I have one week to prepare a curriculum on neonatal resuscitation for healthcare professionals, and submit two proposals to the Makerere University School of Public Health Institutional Review Board for research projects.
Today, I traveled to one of the first villages in which we are piloting our 'Healthy Villages' program. We are rolling out this program in 5 villages in 2009. The basic concept is that we created a list of the bottom 70 villages in the district for sanitation measures (latrine coverage and safe water access) and we are bringing a raft of public health and healthcare interventions, as well as bringing partner organizations to these villages specifically to try to improve health and poverty measures across the board. I'm extremely excited about this program. It does involve a lot of grassroots, tough organizing and advocacy. That means showing up for meetings that never happen, waiting 3 hours for an education workshop to start, going house to house to publicize a program, and other such challenges. I have nothing but admiration for people who do fieldwork full time. I'm far too impatient by nature.
We performed for our second safe birth workshop since my arrival, and it certainly is a performance. A lot of stuffing objects under our shirts for pseudopregnancies, miming of maternal health emergencies, and peals of laughter from the audience. This time the women got so involved in the skits we had designed, one of them even pretended to collapse into the grass and dramatically clutch at the skirts of the woman acting as the village elder. Unfortunately, our 'stage' was a patch of grass in between an irritable (and malodorous) cow, and a swarm of biting ants the size of scorpions. The crowd of men, women and children gathered there didn't seem to mind. In fact, they were our most involved audience, asking so many questions at the end of the presentation that we had to cut them off. They wanted to know what causes preterm labor? What causes hemorrhage? Why can a woman menstruate more than once in a month? What should I eat for protein, if I don't like to eat grasshoppers?
Then they moved on to the personal and sad questions. Why did I have a baby with terrible congenital deformities? Why can't I get pregnant even though I have been trying for so long? And, bringing up a common accusation: why have you brought us this education instead of drugs, or medical equipment, or something we can use?
After that, we moved beyond the personal to the incredibly personal, the how in the world is it OK for you to ask this in mixed company personal: why do I have foul smelling vaginal discharge? Why do I have sexual dysfunction? Is the reason I can't get pregnant because my husband isn't good enough at sex? And most bizarrely: but what about artificial insemination?
Everyone was dying to know why they were not as fertile as they wanted to be, even though to each one, we answered that we could not diagnose or treat conditions in a little field by the roadside and that they must visit a health center. But I am too poor to visit a health center, said one woman, and I am pregnant, so give me an antenatal visit here, right now! In fact, several audience members approached me after the presentation, hoping for a medical consultation. I suspected pituitary tumor in the first one, and traumatic skull fracture in the second one, but what could I do? I urged them to seek further medical care at the referral hospital, and I gathered all the medical students to come see the deformity in the second patient's skill. Underneath his skin, his head was pulsating, but the boy was smiling and seemed no worse for the wear. I cringed as he hopped on the back of a bicycle without a helmet and rode away.
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