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I spent my last day of the trip in Addis Ababa. I had a 24 hour layover and just relaxed at the hotel. I also made sure to have my favorite food-Ethiopian! I am pleased to report that Chicago's version is authentic. The long flight back wasn't too bad as I had the entire row to myself and could stretch out. We stopped to refuel in Dublin and I watched the sunrise over my ancestral home. Coming in to Chicago was a wonderful feeling and I am so happy to be home. I love this city and my place in it.

After dropping my luggage at home and treating myself to a mani/pedi, I met my sweet nephew Enzo for the first time. I love him so much.

Final week in Africa

Hello everyone!

Last Monday, I spent the day with the team from Gardens for Health. GH is a small non-profit that operates a 5 acre farm and nutrition program outside of Kigali. I met the country director Solomon at a conference last year and was thrilled to be able to see their work during this trip. The farm is a beautiful and productive testing ground for their work improving nutrition and preventing malnutrition in the communities they serve. On the farm they grow a variety of crops including mushrooms, fruit trees, amaranth, kale, sweet potato and corn. They share cuttings and seeds with the families they work with and also sell some of their produce to local hotels and restaurants for income. They also use the farm to test agricultural techniques to improve crop yield during the dry season.

In the community, GH staff partner with community health workers to enroll families at risk for malnutrition in a multi-week course on nutrition, cooking practices, healthy pregnancy, and sanitation and hygiene. GH created the One Pot, One Hour initiative which has been adopted by the Rwandan Ministry of Health. This is an intervention which teaches families how to make a nutritious, balanced and low cost meal using one cooking pot and time saving cooking techniques. I accompanied the GH staff on home visits with women who recently graduated from the course. One mother discussed how she learned the importance of prenatal care through the course and noticed a difference in both her health and her second child's health as a result of receiving more frequent care during her pregnancy. Another mother proudly showed off her chunky, happy infant and described the nutritional improvements she has made for her family as a result of her enrollment in the program.

Local people are hired and trained to run activities on the farm. These folks are tending to the fruit tree nursery.

The community table on the farm where the team shares a delicious meal together everyday.

GH also provides childcare for staff and local workers on the farm. The older kids were eager to impress us with their multiplication knowledge!


I spent Tuesday and Wednesday with Partners in Health. PIH's work in Rwanda has been supported for many years by CFP and it was a such a privilege to finally be able to see the work on the ground. I visited two sites that PIH covers in coordination with the Ministry of Health and was so impressed by PIH's commitment to excellence in healthcare, flexibility and ingenuity.  Far up into the Rwandan hills, PIH works with the government to run a state of the art hospital and cancer treatment center (one of the only cancer care centers in the country). They are also building a graduate school that will train Rwanda's next generation of doctors and public health professionals. At the community level, PIH trains and supports a cadre of community health workers who reach thousands of families each year providing basic preventative and curative care, education and support. I was especially taken with the mental health support that CHWs have been trained to provide. We went on a home visit with one CHW who has been working with a mother for many years who suffered significant trauma after her husband was killed in the genocide. Building a trusting relationship, this CHW was eventually able to get this woman to see a counselor and begin a course of treatment for depression. She talked about how she went from not speaking or being able to care for her six children, to being productive and able to integrate back into the community again as a result of the CHWs intervention. 

Entrance to Butaro Hospital

The PIH team, CHW and mom that he has been supporting towards greater mental health.

On Thursday I flew to the the western edge of Rwanda to visit with Heartland Alliance International's mental health team working in Buvavu, DRC. CFP has been supporting the Fikra Timamu ("of sound mind") program since 2012 and this was the first time we have been able to visit this amazing group of mental health clinicians. I crossed the chaotic border of Rwanda into DRC and spent the next two days with the team in the field. The South Kivu region of DRC has a long history of civil war, gender based violence, and trauma from the brutal and exploitative gold and coltan mining industry. The Fikra Timamu program is designed to address this trauma at the community level by providing counseling and linkage to care at hospitals and local health centers. The team took me to visit a local health center and meet with several government health officials that they partner with.

The DRC health system is in much worse shape than anything I saw in Uganda or Rwanda. Families who cannot pay for their child's care for instance, are not allowed to leave the facility until they settle the bill. At the health center we visited, there were at least half a dozen small children living there waiting to be released. Basic medication is often not available and advanced care is difficult to come by.  Sexual violence and its tragic results are very common. A young girl of about 15 was resting in the maternity ward at the clinic having just given birth to a  tiny infant. She had come in complaining of abdominal pain not realizing that she was pregnant and in labor. She had most likely been the victim of a rape. No family was present to support her. It is in these conditions that the HAI psychologists work and provide a comfort to those who would otherwise have no access to mental health care. As a social worker myself, I was moved beyond words by this amazing team of professionals and the work they are able to do in such challenging circumstances. I am so deeply proud to play a small part in supporting their efforts. Bukavu was also the most beautiful part of Africa that I saw on this trip. Lake Kivu at sunset is astonishing.


The HAI team. So joyful and welcoming to me!

The beauty and complexity of Kigali

Hello everyone!

It is hard to believe that my time in Africa is drawing to a close. The last two weeks have gone by so quickly! I am tired and a bit homesick, but also deeply grateful for and energized by this rich and invaluable experience. I have developed a much deeper understanding of the work supported by the Global Health Committee and built important relationships with potential new partners. My educational goals were exceeded in my time with Omni Med and I am hopeful that my final project will be a useful tool for them to use as they think about their strategic direction over the next few years. Personally I have been moved beyond measure by what I have seen here; the great challenges brought by extreme poverty as well as the incredible perseverance and ingenuity of the people who live here. I have also been heartened by the successes of the organizations (large and small) who work so hard to support those in need.

After I left Uganda last Saturday, I flew to Kigali for a few days. Kigali feels a world away from Kisoga and even Kampala. It is a very cosmopolitan city whose relative wealth, compared to its neighbors, is very apparent. I stayed at the Marriott which even by Chicago standards was luxurious. I'll admit to taking two hot showers the day of my arrival! Here again I was reminded of my privilege; moving seamlessly from bucket showers to high end toiletries. That said, I very much enjoyed my stay and appreciated the chance to relax and regroup.

On Sunday, I took a guided city tour which took us all over and provided a great glimpse into the city and Rwandan culture. The day ended at the Genocide Memorial. In 1994, over 1 million Rwandans were systematically murdered by their neighbors in the span of 100 days. The slaughter was encouraged by the government at the time and targeted at a maligned minority group.  In addition to the 1 million killed, over 2 million fled the country. Eventually, Paul Kagame (Rwanda's current president), leading a rebel group, stopped the slaughter. The country was devastated by the trauma, which makes it all the more remarkable the gains that Rwanda has made since that time. 63% of Rwanda's parliament is female; life expectancy has doubled; 91% of the population is enrolled in the government health system; and GDP growth is 7% per year.  I asked several Rwandans what they felt accounted for this astonishing recovery and all attributed it to political will and a strong government.

There is poverty in Kigali to be sure and country continues to struggle with high rates of maternal and child death and non-communicable diseases. That said, it was a good reminder (especially for an American) that Africa is not just one thing or one place, but rather a collection of beautiful countries with unique histories, cultures, challenges and successes.

View of Kigali

Eric takes us to a "milk bar". Cows are cultural currency in Rwanda and highly revered. Sharing a glass of milk together is an important custom.  The pastries were amazing!

A delicious Rwandan lunch. Similar to Ugandan food but spicier. 

We took a water taxi from this dock--just like Chicago!

Eternal flame at the memorial

My final week in Uganda

Hello everyone!

My last week with Omni Med was full and rewarding.  On Tuesday, we went into the field to accompany VHTs on home visits and learn more about the challenges that the families they work with are faced with, especially when it comes to sanitation and hygiene. Many families cannot afford to construct a pit latrine (approximately $400) even though it is one of the best prevention tools against diarrheal diseases. VHTs take a harm reduction approach for these families and encourage them to wash their hands with soap and water and use proper cleaning and food preparation techniques to minimize the spread of disease.

VHT talking with a community member about the importance of sanitation and hygiene.

On Wednesday, I shadowed another VHT who is assigned to work at the health center that serves Kisoga. Rosette assists the health center staff with organizing and packaging medicines, giving health talks to waiting patients, assisting other VHTs who come to the clinic to volunteer, and numerous other tasks. Her work is vital, as this health center in understaffed for the number of patients who arrive each day. On the day we were there for instance, the psychiatric nurse was also responsible for running the pharmacy and reception desk.

Adult male circumcision is a very common procedure at Kojja as it has been shown to be effective in the prevention of HIV

Main building of the health center

Labor and delivery room- only two beds

We also spent one day observing the construction of a safe cook stove. In partnership with the Cookstove Project, a number of Omni Med VHTs have been trained to lead cook stove construction for families who need them. Cook stoves burn less fuel which is better for the environment and more affordable for families and they also create less smoke which can decrease the prevalence of pneumonia in children and adults. The materials can be gathered for free from the community-mud from ant hills and banana leaves-so it is obtainable for most families. It takes a lot of work though and it was amazing to watch these older female VHTS cut into think banana stems and mold thick mud into a sturdy and functional stove. 

I left Kisoga on Friday and went into Kampala where I spent the day with Living Goods. Living Goods also supports and trains VHTs  but their model is quite different from Omni Med's. As an added incentive, VHTs purchase medicines and other supplies as wholesale from Living Goods and sell to the community for a small fee. This way, VHTs  can make a small profit and have the medicines they need to treat children for malaria, diarrhea and pneumonia. Families can  also purchase labor and delivery kits, fortified cereal, solar lamps, and other products they need at a fraction of the cost from a pharmacy or local shop. I spent the afternoon with a VHT in the field and observed her care of two pregnant moms. She showed me the prompts she uses to review good nutrition and health pregnancy activities as well as the data collection tool she has on her phone to enter in the information from her visits. 

Friday night I had dinner with the folks from LifeNet International. Working in Burundi, DRC and Uganda, LifeNet provides training, coaching and technical assistance to health clinics to assist them in improving their clinical and administrative practices. They design a curriculum that fits the specific needs of each center and works with them over a several year period to strengthen everything from accounting practices to hygiene protocols. I really enjoyed learning more about this work from Josh, LifeNet's Country Director for Uganda and his wife Nadine, over a delicious chicken curry at a rooftop restaurant overlooking busy Kampala. A far cry from rural Kisoga!

I said goodbye to Uganda on Saturday and flew into Kigali to begin the next leg of my journey. I'll share more soon about the wonderful experience I have been having in beautiful Rwanda!

Happy Birthday!

Good morning everyone!

It has been a busy few days since leaving Kisoga on Friday. I am in Kigali, Rwanda now and have much to report. But, I'll do that later when I get back from spending the day with Gardens for Health.

I want first to wish a very happy birthday to two of my favorite people who share this day. Today my mother Liz turns 82 and my nephew Joaquin turns 12. I still remember the first time I held him. I miss you both and hope you have a wonderful and fun filled day! Much love to both of you!

More soon!

The committed and hardworking staff of Omni Med

Good morning everyone!

Another quiet weekend at Omni Med. My fellow students went into Kampala for the weekend to explore, so I had the house to myself again. Over these last few weekends, I have really enjoyed the opportunity to relax, read, work and take in the sun. I will miss that when I get back to the faster pace of Chicago.

It has been a privilege over these last few weeks to get to know and learn from the Omni Med program staff. They are a small team of smart, thoughtful, hardworking people and the student volunteers have much to learn from their approach to the work. 

Edward is Omni Med's CEO and has been working for the organization for ten years. He started as a VHT and worked his way up to a full-time paid position as the leader of the team. His depth of knowledge of the communities served is invaluable and he has a wonderful way with VHTs and families. During home visits and trainings, he puts people at ease with humor and stories. He is also an excellent driver which in Uganda is no small task! He handles the rain, pitted roads, boda-bodas, and random livestock with ease. He knows everyone and is always waving to passerby from the van.

Elizabeth has been with Omni Med for nine years. She also started as a VHT, moved on to become a translator for student volunteers, and is now Omni Med's CFO. She manages the day-to-day budget with finesse and is responsible for negotiating with contractors and vendors. She has been so welcoming to me and the other students and I have enjoyed talking with her over lunch about her life in Uganda. 

Henry is the newest staff at Omni Med, having joined as VHT Coordinator a few months ago. Henry is responsible for communicating with VHTs-no easy task- about scheduling and logistics. He is kind, funny and patient with all our questions. 

In addition to their full-time work at Omni Med, Edward, Elizabeth and Henry each have other jobs. This seems very common here as folks have to work extra hard to earn cash for essentials such as school fees, medicine, and travel. Edward is a farmer and sells his crops at local markets. Elizabeth owns a hair salon. Henry runs a small store. The side hustle is essential. 

I sat in on their staff meeting last week. I am not exaggerating when I say this was the most engaging, lively, egalitarian and solution focused meeting I have ever attended. The meeting was opened with a prayer which had the effect of centering the group and bringing a sense of common purpose to the task. We then moved into a great discussion of the logistics of Jack and Jacob's plan to test the ORSTubes. Everyone had a voice in the conversation and sufficient time was taken to talk through the challenges and come to an agreed upon plan. There was a lot of debate and disagreement, but it was welcome- not something to be avoided or minimized. It was also enjoyable! Elizabeth had fun demonstrating the ORSTube process for us and we had a lot of laughs. 

Elizabeth demonstrates ORSTube at the staff meeting.

Last week, we also had a tour of several sites where Omni Med has built Protected Water Sources (PWS). In Uganda, 23 million people lack access to clean water. Those who do not have access must rely on unsafe sources such as rivers, lakes, and unprotected wells. One consequence of poor access and quality is that water-borne diseases are a major cause of infant mortality. PWS are a relatively cheap and effective intervention for improved sanitation and hygiene. When a VHT identifies a community that is lacking in a PWS, Omni Med assists in the construction of PWS in collaboration with the community. Omni Med has constructed 30 PWS, increasing access to over 8,000 people. 

Protected Water Source

Edward demonstrates how to retrieve water.  

A class perspective from an interesting vantage point

Good morning everyone!

My third week with Omni Med continues to challenge and inspire me.

I am no longer the only student volunteer at the house. I introduced you to Jack and Jacob last week. They demonstrated their ORSTube prototype to the Omni Med team on Monday. It was fascinating to hear the perspective of the local staff on how this tool could be used by VHTs and what the challenges will be. They will test it with a number of VHTs starting next week and gather feedback to make further improvements.

Four more students arrived on Tuesday. Three are second year medical students at George Washington University in D.C. and one is a senior at Bates College in Maine. The house is very full and it is interesting having roommates who are 20+ years younger than me. They are eager, kind, very accomplished, and well traveled. This morning, Christina introduced them to the work of Paul Farmer and Partners in Health. They dove right in to Pathologies of Power, Paul's famous treatise on health, human rights and the call for preferential treatment for the poor. I look forward to hearing their thoughts on his work.

Elizabeth and the VHTs

I had a second chance at training at the end of last week. Jack, Elizabeth and I drove out to a remote health center about one hour away and met with five VHTs for a training on healthy pregnancy. I felt a bit more prepared for this one as it is a topic I have more experience with from my time managing a home visiting program for new parents in the Rogers Park neighborhood of Chicago. It was also really helpful to have Jack as scribe. The VHTs took copious notes and asked great questions--many that I could not answer. All in all, it felt like a success.

Exam room in the health clinic

Training tool for VHTs in the field

Health Clinic

Hallway in the clinic. This is a weighing station for infants.

I've been thinking a lot about social class since I've been here. By Ugandan standards, I am wealthy and very privileged. By American standards I am middle class- thanks to a dual income, no children and a relatively modest lifestyle. I was, however, raised in a working class home. My father worked hard to support six kids as a delivery driver. My mother took care of us and our home. While we mostly did fine, we were on food stamps for a time and from a young age I was keenly aware of our status compared to some of my friends from wealthier families.

College was not something that we were expected to do or something that my parents could have afforded to help any of us with anyway.  I was a pretty good student in high school and wanted to pursue college. I moved out when I was 18 and often worked three jobs to support myself and take occasional courses at the community college.  Later, I took out loans and eventually got a BA from a public university at age 29.  There were times in that eleven year period, where I couldn't afford to fix my car or eat a full three meals a day. I cringe to think about the moldy, roach infested studio apartments I have called home. A few years after my BA, with the help of loans and work, I received a MSW.  It is through the generosity of my employer that I have the privilege of pursing this second graduate degree and this amazing field experience.

Thinking about class from an American perspective in a place where many, many people live on less than $2 a day is an exercise in gratitude and discomfort.  I am deeply appreciative of the opportunities, support, and sheer luck I have experienced in my life. I am also made deeply uncomfortable by the persistent and tenacious injustice and economic violence in the world that allows so many to have too little and a few to have too much.

Community is everything

Hello all!

This weekend was a quiet one at the Omni Med house. Staff, except for our cook and guard, are off on Saturday and Sunday, so the last couple of weekends have been a great time for reading, working, taking in the sun, and reflection on my time here and what it means for my work. The electricity was out most of yesterday which turned into a fun game of "beat the clock" as I tried to get as much work done on my laptop before the battery died. Amazing for my productivity!

The next two weeks will be quite different here as six new volunteer students arrive. Two came last night. Jack and Jacob are pre-med students who will be testing a prototype for an easy to use Oral Re-hydration Solution (ORS) tool for the treatment of dehydration and diarrhea in children. They developed the tool in high school and used a 3-D printer to make 150 to test in the field with VHTs. I'm so impressed by their ingenuity (what was *I* doing in high school?) and look forward to seeing how this plays out in the field.

My big takeaway from last week was the importance of community. On three occasions so far, home visits and training have been cut short or cancelled due to village funerals or inheritance ceremonies. Everyone in the village is invited to these events and it is imperative that everyone attend as it is considered a significant personal slight if missed. VHTs are elected by their community to fill this volunteer role and their success is dependent upon trust and close relationships. To maintain these relationships, a training or visit will be postponed in order to fulfill the community obligation.

This is, of course, challenging for Omni Med staff and volunteers. Communication between VHTs and staff is not optimal, so often we do not know these events are happening until we arrive and the VHTs are absent or few in number. This means a loss of time, fuel, and energy spent preparing for training. I felt this acutely myself, when I was tasked with presenting a training on sanitation and hygiene. I spent the morning reviewing the material and writing out prompts and information on poster paper. While I certainly did not feel as prepared as I would have liked to have been, I was ready to give it a shot. Elizabeth and I drove over 1 hour to the site and were met by 5 VHTs (we were expecting 15). They let us know about the funeral and that while they wanted to participate in the training, they could only stay for 30 or 40 minutes. So I jumped in, with Elizabeth translating, and did the best I could. We were able to get through half of the material and the VHTs present had a number of questions and comments, so I think they got something from it. Afterwards, I'll admit to feeling frustrated and disappointed. This was not what I was expecting or what I am used to from training in the United States.

It was helpful to have some time to reflect on this experience both in talking with Christina and reading through a really helpful book, Helping Health Workers Learn by David Werner and Bill Bower. In it, they discuss the imperative of a community-strengthening and people-centered approach to this work. Adaptation to local customs and conditions is key, which inherently means an acceptance of a slower pace of learning and continual innovation, flexibility, and creativity on the part of  trainers/helpers. This is tough for someone coming from a culture focused on quick results and strict adherence to process and agenda.

In the pictures below, you'll see my training intro and the training location (a vacant church). 

I still haven't gotten used to being the object of so much attention in the village. Children, in particular, are incredibly curious about muzungus (white people) and will follow you and call out almost constantly. For those who know me well, you'll understand my aversion to this! The kids in the pictures below were cracking themselves up and daring each other to come close to me. They finally sobered up enough for me to take a picture but fell back into giggles when I showed them the pictures. I've never been more popular.

Special Edition: What about the food?

As a special request from a super fan of the blog (thanks Marc McGee!), I will share a few more details about what my meals have been like these last two weeks.

Food is plentiful. Most families farm and use what they produce to sell and eat. Typical crops are corn, tomatoes, potatoes (Irish and sweet), matooke (a banana varietal), mango, banana, avocado, peppers, cabbage, and beans. Many families also keep chickens, goats, pigs and cows. In the market in Kisoga, there are numerous stalls selling these fruits and vegetables. Eggs too. You can also buy whole fish (Lake perch or tilapia) and meat. There are specific stands to buy beef. A huge hunk of raw meat is suspended from a meat hook and the owner will hack off the amount you want, weigh it and wrap it for you. There are also small stores where you can buy things like bread, tea, milk, pasta, etc. Last week, I spent the equivalent of $2 on a loaf of bread, a box of black tea, and two apples.

Ugandans don't really do breakfast, so I fend for myself in the morning and usually have a bit of oatmeal, a piece of bread or fruit. And coffee! Before I came, I did some research and discovered that Ugandans mostly drink tea, not coffee (kaawa). This was not going to work for me, and my lovely Ian thoughtfully purchased two pounds of high quality coffee grounds for me to bring. So every morning, I have that small indulgence using the French press left behind by another volunteer (I am having my first cup right now). I will not be sharing my coffee with the 6 new volunteers scheduled to arrive tomorrow...

As for meals, we are fortunate at Omni Med to have two women who cook and clean for the volunteers. Ruth and Garetti are excellent cooks- which is no small task. There is no oven, microwave, running water or immersion blender to assist with this. Meals are made using a cook stove- a safer and more efficient alternative to an open fire. What comes out of that is always very good. Lunch is the big meal of the day. Typically there are two starches served (matooke-mashed, posho-a spongy type of white polenta, and/or white rice). With this goes a "sauce" which could be beans (so good), g-nut (peanut) sauce, or a broth of some kind. Depending on the day, there might also be fish (served whole), spaghetti, beef or pork. Garetti also makes a really nice cabbage "salad" and sometimes delicious stewed greens. Avocado and fruit (usually mango or pineapple) is almost always available too (an avocado fell out of the tree in the back yard last night and I retrieved it for breakfast). Ugandans feel that food should be hot and cooked, so they don't do raw veggies like in a salad. As much as I complain at home about salad, I do miss fresh, raw greens and veggies.

Dinner is very simple. Often an omelette served with tomato, a bit of onion and fried potatoes. I love this meal and the hot sauce they have here to go with it! Last night was a treat of pan fried chicken leg and potatoes. So good!

Snacking doesn't seem to be too much of a thing here, although there are stands where you can buy samosa and chapati (there used to be a large Indian population in Uganda before Idi Amin forced them to leave in the 70's) A rolex is also popular. This is a chapati wrapped around an omelette. Really good and cheap (.50), but super greasy and not something I could eat everyday.

All in all, I am loving the food here and appreciating (mostly) the fact that there are no vending machines where I can get my Milky Way or Cheezit fix at 3pm. That said, I do miss chocolate, cheese, wine, and salad (a little bit anyway).

Check out the pics of some of my meals so far.

And just a final note. Knowing that I am due to travel to the Democratic Republic of Congo (DRC) in early June, many of you have asked about the Ebola outbreak the country is experiencing right now. The outbreak is currently 1,000 miles from where I am scheduled to be (near the Rwandan border). DRC frequently experiences small outbreaks in very remote areas and has typically been able to quell the spread pretty quickly. There is concern however that some new cases have been reported in a larger city on the Congo River (very far from my site visit location). I am in close contact with the security and staff team for the organization I am due to visit, in addition to receiving alerts from the State Department. If there is any danger in travelling to the country in June, I will not go. I will keep everyone updated, but in the meantime, please know that I am happy and healthy (if quite a bit more disheveled that I would like to be).

Examining my American ways

Hello everyone!

I hope you are enjoying reading about my time here. Thanks to those of you have have commented or sent private emails of encouragement. It means a lot to me. While I do miss everyone and my life in Chicago, I am so grateful for this invaluable opportunity to improve how I approach my work at CFP. This experience has also been really good for me personally as I am forced to challenge my assumptions, comfort level, and ways of thinking about...well...everything!

This week has been very enlightening from a cultural perspective. It is very common for couples to have 5-8 (or more) children and it seems to be a given that women, when married, have kids. Ugandans will be quite upfront and just ask someone how old they are and if they have children. This question was addressed to me over lunch with two Omni Med staff- Elizabeth and Garetti. I replied that I will be 45 next month and do not have children. They know that I am married, so this response was met with shock and raised eyebrows. Elizabeth asked if I planned to adopt. When I said no, she asked "...what then, do you do with all your money." Such a great question and one that I was a bit embarrassed to answer!

When I was in my late 20's and 30's, I would occasionally have to field questions about why I didn't have kids, but it was not too common.  Maybe because of my age or the work environment I am currently in (thanks women of  CFP!), I am not questioned about that anymore at all. It has been really interesting to think about my choice in the context of a culture where the choice to not have children seems so very strange, or is not even considered a choice at all.

This week in the field with the team was challenging and I felt my first glimmers of frustration which I don't think will be my last. I went back with the team to work on getting the final round of consents from families who will participate in the research trial. It takes much longer to do anything here because of a variety of infrastructure limitations. Except for a few, most roads are unpaved and significantly pitted and uneven from rain erosion. One has to drive slowly and carefully while dodging motorbikes, bicycles, people, and cows.

Once we got to where we are going-which is over an hour away-we had to wait for the VHTs to arrive. They have to make their way along similar roads, so it takes them just as long. When everyone is finally assembled, we began. Homes are not right next to each other as on a Chicago city block, and VHTs have to walk-in the sun or rain- for long distances to meet with families (who are not always home). I have really enjoyed meeting families and spending time with them, but it is tough to be in the sun for so long with an empty water bottle and no snacks. After 2 hours, we headed to lunch--a 25 minute drive to town. We ate at a roadside shack selling beans, rice, matooke (a mashed banana-type staple), beef, sweet potato and g-nut sauce (peanut sauce). Very delicious and about $1.

By the time we finished and drove back, it was close to 5pm and time to round up the VHTs and head home. This took another 90 minutes. The sun was set by the time we got back to the office. A really long day that, through my Western lens, felt inefficient and not very productive. And yet, the VHTs arrived to do the work, the staff was there to support them, and the families were eager to participate in what they see as an important study that may improve their lives. I also had the chance to spend time with a wonderful VHT and see her in action with the families she serves (see pictures). All in all, a good Ugandan day.

A quick note about animals

Good morning everyone!

As I prepare for my second week at Omni Med---we'll be in the field again today--- I wanted to send a quick note about some of the creatures I've seen here so far.

Since most families farm, they also keep chickens, goats, a cow or two, and sometimes a pig. The chickens and goats seem to have free reign to go wherever they like and graze. They wander into the road and into other people's property and I can't figure out how they make it back to where they belong.

There are dogs and cats as well, but they are not typically pets as we understand them in the U.S. They are just around and subsist on whatever they can find. Garbage is burned on the street or in yards, so I imagine they find a bit of food this way. At Omni Med, there are anywhere from 1-6 dogs hanging around each day. They are not for petting and the staff will yell and throw water at them regularly. When I read outside, they come around and sit by my. At night, they bark and fight a lot.

Yesterday morning I almost stepped on a gigantic snail! It was about 6 inches long and moving across the yard pretty quickly. I watched it for awhile but when I came out of the house later, it was gone.

There are a lot of insects here, but none that bother me too much. Cockroaches are common and much bigger than in the U.S. The guy in the picture below was flirting with me pretty hard for two nights. When he tried to get into my room, I had to end it. I thought I had smooshed him pretty good, but the next morning, the body (NOW dead) was further down the hall than where I had left it. Tenacious.

My first week

Hello everyone!

Remember when I said that the internet has been pretty strong? That was before we lost power for several hours over two days. Apparently that is just how it goes here which makes planning a challenge to say the least.

It is Friday night and I have been in Kisoga for almost one week. I have so much to learn, but already this has been an invaluable personal and professional experience. On Wednesday, I went with the team into the field again, but as we drove into the small, remote village where we were to collect consent forms for Omni Med's research trial, it became clear that almost everyone was attending a funeral, including the VHTs who were going to take us house to house to meet families. So that was that for the day. Christina, an American who is on staff here, explained that flexibility is key for anyone working in this environment. Most things do not go as planned.

So it was back to the field today! I accompanied Edward and one of the village VHTs as they went house to house over five hours-in the rain- speaking with families about the research and asking them to participate. Here is a picture of Edward and the VHT walking the path (Edward is looking back to make sure the muzungu (white person) is keeping up). I'm glad I brought this goofy hat; it really helped in the rain.

 Only one woman said no to participating in the study and this seemed to be mostly because the male family member was not at home to give consent. Everyone else was eager to participate and saw the value of gathering the data. One person said that he wanted the government to use this type of information to make policy rather than designing ineffective health programs that don't involve community input and collaboration (I'm paraphrasing...).

Here are a few more pictures of the team in action.

One final, and very happy note. My rock star sister (3 natural home births) had a son last night. I love him so much already and can't wait to kiss his perfect cheeks. I love you Moffitt-Clavijo family!!