Luwero Field Visit

Apologies for the silence! All my plans for updating my website and writing about my field visit were foiled by excessive amounts of food, Season 5 of Homeland (read: Taylor Swift movie), and Baby Robert.
 
I’m back in Kampala after a few great weeks at home in California. I felt sort of like I did around Thanksgiving Break freshman year of college. I was excited to return to the comfort and familiarity of home. By comfort, I don’t really even mean unlimited wifi, going places alone in the dark, or stable electricity. I was most looking forward to seeing people that I knew and knew me – making friends is exhausting!
 
The two weeks before traveling home were busy with launching a large data collection exercise for both our Early Infant Diagnosis (EID) and Provider-Initiated Testing and Counseling (PITC) projects. I helped develop a training where we explained the processes and excel templates that we had created. The goal of this exercise (still ongoing) is to collect data on infant and pediatric volumes, testing rates, yields, entry points, and more at select facilities across the country. This data will serve as the baseline that we’ll measure our progress against over the next 3 years (on a quarterly basis). Having just come from a Deloitte project where I was in charge of helping with the cost baselining for a large separation, I’m feeling comfortable with why we’re collecting this data and how we’ll use it. I’ll be in charge of developing a dashboard where we can look at the data dynamically to pull out trends, identify areas where there are some quick wins, and ultimately define the indicators (essentially metrics) that we’ll set in stone to measure against. Most of these we’ve already defined since we needed to understand what data we wanted, but we’ll need to be flexible given the quality / availability of data.
 
I set off to Luwero with two data collectors, Jennifer and Daisy, and our driver, Lastone. We were one of nine teams that traveled between one to six hours to reach health care facilities around the country. With the “jam” (traffic), the 50 mile drive north took between 1.5 – 3 hours. The drive was relaxing and the roads were great (I got lucky with my placement) so in between my naps, I enjoyed the scenery and getting outside the city for the first time.  

Usual Kampala traffic

Excited to be headed home after a long day of work

Main road to Luwero

The set up in Luwero is almost like a community center with a large courtyard. There is a water pump just inside the entrance so lots of children and young adults passed through all day long to fill up jugs of water. Daisy told me that people are willing to travel quite a distance by boda, bicycle, or on foot to get this water because you can drink it. She didn’t recommend that I drink it, but says for locals, it’s fine. There were several cows (see selfie) and chicken roaming around. Apparently they will always return home since that’s where they’re fed, so owners just let them graze during the days.

Both the drivers and data collectors seem to have experience working with CHAI on a fairly regular basis. Even though I was technically there “overseeing” the data collection, both Jennifer and Daisy had experience visiting sites, obtaining registers, and interpreting the data (why there might be gaps, when missing data could be recorded elsewhere, etc.). Sure, I knew the excel templates inside and out, but I had no idea how to even find the main office at the facility where we were supposed to announce our arrival to the “in-charge.” I think the MoH alerted the facilities that we were coming, but communication channels aren’t always smooth so we made sure to introduce ourselves and explain why we were here to collect data.

As you might imagine, all the record keeping is done by hand in these large books called “registers.” The registers are provided by the MoH and there is an extremely lengthy instruction manual that details what should go in each field of EVERY register. It’s a really comprehensive document that is honestly better than most “how-to” guides on process / documentation I’ve seen. We spent our days sitting in the records room with Sister Kathy who was in charge of all documentation at the facility. Just going through the Outpatient Registers took the three of us just over two full days to complete. Luwero is a Health Center IV and had about 40,000 outpatient visits in 2015!! I think this is a lot for a Health Center IV which is the categorization just under a hospital. I’m not sure if this is still accurate as it’s from 2009 – but this Guardian article explains some of the different types of facilities in Uganda.
 
We were only focused on recording data about pediatrics, but from reading through the different diagnoses in all the outpatient registers, the most common reason people were coming to seek treatment was for malaria and (upper) respiratory tract infections.
 
It was interesting to see how the facility was setting goals and tracking progress on their own through hand-drawn charts. I was told that Luwero won an end of year party for being one of the top facilities in the district or country, so I don’t think this is common at the facility-level. It seems that accountability and goal setting tends to be done by the MoH or even more often organizations like CHAI and other IPs who are held accountable to their donors / funders.

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On the way back, we stopped by a few roadside stands to buy fruit. For smaller fruit (oranges, passion fruits) vendors tend to sell them by the “hip” – which is a measurement equal to a little basket. I only really wanted two passion fruits but ended up with about 15, which cost me just under two bucks. Then, we drove by some meat and fish vendors selling all sorts of fried goodness. It smelled delicious and I REALLY wanted to have fried chicken and chips (fries), but I had just gotten over a stomach bug earlier that week so felt it was better to play it safe, especially with long flights in my not so distant future. This stomach bug is also the reason I will continue to take my malaria medication for the duration of my trip. On a scale of 1 to Nicaragua-food-and-water-poisoning I was not even a blip on the radar, but a few people scared me by asking me if I had any malaria symptoms (feeling weak, fever). I didn’t, but even the thought of getting malaria after forgetting a few malaria pills made me realize that since I don’t experience any side effects and I already have all the meds, I may as well just take them. Most expats I’ve met aren’t taking malaria medication unless they’re doing more remote travel (like gorilla trekking) since it’s apparently not great for your body and it only reduces your risk of getting malaria anyways. Did you know, though, that if you have malaria you can never give blood? I’ve never donated blood because I’m too small, but in the event of a family member / friend needing  a blood transfusion, having had malaria makes you ineligible. Okay…enough of that tangent…
 
Getting to go on a field visit was extremely helpful in understanding the context and day-to-day of health workers in Uganda. It was also fun getting to know a few Ugandans outside the office. After a few hours together, Daisy told me “you’re not like other muzungus,” which I took as a big compliment. I asked her why and she said that compared to other muzungus she’s interacted or worked with, I was more relaxed and joked around with them. I think this is due in large part to how easy I’ve found it to get to know, relate to, and socialize with all the Ugandan people that I’ve met. “Muzungu” is the Lugandan word for white people – a coworker explained that this would include Asians but not Indians (maybe because there are so many Indian Ugandans) and exclude black expats.
 
I am eager to take advantage of similar opportunities in the coming months, even if it means my eyes will go blurry from inputting data all day. I guess the life of a BA is never truly that far away…

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