We have had another very good week at work and feel very fortunate to have been given the chance to work with such a great organisation and really inspirational people. I have spent some time with the nursing team at meetings, and also reading up about the basics of HIV/AIDS care so that I can talk the language and understand the different regimes. TB is very common among people with HIV/ AIDS and much more serious than in others. Although many people live very positively with HIV/ AIDS, there are always a number of clients at the clinic who are clearly very weak, and also some who are too ill to come and are visited by the nurses at home. There are some mattresses on the floor of the clinic where people can sleep and they always seem occupied. Clients often have to wait a long time to be seen and then wait for their drugs from pharmacy. However, many seem happy and they get lunch provided, and they are treated very warmly and compassionately. Clients are encouraged to join in our yoga and reflection and the area used for this had been moved closer to the client waiting area to encourage them to take part. I was at a meeting of clinicians looking at draft Standing Operational Procedures and once they are finalised I will help to correct grammar etc.
I met with the research officer who is leaving and she has handed over projects and other work. I also have to look after students, who seem to write proposals to carry out studies at Reach Out but don’t tell Reach Out until a few days before they are planning to start. In the UK researchers need honorary contracts, and to undergo disclosure checks etc, but here things are more relaxed. However, there is an ethics procedures which can be quite complicated so I haven’t escaped from that. So it looks busy. I spoke to the Executive Director Dr Stella and it looks as if I will be doing two evaluations. One is the Prevention of Mother to Child Transmission Programme, which is very well organised and uses mother – to – mother support using mothers who are HIV + who have gone through the Programme to support other women. Their adherence rates are high and transmission rates low compared to other programmes. Although the guidelines seem straightforward, the stigma associated with disclosing being HIV +ve are enormous so women are worried about people finding out they are on the programme, and also while in the developed world, HIV +ve mothers would not breast feed, in Africa the risks associated with bottlefeeding outweigh the risks of transmitting the virus, and few women could afford formula anyway. There is PMTCT team comprising members of the counselling team, members of the team who support clients to adhere to their complicated drug regimes, and the mother-to–mother health workers who are part of a bigger team who support all clients by home visiting. The whole set-up is amazing and very low-cost apart from the drugs.
On Tuesday evening we went to a VSO cluster meeting for all the volunteers in Kampala, 18 out of 29 came along for a good evening in an Indian restaurant. We saw some of the people we arrived with, and also two who we knew from a course in Birmingham. Most folk seemed very happy and settled. A good bit of the business was discussing the emergency procedures for alerting volunteers in times of trouble and their movement to safe houses.
Reach Out had a visit this week from Canadian donors, the Kenny Family Foundation, which was set up by Peter Kenny, who came with his son Paul. They support many good causes, and have been impressed (as we have been) by the executive director of Reach Out, Stella. We were supposed to go to have dinner with them at Stella’s but unfortunately Stella and her family were unwell so we had lunch in to an Irish pub with Peter and Paul instead. In terms of attracting funding, success certainly breeds success, and Reach Out does seem well resourced and has funding from a variety of sources. Bobby is playing golf with Peter on Sunday, the first time since he broke his elbow, so he may have more of a handicap than usual. It is slightly strange to come to do VSO in Africa and spend time with very rich people, but they are good company and they were keen to get our perspectives on Reach Out, although it is early days for us.
We were at a management meeting yesterday which was interesting. Like all meetings it started and ended with a prayer, and people treated one another with great respect, even when the debate got a little heated. Ugandans have a great sense of humour, and don’t take themselves too seriously (so like Glaswegians) so there are always plenty of light moments. The laboratories had been evaluated by an external evaluator and there was discussion about addressing some of the recommendations, such as maintaining the fridge temperature when having frequent power cuts and periods when the power is very low. The labs in each of the three sites are tiny, squashed into a corner of the clinic area, and they do all their own HIV| and TB testing, liver function tests etc. In the afternoon representatives from a large travel firm came to hand over a cheque for money they had raised by an art exhibition and we had a great band and dancing and a drama by clients. Ugandans seem to be intrinsically musical and all sing and dance at the slightest excuse, they are also heavily into drama. Some of the money is going to be spent improving the tailoring workshop which provides training and employment for clients, some of whom go on to set up their own businesses using the microfinance loan scheme. One of the women who is employed in the workshop spoke very well about how the scheme had helped her, people are generally very articulate though their written skills are not so good. Reach Out also run adult literacy classes to help clients read and write and to improve their English (every facet of clients’ lives is taken care of it seems).
We have had several power cuts in the evening for up to three hours. Bobby plays his fiddle and I read by torchlight and can cook dinner on our two gas rings. So far we have had no water cuts, nor do we have any problems with cockroaches, have few mosquitoes and we have had electricity in the mornings, so I get my kettle of hot water for a shower. So really it’s quite civilised really, our ideas of mod cons have changed very quickly.
WHO published a report this week which showed that diarrhoeal illnesses can be cut by 40% by encouraging hand-washing. One morning this week, after the yoga and prayers one of the Reach Out staff did a very funny short session encouraging staff to use the tippy taps at Reach Out. It all seemed timely, as I have found it difficult to live with the lack of water at work. There is one sink with cold water in the clinic which can only be used by clinic staff, and a tippy tap, outside the toilets, consisting of a container with a hole which operates by standing on a wooden plank attached to the container by a string which tips up the
container and provides a stream of water. Given, that in the spirit of Reach Out, staff and the clients from the slums of Kamala share the same squat toilets, and that there are lots of unpleasant diseases and worms, I go through alcohol hand gel at a fair rate and am relieved to find that it is available here. We also go to a nearby nice coffee shop at lunchtime for both the coffee and to use the facilities. Only 7.5% of households in Kampala are linked to a sewage system and the Government are going to borrow money to increase this percentage to 15%.
