Student Ethnography Projects 2007

Download the 2007 "last letter home" projects here.

Student Ethnography Projects 2006

People Making a Difference in Uganda: Twesigomwe Alan Paton

I met Ugandan medical student Alan Twesigomwe while driving down a rough Kampala road. We were on our way to a remote home outside Kampala to treat a young female cancer patient. On the way to the home, our Hospice Uganda colleagues told us that the patient had basal cell carcinoma; as usual, we were on our way to monitor the patient's care and administer medicine. We leisurely spoke on our way to the home because I did not have many questions on the patient; carcinoma is just another word for skin cancer. When we arrived, however, I was shocked by what I saw.

The small shack we entered was completely dark; at first, I could not even see the patient. I only heard a faint whimpering. When the nurse propped the door open to let light in, her. She was a small albino girl with an open, bleeding tumor bulging from the left side of her face. Before I knew it my heart was racing and I felt like I couldn't breathe. I had never seen anything so grotesque in my life. I could barely look at her for the first few minutes we were there. Alan, however, amazed me. Never having seen this patient before either, he embraced her with compassion. He examined and interviewed her completely attentive and sympathetic. Once we left he spoke of his concern for the patient; her mother was indifferent to her impending death and her father had left, believing she wasn't his child. His selfless nature and true concern showed me that he would be one of those unique, remarkable people whose friendship will affect me forever.

Alan was raised in the small town of Kabale in Western Uganda. His father had three wives, his mother the third. He has seven siblings, two older sisters and five younger brothers. By the time he reached the six level of secondary school, he had the best test scores in his district in physics, chemistry, biology, and math. He is now a fourth year medical student at Makerere University, doing a palliative care rotation at Hospice Africa Uganda in Kampala. Alan states that he truly appreciates the work Hospice does because it approaches the "patient as a whole". He says that in general, medical care in Uganda is "emotionless" and he desires a real relationship with his future patients, one that encompasses the emotional, physical, and spiritual aspects of disease. He wants to look at patients differently than other doctors, but also wants patients to see doctors in a different, more personable light, thereby increasing the quality of medical care in Uganda. His main goal is to serve others through medicine, knowing only good can come of kindness. For his future plans Alan hopes to get his Master's degree in Pediatrics and open a large children's clinic in Kampala. He dreams of a place that offers comprehensive health care services at affordable prices. He additionally hopes to increase the quality of geriatric care for Ugandans, especially the terminally ill. He also dreams of a community health center for the elderly in order to provide them with better care.

When asked about his role model, Alan sings praises for his mother: "She taught me to push through hard situations, use my resources to the max, and how to be happy with who I am and what I have." In this spirit, Alan plans to stay and practice medicine in Kampala. He describes health conditions in Kampala as "terrible", citing the lack of technology, poor sanitation, and corruption within the administration. Life is pressured as a doctor in Uganda, but he plans to stay and "take care of the patients' problems as much as [he] can".

Hospice Africa Uganda is a Non-Governmental Organization founded in 1993 in order to function as a model in palliative care for similar sites in sub-Saharan Africa. It has three main objectives. First, Hospice provides palliative, home-based medical care to patients and families living with 20 km of Kampala. Second, it provides educational programs in palliative care at both undergraduate and postgraduate levels to health care workers throughout Uganda. Finally, it also provides training for those willing to begin additional hospice organizations throughout Africa. Hospice aims to relieve the suffering of patients and families during terminal illness through both medical and psychological therapy. Volunteer activities include going on home visits, working in the on-site clinic and pharmacy, attending classes and meetings, and helping with various administrative tasks. As a volunteer at Hospice, one truly experiences all the aspects of palliative care.

When I think of the work I did at hospice, I remember this quote by epidemiologist Dr. J. P. Muliyil: "How can I understand a figure or a statistic unless I have held the hand that it represents? The people we are talking about are the same as us". Working at Hospice introduced to me both the state of the patient and healthcare worker in Uganda. I learned that the desperation of Africa we hear about in books and the news is not just an abstract idea, but a reality. The conditions under which these people live are truly indescribable. The genuine dedication and compassion however, that the Hospice staff demonstrated was an inspiration. I was also incredibly impressed by the community in which these workers live. The honest manner in which they love one another greatly enhances quality of their work and their lives. This trip significantly increased my interest and passion for medicine; I know that I will continue to pursue this field and dedicate my life to serving others in this way.

It is nearly impossible to see cancer, AIDS, and infectious disease patients suffering in Uganda and not believe that health is a human right. There many days I fought off tears when seeing small children with Burkitt's lymphoma, a type of cancer caused by a virus found in dirty water. These children did nothing wrong, made no negative lifestyle choice, and in no way deserve to die. It is their inherent human right to have access to both proper water and proper medication. With people like Alan and western volunteers working to better the future of Uganda, I am hopeful that one day the people of East Africa will know this to be truth.

Contact info:
Twesigomwe Alan Paton
alandpaton@yahoo.com

Post-Trip Final Project - "Individuals Making a Difference in Kampala"

During my stay at Hospice Africa Uganda, I met one of the most intelligent and insightful people that I've ever encountered. Enock Kibuuka, a twenty-one year old student at Hospice, was a fellow volunteer and constant companion. Enock has been working at Hospice for several months, primarily working with clients in the day care facilities, as well as doing inventory and pharmacy work. He is very adamant about his volunteer work. When his summer vacation came about, he was presented with two choices: remain idle and waste both his time and talent, or utilize his skills and boundless energy for the greater good. Enock was introduced to Hospice by a friend of his and was very impressed by the facilities and staff. He said he was eager to "gain experience in associating and helping clients through the counseling classes as well as basic skills with inventory and the computer." The aspect of Hospice that stood out most to Enock was that it offered the clients "care in all ways: medical, social, and holistically. They see the client as a real person as opposed to just a file" Enock has really enjoyed interacting with the clients themselves and being able to relate to them better through the classes offered at Hospice. Although, like all volunteers, Enock is not getting paid, he chose to give his time to Hospice and "must stick to my promise to volunteer. I made a decision to spend my time at Hospice and I must remain until I go back to school" Enock will be attending Kyambogo University in the fall, but does not think he will abandon Hospice entirely. "I will always respond to the call of Hospice for anything they might need," stated Enock, a testament to his unfaltering loyalty and admirable integrity.

The Site

Hospice Africa Uganda was established in 1993 with three main goals: "1) To provide a palliative care service to patients and families, within a 20km radius of Hospice and to promote this care throughout Uganda. 2) To carry out education programs in palliative medicine, to health professionals at undergraduate and postgraduate levels throughout Uganda so that this form of care can be available to all in need. 3) To encourage the initiation/consolidation of palliative care in other African countries, by providing a facility at Hospice Uganda for training, and experience of palliative care working in the African context" As Enock mentioned, Hospice cares for patients in "all ways: medical, social, and holistically" Indeed, clients of Hospice Uganda are treated in a number of ways. Medically, many clients receive liquid morphine as well as several other drugs to help them deal with their pain. On many of the home visits, during which the clients are given a check-up and their medications, a social worker is present to assist people with the social stigmas of their condition as well as any other counseling they might need. Holistically, the patients have access to aromatherapy and reflexology treatments during a weekly daycare that is held at Hospice itself. In addition to the services offered to the clients, Hospice has a wide selection of classes and informational sessions to teach working professionals of the various facets of palliative care. Students range in professions from social worker to nurse to priest.

"What I learned:"

Nearly everyday during my stay at Hospice, I was allowed to attend the home visits that the doctors and nurses went on in the area of Kampala. This was a rare and valuable opportunity to not only interact with the clients themselves and develop a deeper understanding of their condition, but to see the city of Kampala extensively as we traveled from house to house. When I was not on home visits, however, I was grateful to be working alongside Enock. We frequently did inventory of the Hospice facilities together in addition to several other jobs around the workplace. I greatly enjoyed talking with Enock as we worked together, discussing a wide variety of topics and hearing new perspectives in an alternative cultural setting. One of the most significant of these conversations was concerning our free time. Enock could have done a number of things with all the free time of his summer vacation, but he chose to work for free at Hospice Uganda. The last thing Enock wanted to do with his time was to remain idle: "When you are idle, your mind begins to wander and you become mixed up. This can lead to committing crimes or drug use. When you are idle, you can find yourself in danger" Enock is, seemingly, never idle or wasting his time as he is constantly reading, learning new things, or even drafting constitutions for new Non-governmental Organizations, like Hospice. Over the course of my work period, Enock taught me that time is truly a gift and should be utilized to the best of our ability. We are given only a short amount of time on earth and to waste that time being idle is a terrible thing. Whether it be expanding your mind through education or helping your community through volunteer work, using your time wisely and making your life count is of the utmost importance.

Global Health and Human Rights

Enock taught me a valuable lesson in the importance of using one's time wisely and avoiding the dangers of idleness. In this world, there is a large disparity between those who have the free time to pursue their interests and those that have to fight everyday to survive. Enock was one the few Ugandans blessed with what one can call "free time." He chose to utilize that time to help his community by volunteering at Hospice. If someone is, as many of us are, fortunate enough to have spare time in our day, they should use that time to volunteer and give something back to the world. This can come in many forms, but volunteering in health care services is not only educational, but also immensely helpful and worthwhile. As humans, we are afforded certain rights, whether they be political, spiritual, or otherwise. One such right must be to live a happy and healthy life with ample access to medical services. This is a right that, although globally relevant, is not globally present. With all the free time that people have in developed nations, we must strive to use that time wisely by promoting the basic human right that is health.

Contact Information
Enock Kibuuka
KibuukaEnock@yahoo.com
0712-29-50-25
Kyambogo University
PO Box 1 Kyambogo
Uganda

Hospice Africa Uganda
educ@hospiceafrica.or.ug
hnakanyike@hospiceafrica.or.ug
www.hospiceafrica.or.ug
+256 41 266867/510089
+256 392 766867
+256 41 510087 (fax)
PO Box 7757, Makindye
Kampala, Uganda

Patients at Clinic

The Naguru Health Center is a surprisingly big clinic, by third world standards, located in Kampala, Uganda. The clinic offers a variety of services like maternity, family planning, antenatal/postnatal care, free immunization, STD testing and counseling, HIV counseling and testing, free ARVs, PMTCT, T.B. diagnosis and treatment, and a laboratory. The center also has a small pediatric ward. The most unique part of the Naguru Health Center is the Teenage Center. The Teenage Center provides services for teens with an emphasis on STD care and education. The main point of the Teenage Center is to make it so that teens feel more comfortable visiting the doctor for issues that they would otherwise feel embarrassed or shy about seeking treatment and education for. The clinic is mostly run by nurses with very few doctors on staff. The staff at Naguru is a very lively and dedicated one with tons of patience and a very altruistic view on life.

Dennis Bukenya

The moment I met Dennis, I knew there was something uniquely special about him. The warmth that radiated from his smile and the easiness with which he struck up great conversation was beyond welcoming. I first met Dennis at the Teenage Center of Naguru Health Center where he works as a data clerk and greets patients with that priceless smile of his. Dennis started at the Teen Center as a volunteer but after 9 months, he loved working there so much that he began looking for a permanent position there. According to the staff, Denis is great at his job, but data clerking and greeting is not all that Dennis does at the clinic. Dennis also leads discussions in the teen clinic (to educate teens on STDs and how to best take care of themselves) and started a club, which he leads, called NTCC.

Dennis leading discussion at an NTCC meeting

Dennis started NTCC (Naguru Teen Center Club) because he believed that a club would be the best way to ensure that young people get the information as well as the support they need." The Goals and Vision of the Club are:

1. Help Vulnerable people by conducting home visits for patients and doing things like washing clothes for them"
2. Give teens the opportunity to share their experiences
3. Give teens opportunities for exploration and recognition of their talents.

I had the privilege of sitting in on one of the weekly meeting for NTCC. The meeting was an absolute success, the teens were very eager to discuss the issue at hand and a wide range of views were expressed. After a friendly introduction and a great discussion, the teens had time to hang out with each other and play games which Dennis believes helps them better express themselves and their talents.

So what motivates this lively young man with a smile that never seems to quit? Dennis attributes his greatest inspiration to his family. Dennis is one of 3 boys and 2 girls. In 2001 Dennis' dad died of AIDS and his mom soon became sick as well. With his mom sick and on ARVs, Dennis replaced the father figure in his family and started taking care of his mother and other siblings. When I asked Dennis why he does what he does he was quick to reply, " I do it as part of memorializing my dad, because I saw the pain he was going through and don't want to see any of these kids suffer in the same way". Other spheres of influence In Dennis' life are TASO, the leading AIDS organization in Uganda where his dad got services and his mother continues to do so. Dennis says that the dedication he sees in the workers at TASO keeps him going. Dennis also gives big props to USAID and other humanitarian organizations that he's had an opportunity to work with in Uganda. "The differences these organizations make in the lives of HIV positive persons helps me believe that I can also do more to help."

Me and Dennis at his desk in the Teen Center

After spending a month at a clinic in Uganda, the connection between human rights and universal health care became a lot clearer. The lack of even the most basic health care and health care supplies for individuals was striking - that human beings were being denied the right to long healthy lives. To us, it was unbelievable that patients had to purchase their own gloves for a doctors examination and bring trash bags to lay on - yet this was every day routine necessary for the clinic to function. Interaction with the clinic staff and their patients reminded us of how beautifully human these individuals are and how much they too deserve the health care that we sometimes take for granted. The Teenage center also drove home the fact that, regardless of age, everyone should be accommodated for and supported in unique ways that help them best.

Maya Angelou once stated, "I don't believe an accident of birth makes people sisters or brothers. It makes them siblings, gives them mutuality of parentage. Sisterhood and brotherhood is a condition people have to work at" I experienced this "condition of sisterhood' for the first time in Uganda. Sisterhood is defined as an "association or unification of women in a common cause" ( http://dictionary.reference.com/search?q=sisterhood.) Often many consider sisterhood to be a bond only held by those who share common ancestry. However, at the Naguru Health Clinic sisterhood is a powerful component which allows the organization to run smoothly through this unification. The women working at this clinic join forces with a common passion of helping others. The women I worked with were Ochora Esther Amony, Namuleme Alexandria, and Florence Kizito Kitaka. These beautiful women come to the clinic with varying backgrounds and experiences yet are still able to create relationships so tightly knit that the workplace functions as a home. These three women take care of each other like family and laugh and share stories together as if best friends. They share when one has something the others lack and improvise when there is none to be had. Their personalities create a hard working, slightly competitive atmosphere, yet they have such a degree of respect for one another that the amount of work completed bears no judgment. Esther, Alex, and Florence 's bond creates a loving environment which they all enjoy their jobs.

The Stories Behind the Naguru Family

Ochora Esther Amony, also known as Esther (Es-ta), works with the other two women in the Prevention of Mother-to-Child Transmission of HIV/AIDS (PMTCT) section of the Naguru clinic. Her name comes from her Catholic religious ties because she was born on Good Friday. She was born from a very primitive tribal group, the Karamojong, during a time where Northeast Uganda was in war. Esther spent her early days fetching water, digging in the garden, collecting firewood and taking care of the younger children in the family all while trying to gain a sound foundation for her education. She speaks of these activities not as chores, but simply characteristics of living in the village. The village lacked the facilities for Esther to be able to pursue her fondness for sciences; therefore, she was forced to move to Kampala for senior 5 and 6 (equivalent to upper-class high school) in order to have a chance at getting a job in this field. This event demonstrates one of Esther's greatest characteristics: determination. This trait along with her strong passion to help others directed her to become the secretary for the Red Cross Association throughout her school years. She adopted the attitude that the way to achieve is to keep yourself active, and did this largely through volunteer work. This allowed her to feel a part of the community and invited important executives to talk to her. Today, she works at the Naguru Health Clinic to change the stigma of people with HIV. She states, "You can't hide from HIV. There are many people that have it, and you must not point fingers, but instead learn to live" Her work in the PMTCT as a lab technician lets her use her determination to encourage as many people as possible to test for HIV/AIDS. When she feels lazy or is having a bad day, she often thinks to herself, "Maybe there is someone I can help, some baby's life which could be saved by giving the test and allowing the mother to know her status."

Alexandria also works in the PMTCT part of the Naguru Clinic. One of her greatest traits is her curiosity to continue learning. Alex started out her career as a Midwife and later went back to school for counseling. She will be returning to school this August for further learning. Her curiosity led her to counseling after long hours thinking about how other people have problems with no any way of opening up. She hopes to one day go to America to learn about the culture and further enhance her counseling knowledge. The embassy has denied her twice, but she does not want to give up. Even at five months pregnant with three children at home, Alex doesn't miss a day of work. The feeling that she has helped another person is what keeps her motivated while working at the clinic. If she feels as though she has failed to help another, she experiences setbacks. Alex states, "The only way I move forward is by knowing that I've done something."

Florence is the head nurse at the clinic. She acts as the older sister in the family and teaches the others about life lessons every day. There is a certain sense of nobility and wisdom which glows off Florence 's face. She comes from Fort Portal, a district of Western Uganda. When questioned why she chooses to be a midwife and if she enjoys what she does everyday, she replied, "I was trained for this job. Of course I enjoy it. Why would I ever be in a job which I do not enjoy? If you do not enjoy something you do you must change it" Her rational seems so logical, yet day after day people in other countries go to the same job which they hate when they are capable of getting other jobs. She believes that the money should not matter, but instead you should do what makes you happy. There is no rational in getting a lot of money if you cannot enjoy what you are doing. Florence likes everything about her job as head nurse: helping people, meeting people, and getting results. She states, "It's not just that I am there, but I am able to see the results, give the results, and help process with the patients" She continues to come back to her job for many years because she feels that she has a duty. "I'm expected to perform my duty. I'm punishing everyone else if I am not there and am no where to be found. I enjoy knowing that when I go to sleep I have a duty to do tomorrow. Therefore, I know that I am needed and I am useful to the nation" She believes that while this may be a different attitude of living, it is her own and she is not redundant, but useful. Tears rolled down her face when she spoke of her attitude about living. "Maybe it is just because I'm sick that I can live with this attitude. One day I hope to have a sponsor for my cataracts so I can see again."

The Site

The Naguru Health Clinic consists of a variety of different specialties designated by their distinct wings. It opened in 1968 by the Kampala Council Clinic. This is a government council which does the majority of the funding and pays all of the staff members. After the government council helped set up the clinic, the Women's International Maternity AID helped improve certain aspects of the clinic. Later, the clinic was again rehabilitated by the First Lady. Currently, the Center for Disease Control and the government council fund the entire clinic. It includes: a teenage center, a maternity wing, a pediatric ward, a general clinic, a laboratory, a pharmacy, and an AIDS testing area. The clinic gives off a relaxed feel as the patients wait completely tolerantly without any sense of rush or anxieties. All of the appointments and medicines at the clinic are completely free. The majority of my time was spent at the PMTCT clinic; therefore, I will go into further depth about this section of Naguru.

The Prevention of Mother-to-Child Transmission area is the newest addition to the Naguru Health Clinic. This area is currently in a temporary space. A large white tent covers the area which is filled by wooden benches over the dirt floors. Pregnant women anywhere from a few weeks to seven months find their way to these benches around 9:00 in the morning. After going through a registration process, which requires the women to fill out blue notebooks with their information, the women wait patiently until the counselors arrive. Normally around 10:00 Florence begins the counseling process for those who speak Luganda. Those who speak only English are sent into a sectioned off part of the tent to be counseled by Esther. In this counseling session, the nurses will question the women what they know about HIV/AIDS currently. From there they will check that each woman knows the exact process of how this disease can be transferred to their child. Therefore, the nurses explain the ways of preventing transference of the disease to the child through medication. The women are often asked to recite what the nurses have just said to ensure understanding.

The women return to the benches underneath the tent and wait for their name to be called. The nurses scream out names in large groups and watch the women enter the sectioned off portion of the tent as they wait in line for their blood to be drawn. Approximately 30-60 women and their partners visit the PMTCT area each day. Once all of the blood has been drawn Esther, the lab technician, begins to drop the blood onto the HIV tests. If the first test returns positive, the blood is then put onto a second test to confirm the results. If the second results are contradictory to the second the blood goes to a third test. Meanwhile, the women are waiting in the larger portion of the tent. Once all the results are final, the women return in groups to the sectioned off area for their post-results counseling. The nurse's first question what the women expect of the results. From there, they go on to explain the necessary procedures depending on whether the results were positive or negative.

The women at the site treat the patients at the clinic with the same respect as their coworkers. Once the post counseling results are given, the staff members walk to a small cafe near the parking lot of the clinic to eat lunch. They sit and eat their 1000 shillings (less than a dollar) lunch very contently while they share stories from the past and present without any sugarcoating. Often patients and visitors will come and join in on the lunches. There is no designated seating and it is not uncommon for the two groups intermingle. The clinic draws patients from all over Kampala and wishes to continue to expand their outreach.

What I Learned:

One day while working with Esther, Alexandria, and Florence, Sister Florence asked Alexandria to borrow 500 shillings so that she was able to buy fruit. Alex willingly gave her the money. Florence bought a small container of fruit from a local vendor near the clinic. When she returned, she gave me a toothpick so that I would be able to eat the fruit as well. I thanked her but stated that I had eaten breakfast earlier that day. She explained to me that she would take a piece and then I could take one. I said that she didn't need to do that and she could eat her fruit. Esther piped in from the background and said, "That's how we do it in Africa. You take one, I take one - we take care of each other. It is like a mother bird and its baby, whatever food they find they put right in the baby's mouth to make sure they get all the health and nourishment they can" After I listened to Esther explain about their culture, I became extremely amazed by the selflessness of these women. These women had not known me more than a few weeks and were willing to give and share with me as though I was a member of their family. I would love to say that I would have done the same thing in that situation, but I knew that would be a special occasion. I thought about how I took about a pack of gum earlier that day and how it hadn't even crossed my mind to ask the other women if they cared for a piece. I realized how our culture promotes competition, and thereby encourages every one for themselves. Our culture upholds the idea of natural selection - those who are unable to fend get left behind. I thought about the times someone had eaten my food at school and the frustration and anger which appeared. I never thought how another person was able to enjoy the food instead of me.

The next day I brought an energy bar which I had brought from home in America to the clinic. On this day, I broke the bar into three pieces - one for Esther, Alex, and Florence. While I had brought one granola bar for each day just in case I missed a meal, I enjoyed seeing the women eat the granola bar much more than I would have. I learned that day that their culture doesn't flourish off of competition and money like ours. But instead, the sisters who surrounded me value friendship. They do all that they can to help the people they love. And this is what makes them happy. It is not the oversized cars, the acres of land, or the computers and iPods. It is the friendships - the laughter and stories - with which they find happiness and choose to surround themselves. The women at the Naguru center have taught me the importance of creating strong bonds of friendship and treating those you love like family. Sisters are people who stay with you through the thick and thin. They've shown me that they can be Florence 's eyes when she cannot see. They've shown me that they will work twice as hard so Alex can stay home and take care of her sick children. And most of all they've shown me that it is not "things' that can make you laugh and put a smile on your face, it is your family, your sisters.

Before coming to Africa I valued the ability to work hard to get ahead in the world, i.e. get a good job and thereby not have to worry much about having enough money. My views on this have slightly changed. I still believe that working hard is a useful, significant quality. However, now I realize that almost everyone is preoccupied by money at some point and a good job will probably not change this. Many times, if people have a good deal of money, they continue to want more and more. Instead of valuing a good job because of its monetary rewards, working hard should allow one to choose a job that will reward with happiness. When comparing one job and another, it is important to weigh the time available with your friends and family and the people you will work with everyday. With this, I hope to live my life doing what I love as Esther, Florence, and Alex continue to do.

Also, I have realized the importance of spirituality and religion. My life experiences up to now have never led me in this direction. However, after working with women from all over Kampala and seeing the environment and communities some of them live in, I have reevaluated the significance of spirituality. One day while walking through one of the worst off districts outside the city, we walked into the church in the middle of the homes. The church was nothing more than large sticks, paper, and mud put together to allow some sort of seclusion. But it was not the church which I found interesting. It was the people inside the church. The large smiles on their faces and the singing and dancing that they did for about three hours. Even the children were able to participate in this long ritual. The energy reflected off each of their faces and poured throughout the church. It allows me to understand why some hold these strong religious beliefs. While I have never been much of I religious person, I now am more aware of the benefits of religion and spirituality and appreciate that sometimes the world can be falling down in front of your eyes, but there are still ways one can be happy.

Global Health and Human Rights

Sisterhood and strong friendships often mimic the relationships formed in families at a young age. However, HIV/AIDS is taking away the opportunity for many children to have exemplary relationships because they lack a family. Proper health care can prevent some of these broken families. If the opportunities for free testing and medicine for PMTCT could be available in all areas of the world, there would be a dramatic decrease in the amount of babies born with HIV. Why should one pregnant mother be denied the opportunity to make their baby's life a healthy life because they do not have the money to afford drugs or for transportation to get to a sponsored hospital? Joseph Amon speaks of the "fundamental dignity of each human being' with regards to not only the censorship of medicine but also the censorship of health information. These families break up because of the lack of proper medicine and information, therefore causing the overall health of an individual or family to suffer and puts one's life at risk. Health care needs to be universally available to protect these families and their right to a healthy life.

This risk of failing to live a healthy life will extend far past societies such as Naguru. As examined at the World AIDS conference in Toronto recently, "Everyone is at risk [to contract HIV]" When health care is not available to third world countries, the global health of the rest of the world is affected. Nelson Mandela states, "AIDS is no longer [just] a disease. It is a human rights issue." This is a human rights issue that needs to be taken care of immediately.

Contact Information:
Ochora Esther Amony
Mobile: 0772-937923
Florence Kizito Kitaka
P.O. Box 2484
Kampala, Uganda
Mobile: 0772-895008
*No email addresses currently available

References

Amon, Joseph. Preventing the Further Spread of HIV/AIDS: The Essential Role of Human Rights. World Report 2006.

Milcah Mubiru: Small Gestures, Big Impact

Milcah Nakayenga Mubiru is not the kind of person who loves to be in the spotlight. She is generally reserved and only speaks loudly when she calls the names of people waiting in line, outside of the dispensary. When she is with people she knows well, like her co-workers for example, she chats and jokes, and her true warmth shines through. When I asked her if I could do a profile on her, she laughed a little and did not really understand why I would pick her. She was too modest and humble to know that she was an amazing person who should be revered for the mountains of work she did every day and the great impact that she was making on the HIV/AIDS community in Kampala.

I worked closely with Milcah, basically the entire time I was in Kampala. She is the head pharmacy technician at TASO Mulago. David Amsalem and I spent many days packing ARVs (antiretroviral pills) in the pharmacy as well as pills for opportunistic infections such as Septrin for treating PCP (Penumocystis Carinii Penumonia). Needless to say, she loved the help and often made us pack more than seven thousand pills a day. The job was repetitive and tedious, but also necessary. The seven thousand pills we would pack in one day, would be long gone by the next. I had a hard time staying motivated for four weeks but seeing Milcah who did this for a living, as well as meeting and talking to the HIV positive people that the medicine actually helped, made it a lot easier. This is a story of a woman, who for the past three years, has been doing work that most people could not handle doing for day, a woman who works too hard, but helps saves the lives of hundreds of people on a daily basis.

Milcah was born on February 19, 1966. She had five siblings, three brothers and two sisters, which of course made money an issue. Her aspiration in life was to go to into medicine. She did receive a diploma but, because she did not get enough points to be accepted into Medical School and there was not enough money for her to receive a degree, she instead decided to attend the Mulago School of Dispensing because she still had a strong interest in the medical field. She was there for three years and shortly after, she worked for a pharmacy in Mulago called the Equator Pharmacy. Three years later she worked for the National Medical store for a total of five years. She also worked in the United States for a short period of time in a nursing home, as a nursing assistant in training. She eventually married and had three children.

In 2003, Milcah became apart of the TASO family, mostly because she needed to work closer to where she lived. Her previous job was forty miles away, which can seem about ten times as far considering the traffic as well as the terrible roads. TASO has become her whole life. She works in the pharmacy everyday, dispensing drugs to patients, making sure that patients are adhering to their ARVs regimen, as well as continuously updating files and making sure the field officers have all the medicines that they are supposed to take with them to patients living far away from the clinic. No matter where she is dispensing, whether it be at TASO Mulago, or at an OutReach Site, there is a massive line of hundreds of people. Although there is supposed to be a fixed number of clients, the number increases by approximately by thirty people each day. This makes work very tough and strenuous. Milcah usually works about fifty hours a week, if not more, with no over-time pay. When others are taking their tea and lunch breaks in the dining building, talking and laughing with co-workers, she is taking her breaks in the pharmacy to save time. When most of TASO closes up shop at around 4:30p.m., she usually doesn't leave the pharmacy until about 6:30p.m. She should have four full-time workers and two volunteers at all times, however, she only ends up having about two other people there to help her because everyone will always end up helping in some other department.

Although Milcah believes in TASO's work, she finds herself over-stretched. Even though it may seem that she has super powers, she is really just like everyone else. She has long days and finds her work at TASO rewarding but exhausting, and she does not really know how much longer she can continue in this manner. She serves as a fine example of someone who does extraordinary things, but is human also, and needs to take care of herself and loved ones, just as much as she needs to be apart of the solution to fight AIDS. If she had all the help she needed and is supposed to have, she would most definitely continue working at TASO, but because of the ridiculous work conditions, great people like Milcah find themselves in a terrible conundrum. If fact, TASO loses a lot of their well-trained staff such as nurses and doctors to other places that do not provide virtually free services to patients and so the organization can pay them more money. It may seem selfish, but anyone who has a family to support, knows that they would do the same. In the future, she would like to get into procurement, which would allow her to specialize in professional buying in the United Kingdom. To do so she would like to train at CIPS (Chartered Institute of Purchasing and Supply).

Towards the end of our conversation I asked Milcah what she wanted people in the United States to know about the HIV/AIDS situation. Losing two brothers to the disease, she is no stranger to long lasting effects of the pandemic. She talked about the importance of finding the root of the problem and to her, the root of the problem is the extreme poverty in Uganda as well as the lack of free higher education. It seems clear then that there is a great connection between Global Health and Human Rights. According to the Universal Declaration of Human Rights, Article 25, "Everyone has the right to a standard of living adequate for the health and well-being of himself" as well as "right to an Education" (found in Article 26). And when these rights are ignored, like they have been in most of Africa, that is when the problem becomes cyclical. Those in extreme poverty have no money for an education and then desperate for school fees, or just for money to survive, some become sex workers, which then of course continues the spread of the disease. Those with disease have children who soon become orphans and have little money for living, let alone school fees and then they may become sex workers to survive and the problem starts up again. She also advocates for women to take charge of their own lives, and to try to become less dependent on men. Even though she knows that the United States and other countries are helping, she feels that even more financial support and man power needs to be provided if the people of the world are serious in trying to contain and end the pandemic of AIDS.

Milcah really made me understand my purpose in coming to Kampala. I thought I knew but I was definitely off. My main motivation was to make a physical impact on Kampala by putting in hours of labor into anything I could. I had no idea what I would be doing but I knew I would at least be able to make a small dent in the problems of the city. Little did I know that what I was doing was not of the most importance. Milcah and the other people that I met in Kampala, gave more to me than I could ever give to them. What was most important was that I learned so much about the reality of life in the third world and more importantly, the reality of life in a AIDS ridden area. I met families who struggled together with the disease, as well as individuals who had to go through it alone. I've seen a woman on the brink of death from the disease, and another woman living strong and healthy with it. Most importantly I've learned that the problem can not be solved all at once, it will take time, and it will take organizations like TASO, that really work at a grassroots level, to contain it. This experience has given me a new agenda and has truly changed the direction of my life and has shown me that a collection of small gestures by amazing people like Milcah and all my other friends at TASO can truly make a large impact . . .

TASO

The AIDS Support Organization (TASO) was the first organization of its kind to provide medical and psychological support for people infected with HIV/AIDS. It was founded by Noerine Kaleeba and her husband, Christopher Kaleeba, who was HIV positive. The organization was started when 16 individuals, including the Kaleebas, met informally in their homes and offices to provide support for each other. They were either infected with HIV or were affected by the disease because they had a loved one who was positive.

TASO Mulago was the first TASO center and was established in 1987. It's adjoined with the Mulago Hospital in Kampala, Uganda. Currently there are 10 other centers in Uganda, which are found in the areas of Entebbe, Jinja, Masaka, Mbale, Mbarara, Tororo, Gulu, Soroti, Rukungiri, and Masindi.

Along with medical treatment, the organization also provides a variety of other services such as counseling, Aromatherapy and Reflexology, home visits, food distribution through the world food program, outreach programs once a month to villages around Kampala as well as material assistance to the neediest of the needy (such as child support in the form of school fees and scholastic materials). The center also stresses advocacy and has a drama group composed entirely of HIV positive members. They not only perform for the communities to provide the facts about HIV/AIDS, but they also serve as a support group for each other. Some of the other great services that TASO provides are the TEACH program as well as training for community volunteers.

Today, TASO is the largest NGO (non-governmental organization) providing HIV/AIDS services in Uganda. Since its inception, TASO has served 127,354 and in 2004 alone, TASO served a total of 52,031 individual clients. While at TASO, David Amsalem and Lisa Schmitt were able to meet the heads of all the departments and work along side some of them for four weeks. The woman that was mainly in charge of them was named Anne Kaddumukasa, the Public Relations Officer. most of their time was spent learning and viewing all the different services that TASO had to offer, for instance, going on home visits, talking to counselors, viewing aromatherapy sessions, dancing with the drama group, and going to one of the Outreach sites. When they weren't doing that they were helping in the pharmacy, packing ARVS (antiretrovirals) for HIV/AIDS or other drugs for opportunistic infections. Their co-workers truly accepted them as part of the TASO family and left a lasting impression on the Vanderbilt Students through their warmth and friendliness.

CONTACT INFO: milcah_m@yahoo.com
TASO CONTACT INFO:
Old Mulago Complex
P.O. Box 11485
Tel: +256-41-530034
Email: tasomul@infocom.co.ug

Josephine Namaro: Making a Difference in Kampala and the World

TASO, The AIDS Support Organization was the first organization of its kind to provide medical and psychological support for people infected with HIV/AIDS. It was founded by Noerine Kaleeba and her husband, Christopher Kaleeba, who was HIV positive. The organization was started when 16 individuals, including the Kaleebas, met informally in their homes and offices to provide support for each other. They were either infected with HIV or were affected by the disease because they had a loved one that was infected.

TASO Mulago was the first TASO center and was established in 1987. It's adjoined with the Mulago Hospital in Kampala, Uganda. Currently there are 10 other centers in Uganda, which are found in the areas of Entebbe, Jinja, Masaka, Mbale, Mbarara, Tororo, Gulu, Soroti, Rukungiri, and Masindi.

Along with medical treatment, the organization also provides a variety of other services such as counseling, Aromatherapy and Reflexology, home visits, food distribution through the world food program, outreach programs once a month to villages around Kampala as well as material assistance to the needy (such as child support in the form of school fees and scholastic materials). The center also stresses advocacy and has a drama group composed entirely of HIV positive members. They not only perform for the communities to provide the facts about HIV/AIDS, but they also serve as a support group for each other. Some of the other great services that TASO provides is the TEACH program as well as training for community volunteers.

Today, TASO is the largest NGO (non-governmental organization) providing HIV/AIDS services in Uganda. Since its inception, TASO has served 127,354 and in 2004 alone, TASO served a total of 52,031 individual clients. While at TASO, Lisa Schmitt and I were able to meet the heads of all the departments and work along side some of them for four weeks. The woman that was mainly in charge of us was named Anne Kaddumukasa, the Public Relations Officer. Most of our time was spent learning and viewing all the different services that TASO had to offer, for instance, going on home visits, talking to counselors, viewing aromatherapy sessions, dancing with the drama group, and going to one of the Outreach sites. When we weren't doing that they were helping in the pharmacy, packing ARVS (antiretrovirals) for HIV/AIDS or other drugs for opportunistic infections. Our co-workers truly accepted us as part of the TASO family and left a lasting impression on the Vanderbilt Students through their warmth and friendliness.

Individuals Making a Difference: Josephine Namaro

Josephine Namaro is one of the most beautiful and amazing human beings exuding the most incredible amounts of love and positive energy I have ever met, not to mention in one of the most unlikely places and situations, an HIV clinic in Uganda. She was introduced to me as a TASO client but except for the circumstances I would never have believed she was HIV positive. As she later told me, due to the powerful stigma surrounding HIV and AIDS the majority of the people in outreach programs or awareness conferences she told she was positive accused her of being a perfectly healthy woman being paid by TASO in order to disillusion them about the possibility of "living positively" with HIV. Their skepticism is not unfounded, however, as Josephine lives incredibly positively despite her twelve years of being HIV positive. She has no physical traits of being remotely sick, is bursting with energy, plays an active role in her community helping others and the day I met her was excitedly fixing her hair and putting make-up on to go make her demand for a visa to attend and present at an AIDS conference in Toronto.

Despite being a client at TASO, due to her success with the ARV's (Antiretroviral drugs) and desire to play an active role and help others in her same situation, she was trained in aromatherapy and reflexology and volunteers her services at the clinic. I say volunteer because TASO cannot hire the four trained clients full time but pays for their transportation and somewhat of a small bonus at the end of the month. The first time I met Josephine I was completely blown away by her selflessness, her positive outlook on life and her genuine care and desire to help others, not to mention her overwhelming kindness and warm, wholehearted aura; and I did not even know her entire story yet. She brought Lisa and me into her small office barely able to fit the three of us, the other aromatherapy-trained client and a small massage-style bed separated by a thin curtain. Using faded charts pinned up over the desk she explained to us the different uses and mixtures of the concentrated oils and their applications. She handed us several small, brown glass bottles to sample certain aromas. She than took us through a diagram of the foot with all the reflex points and their respective pressure alleviation areas on the body. It was incredibly interesting. As we waited for a patient to arrive so we could watch a session and see how the oils were applied and the reflexology we flipped through a book of essential oils and their myths and medical applications. Josephine told us how much their work was appreciated by the clients who were so relieved and thankful to have someone care and want to help them as well as massage their aches and pains when everyone else around them was afraid and refused to touch them.

In later discussions with Josephine she recounted her entire story which put me in even more awe, respect and admiration of both her generous and exuberant character and strong will. She was born Josephine Namaro in 1973 in Kampala, Uganda. At the age of sixteen she got married and had two children and shortly after her second child was born, in 1993, her husband secretly began seeing a physician. With hindsight, she now knows that he was HIV positive and was aware of the fact but due to stigma did not disclose this to anyone, even his wife. Soon after, she divorced her husband because he was physically abusive. Rumors began to spread that her best friend was seeing her ex-husband and when Josephine was forced to return to her husband by her family these accusations were denied. Josephine's more informed best friend suggested she get tested for HIV without disclosing to her that she had been seeing her ex-husband and knew both the cause of his sickness and probability of Josephine's infection with the virus. In her hospital bed, dying of AIDS contracted from Josephine's husband, the best friend confessed everything and strongly encouraged that she test herself for HIV. Around the same time Josephine's husband disclosed to her that he had AIDS.

Josephine decided to get tested but feared the results so much that it took several tests before she could bring herself to retrieve them. In 1994, at the age of twenty-one she discovered she was HIV positive. Soon after she became part of the Nsambya Home Care Clinic and remained with them for four months. She attempted to keep an extremely low profile and did not wish to disclose her HIV status to anyone. She then found out she was pregnant with her third child while she was on Tuberculosis treatment. Josephine was devastated and wished to abort her pregnancy but her doctor would not let her because it would be too dangerous and taxing on her health. Not only was Josephine about to have a baby but her ex-husband died in 1995 and his family accused her of giving him the disease, reclaiming all of her property and forcing her to live with her parents. Her third child was born on November 13, 1995 and despite the fact that PTCP (Parent to Child Prevention) drugs did not yet exist, her daughter tested negative. Regardless of heavy stigma, she disclosed her HIV status to her midwife who praised her bravery in order to try and save her child.

Thanks to the amazing care her parents provided her Josephine felt no pain or sickness for quite a while. However, in 2003, the stress of her business began to take a toll on her health. She had been transporting goods from Nairobi to sell them in Kampala and the revenue service accused her of transporting them illegally and confiscated a large majority of her stock even though they had been paid for. She fell very ill towards the end of February and became bed ridden at the beginning of March for 8 months. It was at this point that she decided to join TASO although at the time ARV's were still not available. In November, she was able to join the Entebbe DART Trial through TASO Entebbe and was one of the first to receive trial ARV's. The drugs had a great impact and she became increasingly stronger and healthier. Before beginning her ARV's she had a CD4 count of eight and weighed thirty-one Kg. She now has a CD4 count of over four hundred and weighs a healthy sixty-three Kg. Much of her exploding joy and kindness in everyday life is a result of the amazing second chance at life she was given by these drugs. Josephine told me how during those eight bed ridden months she was simply waiting to die and had completely resolved herself to this fact and now she is strong and healthy and able to help others just like TASO had helped her.

One day while at TASO she heard an announcement that ten volunteers were wanted to be trained in reflexology in order to treat other clients. Feeling much better and stronger she immediately signed up and went for a week of training followed by more training in aromatherapy. She is extremely appreciative and thankful for the care and help that TASO has given her and gets great pleasure out of applying her regained strength and helping others regain their vigor and will to persevere. Josephine picked TASO both initially for her own treatment and later to give treatment to others because in the realm of AIDS organizations it the "mother" organization and the care given there is truly unique. As she says, the founder experienced first hand the pain and suffering that comes with dealing with the virus seeing and helping her husband live with HIV and she knew that the organization was created with the right spirit. TASO cared for her, comforted her and counseled her. They counseled her through her most difficult moments and helped her find the will to keep living and gave here another chance at life and it is for this reason that she wants to be a part of giving that chance to others.

Josephine has extremely bright plans for her future. Right now she just exploding with energy and is simply happy and excited to be alive and is thankful for that every day. Her main goals are to raise as much awareness as she can and teach other about HIV and AIDS and to share her life experience with people around the world. She wants to be an example to others in order to show that HIV does not mean the end of life and it is not the end of the tunnel. She strives to eradicate the stigma that surrounds HIV and AIDS and be an inspiration to all that one truly can live positively with HIV. She is now engaged with another TASO client who she was been close friends with for several years. She plans to see all her children go through school and get jobs of their own and would love to live to see her grandchildren. Her greatest message to the world is to "join hands to fight against AIDS".

My experience at TASO and especially with Josephine was both extremely uplifting and rather sad at the same time. It is very reassuring and heartwarming to met a person that has gone through so much and had such a trying life so completely devoted to helping others and still managing to find the joys in life. It is very frustrating however because we don't have enough of people like this. I became completely convinced that is it people like this, in organizations such as TASO that are the solution to the HIV problem as well many global health issues. After a couple weeks of counting pills and becoming increasingly frustrated with my inability to be of more hands on help, my encounters with Josephine made me willing to do any job needed, no matter how mundane and menial, just be able to help out and be a part of something truly selfless and positive.

Meet My Friend Joseph

While participating in the Kampala Project, I spent four weeks working with the counselors at Nsambya Home Care Clinic. Nsambya Home Care Clinic is associated with Nsambya Hospital. Nsambya Hospital was originally started by a group of Dutch nuns who wanted to provide health care to the poor people of Kampala. Nsambya has evolved into a bustling place that has a maternity ward and a children's ward as well as a general clinic and hospital. Gradually, the health care staff became comprised of people from the local population. Now, Nsambya is directed and staffed by Ugandans. Though Nsambya still receives funding from Catholic Charities, Nsambya also applies for grants to help sustain their budget.

When the HIV/AIDS crisis began to wreck havoc on Ugandan society, the Home Care Clinic was created at Nsambya. The Home Care Clinic has its own group of buildings on the hospital grounds and provides services to children, women, and men infected by HIV/AIDS and affected by the accompanying opportunistic infections (OI). The Home Care Clinic is comprised of a small clinic which sees patients who are suffering from OI, a blood testing station, and two pharmacies, one which dispenses drugs for OI and the other which dispenses Anti-Retrovirals (ARV), which are the drugs that help to sustain the immune system of a person living with HIV/AIDS. In addition to all the medical services offered, the Home Care Clinic also conducts home visits and manages a food relief program. Finally, one of the most important components of the Home Care Clinic is its counseling department, which offers educational sessions to infected people and their families, as well as educational sessions on HIV/AIDS testing and ARV.

I spent most of my time in the counseling department of the Nsambya Home Care Clinic, and it is here that I met Joseph on my first day at Nsambya. Joseph was a regular patient at the Home Care Clinic and had come to start Anti-Retroviral Therapy because his CD4 cell count had plummeted to a mere 13. When I first saw Joseph, I marveled at how he had the strength to even come to the clinic. Joseph was about 35, but he was very emaciated, frail, and weak. Because he spoke excellent English, I was able to conduct most of the counseling session with Joseph, teaching him how to take his anti-retrovirals. For some reason, I immediately felt a special bond with Joseph. I just assumed it was because it was my first day at Nsambya Home Care Clinic and Joseph was the first patient I met who spoke English. Little did I know, Joseph and I would actually have several conversations over the four weeks I spent at Nsambya.

I always looked forward to Wednesdays because that was the day that Joseph came to the clinic. Because Joseph was just starting ARV, he had to come to the clinic once a week so that his progress could be monitored and any side effects assessed. As soon as Joseph started on ARV, his strength and his spirits immediately improved. He would always greet me with a beautiful smile and a warm handshake. Then we would try to find a shade tree to sit under and talk while he waited to be seen by a doctor or waited to get his prescription filled by the pharmacy. I never found out how Joseph became infected with HIV/AIDS. Instead, our conversations revolved not on the past, but instead on the future and on the things that were most important in our lives. Joseph loved most to talk about his nine-year-old daughter Michelle. Both Joseph and Michelle live with Joseph's mother because Joseph had become too weak to work. Before his low CD4 cell count had left him so badly weakened, Joseph had been a school bus driver at Michelle's school. Though Joseph had many dreams for himself and high aspirations for his daughter, he had one goal in life. Joseph was determined to live long enough to raise his daughter.

Though I met many amazing people while working at Nsambya and during my time in Uganda, Joseph is truly one of the most extraordinary people I have had the distinct honor of meeting. Faced with his situation, many people would simply give up hope or adopt an eternally pessimistic outlook on life. Joseph was quite the opposite. He knew that he couldn't beat the HIV/AIDS virus, but he was determined not to let it ruin his life. Joseph was so thankful to have free ARV, even though the side effects that he suffered would probably make most people shy away from taking the drugs. He was meticulous in following the directions we gave him for taking his ARV, as he knew the drugs were the lifeline that would help to protect his immune system from the virus, thereby helping him to stay alive and healthy. He was delighted every time his CD4 cell count improved, even though it was still at a dismally small number compared to a healthy individual. However, Joseph knew that as his CD4 cell count increased, so would his strength, his energy, and his appetite. As he became more and more hopeful about the improvement in his health due to the ARV drugs, Joseph's conversations became less focused on survival, and more focused on improving the quality of life that he could provide for his daughter. For example, as his health improved each week, Joseph began to talk about where he would become employed so that he could afford to send Michelle to a private school and possibly even University.

The lessons I learned from Joseph about living life to its fullest and choosing to approach a difficult situation with optimism helped me to understand the delicate relationship between global health and basic human rights. The affordability and availability of ARV to poor African countries such as Uganda is a very complicated, emotion-ridden topic. The ARV that Joseph was receiving for free were truly his only hope of surviving long enough to raise his daughter. If taken soon enough and properly, the drugs can work miracles in helping to boost a person's immune system. Though they do not cure HIV/AIDS, ARV are currently the only hope that a person such as Joseph has of extending his or her time to live. Though the cost of ARV has greatly decreased since they were first developed, people such as Joseph could still never afford the drugs. As Americans, we believe that citizens are entitled to life, liberty, and the pursuit of happiness. For Joseph and millions of other Africans, one cannot even begin to hope to pursue life without the aid of ARV, much less pursue liberty and happiness. In the face of the HIV/AIDS pandemic, the link between global health and basic human rights can be as simple as a pill that is taken twice a day. Until HIV/AIDS prevention and education programs are 100% effective or until there is a cure or preventative vaccine for the HIV/AIDS virus, the health of the global community will hinge on the human right to access ARV.

Nsambya Home Care Clinic is a division of St. Raphael of St. Francis Hospital, the largest private hospital in Uganda, and is located in the Nsambya district right outside of downtown Kampala. Established by a Dutch nun dedicated to service in Africa, the addition of Home Care to Nsambya Hospital occurred as a response to the HIV/AIDS pandemic that has swept across the continent. Its services focus on testing, treating, and counseling those who are infected or could be infected with HIV/AIDS. The staff at Home Care takes every precaution to make sure their services can be provided without charge, asking only a thousand shilling donation (less than a dollar) for those who are seen by a doctor. Grants received by the clinic allow for free antiretrovirals (ARVs) to all who have a CD4 cell count less than 200 and who have completed the three appropriate counseling sessions. In addition, pre - and post-test counseling, adherence counseling, and medication for opportunistic infections are freely provided to all clients. Due to the rising demand placed on Home Care, a new building for the facility is currently in progress. The staff hopes to see its completion in a couple of years when enough funds have been accumulated. Currently, Home Care consists of two doctor offices, a combination office/waiting-room, a small pharmacy, and a series of counseling and testing stalls sectioned off by curtains; lack of spaced has caused adherence counseling to be located in tin, trailer-like buildings at the other end of the hospital. Nevertheless, it is astounding how much is accomplished at this small clinic. Each day begins with the staff joined together for prayer, songs, and a Bible reading; patients arrive early in the morning and tolerantly wait outside as the clinic tries to accommodate everyone. In an environment that to most would seem ghastly and disheartening, there is an incredible aura of sanguinity. One smiling face in particular always seemed to stand out in the crowd. Lilian, endearingly known as Sister Lilian to those who worked with her, embodies the true spirit of dedication and altruism found in Nsambya Home Care Clinic.

Lilian began her work in the health care profession as a nurse, but then trained to be an HIV/AIDS counselor after witnessing the massive devastation caused by the deadly disease. Growing up with both parents in medical professions was a source of inspiration for Lilian, who learned from these role-models what it takes to be an effective caregiver. After suffering the consequences of a country torn by conflict and dictatorship, she still has dedicated her life to helping those in need. Her beautiful smile and warm heart are as healing as her expertise. Undoubtedly, she is a testament of strength, courage, and enthusiasm for all who work beside her. Continuously considering others first, Lilian always directs conversations away from herself and down plays the importance of her efforts. The way she sees it, she comes into work every morning and does her job just like anyone else. Yet she is someone who I strive to be more like; whether she knows it or not, Lilian is one of Kampala 's unsung heroes.

The most remarkable and touching of Lilian's features are evident in her dreams for the future. After spending countless hours counseling patients at Nsambya and overseeing the clinic, she returns home and continues the work that she loves there. She first began with offering free counseling to friends and neighbors, and has now expanded her services by accumulating drugs and ARVs to dispense. It is her aspiration to one day open a completely free facility for those infected with HIV/AIDS. Through her compassion for others, he she indisputably embodies the sense of community that is prominent across Africa.

Lilian's life does not completely center on her work, however. She is a loving wife and mother as well as a compassionate nurse and counselor. Consequently, taking patients into her home has raised fears concerning the safety of her own family. She particularly mentioned one occurrence where a person with Ebola came to her seeking help, leading to an overwhelming sense of worry about her loved ones. This experience did not deter Lilian from helping those in need, but rather enhanced her vision of establishing a free clinic. After that incident, she asked her husband to put up a separate building on their land so she could still accommodate patients while maintaining her family's safety. Her hope is for this vision to grow into a reality as she gains more financial support to sustain the operation she foresees. Lilian is a blessing to all those who seek her assistance and it is through her genuine kindness and unique fortitude that such magnificent goals can come to fruition.

Spending four weeks under Lilian's supervision and guidance at Nsambya Home Care has taught me a myriad of lifelong lessons. The first is that you must be able to find joy and meaning in the work for which you dedicate your life. It was clearly evident from her cheerful attitude and enduring commitment that Lilian enjoyed coming to work and interacting with the patients. Hearing her uplifting voice during prayer or her infectious laugh as we played Duck-Duck-Goose with a group of orphans further confirmed this assertion. Another lesson Lilian has taught me is that you must find strength from within and strength from God when you are faced with frightening trials. She shared a story with me from early in her counseling career about how she had pricked herself with a needle after taking blood from a patient who was HIV positive. Admitting how terrified she was to be infected, she recalled later crying on the floor out of sheer dismay. The nun who had established the clinic came to her side and listened to what happened, consoling Lilian that God would not let someone who has worked so diligently for the care of others become infected with AIDS. They prayed together at that moment, and Lilian continued to pray until the test did in fact come back negative. Prayers of request changed from prayers of thanksgiving with this wonderful news, and Lilian was able to continue with the work to which she is completely dedicated. Gracefully she rose above what would surely be one of the most trying events of any person's life; she has demonstrated to me the importance of courage and resilience as one encounters life's hardships.

Lastly, the time I spent shadowing Lilian in the counseling sessions or making home visits with her taught me value of treating humans with dignity. As citizens of humanity, we each have the right to be treated with respect - no matter our race, socioeconomic background, or HIV type. Every patient she talked to was regarded as her equal; through her actions, Lilian demonstrated the need for acceptance. Whether working at Nsambya Home Care or administering care at her home, Lilian exemplifies the ideal that health care should be universal for all. Time and time again, this concept was instilled throughout the Kampala Project as I met countless different people who deserve the same rights that are afforded to me, yet were withheld such liberties simply because of where they were born. It is true that we each are unique individuals, but ultimately we are all members of this world. I know that Sister Lilian will always be just that to me - a sister and a great friend.

Site Details

Meeting Point Kampala is a comprehensive community-based organization, founded by Noelina Namukisa formally in 1992, that provides a host of services to its HIV-positive clients, their families, and children orphaned by the AIDs virus. Services are carried out from two office locations, the main location in Namuwongo district in Kampala and the second in Wakiso, a more rural community located a 40-minutes drive from their Kampala office. Personal care is delivered to individual's living with HIV/AIDs through medical support, counseling, home visiting, food support through the World Food Programme, sponsorship of children's formal education, vocational training for orphaned boys and girls, the sponsorship of microfinance projects for families infected and affected by HIV/AIDs, the training of community volunteers in basic nursing care and tools to support individuals living with HIV/AIDs within their own communities, and the complete care of 30 foster children at the Namuwongo facility foster house. Meeting Point is also greatly active in promoting awareness and sensitization about HIV/AIDs within their community through music, dance, and drama performances and encouraged community-member participation. And finally, Meeting Point additionally directs a learning center, providing informal primary education to children who have been affected by HIV/AIDs and who would not otherwise be able to attend formal primary school.

[Service information attained from Meeting Point Kampala literature]
P.O. Box 2623
Kampala, Uganda
Tele: 256 41-510526
Email: mpkla@utlonline.co.ug

"Santa's Story, What I Learned, and Global Health and Human Rights"

I met Santa on my first day of work at Meeting Point Kampala. She was modest and sweet with a reserved, but friendly demeanor. At our first introduction, I did not know how inspiring this woman would become for me, nor did I know the depth of character and strength Santa possessed that delivered her to the present day. The layers of Santa's personality include: a powerful leading example of feminine strength in a society lacking standard women's rights; hopefulness in situations where most others would give up; and determination to triumph with God in her goals for life.

Despite these optimistic characteristics of Santa's personality, her story is harsh and unsettling. This is not a rarity in Uganda. The pleas of the masses go mostly unanswered, and their tragic stories continue to unfold into desperate epics. To me, Santa is the heroine of her own life's epic.

Santa is a member of the Acholi tribe, a darker-skinned ethnic group with origins in Northern Uganda. Santa married in 1985 at a young age, as is tradition with many Ugandan women. She and her husband (also Acholi) lived in the North and worked alongside the majority of the Acholi people, who are subsistence farmers. However, a militia war began to unfold in the early 1990s, and Santa and her husband became increasingly uneasy and fearful.

The militia war is still dragging on today. Joseph Kony, a religious radical who claims to be able to communicate with both Christian God and Muslim Allah, inspires his followers to become part of a group called the Lord's Resistance Army (LRA). This militia army terrorizes village dwellers in the north, burning and ravaging their meager homes and communities. The worst of the militia's actions is the kidnapping and subsequent brainwashing of children from the villages. These unfortunate children comprise the majority of the militia's body, and are maimed and forced to kill and abduct other children or be killed. Clearly, this situation creates enough fear to cause uprooting of families, most from the only home they have ever known. The families impose on another tribe's area in Uganda and are forced to adapt to their culture.

Santa and her husband fled south to Kampala City in 1990. Kampala is the capital of Uganda in the area of the Buganda tribe. Santa's husband secured a job with Radio Uganda, and Santa worked to maintain their home. This included caring for her five children, tending a garden, and looking after livestock. Life was pleasant, but Santa's family would not go untouched by the tribulations affecting so many others in Uganda.

Santa's husband began to fall sick in 1990. In 1992, he acquired the tell-tale Herpes zoster, a rash of blistery sores that appear first on the nerves of the inner thigh and forearms, often the first indicator of a Human Immunodeficiency Virus (HIV) infection. Santa's husband suffered a stroke that left him paralyzed in parts of his body, but he was given treatment and an exercise regimen and recovered. However, another stroke in 1994 left Santa's husband totally paralyzed and immobile. For three months, Santa's husband suffered in a hospital bed, and eventually died and was cremated.

The trauma of her husband's death left Santa in emotional and financial distress. This distress was compounded by the Ugandan tradition for a male's relatives to take back property from his wife and family after his death. Santa said, "For us African women, the moment your husband dies, you are abandoned with so many children" Santa was left with five children, no home or possessions, and an insufficient education to secure a standard job.

I spoke with Santa about women's rights as human rights. Women and children, especially girls, seem to be the groups with greatest lack of equal human rights in Uganda. Changing culture and failing traditions have altered today's Ugandan culture from that of the past. In the past, women were subordinate to men. But according to Santa, men took superb care of the women and treated them with respect. However, the change and evolution in Ugandan society on the large scale have not benefited just treatment, parity, and respect for women. Santa cannot speculate why this societal change came about. But with loss of respect, women have become neglected in many situations and suffered loss of influence in the family.

Family dynamics have especially changed in light of the AIDS epidemic. Men are usually infected with HIV first, then die and leave their wives and families without any method of support, as in Santa's case. Many men also choose to move and find work elsewhere, abandoning their families. The Daily Monitor, Kampala 's private newspaper, quoted Dr. Muhereza Mukuzi, head of the Joint Clinical Research Center for the Kabale region: "The numbers of women who test is high because they are not afraid to test. I appeal to the men to use the chance to save their lives and their wives. While many societal gender rights problems exist, I commend Uganda for recognizing that they have problems" Traditions in Uganda such as the reclamation of property by a man's relatives also contribute to a large ignorance of women's rights.

The connection between women's rights, women's health, and global health is integral to understand. The women in Uganda are important instruments in stopping the spread of AIDS. Each new woman infected with HIV unknowingly by her husband or partner can compound the problem by passing the disease on to children, who in turn will pass the disease on to subsequent generations if they reproduce before being consumed by the disease. Rectifying equality for women's rights in Uganda would be beneficial for families, communities, and would certainly slow the rapid spread of the HIV/AIDS epidemic.

Due to the current unfortunate state of women's rights, non-governmental organizations such as the ones students worked with were founded. The organizations provide support where there is none. Their work is much needed, and according to Santa, every little bit helps. For Santa, even help from the enemy was welcome in her desperate situation.

After her husband's death, Santa was ironically forced to move in with her husband's mother-in-law in a village back in the North. After living there for a while, Santa decided to move back to her home village with her children.

However, in 1998 Santa began to feel weak and became sick more often and more easily. She decided to journey on her own to Kampala to be tested for HIV. Santa tested positive.

Santa became increasingly worried about her own health, but also about the fate of her children. By this point, the violence of the Lord's Resistance Army had surged and quelled in cycle many times. After being tested for HIV, Santa returned to live with her children in the North. Life went on as usual until one vengeful night when the village in which the family was living was raided by the LRA. Santa and her children luckily escaped alive, but were forced to live in the bush, hunting and gathering what they could with the other ambush survivors.

After a while, living in the bush while always on the move became too hard for Santa. She took her children to live in one of the many, large Internally Displaced Persons camps that are scattered across Northern Uganda. The conditions in the camp were unsanitary and destitute at best, with frequent cholera, malaria, and tuberculosis outbreaks. This was no way of life. A weakening Santa decided to move her children to Kampala, where at least there might be hope for their education and a higher logistical probability for reception of international aid. The best living arrangement Santa could manage was staying with a friend in the Soweto slum, named after the infamous slum in South Africa. By this point, Santa's health had declined drastically. She presented with Herpes zoster, and was weakened further by a bout of malaria. The same kind friend who had extended the hospitality of her humble home in Soweto referred Santa to Meeting Point Kampala. Meeting Point was originally founded to help AIDS widows and orphans, those infected and affected by HIV/AIDS. It is because of this organization that Santa is alive today.

Meeting Point Kampala immediately helped Santa. The organization provided funding for Santa to receive Antiretroviral Drugs (ARVs) from Nsambya Hospital (a large public hospital nearby). These ARV drugs inhibit the replication of the HIV-infected cells, and give a client's immune system a chance to recover and restore the number of infection-fighting white blood cells. Santa is very thankful for these life-saving miracle drugs.

Perhaps more important than her health, Santa's hope was restored. Although we cannot depend on the results of hope, hope is sometimes all we have. After registering for treatment with the hospital, Meeting Point Kampala sent volunteer agents to oversee Santa's recovery on home-visits. Santa sent her children to live with an "Auntie" in Gayafza. Auntie is the word commonly used in Uganda for a secondary care-taker. This woman had been helped in the past by Santa's husband, who had funded her teacher training courses. Santa's children began to regularly attend school again, and Meeting point paid their school fees. Santa's health started to return to normal, and she began working with the day care and sewing vocation school at Meeting Point Kampala. The Meeting Point approved her application for a house loan, and Santa was able to once again bring all her children under one roof. Santa remarked about the loan, "I couldn't believe it, and I went and collected my children" Santa was offered a permanent position as a volunteer for medical home visits, in order to reciprocate the favors extended to her in a time her need. Like many others in the Meeting Point community, Santa is very thankful.

Santa has great confidence for the future. Much of her hope stems from her faith in God. "Since God has brought me here, I will be okay" Santa's hopes include continuing to work for Meeting Point. Santa believes that she is a useful instrument because "People who have suffered know what it is like, and must help other people who are suffering" Santa would also like to start a sewing school or perhaps create a cake-making business. Baking is Santa's real love, but at present it takes her almost half a day to properly mix a cake, and then cook it on a small open fire with limited cooking utensils. The challenges and obstacles along the path to achieve these goals are not insurmountable, but they can sometimes become discouraging. The principal for starting a cakes business and purchasing a stove is about $500. This is an incredible amount in a country where many survive on just $1 a day. But Santa is strong like her hope and faith.

Santa teaches others how to be strong and have hope by her leading example. In addition to sharing the layers of her history, Santa has taught me many things. I have learned the power of hope, and its importance as a turning point in many clients' cases. From Santa's example, I can also see that it is our duty as humans to help those who are suffering, especially in those areas which we have been educated or enlightened. I have also learned that sometimes, a friend is the best medicine. I will carry Santa's hopeful spirit in my heart. I will try to emulate her tolerance, determination, work ethic, and faith in the future as often as I can.

Contact Info
Santa Tu-Kema
c/o P.O. Box 465-9
Kampala, Uganda
tele: 256 77-4-15-0529

The Story

Roger is a fifty-six year old Ugandan who has lived in or around Kampala for most of his life. Although his four children are all grown and living in Kenya, the glowing smile of a proud father still sneaks across his face every time they come up in conversation. I can tell he was a loving father who misses them and thinks about them often. His gray hair, warm smile, and kind eyes reveal a wise and gentle demeanor which fails to reflect the hardships and suffering that he has experienced throughout his life.

Roger's early life demonstrates his intelligence and desire to work hard. He completed Primary and Junior Secondary School in Kampala, before taking his Senior Entrance Examination and attending Nyamilyango College and then the Cambridge Police Training School. Upon graduation he began working as a police officer at the Kampala Police Station where he worked for ten years from 1966 to 1976. Despite the unstable, fear-filled political atmosphere that existed in Uganda during these years, Roger enjoyed his job as a police officer. He joined the police force in 1966, just after Milton Obote declared himself president of Uganda. Although Obote's rule was largely destabilized by the military, the violence and corruption in the country would grow dramatically as a new ruler gained power. In January of 1971, Obote was overthrown in a coup by his army chief, Idi Amin. Amin's rule was full of violence. He was known for the persecution of multiple ethnic groups, the deportation of 30,000 to 50,000 Asians from Uganda, and the arrest, torture, and murder of many other Ugandans. Roger recalls that because of Amin's government discrimination "everyone was fearing" The only way for anyone to be safe was to leave the country because the minister of intelligence was floating information to Amin and his army. Amin's paranoia increased as his rule continued, and because he was not educated, he grew particularly scared of those who were and targeted them. Many people, including Roger's friends and neighbors, were arrested and tortured during this time. But despite this hostile environment, Roger and his family remained in Kampala until 1976 when the violence became all too real as Roger, himself, was wrongly arrested by Amin's government. Suspected of carrying information to Obote who was in exile in Tanzania, Roger was tortured while being kept in the barracks. But Roger was determined not to let Amin and his corrupt men get the best of him. Although unsure of what lay ahead, he remained strong in hopes of one day returning to his family. His father-in-law, who was a politician during Obote's rule, had already fled to Kenya in fear for his life. Afraid that they may also be in danger, Roger's wife and four children fled to Kenya to meet her father with the help of some friends while Roger remained in prison. Although picking up and moving is never easy, the uncertain and threatening atmosphere made this experience particularly difficult. Unsure of her husband's condition or what his fate would be, it was both an emotionally draining and physically exhausting time in her life. Luckily, Roger's wife and children were able to take some comfort in the aid and support they received from friends.

After one month, Roger was found innocent and released so that he was finally able to join his family in central Kenya. Their family's exile in Kenya lasted for six years, from 1976 to 1982. Roger spent their first two years in Kenya teaching biology in order to raise money so that his family could eventually move to Nairobi which was a rather expensive place to live at the time. Roger referred to life in Nairobi as the "good life" This is something he desperately wanted to provide for his family given the trying situation they were facing. Once he had raised enough money, Roger moved his family to Nairobi where he joined the Embacus airport as a security officer. He worked at the airport for the remainder of his time in Kenya as his family patiently waited for the political situation in Uganda to improve. Idi Amin's rule finally ended as he fled to exile in 1979. The following year Obote was elected president and began his second term, but unfortunately the fear and suffering did not disappear with Obote's return. While the violence and corruption did not match that present during Amin's rule, soldiers continued to steal property, arrest and torture people. Needless to say, the political situation, although better than in 1976 when they had fled the country, was still not good. Roger recalled that there was no peace in Uganda until Museveni came to power, that is, until democracy.

In 1982, Roger and his family finally returned to Uganda which was now in the middle of a civil war. The Liberation War was a war for democracy between Yoweri Museveni's National Resistance Army and Obote's Ugandan National Liberation Army. The fighting finally ended in 1986 when Museveni was sworn in as president promising to bring democracy to the people of Uganda. Despite the hardships of the war, Roger was successful in providing for his family upon their return to Uganda. For the first few years after their return, they lived forty-two miles outside of Kampala in Mityana where Roger began working with a tea company called Tea Estate. They returned to Kampala in 1985, and the following year Roger joined a company called Stone Sales where he was appointed the blasting master in the quarry. He worked with Stone Sales for eight years until a day he cannot forget. On November 15, 1993 a stone crushed his left leg while blasting taking away his ability to perform physical labor and thus his existence as an effective member of the work force. Roger became unable to support his family and dependent on the assistance and financial support of others. Life was very difficult during this time and their family was lucky to receive help from their friends when they most needed it.

A few months later, Roger's wife decided to go for blood testing and she was found to be HIV positive. She registered as a client with Meeting Point and became one of Mama Noelina's first clients. Roger recalls that this was "long before Mama even had an office" Mama was just getting started so she had very few, if any, resources, but Roger and his wife were very grateful for the aid and support she was able to offer. Roger's wife convinced him to get tested also, and upon receiving confirmation of his HIV positive status Roger also registered with Meeting Point. The two of them were sent to Nsambya Hospital for treatment and to register to receive home care. Struggling to survive with the little assistance they received from their friends, Roger and his wife were fortunate to be given a small amount of food from Nsambya home care and grateful that his wife was able to start a business selling clothes at the market with money from home care loans. This got them by for a while and although it was always a struggle to survive, they were able to live happily until March 17, 1999 when Roger's wife passed away. Roger was left alone and without a job or any way to support himself. Because he was lame, it was very difficult to find a job and with nowhere else to turn Roger looked to Meeting Point for help. Mama Noelina began giving him assistance and eventually he asked her for a job insisting that other lame people work and he should be able to as well.

In February of 2005, Roger began working at Meeting Point Kampala. He is in charge of the Day Care Center and handles all of the registration books, including those for the students at the Vocational School. The Day Care Center meets on the patio just outside the vocational school classrooms at the Meeting Point. It is a place where a group of women gather during the daytime to learn skills needed to support themselves and their families. They participate in many activities including jewelry making, sewing, and basket or mat weaving. Many of the clients are uneducated and most of them come to the Meeting Point with little or no skill and thus no way to earn a living. On top of that, many of the women do not speak Luganda because they are refugees coming from the north or places outside of Uganda. Roger understands what it is like to be a refugee, forced to flee from your home with very few possessions and unsure of how you will survive once you reach your new destination. Thus, he seeks to aid these women in any way he can, arming them with knowledge and skills so that they can make a life for themselves and their families. With a knowledge of Swahili and some of the other languages spoken in nearby countries, Roger is able to translate for these women and help them learn the local language of Luganda so that they can communicate with those in their community. Roger proudly informs me that ten of the women have developed great skill and now own their own businesses and thirty women are learning very quickly and will soon be able to support themselves.

Roger feels very lucky for where he is now and that he has been able to see Meeting Point Kampala grow the way it has. As he describes the need in the surrounding communities he tries to get me to understand just how great the need is: widows who are desperate because they have no way to earn a living, children whose families cannot afford to send them to school or even feed them, orphans who have no parents or even relatives to take care of them. It is overwhelming, but he praises Mama and Meeting Point for all they are doing to combat these hardships. The respect and love he has for Mama Noelina is shared by many in the surrounding communities and across Kampala, even Uganda. Roger feels extremely privileged that he has been here to see Meeting Point develop from the lone woman who once constituted its whole being to the large and respected, yet still struggling organization that it is now. Roger explains, "I have seen Mama's struggles, I have seen her come from nothing" When his wife first registered with Meeting Point, Mama had no office and she had no help. Mama was using money out of her own pocket to buy food to feed all of her clients in need. Now Meeting Point has many volunteers and Mama gets food through the World Food Programme. Meeting Point is still struggling, however, and they still need more funding and support. It is difficult because even though Meeting Point is pouring everything they have into the support they are offering their clients and communities, the need is just so monumental that it is simply not enough. Roger knows the difference Meeting Point made in his own life and he has seen how it has transformed the lives of others as well. He recognizes the importance of the work that Mama is doing and hopes to see Meeting Point develop to help many more people.

The Site

Meeting Point Kampala is a comprehensive community-based organization, founded by Noelina Namukisa formally in 1992, that provides a host of services to its HIV-positive clients, their families, and children orphaned by the AIDs virus. Services are carried out from two office locations, the main location in Namuwongo district in Kampala and the second in Wakiso, a more rural community located a 40-minutes drive from their Kampala office. Personal care is delivered to individual's living with HIV/AIDs through medical support, counseling, home visiting, food support through the World Food Programme, sponsorship of children's formal education, vocational training for orphaned boys and girls, the sponsorship of microfinance projects for families infected and affected by HIV/AIDs, the training of community volunteers in basic nursing care and tools to support individuals living with HIV/AIDs within their own communities, and the complete care of 30 foster children at the Namuwongo facility foster house. Meeting Point is also greatly active in promoting awareness and sensitization about HIV/AIDs within their community through music, dance, and drama performances and encouraged community-member participation. And finally, Meeting Point additionally directs a learning center, providing informal primary education to children who have been affected by HIV/AIDs and who would not otherwise be able to attend formal primary school.

[Service information attained from Meeting Point Kampala literature] * This section was a collaborative effort by myself, Ashley Getz, and Lee Karlsson

What I Learned

Although Roger never ventured out in the field to go on home visits or took part in the music, dance, and drama program (these would have been difficult tasks to complete on crutches with only one leg), he was never at a loss for words when it came to preaching the importance of education and sensitization among community members. As I worked with Roger to fill out forms for the vocational students or sat with him while he was overseeing the activities in the Day Care Center, Roger emphasized the importance of the music, dance, and drama program in fighting the AIDS epidemic. The program empowers people by teaching them how to keep themselves and their lives clean and how to cook and eat right no matter how poor you are. Yet, at the same time it also restores an air of human dignity to those who have been victims of prejudice and discrimination, forced to bear the shame that is so often associated with HIV. Music, dance, and drama arms people with confidence and respect for themselves and their neighbors as it breaks down barriers of misunderstanding and social stigma. It seems to foster an inner strength in these people which I find to be very inspiring as they refuse to let this disease take away their integrity or diminish the fullness of their lives.

Because of the love and support he received in his time of need, Roger has dedicated his life to helping others face this terrible disease and the hardship and suffering that goes with it. While he may not sing or shout, Roger's message is heartfelt and sincere. I have watched him reach out to desperate women and distressed teenagers seeking to support and motivate them as they struggle from day to day by sharing tails of his own difficulties and eventual triumph over them. His stories have taught me, as well as many others, about the true strength of the human spirit and its ability to overcome even the toughest obstacles thrown in its path. Roger was wrongly arrested and tortured and then forced to flee his home and live in exile for six years. He lost a limb and with it much of the capability that makes him a valuable member of the work force and the ability to support his family. Lastly, he lost his wife to HIV, the terrible disease that has torn apart so many homes and families leaving destitution and despair in its wake, and learned that he too is HIV positive. Yet he has overcome each of these hardships, and he shares his story to show those around him that they too must keep fighting. Through Meeting Point I have seen what can be accomplished with limited resources and the strength of the spirit, what people can do when they choose to dedicate themselves to a cause and work together, and the difference knowledge can make in the quality of people's lives.

Global Health and Human Rights

After spending a month in Kampala and learning from so many inspiring individuals who have chosen to dedicate their lives to fighting the AIDS epidemic, it is difficult to deny the essential link between health and human rights. This connection is especially apparent when looking at the devastating effects of the AIDS epidemic on the female population of the African continent where women's rights in particular seem to be almost nonexistent. In sub-Saharan Africa nearly 60% of those infected with HIV are women, and women make up 77% of new cases. This disproportionate burden is largely due to women's lack of basic human rights ranging from economic vulnerability and discrimination to sexual and domestic violence to violations of property and inheritance rights. While speaking with some of the women Roger worked with in the Day Care Center and listening to clients stories during home visits, I have discovered a battery of abuses that they have had to endure. From a widow finding herself destitute and homeless upon her husbands death because all of her property and possessions were seized by his family, to an orphaned girl selling her body in a desperate attempt to find a way to feed her younger siblings, to a woman contracting HIV from her unfaithful or polyganous husband, the gender inequities present in African society fuel the raging AIDS epidemic. Meeting the faces behind the statistics has uncovered the harsh reality of these injustices and the deplorable impact they have on the lives and health of these women and their families. The work Meeting Point is doing by educating these women about their health, arming them with the skills necessary to generate an income, and providing them with financial and emotional support is the first step in combating the human rights abuses that are threatening their very right to life. In order to turn around the AIDS crisis, we must address the rights abuses that put vulnerable populations at risk of HIV. This means the world must finally begin to acknowledge and implement the promotion of women's rights.

Contact Information
Meeting Point is located at Plot 125, Bukasa Road - Namuwango

Their mailing address is:
Meeting Point Kampala
P.O. Box 2623
Kampala, Uganda
Telephone: 256 41 510526
Mobile: 256 77 624521
Email: mpkla@utlonline.co.ug

To contact Roger send mail to the following address:
Roger Joseph Kawagga
C/O Meeting Point Kampala
P.O. Box 2623 Kampala, Uganda

Meeting Point Kampala is a comprehensive community-based organization, founded by Noelina Namukisa formally in 1992, that provides a host of services to its HIV-positive clients, their families, and children orphaned by the AIDs virus. Services are carried out from two office locations, the main location in Namuwongo district in Kampala and the second in Wakiso, a more rural community located a 40-minutes drive from their Kampala office. Personal care is delivered to individual's living with HIV/AIDs through medical support, counseling, home visiting, food support through the World Food Programme, sponsorship of children's formal education, vocational training for orphaned boys and girls, the sponsorship of microfinance projects for families infected and affected by HIV/AIDs, the training of community volunteers in basic nursing care and tools to support individuals living with HIV/AIDs within their own communities, and the complete care of 30 foster children at the Namuwongo facility foster house. Meeting Point is also greatly active in promoting awareness and sensitization about HIV/AIDs within their community through music, dance, and drama performances and encouraged community-member participation. And finally, Meeting Point additionally directs a learning center, providing informal primary education to children who have been affected by HIV/AIDs and who would not otherwise be able to attend formal primary school.

[Service information attained from Meeting Point Kampala literature]

Contact Information
Noelina Namukisa
Executive Director
Meeting Point Kampala
P.O. Box 2623 Kampala
Plot 125 Bukasa Road
Namuwongo
Telephone: 256 41 510526
Mobile: 256 77 624512
Email: mpkla@utlonline.co.ug

Stories

"There is only one way to learn: it is through action" - Paulo Coehlo, The Alchemist

One can not fully understand the significance of what takes place daily at the Meeting Point without being enveloped into the stories of individuals and families that converge at this place, especially the stories of Noelina, the clients that they serve, and the children that they teach. Stories capture history, harsh reality, raw emotion, and candid humor. Stories catalogue life; and stories are shared in hopes that someone will learn from another's experience, or will be better able to understand and relate to another.

And so I first pass on the story of Mamma Noelina Namukisa, but can not end the narrative with only details of her life. Met in person or through my words, anyone who interacts with Mamma will know almost immediately that who she is, her life decisions and choices, her purpose and happiness are all inextricably linked to her family, a family that is not limited by blood lines, but encompasses a larger community of people and families living with the impact of the AIDS epidemic. To understand Mamma, one must then meet her husband, Patrick, one of her sons, Ronnie, and the rest of her adopted family, the Meeting Point clients and children of the surrounding Kampala neighborhoods.

Mamma Noelina Namukisa
Patrick
Ronnie

"Family: a group united by a common interest or common characteristics; a unit:" - Webster's Dictionary Online

[Note: Meeting Point will from here forward be abbreviated as MP]

Mamma Noelina

In the words of Mamma Noelina, "Meeting Point started as a mystery:" It was a warm Sunday evening, and my colleague, Jenn McCaleb, and I, with great curiosity and near instantaneous respect for the woman who sat across from us, settled into the hard wooden bench to hear Mamma speak of her life. It was our hope to come away from the meeting understanding the sequence of events that led to the transformation of a Ugandan woman living humbly in Namuwongo with her eight children and husband to the executive director of a non-governmental organization with donors as far reaching as Italy and the United States. We felt fortunate to have this opportunity, for time to ask questions and ask why.

Our interaction with Mamma up to this point was limited. Mamma spent nearly a month away from Kampala in New York City for leadership training, which meant she was absent for the first two weeks of our time in Kampala. Yet, despite our very recent introductions, I felt as if we knew much about her, at least about the way she was viewed by MP clients, volunteers, staff, and children. Before we met in person, we listened to Professor Barz rave of this larger than life woman, we observed the women and MP staff refer to Noelina as "Mamma', a strong indicator to us of her role in the community, and we also watched with wide eyes as the MP community welcomed Mamma home from the States in an elaborate and joy-filled ceremony that included the whistles and beats of Acholi tribal music, the traditional dances of the vocational students, and the cheers of women, both young and old, at the entrance of Mamma into the room. Mamma's return from New York was a homecoming of a beloved family member and even as an outsider and stranger it was not difficult to see this. It is with this limited knowledge of Mamma that we sat with her on that Sunday evening, eager to understand the surrounding community's deep reverence for this woman, for their Mamma.

With our first question posed to Mamma, a question most likely related to the time with spent earlier in the day with the 30 foster children who live at MP, she immediately prefaced the conversation in saying, "I help these children because of my background" Mamma spoke first of her own mother, sharing words of love and respect, noting her mother's great influence, in saying, "my mother taught me a lot of things. She was a hard working woman" Noelina's family is Rwandan by nationality, but fled across the border into eastern Uganda in the mid 20 th century due to increasing ethnic and political tensions.

Mamma did not deny that her childhood was difficult. This was when she first began to experience the hardships of life as an African woman. A very bright and willing student, Mamma was not always encouraged in her pursuit of education and was more often pushed to devote herself to the family and her family's farming efforts. In reference to her own childhood, Mamma remarked on the socialization of African children - boys are raised to have little responsibility and work, where as girls play "cooking' and carry around babies and are the first to stop going to school when it becomes a necessity for the family unit. Following the death of her parents, her aunts continually insisted Mamma stop going to school and immediately get married. However, the head master of the school would not stand to see one of the school's top students drop out and insisted Mamma continue her education. It was from a young age that Mamma learned the value of perseverance and the importance of an education, despite the deterrence of culture. Mamma did not go into depth about the events that took place from her secondary school years, to her marriage, and the birth of her eight children, but she did explain the overall theme of her life, a life typical of an African woman's experience. In beautiful and harsh words and reality, Mamma explained the suffering of an African woman:

"A woman is the center of problems:in words the man is the head of the household, in action, the woman is in charge. You go for digging [farming], it's so dirty, there is no soap, you come back, the children are crying. When someone is sick you go to the hospital to take care of them. If you are an HIV positive married woman, it is your husband who has brought the virus into your home. Polygamy is O.K. for men, but women would be killed for the same actions"

In the struggle to raise a family, feed many mouths, earn the resources to cloth and educate your children, and care for the needs of your husband, without taking into account the structural challenges present in the developing world, life presents daily challenges to survival, keeping much of the African world at the edge of poverty. For years this was Mamma's own world. Yet, in the midst of struggling to provide for her own children and husband she began to reach out to her neighbors in similar situations, or families whose lives were made exponentially more difficult by the invasion of "Slim' - HIV/AIDS.

Mamma began to notice men and women in her community falling ill, becoming extremely weak, then being abandoned by family and friends, and eventually reaching death alone, often leaving children behind. As a woman of great faith and spirit, Mamma began to share what little her own family had with those whose doors she noticed no one entered any more. She would bring small foods and simple conversation to those who were being ostracized for their mysterious sickness, a sickness often believed to be brought on by evil spirits or immoral behavior. Mamma said that often no one but herself would ever open the doors to these neighbors' homes. She would find individuals lying in their own vomit and diarrhea, without the strength to raise their heads.

In discovering more and more people in her community in need of support and care, Mamma called on the help of a Catholic priest and a leader from the Muslim community to sit and pray with sick individuals. It was her priest friend, upon seeing the great need and Mamma's response, who repeatedly encouraged her to officially create an agency to continue to help people, an organization that could offer even more services to the growing HIV-positive population in Kampala. Reluctant to take on such an unfamiliar project, Mamma turned down her friend consistently for two years.

To describe the next phase of Mamma's story as a transformation is almost an understatement. Encouraged by several friend and feeling called to serve her neighbors, Mamma began to entertain the idea of MP. She was a farmer by trade, a skill set she had known since childhood. However, one day she up and sold her 100 pigs. She began to work with benefactors in Italy. She bought property, opened the doors of the MP office, and began to answers the call of her community:what to do with the orphaned children that have been brought to my office? How do we get food to the HIV-positive woman who is too weak to farm for herself anymore?

Her years of work at MP are bound up in a few thoughts she shared in our time together: "I decided to fight for women and kids, like people once fought for me" And, "I know what suffering means:I do not wish it for anyone" Mamma, reluctantly began to create the community of MP, but has never lost sight of her purpose and motivation behind it all. She sees her work as a way to give back to a community and individual people who told her she was special, intelligent, and worth something.

Mamma has a vision for what she hopes the future of MP will look like. She assured us that she is not doubtful that her vision can be completed, because "look how far I have already come" It is her hopes to build a school for her children at the learning center, both primary and secondary levels. And also, Mamma plans to build a house for her children, the foster children, with separate rooms so they may have privacy. The farmer in her would love to see chickens roaming the property and a pond with fish to catch and eat.

The first question I ever asked Mamma was, "do you ever feel overwhelmed?" The question was fed by my own curiosity as to whether I could ever see myself managing all that Mamma does. She is the leader of an organization that serves as the life line for thousands of people in terms of food, shelter, medication, relationships, culture, and education. I can not imagine the pressure that she feels each day to do more. But she is a wise, gentle, and faith-filled woman, who delights to help others at her core. Her answer to my question was the shortest response of any, but spoke to the recognition of her limitations as a human being, but yet offered a glimpse of hope amidst the daunting task of confronting HIV/AIDS. She said, "Yes, I feel overwhelmed, but you just do what you know and can, and you make a plan"

Patrick

While I never spoke with Patrick, Noelina's husband, about the subject of MP personally, I learned much about him through my conversation with Mamma. As Mamma's partner in all, it is not surprising that much has changed for Patrick as Mamma's career and life's work evolved. Patrick's story, through the eyes of his wife, is one of my favorites. It is honest, real, and human.

When Mamma first began to bring orphaned children into their home and was spending much of her time visiting sick neighbors, "there were many quarrels at this time", she says. Patrick would question Noelina's actions and ask her, "Are you not satisfied with your own children?" He very much disliked her spending so much of her time outside of the house volunteering. In light of his authoritative stance, Mamma began to visit people only when Patrick was away at work, even asking her children to keep her secret from their father.

Mamma told us, "I don't know how God changed his mind, but he changed completely. When I grew the seed and he started to see:he would hear people talking about me in the community:he then started to come one day a week:" She explained how he grew to love the orphaned children as his own and to show sympathy for those who were experiencing great suffering.

I would not recognize this former-Patrick if I met him today in Kampala. The Patrick I met was one of the first people I would see each morning in the MP office. He was the first to offer a smile, the first to put a strong hand on the shoulder of a vocational student, and the first to welcome the youngest of the foster children back after a day at school. He now works side-by-side with Noelina, completely invested in the mission of MP and committed to offer support to his community. When I look at Patrick, I am encouraged by his level of loyalty to his wife and their marriage. Even through years of misunderstanding and disagreement, he remained with his family and was personally willing to be changed and convicted. In his own time, Patrick came to know the same heart of service that his wife has always longed to share with him.

Ronnie

Over a shared dinner of "matoke', fresh pineapple, and Coca-Cola at Mamma's house I had the opportunity to speak one-on-one with Ronnie, one of Mamma and Patrick's eight children. I watched as Jovah, Ronnie's energetic 18 month old daughter, bounced around on his lap as he thoughtfully considered the questions I had for him: "Hey Ronnie, how did you come to work at MP? Did Mamma suggest it or was it your own decision?"

While studying at Makerere University in Kampala, a regionally-renowned university in east Africa, he attained a position as a research assistant for a project involving patients at Mulago Hospital, Uganda 's largest public hospital, located in Kampala. He was involved in collecting data for a study on Ugandan's reactions to antiretroviral drugs, a medical cocktail that was just emerging in the developing world as a treatment option for HIV positive individuals. Within a society in which spiritual healing is a normal and dependable cultural option to illness, Ronnie expressed how many people feared the drugs and the promise of healing through such western modern medicine.

With a strong interest in community health and his experience at Mulago, he began interning at the MP working on a project to expand MP's reach and working with diverse populations. Ronnie worked in the field to plan and implement MP's service in a more rural setting, in Wakiso. The Wakiso location is quite unique from the work done in Kampala. There are a whole host of different challenges to service delivery in this area. Clients live long distances from one another, complicating the job of volunteers in their attempts to visit clients' homes. There are also issues of lack of access to cars to both transport clients to the hospital and bring volunteers out to clients' homes, issues which are only compounded with poor road conditions. Ronnie's initial work was central to bringing HIV testing and counseling, home care, and vocational training to a people often overlooked with a large concentration of NGOs working only within the city of Kampala.

These days, Ronnie spends the majority of his time writing grant proposals, traveling to work at Wakiso weekly, and managing and handling many of the administrative tasks that are crucial to the success of any community-based organization. He admitted that these days he regrettably spends more time in Kampala in the office rather than out in the community of Wakiso, a place where he finds his passions couple with a great need for health, education, and support. In speaking of Wakiso, he stressed to me the importance of first working in the field and interacting directly with a community and their problems before planning solutions. You will never know how to best help a people without walking in their shoes. It is Ronnie's simple, formulaic words that I will forever remember when I think of effective service and problem solving. I will also think of his humble nature and wisdom. In the future, Ronnie hopes to return to school for a master's degree in the areas of community leadership, development, and planning. I have great confidence that Ronnie will naturally assume a position of leadership within his community in the years to come. He represents the hope of a younger generation of Ugandans who are proactive in their response to the far reaching impact of HIV/AIDS in Kampala, in Uganda, and in the developing world. Where most are overwhelmed or silenced by the problems the virus has exacerbated, Ronnie is aware and conscious of the role he and others can play in the education and improvement of their country. I am inspired by his commitment not only to problems with clear and fundamental solutions, but to complex issues that require both creative and collaborative solutions. Before talking with Ronnie, I assumed much about his role at MP. Similar to the stories I have heard of a young man who stayed at home to work on the family farm or a young woman who grew up to run the family business, I thought his place at MP was possibly out of habit or compulsion in growing up with a mother devoted to the service of a particular community. However, Ronnie's presence at MP is clearly by choice and deep concern for others. His identity at MP is not simply as Mamma's son; he is a member of a team, a leader, a neighbor, and a loyal friend.

The Extended Family

Several excerpts from my journal are included below. They are simple thoughts and observations about interactions with MP clients in their homes and our young students at the learning center. My hope is that my recorded reactions and words will speak to the character, bravery, curiosity, and commitment I so often noted during my time in Kampala. Mamma created a place where people could find support and hope; she brought people in off the streets. However, it is no longer necessary for Mamma to seek out those most in need. Out of deep gratitude, it is now the MP's own clients who are pursuing those in their own communities who are also HIV-positive, pointing the way to the place that has helped them in sickness and in health. These women, men, and children are loved and cared for and are inviting those who also identify with lives of fear, abandonment, and physical weakness to be known and accepted.

Meeting Point Clients: 23 June 2006

"Today we went on home visits in Wabigalo, a zone nearly adjacent to Namuwongo. The first woman we visited was Florence. Her story is quite unbelievable. Prior to starting ARVs, her CD4 count was one [a healthy CD4 count ranges from 800-1200] and she weighed 55 kilos. Now, her CD4 count has risen to 800 and her weight is up to 68 kilos:Never forget her smile."

"Margaret was out collecting water when we came to her home. Her neighbors ran to get her. We learned that she is waiting to begin her ARVs until she completes her Tuberculosis treatment. The treatment takes eight months. She says she is already feeling better."

26 June 2006

"'Jaja', grandmother Julianna, cares for her 12 grandchildren. As we left, she handed us a large bag of bananas and carrots. How difficult it is to accept a gift from a woman we thought to have very little materially and also having so many mouths to feed. But there is a strong sense of community and gratitude expressed in what is freely given and shared:

Next, we visited Topista. She has been blind now for nearly a year, a negative side effect brought on by ARVs [antiretrovirals]. She sits on her mat, on the floor in her home all day. I noticed a small dish of popcorn and a spoon near her side. I wonder if that was her lunch:

Later in the day, we made it to the home of Dale, the sugar cane farmer who insisted we make the trek to his garden. He was strong and working, a state of mind and body that have not always been guaranteed to Dale in living with HIV. And yet, again, we walked away wealthier than we had entered his home:with gifts of sugar cane in hand and the sight of human triumph and hope."

Learning Center Students: 29 J