Will it work? New Clinic o2

As the rickety pickup rolled in on the narrow village track, I had 2 thoughts bumping around. One, the nerves and excitement of starting our second clinic. Did we bring all the equipment? Is our young nurse going to be OK? Is the door even going to be unlocked?

And Two. Who is OJ Maxswel?  – The hut right next to the clinic.

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Don’t worry, this blog is not about OJ Maxswel.

I try to be objective and use head over heart when selecting new clinic sites, but my heart has broken a bit for this place. Ocim needs a clinic, it really does. If you get sick there, even accessing bad quality health care is difficult. And the place is gorgeous. It’s the closest you’ll get to an idyllic village, with pigeon houses, traditional granaries, and decorated huts. Even in dry season I was captivated.

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Rev. Ojok speaks. Clinic and OJ Maxwell’s hut in the background

But my heart breaking doesn’t mean that the clinic is going to become sustainable. It’s a 6 month trial, to see whether the demand from the community will be enough to keep the place going. There’s a whole lot of reasons the thing should work. But there are almost many why it won’t.

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Trying to explain things while enjoying doggie’s company

Why Ocim Outreach Clinic will work

1) When I assessed Ocim, I asked a bunch of locals how many hours it took to walk to the nearest health center. I couldn’t get a number, but some people said “We leave to go there just after the sun rises, and we get back just before it sets”
2) It costs $5NZ  for transport alone to access any medical care. Our clinic costs $2 at most
3) Reverend Ojok, the local anglican minister is an publicity machine. On the way back from the clinic he taped 3 posters promoting the health center on the walls of shops and talked to everyone he saw about it. Legend.
4) The community is proud of their new clinic. They want to make it work.
5) The clinic has got instant cred and trust by being  run by the Church of Uganda. Our nurse Naume is a Christian, and the community knows she’ll pray with them if they want that.
6) My heart says it will
7) Because “OJ Maxswel, king of the king” is there. What more do you need?

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Nurse Naume still feeling good on arrival

Why it won’t

1) People are very poor. Nearly everybody there is a subsistence farmer. One dollar for kids and two dollars for adults may not seem like much to be treated for serious diseases, but for Ocim, it still might be too much.
2) The population is relatively sparse compared to around other clinics
3) It’s not on a main road, or in trade hub. We’re using the only available iron roof building in the area. This means the clinic is not very public and visible, and we can only treat locals, not people who are passing through.
4) The day to day existence of a small clinic like this is fragile. One robbery, one fire, and one aberrant guy harassing our nurse and it could be enough to sink the ship.
5) My heart is often wrong

From huts within sight of the health center, two mothers came with their kids while we were still unpacking the truck. Both had high fevers. One had malaria, and had a seizure in the morning. The other had a large skin infection on their right butt cheek. Both mothers had been trying to wait out their child’s illness, unable or unwilling to pay the large transport cost to the nearest health center. Both if the kids will now be fine. That’s why we’re here.

And the second thing on my mind? Here he is, OJ Maxwell himself. “King of the King”.

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It begins – New Health Center 1.0

Narrow road, burnt grass, full load. We breathed a sigh of relief as our small pickup  arrived at Cet Kana, laden with all things required to start a new health clinic.

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Nurse Felix, Yours Truly and the Laden Pickup

The place is gorgeous, with one of the better views in Gulu overlooking thousands of palm trees on an open, sparsely populated plain.

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The clinic is next to the current and future church. Current is a skeleton of palm tree timbers, covered every Sunday with tarpaulins. Future is the brick building, with half-walls only.

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Palm pole church is behind me, and half built brick church behind that

We were a bit shocked to find that the rooms hadn’t been opened for months. After thirty minutes of sweeping and rearranging, Felix our nurse, and Fiona our assistant co-ordinator unpacked the drugs and equipment. Desks and chairs were moved into the clinic room. The blood pressure machine was unboxed. Within a couple of hours, two dusty unused rooms had been transformed into a nice wee health clinic.

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There are two big advantages to the health clinic location.

  • The church owns the building so we don’t pay rent
  • The Pastor and other church members have already been involved in weekly family planning clinics run from the building, so the church/health connection is already rolling.

But we are yet to see whether this will fly. Are there enough people in the area to justify a clinic? Can adults afford the 2500 Ugandan shillings (1 New Zealand dollar) we are asking to treat a child? Or the 5000 shillings (you do the math) to treat an adult? Can our nurse juggle the responsibilities of organising the facility, seeing patients and managing the money? After 3 months we’ll have some idea. After 6 months we’ll make the decision whether to continue or not. Taking a risk like this isn’t easy on the nerves, as it’s a big money and time investment. I keep reminding myself that even if the clinic “fails” to become sustainable, we still will have treated around 1000 patients more efficiently than most NGOs could manage. I also can’t help thinking that Jesus is into this kind of risk.

And its exciting. Seeing the first child handed over to nurse Felix to test for malaria was a small victory in itself. I’ll keep you updated with how things are tracking.

We are starting up 3 clinics like this with money already raised, and are aiming to start 2 more. If you’re keen to donate money towards starting the last 2, then message me at https://ugandapanda.com/contact-us/.

A huge thanks to those of you in New Zealand, Australia and beyond who made this possible. You know who you are.

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Goat “decked out” with 5000 shilling notes

Couldn’t resist sharing this one. Although many stories are weird and wonderful and the reporting quality is beyond dubious, the Acholi Times is a pretty good way to access Northern Uganda local news.

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http://acholitimes.com/2017/01/05/drama-in-omoro-as-goat-marauding-with-30000-shillings-dangling-on-its-neck/

 

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New Clinic Excitement

Our Health Centers have been rolling so well recently, that we’re looking to extend into villages that have never had a clinic there before. ‘Small and Sustainable’ We aim for them to become self sustaining within 6 months. If the patients are enough, the Health Center will continue. If not, then we’ll close it, move the equipment and drugs to another health center and move on. Nothing will be wasted. The great thing is that even if the health center fails to meet the sustainable standard and ‘fail’, we’ll still have treated close to 1000 people for common, dangerous conditions like malaria and pneumonia in a more efficient way than most NGOs could manage.

If you are keen to give money towards this new project, then you can give here

https://givealittle.co.nz/cause/newclinics?_ga=1.21558451.903801577.1477739634

Its hard for me to take a risk like this – risk taking isn’t really in my nature, but we really want health centers which can be fully sustained by the community and don’t require ongoing support.

We’ve already hired a nurse, and got all the equipment sorted for one clinic which is really exciting. We’ll let you know how they go, whether they work out well or not.

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Mickey Mouse – District office routed

Sometimes my eyes pop our at the happenings here. According to a court order, the local council here owes previously sacked councillors around 2 million New Zealand dollars – an impossibly large amount of money here. The council hasn’t paid them. Along with court Baliffs, the councillors came and removed most of the furniture and computers from the council offices to try and reclaim some of the debt. The police were called in, and illegally stopped the reclaiming process. Living in a dysfunctional dictatorship sure brings bizarre experiences.

http://acholitimes.com/2016/12/18/bailiffs-attach-gulu-district-property/

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Saving a life, or two


Our wonderful midwife Gloria ‘in the bush’ at Oberabic Health Center had a hard night recently. She’s the only midwife there, so has to do most the work that involves mothers and babies, and make all the calls under really difficult circumstances. A miscarriage and a tricky delivery led to a long, intense evening which ended up really well for the mothers and newborn baby. Its hard to overstate what a fantastic job she did under the circumstances.

Apart from being a great story, and example of the great work that goes on at our health centers, this story is a microcosm of the struggles our patients and staff face all the time. Amongst other things Gloria and the patient faced these challenges. Feel free to add your own after watching the video.

The Patients
– No access to transport to get to a higher level facility
– Poor knowledge of problems around birth, which led to the mother coming in late and not telling Gloria her waters had broke.
– Lack of social support

Gloria
– Working in the uncomfortable zone above your level of medical expertise
– Having to do everything yourself (sterilise the equipment yourself, after you’ve already completed the delivery)
– Understaffing

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The T-shirt Debacle (Alcohol law launch: the messy version)

The night before the big public launch of our alcohol law, I biked down Juba road, ticking off tasks in my head, moving past the road-side dusk activity, maize roasting, weaving motorbikes. Official speakers ready to talk, tick. Donation of bottled water from local company delivered, tick. Ready to meet the tent people at 6:30am tomorrow, tick. Truck envoy passes on route to South Sudan, patient’s relatives scuttle across the busy road to the hospital with flasks of hot tea. Banner ready, tick. Ring the religious leaders, when I get home. Deep breath.

I turn off the main road to meet Wakonye Kenwa members to finalize how to transport our group of 38 to town for the march. Cut through the narrow gap between half a skinned cow hanging outside the butchers and the ‘Somali hotel’, down the dusty path, past the thatched huts and the ducks.

I jump off my bike to face a row of deeply discontented, accusatory faces. “So there will be no T-shirts?” The tone was serious. Not like the light, teasing requests I had brushed off during the last 2 weeks. I deflated like a punctured balloon. This, again. There was even more frustration after the event.

When I first heard people (not just our group members) talking about needing printed T-shirts to be part of a march, I assumed that people just wanted a free clothing item. I mean, who doesn’t love a nice over-sized T-shirt printed with an out of date event slogan? I have several such excellent T-shirts I like to sleep in. Its simply a classic case of hand-out mentality, I thought. I’ve since discovered there is a bit more to it.

Here is my best attempt to outline the conflict:

My thoughts: (You can imagine my frustrated, incredulous tone)

  • You need a big NGO to give you free T-shirts to demonstrate and make demands from government, or to celebrate to make-known a new law YOU fought for? You are telling me you don’t want to participate in making change with out the right clothes paid for by overseas donor money?
  • As a group, you have just achieved what many have tried and failed- you made a new law!! You are banning sachet alcohol which has been destroying your homes!! This is the climax of 2 years of our group’s hard work, and all you can talk about is that we didn’t get group T-shirts?
  • Why do you want to look like some NGO paid you to be here? Don’t you want to look like what you are, citizens demanding change? I mean, come on, check this out: A big NGO on the day of the launch in their T-shirts:

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And us, Wakonye Kenwa:

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Wakonye Kenwa group members:

  • When you march in Uganda to advocate a cause, or celebrate something, you march as a group with a group identity. Group identity is expressed through looking uniform. Uniforms are deeply cherished, a mark of success, legitimacy and unity. Everyone wants a school uniform, a work-place uniform, church choir uniform, sports team uniform. There are always NGOs around to help make this possible by providing T-shirts! Ask them, and they will provide.
  • On the day of the launch of our alcohol law, there were many community groups and big NGOs (I guarantee you’ve heard of many of them). These other groups wore printed T-shirts, which let everyone know which group they part of. They were smart! Uniform! Identifiable! And yet Wakonye Kewna, our group who started this whole fight, who worked hard for 2 years for this was invisible, unidentifiable as the group who started it all.
  • Does ‘Aber’ Tessa, our organizer think so little of us that we can’t find a way to source some T-shirts to bring recognition and reward to our group after all our hard work?

The bottom line:

Our group marched, without T-shirts. It was a great day. They starred in a drama about alcohol, which everybody agreed was the highlight of the event. We’ve been on local radio many times speaking about this issue, the work we’ve done, putting our group’s name out there. But there are still high levels of discontentment. There are conversations to be had, and it will probably take a while. I want to make sure the group feels valued, and proud of their achievements. Maybe we should just get the group some damn T-shirts.

But there is a bigger, interesting point here. Are NGOs appropriating activism in Gulu, and elsewhere where they work? By ‘facilitating’ the voice of the people, do NGOs make people believe that they can’t be activists without donor money, allowances and handouts? There is a huge gap in Uganda between the kind of public dissent that results in tear gas and arrests, and NGO funded ‘advocacy’ events. Today in Gulu there was a march for road safety. Last week there was a march to celebrate human rights day. Lots of money spent, happy people in T-shirts, but (I suspect) no actual measurable goals, no tangible change. Most marches in Gulu, I’ve learnt, mean nothing.

As far as my historic research reveals, Ghandi’s salt law marchers didn’t need free uniforms. Kiwis protesting apartheid during the Springbok tour…no matching T-shirts. Selma, 1965? Again, no T-shirts.

My prayer is that one day in Gulu, I will actually have to go and buy myself some pajamas, because the time of the giant NGO t-shirt has finally passed.

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