Sunday, April 26, 2015

Reflections on my time in Kamengo - Agnes Zabali Boys & Girls Club

I embarked on this journey with the best of intentions to upload postings to my blog every couple of days but it did not quite work out as planned. Long days working on the medical mission, evenings spent 'dissecting' the day and completing necessary statistics, and intermittent internet access meant that the blog (as some of you who looked for it have already worked out) never happened.

I am back in Gatineau, Canada now and trying to sift through my photos and experiences to convey some of my experiences while in Uganda. First - apologies - it was near impossible to get my head into a space where I could contribute to this blog while I was away in Uganda. 

Those of you who know me well, know that summer is not my favorite time of year - yet I knew, as soon as I landed in Entebbe that I would need to learn to 'embrace the warmth'. Arriving at 11pm at night, Jimmy assured me it was 'cool' yet there I was, flushed, red face and already sticky - and that pretty much continued through the whole time I was there.

The morning after we arrived we made our way out of Kampala in a two-van convoy. Roads lined with small businesses, many operating out of packing containers or very fragile looking sheds. 

This was my first of many experiences of Kampala traffic (horrible) and the lack of seat-belts in vehicles (scary). It was time for me to relax and trust the local driver Miro (who was amazingly patient and steady on every journey). While malaria is indeed responsible for many many deaths in Uganda – road accidents must be up there as the top cause of injury and death.

AGNES ZABALI BOYS & GIRLS CLUB KAMENGO

The community of the Agnes Zabali Boys & Girls club welcomed us to Kamengo with music and dancing and we spent this first weekend getting to know our surroundings and the many many young people who used the Boys & Girls Club as a community center each day. Both boys and girls are talented drummers and dancers and it does not take much to get them into music making and moving.

This first day was spent hanging out at the Agnes Zabali Boys & Girls club and trying to take it all in. I learned a lot from just watching the kids play - I do not think I have seen kids play together  with so much joy and with so few props for a very very long time.

All of us had brought special little things we thought would give some fun to the children. On this very fist day we learned that it did not take much to engage them. Little stickers, stick on tattoos, taking photos and showing them on the iPad. There were countless examples of how the children - big and small - played together. While  there might be little that these young people have to call their own - few have shoes and many over the two weeks wore the same item of clothing each day - they generally play well together and appear to get genuine joy from play - ensuring each gets to have a go and supporting the little ones as they struggle to master skipping, basketball etc. It was watching the children and young men and women play each afternoon that I witnessed the incredible impact of the Agnes Zabali Boys and Girls Club - a safe space where the young can build community through play and learning (there is a homework/computer room). There are always older students present and they play a critical role in supporting the younger ones and being amazing role models.

Dr. Ashleigh's stick-on tattoos were a real hit

One of the mission members brought out a $2 plastic skipping rope which was a real highlight and the kids - big and small - took turns turning the ropes and at times there were up to 10 girls and boys jumping together - below I think I captured 7 at once. By the end of the week the skipping ropes had passed their use-by date and fallen apart but they gave a lot of joy while they lasted (Note to Self: next time bring more sturdy skipping ropes).

The resilience and joy I witnessed on the Agnes Zabali Boys and Girls Club basketball court was a valuable lesson for me. Such talent, energy and community - and all this most likely on one meagre meal a day.








Seven Girls skipping in unison with one of Dr. Kate's skipping ropes


The Agnes Zabali Boys & Girls club is the creation of my friend Jimmy Sebulime's late mother Agnes. Agnes worked tirelessly to bring back to her village some of the benefits Jimmy and his brothers and sister had experienced from growing up in Ottawa. A group of us in Canada support 150 students to attend school and I and the pleasure of meeting most of these students and some of their teachers and parents while I was in Kamengo.

My goal moving forward is to to organize alternative practicum for teacher candidates from Ottawa university to visit Kamengo each year and work with students and teachers in the local elementary and high schools.

While in Kamengo I visited a number of schools and met the principals. We had time to think through together how we could support them from a  distance and through Ugandan-based practicum.


Sister, myself and Geography teacher
 The local high school - St. Brunos has both boarding and day school students. many of the students who are part of the Agnes Zabali Boys & Girls Club attend St. Brunos. Students study long hours and teaching is very much 'chalk and talk' with students copying copious notes that the teacher has written on the blackboard from the one and only text book in the school! They follow the British "O" Level and "A" level system and although Uganda has a national curriculum (and an associated web page) I am yet to get hold of actual curriculum documents.

 My sense is that the students study long hours, rely on rote learning and much of this is ineffective or at the very least inefficient. We would often see students walking home at 9 or 10 pm after studying. I spent sometime with students at the centre trying to make sense of how they were approaching their work and I gained a real appreciation for the need for strategies and resources that would support them across many subjects.  Few if any classrooms, even in the high school, had electric outlets and the principal of St. Brunos key request of me was for a data projector so they could teach more effectively in the computer lab. The lab itself had few working computers and all were rejects from a  large insurance company in Kampala from when the company upgraded.

Children walked everywhere and most often you would encounter them on way to and from school. There are  quite a few elementary and a couple of high schools in Kamengo and I managed to visit a number of them when I could get away from the clinic. Although education is claimed to be free - it is not - every school has its costs.

Not an easy activity in glaring sunshine
At one elementary school I visited children were carrying rocks and stones to fix a bottom step that had eroded away - there are no maintenance staff or janitors - the children maintain their school as best they are able to.  The school facilities are very, very basic with limited access to running water and if there is electric power - it is sourced from solar panels.




Elementary schools cost the equivalent of CAD$60 per year which in North america seems like a very small amount. However, in Uganda the average annual income is around CAD$1,500 so it represents a significant commitment. Schools have large classrooms and many old bench-like desks where, depending on the age group - three or four students sit together.

In the elementary classrooms I visited the children were often by themselves - teachers, who are very poorly paid and largely untrained do not always arrive at school. In some classrooms colourful hand made charts declare the numbers from 1 to 100, days of the week, months of the year etc.

When the teachers are not there the children take turns at the front of the room with a stick - pointing to numbers on a chart or words on a chart - they call out the number or name and the whole class repeats it. This pattern is repeated around every chart in the room by one child - and then starts agin with another.    The children seem content to do this repeatedly, each of them having a turn.



I was not totally surprised by the state of education - it reminded me of time spent years ago in Papua New Guinea but I was saddened by it. The children are so keen to learn, so thirsty to encounter new ideas and so very very willing to study very long hours.

I had the opportunity to sit down with principals and look at the recommended or required text books across levels and curriculum areas and they reminded me so much of content I was learning as a child some 50 years ago. To me the content in the elementary curriculum was quite challenging and this was made even more so by the lack of resources and the teachers' dependence on teaching off the blackboard. Even science is taught off the blackboard - it is not experienced in labs, or within the world around them. Math manipulatives are unheard of and teaching outside the classroom is not an idea that the teachers are familiar with. One thing I did learn was that textbooks (of which each school had none, 1 or a maximum of 6 copies of texts for any particular subject) are published in Kampala and are relatively cheap (all below $10 and many around just $5) so this is something I am really hoping I might be able to mobilize support for perhaps through partnerships with local Canadian schools.





The schools I visited were welcoming and would love to have more teachers and teacher educators from Canada visit - which of course is my hope in years to come. The students are very receptive to new experiences and learning - they are respectful and a delight to interact with. Outside of school they work hard and they are very much aware that many young people like them in Kamengo do not ever get to attend school - so they cherish the opportunity. 



It is difficult as an outsider, from a country with so many opportunities and so much wealth in terms of educational resources - to know where to begin when wanting to assist with education in Kamengo. My first step was talking with principals, teachers and students so I could understand better what THEY wanted, not what I thought they needed. They taught me that we need to work with what is there and to work locally - as change on a national level to curriculum for example, is slow and unlikely in coming years. There is a national curriculum so the principals advised I begin there - they need text books and the teachers need teaching resources, units of work designed around the curriculum objectives and other resources they can use to make learning more accessible.

I learned that there are three key areas that I am committed to working on over coming years:

  • Continue to work with the Agnes Zabali Boys & Girls Club of Kameng Ottawa Committee to sponsor children and youth through elementary school ($60/pa); high school ($200/pa) and university ($1,000/pa).
  • Raise money to purchase Ugandan texts for local schools and for the Agnes Zabali Boys & Girls Club study room.
  • Return to Kamengo each year on an Education trip with teacher candidates, professors and teachers from the University of Ottawa who, during the year, will have prepared resources for teachers and students across different curriculum areas. The goal would be to develop resources that will stimulate higher order thinking but that can be utilized without reliance on technology.
I would welcome anyone to join me on this journey.







CACHA MEDICAL MISSION - KAMENGO 2015

CACHA MEDICAL MISSION - KAMENGO 2015

Part of medical team walking down to clinic
Each day we walked a kilometre down to the clinic around 7.30am to begin the day. That walk back and forth each day, became the time when we could talk through different approaches to ensure people who needed immediate care were identified and brought into doctors first, the medical team discussed interesting and very sad cases on the walk home and we generally tried to understand how, and if, we were making a difference. It was tough on the clinical team members as they had very very limited resources and could not practice medicine how they would like to.
One of the 3 four-bed wards at clinic.

 The clinic had three small wards where the very ill (most often young children with malaria) were admitted. Concrete floors, plastic covered mattresses, no mosquito nets and no bed linen. Note the wooden bench for visitors or family. If you or your child was admitted it was up to you to provide sheets, water and food. We often found ourselves paying what amounted to 40c for bottles of water and handing them out to people in the wards, mothers with young children. We also regularly went round and bought plates of food (about $2) for them as many might have walked from villages 15km away and not have the means to purchase food or to contact relatives.

Annette, mother of 4 including twins Catherine & Nicholas 
Babies ride on back
 The clinic faced over 300 people each day in week one and then around 280 each other day - the first few days were the hardest and this is when we encountered the most gravely ill. We turned up to 50 people away on days 1 and 2 and then the pressure gradually eased. There would typically be 100 people waiting when we arrived at 7.30 - 8am.
As a non-medical team member I assisted with registration, taking blood pressure, weight and generally ensuring that we kept the lines outside the 3 separate consulting rooms (2 doctors or nurses one each) and the dentist moving. The local people were incredibly patient - many had walked significant distances to be there, some had slept under the tent shelter the night before, most waited hours before they were seen by the doctors and then a further hour or so to receive their prescriptions.
Waiting at pharmacy window

Over nine days we saw over 2600 patients and for many people it was the only time they consult a doctor - when the international team comes each year.

Waiting for dentist
Having seen the doctor and/or dentist there is another wait at the window of the pharmacy to receive any medication. All patients receive a worm treatment (as did all mission team members on our departure) and other prescribed medications. When there is no international clinic local people must pay for medication so these two weeks are an opportunity for everyone to consult a doctor or nurse practitioner at no cost. Patients can ask for HIV/AIDS tests (which are always free) but at any other time of year all other tests and medications cost, and the hard reality is - people do not have money.

I captured these children before they had seen the dentist - people waiting at pharmacy window behind them. The medical team has services of a volunteer dentist from Kampala - a very small statured woman whose sole role during the clinic is to extract infected teeth! An infected tooth could lead to greater infections, illness and, in worst cases death. With limited resources - all done in a  plastic garden chair with dentist wearing a camping headlamp - everyone visiting the dentist goes in first to get an injection of Novocain and then to have the tooth extracted some 10-15mins later. The dentist is an amazing woman - works solidly through the day with minimal equipment.  Some kids have to be held in the chair and scream - but many are quite stoic and take it as necessary. I think I got the photo above before their dentist visit since they are ready with their smiles.

Waiting for relatives still with doctors.
At the end of the day the tent, so full in the morning,  is almost empty
As the day draws to a close - we stop the waiting lines at about 4pm - the registered people are all in doctors lines or waiting for prescriptions or have begun their journeys home.  The pharmacists are always the last to finish up their day (sometimes as late as 6pm) and one by one the medical team makes their way back to the Boys & Girls Club to play with kids, shower, wind down, complete statistics, have dinner and head to bed.



The daily routine of the medical mission as described above masks some very difficult and heart rendering experiences. I was not a medical team member so witnessed far fewer cases than did the nurses and doctors - but there were times when the poverty, the sickness and the lack of basic health understanding brought each of us to tears. A little girl with malaria, a raging fever and little response was hooked up to a drip in an effort to hydrate her and I was charged with wiping her little body down with cold cloths to try and help cool her - she passed away on the first night - teaching me the fragility of life where lack of knowledge and basic medical care is so difficult to obtain. There were countless others - children and adults without shoes, women with hands so rough, cracked and creviced from working in the gardens you thought you were holding concrete when you took their blood pressure. Most of the adults I weighed were under 50kg and when I noted someone was around my age, I was shocked at how tired and worn out they were. But amongst all this was astounding human resilience which in and of itself was a rich and deep lesson for me.

Images beyond those posted above will stay with me as I try to make sense of the challenges the people of Kamengo face. I had an incredible experience on the medical mission and am committed to returning to work with the students, teachers and schools to see if basic education can be enhanced and can perhaps mitigate some of the suffering I witnessed as part of the CACHA medical mission.