Slums, Jiggers, and Civil Society in Jinja, Uganda, Part I
In July of this year, I fulfilled the field work component of Columbia University’s Global Competency Certification (GCC) program in Jinja, Uganda. Our recent project in Uganda involved working with four other teachers from the United States to help train a Village Health Team (VHT) in pedagogical methods to be used in community mobilization. VHTs are part of the Ugandan health system, and are comprised of people from local communities who mobilize their communities to combat health issues, promote sanitation and hygiene, and refer neighbors to health clinics. In Jinja, our VHTs are dealing with major infectious skin diseases in their communities, most prominently ringworm, jiggers, scabies, bed bugs, and lice. The conditions in their communities are deplorable, and both children and adults are afflicted with one or a combination of these maladies. The sad reality is that all of these skin ailments are treatable and preventable but that is not what is happening. To effectively deal with this requires a health infrastructure, a health mindset, and effective enforcement of sanitation and hygiene at the home and neighborhood level. In short, it requires an introduction of the horizontal linkages that bond together community. In turn, this requires local bylaws and accountability. In sum, to introduce hygiene and sanitation and to clean up the slums of Jinja requires something that is in short supply in Uganda: civil society. One major question that emerges is, therefore: how do we introduce civil society, or a civic consciousness, among some of the poorest people on the planet in one of the world’s most corrupt polities? In this blog, I will focus on our work in Jinja and some of the major lessons that I learned there. A follow up blog will explore the larger question of how development and civil society have to be related to be truly sustainable.
The slums we dealt with were at first blush horrifying. Without resorting to “poverty porn,” let’s just say that these neighborhoods included as accouterments most of the following: drifts of trash and debris; pools of standing filthy water; soils in which children played, defecated, and became infected; animals of all types, often living in houses with the people; temporary housing with a single room housing upwards of 10 people; and a hideous, smoke-belching still in the center of town stewing up the local brew, Waragi (war gin), a toxic grog distilled from locally grown sugar cane. Our job, after our community visit, was to list the assets that we saw. What emerged was picture that included countless small business. Everybody in the slum was selling something from his or her houses or from ramshackle storefronts. There was a hotel, restaurant, and several movie theaters, though these were of a very rudimentary order. Most children in the village now receive some kind of education. There was a metered spigot for water, though untreated. There were communal toilets, both a plus and a minus. There were no beggars. Children, and everyone, were smiling. People appeared to be fed, happy, and industrious. How, then, to best pitch in for a two week period to progress a community about which we knew little and with which our encounter would be transient? Enter Foundation for Sustainable Development (FSD).
Our local fieldwork was coordinated by the FSD. The Foundation for Sustainable Development lists the following core values: Start with assets, not problems; motivate community ownership; generate enduring results and impacts; focus on the site teams; build capacities; be a bridge; change perspectives; and promote reciprocity. I would have to say that our program was definitely within the parameters of the FSD’s core working with Ugandan health officials to train VHTs, participating in the community mobilizations, and then helping to implement the health clinic at the Masese Childhood Development Center. We spent the first three days visiting the communities, and then working with local Ugandan Health Care officials to develop the program to both impart information about skin diseases, but also to expose the VHT members to pedagogical methods to better their engagement with their communities. The first day of the training was monumental info-out, with a district health official giving the VHTs good word on diarrheal diseases and preventative measures. In the afternoon, however, we participated in breakout sessions with the VHT members, in which they brainstormed sanitary conditions common to their communities and how they might work to prevent the spread of common diseases at the village level. The breakout session that I attended was revelatory. The community members developed a daunting list of at-risk behaviors in their communities and then began to examine common denominators. On the one hand, they all agreed that poverty was the underlying cause of much community health dysfunctions, but they also listed many specific behaviors that exacerbated unhealthy living: bringing animals into the house at night to prevent theft; children playing in dirt; sharing clothing; not washing hands after using the toilet; not helping to keep the communal toilets clean; not cleaning up trash; leaving food uncovered; not working to eradicate bedbugs; human-to-human contact. They then came to the conclusion that they had to develop a community health consciousness to start to alter these behaviors. They weren’t going to fix poverty, but they could help clean up their communities. This was a positive start.
Our team of Global Competency Certification (GCC) teachers conducted the training over the next two days. We worked hard to vary our presentations to showcase ways to make the distribution of information a bit more engaging. For instance, one of my colleagues, Claude, from Edina, Minnesota, worked to develop a game that they could play to simulate the spread of a disease in a community with little sanitation and no clinics. By the end of the fourth round, everyone was infected and most had several infections. This was simple and used scraps of paper and pencils to show when someone was infected. It was a huge hit, and the numbers of those with three, two, or one infections was eye opening for the VHT members. My GCC colleague Jen used walk and talk techniques, I used Band-Aids to illustrate the spread of ringworm, and the VHTs did skits to demonstrate some of the push back they might encounter from their communities. One point rang true: the VHT members were motivated and were ready to learn our teaching techniques to take to their communities. However, in my biggest learning moment, I misread my VHT and discovered that they were much farther along than I suspected. It also showed me the value of interrogating bias, and keeping one’s cultural baggage well stowed if one is to be effective interacting with other cultures.
The major roadblocks to my understanding of my Ugandan peers were language and culture. Because I had no knowledge of the local language, and I dealt with people with variable facility in English (though, overall, their language proficiency in English was advanced), I often missed verbal cues that would have given me some direction on their relative level of understanding. After the second day of training, we had a chance to meet with our VHT to work out their presentations for their community mobilizations the next week. I went over what I thought was a reasonable “lesson plan” with my VHT. Instead of nodding in assent, they instead began chattering away in Luganda (the local language) and seemed to be missing everything that I mentioned. My initial thoughts were “what the heck is so difficult about this outline we are going over?” Alice, one of the colleagues at Masese CDC, came over, listened to the conversation, and then sharply turned to me and noted that they were upset about the scheduled timing of the community mobilization the next Monday morning. Their community, Lakesite, was a fishing community situated on Lake Victoria, and the mornings were the busiest time for the village. If the community health mobilization were to go on as planned, they needed to inform their neighbors in advance of Monday, so that their neighbors could attend. At that moment, it became clear to me that my job was to impart some teaching techniques, to observe, and to critique methods. As a Mzungu (literally, white boy), I was the true outsider. The true experts in community health care matters were the locals. From that moment, I went forward as an engaged observer and mentor, not someone who had to dictate the format, much less the content of the mobilization.
The community mobilizations occurred on Monday and Tuesday. The first one, held in a field situated, courtyard-like, between houses on three sides and a school on the fourth, drew about 25 people from the surrounding community as well as the local councilman and pastor. After the obligatory prayer (Ugandans are extremely religious), the VHT did a nice presentation, though some of the community participants were a bit disengaged. On the other hand, they loved the simulation. I made it a point afterward to offer some small suggestions: Perhaps bring the flip chart closer to the audience by walking through the assembled crowd, as opposed to just standing and talking in front of them? “Meet and greet” people when they first arrive so that they feel welcome. This is also a great time to jot down names and contact information. Be clearer with framing the talk and work on transitions between sections of the presentation and between presenters. The next day, we doubled our turnout, and the VHT incorporated all of my suggestions into a much more polished presentation. When I left after three hours, they were still counseling and talking to nearly 20 people. They were poised, knew their materials and their audience, and were eager for hints on how to improve. The proof to the pudding was the nearly 200 people who showed up on Thursday for the health clinic, where community members and their children received free check ups and access to drugs to treat the myriad skin diseases that afflict their villages.
So, what was the lesson to all of this? One is what every teacher needs to understand: take a step back and trust your students to rise to the occasion in class. As the new canard goes, students (children and adults) need a “guide by the side,” not necessarily “a sage on the stage.” If the training and mobilization had been about me, then I needed to control everything from content to its delivery. In most cases, however, the real learning comes from students grappling with the material and presenting it in ways that make sense to them. This lesson is amplified when dealing with peoples from very different linguistic, cultural, and historical backgrounds. As Mzungu, what really was I going to tell the Lakesite VHT and their community about their problems and the solutions? Even if I had the answers, why would they listen to me, and what follow up and accountability could I impel, being there for a grand total of two weeks? Instead, it was much more effective to enter into a longer term process of building the local capacities to deal with local problems. Sustainability in development isn’t aid, as Margaret, our FSD mentor in Jinja, told us. Rather, it is contributing to small, incremental shifts in behavior that can help people lead better lives. In this case, my colleagues and I helped to motivate VHTs to go into their communities and to engage their neighbors in the task of taking ownership of their own health outcomes. As I will discuss in my next post, local ownership and capacities is one part of the path to development, but let’s not discount the impact of politics and tradition in Africa just yet.