There and Back Again September 17, 2012Posted by ellaweber in Individual Fellowship, Uganda.
Tags: HIV transmission, PMTCT, study abroad, Uganda
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I’ve been home from Uganda for nearly two weeks now, but I still haven’t quite figured out the right answer when people ask me about my trip. It’s difficult to sum everything up and feel like I’m being fair to the experience, the country, and the people who were so instrumental in both my research and my life in Iganga. My time abroad was eye-opening, educational, loads of fun, emotionally exhausting, and most of all too short. By the end of my trip, as much as I missed reliable electricity, skim milk, and simply blending in from time to time, I was choked up in the airplane and clinging to the earthy smell on my jacket.
When I wrote my grant proposal, I was full of great ideas and aspirations of living in some little town in Uganda, listening to women tell stories about babies, living with HIV, social pressures, and breastfeeding, and then formulating this concrete answer of how to assess all this and reform PMTCT (Preventing Mother-to-Child Transmission) programs. As a history and anthropology major, I knew better than this and knew this wasn’t how research worked. In fact, I knew this shouldn’t be how research worked, but I had this romantic vision of a sudden assimilation and active role in town life nonetheless. Furthermore, I thought it would be easy. I’ve always considered myself to be fairly independent, someone who solves problems well, and in doing so have taken for granted all the help my professors at the university have offered me.
When I started research in Uganda, I ran into a number of roadblocks early on: women not being honest with me for fear of being chastised by the nursing staff, realizing my plan of a consistent focus group was impossible given the time restraint and poor quality of roads and transportation, and the necessity to work and rework questions with my translators to fit culture norms and community practices (for instance, I was curious about the use of wet nurses, but women in the Iganga District have no conception or interest in this practice, and I was unable to collect any data on it simply because women thought it was too ridiculous to discuss). At first, I was depressed and scared, my research was going to fail, I was going to be lonely for six weeks, and I was going to disappoint all the people (at home and in Uganda) who had such great faith in my project.
A few days in, however, it really sunk in that this was my project and my responsibility. It was my job to work through the problems, get creative, and most importantly, that I hadn’t been sent out alone and unprepared. The classes I’ve taken and the professors and advisors at the university had prepared me for my work and research, and I had simply been too out of my element to realize it. Dr. Nancy Hunt, for instance, introduced me to Cicely Williams who was largely influential to my project; Dr. Ellen Poteet had provided me with an excellent background in modern African history that helped me piece together the intricacies of health care and gender roles; and a Poli-Sci course I took on developing nations taught me to really analyze the role of NGOs, government programs, and social networks before prescribing a problem and a quick fix to a given community.
After this point, things fell into place for me. I asked for help and opinions from community members frequently, I worked harder to learn the language, I talked with anyone who wanted to, and learned to enjoy soccer, eating the heads of fish, and haggling in the market as ways to become comfortable and accepted in the community. I let little kids rub dirt on my arms and face when my skin confused them, watched the sunset over Kenya, steamed squash in banana leaves, got run off the road by cows, hiked impossibly steep mountain trails, and most importantly learned to observe community life in Iganga appreciatively and not critically.
As depressing as working in the health system often was, I realized the people of Iganga have a much more accepting, peaceful attitude than most people at home (myself included). This isn’t to say they didn’t understand where the government was failing them, or were apathetic to social issues, but, for example, HIV positive women generally accepted child rearing now had unanticipated challenges, and altered their lifestyle to accommodate them with little complaint. I asked a lot of people what they thought Uganda needed most for improvement, and rarely met anyone without an opinion, but it was just as rare to find someone complaining for the sake of it or without ideas on how to correct the issue.
Through my research, I grew academically and personally, but my research itself grew beyond what I had expected. Breastfeeding and societal pressures were so deeply intertwined with other aspects of community life, motherhood, and public health that almost every day I was taken aback by a comment or observation and forced to reevaluate my work and conclusions. As I continue sorting through my notes and recordings, I hope more and more that I will be able to return to Iganga and truly thank the community for their outstanding friendliness, openness, and acceptance. Finally, I would like to extend a huge thank you to the International Institute and the University of Michigan as a whole for their trust and support. It’s good to be home 🙂
HIV, Breastfeeding, and Endless Chapatti July 25, 2012Posted by ellaweber in Countries, Individual Fellowship, Uganda.
Tags: breastfeeding, healthcare, HIV transmission, Lusoga, Uganda
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Vicki, one of my translators and research assistants, laughs when we see something that surprises me and repeats over and over again, “spend time in Africa!” Today, for instance, we took a taxi which contained sixteen adults, a baby, and a very unhappy chicken. Having completed my first week of research, however, life in Africa has proved surprisingly easy to adapt to. The air smells like the red earth and herbal-scented fires; people walk slowly, talk slowly, eat slowly, and little children holler “mzungu, mzungu, see you later,” at me when I walk around, and then fall on each other laughing when I respond in broken Lusoga. Some days though, this combination of peace and enthusiasm has been hard to grasp after a day spent at the local hospital or a regional clinic, places I know I wouldn’t have the mental stamina to carry on from.
The health care system here is broken and backwards; mothers in labor are expected to bring their own gloves, gauze, sheets, and other supplies to the hospital, and the dispensary often doesn’t have the necessary medications. Just this morning, I listened to a nurse instructing a mother on proper nutrition and education. In her arms was her four month old baby, who was covered in sores from the chest up. While watching the woman calmly sooth her squirming child, it dawned on me that her baby likely will not survive the year. In the wake of the raging health care debate at home, it can be hard to watch helplessly, fingers crossed that the information I’m gathering will make a difference.
Doom and gloom aside, everyone who has aided me or agreed to an interview here has been helpful beyond my wildest expectations. At one health clinic, the stately older nurse continually looked me up and down skeptically the entire time Vicki explained my project. I was sure we would get turned away, but all morning she quietly brought us woman after woman to interview (and a really cute baby for me to hold), and then laughed like we were old friends at my reaction to the boiled peanuts one of the medical attendants made me try.
One of the best interviews I’ve had so far was with a woman referred to as a “mentor mother,” at the hospital. These women hold individual interviews for new mothers who are found to be HIV positive, in which they share their own experiences as mothers living with HIV and allow frightened women a safe place to discuss their problems, fears, and seek advice. Fear of abuse by nurses, as well as shame from community members and abandonment by husbands and partners, leads many women to lie about their HIV status. Because of this, some women are afraid exclusive breastfeeding will reveal they are HIV positive, so the mentor mothers are working to promote disclosure as a way to prevent mother-to-child transmission.
As the weeks progress, I will be talking to women in smaller, more remote villages, and have more exposure to traditional birth attendants and healers. So far, I have only had a small opportunity to judge where western and traditional medicine are intersecting, but the varying concerns of men and women, as well as those with access to the hospital, have proved incredibly interesting. The traditional birth attendant I spoke with, for instance, always wears a nurse’s uniform when delivering a baby, but has attained all her midwifery knowledge from sources outside a hospital setting. Men in the villages have expressed little interest in being involved in the breastfeeding decision, but their ability to provide (and show they are able to provide) milk and other substances is very important. With each interview, I find myself coming up with more and more questions, and it’s been great fun to watch what started as a theoretical research program turn into something real. In the meantime, I plan on continuing to practice haggling (poorly) in the marketplace, consuming loads of hot chapatti, and remembering to shower with my headlamp nearby – I learned the hard way that when the power goes out, the lizards emerge.