Day Four - Ruhira, Uganda

The day starts at the Ruhira health clinic. We get to this health clinic up the same windy dirt road we took yesterday. At parts of this drive the view is breathtaking looking both ways on top of a ridge into fertile valleys of banana trees and a scattering of dirt huts. The irony is that if this land were in America, it would be prime real estate.

The health clinic consists of two buildings, one for examinations and deliveries and the other for lab tests. The doctor who shows us around is very professional and kind, introducing his staff of midwives and nurses. He is the only doctor at this clinic. To say that supplies are lacking is an understatement. There are a few beds with some old bed nets hanging over them. In the medicine room, there is a limited supply of anti-malaria meds, ARVs (used to treat HIV/AIDS), and other drugs that I don't recognize. The lab room technician is a woman and explains how she runs crucial tests for Malaria, HIV, and other blood diseases. There is no electricity or running water. I think this is as basic a health facility as you can get. Some community health workers are present at the clinic today. They work with local clinics like this one to refer patients to come in when extra care is needed. Dr. Martin, the only surgeon in the area, explained that CHWs alleviate the work of the clinics because they are able to go out into the community and deliver medical care. In essence, CHWs create a mobile health care system for people who may not have access to the clinics.

Next, we ventured out into the village, again to tag along with two community health workers as they make some of their house rounds. At the first house, the woman had six children and the female CHW went over her family planning, birth control options- condoms, pills, etc... She does this with use of her training manual, which has drawings depicting all of these options. After some discussion (in Ugandan) she chooses birth control pills. The CHW pulls out of her FEED Health backpack a pack of pills that will last the woman for three months. This is an amazing exchange on many levels. Firstly, that in the middle of rural Uganda, women are getting birth control, and secondly, that a CHW, a village peer, has been empowered to give this woman the information and care she deserves. With this help, perhaps women will have fewer children in the village, and the children they do have will be better cared for, better educated, and better fed.

At the second house we visit there were two older women, one grandmother and one mother, with five little ones. The kids are all covered in dirt, and sitting side by side in a little bench outside their hut. The amazing thing is that they are all silent and obedient. Perhaps we were such a spectacle to them (as I'm sure we were with white skin, clean clothes, and a camera) that they thought it best to just quietly take in the moment. The Community Health Worker brought out her manual and started talking to the mothers about good hygiene practices. It was all very orderly and official.

In between houses, a gathering of children would inevitably gather into a curious gang of onlookers. One little girl, maybe 4 years old, wearing a green dress was holding her sleeping brother on her back. The boy must have been half her age, and yet she was entrusted to take care of him She shifted and buckled under the weight on her back. One thing I love to do with kids is to take their picture with my digital camera and then show them their images. They love it, and gradually become more comfortable with me until there is practically a laughing mob of kids surrounding me. I used to bring with me on trips a Polaroid camera, which I would use to take pictures and hand out as a keepsake for people I met on my travels. Most of the time this is the only picture they have to keep of themselves. Polaroid has since gone out of business, so film is hard to come by. And kids, once they realize they get to keep the pictures, start grabbing them right as they come out of the camera. Chaos ensues...