You are Most Welcome

The first morning I woke up in Kampala I was greeted by the sounds of a busy city street outside my hotel window. There were boda bodas (moto taxis) buzzing by, as well as cars and pedestrians going to and fro. I had only slept for a few hours the night after my arrival, but I had a busy day ahead to take care of administrative matters so that I would be ready to head out into the field with my colleagues the next day. After a nice breakfast made of fresh pineapple and mango, fresh-squeezed passion fruit juice, scrambled eggs and coffee, I headed with my STOP colleague, Scott, to the United Nations Department of Safety and Security (UNDSS) office to be outfitted with my official United Nations (UN) badge. Then we went over to the World Health Organization (WHO) offices to receive a security briefing on Uganda. In addition to the information presented on potential security risks in the area, I also received a hand-held alarm with a string attached, which I could pull in case of emergency. I was informed that these alarms are provided for female staff only.

A boda boda in Kampala.

 

After the briefing, we went over to the UNICEF offices where I was to meet my in-country supervisor, Sheeba. She is the lead coordinator for immunization services at the UNICEF Uganda office. Sheeba maintains a very busy schedule but I was able to catch her for a few minutes to receive a brief introduction to the office and receive some quick guidance on what our objective would be as Communications Consultants during the field visit that week. We were instructed to take this trip as an opportunity to observe a specific district in the country, take note of the current immunization situation, and gather ideas of how we could focus our work throughout the next couple of months.

The next morning a fellow STOP consultant, Joseph, who has been working as a Field Consultant in Uganda for the past year, picked up Scott and me with his driver, Amos. We embarked on our long 7-hour journey from the capital to the northwestern region of Arua. The roads were very rough and rugged, and of course it was sweltering hot. Despite the hot and bumpy ride, I was able to observe many interesting sights along the way. When we passed through town markets, there were people bustling about selling fruit, bread, and chickens, women walking with baskets full of goods on their heads, bicyclists balancing large bundles of reeds and other items, and children scampering about, often stopping to stare at the muzungu (white people) in our vehicle.

A local market center on the way out of Kampala

Even beyond the town centers, there were various men, women and children trekking alongside the road, carrying various types of goods and women carrying babies on their backs. It was an adorable and peculiar sight to see a woman walking with two tiny feet poking out from either side of her body. Then as we passed by, I could see a baby cradled across her back with the legs splayed on either side of the mother’s body. I noted how the women here in Uganda carry their babies differently than the women in southern Mexico, who often have their babies hanging diagonally in a cocoon across the mother’s back. We were also very lucky to come upon a safari of wild animals during the stretch of the trip through the national Uganda park reserve. We spotted exotic birds, hippos, monkeys, and even elephants roaming through the grass, only a few meters from our vehicle. It was miraculous! This was not like watching animals at the zoo; these were majestic wild animals roaming freely.

Stopping to feed bananas to the monkeys on the way to Arua.

Wild elephants in the Uganda national park reserve.

The long day trip to Arua went smoothly, except for the flat tire we experienced at one of the military check points. Fortunately, we had a spare tire that Amos was able to change on the side of the road. The sun was beating down on us and poor Amos was completely drenched in sweat after changing the tire. A few hours later, we finally arrived to the Arua district, in the region of Arua. Like Mary and Joseph looking for a place to stay at the inn, we went from hotel to hotel searching for accommodations that night. By the fourth hotel, we finally found a place with available rooms, one double for Scott and Joseph and one single for me. Many of the local hotels had only 7 to 10 rooms, and we speculated that they were full with refugees from Sudan, fleeing the current struggles for safe haven in Uganda.

My hotel room on our first night in Arua, complete with mosquito net.

The next day was Friday, and we took advantage of the opportunity to meet with leaders at the Regional Health Office in Arua. We met with the regional Health Officer and the regional Surveillance Focal Person. Our goal was to inform them of our presence in their region, explain our mission as WHO/UNICEF STOP consultants, and describe our intended efforts to support their work in communicable disease surveillance and routine immunization, with a focus on polio, measles, neonatal tetanus, and adverse events. We were received very positively and instructed that of the 8 districts in the region, we should focus our work on the districts of Arua and Adjumani because those districts are the most densely populated and host large refugee communities, which are known to have some of the lowest immunization coverage rates.

Meeting at the regional health office in Arua.

With the support and recommendation of the regional health officials, we then headed to the neighboring district of Adjumani. While the distance between the two districts is not great, the rough roads extended our trip to almost 4 hours. Once we finally arrived in Adjumani later that afternoon, we met with the District Health Official (DHO) to have a similar discussion as what we had at the district, as well as to ask some questions to quickly assess what is currently being done for communications and social mobilization around immunizations. We learned that there are roughly 60,000 refugees in the district, both in camps and integrated into the community, and that they have the lowest immunization coverage rates in the region. In addition, they are currently experiencing a meningitis outbreak with confirmed cases in two different counties. After a very productive conversation with the DHO, we agreed to meet the next day with a community health leader at the only hospital in the district to make a plan for various site visits during the upcoming week.

Woman carrying chickens on her head and a baby on her back
on our way from Arua to the Adjumani district. 

The ferry to get across the Nile River to the Adjumani district. 

Me on the Nile River ferry to the Adjumani district.

The District Health Office in Adjumani. 

The next day, Saturday, we headed out in the morning for the district hospital. The community health leader we went to meet with, a nurse, was busy seeing patients when we arrived, so we toured around the hospital which was constructed as an open outdoor structure with a courtyard in the middle. The various sections of the hospital had open waiting areas where people were gathered waiting to be seen. There were various posters on the walls encouraging people to get tested for HIV, avoid getting infected with malaria while pregnant by sleeping under treated bed nets, and family planning options such as IUDs, which were referred to as “coils.” We even encountered a laboratory with a plaque on the wall recognizing the “American people” for their support through the U.S. Centers for Disease Control and Prevention. Once the nurse was free, we sat down with her to discuss our plan for the next week to visit various district health centers, local schools, and two refugee camps. After completing our plans, we headed on to find our next place to stay for the rest of the weekend in Adjumani.

Sign outside the lab at the Adjumani District Hospital. 

All in all, my experience so far has been very positive. During my first few days in Uganda, I have found the people here to be very kind, soft-spoken, mild-mannered, and courteous. From the district health officials to the local merchants, I have felt warmly welcomed by all. Many of the Ugandans I have met have greeted me and kindly stated, “You are most welcome, madam."