Uganda – April 2011

April 2nd, 2011

Welcome to Uganda

It is always so lovely for me to land in Uganda, one of my second homes. Being with Adela and Herb on their first visit, it was a pleasure to experience their reactions and wonderment to the rich greenery of Uganda, the red clay ant hills, the warm and proud people, the poverty, the colors.  Adela is focusing on marketing aspects for our programs and there is a regular, “Look at that billboard!” and “Wow, that building is totally wrapped in Coca Cola!” coming from her.  Herb is taking it all in and both are asking a million good questions of our staff teams at all our clinics. Dr. Mina, our East-West (E/W) Africa Advocacy and Public Relations Director, has joined us throughout the trip so far (and will come to Kenya with us).

The AHF Uganda Cares team, led by Dr. Penny, is an organized, disciplined machine that moves mountains. Their testing goal for 2011 is a combined 470,000 tests — just in Uganda.  They key challenge will be to successfully link 80% of the positive people into care. I have no doubt they will succeed and we will be there to help them.

The first clinic visit was to our Owino marketplace clinic in Kampala. It is the largest market in E/W Africa and a ‘first’ experience for Adela and Herb, and always a valued stop for me. Thank god no rain and mud that day. We recently moved from inside the marketplace in a small space with no running water (which we managed to operate in for 6 years) to our new, fully equipped clinic just outside the market. What an improvement! The staff toured us and Herb asked a zillion questions, soaking it all in. There was a very cheerful group of our ART-aiders there (expert clients — HIV positive clients that have been trained and volunteer to assist in clinics).

Marketplace clinics and testing programs are highly effective and a model we plan to expand to other countries. What makes more sense than to bring the services to where the people congregate — the marketplace!

Masaka Healthcare Center

Our Masaka Healthcare Center

The highlight of Uganda visits for most of us Americans is the day long trip to our Masaka district (rural) clinic. It takes about two and half hours each way in a bus and is always a valuable and touching experience. We arrived there on a beautiful day with no rain to a very busy and crowded clinic – there were many patients. The clinic is designed in a U shape with a starting point of registration and vitals at one tip, followed by nurse or doctor exam, counseling if needed, labs and ending with the med dispensary and follow-up appointment given. AHF Uganda Cares sees 17,000 people in that one Masaka clinic. Dr. Penny says we can scale up to 20,000 and still maintain quality care. Truly amazing.

One of our pediatric patients, little Mariam, has become a success story and I always check on her and visit her family.  She was featured in our documentary film, “If Not Now..” and she journeyed to Washington DC with us to advocate Congress and the Senate to continue funding for AIDS treatment. Her family is extremely poor and last year a large group of family and friends gathered $5,000 to build them a new house. We took the AHF bus there (as far as it would go on the rough, dirt roads) and walked the last part in to the house. Mariam and family were not there, but they were fetched and we all had a great visit. It was wonderful to see her jjaja (grandmother) and her sister, Sylvia, in new, clean dresses that were bought with money my sister and I sent. It is not that hard to make a huge difference in people’s lives. Jjaja had been wearing the same ragged dress for two years. Since the last visit we had sent $500 to buy them all beds and bedding so they could get off the floor and that has been a ‘luxury’ for them. The girls love their beds.

As we left and the bus was at the end of the road, little Mariam and Sylvia ran the entire distance to stop the bus – to tell us that Mariam was out of ARVs. Since Sylvia was also sick with TB, we climbed them on board to take them back with us to the Masaka clinic to get lunch and medicine. I have never seen two tiny  girls eat so much! They have very little food at their house. But Mariam is doing well – and their lives have improved tremendously.

We also had many meetings with political leaders while in Uganda and have planned the advocacy course for the next year. Donor dollars are scaling back and there is a consensus all around that countries with heavy HIV/AIDS burdens must contribute more of their own dollars to the effort. We will lobby the Ugandan Parliament to contribute more.

AHF Uganda Cares is a marvel to behold — a systematic healthcare and advocacy operation that both provides service in big numbers but has never lost the personal and gentle touch for the human being — for the lost child. We are not only saving lives, but changing lives.

Our ART-aiders - expert patient advocates

Dr. Mina, Albert, Herb and Adela at the Kampala Owina marketplace clinic

The marketplace is incredible.

Our Uganda Cares bus with our fabulous staff driver - Jacob

Adela, me and Dr. Salami at the Equator line

Our newest Africa doc, Dr. Salami, from Nigeria

A group pre-test counseling group nimbly using the main entrance to the clinic

Albert on the playground

Our dedicated staff.

Walking up the road to Mariam's house.

Mariam remembered Herb from our D.C. lobbying week last year

Grace assessing that Sylvia had malaria

Mariam and Albert

Sylvia ran into the trees and brought me back a gift of 3 beautiful avocados

Adela with Sylvia, jjaja and Mariam

This boy was playing and splashing in the mud at the end of Mariam's road.

AHF Masaka Healthcare Center lab.

HIV medic dispensing meds.

Welcome to Uganda

Welcome to Uganda

Masaka Healthcare Center
Uganda Cares - Africa 2011 Photo Gallery

Kenya – April 2011

April 1st, 2011

We arrived in Mombasa in the evening to a wall of moist heat. Very different from Addis Ababa and Kampala. Earlier, I warned Herb and Adela that it would be hot but the humidity was still a surprise for them.

Mkindani Clinic Team

Mkindani Clinic Team

We spent Friday with our prevention programs coordinator, Mary – first making our political calls to the health department and the Mayor. We then made a quick pit stop at Nakumaat (a “Rite-Aid” type store) for a cold ice cream — it was hot! And, continued our visit to our two Mombasa clinics, Mtongwe and Mkindani. We spent much time talking with the staff at both clinics asking them for input on marketing to new clients and kept an ear out for challenges and suggestions. We all really enjoyed that.

At Mkindani, all the staff and volunteers were in red AHF Test and Treat t-shirts which was a warm welcome. In the doctor’s office, pinned on the wall behind his desk was a black and white photocopy of an extremely ill, thin man with a photo next to it of a healthy, happy man. Same guy, 6 months after anti-retroviral treatment initiation. Very powerful. And the doctor, having no other marketing materials,  just typed it up with the header – Treatment Works! and photocopied it. Every patient that comes into his office sees it — they can’t miss it. I loved it.

We found out some startling things during the meetings — one being a shortage of condoms which has led to a spread of ‘condom sharing’ — people are washing and reusing condoms. This is so frustrating for me to hear because condoms are so cheap (3 cents) and available by the billions.  A major problem is the condoms sit in warehouses and don’t get distributed – we’ve found that the reusing of condoms is only one of many improper ways condoms are used in these countries due to shortage of safe sex materials including lube.

The bulk of HIV/AIDS cases in Kenya are in the rural areas and condoms just don’t get to them. An issue we will take on with the Ministry of Health. Parliament says there is ‘no shortage’. I guess they are not talking to the guys who have a line of washed condoms drying in the sun.

We heard a lot about some of the real issues of why people are not accessing treatment or defaulting from treatment – mainly witchcraft. Witchdoctors tell people they will cure them and advise them to stop their ARV drugs. We know what the outcome of that is .. it’s not good.  This came up a lot so far during our trip. In Ethiopia, it is ‘the holy water’ that is promoted to cure AIDS.  Here in Kenya it is potions and spells and people’s belief in being bewitched.

Mombasa Marketplace

Mombasa Marketplace

We are strategizing on how to best deal with these witchdoctors.   It will be challenging but with a good strategy, we may be able to affect change.

We visited the largest marketplace in Mombasa, which was very griddy – much more than Owino marketplace in Kampala.  A little dicey.  I have to admit that I felt a bit unsafe landing in the middle of it, knowing I had to protect Adela and Herb form any harm  — until the marketplace chairman arrived to show us around. If you have the chairman with you, no one will touch you.

We toured a ‘building’ for rent for a possible new clinic but the structure was in such a terrible state — it should really just be torn down! I watched Herb’s face as he could not believe what he was seeing. Quite strong smells in the marketplace, too. My flipflops were the wrong shoes to wear.

Mombasa and the AHF Kenya program is struggling with the constraints of national policies that need to be changed but our team is a dedicated group and we will help them grow and excel.

Mombasa is a rough town but with beautiful beaches and crystal clear water. The tide was out and on Sunday Adela and I walked the water far past the anchored boats. We fought off aggressive vendors following us but still enjoyed the warm water.

We leave Kenya with a long advocacy agenda and much work to do. On to Zambia….

Herb meeting my pal, Dr. Chidagaya, Medical Officer of Health, Mombasa

Mombasa is "a corruption free zone"

Mary - heads up our testing and prevention efforts. Love those earrings!

Our lab at Mkindani clinic

Our Mtongwe clinic staff.

Our billboard of the Mombasa mayor who we paid a courtesy call to - and he signed on to our DC Declaration for the International AIDS Conference 2012.

Our Mkindani clinic staff

Meeting with the marketplace chairman and owner of a very 'rustic' space we are considering for clinic.

Bats! Bats!

Mombasa Marketplace

Mombasa Marketplace

Mkindani Clinic Team

Mkindani Clinic Team