backlog: Batey hopping.

My work in the DR is structured in a rather circuitous way – as both a program evaluation and a needs analysis concerning access and utilization of health services – making things kind of hectic, much like many endeavors in my life. It’s been a long running start, building up to a rapid finish.

Following weeks of reviewing literature, struggling through meetings (en español, por su puesto) with stakeholders, and participating observantly, the madness of surveys began. I developed a rather extensive, 100-question, quantitative-data collection instrument and trained two Haitian medical students (able to translate Spanish into Creole when needed) in collection methods. After testing and revising the survey, we collected information from multiple field sites in individual Batey communities.

As a background I ought to explain that the organizations with which I’m working provide healthcare through mobile ambulances to communities without access to any other types of health services. This includes preventative medicine, treatment, prenatal care, health-education, and so on. Accordingly, there are huge varieties of unmet needs. At the same time, these Batey communities live on the fringe of society and suffer in need of many other types of services, like education and sanitation infrastructure.

In the name of ethics I won’t reveal too much about the project here or now, but I will say that it has been challenging to segue between the areas of inquiry and practice – between the acts of research versus organizational assessment. The dependency of patients upon these health services limits the accuracy of the reach of a general evaluation survey – these patients lack the typical “rights” of choice, access, and time that other users are afforded in routinized healthcare services. At the same time, as a development and public health practitioner, it’s hard for me to adapt my motivations to fit solely within the “curiosity” realm of the researcher who seeks definitive “conclusions.” Neither my professors nor supervisors were able to guide my thinking in order to pigeon hole the work in one way or the other and I suppose it isn’t necessary.

For the mean time, I’m considering the most appropriate categorization of this project (which will likely inform the thesis I will begin preparing next month) as a practice of applied research to make things work better and more efficiently while meeting the basic needs of individuals who deserve and need critical health services.

backlog - March 25 - 29 - Ft. Portal/Kabarole Visit

Fort Portal was really a great trip – we started slowly in the Matatu from hell that I detailed earlier and arrived to a shoddy, but fine, hotel. We were on an "exchange research visit" with the Kabarole Research and Resource Centre, which is doing all kinds of great work in the realm of social empowerment and sustainable, equitable development. In particular, their model of Community Process Facilitators (CPFs) is quite impressive; KRC’s constituents (community based organizations and civil society organizations – working in various areas, like health, education, anti-corruption, community building, etc) elect/nominate an individual to be the representative of the group to KRC – the CPF is then trained directly by KRC in good governance and in key areas of organizational development. He returns to his community and employs these measures without the intervention of KRC -- the model is working so well and really facilitates sustainable development.



We visited a youth center and met with their CPF who told us how he and two others, upon recognizing the very high school-drop-out and teen pregnancy rate determined that something had to be done within the community. Working with the local church, they received land and donations to build (by hand) a structure to serve as a youth center. The center serves as a place to communicate – through (Ugandans love this method…) “Sensitisation,” (essentially public education/discourse) using dance and drama, about safe sex, gender, public health, the value of education, etc. The students/youth at the center are performing themselves to educate their peers, and have been so successful with their sensitization performances that they’ve been commissioned around the town, district, and general region to perform, in turn, generating money. This money has been utilized for local business development. Adjacent to the youth center is the “piggery center;” the money raised from selling pigs continues to be utilized for school fees and the continuation of the good works of the center. All of these points are great – but most important, is the very tangible outcome of NO teen pregnancies and no high school drop outs in the past five years that the center has been operating. Pretty awesome eh?

At the center:



We also spent time visiting with CPFs at a two rural hospitals, outside of Ft. Portal town. The hospital grounds are the meeting area for the entire community, who come together to lobby for action; there are certain Government of Uganda (GoU) policy provisions that fail to be realized (as in all governments), but these people have been able to mobilize and demand attention for their rights warranted by the government.

Dialogue participants:


For my work purposes, I met with nurses to discuss their record keeping structures, their internal documentation methodologies, etc. Visiting this hospital was a real eye opener that made me even more grateful for modern medicine and our ease of access in the US than ever before. They went through the records together:



136 people with Malaria and 90 new AIDS patients in one month. Horrifying.



The above described sensitization methods seem quite reasonable for promoting HIV/AIDS education when compared with this poster, which is hanging, conveniently, in a closet, and in a community where no one speaks in English.

The waiting room:


Registering new babies:


In front of the hospital:


Also, CARE partners in front of the hospital:


The woman pictured above, Mary, has got to be one of my favorite Ugandan women. She never restricts her opinions, she speaks loudly and clearly, and she isn’t afraid to tell me what she wants me to hear. It is something I appreciate so much, in a country where women’s voices are so cyclically silenced.

A few more from Ft. Portal town:
Making and selling nails:




the famously repulsive Maribou Stork:


Some funny ladies that asked me to shoot them, who gave me their best model poses – please note the Napoleon Dynamite-esque shirt for Uganda’s current President, Yoweri Museveni, dynamically referred to as M7. This photo of him in the cowboy hat dominates every office, restaurant, public building etc. Too funny!


A colleague of mine took a brilliantly off-center photo of me and the ladies in front of the Rwenzori mountains:


Moving and grooving:


Mountains: