Global Health Immersion: Part 2

by Ryan Ross

It’s not often that your expectations are exceeded so completely, but Africa has done nothing but surprise me.  Whether through the adventures, the hospitality, the accommodations, or the work, never would I have imagined so many things to go so right this summer.

Since my last blog post, I was given the chance to immerse myself in the field of global health and development, working with youth in Uganda’s rural Mpigi district.  Getting on the ground to participate in interventions at the community level was my primary goal for the summer.  I realized that goal, and much more.  My education until now – all the books, lectures, podcasts – only took me so far.  From here the real learning begins.  I feel my own beliefs and assumptions in constant flux, and for a lifelong student it is a sensation I crave.

A group of bodaboda (motorcycle taxi) drivers I interviewed on my first day in the field

As part of its strategy over the next few years, Twezimbe Development Foundation will shift a portion of its focus from broad economic and health development to solving youth specific challenges.  Although Uganda has seen rapid economic growth in the last two decades, an explosive population boom coupled with vast inequality between rural and urban investment has created a dire situation for many of the nation’s young people.  With dwindling opportunity for employment and subpar human development, Uganda runs the risk of disenfranchising an entire generation, paving the way for social strife and potential conflict.

Over the course of seven days I interviewed 33 groups including secondary school students, teachers, health workers, and various youth professional organizations.  It was an incredible experience, among the most intellectually challenging and rewarding of my graduate education.  Every encounter provided a chance to learn, whether from an hour-long meeting with 25 students to a quick conversation with a staff member in the back of a truck.  I was a sponge, soaking it all in, and resisting any urges to form concrete conclusions.

My fieldwork began after moving into Madame Amelia Kyambadde’s (Ugandan Minister of Trade and Matron of Twezimbe) country home in Mpigi.  Her house was a beautiful, horseshoe shaped ranch-style that sat on a hill overlooking 40 acres of thriving coffee and banana plantations.  In the mornings the maids opened the doors and windows to invite the warm light and melodic African countryside inside.  I was cooked three meals a day of traditional Ugandan fair, a culinary style heavy on goat meat and starches such as Kasava (like a bland potato) and Matooke (an unsweetened mashed banana).

Walking through Madame Amelia’s plantation in Mpigi, Uganda

Although English is the official language, Ugandans living outside of Kampala are much more comfortable speaking one of their native dialects.  Most of my interviews took place with the accompaniment of Bashir (an MC by night and Twezimbe’s Media and PR Officer by day) to translate.  After seeing him perform as a 17 year old MC, Madame was so impressed with his skills that she took him on as a protégé, financing his secondary and university educations and hiring him to work for Twezimbe.  Bashir’s translation skills became essential to completing my work.  He used his MC prowess to warm up the audiences and win over any detractors.  He translated quickly and succinctly, taking diplomatic liberties when his intuition directed.  His verbal agility allowed me to react swiftly and improvise rather than progress down a canned line of questions.   With him as my voice, I was filled with confidence knowing that any stumble or stutter on my part would pass as charisma.

Each morning Bashir and the Twezimbe field offices planned out a full day of meetings with youth groups and health centers.  At 9 AM we’d hop in the Twezimbe 4×4 truck and race across Mpigi’s back roads at the speed of a Dakar Rally competitor.  Our driver Omar claimed to have picked up his appetite for alacrity after seven years of keeping up with Madame’s dizzying political schedule.  My daily routine started to feel like that of a politician’s, with debriefings between events and waving crowds from those who recognized the Twezimbe truck for its ties to Madame.

Me with a village of brick makers

Although the various groups I met with were unique and suffered their own diverse set of challenges, some themes were all too common among the community.  I’ll try to highlight a few of these themes below:

Inadequate Education:

Lack of free and compulsory secondary education has forced many youth to drop out of school.  With little to no skills, these youth are condemned to a life of dangerous, menial work such as bodaboda (motorcycle taxi) driving or brick making.  School dropouts are at higher risk for STIs such as Gonorrhea and HIV.  Young females are at higher risk for teen pregnancy and marriage.  In fact education is considered foundational for reducing population growth, with female literacy and job participation widely considered to be decisive factors in reducing high fertility rates.

Archaic curriculums and lack of career guidance has ill-prepared many youth for the Ugandan job market.  Based on the British education system and basically unaltered since the 1960’s, the Ugandan school curriculum is too theoretical, training millions of youth for white-collar jobs that don’t exist.  There is a push to emphasize vocational skills and entrepreneurship, training youth to be job creators instead of job seekers.  Unfortunately lack of career guidance has left most youth without any idea which vocations are worth their time and how to go about pursuing them.

Mpigi youth financially unable to attend school, now working as sand miners

Isolation & Fragmentation:

Lack of transportation and Internet has isolated people in the rural communities, preventing expertise sharing and access to wider markets.  This has made it difficult for people to know which jobs, services, and products are in most demand.  One of the most heartbreaking mistakes many make is to sell their land with the belief that life in the city or in some other profession offers more hope.  Agriculture is the backbone of the Ugandan economy, and land here is among the most fertile in the entire world.  It is said that if you have land, you will never starve.  With better guidance on farming techniques, information on crop demands, and access to markets, many farmers could exponentially improve their profits.

Lack of Access to Capital:

Most youth would like to start their own business or get into farming but lack the capital to begin.  As poor individuals, traditional banks and lenders consider them unserviceable.  Microfinance was designed specifically for the poor, offering loans and banking on a small scale.  Due to lack of education, Internet, and transportation, youth are not sure how to access these lenders.

Inadequate Public Health:

With poor health both a cause and consequence of poverty, it is hard to imagine any transformative change taking place in Mpigi until the large incidences of HIV, Malaria, malnutrition, and teen pregnancy are remedied.  As preventable challenges, careful planning and coordination on the part of the government could greatly curb these issues.  Yet a few hours spent in Mpigi will reveal that public health care falls far short of need.

Public health centers in Mpigi, although free of charge to residents, are few in number, and suffer massive medication and staff shortages.  Waiting rooms are insufficient and easily overflow.  Inadequate resources hamstring health education, with insufficient and ununiformed outreach to schools and communities.  Because of lack of transportation, simply getting to a health center is a major challenge.  All of these factors have led to poor health-seeking behavior among Mpigi youth.  Many delay treatment until the later stages of their ailment when treatment becomes more costly and complicated.  Additionally, despite growing awareness, contraception use is still misunderstood and questioned.

Madame Amelia and I

I couldn’t help but think that most of these challenges were only consequences of some deeper issue.  My intuition tells me that so much of the blame lays on the government, that their corruption is stymying the development of infrastructure and public institutions that would help evenly distribute Uganda’s growing wealth.  I also wonder how much good large western aid organizations can do if they are ultimately working through the government and its agents.  Is it possible that they are perpetuating corruption and helping to sustain the status quo?  A little time spent in Kampala will reveal that Western NGOs occupy the richest neighborhoods and pay some of the heftiest salaries in the entire country.  This can’t be efficient use of resources.

Maybe the answer to transformative change is through small, grassroots organizations such as Twezimbe, with their micro-level, piecemeal interventions.  Their size allows them greater flexibility, accountability, and community buy-in.   They don’t seek broad stroke changes, rather simple, observable and direct objectives: lobbying for a power line to an isolated strip of homes, providing new hoes for a farming cooperative, building a maternity ward in a health center that sees more than 80 births a month.  But of course the question of scale comes up, Mpigi is just one small district in an entire Sub-Saharan region facing similar issues.  In the end I am reminded that if there’s anything to be sure of, it’s that I’m not sure of anything.  All I can do is keep an open mind and continue to learn.