The Storm.

From the tropical Ugandan rain showers to the floods of New York's Hurricane Irene I have literally gone from one storm to the next. After a weekend trip to Jinja, Uganda, then a full day of flying across continents and through time zones, and finally a shuttle bus from the New York City airport up to Albany I eventually found myself in the comfort of my parents home. The jet-lag followed close behind as I enjoyed the ease and comforts of my parents clean house, washing machine, home cooking, and lots of attention. My final weeks in Kampala were a mash-up of wrapping up work projects, a going away party at always packed dive bar, a much needed trip to Jinja, a final dinner with good friends, and of course, one overly emotional goodbye at the Entebbe airport at 3:30am. As I passed through the luggage check and stopped by the Ugandan customs counter at 4am the overly energetic immigration officer told me that he was sad to see me leave and would welcome me back at anytime. This customary friendliness was all the reassurance I needed to move forward and realize that once again this wasn't a final goodbye, but merely another stamp to add to my crowded passport.

The tears didn't come immediately as they had in the past, not until I was flying over the Egyptian deserts did I feel a pang of loneliness, which I knew would pass with time. Luckily, I slept the second leg of my journey, a 13 hour flight from Egypt to NYC, and arrived in a daze.

My three months in Uganda, in combination with the expansive time I had spent there over the past 6 years, were extremely rewarding. My internship with the Prevention of Mother to Child Transmission of HIV (PMTCT) research, and my time living with Isaac and other friends, was interesting and comfortable. My colleagues at the internship were some of the warmest and most knowledgeable people I had ever met, and I will miss them immensely. They taught me so much about PMTCT, clinical research, community outreach, and more about Uganda than I had ever known.

My time with Isaac was of course, way too short, but until I finish school, the next chapter of our relationship will have to exist via phone, texts, skype, email, and every other possible form of transnational communication. There's the old saying that "If it's meant to be it will be" but I believe that if it is meant to be then both people will work very hard to make it be. Life is not easy. I have seen people struggling to survive with the bare minimum, and those who have it all yet fight within themselves. I wish I had the answers and knew how to overcome the tough times, but until I do, I will just try my best to be grateful for those things that inspire me, and keep the people I love close to me, whether it be in-person or in spirit.

Next week I will be visiting my sister and brother in the beautiful Portland, Oregon...then it's time to head back to New York City!

Global Love.

The Long Distance Relationship is now a pandemic, spreading through the human population at an alarming rate. Like a rampant disease, debilitating hearts and souls one by one.

As industrialized nations continue to breed generations of restless youth, who neglect paying off their university debts in favor of travelling to and living in the far corners of the globe, the probability of international love increases exponentially.

Over the past 7 years, since I started travelling extensively, I have met countless international couples madly in love, and heard innumerable stories of heart wrenching separations as partners were torn apart by visa expiration's, societal pressure, employment and grad school opportunities, or obligations at "home." Until I joined this elite, yet humble community of Long Distance Loves, I could not clearly understand what it was like to be living two completely separate lives at the same time.

The first thing I have learned is that 'I never am where I am.' No matter how hard I try to live in the present and enjoy the company around me, I am always somehow a bit detached. Whether it be daydreaming about the summer that I just spent living with my taller half, or dreading the looming grey winter months and when my partner and I will see each other next, I am always partially removed from my surroundings. My days are spent wishing he was preparing dinner for me at home, while my nights turn into garbled yet vivid dreams of reality mixed with illusive angst.

The second thing I have come to depend on is the constant stream of texting, emailing, skyping, calling, but most of all future planning, that envelopes a long distance relationship. The authoritative time zones are our "Great Wall" between my morning and his night, afternoon and twilight, awake and asleep. While the widening gap between the northern and southern hemisphere becomes exaggerated by unstable electricity, fluctuating currency rates in times of economic hardship, and incomparable technology advances, for some the mental connection can begin to erode. Compared to a long distance relationship from the 1970's, where letter writing and the occasional expensive phone call may have been the only source of transnational communication, we seemingly have it easy. However, for a relationship to survive in an era where we all feel the need to be constantly connected to everyone, a day of no text messages or emails feels like a month, and a week may even feel like a lifetime.

The most important thing I have come to realize over the past couple of years, is that above all, the one thing that has kept us strong, is trust. Despite the games that my mind can play, I have to remain sane and focus on the person I fell in love with, not the cautionary tales that plague the media or stories from others. I, along with dozens of friends who are also battling with the Long Distance blues, must remember that this is not 'fate' or 'by chance' that we are with who we are with. It is a choice we make, with our partners, and one we should bend with and grow with each and every day.

If cities, states, countries, time zones, oceans, great lakes, continents, languages, culture, visa's, technology, and 24 hour flights haven't weakened our bond, diluted our friendship, nor diminished our passion then maybe this is the real thing after all. Maybe this is what love is all about. Finding that person who is there when the infatuation begins and who will still be there day after day ...near or far...when daily life sets in.

Shifting.

Every morning, as I climb the 3 flights of stairs up to my office in the Community Outreach and Psycho-Social Support Department at MU-JHU, I can't help but notice the dozens of women who sit patiently in the 2nd floor Reception area waiting for their appointment with the Doctor, Nurse, or Counselor....to follow-up with their participation in the HIV Clinical Research for PMTCT (Prevention of Mother to Child Transmission) of HIV. With varying numbers throughout the week, the sturdy wooden benches are usually filled with anywhere from 15-120 breastfeeding mothers, many of whom are also expecting and have toddlers running around by their feet. Peer Mothers are also MU-JHU participants who choose to volunteer their free time to help newly diagnosed mothers adjust to the procedures involved with clinical research, encourage adherence to HIV medication, and also offer comfort and support. These angelique Peer Mothers circle the Reception area handing out porridge, soft rolls, and bananas to the waiting mothers. Compared to the Mulago Hospital, which is just across the street from where our Research Centre is, MU-JHU appears to be luxury. The floors and bathrooms are always spotless, toilet paper is always in abundance, the staff greets everyone they pass and there is even a small playground, a playroom with toys, and a constant stream of movies playing for the little ones who have escaped from circling their mothers tired feet.

Today, as I ventured past the 2nd floor the first thing I noticed was three fathers, all holding their new born infants close to their hearts. From first glance this appeared to be a shift in parental roles, as I saw no mothers in the vicinity. I quickly buried my preconceived expectations and gender stereotypes, and realized that these men were either part of the Male Involvement Initiative, or simply dedicated fathers waiting for their partners who were behind the closed doors for their Doctor appointment. Either way, I was quite pleased to see a growing number of men in the MU-JHU Facilities.

My internship at the Makerere University Johns Hopkins University Research Collaboration is winding down. I have dabbled (yes I said dabbled) in a variety of departments here at the MU-JHU Research Collaboration with my main focus being: organizing Community Dialogues and a nation-wide conference about HIV/AIDS Prevention, Treatment and Research; planning and implementing activities for the weekly Young Generation Alive children's group; working with the Maama-Paapa Crafts group on book-keeping and marketing skills; joining the monthly psycho-social support groups; creating the final edition of a funding proposal to an esteemed international organization; offering support to couples in pre- and post-HIV testing; and creating my own program initiative to improve male involvement in HIV awareness, prevention, treatment and care by reaching out to them in their local community barbershops.

This has all kept me very busy, but of course I have found time to travel a little bit and spend my evenings, Sundays and Mondays with Isaac....and other friends. Isaac and I shifted to a new house for the month of August. We are now staying with his 2 close friends, on the other side of town. They have a great 2 bedroom house, in an area called Kiwatule, where the run-down pot-holed dirt roads are quickly being paved over and huge apartment complexes are rapidly springing up in every vacant lot. I'm adjusting to my new home, if even for just one month...and enjoying the company of a full house. Isaac is working hard as always as we continue to make plans for our future.

Friends here are always travelling in and out of Kampala. Some head to Kigali, Rwanda for a weekend, or Nairobi, Kenya to see family or friends...while others have been to Europe, Asia and back all within the few months I have been back. The constant stream of Hello's and Goodbye's makes it easier to come and go myself, however the emotions hit me harder and harder each time my departure date is approaching.

To see the light at the end of the tunnel is difficult, since the tunnel seems to be winding in many directions and at some points there are intersections that break into a million different 'possible' directions. In the meantime, I will try to live in the present, and figure out the upcoming weeks and months as they come...but to some degree my life comes with necessary planning, since I have chosen the path of a global citizen. Not quite ready to settle yet, and undecided as to where to plant my feet in the future. After speaking with my good friend Lucy yesterday over fresh passion fruit juice and appetizers at a new resto-lounge in Bukoto, Kampala, I gave her wise words time to digest. I don't need to know the future yet. Life never goes as planned...and there is no need to rush to the end. And even if I make a plan, it is ok if it fails and I have to try again with Plan B or Plan C.

That is what Life is all about afterall ...time to try, and try, and try again until it all works out.

Coupling.

An early start today, as I finally had the opportunity to shadow at the Mulago Hospital PMTCT Ward(Prevention of Mother-To-Child Transmission of HIV).

Pregnant women who are going for their first appointment at the Mulago Hospital in Kampala, must first go through a number of blood tests, including tests for HIV and other STDs. In addition, they are required to attend pre- and post- test counseling. If they turn out to be HIV+ then they are given the option to take part in various clinical research trials that are happening at MUJHU Research Collaboration(the Center where I am usually based, across the street from the Mulago Hospital).

So back to this morning...
I began the day at the HIV Testing site, where all of the lovely, round pregnant women are mandated to go upon their first visit to the Mulago OB-GYN. I was invited to observe the Information & Support Group for Pre-Testing: Couples Counseling. The Counselor & Teacher, Ibriaham hosted a dialogue on HIV/AIDS, Mother to Child Transmission of HIV, and the importance of partners learning their HIV status together, for their own health and the health of their unborn child. He focused his discussion on the 3 ways that babies can contract HIV from their mothers, which include: exchange of fluids while the infant is in-utero, during delivery, and after birth through breast-milk. Even though half of this information session was in Luganda, I could still piece together the main points and even understand more Luganda than I thought I would. Towards the end of the session one of the men raised his hand and asked about the male circumcision, and if it eliminates the risk of contracting HIV. Although recent studies have shown evidence that male circumcision reduces the risk of contracting HIV, it is only a slight reduction. The teacher reminded the class that male circumcision can help slightly but nothing is better than using protection and getting tested in order to know your status. Another woman asked about having unprotected sex while pregnant, and if the fetus could contract HIV while in the uterus. Again, the class was reminded that the 3 ways that an unborn child could contract HIV was in-utero, during delivery and through breast-milk. The class seemed very actively involved and interested in the topic. At the end, they were each given a letter of consent to sign, in order for them to get the HIV test and the results.

An hour or so later, after doing some administration work with the counseling team, organizing hundreds of files and letters of consent for the couples, I was invited to sit-in on the individual couples counseling. That sounds like an oxymoron, however, this was the chance for the couples to come into a small office together to find out their HIV test results. The woman and man (which is the typical arrangement in Uganda) would find out their results together and therefore work through the outcome with a counselor, instead of finding out separately and fearing disclosure to their partner. I spent the early afternoon with the Head Counselor, Ibriaham, as he welcomed couples, one at a time, into his office and gave them a short but concise explanation of what would happen. He would give them each their results together, then ask a few questions about their lifestyle behavior, give a short explanation for how to stay healthy regardless of whether they were Positive or Negative, and then conclude by answering any questions they may have had. Thankfully, all of the couples I met had concurrent results, they were HIV Negative. I was told that daily, over 110 people are tested at this particular site, and usually 6-10 are positive.

After receiving their results of being HIV Negative, the relief on the couples faces was subtle but as the pregnant mothers held their bulging stomachs, I could feel their anxiety diminish. The men, who for the most part were 8-14 years older than their partners, at times seemed to be holding their breathe util the results were read. After the counselor read the results for the 2nd couple, he then began to ask the man if he had been faithful to his wife since they were married, 3 years earlier. This 35 year old man first looked down, then glanced at his wife who was just reaching 24 years old, and he nodded yes. As he said this her eyes shifted downward and then she looked away towards the sun coming through the small window without making eye contact with any of us in the room. I consider myself to be a good judge of character and equally good at reading people...I felt this lie linger in the air. However, there is nothing a counselor can do except for continue to ask questions and trust what their patient tells them, or at least move forward from there. At this point it was not necessary to confront those who has made mistakes in their past, nor dive into an intense session when their time for counseling was limited. Especially considering that each couple only had about 10 minutes to sit in the small office, it left little time to discuss anything other than the results, and the next steps of staying HIV negative in the years to come. Opportunities for further counseling for HIV+ couples or discordant couples is available at MUJHU, in the psycho-social department.

Hopefully receiving good news of being HIV negative, will encourage couples to take extra precautions to keep these results the same throughout their lives and to protect their children. After this pre and post-test counseling, they are now knowledgeable of how they can contract HIV, how to pass it to their children, and also how to avoid infection. Sometimes, having the facts is all it takes to change your behavior.




...It seems that my work is seeping into my dreams. I have been dreaming about pregnant women on and off for weeks now!

Shaking it up.

Saturday with the Young Generation Alive, MUJHU children's group turned out to be a great success. At first I felt a bit under-prepared as I sat at one end of the oblong circle with over 40 young faces staring at me with great expectations. "Teacha Hannah, thank you for caring about us and thank you for teaching us and thank you for never neglecting us"...was the exact words of one 10 year old student. After hearing these deep words, which seem to echo throughout the classroom each Saturday, I knew I had to use my Plan A that I had come up with earlier in the week... and move forward with the Music themed activities, singing and rhythm games without stressing over the fact that I can't sing nor do I have much rhythm.

The older children left for a new Computer Training Program that was just initiated at MUJHU. After they departed, heading towards the technology upstairs, the 30 younger children, Teacher Samuel and myself formed a circle and began a singing memory game about walking through a jungle and finding different animals. Then we started clapping and snapping and stretching, which in Uganda naturally turned into a free-for-all dance competition. We formed a tight circle and welcomed children into the circle to show off their impressive dance skills. From break-dancing, to Calypso, to salsa moves, and hip shaking, each child moved better than the last. The roles quickly reversed and before I knew it I was being instructed on how to move my hips and my hands,...and arms and pretty soon we were all laughing.

After hours of dancing through the morning and early afternoon I was feeling quite overheated and was thankful for the cold bottled water and a nice shady walk home. I spent Saturday late afternoon relaxing by a nearby pool and then getting ready for a night out,torn between a series of parties that seemed to be happening in every far reaching corner of Kampala. The night turned into a blur of house parties, with live performers, hyped DJ's, reconnecting with old friends, introducing new friends, heading to the swanky, crowded Cayenne lounge, dancing, seeing more friends, and eventually a slice of pizza and a taxi home in the early morning. The day that lasted nearly 24 hours was a blast and didn't fail to live up to the reputation that beholds Kampala Nights.

The rest of the weekend was used to relax, recover and then plan for an upcoming week of work.

What goes up must come down....

As I sit here and think about my recent postings detailing my experiences with the upper crust of Ugandan society I can't neglect the many complicated economic and social issues that are currently plaguing the majority of the Ugandan population. The staggering 30% inflation rate, resulting in the rapid increase in the price of foods and the sky rocketing fuel prices have left most Ugandans unable to afford their daily meals, let alone transportation, rent, clean water, electricity, etc. The US Dollar, which was equal to 1,600UGSH (Ugandan Shillings) in 2007, has strengthened immensely and is now worth over 2,600 UGSH and rising. As the dollar continues to tower over the Ugandan shilling, the prices of basic foods (including rice, posho, millet, potatoes, oil, eggs, meat, and wheat flour) are literally increasing by the day. Public transportation and fuel prices are also going up hourly, as people are battling to afford to get to and from work with still some small change left for supper. Many commodities are quickly shifting into US Dollars as businesses in Uganda fear they will lose money if their products and services remain in shillings.
In an attempt to show the government how serious this issue is, the lower and middle class Ugandans have begun to protest. Knowing all too well the Governments rapid reaction to riots and protests using tear-gas and night sticks, the Ugandan people have begun to formulate other types of civil disobedience.

Last week all of the market owners and market employees throughout the entire city of Kampala decided to go on strike for 2 days, closing their shops, stalls, and street lining kiosks. If you have ever been to Kampala, or know someone who has, you would realize the incredible affect this would have on the city and the economy. Markets, stalls and shops take up the majority of the Kampala Streets and sidewalks, leaving little room for pedestrians and any large companies to move in. Not to say there aren't large agencies and corporations in town, but the downtown market area and street stalls stand strong in the competition for space. Selling everything from fresh foods, to books, to medicine, beauty supplies, school supplies, household supplies, electronics, soap and shampoo, prepared foods, DVDs, all types of appliances, services such as hair-cutting, laundry, dry-cleaning, welding, key-cutting, shoe-shining, paint-shops, floor tiling shops, those selling roofing materials,etc ...and those are just to name a few.

This 2 day Market and Shop Strike was followed closely by a strike by all of Kampala's taxis. The taxi's, like the Kampala Markets, keep Uganda moving at a relatively fast pace. Daily, these vans transport millions of Ugandans in and out of Kampala for only about 20-50 cents per person. Without these vehicles Uganda is almost at a standstill. On the positive side, traffic is more tolerable, car emissions are reduced and the city can escape the overcrowded, overly noisy and dangerous taxis. On the reverse, people have no other way of getting to work for a reasonable price. Considering the economic downfall, this means that hundreds of thousands of people did not go to work on Monday. The results of these three days of protests are yet to be calculated, however the government was not impressed. As the people here clamor for their daily food and transport money, the dollar continues to rise in strength leaving the shilling far behind.

Uptown Girl.

On Tuesday, I was personally requested, by the President's 30-something year old daughter, to do her Make-Up for a Book Launch honouring her mother's newly released autobiography entitled, My Journey. Just one day after The Face Studio notified me that the First Daughter had called them to see if I was available to be her make-up artist for the high society event, I was escorted in the President's Mercedes Benz S-Class to his main residence in Nakasero, an upscale residential area hovering over the Kampala city center. The presidential compound reached across the circumference of Nakasero hill and was securely protected by numerous gates, walls, military personnel, police, road blocks and of course, metal detectors. As I went through each layer of security I felt so out of place. Finally I reached the compound within the compound, where Yoweri Museveni's actual home sits and I was welcomed into the pool-house, where there was a long hall with countless doors. I was led into a room with a huge mirror and chair, where I would be doing the make-up for the First Daughter. Shortly after, she arrived with her husband, who then left to shower down the hall. My anxiety was quickly released by her friendly smile and casual small talk as I applied coats of foundation, powder, shimmery eye makeup, followed by a vibrant maroon lip stick. We discussed her successful Travel Agency Company based out of a well-known Kampala lakeside resort as well as my own work at both MUJHU and The Face Studio. She was so friendly and we concluded by exchanging contacts with plans to work together in the future.

After I was content with every detail of her beautiful face, she thanked me profusely and I was once again escorted by the military driver to my next destination. I joined a meeting with former colleagues at a nearby Ghanaian restaurant, where of course I had to share my days events with these old friends.

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My work at MUJHU is becoming more and more hectic and exciting by the day. Along with writing grants to maintain our existing programs and add new programs, I am also working on my project proposal and actively engaging in training sessions, community outreach programs and psycho-social group support. My co-workers range in age from 28 to 65 and come from various backgrounds, with the vast majority being born and raised in Uganda. The daily meetings and cooperative group projects maintain a cohesive staff who seem to truly respect each others contributions. This upcoming week I will be shadowing Joyce, who is in charge of the PMTCT (Prevention of Mother to Child Transmission) program at MUJHU. She works primarily in counseling HIV+ new mothers on healthy living, nutrition, as well as addressing mental health concerns. Many of the hundreds of women who are in this PMTCT program work three to four jobs along with raising anywhere from 5-10 children. These jobs may include selling fruits and vegetables at a local market, styling hair at a local salon, cleaning houses, and cutting the grass of big estates. Although these are not glamorous jobs, they are necessary in order for the women to feed their children and if they are lucky. pay the school fees.

I am also organizing Community Dialogue meetings throughout Kampala, in order to improve community involvement in HIV/AIDS clinical trials, as well as prevention education and awareness. Myself and the new intern, a Social Work student from Uganda's leading Makerere University, are working together with local Community Advisory Boards (CABs) to implement a successful event in which we visit each of the local Kampala Divisions and host a full-day comprehensive outreach program.
These Community Dialogues are primarily used to motivate people to participate in MUJHU medical research trials, such as the VOICE Study: (http://www.mtnstopshiv.org/news/studies/mtn003)or other clinical health trials, as well as increasing the rate of HIV testing, reducing HIV transmission between partners and from mother-to-child, and answering questions that the community members may have about the MUJHU Research Collaboration and HIV in general. The positive feedback that has resulted from past meetings has led the MUJHU Community Outreach team to push for an increase in the number of divisions which we visit, and the frequency of which we visit each site. The approach is based on a peer-education model where MUJHU staff, along with MUJHU participants who are HIV+ host the meetings in order to put the community at ease.

My weekend was spent party hopping and linking up with friends all over the city. There is never a dull moment here in Kampala, there is always something to do and someone to see. From a Friday evening starting with Happy Hour with co-workers, then leading to a gathering at a friends hotel, and then finally relocating to an upscale lounge in the center of the city, followed by Saturday meeting up with a long-time friend of mine, then hopping over to a swanky Open-house party near the lake, then spending Sunday lunch with an older co-worker and her beautiful family, my weekend proved to be as equally exhausting as my week :-)

Time to rest.
Love to all.x

Organized Chaos.

My time here at MUJHU is getting more interesting by the day. Last week I visited the MUJHU farm, which is an Income Generating project for the HIV+ MUJHU participants who are interested in growing and selling fresh fruits and vegetables. Its about 40 minutes drive from Kampala, in a peaceful region, not far from where the presidents opposition, Besigye lives. During our drive there and back we noticed numerous police, military and even riot dispersing tank-like vehicles lining the road. These tanks were used to dispense tear-gas during the rallies, riots and protests that took place in April and May, but are now they are just a precautionary measure.

On Saturday I joined the MUJHU Children's 'Positive Living' Group for their visit to another local AIDS organization that also caters to HIV Positive Children. The 2 groups of youth quickly bonded through a number of activities including a competitive trivia game testing their HIV knowledge. Their personal knowledge and teamwork was so encouraging. The teacher himself, was an outgoing man, in his late 20s, who had no problem going into extreme detail and giving real-life examples of how HIV and other STDs are transmitted, especially among young people. He drove the point home that even though these children may be living with a positive HIV status they still must abstain from sex until they are older and at the very least, use protection, since contracting various strains of HIV and other STDs can be harmful to someone living with HIV.

Along with these programs and visits, I also continue to work on a MUJHU Grant proposal as well as a personal proposal for a project that I am interested in implementing in Kampala. This community outreach project that I am working on intends to increase the rate at which men get tested for HIV and protect themselves and their partners from infection, by providing information and services for men at their local hangouts. As I continue to evolve my idea and collaborate with local community members and consult advisers I will elaborate more.

Isaac and I spent the weekend escaping from the dusty Kampala suburbs to enjoy the serenity of Sipi Falls, in Kapchorwa, Eastern Uganda. What should have been a 4 hour journey turned into a 7 hour trek. After a boda-boda ride, three matatu rides which kept stopping to unload and reload new passengers, and then a special hire taxi up a dark mountain at 10pm, Isaac and I finally arrived at the Crow's Nest, a string of cabins sitting at the 2000 metre point of the brisk Mount Elgon. All we could see was pure darkness from the Crow's Nest balcony as we chomped down a late dinner of cold sandwiches and tea, before we collapsed into a cramped single dorm-room bed, thankful to retreat from the chilly night air. (A special thanks to the manager who forgot to write down our room-booking for a private double cabin). We woke up to the stunning views I had remembered from 6 years earlier, my first time at Sipi Falls. Our lodge sat thousands of feet above a deep valley surrounded by waterfalls, caves, coffee plantations, banana & matooke trees and lush vegetation. We spent the next day hiking to a point higher than we were, then way down to the depths of the valley and up again to see the 3 main waterfalls, then exploring the entrance of the various caves....since we weren't equipped to go further in. The trek wasn't easy but the fresh air and exercise felt amazing, along with the back-splash from the bottom of the waterfalls and the cool mountain breeze which refreshed us after living in the Kampala smog for so long. After a long day of hiking we took advantage of the charcoal heated showers and sunset over the hills and falls, with an early dinner followed by a few well-deserved drinks. On the 3rd day we returned to Kampala on a speedy, overstuffed Matatu, which has seats for 14 people but somehow squeezed in 20 with a few dozen squawking chickens strapped to the roof.

Today at MUJHU, myself and a couple other interns had an informational session on PMTCT (Prevention of Mother to Child Transmission of HIV)and how Uganda manages this type of HIV prevention. After an hourlong question/answer session with the lovely Social Worker/Midwife/Counselor/Nutrition specialist/Staff Trainer Joyce, she took us on a tour of the entire Mulago Hospital complex showing us the ins and outs of the PMTCT program at this massive government owned hospital. We must have seen thousands of women pregnant, nursing, in labor, with newborns, with 6 week old infants and those a few months old. The tour was quite a bit longer and more in-depth than the one I had made to Mulago last. I was introduced to countless Ugandan staff, Social Workers, Nurses, Peer Mothers, Physicians, as well as interns from all parts of the world. I stood by as dozens of women in labor were kneeling on plastic sheets in the Maternity Ward and was then welcomed into a room of occupied beds of crying women about to deliver in the Labor Ward. I stood by the head of one small, moaning woman as her unborn infants' head crowned, fluids poured and were immediately wiped away by a few young, but attentive doctors waiting to deliver her child. My mind was racing, and I began to question my own instincts and desires to have a baby soon. However, in the next bed over sat a brand-new mother with her tightly wrapped nursing infant. She seemed to quickly forget the earlier pain, and stared with contentment, mesmerized by her new family member, clutched to her chest.

At the Upper end of the Mulago Hospital complex was the PMTCT Counseling Services, Follow-up Services and Nutrition Ward, where mothers returned with their 6 week old infants for follow-up counseling, HIV testing, medical treatment and other services. I have never seen so many babies in my whole life. It was beautiful. This chance to see and experience what so many women are going through has reminded me how proud I am to be a woman. How amazing it is to give life, especially knowing that it is possible to prevent the transmission of HIV from a mother to her newborn baby, so that the next generation of children can be HIV free.

Night and Day

To get a visual idea of what I am up to, click on the photos at the upper right hand side of this page. Enjoy!

Monday, June 27th 2011

This past week I experienced such extreme contrasts. After a weekend of catching up with old friends and enjoying the Kampala nightlife, I spent all-day Monday at the Ugandan State House in Entebbe (equivalent to the USA White House) doing a makeover & photo-shoot for the Ugandan First Family. The Face Studio was given the job of doing a home photo-shoot for the First Lady, Janet Museveni, her 3 daughters and one daughter-in-law. After going through countless guards, body-checks, scans and metal detectors, we finally entered the expansive, pristine white statehouse where we waited for 5 hours for the first family to arrive so we could begin to apply make-up to the first daughters and first lady for their Flair Magazine front cover debut. Even though they kept us waiting we were seated in a massive semi-outdoor marble courtyard fully equipped with flat screen TVs, soft couches, elegant bathrooms and very friendly staff who kept us well-fed all day. This was not the first time I had met some of the first family, as one of the daughters had come to The Face Studio in January and I also met the president himself, back in 2005. However, this was the first time I was at the Ugandan White House and witnessing such wealth, power and luxery. Despite what you may be thinking, the family was very down to earth, and the 25-35 year old daughters were so friendly and loved the make-up that Sylvia and I did :-) Our "2 hour photoshoot" lasted from noon to 9PM. As we walked from the "palace" to our car we noticed the line-up of 32 cars with their engines running, which stood as a motorcade ready to whisk the family from Entebbe back to their other homes in Kampala.

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Tuesday, June 28th, 2011

I spent Tuesday morning at the main Mulago Hospital, which is uganda's government run hospital that is adjacent to the MU-JHU Research Centre where I work. What I experienced at Mulago hospital was unlike anything I have ever seen before. Compared to the serene, clean and welcoming environment that I experience daily at the MU-JHU research center, Mulago Hospital quickly bombarded me with the realities of the national health care systems, that exist primarily in the southern hemisphere. I was guided by a physician intern who introduced me to the main Casualty Building and then around the other various wards within. As the tropical rains poured down outside, the floors in the hospital quickley filled up with a layer of slippery water. Hundreds of worried and cold patients and families stood, sat, slept and moaned on the floors and few benches that were dispersed throughout the Triage area. Some people entered with plastic bags filled with clothes, others grasped suitcases and rack-sacks as if knowing that their wait to see a doctor or have surgery could last for days and days. As we entered the wards for Surgery and Blood Transfusions I was overtaken by people covered in blood, holding their own broken and limp limbs, those slumped in wheelchairs and even some squatting tightly in a ball, in order to keep warm from the cold outdoor windy rain which poured sideways into the glassless windows.

We made our way up the drenched steps to the 5th floor where we walked through the maternity ward, a hallway filled with women on the floor...some had begun to go into labor, even about to give birth, some with their newborn child close to their chest, others post-cesarean section, or with serious pregnancy related complications. Dozens of women lined the ward, curled up on small blankets, and woven mats with a few fathers scattered throughout. At the end of the hall we removed our shoes and entered the Special Care Unit only to see new mothers nursing into cups, for their newborns which were presently in critical condition. I recently read in the newspaper that out of the 27 incubators in Mulago Hospital only one is working. Past this table of pumping mothers we found a few nurses and doctors circling around the Special Care beds which were occupied by mothers and fathers closely coddling their tiny, ill infants connected to feeding and breathing tubes. There was one mother and father in particular that we went there to see. These were the young and proud parents to 2 twin boys...but not just any twins...these were newborn conjoined twins. As the mother removed the 5 blankets warming her new babies from the outdoor winds, we saw her 3 week old sons, Trevor and Timothy firmly attached to eachother at the belly. Luckily, doctors informed us that only their skin and muscle is attached and they are not sharing any major organs. Since they are so tiny, it is too early to separate the babies now, especially in a hospital that is in these dire conditions. They will wait until the twins weigh at least 10kg before they consider surgically separating them. We thanked the mother and father profousely and then found our way back outside, into the beat of the torrential downpour, to a warm car waiting for us.

The heavy rains continued for hours. They fit the mood for my first visit to Mulago. How can a government let their hospital reduce to such conditions? How can so many thousands of suffering people possibly be serviced at such a place? Then again, this suffering exists worldwide...its not the fault of the people, or even the government. Its a complicated issue that needs to be addressed. The basic human right of quality healthcare for all people, everywhere.

That has been my week so far...such a drastic disparity from one day to the next. A more extreme version of what I experienced this past year in NYC on my daily commute from East Harlem to the Upper East Side. People who don't have enough of what they need, and then those people who have more than anyone could ever need...

Eviction, Babies and Rain.

Awoke this morning at 7:30am to a knock on the door and an overconfident "Good Morning" from a Government Housing Eviction Officer. This tall, well dressed man informed my roommate, Isaac and I that we were being evicted immediately from our house, along with everyone else who shares our compound. We barely had a chance to get the crusty's out of our eyes, let alone comprehend what was happening when this suited-up, jolly man declared that he was a government representative and reclaiming homes that belonged to the Uganda National Housing Authorities. We asked him for an eviction notice document or at the very least a badge that proved that he was from the Government Housing Authorities. He awkwardly pulled out an informal ID that has his name and photo...proving nothing but that his name matched his face. We laughed out of confusion and he smiled widely at his ridiculous form of "official" ID. He evidently enjoyed his job way too much to take it too seriously. I immediately called up our landlord who quickly drove over to the compound, apologized profusely and promised to "take care of it." That is where we are at now....TIA

In other news...my internship at MU-JHU, the Makerere University-Johns Hopkins University Research Collaboration, is going great! I spent this past week meeting with the Chair-Women for the Women's Group, aka Maama Paapa craft group, to organize their book-keeping and financial records in order to keep track of their expenditures and profits to stabilize their income generating business. Along with this collaboration I also joined in the weekly Nutrition class where one of the MU-JHU Nutritionists teaches new mothers how to feed their infants and babies with the most nutritious foods and best cooking techniques. The lovely elderly teacher, Daphne, teaches the class by explaining the health benefits of each of the food groups and which foods are best for which age babies and children. This weeks class had 6 mothers with their infant babies either tied securely to their backs, or napping on woven banana leaf mats on the floor. These were the cutest babies I have ever seen...but then again, Isaac tells me that I think all babies are the cutest...so maybe beauty is in the eye of the beholder :-).

The new mothers learned how to choose and measure the best proteins, whole grains, and fruits/vegetable to keep their babies growing at a healthy rate. During the class the women were taken to a small semi-outdoor kitchen where they learned how to cook the foods, which are traditionally wrapped tightly and steamed or boiled in banana leaves over a contained fire, and then mash the food it in a certain way so that they can be easily digested by a baby as young as 6 months. Mothers are encouraged to breastfeed their newborn babies up to 6 months, or longer, even if the mothers are HIV+. Interestingly enough, even though breast-milk does carry the HIV virus, human milk has some natural technique of lining the infants stomach so that the virus will not be passed into the babies bloodstream. So even if an HIV+ mother is breastfeeding her new baby, the infant has a very low chance of acquiring HIV, from mother-to-child. Additionally, in low-income communities such as those in Uganda, the nutritional value of the breast-milk is vital to the survival and healthy development of the new baby, and is therefore irreplaceable by substitute milks, formulas or foods.

I am now working on a project proposal for a Community Outreach Approach that I first heard about this past year during my internship with the NYC Department of Health, Bureau of STD Control. I was inspired by the positive results of an outreach program in the USA, which was set up to increase HIV education and prevention by reaching out to black men, whom are often seen as hard-to-reach members of society.
I will write more about this project as it develops....

The rainy season is here, and the cool, 70 degree, weather is a breath of fresh air. The sun still presents itself every afternoon filling its role of drying the mud roads and puddles that flood the sidewalks that I walk home on each day. The days and nights are slipping by faster than I had hoped. I am learning more and more about myself and my place on this earth each day...although still a bit overwhelmed, I am making the most of my time here and my time away from the big NYC and looming 2nd year academic commitment that lies ahead.

Much Love.x