Tuesday Highlights

Today, four exciting/interesting things happened:

1) We made some progress on our project. We're going on an outreach tomorrow to see the implementation of some new male sensitization strategies. Yay for progress!

2) We met three seriously malnourished children today. Nova, one of the pediatric counselors who specializes in nutrition issues and therapeutic feeding, came searching for me and Nrupa so that he could introduce us to these children (he also took some pictures with my camera). Two of the children, both less than 5 years old, had severe edema, which was particularly noticeable in their feet and abdomens. The little girl also had skin irritations around her groin. They were both going to be enrolled in the therapeutic feeding program.

The other child in the room was a 2 month old baby that looked like she had been born at least a month premature, though apparently she was carried to term. She was so tiny. Her entire foot was the size of my thumb. Her mother had recently died of AIDS, and now her step mother was supposed to be taking care of her, but often neglected her. Her step sister was the one who took time off school to bring her into the clinic. (We weren't entirely clear on these relationships as we were getting this entire conversation through translation, but I think that this was a multiple-wives situation and one wife died of AIDS so another was supposed to be taking care of her child but instead resented the child and neglected caring for her). Anyway, this was the first time the baby had been brought to the clinic, so her HIV status was still unknown. They were going to do PCR (polymerase chain reaction) to test for HIV (blood tests don't work for children that young because they could have maternal antibodies that lead to a false positive result). Seeing this girl reiterated the importance of prevention of mother to child transmission (PMTCT) programs. With ARV prophylaxis, vertical transmission rates can be reduced to less that 10% (even lower in developed countries), yet some women just don't know or don't have access to such care. Hopefully our project regarding male involvement will help address some of these issues. Since men are the heads of household and the decision-makers, educating them about prophylaxis, etc could have a profound effect on MTCT and family planning.

3) Nrupa and I will be measuring malnutrition among TASO clients as part of a nutrition assessment that Nova wants to conduct at the center. We started today by measuring about 15 children in the pediatric wing. We used what's called a muac tape to measure the circumference of the upper arm. Based on these measurements we can determine if the child is malnourished or not. Obviously such measurements are not foolproof, especially since edema is a common side effect of malnourishment, but it's an easy and cost effective way to get a general idea. Among the 15 children we measured, we found about 4 who were malnourished and will be started on therapeutic feeding. We also had 3 that were previously enrolled in the therapeutic feeding but now measured normal. It's good to see the concrete positive outcomes for some of these programs.

Our major challenge with this task was the language barrier. Most of the clients speak little if any English and though we're trying to pick up some of the local languages, there are way too many and we certainly won't know enough in 3 months to really get to know these clients without interpreters. Thankfully some TASO staff were available for assistance when necessary.

Side note: Nrupa got to hold her first Ugandan baby. It was a truly memorable experience for her and one she has been looking forward to since we landed.

4) We decided to go for a short run after work today. We were slowly making our way up this huge hill behind our house when we met two local women, one of whom was carrying an adorable baby on her back. We got to talking with them and they ended up inviting us over to their homes. We just had quick visits (and we both got a chance to hold the baby, though she wasn't too excited about it...), but their generosity in inviting us over (and trying to get us to stay for supper) shows one of the major differences between Westerners and Ugandans (at least the ones in Mbale. I don't want to be too general). Even when we pass other muzungus on the street, they barely nod or smile at us despite the foreigner connection. But random Ugandans will come up, shake our hands, ask how we are, etc. and then greet us again the next time we randomly bump in to one another (which does happen. This is a relatively small town and we're quite recognizable). People in the US talk about Southern hospitality, but that's nothing compared to the Ugandan variety.