HIV Prevention 101

Post by Nicole

Today is the day I give my first HIV prevention presentation.  Of course, there are a few logistical matters to handle before I get my program underway.  The reason behind my visit was that the first 68 children we had placed at the vocational boarding school 10 days ago were due for a monitoring visit, and we were bringing an additional 37 kids.  This second group was a result of my organizations hard work: scouting for eligible candidates in targeted neighborhoods, and resolving issues that had previously prevented many of the children from placement, such as employers who initially refused to let their child laborer go. 

The morning started out as an instant replay of last week.  We arrived at the police barracks where the children were eagerly waiting for us to take them to the school.  However, word must have spread that we were coming and there were an additional 10 kids than expected, packed and ready to go.  These sly youth had never been interviewed by our field staff and were plainly trying to sneak onto the bus.  Worse yet, some didn’t fit our age criteria while others had been brought from outside our targeted communities.  We didn’t know what to do because while these children undoubtedly are vulnerable (one criterion for acceptance to the program), they did not fit the rest of the characteristics and we must maintain the very strict condition set by our donors for purposes of accountability.  If it is later discovered that we accepted children who do not fit the age requirement, or are not domestic workers (though fit all the other criteria) we run into issues of project credibility. 

Once we resolved the confusion of the magically appearing kids, and some arguring, the staff and I took the names of the additional kids and will have a meeting with senior management to figure out a way to accommodate these children.  We clearly all felt strongly about this heartbreaking issue and want to help them.  We shall see what comes of it…

Children and mattresses board the "school bus"

Off we went on our two-hour ride to Jinja with the prescribed 37 kids.   When we arrived one colleague registered the new kids while another gathered the kids we placed last week for my lecture.  In total about 70 teens, boys and girls, were present.  They were so excited and enthusiastic.  Several wanted to hug me before the lecture even started.  I’m still not sure if they were enthralled by my white skin or just thirsty for knowledge.  Probably, some just wanted to feel cool that they were friendly with a muzungu.

I started my lecture by asking for volunteers to define HIV and AIDS and was impressed by the audience participation.  I had a staff member help translate as English is only one of many languages spoken by the students.  Surprisingly the language barrier wasn’t as much of a problem as I had expected.  Things were off to a great start.  Until my intern colleague approached me and whispered that the warden told him I should not talk about condoms and instead only discuss abstinence.  Not this issue again, I thought.  The school is funded by Evangelical Christians and I anticipated such a problem, but I was assured the topic of condom use and safe sex was fair game by the school’s director weeks ago.  I had also consulted with members of my NGO who offered the same advice.  Clearly there are differing opinions within this institution. 

Action shot: me giving the lecture to the students in their classroom

Let me back up for a moment, a little history if I may.  Uganda was on the forefront of combating the AIDS epidemic in the late 80’s and early 90’s.  While other African presidents were denying the problem or offering false information, Musevini has been praised for immediate and effective prevention strategies (which included distribution of millions of condoms and education on how to use them).  As a result, the HIV rates dropped.  They are now sadly on the rise again, with heterosexual females being the most rapidly growing group to be infected.  While the exact numbers are unknown, it is estimated the 10% of the urban Ugandan population is HIV positive.  The rates are slightly lower in rural areas.

Given this trend and my prepared curriculum of condoms and bananas for a demonstration I decided, with the support of the Director (who’s decisions technically trumps the Warden’s) and my NGO counterpart, to go forward with the program.  I feel it is morally wrong to withhold information from inquiring teenagers.  My counterpart and I we agreed that if the kids ask about condoms we would answer honestly.  I was very cautious with my answers.  I stressed that they are too young to be having sex, maybe I said some things that scared the heck out of them regarding the potential of sex jeopardizing their futures, but I believe they need the whole truth.  Finally, a student—bless him!—asked about condoms and I took the opportunity and ran with it.  They were full of excellent questions and seemed to hang on my every word.  And then I broke out the banana.  The class went wild, roaring with laughter and jumping up and down.  Fearing our potential misdemeanor, my colleague and I shushed the kids and did a quick banana-condom presentation, hoping that the warden wasn’t nearby.   

I felt slightly vindicated about my decision to speak to the class honestly when my colleague told me that last year one of the students sent to the school through our NGO got pregnant while there and was forced to leave.  After the session was over many kids came up to thank me.  I handed out teen-focused newspapers produced by a Ugandan NGO called Straight Talk, which the kids went crazy for.  I realized that with kids at this age the Internet becomes a fountain of information, for good or for bad, but these kids only have the little information they get from friends, relatives, and teachers (if they were fortunate enough to have attended school).  Handing out these Straight Talk publications, it seemed as if they were made of gold by the way the kids expressed such a desire to own an issue.  I regretted not bringing more educational handouts.

We also evaluated their progress at school and asked them to tell us what challenges they are facing.  The first thing that came up was the lack of sanitary pads for the girls, and lack o mosquito nets.  Many were sharing cups and bowls with other students.  They don’t have enough pens or paper.  And, some of the kids have been stealing things from other kids.

Still, when asked if they are happy, all replied with an enthusiastic YES.  They are learning a lot, the teachers are good, and they are hopeful that this education will help them in the future.

As I had expected, my little buddy Derrick found me the minute I arrived.  We took a walk and he told me that he loves school and has chosen the catering and hotel management track.  He promises to work really hard in the courses.  He then told me a bit about his background.  His father died many years ago and Derrick was not able to go to the funeral or ever get information about his father’s death since it happened in the city and he was living in the countryside.  His mother eventually had to move to the city with her children to find work and has been supporting the entire family on her modest police officer salary (71 USD/month).  Some of the money is sent back to the village to support extended family members.  Even though he performed well at school, he wasn’t able to finish secondary school, as his mother’s meager wages just weren’t enough for all the children’s school fees.  He said that he feels blessed to have been chosen for this program and promises not to waste this opportunity.  He hopes to get a job in a hotel so that he can earn a better income and help his mother and younger brothers. 

What an incredible feeling to be part of an organization that is truly changing the lives of children.

"Up Country"

Post by Josh

I keep hearing about traveling “up country.”  It’s where the work of my organization is done, they have two field offices “up country.”  Land rights became a bigger issue after the turmoil that occurred “up country” back in 1996-2006 and we are trying to create peace, harmony, and justice there.  I’ve also heard that it is just gorgeous there, where?….”up country.”

On Tuesday, I left for the greener parts of Uganda (yeah, yeah “up country”), with two staff members from my NGO and representatives from nine other NGOs.  This is supposed to be a learning trip for other organizations whose mission overlaps with ours in the realms of land rights and/or women’s issues.  The idea is that the other participants learn what my org is doing and more about the laws governing land rights.  Because the customary laws—rules within the clans—and the new Land Act have had little time to coexist, the real governing authority is not clear.  As these organizations are well familiar with, people start to act on their volition and take whatever they feel they can have.  Victims do not know where to turn to and the organizations deployed to help may also be jaded by all the wrong ideas that are consistently followed.  Hopefully they will learn something from my organization which is on the leading edge of land rights knowledge in the country.  The second fold of the trip involves one of our donor organizations.  They also donate to the other organizations represented and this is an opportunity for them to see the work we are performing in the field and also speak with some of their other grant recipients.

The trip up was smooth, which is a big deal in Uganda.  In Uganda, people either say the roads are very bad or the roads are very good, fortunately, this road was the latter.  It even had lines, yellow ones and white ones, but still one way in each direction.  The road took us over a pretty fast moving part of the River Nile and then past some baboons hangin’ on the roadside.  There were also many people hangin’ on the roadside.  Just one of those moments I realized that we are not so far off from our monkey friends.  Just six years ago, the only way to travel in these parts was with a convoy of about a 100 cars and army vehicles situated in the front, midddle, and back.  Cars would wait by the Nile crossing until enough amassed and then make the trip, fast, and without stopping.

Tuesday’s main attraction was a visit to a property belonging to the Mwa Otira Tok clan.  This is a clan that is over 900,000 strong, at least that was the reported number of registered voters in their last election, a fact I learned while sitting next to the elected Chief on our way back—that’s right, I sat next to a Clan Chief!  The 70 or so at this meeting were just a tiny sample of the population.  We caravanned into their property in two white vans, a pickup truck, and a Land Rover.  Our reception was load, and proud.  I experienced, for the first time, African women singing (for lack of a better word) in a high pitched way: lalalalalalalala.  One woman came up to shake our hands while kneeling before each one of us.  Obviously, this organization has done something good here.

Hail to the Clan Chief

While we were sitting in a small patch of property beneath a thick old tree whose branches fingered out and above us to add much needed shade from the hot Up Country sun, I observed the skin of the clan people.  It was rough and beaten: much different than my own and that of the other NGO workers in attendance.  The people here don’t work in the city.  Instead they spend their whole life working the fields and outdoors, under the sun.  Many were barefoot and their feet had a whole layer of collouse that my delicate feet do not obtain.  The women all bend at the hip and waist, and fold over like a jackknife.  The grandma seated next to me would get up by first standing, then her hands leave the ground once her legs are straight, then unfolding to an upright position, 

NGO workers mix with the Mwa Otira Tok clan 

My organization has helped this clan in two ways: education through teaching the laws and rules around land rights, and boundary trees.  Boundary trees are a certain type of cheap, easily acquired tree that can be rooted in the ground.  When planted close together like in the picture below it is hard to remove and clearly demarcates the land boarder.  

Boundary trees keep a kid goat from grazing on the neighbor's land

We brought treats of biscuits and soda for those in attendance.  At first I didn’t feel good about giving these treats out, it almost seemed like bribery and a poor use of donor funds, but people flocked to get their “reward” for meeting with us.  The clan chiefs asked us if we had extra notebooks (cost: less than 50 cents).  We did and they were very grateful.  Some things just don’t make sense, I understand that income for clan members is low and a soda seems like a great treat, but when the better-dressed clan chief asks if he could have a 50 cent notebook, I am perplexed. 

As things wrapped up and people were mingling, one of the grandmas got my attention and asked me if there was any more soda.  She asked in her native tongue and after much back-and-forth and some help by one of the younger men I understood that she didn’t get a soda.  I ran back to the cars but the truck with the sodas had left to pick up more program participants.  I went into our van and grabbed a juicebox, you remember, the kind that used to get packed with school lunch every day.  Apple black current.  I brought it to her and, figuring the wrapper and straw might present a problem, opened it for her.  The site of grandma sipping out of a juicebox made others around laugh and made her very, very happy.

Day 2 Up Country

Today was a grueling day of presentations by all the other NGO representatives.  Some were better than others.  There was quite a bit of overlap in the work they all do.  This was mainly an informative session, and not a sharing of ideas on how to benefit from each other’s advances in the field.

Tomorrow it’s back in the field as we visit more people that we have helped in the past. 

To date, the coolest cane I've seen.

Give a Man a Fish

The other night, perhaps It’s best to say the other week (sorry for the inactivity), the eve of Yom Kippur, we met with the other AJWS volunteers and ended up discussing the issue of aid in Uganda and the overall developing world. 

The main question at play was who are the donor organizations looking out for: the person/people in need of help and an improved way of life, the NGO receiving the grant, or themselves—the institute giving the funds?   There are many different sides to this question, we mainly focused on the unintended consequences of NGO work.  In a country where an office complex could have nothing but NGOs, the initial thinking is that things are much better off than they were 10 or 20 years ago, aren’t they?

Walking around Ntinda (pronounced in a fashion where the first letter is hardly but a half humming sound of N), the neighborhood in which we live, in you can’t help but notice signs on top of signs representing the different NGOs.  There are basically office parks that are seemingly NGO incubators.  And they are everywhere.  NGOs that build sanitary latrines, NGOs that focus on Malaria, African empowerment, women lawyers, children with disabilities, HIV, orphans, and tuberculosis, to name a few.  It would be great that, in the land of NGOs, much like say, Silicon Valley, the NGO industry were streamlined and adept at attacking the issues each organization faces.  Instead, there are conflicting ideas of how to battle the issues, money spent on monitoring how money is spent, and other inefficiencies that plague these local NGOs.  The ideal is still a distant dream.  The large bodies of water separating the funding from the organization does not aid in a solution either.

Who runs the NGO?

Who is dictating what to build?  What will a particular program do?  One side says to empower the community to decide how to use donor money; allow the community to choose a new toilet manufacturer.  Others believe that the NGO should decide the best program for battling hunger, for example.  Still there are yet others who think that the West has the best perspective and knows the efficient way to have their money spent.  The latter is not a view held by locals here. 

Example of a bad Idea: create a cheap shoe and market it to Whole Foods customers.  The purchase of one pair of these shoes will be matched by the company and another pair of shoes will be given to a shoeless child in Africa. 

                                       

The Unintended Consequence: Boy receives free shoes and after 4-6 months of wearing said shoes they are worn through, or he has grown out of them.  He cannot find another pair of free shoes and his calluses that once protected his feet are gone.  He cuts his feet when walking barefoot again, risking infection.  Worse yet, the free shoes have corrupted the local market and the shoemaker must now fight with free footwear, which is a losing battle.

Example of a Good Idea: Fund the treatment for AIDS and subsidize the cocktail of antiviral drugs that combat AIDS and HIV. 

When approaching the complexities of a seemingly good idea, there more evident it becomes that there isn’t always a wrong or right answer.  The stakeholders with the best perspectives are ever changing and vary from issue to issue.  One thing we learned for sure—nothing is ever simple.

Monitoring and Evaluation

One catch phrase I can’t seem to get away from hearing is M&E.  At first I thought it was something particular with my NGO, but it is synonymous with many.  Monitoring and evaluation at my NGO takes place every quarter.  It is three days long and all staff drops everything to report on….well, everything.  Each staff member has spent a few days putting their presentation together and will spend a few more after the meetings putting together a follow up report.  With all this time spent reporting on work, I can’t help but think how much other work could be completed? 

M&E  is a direct result of the funding sources.  The NGO needs to report to the donor so the donor can then report to their constituencies all the good that their money is being used for.  But that “good” doesn’t happen in a quarter, and maybe not even in a year.  With staffing an issue for many NGOs they need all the time and effort from their staff to go directly toward that cause.  One of the donors who funds my organization requested each receipt tied to their grant money be scanned and e-mailed.  More of an accountability concern for that organization, yes, but it takes a lot of time to scan 15-20-50 receipts on the type of scanner that the NGO can afford. 

A side note before I move on.  I mentioned above that staffing is an issue.  A perfect example would be Candidate #4 (see blog entry 12 October, 2011).  After extending an offer and him coming to the office to view the contract, he retracted his acceptation.  We are not going back to Candidate #3 because my colleagues agreed he was not the right man for the job.  So now we need to start the process all over again.  Staffing is an issue and not easy to find the right person.

                                                                                                                        

Money Well Spent?

The other morning on the radio’s call in program, a caller said that if the funds spent by the West researching the problems in Africa were given to the country in need, then it would be a better use of the funds.  With so many problems/issues facing the developing world, it seems more money might be the solution, but of course the answer is not that simple.  Funds are best spent setting up systems that can then be supported by the local community on their own.  Any solution that ceases to be a solution when financial aid halts is merely a very expensive band-aid.