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.