let me see you… what is going on? Is BalaSasa (fabled monster) holding you captive? BalaSasa oooh, BalaSasa oooh… where are the children)

As the sound of Mamah’s voice got closer, we all rushed out, each grandchild wanting to help her carry her day’s load. The prize of carrying a lekett meant that you could dip your hands in to the almost empty calabash and scrape out the left over remnants of her ware. Mamah Bwiam would always make sure that there were enough leftovers for all the grandkids so that there was no fighting. She would watch in good humor as my older cousin Khadijatou grabbed the lekett from us, allocating shares of the leftovers. Of course, being the oldest she kept the mammoth share for herself. I wondered when the day would come, that I would be old enough to dish out the leftovers. But, according to Khadijatou, being grown came with a price; a rite of passage that I will need to go through. I had heard of stories, painful and bloody, pricking with needles, ripping, cutting and stitching… It was only years later that I came to understand the implications behind this rite of passage. A ritual practiced for generations in my tribe and passed down for more generations to come. I dreaded the day that this was meant to happen to me.


Every summer, before I packed my bags and left my hometown in Bakau for my family home in Bwiam, I would pray that Nene and Baba (Mother and Father) would find a different solution for my looming initiation. I was afraid. Sometimes I really wondered if my parents knew that my Mamah and the other women planned on hurting me. Did they not love me enough to protect me from such pain? Sometimes I felt like asking them, but I never did because my older cousin Khadijatou had made me swear that I wouldn’t:

Khadijatou: “Zainabou, dung ko hakundeh ma et Allah deh. Sa halli nedor tung hartuff Allah halekeh”

(Translation: This is between you and God. If you tell (spitting sound), God will banish you to hell)

Me: “Hakundeh Allah, su mi halli tung mi faetah, beh naba lang Campama!”

(Translation: I swear to God, if I tell I will go crazy and be taken to Campama)

That day came sooner than I thought. I vividly remember that fateful Friday. I had been in Bwiam for about a week basking in being one with nature and my surroundings. As soon as I woke up, I felt that this day was different. I had an unsettling feeling in my chest; my erratic heartbeat triggered my superstition that something was very wrong. I stalked off in search of my grandma. She always knew the reason why my right or left hand itched, my eyelid twitched or my heart raced.

Perhaps the fact that Mamah Bwiam and the other market women did not go to work as usual should have been a sign that something just wasn’t right. My footsteps faltered as I walked closer to the group of women standing in the middle of the compound. They were singing and chanting tribal songs that were beyond my years. It was hard to recognize my Mamah; her face had been transformed. She no longer looked like the docile dove that would always carry me and hum softly to calm my erratic heartbeat. As I got closer I began to suck on my thumb in fear.  Inside the circle formed by the women were my petrified cousins and playmates. Before I could turn and run back to the safety of Mamah Bwiam’s room, one of the women briskly grabbed my arm and pulled me in to the inner circle with the other kids.

We were led to a little hut across the stream, past the “upside down cooking pot”, to an area we were once forbidden. At the door of the tiny but sturdy built hut stood a toothless old woman; I had never seen her before. I looked up at Mamah Bwiam hoping to get her reassuring smile that always made me feel safe. The stony look on her face told me everything I needed to know. It was time. Musukoye the oldest out of us girls was led in first. After 25 minutes of endless screams in mandinka, another girl was led in. The line before me dwindled until it was my turn. I looked at my Mamah Bwiam one more time, my eyes pleading with her. She looked away, refusing to make eye contact, refusing to save me.

The tears fell silently as I walked slowly in to the poorly lit hut. Taking one look back at my past, I lowered my head in defeat as my tiny arms were tugged roughly and my legs held down for my initiation. I had no fight left in me. There was no one left to save me.

From the future, I look back now realizing that perhaps my only crime was being born a girl. As a girl, a part of me yielded so much power that it had to be feared and forcefully taken away. They tried to weaken me, but what they did not know was that they left me stronger. They left parts of me that should be feared, parts that would rise to the beat of the drum and reclaim my power.

My Revolution.

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What they don’t tell you about being a GHC fellow

  • Apr, 06, 2015

I always dreamed of working in health and the Global Health Corps fellowship was the perfect starting point. I can’t even begin to describe the joy I felt when I found out I had been selected for the 2014-2015 class. What I didn’t realize at the time was just how much more there was to the fellowship.

What they don’t tell you about the fellow community

You’re told that the fellowship brings together a vibrant and diverse group of young people from all over the world to work on building the movement for health equity. What I did not expect was for these individuals to open up my eyes to the world around me. Through the eyes of my fellow fellows I have come to see my country and the world as I have never seen it before.  I am now aware of all the beauty I took for granted. Watching the fellows want to discover and take in as much of the country around them as possible has spoken to the tourist buried within me, to want to reach past the confines of my familiar environment and see the world beyond what I had read in books or seen on TV. I have learned of little nooks and crannies in Zambia that I had no idea existed, like a beautiful little place called Tiffany’s canyon or the Ethiopian and Nigerian restaurants hidden in plain sight that serve up yummy and exotic delicacies. I have made lifelong friendships with people I wouldn’t have ordinarily met had I not become a GHC fellow. My co-fellow Nicole isn’t just my colleague, she is a friend and a sister to me. The GHC community has become a second family to me. Our relationship doesn’t simply end at the great work that we are doing to advance the cause of health equity. We work together, we laugh together and we play together. I have never met a group of people more enthusiastic about health and fitness. They have motivated me to take a more active approach to life. Goodbye sedentary existence!! Hello fit and healthy me!!




What they don’t tell you about Still Harbor

What else surprised me about the fellowship? Still Harbor! What an alien concept this was to me. I won’t lie, initially it was hard for me; I struggled with the self-care and introspective exercises. It was a bit too much to deal with. Digging deep within and having to face truths about yourself that you had long forgotten, ignored or buried. I am glad to say, however, that with time I have come to learn the value of those sessions and really appreciate the important role that Still Harbor plays not only for the fellowship role but for personal growth. Half way through the fellowship, at our mid-year retreat, I was pleasantly surprised to find that I no longer had a hard time answering the questions that were asked of me during the sessions. I was in fact actively looking forward to Still Harbor!!












What they don’t tell you about the readings

If you are not much of a reader, brace yourself! As a fellow you are expected to be well read on several topics. And read you shall. You are provided with several readings at the beginning of and throughout the fellowship. I can personally say the readings have proved to be a tremendous wealth of knowledge and information. I find that I am able to have more informed opinions and diverse conversations thanks to all the readings. Trust me, even if you do not like reading, you will definitely come to value the greater impact it has as you navigate through different networks.

What they don’t tell you about the placement

The fellowship positions are not a hand holding, spoon feeding student style gig. In as much as GHC does not require its fellows to have past experience, you are expected to know your stuff, to be ready to put into practice what you have learned and have long been preparing for. The role of change maker has no room for self-doubt and experimentation.

I wish I could say it is all roses, but it isn’t – sometimes the beginning doesn’t go smoothly. In-house communication may not be perfect, roles may change, or you may actually find yourself having no defined role. The one thing all fellows have in common? A resilience like no other. They are able to rise above the challenges of any situation, to – as one fellow put it – “Do a lot with a little”. I remember being asked during my interview for the fellowship what I would do if I was picked for a position only to find myself with no supervisor and no role to play. How would I handle that situation? Flash forward to midyear of the fellowship: I’m reading through the case study reports of different fellows and I am both proud and overwhelmed by the strides that fellows have taken to address and overcome the challenges they have faced during their fellowship, all for the cause of health equity.

Each day and each experience of the fellowship is an opportunity to grow and learn something new. It is up to you to make the most of this remarkable and dynamic opportunity to change the world.

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Understanding Uganda’s MDG Progress

  • Apr, 06, 2015

2015 may be just another calendar year, or maybe not, as it marks the final year for the implementation of Millennium Development Goals (MDGs) 2015. The implementation years for the MDGs were 1990 to 2015. It is also a year away from 2016 – when Uganda holds its next general elections. I would like to evaluate Uganda’s MDG achievements in promoting health as a major tenet of the MDGs, of which goals number 4, 5 and 6 are directly health related.

Team of Global Health Corps Fellows (L-R: James, Sam, Rebecca C, Orrin, Kimberley and Rebecca R) who participated in advocating for health on Kaaza Island, Lake Victoria one of the least served areas in the country. Photo Credit: Chris Brooks

Goal 4: Reduce child mortality
Target 4.A: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate

This goal shows a lot of mixed progress. According to UNDP, there have been some positive results, though much more needs to be done. Between 1995 and 2009, the Infant Mortality Rate (IMR) under 5 fell from 156 to 137/1000 live births. This coincides with a World Bank report, which notes that up to 95% of Ugandan women now receive antenatal care from a skilled provider at least once, and 57% deliver babies under the supervision of a skilled health provider. Furthermore, 33% of mothers received a postnatal check-up within two days of birth. On the other hand, according to the World Health Organization (WHO), Uganda is among 24 countries responsible for more than 80% of deaths of children under five years last year. The country has a maternal mortality ratio of 310 deaths per 100,000 live births and an under-five mortality rate of 56 deaths per 1,000 live births.

According to Dr. Anthony Mbonye,

Uganda can clearly not meet MDGs four and five—to reduce by three quarters the maternal mortality rate and to reduce by two thirds the child mortality rate between 1990 and 2015 target of 131 per 100,000. It is yet to meet the 15% budget allocation required by the Abuja Declaration to which Uganda is signatory”.

This goal requires an average reduction in rate of under-five deaths by 5% per year. To that end, between 2006 and 2011, rates dropped from 137 to 90 deaths per 1,000 live births; representing a reduction of 8.1%; by 2012. The major causes of under-five mortality were malaria (28%), pneumonia (15%), anemia (10%) and other respiratory infections (9%).

Goal 5: Improve maternal health

Target 5.A: Reduce maternal mortality ratio by three quarters – between 1990 and 2015.

Between 1995 and 2001, Uganda experienced stagnation in maternal mortality at 506/1000 births. However by 2006, according to UDHS the rate had declined to 435/1000 births. Between 1995 contraceptive prevalence rate increased from 15% to 24%, and up to 30% by 2011. Adolescent birth rate dropped from 198 to 159/1000 women between ages 15-19. Unmet family planning needs plummeted from 41% to 29%. Unfortunately, only 9% more births were attended to by skilled health workers in years after 1995 thus a shift from 35% to 44%. This mostly affected the ever increasing poor population  among which only 29% in 2006 delivered attended to by a health worker, compared to the wealthy where 77% received professional birth attention. Between 2006 and 2011, births assisted by trained health workers increased from 42% to 58%. In 2011, 33% of women in rural areas were receiving post-natal care already. This status has however stagnated.

Proper attention by health workers towards expectant mothers is one means of improving maternal health: Photo Credit: Charles Akena

Goal 6: Combat HIV/AIDS, malaria and other diseases
Target 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Target 6.B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it

As noted by several reviewers, Uganda made tremendous progress on HIV in the 1990s. However in the 2000s, the number of HIV positive expectant mothers attending antenatal care dropped from 18% to 6%. By 2012, the rate of condom usage had increased to an average of 72% from 49% in 2001. Level of HIV literacy increased to 42% in 2006 as opposed to 39% in 2001. By 2008, 44% of advanced HIV cases had access to medication, and 2009 saw an increase to 54%. There was a slump to 50% in 2010, but 2012 access increased to 62% against a 2015 target of 80% access.

However, HIV indicators showed vulnerability among girls aged 15-24 averaged 6.3% and 2.4% for boys of same age group. The total number of people living with HIV in 2010 was around 1.2 million, higher than at the epidemic’s height in the 1990s. With about 200,000 new infections yearly, HIV provokes not only concern but shows complacency over recent past years. In 2014, I wrote an opinion piece trying to understand the upturn in new HIV infections in Uganda.

The year 2008 saw over 110,000 malaria cases reported, representative of 37/1000 of the population. This was much higher than figures in 1990, which hovered around 15,000 – 30,000 per year. Recent years saw an increased distribution of Insecticide Treated Nets from an 8% usage in 2000 to 33% in 2009. One major concern is that less than 30% of children who needed malarial treatment in 2005 were able to receive the appropriate medicine.

Tuberculosis, another disease of concern in Uganda, was reduced from 652/100,000 to 350/100,000 persons between 2003 and 2008. This was because between 1998 to 2014 we saw a marked decrease in the number of HIV patients suffering from TB with 69% case detection rate and a 71% recovery rate in 2011.

In summary;
4. A: Reduction of under-five mortality rate by  two-thirds is on track
5. A: Reducing the maternal mortality rate by three quarters has stagnated
5. B: Universal access to reproductive health is progressing too slowly to be achieved
6. A: Halting and beginning to reverse the spread of HIV has suffered setbacks
6. B: Achieving universal access to treatment for HIV for all who need it is on track
6. C: Halting and beginning to reverse the incidence of malaria and other major diseases is on track

You can tweet me: @samagona