A review of 10 days with TAMTAM in Gulu

children caring for children: a legacy of the LRA in Gulu?

The evidence of two decades of LRA terror both stares you in the face and bubbles under the surface in Gulu. (The Lord's Resistance Army is a group that murdered many in Northern Uganda and abducted children to make child soldiers and sex slaves, now working in Sudan)


IDP camp in Gulu town

Many have horrific stories full of fear from personal experiences during the LRA terrors. IDP (internally displaced peoples) camps are seen everywhere tightly packed for group safety, in Gulu town and on the roads around Gulu town, schools were closed and health declined.



Today, many NGOs still operate in the area and the health networks are sufficiently developed - each village nominates a person to be its health information volunteer; this person is trained, sometimes to do immunizations, or talk about malaria, etc. TAMTAM worked closely with some wonderful Village Health Teams (VHTs) and youth leaders to disperse 1300 bednets to a very needy population, still struggling to return to a life of normalcy and independence.

A photo tour of TAMTAM's work in Gulu...

TAMTAM's bednets: the best in the biz! Nets are coated with insecticide that lasts 3 years, and net holes are small to prevent mosquitoes from entry. Note the different colors of rope, corresponding to the different distribution interventions

VHTs receive malaria training from Doctor Samuel and learn about bednet distribution interventions TAMTAM hopes to test at KAIROS health and community development center

The distribution of nets took place in community meeting places, often under a large tree, in a school yard or in the market. The village would gather and men and women would inevitably separate themselves.

In one site, 300 people packed in an open air community space to pick up nets. It was overflowing with people!

Here, Goretti, a VHT gives one of 4 intervention messages

A woman and child take their new bednet

five women begin what may be a long walk home with their bednets. We learned as we did home installations of bednets that some villagers travel from an hour away to a bednet distribution site.

After the nets are distributed, Thomas, Albert and Charles, several village health team members divide up the home installation lists by location: some will head into the IDP camps to do up to 30 installations in 2 days, while others will see 5 homes deep in the bush over 2 days.

inside a home, two children play while a new bednet is being installed by a VHT.

So that's a quick tour of TAMTAM's work in Gulu. 1,300 bednets distributed. Not too bad for 10 days' work. Many thanks to our dedicated VHTs, youth leaders and the staff at KAIROS!

Operation Gulu: Distribution and Installation Complete

Villagers wait patiently for their names at the Pageya parish distribution

After 9 days in Gulu District, the TAMTAM team has dropped down in all 6 parishes of the Koro Sub-county. With the leadership and guidance of Mr. Christopher and Dr. Beatrice from Kairos, much travel and coordination with 14 youth leaders and Village Health Team members, and the facilitation of local government officials, brand new nets have reached over 1,300 households. It has been an exciting time for the team, to see our many data files come to life as thousands of people gathered to receive nets. Our nets went out with malaria information and specific messaging about proper care and installation. With this distribution in Gulu, we also hope to learn about the effect of certain messaging on the use of the net in homes. The final follow-up phase will begin in early September, spearheaded by Ash.

LEFT: Curious neighbors watch a net installation, RIGHT: Village health worker, Alfred, installs a new TAMTAM net

We have learned a lot in Gulu and look forward to working there in the future. A job well done by all of our partners and cheers to all the kind people we met. In the meantime, plans are being hatched for a distribution through Kairos health clinic's weekly immunisation day...

TAMTAM team (Paul, Ash, Eric, Jasmine, Esther) with the distribution and installation team (Mr. Christopher, Youth leaders Chris, Samuel, and Goretti, and Village Health Worker Alfred).

Ash and Jeff on the ground!

Both Ash Gupta and Jeff Grosz have arrived in Uganda as of today! The team is excited to welcome them to the TAMTAM team. Ash was put to work immediately and has made the rounds at Ntenjeru and now here in Gulu. Jeff has been here for mere hours- his travel is to come! We also bid a fond farewell to Meredith and Lekha- you will be missed in Uganda!

Day 1 of distribution: Labwoch Parish

Today we started our distributions in Labwoch Parish. We were both eager to get the nets out, and a bit apprehensive about the problems that might arise. Would people come from the villages to the meeting? Would many expect nets who were not assigned to nets? Was there something we hadn’t anticipated?

The first sign of trouble was our incredibly late start – a sign of trouble, fortunately, only for those uninitiated with African time. As we readied ourselves, people kept arriving and when they did, waited patiently. Speeches were made on malaria and bed net care, on self-reliance, and then nets (and a large net transport bag too) were distributed.

Following distribution, some stayed to argue their cases for receiving a net and a protocol was decided. Extra nets went to pregnant women, families with young children, the sick, and the elderly. Once established, few could argue the logic and those that did not receive a net left with without complaint. We gave out 132 nets today and can count the day a huge success!!

Meet our partner NGO in Koro County, Kairos

Paul and Dr. Beatrice in front of partner NGO, Kairos. Medical Center in background.

TAMTAM's partner in Koro County (Northern Uganda), Kiaros, is located 10 km south of Gulu town and run by a well organized and highly motivated woman, Dr. Beatrice and her husband, Chris, both of whom are faculty with Gulu University. The center was started to address rural community health (and education) needs. This population has been growing quickly for the past 2 years as internally displaced peoples have left the refugee camps to return home (post-LRA).

The plan is to first conduct training with Koro County's community health representatives, the "Village Health Team" VHT so our partners know the bednet distribution, data collection and bednet installation procedures. The rest of the week will be spent in the parishes (localized regions consisting of 2-3 villages) distributing nets and installing nets.

TAMTAM sets up in Gulu

The TAMTAM team has arrived in Gulu District, where we will be working in the 6 parishes of the Koro sub-county. The area is transitioning from years of unrest and violence after the Lord's Resistance Army terrorized the Northern regions of Uganda. Currently, the district is experiencing serious drought as well, adding to the challenges of daily life for the people of Gulu.

TAMTAM arrived here this week and are gearing up to train the volunteers who will assist TAMTAM and our partner, Kairos Community Health Organization, in distributing nets and administering follow-up in the villages. As of now, 1,350 nets have arrived in Gulu and will be distributed shortly!

In recent news, Gulu has been struck by a malaria outbreak- article below from a Ugandan national newspaper.

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Uganda: Gulu Declares State of Emergency Over Malaria Outbreak
James Eriku, 19 July 2009

Gulu — Gulu District health department has declared a state of emergency over what authorities have described as a severe outbreak of malaria in the district.

The worst hit area is Gulu Municipality while the counties of Omoro and Aswa have registering relatively low number of out patients' attendances, according to statistics released by the health department.

The department released the report in a special council meeting organised by Unicef in conjunction with the district health department and municipal councillors on the sudden disease outbreak at the district council hall on Tuesday.

The acting head of delegation of the Child Focused Organisation in Gulu sub-office, Dr Vincent Yomani, said the data they have indicates that out patients' department attendance of malaria rose from 25/100 to 40/100 in the district - accounting for about 43/100 school absenteeism rate among children.

"There is an urgent need to strengthen preventive measures as well as encouraging the local people to visit health facilities early enough to keep avoidable deaths at bay," Dr Yomani said.
He attributed the sudden rise of malaria cases to the unpleasant climatic conditions that favours breeding of mosquitoes in many parts of the district.

Meanwhile, Dr Paul Onek, the District Health Officer, said the district has already alerted the Health Ministry about the outbreak because the district does not have the capacity to fight the upsurge as they relied mainly on donor agencies.

"We do not have adequate support from the central government to fight this epidemic and this leaves us at the mercy of our partners in health," Dr Onek said. He revealed that the district receives about Shs300 million per annum for drugs and other management expenses, an amount that he said is far below the need of the health sector in the district.

Copyright © 2009 The Monitor. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com).

VHT Training Day

First day on the ground in Koro sub-county! Esther, Paul, Eric and I met with Dr. Beatrice and Chris in Gulu town and headed out to Kairos for the village health team (VHT) training. Our first task for training day? Morning tea! We met our 13 village health team (VHT) and youth leaders in one of these rooms and did our introductions over hot milk tea, chapattis and a boiled egg. (lunch would be generous portions of stewed chicken and veggies, rice, and matoke (mashed plantains))

The team was made up of elected representatives from the various villages in the Koro sub-county; their community responsibility was to provide health information to their constituents. All had previously worked with Kairos and many impressed us with their experience and local leadership.















During the training, Esther gave the VHTs an overview of our study, the essential role the VHT would play and the timeline for participation. Paul talked about TAMTAM. Dr. Sam, from the local MOH, gave some information about malaria.

I had a lot of fun running the Bed-net Distribution Day Simulation, and Esther had an equally good time running the Bed-net Installation Day Simulation. We also earned a ton in the debrief! A few tidbits:

• Villages would self-monitor effectively to ensure fair and honest distribution of the nets
• Opened net bags were less likely to go to market
• And how to turn down a thirty minute stay and two cups of tea politely!

Welcome to Jasmine and Eric!

Our newest teammates, Eric and Jasmine, arrived yesterday! They will soon be whisked away into the field, just in time for the distribution of 1,346 nets in 6 parishes of the Koro sub-county of Gulu District. Exciting times and we are so glad Eric and Jas are here. In other news, team TAMTAM has enjoyed many visitors in the past weeks- very glad for all of your encouragement, entertainment, and extra hands too!

The Nets Are Out!

We’re getting the nets out!

Yes, in our first site of Ntenjeru, we have Village Health Team (VHT) members distributing our first set of nets and they’re doing a bang-up job!

Tuesday, the TAMTAM team (currently Paul, Esther, Lekha and Meredith) traveled to Ntenjeru to run our first training for VOLSET’s Village Health Team (VHTs). This first set of seven VHTs – respected members of their communities trained in basic public health direction – would distribute nets to well over 150 households over the next few weeks. The training consisted of explaining the program to the VHTs, practicing the protocols for net delivery and installation, and fielding a great variety of thoughtful questions. The day ended with a ceremony in which we presented each VHT with sufficient nets to start the distribution, as well as a bag to carry their nets in, string, nails, pens, logbooks, and an ink-pad for recording thumbprints. Further, we gave each VHT a net for their own home; much to the VHTs’ delight, their own homes would be the first recipients. As they left, the VHTs seemed delighted by the tools we had given them and eager to get the nets to their communities.

With that, the VHTs were off and running on Wednesday, heading to the villages of Nsumba and Kabira to deliver the nets to the households that they are getting to know so well.

Thursday, in fact, we were witness to the commitment of the field team and the quality of the training. TAMTAM team members shadowed two VHTs – Edward and John – and observed the distribution itself. To the teams delight, the VHTs flawlessly executed the net delivery at the homes we shadowed. The team was also pleased to hear that the VHTs were delivering the nets faster than anticipated given their eagerness to get the nets out to as many household as soon as possible. We are all excited for the next net pick-up day next week so that even more nets can be delivered!

Being in the field for training, shadowing and distribution has been some of our most satisfying and productive time this summer. This is certainly the most tangible way in which we’ve seen our mission being fulfilled! See below for just a sampling of the many pictures we have taken as distribution starts!

NTENJERU TRAINING DAY, JULY 21st 2009

Sewing Circle! Nsumba resident Deborah, TAMTAMer Lekha, VOLSET volunteer Ally, and TAMTAMer Meredith cut and bundle the string that will be used to hang the nets


TAMTAMer Lekha displays one of the new nets and kicks off training. Attached to the front is a script in Luganda that the VHTs will read to the net recipients.

TAMTAMer Esther role-plays an elderly net recipient while VHT John Lubanga practices delivering and installing the nets. Esther’s role-plays were difficult, but each VHT proved him or herself easily up to the challenge.

VHT John, VOLSET volunteer Joshua, VHT Phoebe and VHT Margaret enjoy a tea break at VOLSET’s headquarters.

Congratulations! TAMTAMer Esther and VOLSET Founder Festus congratulate VHT Harriet on finishing training and happily hand her the first set of nets to deliver.

Training Day! The team celebrates after finishing a successful day of training. Front row (left to right): TAMTAMer Esther, VHTs Prossy, Harriet, John, Edward, Dan, and Phoebe and Margaret, TAMTAMer Lekha. Back row (left to right): TAMTAMer Paul, cooks/helpers Deborah and Sarah, Peace Corps/VOLSET volunteer Zac, VOLSET Founder Festus, VOLSET volunteer Joshua, and TAMTAMer Meredith

Delighted to receive her own family’s net, VHT Margaret dances with the net on her head at the end of the day.

SHADOWING VHT DISTRIBUTION, JULY 23rd 2009
VHT Edward carries his TAMTAM distribution team bags as he visits the household in his village to deliver the bed nets

VHT Edward delivers a net to a household and explains how to set-up and care for the net

Trip to Assess Distribution on Damba Island

It was my third full day in Uganda – and my first on Team TAMTAM – and I was off to Damba Island. Damba had been described to me as a place where the local fishermen make lots of money from their daily catch and spend it on the classic pastimes of seafarers everywhere – drinking and carousing. Needless to say, this meant that there would be lots of people – and, to be specific, lots of babies – on the island. Given TAMTAM’s mission of distributing bed nets to particularly vulnerable populations, Damba Island would seemingly fit the bill.

My mission in Damba was to understand how TAMTAM could potentially plug into the existing health infrastructure to distribute bed nets on the island. In particular, I would be assessing the feasibility of working with two organizations: The first, VOLSET, is our current partner in Ntenjeru, one of our two existing sites. VOLSET has a network of VHTs – Village Health Teams – that includes three workers on the island. They visit local houses and could potentially distribute nets in the course of their daily activities. The second organization, Damba Clinic, is a government-run provider that offers basic outpatient services, immunizations, and family planning services.

I headed to Damba Monday morning with the VOLSET team from Ntenjeru via a wet-ish two-hour boat ride across Lake Victoria. We arrived on the island to find that it was certainly rough (though less explicitly “pirate” than I had been warned), but that the hospitality of the residents was overwhelming. Joseph, one of the island’s three VHTs, welcomed us to his home with tea, a full Ugandan meal, and a can of dill pickled-flavored Pringles. We settled into his homestead to plan our next few days (see picture to right). Tuesday would be a day of HIV-testing (for the VOLSET volunteers) and checking out the island clinic (for myself and a small legation). Wednesday would be a day for household visits and pulling together our thoughts.

The days were both productive and insightful. While we could speculate about the challenges of island distribution from afar, hiking the two hours through the jungle and over mounds of safari ants to the clinic gave me the first-hand experience of how difficult it would be to move kilos of bed nets across the island (see picture of clinic to left). Similarly, meeting the VHTs and seeing how integrated they were into the community gave me a better sense of their ability to deeply impact the people they served.

Currently, we are hopeful that distribution of nets to Damba will work and we continue to try to solve the logistical issues that beset our work on the island. Now we are focused on getting a distributor to deliver to the island, finding a location for secure storage of the nets, and creating a distribution system to spread nets as broadly as possible while still encouraging crowding-in of immunizations through the local clinic.

Meredith

Week 4

We had a busy week which was split between Gulu, Ntenjeru, and Kampala! In Gulu, we met with Kairos to understand what data they collect on the residents who live in the surrounding villages. This will give us a clearer picture of how many bed nets should be distributed to the community. It also provides us with baseline data on current bed net penetration in the region.

Our visit to Ntenjeru involved shadowing a Village Health Team (VHT), as they made their regular home visits. From watching the VHTs in action it is clear that these volunteers are hard working individuals and are committed to providing better healthcare services to their village. Visiting the home first hand gave the team an idea of the need for bed nets in the region. It is clear that there are many families that do not have the resources to afford bed nets. The home visits also provided the team with ideas on a bed net distribution strategy and how to best leverage the VHT network as we launch our pilot.

In Kampala, we had meetings with a few NGOs that work on AIDS/HIV outreach, testing, and/or treatment. We met with the following NGOs: EGPAF, PREFA, and MSF France. These meetings gave us a greater understanding of the AIDS/HIV support that is taking place in Uganda. As we think about the potential to “crowd in” public health services, such as HIV testing, we hope to potentially partner with one of these NGOs to complement their existing work in Uganda.

The week ended with the arrival of a new team member, Meredith. Meredith is already hard at work in the field. Her first stop is Damba Island, which is located ~2 hours off the shore of Lake Victoria. Stay tuned to hear about Meredith’s adventures to the islands!

Week 3 Update

We spent most of Week 3 in the field visiting potential partner sites. During the beginning of the week we went back to Buluba Hospital to observe one of their immunization days (photo above) and understand the data that they record for their patients when they come in for antenatal visits or immunizations. We also had the opportunity to visit Kairos, an organization that runs a health clinic 10km outside of Gulu (~5 hours north of Kampala). Dr. Beatrice from Kairos showed us around and gave us some context on the patients she sees through the clinic. It is clear that there is a real need for bed nets in the region, and that there is a passionate team on the ground trying to deliver better healthcare to the surrounding area. Kairos has begun collecting data including malaria and bed net information through community gatherings- a potentially useful forum for TAMTAM's partnership.

Meanwhile, meetings in Kampala continue:

• Ministry of Health - Malaria Control Program
• Mildmay- a UK-based NGO focused on family HIV/AIDS treatment
• BASF/ Cooper Pharma- a commercial distributor of bed nets in Uganda

On some exciting news outside of work, team TamTam came in first place at the bi-monthly trivia night at the expat bar Bubble’s! What is the prize for winning such a tough competition? Well, on top of flaunting such an honor to the rest of the small expat community, we get to write the next quiz! The team is busy trying to come up with some tough questions. In the coming week we are looking forward to our visits to Ntenjeru and Gulu. By end of this week we will have an additional teammate- Meredith! We are looking forward to welcoming her to the team and getting her up to speed on the work that we are doing on the ground.

Week 2 Happenings

Another good week here in Uganda, this time a nice mix of field time and in-city meetings. Lekha and Sarah have survived their first week and are full-fledged TAMTAMers.

This week, we met with the following organizations in Kampala:

• Ministry of Local Government
• UNICEF
• Ministry of Health
• FXB
• Clinton Foundation - CHAI (Country Director and Malaria Program)
• Netmark

This week our field visits included VOLSET Foundation in Ntenjeru/Domba Island and Buluba Hospital near Musita. Next week we will return to these sights to learn more and spend dedicated time. We will also head north to Gulu to visit the organization Kairos. Busy first week for Sarah and Lekha- we wish the rest of the team were here too!

We also found ourselves a team mascot, Chris TAMTAM Tam. It's his birthday! Thanks to Chaim and Phil as well for hosting a fun time.

Buluba Hospital and VOLSET Foundation

This week the TAMTAM team set out on our first two field visits in Uganda. We visited Buluba Hospital (located about 2.5 hours east of Kampala) and the Volset Foundation's Village Health Team program in Ntenjuru, north of Mukono. At both of these locations, we found passionate health workers in areas troubled by malaria and without adequate bed net availability. We are in the process of learning more about the data collection, health services, and needs of each of these places. Team TAMTAM seeks to distribute bed nets through our partners in underserved areas and with a focus on "crowding in" other health services. For example, free distribution of much-wanted bed nets could draw mothers into a health clinic to receive an immunization for her child, or partake in pre-natal services. We look forward to getting our nets out in the field and into healthier homes as soon as possible.

In unrelated news, team TAMTAM discovered a bowling alley in Kampala and have decided not to quit our day job.

Welcome to Lekha and Sarah!

Sarah Dillard and Lekha Doshi have arrived safely and soundly in Kampala! They have hit the ground running and have joined us out in the field this week. For your reference, here is the park from which we depart when headed into the rural areas of Uganda...

One week down...

After 5 full days in Kampala, we can say that it has been a productive week. Before landing in Kampala, we had been introduced to some contacts in the Ugandan malaria sphere but many variable were still unknown. Now, after our first week, we have been fortunate to meet many knowledgeable and helpful people at various hospitals, government offices, and NGOs. Some highlighted meetings:

• Africare
• Rotary Club
• Malaria Consortium
• Kairos
• Centers for Disease Control/President's Malaria Initiative
• Ford Family Program
• Various hospitals and officials in rural Ugandan districts

Right now, we write to you from Busia, Kenya, the birthplace of TAMTAM (where the research that began bed net distribution was conducted by development economists). In fact, Jessica Cohen, one of the original founders, happens to be here in Busia with us.

In other news, we will add photos soon- bear with the less than visually-stimulating blog at the moment. We are also moving into a house on Monday- right near an ice cream parlor!

Kampala life

3 days in Uganda and 3 days in Kampala. Kampala is as welcoming as advertised... friendly folks, appealing vistas, fine weather. Hasn't taken much time at all to get up to speed here.

This said, we are a bit champing at the bit to visit some sites in the field. Urban Uganda is one particular experience, but the rural areas completely different. The rural areas is where malaria hits the hardest, and life generally more rough. Only then do I think we can really appreciate what fighting malaria in this country entails.

Until then, can't say we've too many complaints. Meetings are starting to come thick and fast... very grateful Lekha and Sarah will be joining us next week! Otherwise, very happy to have hit the ground running... very eager to see what will unfold!

P

Hello, Uganda

Greetings from Uganda! Paul and I have arrived safely and are busy scheduling meetings with a variety of organizations working on malaria here. We're looking forward to a quick ramp-up and a lot of learning in the early days.

In other news, TAMTAM historical fact of the day: TAMTAM stands for "Together Against Malaria, Tunapenda Afya na Maisha". The latter Swahili portion means "We love health and life". Hope you can get behind that motto too!

Special thanks to Owen Ozier for sending us some of the original TAMTAM files still housed in Kenya!

Greetings!

TAMTAM friends and colleagues,

Welcome to our Summer 2009 TAMTAM blog! Here you will find the latest updates from our work in Uganda. Glad to have you on board!

P