Global Health Immersion: Part 1

by Ryan Ross

It is a great honor to be awarded this year’s JSI Fellowship, a grant that supports student driven public health and international immersion.  USC has partnered with Twezimbe Development Foundation, a nonprofit organization that seeks the socio-economic transformation of rural communities in Uganda.  As part of my fellowship, I will work with Twezimbe and its stakeholders to lead my own student driven health program.  The chance to travel and work in Africa is something I’ve dreamt about since seeing my first National Geographic as a child.  With the opportunity to represent my University and Country, and to make an economic and health impact on the people of Uganda, my role as the JSI Fellow is a responsibility I take very seriously.

Although I have been in Uganda for a little over one week, “the Pearl of Africa” as Churchill coined it, is already starting to feel like home.  Actually this is the longest I’ve stayed in one location since leaving Los Angeles on May 15.  It’s been a dizzying month traveling to Geneva, the Swiss Alps, Southern France, Paris, Mount Kilimanjaro and Zanzibar.  From the apex of global health at the World Health Assembly (WHA) to the putrid aromas of poor sanitation in Tanzania, my studies in public health and development have literally come alive.

My curated reading list on Africa, Global Health, and Economic Development has added background and context to my experiences thus far.  With stories of Paul Farmer, James Oribinski and Jeffrey Sachs, I feel inspired and empowered to take up the challenges of addressing poverty and suffering in the developing world.  The obstacles they faced, and the reoccurring themes associated with working in vulnerable populations played heavily in my mind, especially as I transitioned from high income Europe to low income Africa.

Much has been written on the WHA so I won’t spend a lot of time discussing it here, but to summarize, the experience was both educational and challenging.  Geneva felt like a crash course in global health governance, international relations, and health current events.  As a graduate student lightly treading water in a sea of health leaders and experts, it was easy to feel confused and intimidated.  Topics such as WHO reform and Ebola response were casually discussed like they were new office dress policies.  With only one year of public health schooling under my belt, it was easy to feel detached from the issues at hand.  I’m appreciative for the unique opportunity to participate in the WHA and to witness a world not many people see.  However, I knew this was not where I belonged, at least not yet – I needed to be in Africa facing these challenges head on.

From Europe I jetted off to Tanzania to accomplish a life’s dream of summiting the tallest mountain in Africa, Mount Kilimanjaro.  It was a marathon of physical and mental endurance, hiking for six days, camping in primitive tents, and enduring sub-zero temperatures at night.  It was also the adventure of a lifetime, passing through five life zones on the way to the summit – the cultivated zone, rain forest, heather/moorland, highland desert, and arctic summit – and in the process witnessing some of the most pristine, unique landscapes on our planet.

Because the peak is so high (19,380 ft.), altitude sickness is the main obstacle to completing the trek.  Guides have near-perfected a climbing strategy that ensures adequate acclimatization by stretching the ascent over several days, and zigzagging from high to low altitudes in the same day.  That being said, it is impossible to know how your body will react to high altitudes, and the risk of nausea, headache, shortness of breath, and even death weighed heavily on everyone’s minds.  Three people from my climbing party succumbed to altitude sickness having to turn back in painful defeat.  Many more suffered through the final days of the trek, turning a pale shade of green resembling zinc-faced tourists at the beach.

On the final summit day I was terrified of failure.  Kilimanjaro was such a commitment, both financially and logistically – I might not get another chance to achieve this goal I’ve dreamt about for most of my life.  An hour from the peak, realizing the finish line was imminent, I couldn’t help but break down into tears of joy.  It was the second time in my adult life I’ve cried, and I did it all the way to the top.  It was one of the happiest moments of my life.  Reaching the summit at ten minutes past six, just in time to see the sunrise over the African continent, will be a memory I never forget.

After roughing it on Kilimanjaro for six days, the white sand beaches and slow pace of Zanzibar was a welcome reprieve.  I booked a cheap hotel in a remote fishing village called Matemwe on Zanzibar’s northeast coast.  For four days I slept, caught up on emails and mentally prepared for my work to come.  Matemwe had some of the most beautiful watercolor skies I’ve ever seen, coupled with idyllic, endless white sand beaches and a pastoral maritime way of life.  The photo opportunities were plentiful.  I made friends with villagers, getting personal tours of small huts and family communes.  I lost myself among the ancient labyrinthine streets of historic Stone Town, a medieval amalgam of Arabic and Swahili cultures and ex-center of East African trade.  It was a nice rest, but it wasn’t Africa.  It was a dream, not real.  I was ready for Africa, to begin my work, to finally be…”immersed.”

On Sunday June 14 I left Zanzibar for Uganda to begin my fellowship at Twezimbe Development Foundation.  My host Charles Buwembo and his lovely girlfriend Karima were waiting for me at Entebbe International Airport.  We traded introductions over the hour-long car ride to their home in Uganda’s urban jungle Kampala.  They live in a beautiful, spacious apartment in a gated community in one of Kampala’s most posh neighborhoods.  I have my own large bedroom and bathroom, access to a communal pool, gym, and restaurant.  Needless to say I was not expecting to live so lavishly my first summer in Africa.  I can’t complain though, as my hosts have been incredibly warm, gracious and accommodating.  Charles has gone to great lengths to make sure I am comfortable and enjoying myself.  He has taken me out to experience Kampala by day and the night, integrating me with his friends and family, and even giving me a Ugandan name – Kagimu.  By the end of the summer I know that Charles will be more than a colleague and host, but a close friend.  I hope that when the time comes to return the favor I can be one half the host he has been to me.

Living in Kampala is both overwhelming and exciting, as any good city should be.  Traffic is lawless with cars commanding any lane they choose, even the sidewalks.  Like most cities in the developing world, rapid urbanization and congestion outpaced any chance for urban planning.  I asked Charles if there were traffic rules, he jokingly replied, “of course, anything goes if you don’t get caught.”  What I find striking about Kampala is that despite its cramped streets and urban bustle, there is a verdant undercurrent that runs through the city.  There are explosions of green growth and alien trees between buildings, and a wildness is present, reminding us that this was all dense jungle not too long ago.  You only have to open your window to hear the most exotic and haunting birdsong, resembling microbursts of sonar, a cackling band of Alvin and the Chipmunks, and tookie tookie from George of the Jungle.  The energy is strong here, both from its people and from something deeper.

Twezimbe’s headquarters are in a quiet, upscale neighborhood of Kampala.  There is a handful of staff managing communications, programming, and administration.  In the morning a Twezimbe truck waits outside our apartment, ready to shuttle us around the city to complete whatever development tasks are on the day’s docket.  My first week at Twezimbe is spent familiarizing myself with their programs and interventions.   I am eager to find my work focus and get out into the field.

Twezimbe was founded by Madame Amelia Anne Kyambadde, the Ugandan Minister of Trade and Industry, as well as the Member of Parliament for rural Mpigi District outside of Kampala.  Through her organization Madame Amelia runs a diverse portfolio of interventions encompassing health, poverty alleviation, infrastructure, security, and economic development, all aimed at improving the socio-economic outlook for the people of Mpigi.  It is her vision that the work Twezimbe does in Mpigi will become a model for other districts, and that Twezimbe will lead grassroots interventions for the betterment of rural communities throughout Uganda.

Twezimbe is unique in that it targets needs often outside the scope and budget of the federal government and the UN.  Her position as a politician and her on-the ground connections to the people of Mpigi give Madame and Twezimbe a direct link to community leaders and important institutions.  Twezimbe’s strengths are in its ability to mobilize the Mpigi communities and empower them to take ownership in the interventions affecting them.  Additionally, Madame’s influence in government serves as a catalyst allowing the NGO to achieve results quickly while circumventing bureaucratic tangle.

Charles and the rest of the Twezimbe staff have been keen to ensure my work with them is both enriching and meaningful for all parties involved, and I can’t thank them enough.  Because of my background and expertise in business and marketing, Twezimbe initially wanted me to investigate ways to improve the awareness and engagement of their interventions using digital marketing.  As the week progressed it became clear that I needed to get out into the field to observe Twezimbe’s constituents and interventions in action. Being in the field would bring clarity and direction to my area of focus.

On Thursday we toured Twezimbe’s four field offices, meeting with staff, and learning about the various challenges that the people of Mpigi face.  Leaving Kampala, passing its outskirts, urban chaos abruptly melts into peaceful countryside.  As one of my seasoned classmates told me, “it gets rural really fast in Uganda.”  We drove through fields, forest, and villages, mostly on pothole ridden ocher dirt roads.  The countryside was lush, bucolic, with undulating green hills like a serpent’s back.  Most homes detached from the main roads do not have electricity.  The majority of these people live on less than $1.25 a day, below the UN’s international poverty line.  They survive through subsistence farming, eating whatever their gardens produce, and selling any surplus for small change.  Malaria is rampant, and high fertility rates coupled with low healthcare utilization equate to an abysmal maternal mortality rate.

The highlight of my trip to the field was visiting Mpigi Health Center and meeting with its Director, Dr. Jubilee.  Staffed with just four doctors, nine nurses, and seven midwives, Mpigi Health Center serves a population of over 200,000 residents.  As we walked, Dr. Jubilee gave me a detailed tour of his facilities and introduced me to various staff.  I vigorously asked questions and took notes, trying to get a grasp on the overall health system and health challenges facing Mpigi District.  Dr. Jubilee manages several smaller health centers throughout the district, as well as a team of community health workers.  His challenges are great, including a lack of staff, inadequate medical supplies and medications, and low spatial capacity for his patients.  I was thrilled when Dr. Jubilee invited me to come back and work with him several days a week.  Returning to Kampala that night, I realized that I needed to be in the field, that immersion in Mpigi was where I would truly learn global health and make an impact.

Dr. Jubilee and Me at Mpigi Health Center[/caption]

Apparently Madame Amelia agreed with me.  In our first meeting of my second week she scrapped all plans to involve me in marketing and decided to send me out to Mpigi for complete immersion for 14 days.  Her mandate: spend time with the youth, observe youth interventions, interview them, interview health workers, meet with Dr. Jubilee.  “How can we improve their economic outlook, how can we improve their access and utilization of healthcare?”  So my work is solidified, a clear mission to guide me: deep immersion, research, and strategy development for improving the economic and health prospects of Mpigi youth.  Am I excited?  You bet.