The Scrapbook: Outposts

Outposts

Outposts: Compounding Truth

May 12, 2008 – 6:24 am

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It’s the sort of stuff you read about in the news, and see photos on TV, so I’m not sure that I can reverse any desensitization that many of us feel when we see stories about HIV/AIDS but this particular day changed it for me .

We pulled into a grassy compound with a number of small cottages filled with villagers awaiting treatment for HIV. The patients ranged in age from babies to what we would call middle aged, what Ugandans would call old, about 50. I have only seen two elderly women and one elderly man in my time here, life expectancy hovers around 59. The patients had undergone their various treatments, including the relatively recent addition of anti-retro viral (AVR) drugs, and were waiting for speak to us and help us learn about their lives.

I spent most of my time with a group of teenagers. They were solemnly seated on a bench and appeared deep in thought, their minds, most definitely, somewhere else than here. These kids ranging in age from 13-18 are all HIV positive, all had lost their parents to AIDS, some could not remember when.
Meet John Bosco, Alphanti Kigemuzi and Abdul Kareem
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15 year old Alphanti Kigemuzi, in 2nd grade told me in his soft spoken way he would like to be an engineer in the future, he then stopped and amended gently, “if life allows me to”.
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Both of his parents are dead. His father died in 1998 and his mother died in 1999. He doesn’t have any brothers or sisters so he lives with an uncle. In his soft spoken way Alphanti told me he doesn’t remember when he became ill or when his parents died. His case is typical. John and Abdul have similar stories.

John, a shy young man, is 18 and only in 2nd grade due to his illness.
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Abdul Kareem is 16 lives with a grandfather and doesn’t remember when he became sick although it was quite a long time ago.
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These kids at least have an adult caring for them. This area became famous for child-headed families where a child as young as 9 could be raising the children that were orphaned due to AIDS.

It really hit home that these teenagers know their fate is uncertain and in fact the doctors are not sure how their illness will progress or how long they will live. Although they feel less sick now with the medication and say they have no problem taking the drugs, the depression that surrounded the kids was striking. That’s when it changed for me. It’s not often that you have a group of teenagers hanging out together but they didn’t interact with one another, they didn’t exude any of the usual energy that teens are supposed to have.

It’s obvious, even to an outside a non-medical observer like me, that these kids are sick, some of them very sick. I should mention that speaking with the doctors that treat these kids, they are not only hopeful but really proud to share what they have accomplished for these kids primarily with funds from PEPFAR. I asked whether they had many journalists visiting, the doctors found my question really amusing, and laughed out loud, a group of journalists hearing their stories, was an unexpected though much appreciated novelty.

Outposts: Mud Wrestling

May 9, 2008 – 8:06 am

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Quick video interlude on how to use the resources you’ve got, rather than the resources you wished you had, to paraphrase Donald Rumsfeld inappropriately.

I’m traveling with a group of editors and producers as part of the International Reporting Project and we have a rather ambitious schedule that, might I add, we have been able for the most part to complete.

There’s one place we didn’t get to though, but not for lack of trying… We wanted to go to Kasensero, it’s a small fishing village on Lake Victoria, that has been integral to the history of HIV/AIDS. We traveled for a couple of hours from the clinic at Rakai down a dirt road with quite a few bumps, and even a few baboons, and were only 20 kilometers away when we encountered a road block of sorts.

I used the perseverance I observed among the villagers when uploading the following videos. Using the term “glacial pace” to describe the Ugandan Internet connection is being magnanimous.

Part 1 - Mud Wrestling

Part 2 - It Takes a Village

And don’t be discouraged, there’s even a…

Part 3 - Try, Try and Try Again

These clips are short, but by the time the car was cleared, night was falling and rain was likely, so we had to abandon our expedition. I’ll just have to come back.

Outposts: Men, cross your legs

May 8, 2008 – 5:37 pm

So if you read the previous post, you heard about the Rakai Health Sciences Program, a leader in HIV/ AIDS research that I visited yesterday. And you’ve probably heard about the ABC of HIV prevention: Abstinence, Be Faithful, and Consistently and Correctly use Condoms.

Condoms have been controversial of late, as in order to receive funding from PEPFAR (the President’s Emergency Plan for AIDS relief), the ABC program must comply with the regulations of promoting abstinence over condom education.

Well there’s a new C in town, or to be accurate, there is now ABCC…

What’s the new C? Men, cross your legs, it’s male circumcision.

In 2005, a trial at the Rakai clinic saw a decrease of 51% in HIV infection in circumcised men. This was so significant a number that they stopped the trial 6 months earlier than planned and began rolling out a comprehensive circumcision program, which is now underway.

OK, the skinny on foreskins… Here’s a box of them at the clinic about to be sent off for testing… eek.

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Globally, 30% of the men are circumcised. Usually it’s done for religious or cultural reasons. It’s probably the oldest and most common form of surgery. So why does cutting off the foreskin better protect a person from HIV? Scientists suggest it’s effective because cells inside the foreskin are an ideal breeding ground for the virus and allow it be passed on during sexual intercourse. Cut them out, and the breeding ground is gone. And, apparently size does matter; they have figured out that the larger the foreskin, the easier it is to be infected with HIV.

Next, I went to the circumcision surgery waiting room. A group of men from aged 15 to 61 were waiting in line to get circumcised. I tried talking to some of them about what led to their decision, but the uncontrollable giggling that erupted from the group led me to believe they were never going to talk about that decision with me (yes, I’m female). They didn’t mind my taking their picture, though.

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Here are the issues:

Currently men from age 15 on are getting circumcised. What’s the right age for circumcision to be performed? Babies, teens, adults? All of the above?

Who should consent for the children? There are a heartbreaking number of families without adults in this district due to parents who died from AIDS. More about those children later.

The doctor-to-patient ratio is overwhelming: 1 doctor to every 18,000 patients. Currently doctors perform the surgery, but that’s probably not sustainable. Who, then, should perform the surgeries?

Should antibiotics be used, or could they create antibiotic resistance within the community?

How do you do appropriate follow up with a remote rural population?

Rakai is trying to answer those questions. And while we are on questions, here’s a rhetorical one: Did you know, on average, it takes 1,000 unprotected sex acts with an infected partner to contract the HIV virus?

Would you like to read more on this circumcision study?

Outposts: Slim Disease

May 8, 2008 – 3:22 pm

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It’s kind of difficult to describe the past 24 hours that included crossing the equator, visiting a unique AIDS research and patient facility, hearing some hair-raising stories about witch doctors and attempting to dance to Ugandan and Congolese reggae (no pictures please), but here goes. I’ve managed to score an Ethernet cable, which makes the job much easier.

We left our hotel in Kampala really early yesterday morning. I must remember to tell you a little about our hotel at some point, it’s got a tale or two. But not now. So, yesterday we got up early and hit the road toward the rural district of Rakai in southwestern Uganda.
Dr. James Ntambi sat beside me on the bus ride and recounted the following story. In the early 80s a number of people started getting very slim (in a culture that adores curves – they even add a few pounds to the store mannequins). These very thin people died after a relatively short time, but nobody could figure out what was ailing them. The disease became known as Slim Disease in Uganda and really baffled everyone as to the cause. There was a number of rumors including witchcraft, but none could be substantiated. Here’s where Rakai comes in. Two Ugandan researchers, Drs. Nelson Sewankambo and David Serwadda from Makere University in Kampala, noticed the particular severity of the epidemic in the rural Rakai district in southwestern Uganda. They began extensive research on the people of Rakai, and through their work discovered the first case of HIV in the country by making the connection between Slim Disease and HIV. Drs. Sewankambo and Serwadda then planned an investigation into the baffling disease and set up shop in 1987 in a rented room at the Milano South-View Inn in Kyotera.
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That tiny clinic, lit (when there was electricity) by a 40 watt bulb and home to blood samples spun by a hand centrifuge, grew to be a leader in HIV/AIDS research and prevention. The clinic is now in direct partnership with the NIH and CDC. The area became the epicenter of HIV and AIDS in Uganda, both in cases and research, and even slipped in Ugandan vernacular. f you wanted to insult someone, calling them “Rakai” or “Slim” was an effective way.

We were fortunate to visit the Milano South View Inn yesterday in the middle of a health mobilization meeting. The meeting brought together health mobilizers from the neighboring regions who were chosen through local elections in their districts.
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The health mobilizers then come to Rakai to get the latest information on prevention of HIV/AIDS and bring that information back to their villages.

I also got to interview one energetic young man, Siraje Ssenyonga.
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Siraje took his role as a mobilizer as a prestigious honor, and was delighted to share how his thoughts on his village’s reaction to HIV prevention information. What were those thoughts? All will be revealed in the next post!

Outposts: De Nile

May 6, 2008 – 3:59 pm

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Our guide Sam Nabaasa brought us to see the source of the Nile today. It’s not every day you can say that. And you know what? There were no tourists. Apparently white-water rafting is much more popular as a tourist destination in Uganda. Wonder what it’s like? Check out my very short video with Sam as our guide.
Do I have to specify that the video it’s about the Nile and not white-water rafting? Oh..whatever…..

In the afternoon we had lunch and a very lively discussion with 20 students from law and public administration from Uganda Christian University in Mukono.
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The students were passionate about the US presidential primary. They were eager to know how the next president of the US would work with Africa. Senator Barack Obama was the clear favorite with the students; they cited change and racial harmony as reasons. A discussion on HIV/AIDS led to another discussion. A number of students, male and female, didn’t believe that equality between men and women could happen in Uganda. More on that and their thoughts on President Bush and President Museveni later.

Outposts: The Writing on the Wall

May 5, 2008 – 5:37 pm

We had a taste of Kampala today.
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One of the main roads is lined with store upon store selling wooden furniture, tables, chairs, beds and chests. One Ugandan scholar Aili Mari Tripp told me that when HIV/AIDS was at its peak in Uganda these stores only made coffins. The sight that greeted visitors in Kampala was a brutal reminder of what was really going on in the country. Tripp sees the transformation of these stores from coffin makers to furniture makers as one measure of success for Uganda’s HIV/AIDS programs.

Also today, we had a number of briefings on the Ugandan constitution, and in particular the constitutional amendment that lifted term limits for the presidential office and allowed President Museveni to run (and win) a third term in office. I found downtown’s murals interesting; here’s a noisy short video snippet from our bumpy bus ride.

Outposts: It’s bananas!

May 5, 2008 – 10:15 am

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This afternoon, we went to the National Agricultural Research Organization (NARO) and took a trek through the banana fields there. Now, as you probably know, New Yorkers love bananas. I think it should be the official food of the city. They’re cheap, on every corner, and they work for people on the go. One of our hosts today, Dennis Kyetere, said he saw what they sold in the US and what they called a “bunch of bananas” — you know, the 5 or so bananas that are usually together on a bunch. No, according to Dr. Kyetere that’s not a bunch, this is a bunch of bananas:
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The issue of food security is an interesting one in Uganda. They consider the term “food security” more apt for their circumstances rather than “food shortages.” They have food, but the issues they face are transporting it, refrigerating it, and in the case of the banana, depending too much on one food. Some communities eat only bananas and that leads to severe malnourishment. At NARO they are in the process of experimenting with GM foods. What the researchers would like to create is an enriched banana one that has extra iron and vitamin E and could combat the diseases that result from over-dependence on the banana. There is no opposition, being for research and not for commercial sale — which was clear even before the following sign reiterated the point.
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Uganda is the biggest grower of bananas in Africa, and second in the world only to India. Having said that, they export less than 1% of their crop. Bananas are grown here and eaten here. Incidentally, our hosts were also horrified at the taste of bananas that Americans eat. I’m going to try a few Ugandan bananas and report the results.

With the current global food shortages, Uganda may be in a position to supply food where there are shortages. Uganda has many small farmers, so called botanical garden farmers. They grow a little of everything, but these farmers are now considering adapting their farming habits to cultivate only rice or another foodstuffs that could provide large profits.

We have been told a number of times over the past 24 hours that all the food in Uganda is organic. Some say it’s only because there is no access to pesticides here.

Outposts: Out of the Gate

May 5, 2008 – 2:21 am

Landing

As we touched down at Entebbe airport on Sunday evening, we saw stars… thousands of them. Welcome to Uganda and to one of the challenges facing the country: regular rolling blackouts and a general shortage of available electricity. This should make blogging an interesting experiment.

Descending the airplane, the scene in front of me resembled a giant ticker tape parade, a million swirling white slips, spinning, spinning, furiously. As Kampala, the capital city, is in full bloom at this time of year, I asked whether it was exceptionally large white pollen particles enveloping us? A Ugandan informed me that they are insects that are churned up from the neighboring Lake Victoria and that they are pretty good to eat… Did you know that Lake Victoria is the planet’s second largest body of fresh water and covers an area roughly equivalent in size to the Republic of Ireland? I like that statistic, but I’m from Ireland, so I would. It’s about 65,000 square kilometers. I would have taken a photo, but there’s no photography or filming allowed anywhere in the airport.

I’m in Uganda as part of the International Reporting Project’s Gatekeepers Editors Trip to Uganda along with another 11 editors and producers from around the U.S. We’re here to explore issues of food security, agriculture, health in particular HIV/AIDS and malaria and poverty alleviation. If all goes accordingly to plan next week we will get to meet with the head of Uganda, President Museveni.

I’m off to the National Agricultural Research Organization (NARO) in a few minutes, so more on food security later this afternoon.




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