Thursday, October 15, 2015

Mobile Medicine, Punching Above their Weight, BKB Battles Disease in Rural Villages

Residents of Kamuli Buzimba village wait to see a nurse at Bega Kwa Bega's mobile clinic.
Edward Mugume distributes malaria medication
in Kamuli Buzimba village

          On the veranda and in the front yard of a local church, healthcare professionals triage symptoms, draw blood, discuss concerns, dispense medication and advice. A large canister of malaria medication dominates the pharmacist’s table as he dispenses a package of the curative to every other patient who turns up for care at the quarterly mobile clinic.

          Bega Kwa Bega’s (BKB, Shoulder to Shoulder in English) crew visits, to date, 50 villages per quarter in an effort to make healthcare more accessible to rural areas of central Uganda.

          That they operate in much the same way much larger, world-wide non-governmental organizations do but with a shoe-string of a budget by comparison, is impressive.
Malaria testing kits

Nurse midwife Nora Nakiwolo distributes
anti-worm pills to children in Kamuli Buzimba.
          In these rural locations, healthcare can be 15 or 20 kilometers away from the nearest level four or level three government health facility.

          If their needs are more serious, those level one and two facilities are even more scarce. Access to decent healthcare is a challenge that can turn a curable, nuisance issue into a fatal one.

          The team tests and treats numerous patients for malaria, worms and many other health issues during their  visit. Not surprisingly, numerous patients present with malaria, a parasitic disease that feels much like a flu on steroids. Malaria claims many lives each year, mostly from lack of treatment,  and is among the most common but treatable illnesses in all of Africa.

          In my years of working with such NGOs, I’ve seen many projects and efforts to make a difference. These operations take their work very seriously, doing all they can to run their programs worldwide to reach as many people as possible while preserve the quality of their programs. They are large, multi-national relief and development organizations that often receive millions of dollars in grants to combat disease, poverty, and hunger while giving local populations a leg up in development so that they may eventually sustain their own needs.
Waiting their turn to talk to a healthcare professional.

          As I witness BKB crews carrying out their work, I'm struck by how much their professionalism and effectiveness makes this feel like a major, alphabet-soup -NGO operation.
BKB operations harness the same knowledge and methods, but on a smaller geographic scale, doing all of their work in central Uganda, with far fewer resources.
 Of the 50 mobile clinic stops, four are funded by a grant from Vibrant Village Foundation, the rest are through general fundraising that BKB supporters do in the U.S. and UK.

          I’m not sure how they do it, but it seems Bega Kwa Bega is punching above their weight, battling health issues with resources that somehow stretch to 50 villages.

Be sure to check out other blogs in the Africa series.
Nurse midwife Nora Nakiwolo distributes anti-worm pills to children in Kamuli Buzimba village
Nurse midwife Nora Nakiwolo distributes anti-worm pills to children in Kamuli Buzimba village
Children wait their turn for anti-worm medication.
Edward Mugume distributes medication to patients in Kamuli Buzimba village .
Edward Mugume makes a patient laugh, while distributing  medication to patients in Kamuli Buzimba village
Testing for Malaria
Testing for Malaria. In some African languages, the word malaria means to be sick. As a result, although malaria is so prevalent, people often decide they have malaria when it is some other common, less serious illness.

Wednesday, October 14, 2015

Waiting for a Life, UN Protection of Civilians Camp

With Family work completed for the morning, the wheelbarrow becomes a toy of the boys.

Water in the Protection of Civilians camps in Juba,
   South Sudan is delivered four times daily by truck from the White Nile.  
     ON the day an agreement was about to be signed, we rode in an International Medical Corps SUV, entering POC 3 through a battered gate, overlooked by Japanese UN Peace Keepers sitting behind a sandbagged bunker wall.

      Protection of Civilians Camp 3, the more organized of the three UN House-compound camps has been home for a varying number of internally displaced South Sudanese people for almost two years. Many had fled in December of 2013, in search of a safe place to survive a new conflict between a number of factions in the nascent country.

      If the peace holds, it is a historic day to be here in the camp for those caught in the middle, their lives interrupted in the infancy of this country's life. If not, it will be more of the same, conflicts exercised by armed disagreement, continued chaos, disruption of basic needs and security, with no end in sight.


                                Water for the morning, POC 1                                    
      Fast-forward a month or so, and the ceasefire has been violated numerous
          Produce stand in a marketplace in POC 3         
times.  The president has discussed plans to tear of the map of states and redraw with twice as many state or districts in the country without consultation with the opposition.  Like politics in many places, they are more complicated that I understand given my short history of more direct engagement in South Sudan. This sort of thing suggests the possibility that this peace agreement may end up at the bottom of one of the many dusty potholes of the deteriorated roads of the capital, Juba alongside many other past agreements.

      Their life in POC 3 is rough.

      Water collection used for all daily needs limited to 11.3 litres, and comes from plastic 2,000 gallon tanks stationed strategically throughout the camp, refilled four times daily by trucks.

      Only women and children are allowed at the taps to minimize conflict and even the potential for conflict and  power games.

     Water drains through the pathways and trenches between the tents, carrying, in theory wash water away, although the odors make you wonder what else may be present.
Emergency School, POC 1
Emergency School, POC 1
People live on top of each other in closely-spaced, dirt-floored, dust-covered tents that are nearing the end of their rated-for two-year life. There are conflicts like in any small city, based on normal daily things, but also on tribal differences.

    What it meant for me while in-country, revolved around concern for potential disruption of the peace and tranquility that seemed to have become the norm in the place I lived and worked for three weeks. To me, it also leads to questions about what happens for people who have been displaced in fear for their lives who do not, like me, have the ability to leave the country and land somewhere safe.

Emergency School POC 3
       With its proximity to the Capital, Juba, food is available, through the many small shops that pepper the camp, and the World Food Program provides vouchers for residents to purchase from their qualified neighbors, reducing the need for food-aid and this supporting local businesses rather than harming them through deliver of food-aid from the outside. That said there is often the presence of malnourishment within the population.

      Through constant vigilance,  groups such as the UN and IMC keep diseases such as Cholera, Malaria and Tuberculosis in check, but they cannot prevent it from making regular appearances in the camp and in the region.

       Babies are born (83 in the past month before I arrive), people die naturally and through violence.

      Children attend emergency schools, from grammar to science taught by dedicated teachers and tented and thatch-walled classrooms, play pool and soccer, wash clothes and sell vegetables and dried fish.

       It is a temporary life with an unknown expiration date in a rough place that no one should have to live.
In one month 83 babies were born
in the POC hospital.
International Medical Corps
tuberculosis patient.
Medical staff discuss recognizing symptoms while working with a tuberculosis and malaria patient.
POC 1 began before the UN arrived, contributing to a more
disorganized landscape than the planned out POC 3
Purchasing roofing repair material in a POC 3 marketplace

Sunday, September 20, 2015

Seven days in Uganda


     Along the side of the road, a young man sparked up his welder, carefully creating a set of decorative and functional window bars for a customer in Kikiri. Measuring twice before beginning a weld, he focused on getting it right as trucks and matatus trundled by carrying goods and people through the countryside in clouds of dust and smog.
Coaching ladies on caring for their banana trees. 
Earning a living, making clothes on main street. 

     Nearby, a tailor focuses on threading the sewing machine for a color change while creating a new shirt for a client in a tiny shop littered with completed projects, custom clothing for clients. She deftly changes from one thread-color to another making precise stitching while driving the Singer Sewing machine using the footplate and her own human power. Their skills came courtesy of Bega Kwa Bega, or Shoulder to Shoulder, a grass-roots organization founded by a Ugandan lady who now lives in the US, where she and a team raise funds so that their hard-working and well-trusted crew can focus on making lives better on the ground.

     Whether it be coaching farmers in raising a healthy variety of food-stuffs, attending to health needs of the sick in remote villages where people rarely see doctors, or the income-generating playground where city kids can have a blast while the center assists in keeping the other programs operating without interruption, BKB appears to be a success story that usually is told in the same breath with the more famous alphabet soup of international development organizations. They drill wells and set up springs for cleaner water supplies, keep orphans and vulnerable children in school, coach villagers on improved agriculture techniques and the nutritional concerns that will affect their growing choices in this very fertile part of the world.
     I spent my week in Uganda (six days of it) delivering that same level of professional work that major NGOs have requested to this little engine that could in part because they are a friend of a friend and in part because I was intrigued by their work and the breadth of their services. It seems to me that they are truly making a difference especially in these rural areas where guidance can be absent.
Children receiving anti-worm treatment at mobile clinic.
Word find Kakiri
Gogolo Play Place
Fresh water from the BKB-constructed spring at Mpigi
waiting for care at the mobile clinic.

Gogolo Preschool

Gift of a cow creates income through milk and manure for a village lady. 

Getting the hang of techniques, spreading fertilizer while preparing for planting.
Preparing the garden.

Thursday, September 10, 2015

Liquid Life, a City run by Water on Wheels


     Just as we thought photography for this project was done, one more nugget presented itself under USAID's Water, Sanitation and Hygiene program in Juba, in the form of water supplies to the city and to santiation efforts at a girls school.

     I learned some time ago to expect to learn and see something new each time I go out. On this trip I've seen many things not new, refugee life in general, and how much refugees try to find a normalcy in their context, food programs, agriculture....

     The water stations often look similar, depending upon the source of that water. But Here I see talks all over town being filled with a fleet of blue trucks that make repeated daily assaults to quench the city's needs for liquid life. Truck after truck fills their tanks to haul water to another part of a thirsty city on a hot and very dusty day.

Next in the series, Africa 2015, Seven Days in Uganda



Opportunity knocks, as this guy fills his cans with overflow from the truck.




Saturday, September 5, 2015

Just a few moments from Torit

A bouquet of groundnuts
     This past week we flew down to Torit, considered the breadbasket of South Sudan, to photograph some World Food Programme/PLAN International projects, that are supported by USAID.

Road builders
      First, I must say that we met some of the most dedicated, hard-working and deeply caring development professionals I have ever met. That's saying a lot considering the heady company of the many great development professionals I've had the honor to work alongside.

     Matuk, Nelson and the rest of the crews from WFP and Plan worked very hard to make our visit productive and, I hope, effective.

     We photographed programs that are trying to energize agricultural endeavors for better crops in an attempt to eliminate food distribution needs. I always say that I learn something new or see a new approach to development every time I go out and this was no different.

     Roads for food?
     Yup.
     Not only are they working with communities in the bush to connect them to main roads to provide more access to markets for their produce, but when there is food-aid need in other parts of the country, they are purchasing that grain, usually sorghum and maize, and delivering it to places where it's needed rather than relying completely on imported aid. My friends at Local First Arizona would love this as it is the ultimate buy-local initiative. 
Nelson examining the groundnut crops with a farmer, noting incomplete growth.

Building a road by hand.
          The bad news is that Mother Nature has not been kind. These folks have been through much in terms of civil war with the north and then internal civil war since independence.

     And now after planting with the first rains of the season several months ago, much of their sorghum has grown only 12 inches tall rather than six feet. With so little rain in the last couple months a high percentage of their groundnut crop (peanuts) failed to germinate,  the yield will probably be half or less of what they planted.

     Of course the fear now is that the breadbasket of South Sudan that supplies much of the country may well be receiving food aid themselves in a few months as a result of this rainy-season drought.

     And yet the people sort of shrug their shoulders and say we will get through, because they have always, somehow gotten through.

    Next in the Series, Africa 2015:  Juba: Water on Wheels
Building a road by hand, connecting their village to the main road, so that they can get their crops to market.
Sorghum should be six feet tall now.
Cabbage is growing a bit better than the Sorghum.
Bagging up local grain to distribute as food assistance to needy areas of South Sudan.