Four Reasons to Hope

Yes things seem dire, but there are actually a lot of reasons to hope that we’re going to get through this. Humanity has come a long way over the millennia, and we’ve never been in a better position to fight a global pandemic. Here are four reasons to hope.

China’s miraculous efforts
China houses 1 in every 6 people on this planet. Just 6 weeks ago China had 4000 new cases in one day. Now, for 3 days they have reported no cases of internal transmission and they only have to worry about the rest of the world bringing it in. China  proved this thing is not only controllable, but it can be decimated quickly and completely. This is nothing short of a miracle, and should give us great hope.  The west should swallow their pride and look to China for advice and the way forward.

China new coronavirus cases.png

Summer is coming!
90% of the world’s population lives in the northern hemisphere. Europe, the biggest problem zone has moved into spring. For the next 3 months it’s getting hotter and hotter there which is ideal. There’s no question that hotter weather makes it harder for the virus to spread. Summer alone isn’t going to solve the problem, but it could be just what we need to turn the tide.

Promising Medication research
Initial medication trials have been more promising than for previous viral outbreaks. These medications won’t cure the virus, but could greatly reduce transmission and mortality rates. We have to be cautious, as randomized controlled trials haven’t been completed, but it’s possible that within a few weeks effective treatments could be disseminated around the world.

The vaccine will happen
A Vaccine isn’t going to help us int the near future, but even if we fail to control the virus this year, by early next year the vaccine should save us. Over 20 vaccines are in development, and early human testing has already started. Once we vaccinate the world, it’s likely we won’t have to worry so much any more.

Keep loving amidst both hope and fear (an encouragement)
Hope is important, but it’s even more important in this stressful time that we continue to love each other every day, through both kind words and kind actions. Remember that every time we wash our hands, we love our fellow human.

“And now these three remain: faith, hope and love. But the greatest of these is love.”

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Uganda closes schools – before Case no.1!

Ugandan President Museveni has just announced sweeping restrictions on social contact. This might seem normal to many of you around the world except…

Uganda hasn’t had one confirmed case yet!

For 1 month (and almost certainly longer)

– All schools closed!
– No religious gatherings
– No weddings/funerals/political gatherings/concerts
– No regular market days (This cuts off large scale trading between the village and town)
– No foreigners from 32 coronavirus rampant countries (Sad for people on holiday overseas)
– Only “essential” public transport (whatever that means, maybe more bribe opportunities…)

These are (I think) is THE MOST EXTREME MEASURES any country has taken before having a case

Do I agree? Probably not. Closing schools before the first confirmed case seems  premature if you believe in your Covid testing system. If you think you are missing cases than I would understand. Perhaps Uganda could wait for the first few cases at least before pulling the plug on the entire education system. Also we haven’t seen previous influenza pandemics or coronavirus go rampant in tropical countries, so we don’t know what course coronavirus will follow in Uganda – it’s not quite Europe in winter.

On the other hand many countries that haven’t acted so early have suffered terribly, so I understand the sentiment. It’s impossible to be even close to sure what the best decision is yet, as we are still so early in the pandemic process.

More than anything, this is going to be a test of the power of the government in the everyday lives of Ugandans. Previous orders have failed both due to poor implementation and public resistance, like forcing people to register sim cards and enforcing a plastic bag ban. Will market days in remote places really stop? Will public transport slow down or will the police just cash in on extra bribe opportunities? Fear however is a powerful motivator, and will help enforcement

There’s also going to be huge grey areas. At the moment we are in the middle of launching 20 remote health centers through our social enterprise OneDay health. Are we allowed to keep doing that?

Also if you are Ugandan and keen for Uganda-specific advice and updates, St. Philip Health center just started sharing twice daily Coronavirus news and advice to help keep yourself safe. Sign up and stay informed!

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Fake news goes viral – in the time of Coronavirus

First switch on your brain, then read carefully, then decide what’s right, what’s wrong, and what needs checking.

If there was ever a time for fake news to go viral, it’s now. You can publish anything with “coronavirus” in the title and people will clickity clickit. Even better if it instills fear. Who cares if a few of the facts are you know, not quite correct…

This matters because masses of us (me included) mindlessly scroll our facebook feeds, clicking on every coronavirus blog post, graphic and article. What we read affects how we feel, how we react and what we do. Every error-ridden article that instills fear can push our mental health down a notch. Or fuel a run on toilet paper. Or encourage us to stockpile masks…

I present 3 cases of fake news I’ve observed over the last few weeks, both from viral blog posts and the mainstream media.

Fake news no.1
“In Italy, doctors are having to decide who is worth saving”

When the clickbait article is entitled I need you to read this…”, your bullsh!% radar should already be going ding ding ding. She propagated the  myth that Italian doctors are forced to decide who should survive and who dies. Currently Italian doctors  are stretched to the limit, but The Lombardy health chiefhas stated they aren’t turning critically ill away. “Gallera denied that ICU capacity was so limited that doctors had changed the criteria for ICU admissions.”

The Italian health system (and others) might well reach that point, but they haven’t yet.

Fake news no.2
“Coronavirus deaths and cases spike”

The BBC had the nerve to lead with this, after the number of new cases in China had been reducing for over a week! China had changed their case definition, which made the reported number of cases artificially increase, while the real number continued to drop. China had been doing an amazing job, and if I had to pick the headline, I might have gone for the opposite. “Coronavirus cases plummet” or “China defies the odds to control the virus”.

China coronavirus cases.png
In this light, it’s a bit rich that the the BBC thinks that they are above major errors. “Over the past month, 12 February to 11 March, there have been over 575m page views globally to stories about coronavirus. People want trusted information and – unlike Megyn Kelly – know where to turn”. The BBC has proved more than once they are far from immune from using fake news to go viral. Another shocker was “There is no specific cure or vaccine. A number of people, however, have recovered after treatment.” By “a number of people” I take it you mean 98% percent of people? Nice one BBC… To their credit though, they did  remove this statement eventually.

Fake news no.3
“One of many tidbits of misinformation the president has broadcast during the coronavirus outbreak is his belief that warm weather will halt the spread of COVID-19. “The heat, generally speaking, kills this kind of virus,”

This New York magazine article popped up at the top of my feed when I googled “Weather and coronavirus”. Trump spouts so many lies about coronavirus and everything else, why did they bash on a rare statement that is largely true? Heat, generally speaking does kill this virus. What’s more bizarre is that the second half of this ‘publication’ contradicts the title and first paragraph, quoting a scientific article which states that hot weather will in fact, slow the spread of the virus. Absolute trash journalism!

A not yet peer reviewed Chinese study  showed that Coronavirus appeared to spread best in chilly temperatures of around 9 degrees celsius, and in a much better AlJazeera article one virologist stated that coronavirus is “not very heat-resistant, which means that the virus quickly breaks down when temperatures rise”.

This is just the tip of the fake news iceberg, and there’s plenty more coming soon so…

First switch on your brain, then read carefully, then decide what’s right, what’s wrong, and what needs checking.

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Why Coronavirus won’t devastate Uganda

This may seem like a bold statement with the probable pandemic peeking over the horizon but even based only on reason 1  (spoiler alert), I’m happy to make it. Uganda has multiple factors in its favour when it comes to Coronavirus.

Here are 3 reasons coronavirus is unlikely to be as bad in Uganda as in other countries, 3 reasons why Uganda might struggle with the virus, and 3 actions Uganda should take to mitigate the risk.

The BIGGEST REASON why coronavirus will not devastate Uganda

Ugandans are SUPER young

 It’s hard to fathom how young Uganda  is. Half  the population is under 15. Only 2% of Ugandans are over 65 years old and 9 out of 10 are under 50.

To compare this with other affected countries, China and Italy have over 10% of their population over 65.

Coronavirus mainly kills older people. The contrast between the mortality rates of the old and the young is staggering. If you are over 70, coronavirus is very dangerous – you have more than a 1 in 10 chance of dying from the disease, if you are under 50, it’s only 1 in 500.

Death rate coronavirus

So even if the virus becomes widespread here, few people would get severe disease, and far, far fewer people would die compared with current countries ravaged by the virus. Based on Uganda’s demographics, 0.5%, less than 1 in every 200 infected people would die from the virus.

Reason 2: Previous pandemics have spared Sub-Saharan Africa

Africa was the least affected continent (besides Antarctica) in the two most recent viral pandemics, SARS and H1N1 swine flu. We don’t know why exactly, but one factor is that diseases spread by droplets don’t do well in hot, dry conditions. Perhaps the relative lack of international travel here also means less virus is imported. Although coronavirus a different disease, it has a similar mode of transmission to SARS and H1N1 so worldwide spread may to some extent follow past trends.

H1N1 pandemic map

Ref: Swine flu and the current (H1N1) pandemic in humans: A review. Pwaiya et al.

SARS map

Black indicates countries with confirmed death, red countries with confirmed cases.        Created by Maximillian Dorrbecker, using WHO data.

Don’t get me wrong, coronavirus will reach Uganda and will most likely cause a major public health problem, but if this virus follows past trends we may get off lightly compared to countries from other parts of the world

 

 


No. 3 Most people still live in the village

 Uganda is 70% rural. Many people are still in remote villages, and only have sporadic contact with people from town. Yes people move around and there is connections  through market days and visitors from town, but most people in Uganda aren’t packed into busy cities where the virus can easily spread. This means that the virus may spread more slowly, and may be easier control. This factor is weaker than the previous two, and is based on logic and intuition rather than evidence.


Reasons why Uganda might not manage the virus well

1. Lack of government ability to implement plans

It’s ironic that although Uganda has suffered under 35 years of a one-man dictatorship, the Ugandan government struggles to implement their most basic plans. This impotence is caused by understaffed government departments, disorganized bureaucracy and (obviously) corruption. Last year the government threatened to cut phone lines off if people didn’t register their sim-cards. People didn’t take the order seriously for a long time. The deadline for registration was extended 3 times, before the government finally started cutting of some lines.

In China, when the government ordered people to stay at home because of the virus, people stayed at home. If Museveni tells Ugandans to stay at home, it might take weeks for it to actually happen. If roads are blocked to prevent virus spread, “important” people will bribe their way through. If medical supplies are needed in remote regions, corruption and poor supply chain systems will cause huge delays. Government orders and the law aren’t taken seriously, which doesn’t bode well when managing an epidemic


2. The health system (obviously), especially the lack of oxygen

It goes without saying that the Ugandan health system is poorly equipped to cope with current health problems, let alone a new viral epidemic.

One major problem could be the lack of beds with oxygen. Coronavirus kills through respiratory infection. To grossly oversimplify, the virus damages the lungs until they can’t supply enough oxygen to the body. Supplying extra oxygen to the lungs is a crucial part of supportive care in severe coronavirus cases, buying time while the body fights off the disease. Towns of 200,000 people like Lira currently have under 20 hospital beds which can supply Oxygen, nowhere near enough.

3. Co-infection with malaria

Unfortunately if coronavirus does hit Uganda hard it may well be between May and August, the heart of malaria season. We don’t’ know how malaria interacts with coronavirus, but we do know that when pneumonia and malaria combine it can be a deadly combination. Coronavirus both causes a pneumonia like syndrome, and leaves the lungs vulnerable to secondary bacterial pneumonia infections. With over 50% of the population contracting malaria up North here in a bad year, there will be a ton of Covid Co-infection and it could turn ugly.

 

Actions Uganda should take

 1. Don’t waste Money and human resources testing for the virus

There will be the temptation to try and roll out expensive Coronavirus testing facilities across the country. Testing may have some value in the early “containment” phase to track where the virus initially spreads, but after the virus starts to move around the country it will be an exercise in futility to test everyone with a runny nose. Uganda doesn’t have the money, expertise, or infrastructure to track the virus real-time around the country in the same way as countries like England or China.

This global pandemic isn’t like an Ebola outbreak, where experts from around the world and tens of millions of dollars descend on the affected country to track and manage the virus. As the whole planet is affected at the same time, Uganda will have to manage this largely alone, and they should focus their efforts on fundamental public health measures and treating sick patients rather than virus testing. Unfortunately I doubt this will happen, and a lot of money and human resource is likely to be wasted on futile efforts to test for the virus and track the spread.


2.
Supply More Oxygen to hospitals

Oxygen is a key resource to support patients who are critically ill with the virus and Uganda doesn’t have enough for their current illness burden, let alone for coronavirus patients as well. If the virus does take hold, Uganda is going to need more beds with oxygen. There may only be a few weeks to prepare now, so we should start buying now. Every empty cylinder in Uganda should be filled, and other oxygen production devices like concentrators should also be purchased. Uganda needs to stock up in a big way, and start transporting the extra oxygen to rural hospitals as well. Ugandan hospitals need more oxygen anyway so even if the virus doesn’t hit in a big way, it’s not like the money will have been wasted.


3.
Break connections between “town” and the “village”

70% of Ugandans live rurally, in clusters of households on subsistence farms. Many of these people could be protected by minimizing the movement of people between towns and villages. Simple measures could be taken. Only allowing food and commodity supply vehicles to travel on main roads, while cutting off public transport would be one simple way to slow virus spread. Uganda has a huge advantage in that most people are largely self-sufficient and produce their own food, so cutting off the town from the village for a month or two wouldn’t be dangerous.

All things considered, coronavirus may not devastate Uganda to the same degree it will other countries. Feel free to share you own views and questions!

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Ignore the fake News – Let your kids be vegetarian!

Sloppy reporter Esther Taunton should be reprimanded by Stuff for quoting the quack dietician “Sylvia North”, and said dietician Sylvia North at least re-educated for spouting this distasteful misinformation (let the food puns begin). It boggles ones mind that in 2020, these false ideas about vegetarian diets not only exist, but are cooked up by a supposed dietician, then fed to the public by a mainstream reporter.

https://www.stuff.co.nz/business/farming/118905679/preteens-too-young-to-make-vegetarian-decision-dietitian-warns

I’ll say it straight up. Vegetarian diets can be 100% fine for children. In New Zealand. In India where almost half the population is vegetarian. In Uganda. Anywhere.

Dietician Sylvia North, who is registered with the New Zealand council of dieticians somehow decided that some year 7 or 8 kids who made the wonderful decision to go vege for their own health, and to save the planet was “hugely concerning”. She then backs up her vegetarian hating with a combination of extremely poor logic, and straight up lies. Let’s start with the lies.

“”Plant-based protein sources such as beans, lentils, rice, quinoa have lower protein bioavailability and are incomplete sources of all the essential amino acids needed to support life.”

WRONG – Rice and beans eaten together have all the amino acids that you need. If she is trying to say that individually these foods don’t have all the required amino acids that’s technically true, but then her argument is meaningless because no-one eats only one type of food.

“Children could also miss out on necessary iron, zinc, essential fatty acids and B vitamins if meat and dairy was removed from their diet.”

Again, just wrong for half of these. The article states that kids are become vegetarian not vegan. Don’t burn strawmen! I’ll set veganism aside for simplicity, and am happy to say (backed up by real professionals) that any vegetarian kid eating a halfway balanced diet aren’t at any more risk of iron or zinc defficiency a meat eater, probably aren’t at risk of clinically meaningful fatty acid deficiency, but yes unfortunately are at risk of B12 deficiency. She got one out of four right for vegetarians at least.

In New Zealand, we don’t have a swathe of vegetarian kids with nutrient deficiencies. That’s not our problem. Our problem is that 1 in 3 of our children are overweight or obese, fuelled by diets with way, way too much animal fat in them. For Sylvia to focus on the unlikely problems of nutrient deficiency on a vegetarian diet, while ignoring the enormous protective effects of a vege diet in reducing the risk of death from the real killers Heart disease and Cancer, is completely ridiculous.

Now for the inane lack of logic

“North said children were less likely to eat dishes like lentil casserole and quinoa salad, which adult vegetarians would do to ensure their diet was well-balanced.”

Children will eat what they are used to and what their parents eat. Kids brought up on lentils in India eat lentils. In Uganda, you won’t find one kid who refuses to eat beans. In addition, kids in this article decided to become vegetarian. Kids who make the fantastic decision to go vege, are unlikely to then refuse staple vege food. Scaring parents that feeding their 10 year old kids actual healthy food might make them have a less balanced diet is straight up irresponsible.

kids blog reading

Many Ugandan kids are perfectly healthy with next to no meat.

Children making the bold decision to go vegetarian is not “deeply concerning”, but a fantastic step both for the planet and their health. Don’t believe everything you read in the news!

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Well done USAID! Allowances goooooone.

This seemingly small announcement in a minor Ugandan newspaper, might herald one of the most significant changes in the future of foreign aid in Uganda,

“The US government will also never support facilitation, participation, or sitting fees for any event,” – US Ambassador Deborah Malac. WOW WOW WOW. This is fantastic for so many reasons, but here are three.

1) There will be less meetings in general as not having a huge cash bonus assoiciated will remove the incentive to hold so many of them. I’ve mentioned this before in a ranty blog about NGO trainings/meetings.

2) More relevant people will be at meetings. There’s no reason why random government officials need to be a major distraction at every health, education and agriculture meeting.

3) Maybe this will spark a local mindset change. Perhaps meetings will become more about the thing they are supposed to be about, not the allowance you get and whether the important politician attended.

Call me optimistic, but this could be huge. I hope that this other foreign aid agencies (DFID, GIZ etc.) and large NGOs follow this lead and ditch the allowances!

OneDAy nurses full team fu.JPG

OneDay nurses discuss how to deliver quality care deep in the village – A meaningful meeting!

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Still powerless! a local perspective.

By Akwero Fiona!

Umeme Gulu. So frustrating!!!

3/7 days power presence, thanks for trying but I expected more from you guys than this

Because of the fani power issues, know that

1. People have failed to perform along their duty line as a result of 2/5 days power presence on weekdays (of coz weekend is a must power off).
2. Some bodys daughter or son out there failed either a paper or so because of this annoying power absence
3. Some body out there could die/ has ldied because of your half day half night or even 1 or 2 hours on n off power. So disheartening.
4. Business people are stranded in all corners, don’t know whether you people are able to provide food for all their families members since they can’t work because of power.
5. For leisure we can’t follow to the dot the amazing series on telenovela (South American soap) peacefully. Before you sit for 20 mins on the couch, boom power is off. Goodness.
6. Alot of insecurities at night because of nooooooo poweeeeeer. Lord have mercy.

Now what I have failed to understand is if this main power line having fault n technical team working on it as always said can’t be corrected at once or so for some good time. because this line gets problem like ten hundreds thousand times a year (if it exists) both in dry n wet season?. Or is it the so called technical team not technical enough? Or is it some intentional arrangement to fastrate people? Or what’s going on……………………………?

Some customer care issues with this team(umeme guys)

1. These guys are never moved with customers complains. Apply for connection and then wait for the wrath of time they take to come n connect you and then finally when they come they behave like they just dropped down from heaven( real angels from heaven are more humble) n they think they are only guys who went to school. You need to do some kind of community dialogue otherwise people have lost hope in umeme a great deal.

2. When removing power for some reason they are so timely but returning it back takes forever years

3. Speed at which they come to disconnect you is for World Cup (if this was the same speed they use to sort out the things people complain of, this Gulu area would be a better place but waa ) but go to their office n pay their reconnection fee. Goodness it’s another night mare to be reconnected back let alone the arrogancy.

We pray that you improve at least in some what way with your service delivery otherwise it’s won’t be pleasing at all. For some reason one time surprise your best power users by rewarding them just out of no where.

Anyway in the end, “who cares for the fish when the sea dries up”

 

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Fiona with the American ambassador to Uganda

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