TASO Gulu - backlog, June 2 - 13

Gulu is a crazy, incredible place. I've been awash with a million emotions,made more complicated by lack of processing time. The work I was part of over the two weeks with TASO was inspiring, gut-wrenching, important, and, dare I say it - somehow fun.

My terms of service as a “professional volunteer” were to document the engagement of TASO-Gulu (via photography and video) and to help draft a set of guidelines to support creative arts in the child-counseling/child play functions of the Gulu Centre.

After a short visit to TASO-Mulago, a meeting with the Dr. in charge of programs, and a 4 hour ride in the car of the Executive Director, I found myself overwhelmed with questions about the work and working circumstances of TASO. My first reaction to learning about the enormity of TASO’s function was sheer delight – imagine this: a civil society organization, created in a completely grassroot fashion, that has grown to 17 offices across the country, 1200 employees, an annual budget of $22 million USD, while providing EFFECTIVE care to over 60,000 clients a year. The words “absolutely fantastic” can’t quantify the awesomeness of what these stats mean in a country plagued by AIDS, fraud, and frequent ineptitude at a civil society level.

drama performance at TASO Mulago

Wednesday morning I was welcomed (along with the Exec Director and the Danish Ambassador to Uganda…) by 30 TASO clients who are members of a drama/dance group "living positively." Much to my chagrin the traditional Acholi dancing involved monkey skins tied around the dancers' hips. COLOBUS MONKEY skins! I was slightly aghast, but the views of Gulu town, coupled with the drums, synchronized movements, and the freshness of the morning made my balcony view somehow acceptable. Had a lovely lunch with the Ambassador – a really brilliant, insightful guy – at which point he pledged an unexpected 5 million USD to TASO for the next three years (!!!). I had a small briefing shortly thereafter to set out the general plan of attack for my time…visits to a handful of IDP camps, homes, dramas, outreach centers etc to “capture” the medical, counseling, social/support and general activities.

That night, my second in Gulu, someone from TASO took me on a walking tour of Gulu town to help me gain my bearings. This didn’t involve walking through the market, or to the second hand clothing stalls, or even past the post office. No, it involved walking past the former shelters of the famed Night Commuters, to a public hospital full of sick babies, and to the UN-World Food Program tents. Can you even imagine – 1.6+ million people have been living off of this for over two decades?

Most war statistics and stories are horrifying, and after working with others who have struggled with forced migration, the generalized stories and statistics weren't so shocking. The most brain bending information for me really concerned how migration patterns and transitional security influences the spread of HIV/Aids and other medical epidemics. IDP populations are likely to become more transitory if the government’s policy of decongesting camps and relocating IDPs to villages continues. Point blank, as security improves across the north, and people move back and forth between their villages and respective camps (keeping two homes) the virus explodes; this migrancy epidemic ultimately afflicts women and girls disproportionately, who comprise the highest number of new infections, only magnifying the gender based aspects of inequality rampant in war-torn societies. Generally the prevalence of HIV in rural settings is half that of in urban centers; currently Gulu has a 8.3% prevalence, the highest in Uganda.

Stats (from TASO):

• It is reported that there are over 200,000 refugees living in camps situation within northern Uganda.
• The region is characterized by the breakdown of family, social and community structures
• Poverty rates in the north are almost double the national average
• Illiteracy levels are extremely high; 73% of IDPs above 10 years of age can not read or write or do so with difficulty
• WFP estimates a shortfall of 27-35% of the Recommended Daily Allowance among IDPs; most IDPs are dependent on food aid
• Early age of first sexual encounter, exchange of sex for food or money, rape and sexual violence, multiple sexual partners and unprotected sex have been indicated as drivers of the epidemic
• It is estimated that between 100,000 and 130,000 IDPs between the age of 14 and 49 are living with HIV / AIDS
• The prevalence rate in the conflict affected north central region is higher than the national average
• A 2003 survey estimate of Gulu district suggested a rate of 11–16%.
• At Lacor hospital analysis revealed a rate of 21.1% for women aged in the 30-34 age group.
• The prevalence among children and adolescents visiting the same hospital aged 6 to 10 years was reported at 7.6% for males and 11.8% for females.
• The prevalence rate among pregnant women in Pader district was reported as 12% compared to the median national rate of 6%.
• There is a total or partial breakdown of HIV / AIDS services in IDP camps
• There is a disproportionately high number of children living in camps (in the eight camps in Gulu 60% of households members are less than 18 years old)
• Child mortality in the conflict affected areas in the north is very high.
• In Pader a child mortality rate of 4.33/10,000/day and U5MR 10.46/10,000/day were recorded
• AIDS currently accounts for about half of all orphans in Uganda Given the higher HIV prevalence, poverty and adult mortality rates the proportions of orphans is likely to be higher in the North. Likewise, there is a high proportion of child headed households in the north.

Although the security is improving there are still so many people living entirely within IDP camps (an interesting map), or the visions of squalor that most people conjure when thinking of refugees in blue-unhcr-tarp-roofed tents, made more permanent by the addition of grass thatched roofing and mud walls, but less than 5 feet apart, and with no land for digging.

The work of TASO in Gulu is unique when compared to their other operations around the country, because of the basic living conditions of the north, in summary:

People in the Northern Region live in an emergency setting and face insecurity, poverty levels above the national average, have compromised food security and limited access to health and education facilities. Furthermore most of the population is displaced and resides in IDP camp where there is increased risk of being victim to sexually based violence. Overall the conditions are conducive to HIV infection and higher rates of HIV / AIDS and related illness mortality.

An excerpt from my paper journal, written June 7:

"But yeah, I’ve been in and out of IDP camps all week. Today we visited a small sub-county in Awwo camp, that involved sing, drums, traditional dancing, plays about fideltity, and lots and lots of dirty, hungry, little Ugandan kids. It’s incredible that I’m sensitized to it and it isn’t shocking. These kids genitals hang out because their clothes are worn through. Half of them stare at me and gasp at my whiteness, others smile, or laugh, or are generally excited by my whiteness, and still others are ambivalent. The last ones fascinate me the most and are they ones that make me think about each individual’s personal, existential crisis with the world. I think we all try and think of young, disaffected youths as so very different from what and who we are, but I think that they are probably having the same concerns, fears, panics, and friendships that we all had, just made miniscule through the lens of war, rape, AIDS, and poverty."

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All I can say is that the best place to find a ton of Americans in Uganda is in Gulu. Despite the somewhat reverse culture shock I experienced, I got to know some really amazing people – from MPH candidates researching IDP women and reproductive health, to photo-journalists turned medical logistic officers.

The (partial) Yearbook of people scattered across the bajillion NGOs of Gulu:

• Rebecca – American Jewish girl from CA, doing research on Acholi IDP girls’ sense of self-esteem, and if PTSD is a proper diagnosis for so many of these girl-children scattered across different camps in the district.
• Lauren – Darling British/Australian hybrid studying at Utrecht in Holland. I’ve yet to find a more fashionable girl in UG, in so much that i had her tailor produce to copied dresses for me. Anyway, I know that’s not a lot to say about a person, but I like her and the way she takes charge of a scenario, is a gracious hostess, and has interesting interests - ie the traditional justice, the ICC, and that she's been attending the Juba peace talks...
• Invisible Children– I still have a thing against the “invisible children” posse of shmucks. I think they are unbelievable pretentious and absurd! I mean, all three representatives of the organization have been incredibly condescending, somewhat boring, and arrogant. Yuck.
• Miguil – French citizen of Tunisian ancestry, who’s been living in Quebec before beginning work Action against Hunger – Kinshasa and now MSF-Swiss in Gulu – as an accountant! Kind of boring, in a bad-posture, nothing too much to say kind of way, yet still dark, handsome, and somehow brooding.
• Nathaniel – recent graduate of North Western who started an international students-study – work startup attachment to the university. He’s bringing something like 20 university students to Gulu in the next week or so…
• Jackfruity – this blond girl who is president-equivalent of the Uganda’s blogger forum and studied Russian Literacture (Slavic studies…) in Kansas, and now works for GYPA as a volunteer full time, supporting herself through Web design. Neat, ehh?

New friends (and a few old):

Also made friends with some really awesome Acholi folk, the first that I’ve actually met in UG.

Benon. 24, cute and really quite smart. From kitgum, father’s an opthomologist, B went to Makerere and studied anthropology. I rode behind him on a motorcycle for about 45 minutes to reach an HIV/AIDS hospital in the depth of an IDP camp. As a field officer he makes daily deliveries of medication and test results to hundreds of Northern Ugandans infected and affected by HIV. We talked about war and death and (what else) AIDS. Benon told me how he thinks it will take at least one hundred years of stability for the Acholi people to regain the characteristic aspects of true Acholi culture, as so many have been reduced to begging and dependency from their previous selves as strong, self-sufficient and able-bodied.

A snap of me and Benon, inside Awwo camp:

An afternoon of delivering Anti-retroviral drugs in an IDP camp or a walk on the moon?

Quinton – An acholli of maybe 35 years, who works at the hotel. He, like most men in Uganda, has a shaved head, but I think it makes him look older than he is. That or maybe it's years of war and telling the same horrifying stories to tourists.

Patrick. P is 28, Acholi, from Gulu, lost both of his parents for different, seemingly health related reasons. He works at TASO through WFP appointmentship and is something like a program officer. He talks in a round about sort of way, that made me lost and and often confused, but he so graciously helped me tour Gulu and introduced me to his family and filled me in with tons of baseline information about TASO. I've never met someone as gracious for the simple gifts of life.
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A Summary: The Work of TASO-Gulu

Medical Treatment: As an HIV/AIDS organization TASO offers a variety of medical services, including Anti-retroviral therapy (medications), hollistic and general medical treatment (in a formal clinic setting), voluntary councelling and testing, and homebased care. Most interesting, and in the case of Gulu, most important, are their decentralization/outreach activities. In rural areas where medical facilities are scarce or missing entirely, TASO operates mobile clinics, complete with patient files, medical supplies, drugs, counsellors, doctors, and nurses.

Medical outreach at Awach IDP Camp, TASO brings outreach services bi-weekly to different camps scattered across the region:

Home based ART service delivery includes bi-monthly drug refills, general counselling and question answering:

Home based VTC , The family members of TASO clients qualify for counselling and testing services. The following images were from a visit to a client living positively who's family had yet been tested. The protocol for VTC involves counseling the client on the process and results of testing, taking samples/testing, disclosing (confidentially) the status, and offering follow up counselling:

At the physical TASO-Gulu Center a flurry of regular health activities can be found three days a week - all of the medical services operated on an outreach level also operate at the main center: testing, check-ups, counseling, health talks, drug therapy, etc. To cater for younger clients, and children of adult clients, TASO has developed a Child Play Center, complete with games and toys, and now with an art curriculum!

Councelling: TASO has gained noteireity for providing life-saving support through varied forms of counseling for people living positively; shining green sign posts dot all of the major towns in Uganda, reading "positive living" with an arrow pointing seekers in the direction of support. The counselling activities range from individual adult and/or child, couples, family, group, and community counseling. with well-trained medical professionals leading the sessions daily in different capacities. Pictured below is a snap from a group session at the Center and a child-counseling session, where the client is discussing her art work, in the Child Play Center.

Advocacy - TASO is engaged in various forms of advocacy work throughout different sectors of society. Ranging from weekly radio talk shows in both English and Luo to training of non-health care workers at the district level, TASO works to spread partnerships, decrease stigmatization, and work collectively in the fight against AIDS. One of their unique approaches to this is the CASA program, which trains members of different communities to serve as Community AIDS Support Agents, who act as intermediaries between registered TASO clients, Field officers, and broader community members. Mobilizing civil society at a CASA training:

Social Support: The fourth critical area of TASO's operations consists of various forms of social support for infected and affected persons. Food distribution within IDP camps, through partnership with World Food Program, activities catered for Orphands and Vulnerable Children (OVCs), and Drama, dance and singing groups, are some of the varied methods of social support operating at TASO-Gulu.

The OVC and Household Empowerment project provides formal training apprenticeships for young adults who have been orphaned, whom are child-mothers, or who are in otherways extraordinarily vulnerable. The group pictured below are packing up their new supplies and headed to a vocational training program where they will learn tailoring, catoring, and other skills, while having childcare provided for their babies.

TASO Friends project provides Income-Generating Activities (IGAs) for a select number of orphaned children who are now part of child-headed households and need a financial means for their survival. As part of the TASO Hollistic Care approach these clients recieve both medical and counselling services, but have also been able to start a duckling/chickery project to support their livilihoods.

Child dramas, Singing group, Cultural Dances

An innovative approach for educating children about the dangers of unprotected sex, drug use, polygamy, etc is through child-led drama sensitization. In this play at Awwo camp, children act, for a child audience, what can happen when partners are unfaithful. A strong support structure for adult clients is the opportunity to come together and sing about their shared experience fighting HIV and AIDS. Likewise, through group performances (at the center, at ceremonies, during outreach events, etc) the Cultural Dance group is able to share their story of living positively, in the familiar form of traditional Acholi dance. For outreach sensitization purposes the performance begins with group singing and dancing, proceeds unto story telling and dramatic examples, and concludes by involving community members in the fun!

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