Zanzibar

Unfortunately (due to malaria), I spent most of our trip to Njombe in the fetal position, but after a few days in southern Tanzania, Amy and I headed to Morogoro and then on to Dar and Zanzibar, where we would spend our last week before flying home for Christmas.

Onions for Sale

Malaria is hell...

But after 4 days and 48 pills (16 ibuprofen, 5 flagyl, 24 ALu, 3 Cipro) I'm happy and healthy again!

Heading South

Tomorrow Amy and I are heading to Njombe, which is about 13 hours south of Karatu, where we'll visit a hospital that MIHV is considering partnering with to send medical volunteers to in the future. I'm really looking forward to seeing another part of Tanzania, and after a few days in Njombe, we'll head to Dar es Salaam, and then spend a few days in Zanzibar!

Where is the rain?

The rainy season started in Uganda just before I left for Tanzania and a few weeks ago Karatu seemed to be following suit, but after a couple days of rain, the skies cleared.

The slightest breeze sends dust everywhere. Today, walking into town, the wind picked up and all the people in the street had to stop, shielding their eyes with their hands, hiding their faces under congas, as the road jumped up and around, into hair and noses and mouths.

It's the end of November and supposedly the middle of the short rainy season, but we seem to be missing a key ingredient...

Ngorongoro Crater

This weekend, we visited Ngorongoro Crater, one of the most spectacular safari spots in all of Africa, that's just 15 minutes from MIHV's Karatu office. Ngorongoro is reputed to have the densest population of mammalian predators in all of Africa. Inside the crater, we drove past hyenas, herds of zebra and wildebesets, buffalo and elephants, a pride of lions and even a black rhinoceros! (In 1965, there were estimated to be about 108 black rhinos left in the world; in 1995, this had fallen to between 11 and 14).

Give Thanks

If the only prayer you said in your life was “thank you,” that would suffice – Meister Eckhart

This was my first Thanksgiving away from home.

I was expecting it to be a difficult day, anticipating that most of the traditions that mark the holiday for me would be absent. There were different people around the table and different food on our plates, but I was surprised that it still felt like Thanksgiving.

Thanksgiving is a completely American tradition and some parts of the holiday were difficult to explain to my Tanzanian coworkers (Pilgrims? Cranberry sauce? Balloons of cartoon characters on 5th avenue?).

The important parts, however, translate. There was good food, good people and a day to appreciate the generosity I’ve received. Silent thanks for teachers who have inspired; for family who have loved selflessly and siblings who have always been my toughest critics and most loyal companions; for friends who have walked with me and strangers who have made the journey a little easier; and this year, most of all, for the many people who have welcomed me into their country, their homes and their lives.

Another deeply American tradition is expressing our gratitude by sharing what we have with others; sharing a meal, sharing our stories, sharing our wealth. Americans have a long tradition of giving and, looking at charitable giving as a percentage of a country’s GDP, Americans give over twice as much as any other country. In 2006, Americans contributed $295.02 billion and nearly 76% of this money came from individuals. (You can read more here).

According to a July 2007 study by the Charities Review Council, Minnesotans are especially likely to support charities, with more than three-fourths of Minnesotans giving to non-profit organizations (other than religious groups and colleges and universities).

Consider supporting MIHV. Your generosity makes a difference in the communities we serve.

$50 for a brick will help establish and support on-going activities at Health Mother/Healthy Babies Centers throughout the project area.

$80 will purchase a bicycle for use by a Village Health Worker in the provision of community based health education and identification and follow-up on pregnant women and sick children under 5.

$10 will purchase a delivery kit for project trained traditional birth attendants to provide safe deliveries of women in emergency situations and isolated areas while protecting the traditional birth attendant and mother from blood-borne diseases.

$500 will provide training to 20 traditional birth attendants in safe delivery, antenatal care, post partum care and referral services.

$3,000 will provide training at ward and village level for community-integrated management of childhood illnesses.

$100 will support performances in two communities by the project’s trained cultural troupe disseminating life saving information on malaria, diarrheal disease, MNC, pneumonia and child spacing.

$250 will support one year of meetings for a village level Survive and Thrive Group providing health information and capacity building training to young, unmarried, pregnant women.


For more information and to support MIHV, visit us online.

Sundays are for Scrabble

On Sundays, Jolene, Amy and I try to find a place more beautiful than the week before to play our weekly scrabble game. In such a small town you’d think we’d be running out of places, but Karatu is a mighty beautiful small town.

Funerals

In the last seven days, there have been two funerals.

A week ago, our District Medical Officer died and Saturday, one of the women on our staff lost her sister.

I can count the number of funerals I’ve been to in the last 18 years on one hand, so two in one week seems to me quite a lot.

At the last funeral I went to, the horses pulled my grandfather’s body across his farm, his home, to the grave and we followed, a trail of black. Here, as the doctor is carried across his farm, his home, to the grave, women in brightly colored congas follow: greens and yellows, red, lavender, white, patterned with flowers, chickens, the moon and stars.

For days before the funeral, the family holds all night vigil. Everyone goes. We sit for hours together, sometimes in silence, sometimes drinking tea and eating pilau, sometimes talking about Doctor, about work, but mostly silence.

The Burden

Malaria Program Featured

Check out the article on our new Malaria Communities Program, featured in the New Vision's Health section this Monday.

Duka La Dawa

A child gets sick. Often, Tanzanian parents take the child to a traditional healer first. If, after a few days, the child is not better, they will then take their kid to a duka la dawa (drug shop), which has medications, but no one licensed or trained to prescribe them. The medication may not be the correct treatment for the illness or it may not be the right dosage. So, a few days later, if the child still is not better, the parents now take the child to the health facility (a facility where they could have gotten the correct medication, at the correct dosage, for free). The child is now very, very ill; and has been sick for several days. Sometimes, the health facility can help, but often the child is now too far gone. The child dies, and of course, “the health facility killed my child.”

This compounds the problem and only makes families less likely to seek out the formal health sector. Meanwhile, duka la dawas prosper. In Karatu alone – a town with a population of just 71,000 – there are 14 drug shops. In August and September, to assess the extent of the problem, MIHV trained “secret shoppers” to visit the shops with their sick child. Our “shoppers” found that while correct medications were usually prescribed (two-thirds of the time), they did not provide proper dosage and consistently gave partial dosages. For example, if a parent comes in with a feverish child, the drug shop keeper may tell them the child needs to take an anti-malarial -- the first line malaria treatment in Tanzania, ALu, is 24 pills -- if the parents have only, say, half of the cost of the drugs, the shop keeper will take the money and give the parent 12 pills.

Involving these informal links in the chain of health services is crucial. In October, MIHV held the first of several drug shop keeper trainings, where they discussed the importance of not giving partial dosages (in the short term, people don’t get better; in the long term, partial dosing leads to drug resistance) and if a family can’t afford the full amount, then refer them to a health facility where they can get the drugs for free.

Recently, Jolene, MIHV’s Tanzania Country Director, started feeling sick. We have a pile of partial dosages left over from the “secret shopper” assessment, so Jolene took part of the medication she needed and then sent someone to a duka la dawa to buy her the rest of the dosage.

The drug shop keeper refused to sell the man a partial dose.

Tembo

We're Growing!

Minnesota International Health Volunteers arrived in Karatu last January and as we approach our first anniversary, we’re growing. Our Tanzania Child Survival Project now has 18 full time staff.

Some of our incredible staff:

We’ve out grown our first office, and there’s a team hard at work on the new office!

The new space will have a training room, a resource library for the community and plenty of office space. Move in date is January 1st.

Statistics

In sub-Saharan Africa, one child dies of malaria every thirty seconds.

I’m working on an article for an African newspaper about the U.S. President’s Malaria Initiative, which hopes to reduce malaria-related deaths by fifty percent. I was trying to make this statistic positive, to show what a difference programs funded by the initiative, like MIHV’s new Malaria Communities Project will make.

They will make a difference. And if they halve malaria deaths it will be huge.

But a child will still die of malaria every minute.

African Time

Recently, I was having dinner in Nairobi with Father Joe and his friend Charles. We were discussing when we would leave the next morning.

Joe: Well we want to be there at ten, so we should leave at eight.
Charles: There’s no way it will take us two hours to get there!
Joe: But we need to leave time for the people we meet on the way.

Shades of Black

“Those kids are sooo Ugandan” says Mercy, one of MIHV’s Tanzanian staff, looking over my shoulder as I sort through some photos on my computer.

“How can you tell?”

“Well, they’re darker. And look at those cheeks!”

Mercy’s skin is lighter, but not by much, and I’ve met Ugandans with surprisingly light skin.

“You can really tell if someone is Ugandan or Kenyan or Tanzanian just by looking at them?”

She nods. So I sift through my pictures, avoiding shots of women in traditional clothing, which would give away the region.

“Ugandan.”

“Kenyan.”

“Ugandan.”

“Tanzanian.”

“Ugandan.”

“Kenyan… oh no Ugandan. Definitely Ugandan.”

She’s right every time.

As I’m walking home later, I try to see the differences in the children I pass, but I can’t. As an outsider, there is so much that I just can’t see.

Karibu Karatu

After almost two months in Uganda, working on MIHV’s Child Spacing Program and new Malaria initiative, I’ve moved to Karatu, Tanzania, a district in northern Tanzania that is home to MIHV’s Child Survival Project.

In Karatu, where 112 of every 1,000 children born die before their fifth birthday, MIHV's project is promoting maternal newborn care and child spacing and working to control malaria, diarrheal disease and acute respiratory infections. Over the next five years,the project will help over 100,000 people. The project reaches the community through groups like Survive and Thrive, a support group that enforces healthy behaviors for young single mothers and MAISHA (Men Active in Sustaining Health, MAISHA means "life" in Swahili). MAISHA works with taxi drivers in the region to convey health messengers to their passengers and trains the drivers to assist with emergency transport to clinics.

Karibu Tanzania!

Kitui

Driving through southern Kenya, Uganda’s green expanse of banana trees and dark red soil is replaced by sparse fields, home to the occasional baobab tree, whose twisted arms reach up to the scorching sun. Here, the dirt is thirsty, khaki colored.

Kitui, is one of the most arid regions in Kenya. Locals told me it hasn’t rained since April. Some claimed that a few drops came down in July.

I was able to spend a week in Kenya, visiting a dear friend, Father Joe. We traveled from Nairobi, across Kenya, to his parish, and later to his childhood home in Mwingi, and to Tsavo, a huge wildlife reserve.

As we’re driving I ask Father Joe to stop, I need to stand on the ground, so I can understand what I’m seeing in a way that’s only possible when your feet are on the earth. “You are so lucky to live in this beautiful place” I say over and over. “It is very dry” he replies, over and over.

Some people say that beauty is painful. Though I suspect they’re more often talking about dieting or cosmetic surgery than the Chyulu Mountains, as I look out at those dry mountains, terraced by farmers in a feeble attempt to support their families, as we drive over bridges that cross dusty river beds, I see so much beauty; so much pain.

Lake Mburo

I spent my last weekend in Uganda at Lake Mburo National Park… no lions, tigers or bears, but lots of impala, baboons and zebras!

I especially liked the zebras.

“…Zebras have a lot of stress because they have to flee from lions on a regular basis, but after the crisis they mostly just graze calmly. People, on the other hand, spend too much of their downtime worrying about the lions in their lives.” –NY Times

In the Southwest Journal

A banana tree with a few stalks is stronger

On both sides of the road, going on forever it seems, are fields of banana trees. And as we drive to Nanseko, a village in rural Uganda, we avoid the deep ruts in the dirt road by swerving from one side and then to the other, veering so close that the long banana tree leaves brush the car's window.

Check out the full article on MIHV in Monday's Southwest Journal.

Rainy Season

“It will rain every day now,” Robert tells me.

On Sunday, the rains came along with the wind, blowing the fronds off palm trees and uprooting a hibiscus plant in the yard.

The rainy season has started.

In Uganda there are two rainy seasons – a longer one, lasting from March through May, and a shorter one in October and November.

On Thursday, the rain started softly, the pregnant clouds just drip-dripping, but by the time we reached the bottom of Mbuya Hill, near the Kampala office, the rain was coming down hard. As we started up the hill the car lurched back and forth as Peter, the driver, tried to avoid the rivers of ochre mud rushing down the road. As the car rocked from one side, it jolted, stalled, stopped and then started again.A plastic rosary swung back and forth, looping around the rear-view mirror. As rain covered the windshield, the blue beads and tiny cross danced to Peter’s reggae music.

Religion seems to show up a lot here. Rainstorms. Supermarkets. Introductions.

When I first met Lilian, who I would room with for about three weeks, one of the first questions she asked me was “Are you a Christian?” A little confused, I nodded. She smiled, approvingly. I had just won some serious brownie points. “And what Church?” She was visibly disappointed when I said “Catholic.”

When I was later introduced to MIHV’s Mubende driver, Ronnie said, “This is Mwange. He’s a Muslim.”

The street merchants market light-up pictures of the Virgin Mary to the cars stopped in traffic. And Eid-ul-Fitr, the last Friday of Ramadan, is a national holiday.

Sunday morning, as I walked to church with Passy, a friend who I stayed with this past weekend, she explained, “Sometimes it’s hard to get people to go to church. They don’t know that they can do no work without God.”

The night before, I had fallen asleep to Passy’s children reciting their prayers, the Luganda words flowing together into a holy stream.

Unsure of my own faith, being surrounded by such certainty is at once comforting and disconcerting.

Now the beads stop swinging. The car has stopped. “It’s out of gas,” says Peter. We’re two houses away from the MIHV office, but it’s pouring. Peter turns off the engine and the reggae and we sit, quietly, trying to discern anything beyond the windshield. Peter puts the car in neutral, and we start to roll back down the hill.

“What are you doing!?”
“Oh, it will start if we go backwards,” explains Peter.

We roll down past the offices, the gated houses and near the bottom of the hill, Peter tries again. It doesn’t start. And now we’re at the bottom of the hill.

So I get out of the car and run. The water rushes down and over my ankles as I make my way through the henna colored dirt-rivers, up the hill.

Soaking, I run and run and laugh and laugh, because here I am in Uganda, crossing the red sea.

Lamadan

For the last month, during Ramadan (which often becomes "Lamadan," because in African English "r" and "l" are pronounced the same, making my name often "Sal"), men in long white galabiyyas and hats and women in hijabs color the streets as they make their way to mosque.

Under a Mango Tree

This is Sister. Her Christian name is Mary, but Sister is the name used for older Ugandan women who have earned great respect in their communities. Sister’s whole life radiates a deep reverence for the dignity and wellbeing of the people in her community

Sister’s father wanted her to be a teacher, but she insisted she wanted to be a nurse. Nursing doesn’t feel like work, she explained. Along a shelf in her home rests a piece of painted wood with the words carefully carved, “Do your work not for mere pay, but from a real desire to serve.” (1 Peter 5:2). After working for seven years as a bedside nurse, Sister went back to school to be a nurse trainer, fulfilling both her and her father’s dream in combining teaching and nursing.

Twelve years ago Sister was hired by MIHV. Although she has worked in several positions, today she is the Deputy Country Director and the Family Planning Coordinator. She’s a busy woman; she’s the leader of her church’s Christian Women’s Fellowship and a human rights activist, having trained several years ago as a paralegal, she works in outreach programs to spread awareness to rural Ugandans about their rights.

Sister raised three children of her own. She lost her oldest son, Andrew, to sickle cell anemia at seventeen. Her youngest daughter, Annette, graduated from Makerere University last weekend. Her older daughter, Esther, will give birth to Sister’s first grandchild any day.

Sister is not wealthy. “Sincerely,” she said, “I’ve had to take out bank loans to get by.” Yet she would never turn away someone in need. Norman, 6, and Shakira, 14, are only the most recent children to take up residence in Sister’s house. Over the past several years, Sister has taken in and covered the school fees of a number of her brother’s children, orphans and even the daughter of one of MIHV’s Ssembabule guards.

Like many of MHIV’s staff, Sister has deep roots in the community and is nourished by her faith. With roots and faith, MIHV’s passionate staff are deeply committed to the health and wellbeing of others. No one would dispute that Uganda is materially a poor country, and yet I have never received richer hospitality. “We don’t have a lot,” said Sister, “but what we have, we share.”

“With committed staff you can set up a clinic under a mango tree.” –Helen Epstein

Jesus, etc.

Many Ugandan establishments endorse a higher power.

Organized by Collective Disorder

In grade school, I went everywhere as one segment of a straight line of classmates, dutifully ducky-ing along behind my teachers. I remember one teacher would play a game with my class as we walked from the art room to the lunchroom or back to our classroom, surprising us by turning around from her position at the head of the line to inspect our line. We loved the game, and giggled as we carefully followed the child in front of us to ensure that all twenty-one of us stood neatly like dominos.

I don’t think Ugandan kids play that game.


Ugandans don’t order themselves like Americans. There are few zebra crossings (crosswalks) here and where there are, people don’t use them. Rather, people cross four lanes of traffic wherever they please. And when I say lanes, I really mean a road three cars wide, that has boda-bodas (taxi motorcycles) weaving in and out of the cars and matatus (mini-buses), because there are no lanes.

In churches, a collection basket isn’t passed around. Instead, there is one large basket at the front of the church and at a designated time in the service, everyone gets up and squeezes past the others to put their donation in. At communion, people don’t get up row by row or form a line. There is a holy free for all towards the priest and the little round wafers.

Last week, while I was in town, a man stole something, or at least that’s what someone said. In retribution for the theft, the shopkeeper threw a rock at him. Another man joined and then six more and soon there were thirty some people throwing rocks at one man as he ran away, stopping occasionally to deflect the rocks with a large stick.

One Month

This is a letter I sent to many of my friends and family a few days ago. A few people suggested I post it as well.

Dear Friends,

Tomorrow I will have been in Uganda for a month.

Every morning I wake up at seven to gospel and/or Christian rock music (I am rooming with a Born-Again Christian who likes to start her day off with a healthy helping of Jesus). I spend most of my day traveling between villages visiting and interviewing people and in the evenings I write profiles and articles. I love the work I’m doing here and I feel like it’s been a very good “match” – I am getting so much out of living here and think in turn I’m also able to give a lot to MIHV in return.

I am deeply grateful to the people I meet everyday who welcome me into their homes and tell me their stories. I spend six or seven hours a day sitting with people and having conversations about their family, education, aspirations for their children, their sex lives, marriages and separations, religion, childhoods, reasons for using (or not using) contraception, and their goals for their communities.

Today Specioza, a 50-year-old woman, brought out a blue plastic photo album filled with photographs of her ten children. Another, Benedict, told me how while giving birth to her fifth child, labor was obstructed and her uterus ruptured. That child, who died in birth, would have been her first with her husband. As she told me her story, her husband picked up his three-year-old daughter from his second wife, who he married shortly after Benedict’s hysterectomy.

Sometimes it’s a bit strange, going up to strangers and asking them what type of contraceptives they use and why, how their religion affects their decisions, how being one of three wives affects them emotionally or their children financially. But when you get past the initial fear of asking such personal, at times painful, questions, you realize it is a glorious opportunity to be invited to ask these questions. It is an opportunity to begin to know a country, one woman, one family, one story at a time. Sometimes, when I’m walking along the little paths that weave past mud houses and through the fields of banana trees, I inhale Uganda and try to exhale gratitude.

I cried for the first time during an interview recently while talking to a 14-year-old girl named Fatumah. Fatumah’s parents separated when she was an infant and the family lost contact with the mother. Fatumah’s father raised her and her siblings. When Fatumah was 11 her father was diagnosed with AIDS. The girl’s older siblings had moved away and Fatumah became his full time care taker. He died a year ago.


School started for Ugandan children about two weeks ago and when I spoke with Fatumah, a few days before school would begin, I asked her what grade she was going into. She explained to me that she was kicked out of school last July because of overdue school fees (Uganda has universal primary education, but school fees for secondary schooling can be prohibitive, even for families where both parents are living). She plans to spend the fall working her family’s small farm to raise money so she can go back to school. When I asked Elijah, one of MIHV’s Ugandan staff if he thought she could feasibly do this, he said it was unlikely she would ever go back to school. “Other expenses will come up,” he explained. “Who will pay for the paraffin for the lamps?”

I asked Fatumah how much she owed the school. She owes 15,000 Ush for the construction of a new latrine, 5,000 Ush for lunch, 14,000 Ush for her uniform, 3,000 Ush in exam fees and 7,000 Ush for school supplies. When I realized 44,000 Ush (about $27) is keeping a 14-year-old from going to school, I started crying. I’m not sure if it’s a good idea to cry in the middle of an interview, but I’m pretty sure I wouldn’t be any good at this job if life here didn’t make me cry sometimes.

Take care,
Sarah

My Wednesday

Today I woke up, made tea, helped distribute 30,000 condoms, spent 6 hours interviewing family planning community health workers (essentially peer counselors trained by MIHV), and spent another couple hours writing up the interviews and sending queries for MIHV.

Overall, a pretty normal day.

In the New Vision today

It takes two to plan a family

MANY young Ugandan men know they do not like birth control, even if they do not know much about it. “Most men think family planning is harmful,” explained Kassim Balikyweunya, 17, from his spot cheering on the sidelines of the football match. “They think those hormones destroy a woman’s uterus.”

Balikyweunya was among the 250 people at Minnesota International Health Volunteers (MIHV)’s first “Family Planning Day” in Nanseko Village. He expressed a prevalent misunderstanding about the side effects of contraceptives.

The full article appeared in the New Vision today, Uganda's leading daily newspaper. You can view it online by clicking here

Emma

“I’m surprised he’s not scared of you,” said Lilian. I have just picked up Emma (short for Emmanuel, a common name for Ugandan baby boys born on Christmas). His dark eyes gaze up at me, he pokes his tiny fingers at my pale face, then he sighs, sticks his thumb in his mouth and rests his head against my shoulder.


I think there is a joy in holding a baby, because you are holding close to you someone who knows a great secret.

As infants we know something that is lost when we no longer know what we know because it is what we feel, but because it is what everyone around us does. We do not learn language because we instinctively feel that the word “milk” means lunch or that “mzungu” means white person, outsider – we acquire language from others. But before language, there are some things that are not acquired, things that are imbedded deeply in our brains and heart and pancreas, and seem to be lost on everyone over the age of 18 months.

Where ever I go, people stare at me.

Not a surprised glance or a quick once over, a long, uncomfortable stare. Sometimes I meet their gaze, hold it, smile, all the while thinking, ‘Yes, I see, you’re looking at me, I’m white, but that’s enough now.’

Ugandans may be many things, but they are not mind readers. They just keep staring.

Every time I go to the latrine behind the Mubende office, a little girl calls “Mzuuuunnnnguuuuu, Mzuuuuunguuuuu,” drawing out the “ooooo” sounds. It’s been a week and she still feels the need to herald my presence. Yesterday, a man at the market, ten feet from me, barked, “Mzungu, Mzungu, Mzungu.” While running in Ssembabule, I looked to one side of the road, and there were a dozen people, adults who had been working, children who had been playing, all frozen, their eyes following me down the rutty road.

Emma’s mother is one of our puppeteers for Family Planning Days. As his mom rehearses, Emma and I walk around the event, stopping to watch the cattle being herded by, wandering over to a group of children laughing, past the women who stare.

Emma isn’t offended by my whiteness. For him, my hip is just a hip and my shoulder’s paleness does not merit an announcement. It’s just a shoulder, a good a place as any to rest his tired head.

Little People, Little Shadows

Are we speaking the same language?

I think Mwange (MIHV’s Mubende driver) and I are both speaking English, but sometimes it’s hard to tell.

Earlier today I called him and said he did not need to pick me up, I would walk. He arrived a few minutes later.

Then this afternoon, as we arrived at the apartment complex several of the staff live at, we had another meaningful conversation:

Sarah - “How long have you lived here?”

Mwange – “Oh he’s just opening the gate.”

(I look confused.)

Mwange - “Wait what were you asking?”

Sarah – “Oh, I wanted to know how.... long .... you .... have.... lived .... here?”

Mwange – “Ooooooh. About three hours.”

Family Planning Days

Sunday, MIHV hosted the first of four “Family Planning Days”


After a rainy morning, we had a beautiful afternoon. Over 250 people attended, including many of MIHV’s target audience – teens and men. The idea for the “Days” is to bring in communities not served by other MIHV outreach programs and invite them to an event that is both fun and provides information on family planning.

The average Ugandan woman has 6.7 children, the highest fertility rate of any country in eastern and southern Africa. Although most Ugandans know about family planning (96.6% of all women and 98.1% of all men can name at least one method), usage of contraceptives is fairly low. Just 24% of women age 15-49 report using any method of family planning and when limited to modern methods, this number drops to 18% and further yet to 15% in rural areas.

The people gathered seemed to enjoy the afternoon; children danced to the drumming and songs and the crowd often erupted into laughter while they watched the drama show, which depicted a married couple struggling to handle their nine children.

I interviewed a lot of men in their late teens through early thirties. They had come to the event for many reasons – some just came to watch the football game, one was taking care of 13 children and knew he and his wife couldn’t afford another pregnancy, more often, they had heard a little bit about family planning, but had never used any form of contraception and came to learn more.

A small part of me doubted that one community event would change things. If 98% of men have heard of family planning and few are using contraception, how is one afternoon going to change their habits?

I was reminded, talking to one man, that the way we receive messages can make all the difference. Do, 25, is a farmer and father of two. He explained to me that he had never used birth control before, although he had heard messages about family planning on the radio. “I listened, but never really took any notice,” but he said, “now I see.”

A box with no hinges, key or lid, yet golden treasure inside is hid

Yesterday, I wanted to take a photo of the Minnesota International Health Volunteers sign that sits at the beginning of the turn off to our Ssembabule office. As I walked down the muddy turn off, a woman was walking along the path with her goats. She did not speak any English, but seeing my camera, she began gesturing for me to cross the road with her and pointed to my camera and then to her three little boys standing in her yard across the street.


We cross the road and she eagerly lines the boys up. I motion for the boys to come towards me, into the sun light, and she hurries them along. I photograph her and her children and then thank them and leave.

Later, as I’m waiting at the office for the Family Planning Implementation Team meeting to start, I think about those little boys. I go to my room and take a handful of Starburst out of my duffel and I make my way back down the turn off and give the woman the little yellow, pink and orange candies. She smiles broadly and gives the sweets to her children.

Today, I am in my room working and Mabol, MIHV's cook, comes to my room. Mabol speaks a bit of English and I hear her say from the hallway, “Sarah”…”Madam for you.” There is a woman standing a few feet from the door, but I do not recognize her. I have met so many people in the last two days that I am confused. Is this a woman I met in the market? Was she at the meeting yesterday? I smile and nod to her and Mabol then explains, “She says you took her photograph.” Now I remember. The woman comes to the doorway and kneels down on the steps. She holds up three eggs to give me.

I ask if I can pay her for them. Mabol interprets and the woman shakes her head no. Really, I say, I would like to. I think about the children’s bare feet and dirty clothes.

“Gift” Mabol says. I nod.

The Hospital Bed

I’m sitting in on the Family Planning Implementation Team’s quarterly meeting for Ssembabule District.

Noelina, who works in Ssembabule’s hospital, mentions that one of the surgical beds at the hospital is broken. The bed cannot be adjusted up and down, she explains, so tubal litigation and vasectomy operations cannot be performed. Men and women are turned away every day.

Around the table are MIHV staff, a representative of the Director of District Health Services and a Community Development officer who works for the Ministry of Gender, Labor and Social Development.

The hospital has a second, working, surgical bed in a different room, but they are unwilling to use it for these operations. Noelina explains the other room is reserved for emergencies.

The district claims they do not have the money for the bed and has asked MIHV to pay for the repairs. MIHV says they will not pay, knowing that in doing so they will not only pay for the bed, but open the door to funding requests every time something is broken.

The repairs would cost 80,000 shillings ($48).

Paige, MIHV’s Country Director, parts her lips. She seems weary, frustrated, but her voice stays calm. “This is now our third quarterly meeting where we’ve talked about the surgical bed needing to be fixed.”

$48 would give men and women in this district access to permanent forms of birth control.

$48 would mean fewer Ugandan children would grow up in families that cannot afford to care for them.

At the end of the meeting they have found no solution. They will meet again in December.

To the Field

This morning I'm leaving for Ssembabule (red), one of MIHV's two Ugandan field sites. The drive from Kampala (blue) to Ssembabule will take about four hours.

Being in Kampala has been wonderful, I've gotten to meet Paige, MIHV's Uganda Country Director, who is incredible. I've wandered through the tombs of the ancient Buganda kings, met with editors at the local Ugandan papers, visited the Nommo National Art Gallery and feel somewhat adjusted to life here.

That said, I can't wait to get into the field. The work MIHV does really happens in the field. Throughout the month of September every Sunday MIHV will be hosting a Family Planning Day, a day designed to be fun for the community while also increasing awareness about reproductive health and MIHV's programs. These Sundays will target males and youth and aim to increase their involvement in family planning. The events will include a drama show, quizzes, a puppet show, a soccer match, and a film show.

Being in the field will give me the opportunity to meet MIHV's Ugandan staff (Paige is the only American working for MIHV's Ugandan programs) and Community Health Workers as well as the beneficiaries of MIHV's programs. I hope that being there, sitting and listening and sharing time and place, will allow me to start to tell their stories.

In the next few weeks I'll be at both the Ssembabule site and Mubende (yellow) site. Ssembabule doesn't have electricity or running water, let alone internet, so I may not be able to post until I get to Mubende.

I'll write soon. Take care.

Morning at the Market

As I enter the market, women beckon me to their booths saying, “Madam, here” and “Sister, come.” Stalls overflow with pineapples, garlic cloves, rice, beans, peas, apples, zucchini, onions, dried vanilla, melons, peanuts and corn. I pause to negotiate the price of a bunch of bananas and then hurry past the stalls where meat hangs from the ceiling and hooves lay stacked on the counter.

I am the only muzungu meandering through the crowded aisles and people ask me my name, where I am from and why I am here (many ask if I am from Colorado or Texas, others assume I’m a journalist writing about CHOGM). Some, seeing my camera, cry, “Photo me! Photo me!” while others, mostly the older women, hide their faces.

Nawolovo

The Kampala office has a resident chameleon

No matter where you go...

Robert, the gardener at the Kampala office, is a Jehovah's Witness... they don't wear the suits here.

Waste Not

A Kampala journalist named Michael Wakabi told me that Kampala has become ''a used culture.'' The cars are used -- they arrive from Japan with broken power windows and air-conditioners, so Ugandan drivers bake in the sun. Used furniture from Europe lines the streets in Kampala. The Ugandan Army occupies part of neighboring Congo with used tanks and aircraft from Ukraine.

(Packer, George. “How Susie Bayer’s T-Shirt Ended Up on Yusuf Mama’s Back” The New York Times. 3 March 2002.)

Check out the full article... it looks at the used clothing trade in Uganda: http://select.nytimes.com/search/restricted/article?res=F10D14FA3E5F0C728FDDAA0894DA404482

* * * * *

My Coke bottle’s label is worn away in some places. I’m out to dinner with Paige and Phil at the local pizza shop and my glance at the bottle has turned into a stare. The red is faded, but just slightly.

“Is this bottle used?”

“Yep,” Paige says, looking up from her salad, “Best recycling program in the world and nobody knows it’s happening. You actually have to pay more for the soda if you want to take the bottle with you.”

“There’s no broken glass in Kampala,” adds Phil. “Not when it’s worth something.”

* * * * *

Later, we stop by a going away party for one of the expats Paige and Phil know.

In one of those awkward, no-one-knows-anyone-in-this-group moments, a girl from Boston looks down at one of the Ugandans' sandals.

“Hey, nice Jesus sandals!”

Looking down, he laughs, “I made these”

"You made them?”

“Yes,” he shows us the sole of his shoe, “From old tires.”

From where he stands the sandals look black, albeit a bit plastic-y, but the bottom of the shoe reveals tire treads. The Americans launch into how ingenious the tire-shoes are. He shows us how he cut the tire and with four nails affixed the straps. The Ugandans laugh at our fascination.

“These shoes – lugabire – are all over. They sell them for 2,000 shillings ($1.18) in Kampala.”

“I love them!” the Boston girl exclaims, “What market did you say?”

The Ugandans laugh again.

“It won’t be 2,000 shillings for you – 50,000 ($30) maybe”

Americans buy clothes in disposable quantities -- $165 billion worth last year. Then […] we run out of storage space, or we put on weight, or we get tired of the way we look in them, and so we pack the clothes in garbage bags and lug them off to thrift shops.

The Monkey on the Roof

This morning I woke up to the sound of monkeys dancing on the roof.

This tree is in Paige’s yard in Kampala.

Firsts

“Would you like a hot towel, ma’am?”

I’m sitting in World Business Class (thanks to a frequent flier upgrade) for the first time ever and am being offered a hot towel before my dinner of goat’s cheese with peppers, beef tenderloins with a horseradish sauce, a cheese plate, and Ben & Jerry’s ice cream.

I am quite sure I do not belong here.

Thank God for the Indian businessman next to me, whose mime-like gestures helped me figure out how to use my button-adorned chair.

With attendants offering me bottled water and eyeshades and wine and fresh fruit and “raspberry vinaigrette or balsamic, dear?” and pillows and “anything else I can get for you, young lady?” I am stuck somewhere between very comfortable and horribly uncomfortable with my situation. I like my big chair and the little television that pops out of my arm rest, but I also feel like I do not deserve this seat. What about Helen, the elderly Danish woman I met waiting at the gate, who is wheelchair-bound? She certainly needs the attentive staff more than I do, and would probably appreciate the extra space more. Why should she sit in the back of the plane while I sit comfortably (or not) in C-06? The single, yet defining, separation, of course, is money. Pieces of paper – that we all agree – mean a minority of passengers get a substantially better lot than the majority on board.

I think that this feeling, this guilt, that I have money when others do not and that I have this not by any merit of my own, but by the luck of my birth – that I was born in a Minneapolis suburb rather than rural Uganda – is something that may haunt me over the next four months.

My name is Sarah Schewe. After being accepted to Dartmouth College last spring, I chose to defer my college matriculation for one year. This fall, I will be volunteering for MIHV in Uganda and Tanzania, where I will blog, write articles for MIHV’s website and other literature, and provide photographs for these publications.

Three flights and 24.5 hours after leaving Minneapolis, my flight arrives in Entebbe.

When I step off the plane, it’s only 8:15 pm, but the sky is dark, and the moon is full. A new cycle starts tomorrow. A beautiful, dark face catches my wide eyes and crinkles into a smile, saying “Welcome to Uganda.”