Field trip to Iganga. Part 3: the reflective return.

The country director invited us for a late lunch; a kind offer that was much appreciated by all. Arriving at a restaurant we agreed after some time to each order a plate of chicken stew with the standard collection of carbohydrates. We made polite conversation until the food came: plain boiled chicken, plain boiled rice, plain boiled sweet potato and matooke (a type of savoury banana/plantain that is steamed for hours in leaves). As I have discovered, Ugandan food is often a neutral palette of cream, beige, mustard yellow and off white, occasionally brightened by a splash of miscellaneous "greens", and tomato. Flavours are equally neutral, with Ugandans tending to eschew any use of spices and seasoning beyond salt, in favour of  unadulterated blandness. The waiter brought us each a small bowl of salty vegetable broth of the type my great grand mother used to prepare. "Is this chicken stew?" I asked, wanting to know so I could avoid ordering it again. The driver laughed, and said she was happy because she didn't like stew anyway-too spicy. The CD was back to business of one of his three mobile phones (It is not uncommon to have multiple phones here, with a sim for a different network in each phone to reduce call charges) . We finished up and travelled to the district health office to try and gather some more information on infection rates in the area.

I asked the CD if the information was collected centrally by a demographic health survey (DHS) and accessible from Kampala. He explained that invariably one would be passed from office to office on a wild goose chase and that the breakdown per district would not be available. He noted that the last DHS had been conducted in 2005, and at last I understood his eagerness to get at least an idea of what the current infection rate stood at. As the others disappeared into an office to hunt for numbers, I stayed outside, and introduced myself to the team from JSI who had just pulled up. JSI are NACWOLAs donors on the STAR EC project-strengthening HIV&AIDS and TB response in central/eastern Uganda. JSI themselves received funding from USAID and then subcontracted the actual implementation to local partners like NACWOLA. Ideally NACWOLA should be able to attract large grants directly, but they currently lack the M&E systems and management capacity to make this happen. I introduced the possibility of working with NACWOLA to develop an M&E strategy, and the specialist from JSI said he would be glad to offer technical assistance to the process.

I relaxed a few moments on the step, in the sun, before the others emerged and we set of back to Kampala at around 4.30pm. We tucked into the bananas given to us by the psychosocial support group leader. Irene made the (subconscious) connection between our visit and that of politicians, saying that when she travelled as a journalist on a political campaign, villagers would present far more than they could possibly afford to politicians in the hope of increased support. The politicians would return to Kampala with goats, chickens and great sacks of maize, only to deliver nothing. We all agreed that a bunch of bananas was probably acceptable, but that when people offered more, clever ways of turning the offer down without out rightly refusing needed to be exercised. Suggestions for such excuses included being unable to strap the goat to a bicycle that you intend to travel part of the way home on. 

We passed the time in the traffic home, discussing the universal challenge of encouraging men to access health care services in general, and not just for HIV&AIDS. Irene spoke of how you could treat woman for a sexually transmitted infected but that unless her male partner was treated too, she would repeatedly reinfect herself and return for services indefinitely.  We identified the need to reach out to more men, and to target men more with sensitisation. We discussed the big cultural ceremonies at which community sensitisation, for men in particular, could be conducted. Irene talked of the male circumsision season in western uganda, where almost everyday you could see small boys getting their foreskins "chopped"  in full view of the audience gathered. Sensitisation and HIV education activities had at least already increased the use of a fresh blade for each boys procedure. We spoke of the silent HIV epidemic in Iganga, and the practises among most at risk populations, including plantation workers, long distance drivers, sex workers, men who have sex with men.

We talked about the problems of polygamy for HIV prevention, and how the taboo nature of talking about sex that makes discussion of HIV&AIDS transmission& prevention and family planning an extra sensitive issue. We talked about the possibility of streamlining family planning into the information and support  provided by community support agents.  We talked of better partnerships between organisations working with community health workers and village health teams, and the serious need to identify opportunities for collaboration, to reduce overlap, and to fill in gaps. Irene and I discussed that I  (NACWOLA) and possiibly Marie Stopes could at least look at the other organisations and government involved in Iganga district. We saw a great need for these organisations to partner up, to try and streamline activities and resources, and to provide better, fully co-ordinated outreach services to the poor. A national strategy for the use of community health workers loomed as a gaping gap that we began discussing how best to fill. 

We dropped the CD at home with a big thankyou and a vigorous wave. It was brilliant that he had come, and that he was genuinely interested in engaging more with the realities of what was going on at the community level. His interest and genuine offer of support will no doubt be of great help to NACWOLA in the coming months. As we wound up and down and across the hills of Kampala, to the other side of  town, the dusk quickly tuurned to darkness. Each black mound was sporadically illuminated with the warm glow of houses and the snaking lights of heavy traffic. The driver dropped us at the hotel, Irene drove home, and I settled happily onto the veranda of the hotel with Brooke, the fellow anthropologist, and a beer.