This summer has wrested from my grasp all familiarity I previously had with the word comfort. Since my arrival in Uganda, I have broken my nose (don’t tell my mother), been left in the middle of nowhere by a bus driver gone rogue, woken in the middle of the night to what seemed like a whole family of lizards throwing a party on my bed, and briefly battled a monkey who attempted to make off with my clipboard. My time as an HIV/AIDS policy intern with the World Health Organization has had little semblance to any internship I have had before. Life and work here is a bit of a free-for-all, dictated in part by constantly changing health crises (the recent Ebola outbreak and refugees from South Sudan, to name a couple), but also by a particular, somewhat enviable, easy-going-in-the-midst-of-chaos, East African way of living. Whenever I ask my colleagues how long it will take me to walk somewhere, they ask if I mean in African time or in Muzungu (a Swahili word for someone of European descent) time.
This summer has dictated that I do a lot of things that I would not normally be “comfortable with”. The very top of this list includes keeping my views and thoughts to myself during discussions of Uganda’s recently passed Anti-Homosexuality Act, which has been difficult, but also taught me a lot about how to listen to and try to grasp what is happening around me even when I stand (or sit quietly) in profound disagreement. The recent turmoil caused by the law has shifted the balance of many things in Uganda, especially the roles of NGOs and the UN. It has been eye opening to observe those agencies scrambling to reconcile their duty to comply with the decrees of local governments with their commitment to disseminate unbiased and discrimination free care and health information. Unfortunately, since the ratification of the law, entire research operations have been shuttered because of the threat that the law may pose to some researchers. It is grim to watch such acute intolerance hinder the progress of decades of work in the health sector.
The work I have participated in here has involved everything from data collection at the regional level, to a national strategic budget aimed at the treatment of all known cases of tuberculosis in the country. Each task always begins with the thought: “this seems straightforward enough,” and ends with me in some sort of fugue state, wondering if all of the columns I just created really mean something. Some of the tasks I am given present opportunities for moral dilemmas; allocating funding becomes a challenge when limited resources inevitably leave out vulnerable populations desperately in need of things like HIV drugs or TB medications. My coworkers are seasoned veterans, but I am the novice here, drowning out their practiced pragmatism with emotional arguments not founded in financial realities. My respect for what my colleagues tackle regularly grows every day.
Yesterday, I was lucky enough to escape the office to go into the field to several rural health centers to monitor the status of programs aimed at the prevention of mother to child transmission of HIV. We accidentally (not so strategically) timed our arrival with the weekly ART (antiretroviral therapy) clinic for HIV positive mothers. In true bureaucratic fashion, we managed to disrupt the little clinic as much as possible. Research takes on a different tone when you’re sitting in the sun, nursing various injuries and trying to keep charts from blowing away in the wind. Asking where the restroom is elicits the response, “watch out for the snakes that live in there!” For me, this research became very real when I picked up the chart of a young woman, 21 years old, who had recently given birth to a baby boy. The child had been tested for HIV, as is protocol for babies born to women with HIV, and the test had come back positive. I think that my colleagues would agree when I say that your heart always sinks a little when you see charts like that. Among other things, I was tasked with assessing charts for completeness, and in doing so asked the supervising nurse why the box where the date the mother has been informed of the child’s status was blank. The nurse pointed to a woman and a baby, sitting on a plastic chair across the room. She hadn’t been told yet, that was on the agenda for the appointment today.
Today over 1,000,000 people in Uganda are living with HIV, and over 200,000 of those people are children. Tremendous progress has been made in the fight against HIV, and Uganda has certainly made great strides from its high infection rates in the 90s. However, the Ugandans who wait for hours at rural clinics for drugs that may not even be there are the reason that my colleagues at the WHO and UNAIDS continue to fight for improved programs and more efficiently allocated funding. I am writing this post from hour eight of a national conference held twice a year by the UN, where all of the NGOs who work on HIV get together to update each other on projects and programs. The amount of teamwork and collaboration here is a little surprising, and very impressive. It is reassuring to me, as someone who is going to graduate and make my way (hopefully) into the working world soon, that such passionate groups of people exist in these fields, and that they really are committed to working together toward viable solutions to these major health issues.