Intervention…this is where we are at now. Some has been good, some has been frustrating, but all of it has been worth it. Some fears were confirmed, some stereotypes were reinforced, but on the whole, people were grateful for the time we took to share with them what we learned from interacting with their communities. There is a lack of education and information and some communities almost get stuck, unable to move forward because nothing has come along to challenge the status quo. When you present the problems you’ve found to people, they know. They want better. Holding it up to the light, bringing it to eye level…you can see the recognition in their faces. And you can see a guilty sense of grief in some of the faces because they know that they could be doing more, but have given in to the status quo. The challenges they face are real and significant, however, I truly believe that if you can strike a cord in just a few people who know deep down that they could do better, that a huge ripple effect is possible if they choose to take action.
All of the interventions we did were a direct result of the needs assessments we had conducted previously in each place. So we went to share with them our results from those meetings. The information that we had to share came from the mouths of their own community members.
First, we went back to the fishing village. We decided to have separate meetings with four groups: the fisherman, the mothers, the primary school children, and the youth not in school. I was present for the fishermen and the mothers. The fishermen are like a sub-culture within themselves. Once they are in from the water, it is common to engage with prostitutes, drugs and alcohol. Everyone likes to relax after a hard days (or night’s) work, but lets get real. This community has a much higher prevalence of HIV. If the nurse’s estimate was right, close to 30% of people are infected. Also, men like to go for the younger girls, thinking that they are innocent and don’t have HIV. Well, after they have their go with her, she is now infected. Most people don’t use protection and a lot of girls have their first child at about 16 to 17 years old. Then you have transmission from the mother to the child. Also, a lot of these fishermen have families outside of the village. After working for a length of time in the village, they return home. From one generation to the next. You can connect the dots. It is not the greatest legacy to leave behind you.
With both the fishermen and the mothers, one specific topic was a focal point: 50% of the children that we interviewed had witnessed sex in their community. It is no surprise that those children were more likely to go on and engage in sex at an earlier age. Of course experimenting with sex is a normal part of life. But experimenting in an environment such as this carries far greater consequences. A lot of the kids growing up here fail to think that there is life outside of the fishing village. Most do not get more than a primary school level of education. It is almost like people are just waiting around to die. The fishermen themselves said that they expect they might die every time they go out into the water. There is no planning for the future. That mindset, when shared on a village level is like a death sentence. However, I have to say…after talking bluntly with these groups of people, especially the mothers, you could see some people just hungry for this kind of talk. They wanted to learn more about what we had to share. Talking about sex, talking about HIV, cervical cancer, family planning and parenting, education…these topics seem like no brainers to a lot of us. We take a lot for granted. All in all, it was a successful visit and many people thanked us and said that when we come back, we will find their community in better condition.
Today we went to meet with Commercial Sex Workers on the Uganda/Congo border. This area is a perfect storm for prostitution: the border, the highway, businessmen, truckers, traders…there is a lot of movement and a lot of men coming through on a temporary basis.
There is an organized group of women that are all sex workers, so that is how we have been meeting with them. When we did our needs assessment, it became very clear that most of them had no idea what Cervical Cancer was…but they thought they did. About 50% of them were HIV positive and condom use was a problem. The majority of the women said that if they could find other work, they would leave the streets. They expressed interest in sewing or having a salon. They also said that they have no one to offer them support. So we brainstormed as a group. What could we offer these women for advice? We knew that we could give them useful information about Cervical Cancer, but what about the desire to start a business? We decided to think what they could do united as a group. If every member (around 70) saved 500 shillings a week (this is about 20 cents), they would have enough to buy a sewing machine in two months. One step at a time, they could grow.
We were a bit hesitant about the meeting in the first place. This group of women tends to be a bit feisty and are often looking for handouts of some kind. Every time we have visited them, they have asked for money. I am not saying this as a generalization of all sex workers all over the world. I am talking about this specific group of women and I have confirmed these suspicions with my own eyes and ears. Especially being a white person. They see you stepping into the room and they immediately think that you have money. With every suggestion that we had, they had an excuse for why it wouldn’t work. They did have a savings circle, but they only lend small amounts to individuals. They had never pooled their money and made an investment or a purchase as a group. I reminded them that they told us that they have no one to give them support and right now this group of women is their largest asset. No one is going to come along and solve their problems. It is up to them to solve their own problems. It sounds harsh, but it is true. There is this lack of planning for the future. It is as if every day stands alone and tomorrow is something that happens tomorrow. So, it was a frustrating meeting. I think that we did leave an impact. They at least got to learn about Cervical Cancer and, yes, we did give them some condoms. For free.
Another group did an intervention in a pastoralist community about disease transmission and risks involved when people live close to animals. This community deals with brucellosis, which comes from drinking raw milk. Of course if the animal is healthy and the milk is dealt with in a hygienic way, raw milk is fine. I drank raw goats milk until I was 13 and I only turned out a little weird. Anyways, they also have issues of rabies, anthrax and tuberculosis. I want to share one story that we heard, and this was through translation so I may have some of the details wrong. Apparently a cow had fallen sick and died. I think from tuberculosis or some other disease that infected the lungs. Well, the farmer buried it and then later someone from a neighboring village came and exhumed the body for the meat. To this day, those people have a persistent cough and are quite sick. Again, there is just a lack of understanding about these things. Some people sleep in the same room as their chickens. The animals just roam around the home and defecate wherever and it is common for people to go without shoes.
I want to end on a bright note. When my colleagues went to share our information with this community, they were well organized, showed up in large number and were eager to hear from us, eager to learn. If you don’t have access to information, how can you learn? All you can do is observe what is happening around you and draw the most well educated conclusions from what you are dealing with. They can’t just “Google it”.
So, my time here is almost done. We are going to start writing the final report. We head back to Kampala on Thursday and then I fly home on Sunday. How fast this month has gone. I don’t expect that I will write any more posts…access to internet is really hard to come by. That is why I made this post so long. Whoever is reading this, ‘thanks’. I hope I was able to hold your attention and share my experiences with you in a thoughtful way.