Uganda

The Mayor Saga Continues

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“He has arrived; he is in office.”

Excellent. Against all odds, we have everybody in the same space. Media present? Tick. Religious leaders? Tick. Mayor in his office with no known escape routes? Tick. Ready for ambush.

Since the Mayor intervened and ruined the last sachet alcohol-impounding operation, he had affectively blocked all enforcement by refusing to let his enforcement officers take part in operations. Theres a lot riding on this ambush.

Our District’s former Anglican Bishop (still an influential figure) and Muslim Sheik lead the way with a gaggle of media swarming behind them. At first, I tactically remain outside. The last time I saw the Mayor, we both lost our tempers. I waited. Then my phone rang and I was summoned inside to join the discussion. Things weren’t going well. The Mayor dodged everything, weaving in lies and half truths. His attack was threefold-

He claimed enforcement was unfairly targeting certain businessmen in the town area, and that we should be going out to the villages. This is true but justified- the main suppliers of illegal alcohol are in town! He claimed that business owners had not been properly ‘sensitized’ to the ordinance, and there should be multiple meetings hosted for business owners to have ‘input’ into implementation of the ordinance. Firstly, the news about the ordinance had already saturated the media since its launch the previous year, and business owners had already had illegal product confiscated! The time for ‘sensitization’ had clearly passed. ‘Sensitization of business owners’ is at best a delay tactic to make sure nothing happens, and at worst, an opportunity for business owners to rebel and swing things to benefit their profit focus. Most bizarrely, he claimed that the first round of impounded sachets were never actually burned, and that the big public bonfire was ‘faked.’ How on earth he thought this ridiculous claim would even help his position, I’m still not sure. Afterwards I provided the video footage and photographs to the media of the sachets being burnt.

The Mayor completely dominated the discussion. The religious leaders (who I clearly had not prepped strongly enough), folded under his pompous display of authority and importance. Too gentle, too polite, their message demanding the Mayor release his enforcement officers for operations was lost. My own attempts to ‘up the anti’ were shushed. We left, I felt deflated.

Outside, we reshaped things with the media, and managed to rework the message to make it stronger!

Despite having essentially failed in our main mission of influencing the Mayor, our ambush had an unexpected positive result. Perhaps frustrated by failed ambush, the Muslim Sheik called the District Chairman and they went on radio and thoroughly dressed down the Mayor. The District Chairman then resolved to go above the Mayor’s head, and ensure enforcement would go on, with or without the town enforcement officers. Boom.

Most of the media coverage was on local radio, but a local reporter also wrote it up on their news blog. 

The Health Centre That Wasn’t To Be

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Phase 1 – Great hope In March, we rode out with our enthusiastic nurse Walter to the frontier town of Elegu on the South Sudanese border. High population, no health centre, traders with a bit of money. What location could be better? The location even came with our Bishop Johnson’ recommendation.

Phase 2 – Bewilderingly slow Things started surprisingly slowly. Only 60 patients came the first month. 97 the second. Walter was bored. The patients who came appreciated the service greatly, but we were bewildered by how few there were. After an amateur advertising campaign where we shouted through a megaphone, smeared A4 notices around town, and gained the trust of the local Maadi tribe, things started to pick up.

Phase 3 – Maybe yes? In July, the clinic broke even for the first time, with a bunch of sick patients coming for IV treatment, in addition to more minor conditions. 175 patients for the month. Walter called excitedly with the statistics, sharing that the word had spread, that people were appreciating him, the health centre, and the care – the only high quality care available in the area.

FLOODED OUT  – We’ll never know On Tuesday August 22, at around 4:00pm the banks of the Onyama River burst. The flooding was swift and violent. The scale is huge – as of now at least 3 people have been found dead, and over 2000 are displaced. Our nurse Walter ran 50 meters to the clinic from his hut in an attempt save the drugs, but only managed to gather half before the water reached waist deep. By the time he filled a bag with drugs, his own home was flooded. He lost all his rice and beans, but he and his wife made it safely up to the safety of the raised main road.

I thought he exaggerated when he said the water level reached over a meter, until I saw the water line on our drug cupboard today. Around 1.2 meters high. Today, a week later the water is still ankle deep, and Fiona from our Health office went to Elegu to retrieve the cupboard, desks and other equipment that were covered in mud. Amazingly the clinic hadn’t been looted. We spent this afternoon washing them up, so we can use them in another health centre soon. It hurts to lose Elegu clinic. something that could have done so much good. Time to mourn and move on.

There’s a great song, “Flood Waters” by Josh Garrells (do listen) which discusses a deep love which can’t be washed away. A love which can’t fail no matter what. Our love for this place, and Walter’s love for the people he treats won’t be washed away by this flood. We’ll all find new ways to put it into action.

Health Clinics by the Numbers

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We’re 5 months into the trial of the 4 new clinics, with a total of 12 operational months between the health centres – the halfway point in the trial. Cetkana has been running for 5 months, and our most recent Obanga pe Wany. only 1 month. We’re aiming for ‘operationally sustainability’, which means the patient fees cover running costs. The new clinics have already treated 2293 patients combined which is impressive. YAY stats – here goes…

The patients

Here’s the graph of the number of patients seen by each clinic every month. Note Obanga Pe wany only has one dot – the clinic has only been running for a month. I’m not currently collating the data for conditions seen (its available at the health centres), but over 60% of these patients had malaria.

Two Thirds of our patients are kids under 12, which is great from a saving lives perspective, but not so good for our sustainability as they pay less money.

The money

Patients pay a flat fee which covers Consultation + Test + drugs. This means someone knows before they walk 2 hours to the health centre exactly how much money they need. Patients 0-4 years old pay USD 0.70c. 5-12 pay US $1. 13+ pay $1.50. Even in Uganda where people have very little, this is a relatively small amount of money, and always less than transport to the nearest other health facility. You won’t find cheaper healthcare in Northern Uganda outside the hopeless government system.

Over 90% of our running cost are drugs + the nurse’s salary + rent, and from our current experience it takes around 235 patients a month to raise the money required to pay for this. Here’s the graph showing how much money our health centres are losing/gaining each month. The line in the middle is the “sustainability line”, which the health centre has to stay above on average to be viable. Keep in mind a couple of really good months can offset 4-6 not so good ones (see Ocim) If you’re wondering why its US rather than NZ dollars, its because the New Zealand Dollar is a backwater currency and we want to be taken seriously. A beautiful backwater though…

As a side note, we also give some stuff out for free, like condoms, family planning and mama kits for pregnant mothers. Nurse Naume at Ocim gave out 300 free condoms one month. Awesome.

Take away points

Around 235 patients a month is what’s needed for sustainability Even after only 4 months, Ocim is doing well enough for us to say they can continue indefinitely. Sustainability win and compounded good! Obanga Pe wany had a fantastic first month, if this continues it should also become sustainable. Cetkana is doing a great job, but is unlikely to become sustainable,. Elegu has started very slowly and is losing a lot of money, but its early days. Stats alone don’t show the good these places are doing. Stay tuned for the non evidence based stories to pull the heartstrings and give the majority of people who didn’t read this blog a warped view of how awesome these health centres are… 2/3 of our patients are kids, which is great for their health and their future.

PS: We’ve decided to extend Cetkana’s trial another 3 months to 9 months. Despite their currently unsustainably low number of patients, they’ve actually lost very little money. Unfortunately I doubt they will reach the magical 235 number to be able to continue, but we wanted to give them every chance. Their deficit is only USD $40 a month. You might say, why don’t we just fund that shortfall? That’s so little money to help provide healthcare for 150-200 really poor people a month. People have already offered. Maybe in future we will run centres with small subsidies. For now though lets shoot for the moon and go for 100% local sustainability. It may hurt to shut places down, but we can always go back and through this approach we’ll find the areas which desperately need quality health care, rather than just a lot.

If you got to the end my respect for you is immense. More exciting and inspiring stories coming soon.

NGOs part 1 – Pay your workers less

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I don’t usually preface, but in this case it may help people dislike me less. I believe that NGOs go about much of their work the wrong way in Northern Uganda, to the point where some of them may do more harm than good. I’m writing a series of blogs on where I think NGOs are going wrong, and how they could fix it. These here are opinions. Informed opinions after 4 years operating amongst NGOs in Northern Uganda, but opinions only.

Abandon Ship

Last year, one of our best nurses left one of our rural health centers. With no warning and without telling anyone. It was the 3rd nurse that year who left for an NGO job. We rushed to replace him, but it put the only remaining nurse there under a lot of stress, and I’m sure patients weren’t cared for as well in the meantime. Our replacement wasn’t as good. I didn’t hear the nurse who left again until 6 months later, last week. He came to apologise for leaving abruptly. He said he felt really bad about it, that he had let his fellow staff and the patients down. He’s a great guy and it was good to catch up and reconcile everything. When I asked him why he left for the NGO job, he looked at me as if it was a stupid question.

“The money was too much, of course” Too Much Money?

So why is it bad to pay Ugandans a lot of money in NGO jobs? Surely you pay them as much as you can afford to help them and their families get by in a poor country. Unfortunately, its not that simple. There are at least 3 enormous negative effects of high NGO salaries.

1) High quality workers get lured out of sustainable, productive service provision jobs (health work, business, teaching etc.) and into the NGO sector. It’s a local brain drain of epic proportions. In one case this became so extreme that the run-down government hospital wrote to anNGO asking them to stop stealing their nurses! Most of the best minds should be innovating and leading the society from institutions and businesses that will continue serving people indefinitely. Instead the NGO sector is overloaded with the best educated and most capable, while the cogs which drive sustainable progress creak and come to a halt.

2) The distraction of huge NGO salaries means that workers don’t concentrate and get stuck into their current jobs. Many workers have a legitimate ‘grass is greener’ syndrome. People are ever on the look out for that ‘Golden Goose’ job which pays 2 or 3 times as much, even if the NGO job only lasts 6 months. You wouldn’t believe how much time and effort local people spend thinking about and applying for NGO jobs rather than getting on with their current work.

3) High NGO salaries wreck the aspirations of young people and skew the entire education system. When you have a deep, honest conversation with people at university about what they want to do, very few have serious aspirations to help their country, or bring people out of poverty. What they really want is a cushy, high paying NGO job. People should have a heart to start productive businesses, teach at schools, be nurses at hospitals. To work within the system to create lasting change. When we advertised for a job managing our Anglican church health centers, I was expecting degrees in public health, or at least administration. But no, over half of the 80 applicants had a degree in “development studies”. What even is that degree? A ticket in the lottery for a bloated NGO job. Another phenomenon is that many people want to be ‘drivers’ so they  earn more than teachers or nurses by driving NGO workers around. Bizarre.

So why do NGOs pay too much? From talking to a bunch of people about it, these are some of the reasons (again add your own!)

1) The donors back home just don’t understand local salaries 2) NGOs have a budget which they need to spend, and salaries is a way of spending it. 3) NGOs rely on local NGO workers to suggest/decide on salaries – perpetuating the cycle 4) Wanting the best worker possible for their job (not OK, see below) 5) Wanting pay equity between local and Ex-pats (White guilt plus healthy instinct)

The Solution

The good news is that we can solve this problem almost overnight! Here’s how.

Pay the market rate for your staff. Find out what the local market rate is for teachers, nurses, lawyers or whoever else you hire. Ask for the salaries for similar positions among business people, government and private not for profit enterprises (Church Run) and add no more than 10% to that. Not pay Ex-pats much more than you pay locals. Wanting equity between local and expat workers is fantastic, but the solution is not to increase the local salary, but lower the Ex-pat’s! This reduces the tension to have to pay locals ludicrous salaries to match. If Expat NGO workers can’t handle being here on close to local salaries, then I don’t believe they should be here. It should be a sacrifice to work a place like Norther Uganda, a big one. Awesome hard working, caring Ex-pats will still come work for your NGO, even if they are paid less. Be prepared to not hire the ‘best of the best’ with a reduced salary. Why should NGOs get to hire better workers than the government, buisnesses, or mission hospitals? Realise that your work is not usually more important than what everyone else is doing. Be comfortable with hiring good workers, even if they aren’t the best. You’ll still get good workers, don’t worry!

Then spend the money you save on salaries on…. whatever you think is best! Hire an extra worker, sponsor more kids to school, drill more boreholes. It’s a win-win for everyone.

Feel free to disagree, comment, agree, ask questions, disagree or whatever you please.

More than the worst thing we’ve done

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“You have to wash! Look at you! I’ll tell the school matron to beat you if you don’t wash!” Kenneth’s mum scolds him, inspecting his uniform and behind his ears. Its visiting day at Gulu Primary Boarding school.

Its true, Kenneth is looking a bit grubby. But he isn’t roaming the streets stealing and setting fire to grass-thatched huts. And in front of us sits a little report card full of top marks, indicating he is currently placed 4th out of over a hundred students in his class.

While his Mum is over-fixated on his messy appearance, she brought him a soda and his favorite meal: fish and rice. I brought a big box of biscuits and bananas. In the shade of a red flowering tree, he reads to us from an English story book, perfectly. As always, he is quiet. But he is smiling a lot. It’s a beautiful day, in lots of ways.

Backstory

For those who haven’t heard this story, about a year ago, we woke up to find our grass-thatched hut roof ablaze with fire. When I screamed, neighbours came sprinting with basins and jerrycans of water (no taps, no hoses!). Miraculously, Lacor fire truck arrived quickly to further douse the flames. Within an hour, it was all over and we were left amongst our sodden, ashy but intact home feeling shocked but grateful. Our initial suspicion turned out to be correct: this was the work of an 11-year-old neighbourhood kid, Kenneth.

Why? Kenneth’s mother and our close neighbor Lucy were caught up in a complicated family feud to which we were completely oblivious. Two weeks prior, we found smoke billowing out of Lucy’s window, and discovered her bed, piled with her possessions, blazing. At the time Lucy (who has sickle cell disease) was on oxygen in hospital. So it was us who confusedly marched the culprit, wee Kenneth, to the police. After this we were added to his enemy list. Two weeks later again, our roof was burning

By the day of his hearing in court, we’d made up our minds. Drop the charges, bring him back home. My friend Christo, a counsellor, agreed I could bring Kenneth once a week for sessions. He joined our after-school phonics class for neighbouring kids. Nick’s parents generously offered to sponsor Kenneth to go to boarding school, which served the double purpose of removing him from a chaotic, harmful home environment and getting him back in school. Kenneth slowly started to unfurl, the depth of his eyes slowly started to wake up.

We are not heroes.

The risk in this story is that we make ourselves the heroes. The white saviours who found the black miscreant child a sponsor to school and become his patrons.

Please allow me to dissolve the hero narrative for you:

Mercy and reconciliation was not our first response… remember, we were the ones who marched Kenneth to a police station after burning Lucy’s bed, where he spent two nights alone in a cell. It wasn’t even our second response. Post-igniting our hut, we took him straight back to police and followed up to ensure he was held in the youth remand home until his charges could be heard, which is a horrible place. Mercy is easier when you have resources. Spending time together and including him in our class reconciled us with Kenneth. But we also had the social capital to find him a sponsor for school. This guaranteed goodwill and a new start with Kenneth’s mum, who I believe was the embittered brains behind the arsons all along. Most people here can’t summon this kind of help. Long term, the forgiveness approach has a higher probability of turning out better for us as well as Kenneth. Our action was very pragmatic! Kenneth was clearly capable of revenge. Leaving him to Uganda’s criminal justice system for a year or so could keep us safe temporarily, but what could he do upon release?

Now that we’ve cleared that up, this story has two major points.

Point 1: Non-complementary behaviour (aka, ‘love your enemies’) actually works

A group of friends sat around on a lazy summer night, drinking wine and eating cheese. Out of the blue, a guy with a gun appears, highly agitated, demanding cash and threatening to shoot. Except no on had any money. What do you do? Well, it was a true story. And in that moment, one of the cheese-eaters offers the guy a glass of wine. And the script gets flipped. They humanize him, he takes the wine. They all drink, talk, eventually he leaves.

It’s a true story, check it out on Invisibilia podcast. Offering wine to your gun wielding assailant is an example of non-complementary behavior, which is essentially responding to hatred/violence with an opposite approach, such as kindness. Again and again, life shows us that non-complementary behavior can ‘flip the script,’ and transform relationships. I believe this concept was first coined by Jesus… ‘love your enemies.’

The most awesome story in this episode is about a small Danish town’s approach to terrorism prevention. Police noticed a pattern of missing young men – 34 guys who left for Syria, responding to a call by ISIS to come build the Islamic State. They didn’t close their borders, declare those who left ‘enemies of the state,’ or make arrests upon their return. Instead, when they came back they invited them to have tea. They help them to enrol in courses, find jobs, find accommodation, even get medical treatment for bullet wounds. Most importantly, they offered them a mentor, and made sure they felt like they belonged in Denmark. It worked. Incredibly, the returnees they invited came, as did over 300 other ‘potential radicals.’

Whether it’s in the realm of personal interactions or national policy, the Jesus-logic ‘love your enemies’ actually works on a deep-principle-of-the-universe level. Surprisingly often, the guy with the gun picks up the wine glass and the kid who lit your roof on fire becomes a regular visitor, and wannabe-terrorists decide they would rather be proud Danish citizens. Obviously it doesn’t always go that way. But respond with love and it becomes a possibility, and you will expose hatred for what it is and at least contain its spread. Match the antagonism and you step into the cycle of escalation, retaliation and alienation. The last couple of decades of American foreign policy makes that pretty clear.

Point 2: “Each of us are more than the worst thing we have ever done”

– Bryan Stevenson, death-row lawyer, author of ‘Just Mercy’

Stevenson describes a man in his last few hours before execution who came to him and said, ‘this has been such as strange day. All day, guards asked me how they could help me, what meals I would like, whether I needed stamps to send last letters.’ The man continued, “more people have said, ‘What can I do to help you?’ in the last 14 hours of my life than ever did in the first 19 years.” Bryan wrote, “All I could think was… Where were they when you were 3 years old being abused? … Where were they when you were a teenager and you were homeless and struggling with drug addiction?”

When I first met Kenneth, people told me he was bad news, a hopeless criminal. When I visited him in the remand home, I started to piece together his story. He was born in a time of war. After his father died, he was expelled from home whenever his mother’s mental health tipped over the edge. His brothers taught him to steal to survive. Slowly, the real Kenneth is emerging. He is super intelligent, inquisitive, shy, but warm.

Each of us are more than the worst thing we have ever done.

Jesus specialised in this. When a corrupt official, a tax collector for the Romans climbed a tree to get a better view of Jesus passing, he visited the man at his home. The man turned his life upside down to join Jesus’s movement and paid back all the people he had cheated double. When Jesus saw a group about to stone a woman for cheating on her husband, he challenged them, ‘let the one who has never done anything wrong throw the first stone.’ They left, and he stayed to talk to her. Jesus engaged with the people everyone else despised or ignored, he understood their full story, and reclaimed their humanity. Prostitutes, self-righteous religious leaders, the poorest of the poor, the sick, prisoners.

To sign off…

I’d like to share that Kenneth just finished reading his very first chapter book. It was Fantastic Mr. Fox. He devoured it in one day, and actually understood it. Here in Uganda, that’s a miracle. We are going to watch the movie together when school breaks for holidays next week. Imagine if he was still in Gulu’s youth prison and we all missed out on all this life.

The Show Down

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This article is a continuation of part 1 and part 2 of a series of posts by Tessa.

On Saturday morning my phone buzzed, early. “The Ministry of trade are coming on Monday.” Coming to make our councillors halt the alcohol ordinance. The snake show-down. I leapt out of bed with a rush of adrenaline. Good-bye sleep in, good-bye weekend.

“Real” Organizing

For the next 60 hours, I got to feel like a ‘real’ community organizer, constantly on the phone saying things like, “So Pastor, you are Councillor Simon’s friend? Think you can influence his vote on Monday?” and “how many people can you bring with you to the council hall?” The tactic was two fold. 1) Fill the the council hall with as many community members and prominent religious, cultural and political leaders as possible, and 2) create pressure on each of the councillors to use their vote to defend the ordinance. Those councillors got a lot of phone calls in the following 48 hours. Despite all the efforts, on Sunday night we were still nervous. There were still rumors of bribes floating around.

On Monday, Wakonye Kenwa members were the first ones there (pictured above).

By 10am on Monday morning, the council hall was absolutely packed. The mood was excited and defiant, as the clip on on national TV captured. Every time a prominent Acholi personality entered there were cheers and waving of placards. Our group had made our own signs, messages for the councillors like “Leaders, don’t back down” and messages targeted at NRM (the ruling party) based on their own slogans like”Wealth Creation” and “Productivity and Growth.” Others had written their own edgier ones. My favorite: “Ministry of Trouble, Indecency and Corruption” (instead of trade, industry and cooperatives).

The Debate

I was disappointed Amelia didn’t come in person. Her represent spoke at length, using as many long words as possible. His main point seemed to be “we are sailing in the same direction” but that Gulu needed to wait. He claimed Gulu was breaking Uganda’s agreement with the World Trade Organization (Technical Barriers to Trade, Articles 2 and 3), because Gulu was not giving ‘time’ for companies to adjust their packaging.

One after another, the councilors responded. They spoke about how important the ordinance was to Gulu District. They challenged the Ministry’s motivations for interfering, and why there was no need for Gulu to ‘wait,’ noting all the times the Ministry had blocked national efforts for alcohol law reform. My favorite response was a councilor smoking the Ministry’s WTO defense by pointing out that all of the sachet alcohol trade is within Uganda, not between countries (and therefore has nothing to do WTO agreements).

Acholi pride

A tipping point reached when Norbert Mao showed up, a much loved Acholi (regime opposition) politician of iconic-hero like proportions. Whose name makes him sound like some kind of epic Chinese dragon. A councillor moved a motion that a sample of sachet alcohol be presented to the Ministry’s representative ‘for tasting.’ The speaker emotionally declared that ‘normal procedures’ for a full council meeting would not be followed, and invited all the ‘VIPS’ to speak- Bishops, Shieks, traditional chiefs, and of course, Mao. They spoke about how Acholis had suffered for decades of war. Years of fear, violence and oppression led to heavy drinking patterns. Alcohol companies exploit this. The Ministry wants to protect these companies to maintain their profit at the expense of Acholi people. How dare these people from Kampala tell Gulu to get rid of their law? The debate took on new dimensions. This was a matter of Acholi pride, protection of Acholi people.

In the aftermath of that Monday, there was a collective sense of triumph and unity. While I’d questioned the Chairman (Owl’s) wisdom in allowing the meeting to take place, I believe it achieved something quite profound.

All the local media stations covered the story, and so did the national paper, The Daily Monitor. Norbert Mao wrote an opinion article featured in the Sunday monitor titled “Gulu trailblazing ordinance should be supported”One online media outlet even ran a piece about how the Speaker turned down millions of shillings of bribe money to protect the Ordinance. I took him a clipping and some photos. He was stoked. When a Ugandan politician is proud of turning down a bribe, that is something to celebrate.

The enforcement begins

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I woke up, wired, my head buzzing with questions. Would the police go ahead with the plan? Will the District send a big truck like they promised? Will we find the sachets of alcohol or have retailers hidden them too well? How will the shopkeepers react? If we do find sachets, will the District come through on their promise to give us somewhere to put them? In Gulu, no matter how much you try, a ‘plan’ is never really more than a series of vague uncoordinated questions. Fred, a key ally is already waiting at the police station at 7am, coolly sipping a mug of millet porridge. We are soon joined by Anthony, Boniface and Cristo, all revving to go.

After an hour and a half of milling around we spot the District Police Commander. “There’s an emergency, the operation will be delayed until its dealt with.” We watch as officers are loaded into an open-topped vehicle and speed off. The Police Commander, standing near us, demands updates on his cell phone “Is he dead? Where are the suspects?” A mob were lynching two suspected motorcycle thieves. By the time the police arrived (an hour late), they had been burnt to death. Officers returned and joined our circle, cheerfully one-upping one another on the most horrific lynchings they had seen, the details of which I shall spare you. I politely declined viewing a cell phone snap of this mornings victims. More time passed. 10am came and went. With plenty of phone calls from our team, we managed to get the District truck sent with a driver to wait on standby, and made sure the police vehicles had fuel.

Then suddenly, my mouth still full of chapatti, we were all go. Officers piled into police vans, last second confusion and changes of targets. My convoy hit up the wholesale street in the centre of town. While I’m used to seeing police operations on my teenage favourite “The Bill’ or more recently the infinitely superior “The Wire,” this operation resembled toddlers playing tag in the dark. The District Police Commander soon became completely redundant as operation commander when he got into what turned out to be an hour long dispute with a shopkeeper.

Most of the police considered themselves above lifting boxes and loading them into the truck. They had no plan for how the loading should take place. We lifted boxes ourselves, and hired some young guys on the spot.

While most of the shop keepers responded calmly, one retailer was furious. He had 30 boxes of sachets confiscated, worth millions of Ugandan shillings. He leapt on the truck and tried to throw his boxes back. The drama attracted a crowd.

By 2:30pm, the mission was complete. Between the two sites targeted, 307 boxes of sachets were impounded. That’s around 44000 sachets. Despite our hassling, a storeroom had still not been identified. I had to check several major hotels to find the District Chairperson at one of two meetings he was supposedly attending, accompany him back to the District Headquarters, find the storekeeper, accompany the storekeeper to find an appropriate store, and ring the truck to come. An hour of lifting heavy smelly boxes in the sun later.

Boom. First operation, done.

It was reported in the national papers…even if they got the numbers wrong:

Daily monitor report “police confiscate 150 cartons of sachet waragi”

Will it work?

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As the rickety pickup rolled in on the narrow village track, I had two thoughts bumping around. One, the nerves and excitement of starting our second clinic. Did we bring all the equipment? Is our young nurse going to be OK? Is the door even going to be unlocked?

And Two. Who is OJ Maxswel?  The picture above is of the hut right next to the clinic.

Don’t worry, this blog is not about OJ Maxswel.

I try to be objective and use head over heart when selecting new clinic sites, but my heart has broken a bit for this place. Ocim needs a clinic, it really does. If you get sick there, even accessing bad quality health care is difficult. And the place is gorgeous. It’s the closest you’ll get to an idyllic village, with pigeon houses, traditional granaries, and decorated huts. Even in dry season I was captivated.

But my heart breaking doesn’t mean that the clinic is going to become sustainable. It’s a 6 month trial, to see whether the demand from the community will be enough to keep the place going. There’s a whole lot of reasons the thing should work. But there are almost as many why it won’t.

 

Why Ocim Outreach Clinic will work 1) When I assessed Ocim, I asked a bunch of locals how many hours it took to walk to the nearest health centre. I couldn’t get a number, but some people said “We leave to go there just after the sun rises, and we get back just before it sets” 2) It costs $5  for transport alone to access any medical care. Our clinic costs $2 at most 3) Reverend Ojok, the local Anglican minister is an publicity machine. On the way back from the clinic he taped 3 posters promoting the health centre on the walls of shops and talked to everyone he saw about it. Legend. 4) The community is proud of their new clinic. They want to make it work. 5) The clinic has got instant cred and trust by being  run by the Church of Uganda. Our nurse Naume is a Christian, and the community knows she’ll pray with them if they want that. 6) My heart says it will 7) Because “OJ Maxswel, king of the king” is there. What more do you need?

 

Why it won’t 1) People are very poor. Nearly everybody there is a subsistence farmer. One dollar for kids and two dollars for adults may not seem like much to be treated for serious diseases, but for Ocim, it still might be too much. 2) The population is relatively sparse compared to around other clinics 3) It’s not on a main road, or in trade hub. We’re using the only available iron roof building in the area. This means the clinic is not very public and visible, and we can only treat locals, not people who are passing through. 4) The day to day existence of a small clinic like this is fragile. One robbery, one fire, and one aberrant guy harassing our nurse and it could be enough to sink the ship. 5) My heart is often wrong

 

From huts within sight of the health centre, two mothers came with their kids while we were still unpacking the truck. Both had high fevers. One had malaria, and had a seizure in the morning. The other had a large skin infection on their right butt cheek. Both mothers had been trying to wait out their child’s illness, unable or unwilling to pay the large transport cost to the nearest health centre. Both if the kids will now be fine. That’s why we’re here.

And the second thing on my mind? Here he is, OJ Maxwell himself. “King of the King”.

It begins – New Health Center 1.0

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Narrow road, burnt grass, full load. We breathed a sigh of relief as our small pickup  arrived at Cet Kana, laden with all things required to start a new health clinic. The place is gorgeous, with one of the better views in Gulu overlooking thousands of palm trees on an open, sparsely populated plain. The clinic is next to the current and future church. Current is a skeleton of palm tree timbers, covered every Sunday with tarpaulins. Future is the brick building, with half-walls only.

We were a bit shocked to find that the rooms hadn’t been opened for months. After thirty minutes of sweeping and rearranging, Felix our nurse, and Fiona our assistant co-ordinator unpacked the drugs and equipment. Desks and chairs were moved into the clinic room. The blood pressure machine was unboxed. Within a couple of hours, two dusty unused rooms had been transformed into a nice wee health clinic.

There are two big advantages to the health clinic location.

The church owns the building so we don’t pay rent The Pastor and other church members have already been involved in weekly family planning clinics run from the building, so the church/health connection is already rolling.

But we are yet to see whether this will fly. Are there enough people in the area to justify a clinic (my biggest concern)? Can adults afford the 2500 Ugandan shillings (1 New Zealand dollar) we are asking to treat a child? Or the 5000 shillings (you do the math) to treat an adult? Can our nurse juggle the responsibilities of organising the facility, seeing patients and managing the money? After 3 months we’ll have some idea. After 6 months we’ll make the decision whether to continue or not. Taking a risk like this isn’t easy on the nerves, as it’s a big money and time investment. I keep reminding myself that even if the clinic “fails” to become sustainable, we still will have treated around 1000 patients more efficiently than most NGOs could manage. I also can’t help thinking that Jesus is into this kind of risk.

And its exciting. Seeing the first child handed over to nurse Felix to test for malaria was a small victory in itself. I’ll keep you updated with how things are tracking.

We are starting up 3 clinics like this with money already raised, and are aiming to start 2 more. If you’re keen to donate money towards starting the last 2, then message me at ugandapanda.com/contact-us/

A huge thanks to those of you in New Zealand, Australia and beyond who made this possible. You know who you are.

Saving a life, or two

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Our wonderful midwife Gloria ‘in the bush’ at Oberabic Health Centre had a hard night recently. She’s the only midwife there, so has to do most the work that involves mothers and babies, and make all the calls under really difficult circumstances. A miscarriage and a tricky delivery led to a long, intense evening which ended up really well for the mothers and newborn baby. Its hard to overstate what a fantastic job she did under the circumstances.

Apart from being a great story, and example of the great work that goes on at our health centres, this story is a microcosm of the struggles our patients and staff face all the time. Amongst other things Gloria and the patient faced these challenges. Feel free to add your own after watching the video.

The Patients: – No access to transport to get to a higher level facility – Poor knowledge of problems around birth, which led to the mother coming in late and not telling Gloria her waters had broke. – Lack of social support

Gloria – Working in the uncomfortable zone above your level of medical expertise – Having to do everything yourself (sterilise the equipment yourself, after you’ve already completed the delivery) – Understaffing