Friday, October 27, 2006

grand theft auto

in uganda car license plate numbers essentially replace VIN numbers for permanent car identification. for example, all offical records of our landcruiser refer to UAD 592H. not only is the license number on the plate but it's also etched into every removable piece of glass on the car. until tonight, i didn't know why. i'd heard about people's mirrors being stolen, but didn't think too much about it until last weekend when my driver side mirror was stolen while i was shopping in nakasero. then tonight on my way to dinner at the local sushi restaurant i got stuck in a traffic jam at the garden city roundabout. i am in the car surrounded by lots of other people in their cars, and some guy casually walks up and steals my passenger side mirror, too. while i am sitting right there in the car! i had enough time to yell "you f#%&er!" but that was it. turns out people etch all the glass on their car with the license plate number to prevent theft. go figure. i plan to etch away once i buy new mirrors.
101paige 101africa
another revelation is that the taxi drivers keep their cars on empty only partially because they don't have money to pay for gas. the bigger reason is to protect themselves against losing a bunch of gas to the gas siphoners making good business in the city.

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Thursday, October 26, 2006

uno to uganda

uno's spent the afternoon alternating between rubbing his face on my laptop screen and walking across its keyboard, and in doing so has effectively reminded me that i have yet to blog about him making his way to africa. this is uno's minnesota-to-uganda story, sort of like a rags-to-riches story but not really...

we'd debated back and forth for months on whether or not to bring uno to uganda, until i finally woke up one morning and knew there wasn't any other option than to have him here...with me...with us. uno's part of the family. for the cat people out there, you know what i'm talking about. (trish? chris?)

the hoop-jumping involved in making uno a real africat was extensive. if you're thinking of doing the same and want to get your cat into uganda, you'll need the following:
(1) veterinary import permit from the uganda ministry of agriculuture, animal industry and fisheries. write a letter to the commissioner on livestock health and entomology requesting permission to bring a cat in from the u.s. and a corresponding import permit; be sure to include breed, age, sex, color, name, vaccination status, and microchip # (if you don't have one, you should!). the commissioner's name is dr. wesonga wanderema, and the best way to get him is +256 (0)41 320376. (note: the ministry of ag is inconveniently located in entebbe, but dr. wesonga's pretty nice about arranging for delivery of the import permit to kampala.)
(2) current rabies vaccine, plus a rabies vaccination certificate signed by your veterinarian and certified by a USDA veterinarian
(3) blood test results of an approved laboratory indicating the neutralizing antibody titres achieved post-rabies vaccination
(4) clinical examination 48 hours prior to departure from the u.s.
(5) international veterinary health certificate completed by your vet and certified by a USDA vet
i also suggest bringing a current health record (showing all current vaccinations and internal/external parasite treatment) and duplicates of every document 1-5. remember, nothing in uganda is valid unless it's signed and stamped so don't hold back on that detail. considering my batting average for being turned away at the door for missing a minor detail (see this post and this) i went overboard on the details. there was no way my cat was going into quarantine because some document wasn't properly stamped.

there are all kinds of companies specializing in international pet relocation that cater to the career expats and are uber expensive ($thousands). doing it all myself cost $24 USDA services, $75 rabies titer, $60 pre-departure exam, $150 flight. i recommend the do-it-yourself route, but if you have the money to spend (or your employer's paying it for you) then more power to you.

uno and i flew on northwest/klm. uno made the weight cut-off for cabin carry-on for northwest (6.6 kilos), but didn't come close to klm's weight limit (4.5 kilos), which meant it was luggage check for him. i wasn't so sure i was comfortable with that, but decided i had the conviction and stubbornness to make anyone's life hell if they messed with my baby. so, with uno's adaptability and my fierce mother's instinct, i decided we could do it.

there's strict regulations on kennel make, shape, and size for animals that are checked as luggage. but, if you buy a kennel that's "airline approved" and fits your pet comfortably, you'll be fine. they inspect the kennel at the airport, but it's prefunctory and i imagine they'll approve most anything you can buy at petsmart. use this nifty guide to figure out the right kennel size for you and yours.

northwest has its "PriorityPet" program, of which the best feature is the hand-delivered confirmation to the owner that your pet has been safely loaded onto the plane. i took this feature seriously. i must have asked the steward 5 times if uno was on the plane before he finally brought me my confirmation note. i was able to relax MSP-AMS knowing that uno was safe on the plane, but switched quickly to panic mode once i landed at schiphol. my connection in amsterdam was supposed to be 1 hour, but i didn't de-plane until 20 min before my next flight (departure gate conveniently located on the opposite side of schiphol). i made it to the gate with enough time (delayed flight), but refused to board the plane until i saw uno with my own eyes get on the plane too. luckily the klm attendants have sympathies to match their looks and strikingly blue suits. they got on their walkie talkies, tracked uno down, and got a truck driver to promise he'd get uno to the plane on time. i waited and waited and waited. the gate area was empty and i had the unpleasant task of thinking about my options if uno didn't make the flight. thankfully, he arrived in the nick of time, i waited until they shut the luggage hold, then we were off to EBB. (i'd decided if he didn't arrive, i wasn't leaving. can you imagine me and uno stranded at schiphol airport? that would've been a sight.)

somehow when i arrived in entebbe, i was one of the last people to go thru immigration. i had all my documents ready (see list 1-5 above) and wanted to show them to someone, instead i just waited. uno got through immigration long before me and sat in baggage claim crying loud enough for the entire airport to hear (entebbe airport isn't all that big). people in the immigration line kept turning to me saying, "isn't that your cat?" waiting in that line tested my patience more than anything before as my heart broke every time he cried. but, then even worse...he stopped crying. for a l-o-n-g 20 minutes i had to rationalize that he'd been okay without food and water for 24 hours, that he'd just decided to stop meowing 'cos it wasn't getting him anywhere. finally, i got thru immigration, made it to his kennel, and he was good - i guess he was at the end of his patience, too.

we weren't allowed to leave the airport for a while because they were trying to track down the state veterinarian who would certify all my documents and legally allow us into the country. while waiting i let uno out of his kennel to stretch, explore, relax. he soon had an audience of 5 ugandan airport staff shocked by this crazy strange animal. "is that a dog?" no. "what is it?" it's a cat. "a cat?!? but, it's so big!" they wanted to pet him, pick him up, give him water, walk him around the airport by his leash. welcome to uganda, uno! eventually the airport workers gave up on getting the vet to the airport at such a late hour (10ish pm) and said we could just go on thru customs and go home. i was in shock. after all my work of getting all the documents, having them filled out in blue (not black!) ink and copiously stamped, and no one was even going to look at them?! uganda never ceases to astound.

our friend peter picked us up at the airport with his 6-year old daughter. similar to the airport workers, neither of them could get over that uno was a cat. he hardly made a peep the whole ride home, just sat on my lap, paws on the windowsill curiously looking out the window at his new habitat. not more than 5 minutes after walking in the door it was as if the last 24 hours had never happened. thank god for an adaptable cat with a short-term memory.

pets are a decidely expat thing in uganda since not too many ugandans have the money (or time) to add another stomach to the household. so, having a cat in uganda isn't cheap. the basic expenses:
- 5 kg bag o' litter = $12.
grocery store ordering and shipment schedules are pretty erratic here. one month they'll have a huge quantity of a particular item (e.g. litter), then once it sells out they won't stock it again for months. i'm waiting for another supply of litter to come into the country...i'm hoping it shows up soon otherwise i'm going to be borrowing sand from luc & majo next door.
- litter box = $28.
$28 for a small plastic bin that's no different than any other small plastic bin except that it has a fancy tag that says "litter box." nope, didn't buy it. i went and found the equivalent for $1.50. most anything plastic, electronic, or manufactured has to be imported, and since the expats are the ones interested, the prices balloon out of realistic proportions fast.
- 500g bag o' food = $6.
i found a brand that sells 1 kilo for $6, but then uno didn't eat for 3 days 'cos little did i know that he has a taste for the high-quality, high-cost stuff. i've since mixed the cheap and expensive, but he spends hours picking out the good stuff. crafty.
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no matter the expenses, though, it's worth it. for those of you who know us, you know how much uno means to us. for those of you who don't know us, you can check out the "uno anthology" - it'll give you a pretty good idea of uno and the bowens. uganda feels like home already, but now that the family (me, phil, uno) is back together it's even more so.

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Tuesday, October 24, 2006

driving independence

every time i get into my car, i'm reminded that i really live here. i've never lived in a foreign country long enough to own a car before. now i do, and i do. i'm no longer intimidated by the traffic or the drivers or the lefthand-side-of-the-road driving. in fact, i rather enjoy all that. understanding it all and knowing where i fit in makes me feel at home.

driving in kampala is kind of like playing a game of frogger. everyone's got a sense of self-preservation (excluding matatu, bus, and semi drivers), the potholes are always negotiable if you go slow enough, and drivers are accomodating to a certain degree. the traffic jams are horrific (it took a friend 2 hours to go 10 km the other day), but when you're in the thick of it you're also in the thick of living in kampala. i like that. 101africa 101paige

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i respect you coach

moving to uganda i expected to take some time off from ultimate - both as a player and as a coach. as it turns out i've done neither, and happily so.

coaching in uganda and coaching in the states are the two extremes. there i coached one of the best college women's teams in the country. each year we have a small incoming class of rookies (4-5) who learn the game fast because they're surrounded by returners (15), who are a core group of really smart, really experienced players. in nothing flat, we have a team of 20+ women who play the game like savvy veterans. here, the number of returners is 3-4 and the number of rookies is 30+. with such a skewed ratio of returners:rookies, there isn't anything flat about the learning curve here. add into the mix that each week we have at least 2-3 players who have never seen the game or thrown a frisbee, and you start to see the challenges of coaching ultimate in uganda.

i have to admit though, it's really fun. there's something about teaching people a game you love, especially when they're eager to learn. i love to teach, i love ultimate...i guess it's a natural fit to really enjoy coaching here. a new twist to the coaching scene that i'm not used to from home is being called "coach." it's my name on the field, off the field. the best part about it is they call phil coach, too. so when they ask me about how phil's doing and how his season is going (they're all rooting for sub zero at nationals this coming weekend), they say "hey coach, how's coach doing?" ha! always makes me laugh. my favorite coach story is emma yelling "i respect you coach!" over and over an entire night's worth of a party. i call this my i-respect-you-coach picture; it's of me and emma at said party.

the team's come a long way in the last 1-2 months. i'm really proud of them. just to name a few accomplishments over the last few weeks:

- we now play on a regulation size field. no more skinny fields with 10 yard endzones.

- people actually stand on the line or behind it for the pull. big difference from the 15 yards into the field standard that everyone used to be perfectly comfortable with. plus, the need for yelling cross field has been virtually eliminated now that most players accept the concept of raising an arm to indicate readiness to pull/receive the pull.

- players are learning a stack offense and the corresponding defensive strategies including a force and downfield defensive positioning. okay, we're still working on this one, but at least the concept is starting to catch on. in sunday's scrimmage, there were multiple people yelling "get into the stack!" whenever there was someone clogging a cutting lane. wow. that's a pretty big accomplishment for a team whose idea of cutting was to hang out in space, stationary, yelling for the disc.

- i've introduced weekly hour-long rules tutorials that everyone is really gung-ho about. i thought they'd be bored but au contraire. i suggested a week off to let the rules sink in, but nope. no break for them, they wanted to keep learning! the first week we discussed the field, pull, traveling, and stalling; the second week was fouls and picks (considering 50% of the players are current/former rugby players the fouls discussion was in high-demand by the non-ruggers). the rules tutorials come right on the heals of the upa's release of the proposed 11th edition rules, but i'm teaching the 10th edition here. first, it was easier to get 10th edition rulebooks for everyone. second, only a draft of the 11th edition is out so far so who knows what'll make it thru membership scrutiny and what won't. third, the final 11th edition rules aren't slated to come out for a while yet and we really needed to cover the rules here asap; for example, even though most of these guys have been playing ultimate for 5+ years not a one of them could answer the question: what's the pull?
(two weeks ago we talked about strips. a "strip" is no longer a call in the draft 11th edition rules - strips are now treated like fouls. i guess no harm done though since they all got a kick out of yelling at someone to strip.)
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- we are now meeting 1/2 - 1 hour earlier than when i first arrived so everyone can get in quality throwing (30 min) before we drill (45-60 min), which still leaves us a full hour to play a real scrimmage. everyone's really getting into the drills...so far we've done santa cruz, box drill (aka cornell), 3-person marking drill, a stack throwing/cutting drill (with/without d), flygirl (syzygys, you know what i'm talking about), straight-on drill, straight-on drill with angled modification. a lot of drills in a short amount of time, but they want more...yesterday a group of us went to a beach on lake victoria for the eid holiday. throwing, running around, flutterguts, then it wasn't long before emma asked, "coach, can we do a drill?"

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Monday, October 23, 2006

Last King of Scotland

i saw the last king of scotland the other day. i'm not really a reviewer but i think you should see it. forest whitaker will win the oscar for leading actor, and for the most part it's often worth watching oscar-winning movies.

the last king of scotland is historical fiction about idi amin and his rule over uganda in the 1970's. a lot (most? all?) of it was shot in uganda and it was totally a thrill to see kampala and the countryside. i wanted to brag to everyone in the theatre that i live there. i heard an interview with forest on NPR, and he told an interesting story about shooting scenes of amin giving a political speech to villagers out in the country. apparantly there were some villagers who were wondering why amin was giving the same speech over and over (answer: multiple shoots of the same scene). they were extras who had been paid to be in the crowd. they thought forest was really amin. getting paid to show up to a political speech back in the day wasn't out of the ordinary, and they didn't know that amin was dead. when told that amin was really an actor from LA, they said no, that is really amin. forest is that good. his accent is ridiculous.

anway. the scottish doctor who is the other starring role was a little annoying. i liked his character better in the book. and they put more sex in than i think there needed to be, but what are you going to do with hollywood?
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watching the movie made me really miss uganda. it has an attraction to me that i can't really explain. it took no time at all for me to think of it as home. on paper, nothing about uganda really matches who i am or what i've done with my life up to this point. but there it is; it just feels right. this is sort of random, but i have a similar relationship to sailing. i am totally happy riding the rail and staring at the water for hours and i'm not sure why. both my brothers have sailed and raced internationally, extensively, at times fanatically. i have sailed minimally, but i know that i could be totally content setting off around the world. uganda seems to have that same unexplainable pull.

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Saturday, October 21, 2006

life is life no matter where you are

you'd think that moving to africa would be a whole new world, and it is on a certain level. there's new sights, new sounds, new people, new culture. but, really it's all the same. no matter where you are you need a place to live, a way to make money, friends to care about, hobbies to entertain yourself, food in your tummy. here, there, wherever, the basic needs don't change. i think that's what's most surprised me about africa...that it's not really different. life is life here, just like anywhere else.101paige 101africa

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Friday, October 13, 2006

you are welcome our visitors

i visited an orphanage just outside kampala today that serves children orphaned by HIV/AIDS. the public health term for AIDS orphans is "orphans and vulnerable children" (OVC). OVC encompasses children orphaned by other causes, too - famine, conflict, accident/injury - but in its most common application it refers to children who lost one or both of their parents to AIDS.
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the orphanage is run by new hope for africa, a local community-based organization. it serves over 300 children in the community feeding them breakfast (porridge made from maize flour and water) and lunch (dried porridge from breakfast + potatoes and meat), teaching them for free (a big deal since it costs money to go to school here, even public school), taking them to the hospital when they are sick and paying for their medical bills, and giving those without a home a place to live.

i visited the site because i am considering partnering with new hope for africa on an OVC project funded by PEPFAR (the president's emergency plan for AIDS relief), which is a huge pot of money set aside by president bush to fight AIDS worldwide. this is me admitting that bush has done at least 1 thing right over the last 6 years.

anyway, the field visit. i was impressed from the word go. annet (the director of new hope for africa) is a real go-getter. she has single-handedly built this orphanage from the ground up, almost all with her own money. the site now includes bamboo classrooms for grades pre-school through 6th, a soon-to-be-finished medical center that currently doubles as rudimentary dorms for the homeless kids, latrines, electricity, a small soccer pitch, chicken coops, and pig pens.

i met all of the children, from the little little ones (3-4 years old) to the big'uns (early teens), as i went from classroom to classroom. (classroom is used here to refer to a group of children in school, don't let it be confused with a physical structure. in fact, the physical classrooms were simple temporary structures made from bamboo and corrugated tin, each grade level only separated by a woven stand of bamboo.) the school is divided according to grade level rather than age since a direct course of education is often broken up in uganda by poverty, illness, the death of a parent. it's not uncommon to find a 10-year-old in 2nd grade because he missed several years of schooling somewhere along the line. every class i met today greeted me by standing up and reciting "you are welcome our visitors." i responded in my broken luganda, which got many laughs, then quizzed them on what they were learning that day by peeking at the chalkboard. mathematics for money, multiplication of reciprocals, roles of mothers and fathers in the family, influence of arabs on east africa. not surprisingly, they all scrambled to show off their new knowledge to the visiting mzungu. i taught them a new congratulatory clap i learned from one of the frisbee guys, and soon i was greeted by the same clapping pattern in each new classroom i entered.

annet and i brainstormed all the ways to join forces between new hope for africa and "minnesota" (the colloquial name for MIHV). finish construction of the medical center, drill a borehole for water, supply the clinic with medical supplies and equipment (xray, ultrasound), build dormitories and permanent classrooms, get school supplies (textbooks, desks, notebooks, pens...computers). on the public health side, provide immunizations, voluntary counseling and testing for HIV/AIDS, vocational training, education on prevention of HIV and healthy living for those living with HIV/AIDS, nutrition retreats for caretakers, training for AIDS counselors. plus, we had grand plans of creating a long-term voluntary medical service that included a clinic manager, physicians, nurses, dentists. our dream list just kept going and going. there is something very rejuvenating about dreaming.

it was inspiring to see what annet was able to accomplish when she believed in something, and today gave me a much needed reminder of why i am where i am doing what i do.

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Thursday, October 12, 2006

the bureaucratic headache

i'd allowed myself to be lulled into complacency, ignorance, acceptance. i was spoiled. for over a month i have not had to deal with any government agency (other than the ministry of health) directly for any kind of service. then, today i was thrown back into the deep end. today i had to apply for my work permit - without one i cannot legally stay in uganda, so i knew i had to bite the bullet. my accountant/field administrator/go-to-guy (michael) has been working on my work permit for over a month now. finally, after 10 trips to immigration by him, multiple application forms completed and documents gathered by me, we thought we had everything we needed. little did we know. what was missing? my criminal record. that's right, my criminal record.

my day then became the following: immigration office to NGO board to u.s. embassy to office to u.s. embassy to NGO board to photocopier to NGO board to immigration office. a 30-minute process turned into a 5+ hour wild goose chase all over kampala.

an application for a work permit requires any number of things, including: 2 passport-sized photos (of course!), CV, academic qualifications, appointment letter, income tax clearance, annual report, audits, proof of failure to employ a ugandan...oh yeah, and a criminal record. but, the most mundane requirement is a file folder. yep, you have to supply your own file folder so the immigration office can file your application. not surprisingly a little cottage industry has developed right outside the immigration offices selling file folders. women sitting on mats on the ground selling stacks and stacks of file folders.

we get our file folder, but still no criminal record. how do you get a criminal record in uganda? simple. you write up a statement on company letterhead that says "i, (insert your name), swear under oath that i have no criminal record." then the consul at the u.s. embassy puts you under oath (contrary to the movies there is no bible), watches you sign the document, and attaches a cover sheet notarizing the statement with the seal of the u.s. embassy. no looking up of a record, no nothing, they just take you on your good word. of course it has to be stamped...uganda is really big on stamps.

criminal record in hand, we naively return thinking we've done it all when we're blindsided by the assistant secretary to the NGO board, who had randomly sent us off to get the criminal record in the first place.

her: i need photocopies of all these documents for my files.
me: why didn't you tell us that when we were here before?
her: i am telling you now.
me: but, if you'd told us before, we could've come with the photocopies already.
her: hmm...well... how did you know you'd have the right documents? i couldn't tell you before.
me: but, you saw all the documents we had and you said they were all fine except the one we were missing. so you could've told us before.
her: well, i am telling you now.

ooohhh, i was irked. but what could we do but go photocopy? lucky for us there was a photocopy machine close by that had paper and power. the power is key 'cos (1) photocopiers need power (duh), and (2) there's hardly ever power. so, we got uber lucky. granted the photocopier only copied one page at a time (and we had something like 50 pages of documents), but at least it copied.

finally, we have it all. they accept the documents, they will work on my permit, they'll get back to and then...the real kicker...the immigration office keeps my passport. blech.

a dutch friend commiserated with me tonight, saying "opening a bank account, buying a car, getting a TIN (personal tax ID), getting a work permit, paying taxes." my list exactly. multiple hoops to jump through, lots of waiting, and overkill on the documentation. beware of doing government business in uganda.

i don't mean to whine or to sound bitter, but i really did start to question people's motivations today. what is the point if when we finally get and do everything we're told, you simply toss the file aside without looking at it while saying "fine, come back in a week." michael decided that it was worker dissatisfaction. i might agree with him. where is the motivation, where is the supervision to keep these workers going enthusiastically when they're holed up in cement offices with cracking paint, broken wooden desks, missing filing cabinets, no electricity? all they do all day is stamp, stamp, stamp and deal with disgruntled customers. the government top to bottom is plagued by lack of funds, corruption, and nepotism. what is this one worker going to do to change that?
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the bright spot of the day is that michael got to go to america. yep, he stepped on u.s. soil at the embassy. i said "welcome to america," and he asked "is this what america looks like?"

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i have a gecko on my arm and cockroaches in my kitchen

one of the perks of living in africa: when it rains all the little creatures come out to play. okay, so the geckos are around all the time (on the walls, on the ceilings), but after yesterday's afternoon downpour i was plagued by more cockroaches than i could count. and, they were gi-normous. the evening started out inocuously enough. i was laying on the couch watching the gilmore girls when i felt something whisk my arm. figured it was uno. nope. it was a gecko...on my arm. i'm sure i made some sort of girlish sound (more surprise than fear) before swiping it onto the floor. where was uno? asleep on my desk chair. he managed to lift his head to look at the gecko, then he complacently fell back asleep. my trust in my cat's hunting skills were momentarily diminished. then, i went to the kitchen for a glass of water, and what did i find? not less than 5 cockroaches scurrying around like they owned the place. yuck. no doubt, lots of girlish sounds (ok, screams) came out of me as i chased them around trying to kill them. there's just something about cockroaches that really bugs me. double yuck.
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i've heard many cat owners talk about finding a dead mouse or dead bird on their back porch that has been placed there as a "gift" by their dutiful hunter-cats. well, my faith in uno as a hunter was restored this morning when i woke up to find 2 huge dead cockroaches laying next to my bed with uno standing proudly next to them. yep, i'm going to encourage a repeat of that behavior.

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Thursday, October 05, 2006

favorite, least favorite

a friend asked me today what my favorite and least favorite things were about living in uganda. my response...
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favorite: working in a position that actually matters both within the organization and within the community.

least favorite: the culture of dependence created by the international aid community.

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africa is different: FP in uganda

i attended an all-day workshop today hosted by the ministry of health and family health international (FHI) re: community reproductive health worker (CReHW) provision of family planning methods in uganda. in 2004, FHI partnered with the ministry and save the children to conduct research on a pilot program in nakasongola district that trained CReHWs in community-based distribution (CBD) of depo-provera. what does this mean? it means that women and men who lived in the community and who didn't necessarily have any medical background were recruited by save the children to work as CReHWs, and as such underwent a 21-day training on STDs, HIV/AIDS, reproductive health, and family planning. once trained the CReHWs worked within the community educating men and women on the above topics, providing basic family planning methods (pills, condoms), and referring clients to local health facilities for reproductive health services. (sound familiar? yes, it is very similar to MIHV's family planning community health worker program described in this post.)

the idea of CReHWs isn't novel (community health workers are used all over in public health, both stateside and overseas). what is novel is the addition of another, separate 21-day training exclusively on community-based distribution of depo-provera. if you don't know what depo-provera (aka DMPA or NET-EN) is, it's an injectable contraceptive containing progestin, which is one of the hormones found in combined oral contraceptives (the pill), and prevents pregnancy using pretty much the same mechanism as the pill. in a nutshell, a CBD program for depo means that we are training non-medical providers to provide an injection. i highly doubt that would fly in the U.S. as far as i know, there is a very strict regiment in the U.S. that regulates who in the medical hierarchy can give injections. but, here it's different. there has been CBD of depo in bangladesh since the 1970s, it's been available in parts of latin america since the 1990s, and it's been in africa (specifically uganda) since 2004.

why is africa different?

at first glance, one might question the medical wherewithal of allowing a non-medically trained individual to give injections. but, as research shows, these paraprofessionals actually achieve comparable outcomes to the medical professionals in numbers of satisfied clients, percentages of clients who experience side effects associated with the DMPA, and percentages of clients who suffer from injection site problems (e.g. abscess, infection). to be honest, when it comes down to it, you have to be creative in the delivery of care and services when you live in a country whose health infrastructure is at times non-existant. no, i cannot imagine my neighbor walking into my house in the U.S. and giving me an injection, but i also cannot imagine having to walk 25 km to get to the nearest clinic or doctor or nurse.

in my earlier post i talked about "why family planning," but i didn't put family planning specifically into the context of uganda. so, what's the picture in uganda?

- the infant mortality rate (IMR) in uganda is 97. IMR is conventionally defined as the number of deaths <1 year of age in a defined time period per 1,000 live-births during the same time period. as reference, the IMR in the U.S. is about 6 (i say "about" because the IMR fluctuates based on region, race, ethnicity, socioeconomic status, etc).

- the maternal mortality rate (MMR) is 506, which means that 506 women die due to complications of pregnancy and/or delivery for every 100,000 live-births. again, as reference, the MMR in the U.S. is 9.8 (it drops to 7.5 for white women and spikes to 22 for black women...but, that's a topic for another time).
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- the total fertility rate (TFR) in uganda is 6.9. in other words, the average ugandan woman gives birth to 7 children in her lifetime. at today's workshop a man from nakasongola district shared that he and his wife opted for family planning because they'd had trouble spacing their children...they had 5 children in 6 years.

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