Strangers in our own home after 50 years!

As Uganda celebrates 50 years of independence, I thought strongly about my come back on the blog scene. Of course, the comeback was a prior plan and I am not just taking advantage of this special occasion that the pearl of Africa is bound to witness a few hours from today!! But let’s be honest, much has changed especially since my last blog post. Indeed I will miss my experiences among the local communities that I served that time; but that too has a comeback strategy in plan. Denmark is a whole lot of new experience and I am sure the two years will be a long tale!

Well, enough about that! My agenda tonight is about celebrating Uganda’s 50 years of independence. It is a great feeling to be free! I feel my blood traversing my system with fresh energy!! But as I reflect on this achievement, I cannot hide the perplexing feeling that re-echoed in my mind for a minute. At least I won’t hide it from my fellow Ugandans! To some extent, I feel a stranger in my own home!  Sounds crazy doesn’t it? And maybe not true?

Well, here is the point! While here in Denmark, if I meet people who do not or speak little English and we cannot communicate, I feel so lost! To put it right, I feel a complete stranger and at times a loser; just looking at people speak in tongues… and trying to guess what they could be talking about….and just hoping it is nothing bad about me. In the same manner, after 50 years of independence, it is just a pity that Uganda lacks a unifying language like her neighbors (Tanzania, Kenya, Rwanda…). In fact, the negativity of this situation cannot be under estimated considering this era of globalization. I am convinced that the socio-economic disparities in land (Uganda) are partly and largely as a result of different regions being torn apart on a basis of the lack of a unifying language. If you want to think about it in the aspect of professionalism (which is widely my basis of argument), then imagine how many skilled professionals have shunned working in some parts of the country just because they cannot speak the local language there! Or imagine how many job opportunities have passed by you just because you do not speak the local language in the “would have been” work station but you posses the required skills to perform the job! And then, how many lives have we lost in this mess of language inadequacies? And how much money and resources have we lost as a result of language incompatibility? How many social networks have we missed in this mess? And then how many business investments and other social services have been missed out in certain regions just because the entrepreneurs do not feel comfortable about the languages spoken there? It is true that many good programs are impended by the absence of a unifying language in Uganda! Of course in this context, national unifying language puts the locals (who in many cases lack formal education) at the fore front since a few elites may characterize English a unifying language in Uganda today. I envy many countries that I have been to just for presence of a national unifying language amongst their citizens.  

In my own views, I feel that one of the achievements towards ending the social and health inequities in our own country will be the attainment of a national unifying language. But all that said, I am proud to be Uganda. Happy Golden Jubilee celebrations and for God and my country!

Is lifestyle failing our health?

My exercising schedule has lately succumbed to inconsistency. The evening soccer with the village boys near our staff residence quarters has over the months always been a ‘must do thing’ especially for someone like me who loves stress relief after a long day of work. My former work in the city (Kampala) was quite a different arrangement all together. After some seven or so hours of work, I would board a taxi back to my small apartment and catch a couple of movies or listen to music playing in the background as I rested by or fried my dinner. Definitely, weekend would be a climax. Catching a few drinks at a local club or visiting some friends was a usual weekend program. Save for some details like pork feasting, pool games and so on.  

I guess my urbanized lifestyle during my former work may not sound so close to your picture or experience of the usually fancied ‘urban lifestyle’. Many city dwellers, especially those that usually or even occasionally have some money stuffed in their wallets from their earnings love the up-town life. They young professionals, mid career and older fellows often stuff their tummies with excess alcohol and unhealthy but seemingly ‘modern’ fatty diets. In fact, even many teenagers that I meet in ‘happening places’ puff chunks of cigarettes and booze large as a sign of swagger. Some destructive up-town attitudes like; ‘‘who has time for a daily evening or early morning jog? or where is the swagger when you get seen riding a bicycle in the neighbourhood? or which modern campus girl goes out on a date and orders for a traditional dish instead of fries (chips), chaps and chicken? ”have fuelled in this era. Then here comes the up-town mums plus some few dads who have to buy chocolate bars or an ice cream or some other junk foods for their 5 year old sweet heart son or daughter every evening as they retire from work.

Anyways, all the thoughts about urban lifestyle came up as I dug up in the archives on how NCDs (Non Communicable Diseases) are eating up our communities. NCDs are those diseases or conditions that are not caused by a disease causing organism (like bacteria or viruses) but rather their risk of occurrence is highly determined by lifestyles. Such NCDs may include; diabetes, cardiovascular conditions, obesity, and certain cancers. The World Health Organization estimates that by 2015, about 2.3 billion people will be overweight and about 700 million will be obese. Apparently, obesity and overweight are some of the major risk factors known to lead to diabetes. Diabetes which is a major killer and chronic illness that accounted for nearly 285 million patients (6.6%) aged between 20 to 79 years in 2010 according to the International Diabetes Federation.  Obesity and overweight are as well linked to increasing risk of cardio vascular (heart related) problems including hypertension and dyslipidemia. Proper functioning of internal organs especially the kidneys are as well disrupted due to overweight and obesity. Uncontrolled alcohol consumption, smoking, poor dieting (such as excess consumption of fatty foods, highly processed foods, junky foods, foods with high amounts of carbohydrates) and living a sedentary life style (characterized by lack of adequate physical body activity) are the major factors contributing to someone becoming obese or overweight.

In this regard, adjusting one’s lifestyle to better feeding and exercising is a means to a healthier body and mind. In addition, the controlled use of alcohol and cigarettes plus other general health practices such as routine medical check-ups, sanitation and hygiene are key. I already began on the mission of selling the benefits of physical body exercising to my elder sister that works in city. I am glad she is already thinking about it strongly. Enabling people to increase control over and improve their health is my and your role as a health promoter.

Think T.B

A “Think T.B” slogan appeared in many of the slides during the training presentations last week. There has not been a training that I loved beyond this one on Tuberculosis and HIV co-infection among all the ones I have so far attended in Kyangwali. The two days’ training left me pondering about our fate; given the existing trends of such terrible communicable diseases like Tuberculosis (T.B). Surprisingly, T.B in early stages usually manifests as a simple cough that persists beyond 2 weeks. This simple cough is most times accompanied by night sweats and also weight loss. Our training was endowed with topics on pathogenesis, diagnosis, chemo-therapy and other clinical stuff that most time sound as complex as ancient Greek to lay people. In fact, while the trainer mentioned of terms like; isoniazid, rifampin, pyrazinamide, hemoptysis, adenopathy, pneumonitis and others, it felt as though I was in Medical school which actually was a few yards from our School of public health at University. 

What stood out for me in this training were the public health concerns about tuberculosis especially in our developing communities. Uganda is among the 22 countries with the highest T.B burden worldwide. The fact that T.B is hard to recognize by someone who is not aware of its signs and symptoms poses a significant risk of infecting other close contacts such as relatives and friends. Worse still, about ten to twenty percent (10-20%) of T.B cases are asymptomatic which means that they do not normally present with signs of the infection. The mode of transmission is mainly through inhalation of T.B pathogen contaminated air (usually from an infected patient). This route is quite hard to block off. Just imagine the times you could have been exposed to T.B by just using public transport. Health workers too are at risk and ought to take serious precautions especially while interacting with patients or performing laboratory procedures. Matters made worse, T.B diagnosis (detection) is still quite problematic even at many health centers in our communities and yet missing out on some patients most certainly causes them to infect others. The Tuberculosis and HIV co-infection is quite complex since one infection worsens the other and thus posing higher risks of case fatality. Pulmonary T.B which is the commonest can easily progress to extra pulmonary T.B especially among people with compromised immunity. This mishap implies that T.B could then spread to other body systems besides the lungs and seriously affect the other body organs such as; the bones, brain, kidneys, eyes and others. 

Much as the first line drugs are fairly available for T.B treatment in the Ugandan communities, there is a life threatening condition that is sparking out! A new strain of tuberculosis called Multi Drug Resistant Tuberculosis (MDR-TB) that is resistant to first line medication is on the loose. The current absence of second line T.B drugs in Uganda and their associated unaffordable costs to majority has left the lives of quite a number hanging by a thread. It is estimated by Medecins Sans Frontieres (MSF) that a single complete regimen of around 18 to 24 months treatment for second line TB drugs could cost between 4,000 and 9,000 US Dollars. How many sick people will think of that option yet even so many cannot afford a kilo of sugar (1.5 US Dollars) for months? Uganda is estimated to have 870 MDR-TB cases per year according to the MSF report (From the ground up: Building a drug-resistant T.B program in Uganda, March 2012). People develop this kind of T.B if they are not treated with the appropriate regimen, if they did not follow the treatment regimen as prescribed or if the supply of the drugs is interrupted (these are the secondary routes). Proper adherence to T.B drugs is such a challenge due to pill burden that many patients face with the long T.B dose. The primary route of transmission of MDR-TB is quite shocking! A patient with MDR-TB spreads this same strain of the disease to a normal person just through air. The trainer who works with the National Tuberculosis and Leprosy Program added to our fear on breaking the news that nearly 200 cases of MDR-TB had been so far diagnosed in Kampala (just one of the many districts in the country)  

  

 Protection of oneself from T.B is their responsibility given the complexities of the disease. Watching out for and quickly responding to the warning signs and symptoms of the disease whether from a stranger, relative or self is vital. Seeking for and linking persons to proper diagnosis and medical care is a sound response. However, being an advocate and paying lip service will never cease being your contribution in this good fight. On a good note comprehensive, decentralized and community based care model has been proved by MSF as feasible in combating drug resistant T.B in Uganda. In fact, MSF calls on all key stakeholders to assure quality rapid TB diagnosis, treatment and care, and argues that a scale-up of the decentralized and community-based approach, including access to second-line TB drugs at district level, is the most feasible method of averting the country's current T.B crisis. The DOTS strategy that also worked exceptionally well Peru (South America) and has currently wiped this country off the list of the top countries with most T.B burden also leaves much to learn and emulate in our own country. 

Meet you my good friends at the battle front

They all came in with the usual feeling; they always can’t hide the feeling of uncertainty. Some were teenagers, others were pregnant mothers, and others were adults that did not come with their spouses. I was really impressed with some few clients that came in as couples. Anyways, to face the truth, HIV is such a nightmare. While I assisted with the HIV testing and counseling services at Kasonga health center last week, I was glad that all the twenty plus clients we tested were negative. Voluntary counseling and testing (VCT) services have been impressive in the fight against HIV/AIDS in Uganda. In fact, linking HIV patients to quality care and treatment services has been a major attribute by VCT program and this factor is an important consideration for more clients to seek these services according to F.Nuwaha et.al., (2002). Early this month, using the data collected and stored in the health centers’ VCT record books, I conducted an analysis to find out if there are any things to improve about the program. I analyzed a data sample of 1,177 clients from those had come to test for HIV between 2011 and May 2012. I generated a snap shot of the sex, age and sero type composition of VCT clients in Kyangwali refugee settlement. This was to address the 3 broad questions in mind which were to do with; the extent to which the VCT services are being utilized, the groups of clients that seem to be at greater risk or vulnerability, and on which initiatives to strengthen or introduce within the HIV prevention, care and treatment program. 

Much as the general HIV burden among these clients was low (2.89%), it was quite sad that the vibrant young age group of clients between 19-30 years contributed nearly half of this burden. In fact, out of 743 VCT clients that were in the age bracket of 1 to 30 years, 20 of them (2.69%) were found HIV positive. Younger people are increasingly succumbing to the HIV pandemic. I bitterly remember my eyes falling upon many 18s, 19s and 20s in the age columns while I randomly viewed ART clinic records at Kituti health center. Is it not worrisome that HIV is soon pitching its tent among the younger generation? Besides the sexual transmission route, Mother to Child Transmission (MTCT) has registered its spot with nearly 22% contribution to 100,000 new annual infections in Uganda according to Uganda Aids Commission (UAC). MTCT could be explanatory for the 4.7% age specific HIV rate among the 42 VCT clients that were 10 years and below from my study. 

It is really saddening to imagine how many dreams, energy, talent, skills… (list endless) are at stake due to the HIV scourge. In fact, the Modes of Transmission study predicts more new infections to occur among the persons in mutually monogamous relations that are in the age bracket of 15-49 years. The impact on general health and development of our communities is really immense. I remember reading somewhere that in the early 1980s, when this new HIV scourge had hit Uganda, the government had resorted to ‘burying head in sand’, shying away from spreading the ugly truth on HIV transmission as being majorly by sexual intercourse. However, when the new government came out openly and strong on mass awareness on HIV, we saw prevalence and case fatality rates dropping tremendously.

While reflecting on my role in addressing HIV, especially among the young generations, I appreciated the fact that the fight starts with me. The “True Manhood” campaign puts it right, ‘Be in charge of your life by protecting yourself and your partner from HIV.’ I was then proud and happy with my current work experiences of serving communities to protect and better their lives with the fight against HIV being priority in many of interventions. I however need to up this game by doing much more in reaching out to communities, friends and strangers through various channels. Living an exemplary life is definitely topping my list of planned action. I pause with a global call upon everybody to join the fight against the HIV pandemic. Endowed with a vast friends’ network on my facebook account, I take this opportunity to post the True Manhood campaign message, ‘Be in charge of your life by protecting yourself and your partner from HIV’. I hope to meet you my good friends at the battle front!