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!!

More pictures of the Omni Med house and a day in the field

Hello everyone. So far, the internet has been strong, so I think it will be easier to post more frequently than I originally thought.

I have more pictures of the interior and exterior of the Omni Med house where I am staying which should give you a pretty good idea of my current living situation.

I'm slowly getting the hang of the very different living arrangements. It's not always comfortable- in fact it mostly isn't- but it is definitely changing my perspective and  helping me be much more appreciative of my life in Chicago.

This morning I worked on my literature review and corresponded with the doctors I am working with on the paper. After lunch, I joined the team in the field. Omni Med is undertaking a research study to examine the impact of their model on communities they serve. In addition to providing health education, basic treatment, and referral for cases of malaria, diarrhea, and pneumonia in children under 5 (the leading causes of death for children in many very poor countries), Omni Med also assists families in building cook stoves (pneumonia prevention), obtaining and installing bed nets (malaria prevention), and building latrines and protected water sources (diarrhea prevention). This is considered an enhanced model and one that Omni Med is eager to show works so that they can get more support from the Ugandan government and other funders.

This afternoon was spent collecting consent forms from the families that will be participating in the study. Not understanding a word of Lugandan except for muyembe (mango), ki kati (hello), weebale (thank you), kale (you're welcome) and sula bulungi (good night), I still found it fascinating to observe a process I have only read about from grantee reports. The VHTs (volunteer health workers) had great rapport with the families and had clearly built a lot of trust through their work. Even though there are no street signs or home addresses, the VHTs knew where every family on the list lived.

It was very humbling for me- clearly an outsider- to be welcomed into every home. Most families live in two to three room brick sheds with tin roofs. There is little furniture and most cook over an open fire in the yard. All the children I saw looked healthy and were excited to see a stranger. Most smiled and waved when I said hello except for one little boy, who burst into tears when I entered his house.

I also enjoyed the chance to see more of the landscape as we walked through the village. This part of Uganda is very lush and green. It has rained both a little and a lot each day I have been here. There were small farm plots at nearly every house growing a variety of vegetables including corn, green pepper, onions and potatoes. My mother grows potatoes too. I need to take a picture for her of how they do it here. It may improve her harvest.

The Omni Med House

I made it!

Hi everyone! After an uneventful, albeit very long, flight, I made it to my destination!

I left Chicago yesterday at 6:30 am and connected in D.C. for the 13 hour leg to Addis Ababa. I got lucky with my seat mates: a young Ethiopian guy living in Madison returning to Addis for a family wedding, and an older gentleman living in Grand Rapids heading to Malawi to teach a biblical studies course in Swahili (his native language from having been born to missionary parents in Congo). It was the Midwest contingent!

From Addis it was a short flight to Entebbe, Uganda. Charles from Omni Med waited patiently for me while I slogged through immigration. We spent the next 3 hours making our way through unbelievable traffic and terrible roads to get to Kisoga in the Mukono District of Uganda and the home of Omni Med.

Omni Med is a small non-profit that, for the last ten years, has trained and supported Village Health Teams (VHTs). VHTs are trained community members who provide education, support and basic care to their neighbors who would otherwise not have access to safe, affordable and reliable care. You can read more about Omni Med's work here: https://www.omnimed.org/about_us

Over the next four weeks, I'll be accompanying VHTs on visits in the community to observe their work. I'll also be completing a literature review exploring best practices for non-monetary compensation for VHTs. This work is the nearly final component of my graduate degree.

When I first arrived at the house at Omni Med, I'll admit to feeling overwhelmed. I knew the house had no running water, but knowing that and then experiencing the reality of it are very different things. Suffice to say the bucket shower and outhouse will take a bit of finessing. I'm also pretty sure, I saw a lizard skitter behind the curtain on my bedroom window. Hopefully he'll stay put when I go to bed.

I look forward to having some time tomorrow to recover from jet lag and get my bearings before diving in on Monday. I have a lot to learn.