2nd week of internship

 So I have to write to my practicum director every week and will also post that report here.  I may be a little technical but it's a good update on the work place.  I hope to add some pictures but have hardly taken any yet.  I will try to get better at it.  It rained hard most of this afternoon so a very gray day.  I'll describe some free time activities next time  Love A

Journal 2:   6-10 to 6-16, 2011

            The second week of the internship has been very interesting, challenging, at times boring and as always full of new experience and learning.

My last journal ended with our meeting with our field supervisor and the plans for the following 2 weeks.  The weekend I kept purposefully slow.  I shopped (a 2 mile round trip walk to the market) wrote, swam, washed clothes and such on Saturday and Sunday took a minibus into town to walk around and then take a return taxi in order to figure out the route for half of our commute.  Very quiet in town on a Sunday.

            Monday we were back to work.  We took a taxi to work, a luxury especially because most interns are students on limited means.  5 interns, 3 from Africa and 2 of from the US went to an outreach clinic 75 km from Kampala.  TASO takes everything they need and a staff of maybe 15-20 people to government medical buildings in outlaying towns and sets up shop.  It’s a very complex operation, big boxes of files, a simple lab an extensive pharmacy.  The counselors and the medical staff saw people under the trees in the back.  The MDs see people only for AIDs related problems and there is a van to take people to the government hospital if they need serious care.  I was amazed how organized everyone was though it looked very chaotic because there were perhaps 150 clients milling around.  They registered, got their charts, were triaged to lab and/ or medical then counseling and then went to pharmacy.  Everyone sees counseling to go over how they are taking their drugs and to see if they have any concerns.  That’s where I was.  No one spoke English in this village so the counselor would talk with them and then tell me what was going on.  She also went over the main HIV drugs, side effects and disease process between clients so I learned a lot.

Tuesday I went with a counselor and nurse for home visits.  In 8 hours we saw only 5 people and 2 of them were government officials who were being consulted to set up a outreach clinic in their area.  We went through very crowded slums with directions like “go to the big tree, go down ask for Mama Blessing.”  Sometimes we never did find the client.  This is not unusual as some people give wrong information because of the social stigma of having a medical visit.  Everyone knows that means HIV+.

The houses were the size of a large bathroom in the States with everything you need to live crammed in and flies, and open sewers and real 3^rd world slums.  But the people we visited were friendly and mostly welcoming and it was great to get out into the city and see where people live and work.  Very cute little kids everywhere and chickens and goats.

TASO won’t start anyone on ARVs unless this home visit is made.  They want to know that there is a place for the medicine and a support system to help the client take the meds and help with the side effects.  They control resistance to 1^st line meds by being fanatic about engaging the family and making them all commit to helping in the care.  The main support person has to sign a contract.  They, also, with the client’s permission, test everyone in the house so that everyone who needs it can get care and support.  This is very different than orgainizations that test and give meds and then send clients home.  It takes a lot of time but their adherence rates to taking meds is about 95%, very high for Africa.

            Another change on Wednesday.  Our supervisor realized that we had been put in with the African interns who were there to observe and became more active in connecting us to who we should be working with.  I had a good meeting with the Director of Counseling and Community Support.  She has her mph with a reproductive health focus so we had a lot in common.  I won’t be working with her directly but will be with the counseling manager who is named Robert and I will meet him Friday, 6-17-11.  She explained a lot about what the priorities of the counseling dept are.  They emphasize counseling and testing special high risk groups so they do outreach in these communities.  The communities include sex workers, truck drivers, fishermen, taxi scooter guys, children and especially married couples.  30% of new positives occur in married couples in Uganda and this is the fastest growing segment.  They are emphasizing couple testing and counseling.  As you can see the concerns are very different from the states.  I tried to imagine what would happen if 30% of HIV cases in the US were in married couples.  It would change the money and the policies incredibly! 

Last day was today.  We went to the USAID office which was in the US Embassy.  Behind the walls multi-levels of security, it felt like the US.  Clean sidewalks, cut grass, water coolers, real air conditioning.  All that still felt pretty natural.  We haven’t been away from the US long enough for US comforts to seem strange.  We met the Program Specialist for HIV/AIDs who is responsible for us being in Uganda.  He had been an intern in DC for USAID last year (though has been working for them for 10 years) and had initiated talks with the summer internship program for interns to come to Uganda.  It’s a bit strange as a set up because we are not part of the Uganda USAID mission but part of the USAID based in the States.  We don’t quite fit anywhere in the system.  He is a Ugandan and worked for TASO for a number of years before moving to USAID.  He tried to answer all our questions but some things just did not get through. Bulleted items follow:

·         USAID mission in Ugandan goals are to improve government and democracy as a 1^st priority, encourage economic growth and agricultural trade, improve education, health and HIV/AIDs, maternal/child health

·         Biggest transmission cohort for HIV are couples  the issues are multiple-- concurrent sexual partners and “sexual networks”

·         PEPFAR has been very helpful to Uganda.  Treatment has increased by 50% under PEPFAR

·         But due to this, prevalence has greatly increased while incidence slowly decreasing so system is under great stress

·         Prevention must be implemented

·         Orphans and vulnerable children are a big problem  70% of Ugandan children are considered vulnerable ie live far below international standards for daily living

·         PEPFAR visibly changed life in Uganda.  In the 1990’s you saw coffins waiting to be buried on all the roads. ( I haven’t seen one.)

·         63% of HIV + people in Uganda are women

·         Women are 100% dependent on men.  With current inheritance laws women own no property and if the husband dies lose the rights to their children.  Everything goes to the husband’s family

·         Present policy in Uganda is not to try to change population behavior as in the past but to identify key drivers or populations and test and educated these groups

·         “Safe circumcision”  i.e. medical circumcision is strongly pushed for adult males.  Studies show a 50% relative risk reduction of acquiring HIV with circs.

I’m actually going to add 1 more day which was good but just strange.  I went to TASO Friday morning to meet Robert and to attend meetings with him as instructed by Sophie.  Went to a staff meeting which started an hour late and everyone tried to hurry because there was a big stress reduction training for the whole center at 11.  I asked what type of stress reduction, yoga, breathing, others?  No I’m told eating and playing games and leaving work behind to “recharge the batteries”  So from 11 am on we went to Club Afro and ate and everyone drank lots of beer (but me and a few others) and played pool and the men played cards and the women and a few men danced to a bad PA system.  Fun for a few hours and then my head and jaw started to hurt from smiling and talking and talking and talking.  Lots of interest in the new interns.  I also did a lot of dancing.  Boy can those people move!!  But we told someone we 3 interns were going to find our way home about 4:15 and they said no, no, no we must let them get us back to the center.  So we sat and sat and sat while maybe they arranged it.  Left after 6 and it was obvious the party was just getting started!!  Took 2 ½ hours to get home, terrible traffic, and dark crowded streets.  3 of the ladies from TASO helped us find the right mini-bus but we had to walk the mile from the bus to our hotel in the total dark with just a pen light.  It’s very hard to weigh rudeness vs safety (though we never were truly unsafe, just uncomfortable) vs what “soon” means  etc etc etc.  We have decided to always ask when something will be over and just say we have to be home before dark and it takes 2 hours to get home.  Cultural things are the hardest to understand.  The meaning of time is especially hard as TASO in most ways maintains a pretty strict 8:30 to 4:30 schedule.  Everyone else knew what was happening but we didn’t so were really confused and uncomfortable.  Live and learn.  That’s why I so wanted to do this.    Love   Anita