Thursday, September 21, 2006

more about the hand

i know you're all wondering, so i'll just save you the trouble of asking. my hand is doing well. i played in an ultimate tournament 7 days later and took the stitches out afterwards, 8 days after the injury. there was never any infection and it's all closed up nicely. the added benefit is that now my life line is extra long and, might i add, quite robust in the latter stages. or is that my love line? well, either way it's win/win.

3M nexcare band-aids are the bomb. i also used a brush-on antiseptic superglue substance that i liked a lot. comes off with fingernail polish remover? wish i'd found both of those sooner, as i think the hand would have healed faster, and that first tournament would have been more comfortable.

the US is ok, and it's especially good to be back in MN for the fall. my favorite season here. paige got in yesterday to do some work here at world headquarters and we head to washington island (lake michigan. door county, WI) this wknd for a wedding.
uno and i have similar luck with dentists. he got two molars out yesterday, and he has one more pre-flight trip to the vet to get all the paperwork in order. an official africat!


Saturday, September 16, 2006

the rechargeable mosquito-hitting swatter

the section of kampala road (surprisingly enough, the main road through kampala) between the round-about up to garden city and the jinja road round-about is lined with street hawkers selling all kinds of random stuff. you can usually tell what the latest shipment into the city is because every hawker for 100 yards is trying to sell you the same thing. when we first got here it was padlocks, then it was mini-pillows, then came the multi-colored felt cowboy hats, and today it was the rechargeable mosquito-hitting swatters. no kidding. exact wording on the package: the rechargeable mosquito-hitting swatters. you got to see it to believe it. 101paige 101africa

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Friday, September 15, 2006

a treatise on family planning

(i haven't been writing nearly as much as i'd like about my job here. this is my effort to change that. if you're not interested in public health, no need to read further. if you are interested in public health, sorry i haven't been more descriptive about what it is i actually do here.)

the organization i work for - minnesota international health volunteers (MIHV) - is a U.S.-based NGO/PVO (non-governmental organization/private voluntary organization) that works in community-based maternal and child health, both in the U.S. and in Uganda. our expertise is in community health education, mobilization, training, participatory research, and monitoring and evaluation. everything we do involves partnering with the communities in which we work to positively influence behavior change.

health is influenced by 4 factors: access (to health services/medical care), genetics, environment, behavior; but the factors don't enjoy equal influence. their proportional influence on health status more-or-less breaks down as follows: access 10%, genetics 10%, environment 20%, behavior 50%. when it comes to dollars spent, the proportions reverse. most of the healthcare dollars in the U.S. are targeted toward improving access to care (think public health insurance programs, universal healthcare, "free" emergency care), and very little is targeted toward modifying behavior to achieve desired health results or to prevent poor health outcomes.*

take the following health outcome: maternal mortality (public health lexicon: # of women who die due to complications during pregnancy or in the immediate post-delivery period). causes of maternal mortality can either be direct or indirect. in the developing world, direct causes of maternal mortality primarly include hemorrhage, sepsis, eclampsia (hypertensive disorder of pregnancy), complications of unsafe abortion, obstructed or prolonged labor. many illnesses are aggravated by pregnancy, such as anemia, hepatitis, tuberculosis, malaria, STIs; maternal deaths attributed to complications of these pre-existing illnesses are qualified as indirect.**

if you approach the problem of high maternal mortality from the "access" perspective, you might consider building a maternal health hospital that has highly-qualified and -trained health professionals, well-stocked supplies, and modern technology so that when a pregnant woman is in trouble, she can get to the hospital and get the necessary care she needs to both save herself and her baby. on the other hand, if you try to reduce high maternal mortality from the "behavior" angle, you might examine what behavior puts the pregnant woman at risk in the first place. then, you ask: is this "risky" behavior something that can be changed positively in order to prevent the complication from ever occuring?

most poor health outcomes can be prevented, that's the basic premise of public health. but, what about pregnancy can be prevented in order to minimize the risk for the mother? certain types of pregnancy qualify as "high-risk." if you're from the developed world, you're probably thinking ectopic pregnancy, multiple birth, prematurity. but, if you live in the developing world high-risk pregnancy is a whole different bag o' tricks. young mothers, women with inadequate nutrition status (e.g. stunted growth, poor pre-pregnancy weight, anemia), high parity (public health lexicon: number of births) mothers, very old mothers, women with closely spaced or unwanted pregnancies. each of these scenarios increases a woman's risk of dying due to pregnancy and/or delivery. but, each of these scenarios is also preventable.

thanks to modern contraception, all women can make the choice when, how many, how often, and when to stop having children. when: a teenager decides she wants to wait to have children until she is old enough to be a mom. how many: a mother who already has 3 children decides 3 is all she wants. how often: a mother with a 1-year old decides she wants to wait another 2 years before her next child. when to stop: an older woman wants to be sexually active but decides she does not want any more children. each of these women's choices reduces their chance of a high-risk pregnancy and increases their chance of being healthy throughout pregnancy/delivery and their baby's chance of surviving to 5 years old.

but, what if you live hours from modern development? what if you are illiterate? what if your religion prevents you from using modern contraception? what if your culture values loads of offspring because it proves the man's virility and strength, upholds the woman's role as caretaker, and assures there will be someone to take care of you in your old age? what if infant mortality is so high in your community that you feel you must have many children to compensate for all your children that will die before their 5th birthday? what if your culture prizes boys over girls, and a woman is not worthy unless she bares a boy? what if you don't know that the decision to have children is yours alone?

enter public health organizations like MIHV.

almost 50% of my salary in uganda is funded through a grant MIHV received from the FlexFund, which is a funding arm of USAID specifically directed at community-based family planning and reproductive health projects. our FlexFund family planning project aims to increase contraceptive use among women of reproductive age, but as you can see from the list of barriers noted above, increased contraceptive use isn't exactly straightforward. to increase contraceptive prevalence rates (public health lexicon: number of women using contraception), we are...
(1) educating community members (both women and men***) on the benefits of family planning for women, families, children, and communities to stimulate demand for family planning
(2) expanding service delivery by training community health workers to visit women and families in their homes to educate on family planning, provide selected family planning methods (condoms, pills), and refer women to local health facilities to receive other modern family planning methods (injectables, IUDs, implants)
(3) training health facility workes and private practitioners in proper counseling techniques to assure that women choose the family planning method appropriate for them
(4) assisting health facilities in managing their family planning logistics (public health lexicon: supplies) to enable them to meet generated demand for family planning.

our strategy is that by increasing awareness and demand, improving the supply chain, and sensitizing (public health lexicon: educate, dispel myth, calm fears, introduce new ideas) the community, we help to create a supportive environment for family planning, thus increasing the liklihood that a woman and her partner will choose to plan their family.

as you can imagine, family planning is a sensitive topic. we could not possibly be successful if we simply walked into the community and said "this is what we think, this is what you're going to do, and this is why you're going to do it." i started this blog by saying that MIHV partners with the communities in which we work on every project we undertake. public health-ers are not in it for personal benefit, profit gain, or to climb the corporate ladder. what good does it do me to help someone live longer and healthier (except make me feel good about what i do)? but, it makes all the difference in the world to that woman or that child or that family, that she lives longer and lives healthier. MIHV partners with communities because they are the ones who will make the change, who know what change they are willing to make, who will benefit from the change made. they're the experts. we just support them in exercising their expertise.

my first term in grad school, i wrote a brief paper on margaret sanger for beth virnig's class. margaret sanger is known as the mother of modern family planning. she was the first one to bring family planning to the global table as she advocated for a woman's right to choose when, how many, how often, when to stop. of course, as a daughter of a very liberal, independent woman who has been inculcated with women's rights since i was born, i looked at margaret sanger as the harbinger of women's lib and the fore-mother of roe v. wade. beth called me out quickly saying, "yes, all true, but this is a course in public health. what is the public health significance of margaret sanger and her work?" of course! margaret sanger in the 1920s, the pill in the 60s...the beginning of the decrease in maternal mortality through the increase of family planning. in the 1st world, family planning translated to more women in the workforce, a stimulated economy. in the 3rd world it translates to less poverty.
101paige 101iph

*credit to lynn blewett's health systems course, u of mn school of public health

**credit to ian greaves' working in global health course, u of mn school of public health

***almost everything i have written re: family planning is about the woman. however, family planning is not just about the woman. public health-ers working in family planning are very, very specific about that. successful family planning involves both partners in a relationship. in the case of this blog, however, it's just been easier to write about the woman (i.e. easier to say "she" instead of "s/he" or some other PC version of saying "she and he"). i apologize for my blatant bias.

disclaimer: all views expressed are mine and mine alone. in no way do i speak for or on behalf of MIHV in this forum.

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Thursday, September 14, 2006

5 gallons in 11 days

when you buy all the water that you drink (no drinking the tap water here!) and you're the only person drinking it, it's really easy to track how much you drink in how much time. so, that's what i did.

we buy our water in 5 gallon jugs and have created our own little culligan water cooler with the help of a small igloo-like water jug (think the type the NFLers use to dump the gatorade on top of the coach's head after a big win, but smaller). i bought a 5-galloner a week ago sunday, and today it's all gone. that's 5 gallons or 640 fluid ounces (1 gallon:128 fluid ounces) in 11 days, which means approximately 58 ounces/day. assuming 6-8 ounces of water in a regular-sized glass (i used 7 ounces in my calculations), i'm drinking about 8 1/4 glasses of water a day. hello, hydration!

i always thought the recommended 8 glasses of water per day sounded like a crazy lot of water, but then again maybe not. granted, i've been drinking like a fish because of the heat the last few weeks, so maybe the 8 1/4 glasses isn't my true baseline value? 101paige 101africa

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Sunday, September 10, 2006

no chickens on the matatus

the matatu is the east african version of public transport - a minivan converted into a mini-bus. unlike tanzania & kenya, the matatus in uganda aren't overcrammed with people. rather, the drivers and conductors here (mostly) stick to the 14 passenger limit, which imo is a nice feature.

i took a matatu to the rugby game yesterday. when the matatu stopped to pick us up, the man i was waiting with nicely allowed me to get in first. then, he turned around to pick up the chicken sitting at his feet behind him. he stepped up into the matatu and the conductor said "no, you cannot come with us with that" pointing disdainfully at the chicken. the man was left on the side of the road holding his squawking, flapping chicken by its feet. i was saddened to the point of tears. with the little money he had this man was trying to either get the chicken home to feed his family or he was trying to get it to market to sell it to feed his family, and he wasn't allowed on the bus. i almost got out of the matatu thinking, if he can't get on the bus, i'm not going to get on the bus either. instead, i mutely watched as someone with little discriminated against someone with even less. i felt sad...both at the situation and at my inability to do anything about it. 101paige 101africa

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Saturday, September 09, 2006

uganda v. morocco

the uganda national rugby team (the cranes) played morocco today in a world cup 2007 qualifier match. they played at the kampala rugby club, which is where we used to play frisbee until we got kicked off so that the pitch could recuperate enough for the big game. the women (the lady cranes) played first versus kenya drawing about 1/100th of the crowd that came for the men's match. typical. granted theirs wasn't a world cup qualifier, so i shouldn't be too bitter and i didn't actually make it the women's game myself, so really, i am not entitled to my bitterness. but, this is years of build-up, so the bitterness still rears its ugly head.

the crowd covered two sides of bleachers, plus all other space around the field lined 3-4 people deep. it was a good scene - music, dancers, beer, cheering, singing. we sat with the womens team, who got into it louder than anyone.

i knew nothing about rugby (i learned lots from my friend, a former princeton womens rugger, during the game) and was sad that my friend and frisbee teammate, emma, was injured and not playing. regardless, i was quickly swept in. the last seconds of the game, uganda down by 2 fighting to get the ball down across the tri-line, and i was screaming as loud as the rest of them. sadly, it wasn't meant to be...uganda 3, morocco 5. the prediction was uganda 3, morocco 36.

i started learning the ugandan national anthem. kind of hard not to since it was sung multiple, multiple times. here's the lyrics:

oh uganda! may god uphold thee
we lay our future in thy hand
united, free
for liberty
together we'll always stand

oh uganda! the land of freedom
our love and labour we give
and with neighbors all
at our country's call
in peace and friendship we'll live

oh uganda! the land that feeds us
by sun and fertile soil grown
for our own dear land
we'll always stand:
the pearl of africa's crown
101paige 101africa

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Thursday, September 07, 2006

my Africa goggles

Some things I’ve stopped noticing after living in Africa for a while, such as (listed in no particular order):

  • “The parade of Africa,” a.k.a. the steady stream of people walking, riding, sitting, selling along every road in Uganda.
  • All of the guns. They look like toy wooden rifles, but don’t be fooled. They’re real and they work, mostly. Security guards have them, security guards are everywhere, therefore guns are everywhere. It’s not unusual to find the guard outside the shop he’s guarding, sleeping curled up with his gun.
  • Everyone is black (subtracting out the white development workers and the Indian businessmen, that is). A little different than MN.
  • The size, weight, and awkwardness of the various items women carry on their heads. They do it with such seeming ease that you forget that, sure enough, that woman is carrying 5 gallons of water…in a jerrican…on her head.

Things I haven’t stopped noticing, yet:

  • The potholes
  • The smells
  • The pollution (esp. air)

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field guide to east african birds

If you're living in East Africa, hands-down the birding book to get is the Helm Field Guides Series, Birds of East Africa by Terry Stevenson & John Fanshawe. It covers Kenya, Tanzania, Uganda, Rwanda, and Beware it's size, which makes it somewhat cumbersome to take along while traipsing through the forest. But don’t worry, its usefulness (i.e. good illustrations and accurate distribution maps of every bird imaginable in East Africa) quickly outweighs its heft.

Our trusty copy of the field guide has already served me well. With it I’ve now correctly identified the following birds from the last few weeks: the two woodland kingfishers playing in our pool, the black-and-white-casqued hornbills (misidentified earlier as trumpeter hornbills; as it turns out trumpeters aren't found in uganda) and great blue turacos on my recent drive to Masaka, and the crested (?) guineafowl and flock of 10 crested cranes I saw smack in the middle of Kampala city. 101paige 101africa 101ht

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Wednesday, September 06, 2006


so i'm back in the states now for a couple months playing ultimate with sub zero. jumping right in, five days after i got back i was out in santa cruz for the labor day tornament where we lost to seattle sockeye in semis. i've been bouncing around a little, but now i'm settled in and even got the cat back from CY and TY, who were generously taking care of him. thanks!

a coffee shop with free wireless is right across the street from my apt, and this morning i finally installed skype, which is a free program that allows you to make phone calls online. it's 100% free to talk to other computer skype users online, and costs something like 2.1 cents a minute to call land land lines or mobiles. not so bad.
so i fired it up and called paige, and the sound quality was perfect and it really couldn't have been easier. the pace of technology in the last ten years has been ridiculous. wasn't too long ago that i was psyched to get long distance for under 25 cents a minute. the world is getting so small and accessable.

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Monday, September 04, 2006

marriage, the cultural handrail

an excerpt from our wedding (fyi, yesterday was our 3 month anniversary):

"...there's no denying the fact that marriage ranks right up there with birth and death as one of the three biggies in the human safari. It's the only one, though, that we'll celebrate with a conscious awareness. Very few of you remember your arrival and even fewer will attend your own funeral. You pick a society, any society: Zuni, Nudembo , Pennsylvania Dutch. What's the one thing that they all have in common? Marriage. It's like a cultural handrail; it links folks to the past and guides them to the future."

(some of you may recognize this more accurately as an excerpt from a monologue by chris stevens, the clergyman and radio DJ of northern exposure fame)

i went to masaka with astrid on saturday to attend sister's daughter's wedding. no doubt - marriage is the cultural handrail. sure, we may be 1/2 way round the world, but the bride's still in white. it was a fun day - granted i was a little overwhelmed by all the sherbet green worn by the 11 bridesmaids, but i was relieved that astrid talked us out of having to sit in the "honorary" seats up front and eventually my butt did regain feeling after having gone numb from sitting in hard church pews for 3.5 hours (2 hour ceremony + 1.5 hour delay). and, since the entire ceremony was in luganda, i had lots of time to think about my own wedding...

one of the things i just cannot get over when remembering our wedding is knowing that everyone was there because of us. so many of our loved ones, all of these amazing one place...because of us. when else will that ever happen? this realization caught me by surprise during the ceremony. it gave me momentary stage fright, then i started to cry, then sethG saved me because he started talking about accepting money to get us to take our clothes off on stage. which reminds me, phil & i realized later that neither one of us remember anything from the first minutes of the ceremony. nothing, nothing at'all. the excitement, adrenaline, thrill wiped away all cognition except the feeling of being here doing this together. 101paige

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