Posts Tagged ‘development’

Health Care in Uganda – Problems determined, solutions unknown

Wednesday, January 12th, 2011

The health care system in Uganda is overrun with problems.  As a community health volunteer for Peace Corps, I have been working with a Health Center II (a basic-services clinic) and have been assessing the state of health care here in Uganda.

While government health care is intended to be free, there are so many hidden costs that patients are often still unable to afford health care.  The government provides free drugs and care, but when those drugs run out (which is all-too-often), the patients are responsible for going to a private drug shop and buying their medicines.  Women who want to deliver at a government health center are often required to bring their own “mother kit”, a set of supplies which can include such things as cotton, gloves, needles, etc.  At our small Health Center II, we have no capability of running tests such as urinalysis, blood smears for malaria, or even taking blood pressure, and often have to refer patients to either a larger government health center or a private clinic for the care they need.  Many people cannot afford even 4,000 Ugandan shillings roundtrip (less than $2) to the Health Center III, a few kilometers away, for testing or maternal care, let alone a trip to a private clinic where all costs are out-of-pocket.  Some of our patients walk several miles to get to our clinic.

Malaria is one of the leading causes of morbidity and mortality, and is severely over-diagnosed.  Practically everyone with a fever is given anti-malarial drugs, and subsequently health centers often run out of the drugs before the next shipment arrives from the government.  The cost of these drugs in a private drug shop can be 15,000/- (about $7), which is too expensive for the average rural Ugandan.  The nurses at the health centers have little choice when they have no way to test for malaria before dispensing drugs – if the patient does have malaria and is not treated, he or she could die.  Better to be safe than sorry, but being safe in this situation causes its own host of problems.

There is also a big problem with motivation among health workers.  Salaries are very low, and some workers feel no obligation to give good ‘customer service’, which is a huge concern in privatized health care systems such as the U.S.  Health workers often show up whenever they feel like it, and leave the clinic hours before the official closing time, leaving some patients to wait for hours to be seen.  A small aspect of this stems from the culture where family comes first – if the nurse has to harvest millet or help a family member out, they don’t see a big problem in staying home.

So what, as a Peace Corps Volunteer (PCV), can I do?  It’s a difficult question to answer – if there were an easy fix, Uganda would have great health care.  PCVs don’t come with any funding or external assistance, we come to act as change agents and co-facilitators to mobilize local resources and work with what is already available.  While it’s difficult to make system-wide changes or improve facilities and equipment without funding, I am working to encourage healthy behaviors, build capacity among health workers, and provide people with the knowledge they need to keep themselves and their families happy.  Another PCV I know is working at the district health office, so he can encourage health officials to improve efficiency and make positive changes in the health care system.  These are small steps, not a big NGO project with millions of dollars backing it, but these small steps are (hopefully) sustainable, using local resources and requiring the community to get involved to make changes in their own lives.

Tuesday Talks: Young People can innovate for health too!

Tuesday, November 16th, 2010

Our key stakeholders in the United States are young people and students at universities. More often than not, business leaders, non-profit directors, politicians, and other “experts” don’t think that young people have much to contribute in the way of new ideas of skills to improve or make a difference on global health issues. This video was chosen today because it is an excellent example of how young people are entering into development projects with an open mind, understanding of community control over projects, and the limitations of their work. These students from Harvard present an excellent idea adapted from a Western development project to improve the health and nutrition of people in Kibera slum of Nairobi, Kenya.

The video is very quiet, turn up the volume and listen closely.

The world isn’t flat, health disparities persist

Monday, November 1st, 2010

Health has long been a gift that we have attempted to give to the rest of the world. Disease eradication programs, vaccination outreach campaigns, and the Western biomedical system have all been spread to countries near and far. These gifts were often colonialist in design, given without community consent, and without regard to culture or custom. Contrary to Thomas Friedman‘s thoughts, the world is not flat. Rather we live in a world that is increasingly connected by technology, but still remains sharply separated by those who have and those who don’t.

When it comes to global health, we no longer have the luxury of saying, “those people over there have health issues.” There is no simple separation between “us” and “them.” Health problems aren’t over there any more than they are right here. In the US, lifestyle choices contribute to heart disease, diabetes, obesity, and lung cancer. When we talk of disparities in access health in other parts of the world, we cannot forget the glaring health disparities in US inner cities and across communities of color.

The curtain has been lifted and hopefully we have looked in the mirror to see that we too have health issues in our country. While the ideas to make health better have long come from the West and developed countries, that paradigm is no longer applicable to global health today. Our world is still expansive, but we are more connected than ever before. With the internet at our finger tips and friends across the ocean only a skype call away, solutions in global health come from around the world. The past demonstrated that “developed” countries believed they were giving something valuable to those who didn’t have what they had. The result was a plethora of failed aid goals, missing life-saving medications, and decrepit health care systems.

Innovations for better health come from all around the world. It is no longer the “developed” giving ideas to the “developing.” The increasing use of mobile phones have inspired some exciting programs for health records management while SMS and texting have led to revolutions in access to health knowledge and care. However, it isn’t always technology ideas that are most effective. Developing countries have reminded us how important and critical health insurance can be, while at the same time demonstrating the severe need for more trained health care workers. Models that train community health workers, access micro-health insurance on your mobile phone, and social enterprises that provide ambulance emergency services have all been launched in “developing” countries. I can only hope that our health care system can take the time to look around the world for ways to improve.

For many years, complex issues in international development and global health have been tackled by simplified single-issue campaigns that have created short-term “band-aid” solutions. This can be attributed to the limited view most Americans have of the world. For many, issues of global health remain remote and abstract. We, young people, have grown up with the internet in our laps, basic knowledge of different cultures around the world in our classrooms, access to easier communications and travel, and more opportunities to study abroad and participate in global exchanges. These factors have made the world seem more connected, and have bestowed upon us the capability to serve as the key drivers of social change.

We must bridge the divide between rich and poor, privileged and oppressed, developed and developing. We, as privileged young people, can be the voice that changes the actions of our largest institutions to focus on programs that work, projects that benefit people in need, and efforts to build healthier communities.

Reposted from the Blog of Americans for Informed Democracy, where I am writing as a Global Health Issue Analyst.

The Role of Volunteers in Development

Tuesday, October 5th, 2010

As a Peace Corps Trainee in Uganda, I have learned a great deal during the 10-week training period about topics from language (I’m learning Runyankore-Rukiga, but there are 7 other languages being taught to other Trainees), cross-cultural issues, income generating activities, community health, agrobusiness, water and sanitation, etc. However, no matter which topic we are discussing, it is all based on the Peace Corps’ approach to development, which is a grassroots, assets-based (rather than problem-based) approach. Essentially, as Peace Corps Volunteers (PCVs), our role is to act as change agents and co-facilitators to help communities realize the resources they already have to change their lives. The idea is to break the traditional cycle of dependency on outside aid for development to happen, and to empower people to stop thinking of themselves as ‘poor and helpless’, as the Western world has so often labeled them, but rather to believe that they have control over their own lives. We are here to share skills and ideas, and to motivate people to use what they do have rather than thinking about what they don’t.

However, this approach is not without difficulty. Since so many NGOs and short-term volunteers have already been working here in Uganda, and indeed throughout Africa and the rest of the developing world, many Ugandan communities have come to expect that a muzungu (foreigner or white person) brings money and outside resources. While monetary aid does have its place in certain contexts, this dependency on resources that come from outside the community is unsustainable and discourages people to rely on themselves and take charge of their own development. While the problem exists all across Uganda, I have heard PCVs serving in Northern Uganda complain of the “war tourism” occurring there as short-term volunteers and tourists flood the region in the wake of the devastation caused by the Lord’s Resistance Army (LRA). The existence of war tourism makes their job as PCVs much more difficult because of the expectancy that the muzungu will come, build a school or make a donation, and then leave, while the PCV comes for two years with motivation and skills but no funding to speak of.

My purpose is not to bash foreign aid, more traditional development work, or short-term volunteers (indeed, most PCVs have been short-term volunteers themselves at some point, which could have been the spark that inspired them to serve in the Peace Corps), but rather to encourage people to think differently about the impacts that these approaches have on the communities which they are trying to ‘develop’. Sustainability is key in any development context, and the assets-based approach that Peace Corps takes aims for sustainability through community-driven development. After all, only when people take ownership of their actions in order to continue improving their own lives long after an NGO or volunteer leaves can development work be truly sustainable.

Tuesday Talks: navigating global development data for health

Tuesday, October 5th, 2010

How many people actually understand charts, graphs, and spreadsheets? Likewise, how often are these displays of data constructed to make us think a certain way? Thanks to the innovation of Hans Rosling and others we can now sift through our own data however we want to in a way that is simple and understandable. This is a great innovation for health since it allows everyone to understand various indicators of good health around the world. Listen to Hans Rosling’s TED talk and check out his program called Gapminder. I recommend the “Africa is not a Country” installation of Gapminder.

What does a Peace Corps Volunteer do?

Thursday, July 22nd, 2010

As a previous member of the Michigan State University SCOUT BANANA chapter, I am absolutely thrilled to begin my service as a Peace Corps Volunteer in Uganda starting in just a few weeks.  I know many young (and older!) people who have considered doing the Peace Corps, so I’d like to detail what my work will probably entail (not to mention the equally-challenging cross-cultural adjustment, language acquisition, being far from home and family for 27 months, etc.).  However, every volunteer is in a different situation and has a different set of skills and experience – therefore everyone ends up doing many different things!

I’ve been given a job title, program, and job description, but nothing about the details of my job are clear yet, and probably won’t be for a long time to come. Part of the model of Peace Corps, and any type of grassroots participatory development work, is doing needs assessments in your community and doing what the people there are interested in and need, not what your international organization deems necessary (radical thinking, I know). So the details of my work are still yet to be determined, but here is the general idea of what I’ll be doing:

Program: Community Health and Economic Development (CHED)
Job Title: Agricultural Extension Volunteer
Your Primary Duties: Volunteers in our Community Health and Economic Development Program work as staff members in a variety of host organizations in Uganda. Uganda’s Ministry of Health, and local and international organizations request Volunteers to assist them with developing and implementing programs with the goals of improving overall levels of community health and economic development, preventing HIV/AIDS among adults and youth, caring for orphans and vulnerable children, and supporting people living with AIDS, their families, and their caregivers. As an Agricultural Extension Volunteer it is important for you to know that more than 80% of Ugandans depend on subsistence agriculture for livelihood.

The info packet then goes on to explain a number of activities with which I could be involved with the overall goal of improving livelihoods through agriculture, especially for people affected by HIV/AIDS and youth. I’m really hoping for a livestock/animal husbandry post (I majored in animal science and plan on veterinary school after Peace Corps)! However, volunteers always get involved with secondary projects, as described below:

While your primary assignment will be work in an advisory role full-time with a local host organization or government agency, there is little that goes on in your community that falls wholly outside of your role as a Community Health and Economic Development Volunteer. Your primary assignment will be the door through which you enter and initially come to know your community, allowing you to identify activities that are of interest to your community as a whole, and that further enhance your sense of fulfillment and professional development…

Oftentimes, secondary projects are among the most fulfilling to Volunteers. Such projects may include working with a local women’s group to improve their health practices; teaching adults basic computer skills; teaching English or basic reading and writing to low-literacy adults in your community; setting up girls’ empowerment or sports camps with students in local schools, to name a few such possible secondary activities.

Hopefully that gives you some insight into what some Peace Corps Volunteers do!  Others going with me to Uganda include economic development, NGO development, youth development, and community health volunteers, so we will all be involved in a variety of projects.  I leave the U.S. on August 10 and will be in training until October 21, at which point I will begin service at my assigned post.  While I’ll be focusing most of my posts on this blog on my actual work, thoughts on development and aid work in Africa, etc., I’ll also be posting more of my personal experiences on my own blog for those who are interested.

The Week in African Health

Friday, March 19th, 2010

Photo Credit: African Health Platform

After a long overdue absence, The Week in African Health is back. Subscribe to the blog to continue to get the latest news and innovations related to health and health care across the African continent.

Bringing everything full circle, Alanna Shaikh provides us with a repost: Why you can’t understand global health

Alanna reminds us all that if we overlook the intricate relationship between poverty and ill-health then we are set to misunderstand global health. “If you can read this, that’s not you. By definition, you speak English and you have access to the internet. You earn more than a dollar a day. You can’t understand.” For all the talk, analysis, and good intentions – we must remember that it is the poor who know best what interventions will work for better health around the world.

The World Health Organization has released the first ever guidelines for procurement of effective anti-malarial medicines

The guidelines emphasize testing for effective treatment. The WHO cites in 2008 that only 22% of suspected cases were tested in 18 of the reporting African countries. Thanks to new quality assured Rapid Diagnostic Tests (RDTs) that use a dip stick, testing is easier and quicker.This emphasis on testing will assist in stemming drug-resistance issues with quick and effective treatment.

South Africa has launched a massive HIV Testing campaign that marks a definite reversal from its past HIV/AIDS initiatives more focused on denial.

Beginning on April 15th, everyone who enters a clinic will be offered an HIV test, regardless of history or symptoms. Every health facility “should” be prepared to test by April, but the larger problem will then be access to medications and clinics have not yet been certified to distribute ARVs, especially those located in remote or peri-urban areas.

One of the few good things that I have heard about the Millennium Development Goals (MDGs) is that most countries are on track to reach the goal on access to clean water.

With 80% of all disease transferred by contaminated or dirty water, this MDG is a critical piece to improving health. Some countries are even set to exceed this goal by 2015. On the flip side the UN reports that unless “huge efforts” are made most countries will fail to achieve the sanitation MDG. This could be an unfortunate setback as clean water sources require proper sanitation to remain clean.

“If you kiss for five minutes you get it” HIV/AIDS in Namibia

This is one of the lessons learned by young students in one of Namibia’s HIV/AIDS after-school courses. The primary student ended by saying, “People with AIDS should keep to themselves.” Some of the teaching may be misguided, but the program offers much needed psychosocial assistance to young children who have difficulty coping. One student learned he was HIV-positive 3 years ago at age 8, but that hasn’t ended his dreams of becoming a doctor someday.

Need HIV/AIDS help? Look on the map!

A new program in East and Central Africa has printed 20,000 road maps that pinpoint the locations of roadside clinics where truck drivers can go for help with HIV/AIDS. One driver said, “Many of us want treatment but at times you might not know where to get it when you are on the road but these maps can help us now.” The wellness centres and clinics have been constructed in areas where high-risk populations converge.

Tweeting Against Malaria

The UN has selected a group of 24 social media envoys to tweet for malaria control. The WHO says that 3.3 billion people (half the world’s population) is at risk for malaria and sub-Saharan Africa is the epicenter where 90% of malaria deaths occur.

Other interesting articles of the week:

Articulate: Call for Papers (Fall 2009)

Wednesday, August 5th, 2009

Want to get published? Got an exciting term paper? Have some eye-opening stories about your work abroad? Looking to have your voice heard?

Articulate: Undergraduate Research Applied to International Development is now accepting submissions for its Fall 2009 issue! The journal will be published in November, and we encourage all undergraduates and young people (under 30) who are interested and experienced in the areas of development, African studies, and/or health care to consider making a contribution. See the Call for Papers below for more information.

Announcing Official Nonprofit Status!

Friday, January 16th, 2009

16 January 2009


East Lansing – To suggest that college students armed with bananas could create anything wholesome and family-friendly may raise a few eyebrows.

But to suggest that college students and bananas are the backbone of a dynamic, progressive organization that has raised more than $150,000 to date and inspired countless people to improve basic health care in Africa? That may raise more eyebrows.

Eight years ago, Alex Hill was going door-to-door to raise funds for a health center in Uganda. Today, along with an army of colleagues sporting banana-yellow shirts, his organization, SCOUT BANANA, has become an official nonprofit that supports 10 health care projects in 10 countries within Africa.

With its new status, SCOUT BANANA has a new education program in the works that will create curriculum that increases knowledge and awareness about the African continent. The program includes an interactive education website, curriculum and resources for elementary and high school classrooms, and an internship program for university students to participate in on-the-ground health care projects.

Current programs of SCOUT BANANA are thriving and growing, including the new academic journal, Articulate: Undergraduate Scholarship Applied to International Development. SCOUT BANANA continues to serve as a hub that brings together communities, academics, activists, community leaders and young people to ensure that global health is everyone’s responsibility and every individual’s human right.

SCOUT BANANA started in 2001 as a project that delivered an ambulance to the St. Ambrose Health Center in Uganda by raising over $67,000 through the support of hundreds of families and over 60 community organizations. SCOUT BANANA, which stands for Serving Citizens of Uganda Today Because Africa Needs A New Ambulance, became the acronym of Hill’s Boy Scout project.

SCOUT BANANA will spend its next phase building a youth movement of individuals who will are compassionate, competent, and collaborative agents of change. “It’s not just about donations anymore,” states Monica Mukerjee, a staff member of the organization. “It’s about research, collaboration, and bringing Africa to the forefront. By inspiring others to be dedicated to Africa, SCOUT BANANA is fueling long-term change and growth in health care and development.”

The organization invites all supporters, interested public, and close friends to their Nonprofit Launch Party on 21 February 2009 at the Gone Wired Cafe (6pm) for music, food, fun, and to celebrate the launch of the nonprofit!

To learn more or make a donation, visit For additional information, contact the Executive Director, Alex Hill, at or (810) 516-6547.


It’s All About the Women

Friday, November 21st, 2008

This past weekend, as I was sitting in one of the “Breakout Sessions” at the Global Missions Health Conference in Louisville, Kentucky, it suddenly occurred to me.

Think of it this way: It was as if I had been spent hours and hours staring at an acclaimed piece of abstract art, wondering what made it so special, when, amazingly, in a stunning revelation, I realized what it was.

For a moment, I reveled in my mental accomplishment. I felt like I had figured out a piece of the public health puzzle. I wanted to sketch my message on a white board just like the famous 1992 Clinton campaign saying: “It’s the economy stupid.” But instead of that message, I would write my most recent revelation:

“It’s All About the Women”

Because it is. Public health (and, for the most part, health in general) is all about the women.

Let’s go over the basics:

(1)    In the majority of situations, who is the primary health care provider in the household? Women

(2)    In the majority of situations, who controls the cleanliness of the household? Women

(3)    In the majority of situations, who prepares the food and water for the household? Women

So, if we look at public health from this perspective, suddenly it seems that women have direct influence over three crucial factors in public health: (a) Primary Care, (b) Cleanliness/Sanitation, and (c) Food & Water.

It’s All About the Women

Public health programs need to target women in order to maximize their effectiveness. Educational initiatives ought to begin with women (the real “heads of the household”) in order to catch on and spread throughout the community. Similarly, micro-finance programs ought to be targeted towards women and their entrepreneurial goals.

Some might argue that women shouldn’t have to be responsible for the health of the household. To this point, I’d agree. Women should be given the opportunity to receive a high-quality education and should be promoted to positions of leadership (including political representation) in their communities. They should be provided with the power and opportunity to pursue whatever goals they desire.

Nonetheless, public health policy-makers would be remiss to overlook the current critical importance of women. It Really Is All About the Women… Stupid

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