Is lifestyle failing our health?

My exercising schedule has lately succumbed to inconsistency. The evening soccer with the village boys near our staff residence quarters has over the months always been a ‘must do thing’ especially for someone like me who loves stress relief after a long day of work. My former work in the city (Kampala) was quite a different arrangement all together. After some seven or so hours of work, I would board a taxi back to my small apartment and catch a couple of movies or listen to music playing in the background as I rested by or fried my dinner. Definitely, weekend would be a climax. Catching a few drinks at a local club or visiting some friends was a usual weekend program. Save for some details like pork feasting, pool games and so on.  

I guess my urbanized lifestyle during my former work may not sound so close to your picture or experience of the usually fancied ‘urban lifestyle’. Many city dwellers, especially those that usually or even occasionally have some money stuffed in their wallets from their earnings love the up-town life. They young professionals, mid career and older fellows often stuff their tummies with excess alcohol and unhealthy but seemingly ‘modern’ fatty diets. In fact, even many teenagers that I meet in ‘happening places’ puff chunks of cigarettes and booze large as a sign of swagger. Some destructive up-town attitudes like; ‘‘who has time for a daily evening or early morning jog? or where is the swagger when you get seen riding a bicycle in the neighbourhood? or which modern campus girl goes out on a date and orders for a traditional dish instead of fries (chips), chaps and chicken? ”have fuelled in this era. Then here comes the up-town mums plus some few dads who have to buy chocolate bars or an ice cream or some other junk foods for their 5 year old sweet heart son or daughter every evening as they retire from work.

Anyways, all the thoughts about urban lifestyle came up as I dug up in the archives on how NCDs (Non Communicable Diseases) are eating up our communities. NCDs are those diseases or conditions that are not caused by a disease causing organism (like bacteria or viruses) but rather their risk of occurrence is highly determined by lifestyles. Such NCDs may include; diabetes, cardiovascular conditions, obesity, and certain cancers. The World Health Organization estimates that by 2015, about 2.3 billion people will be overweight and about 700 million will be obese. Apparently, obesity and overweight are some of the major risk factors known to lead to diabetes. Diabetes which is a major killer and chronic illness that accounted for nearly 285 million patients (6.6%) aged between 20 to 79 years in 2010 according to the International Diabetes Federation.  Obesity and overweight are as well linked to increasing risk of cardio vascular (heart related) problems including hypertension and dyslipidemia. Proper functioning of internal organs especially the kidneys are as well disrupted due to overweight and obesity. Uncontrolled alcohol consumption, smoking, poor dieting (such as excess consumption of fatty foods, highly processed foods, junky foods, foods with high amounts of carbohydrates) and living a sedentary life style (characterized by lack of adequate physical body activity) are the major factors contributing to someone becoming obese or overweight.

In this regard, adjusting one’s lifestyle to better feeding and exercising is a means to a healthier body and mind. In addition, the controlled use of alcohol and cigarettes plus other general health practices such as routine medical check-ups, sanitation and hygiene are key. I already began on the mission of selling the benefits of physical body exercising to my elder sister that works in city. I am glad she is already thinking about it strongly. Enabling people to increase control over and improve their health is my and your role as a health promoter.

Think T.B

A “Think T.B” slogan appeared in many of the slides during the training presentations last week. There has not been a training that I loved beyond this one on Tuberculosis and HIV co-infection among all the ones I have so far attended in Kyangwali. The two days’ training left me pondering about our fate; given the existing trends of such terrible communicable diseases like Tuberculosis (T.B). Surprisingly, T.B in early stages usually manifests as a simple cough that persists beyond 2 weeks. This simple cough is most times accompanied by night sweats and also weight loss. Our training was endowed with topics on pathogenesis, diagnosis, chemo-therapy and other clinical stuff that most time sound as complex as ancient Greek to lay people. In fact, while the trainer mentioned of terms like; isoniazid, rifampin, pyrazinamide, hemoptysis, adenopathy, pneumonitis and others, it felt as though I was in Medical school which actually was a few yards from our School of public health at University. 

What stood out for me in this training were the public health concerns about tuberculosis especially in our developing communities. Uganda is among the 22 countries with the highest T.B burden worldwide. The fact that T.B is hard to recognize by someone who is not aware of its signs and symptoms poses a significant risk of infecting other close contacts such as relatives and friends. Worse still, about ten to twenty percent (10-20%) of T.B cases are asymptomatic which means that they do not normally present with signs of the infection. The mode of transmission is mainly through inhalation of T.B pathogen contaminated air (usually from an infected patient). This route is quite hard to block off. Just imagine the times you could have been exposed to T.B by just using public transport. Health workers too are at risk and ought to take serious precautions especially while interacting with patients or performing laboratory procedures. Matters made worse, T.B diagnosis (detection) is still quite problematic even at many health centers in our communities and yet missing out on some patients most certainly causes them to infect others. The Tuberculosis and HIV co-infection is quite complex since one infection worsens the other and thus posing higher risks of case fatality. Pulmonary T.B which is the commonest can easily progress to extra pulmonary T.B especially among people with compromised immunity. This mishap implies that T.B could then spread to other body systems besides the lungs and seriously affect the other body organs such as; the bones, brain, kidneys, eyes and others. 

Much as the first line drugs are fairly available for T.B treatment in the Ugandan communities, there is a life threatening condition that is sparking out! A new strain of tuberculosis called Multi Drug Resistant Tuberculosis (MDR-TB) that is resistant to first line medication is on the loose. The current absence of second line T.B drugs in Uganda and their associated unaffordable costs to majority has left the lives of quite a number hanging by a thread. It is estimated by Medecins Sans Frontieres (MSF) that a single complete regimen of around 18 to 24 months treatment for second line TB drugs could cost between 4,000 and 9,000 US Dollars. How many sick people will think of that option yet even so many cannot afford a kilo of sugar (1.5 US Dollars) for months? Uganda is estimated to have 870 MDR-TB cases per year according to the MSF report (From the ground up: Building a drug-resistant T.B program in Uganda, March 2012). People develop this kind of T.B if they are not treated with the appropriate regimen, if they did not follow the treatment regimen as prescribed or if the supply of the drugs is interrupted (these are the secondary routes). Proper adherence to T.B drugs is such a challenge due to pill burden that many patients face with the long T.B dose. The primary route of transmission of MDR-TB is quite shocking! A patient with MDR-TB spreads this same strain of the disease to a normal person just through air. The trainer who works with the National Tuberculosis and Leprosy Program added to our fear on breaking the news that nearly 200 cases of MDR-TB had been so far diagnosed in Kampala (just one of the many districts in the country)  

  

 Protection of oneself from T.B is their responsibility given the complexities of the disease. Watching out for and quickly responding to the warning signs and symptoms of the disease whether from a stranger, relative or self is vital. Seeking for and linking persons to proper diagnosis and medical care is a sound response. However, being an advocate and paying lip service will never cease being your contribution in this good fight. On a good note comprehensive, decentralized and community based care model has been proved by MSF as feasible in combating drug resistant T.B in Uganda. In fact, MSF calls on all key stakeholders to assure quality rapid TB diagnosis, treatment and care, and argues that a scale-up of the decentralized and community-based approach, including access to second-line TB drugs at district level, is the most feasible method of averting the country's current T.B crisis. The DOTS strategy that also worked exceptionally well Peru (South America) and has currently wiped this country off the list of the top countries with most T.B burden also leaves much to learn and emulate in our own country. 

Meet you my good friends at the battle front

They all came in with the usual feeling; they always can’t hide the feeling of uncertainty. Some were teenagers, others were pregnant mothers, and others were adults that did not come with their spouses. I was really impressed with some few clients that came in as couples. Anyways, to face the truth, HIV is such a nightmare. While I assisted with the HIV testing and counseling services at Kasonga health center last week, I was glad that all the twenty plus clients we tested were negative. Voluntary counseling and testing (VCT) services have been impressive in the fight against HIV/AIDS in Uganda. In fact, linking HIV patients to quality care and treatment services has been a major attribute by VCT program and this factor is an important consideration for more clients to seek these services according to F.Nuwaha et.al., (2002). Early this month, using the data collected and stored in the health centers’ VCT record books, I conducted an analysis to find out if there are any things to improve about the program. I analyzed a data sample of 1,177 clients from those had come to test for HIV between 2011 and May 2012. I generated a snap shot of the sex, age and sero type composition of VCT clients in Kyangwali refugee settlement. This was to address the 3 broad questions in mind which were to do with; the extent to which the VCT services are being utilized, the groups of clients that seem to be at greater risk or vulnerability, and on which initiatives to strengthen or introduce within the HIV prevention, care and treatment program. 

Much as the general HIV burden among these clients was low (2.89%), it was quite sad that the vibrant young age group of clients between 19-30 years contributed nearly half of this burden. In fact, out of 743 VCT clients that were in the age bracket of 1 to 30 years, 20 of them (2.69%) were found HIV positive. Younger people are increasingly succumbing to the HIV pandemic. I bitterly remember my eyes falling upon many 18s, 19s and 20s in the age columns while I randomly viewed ART clinic records at Kituti health center. Is it not worrisome that HIV is soon pitching its tent among the younger generation? Besides the sexual transmission route, Mother to Child Transmission (MTCT) has registered its spot with nearly 22% contribution to 100,000 new annual infections in Uganda according to Uganda Aids Commission (UAC). MTCT could be explanatory for the 4.7% age specific HIV rate among the 42 VCT clients that were 10 years and below from my study. 

It is really saddening to imagine how many dreams, energy, talent, skills… (list endless) are at stake due to the HIV scourge. In fact, the Modes of Transmission study predicts more new infections to occur among the persons in mutually monogamous relations that are in the age bracket of 15-49 years. The impact on general health and development of our communities is really immense. I remember reading somewhere that in the early 1980s, when this new HIV scourge had hit Uganda, the government had resorted to ‘burying head in sand’, shying away from spreading the ugly truth on HIV transmission as being majorly by sexual intercourse. However, when the new government came out openly and strong on mass awareness on HIV, we saw prevalence and case fatality rates dropping tremendously.

While reflecting on my role in addressing HIV, especially among the young generations, I appreciated the fact that the fight starts with me. The “True Manhood” campaign puts it right, ‘Be in charge of your life by protecting yourself and your partner from HIV.’ I was then proud and happy with my current work experiences of serving communities to protect and better their lives with the fight against HIV being priority in many of interventions. I however need to up this game by doing much more in reaching out to communities, friends and strangers through various channels. Living an exemplary life is definitely topping my list of planned action. I pause with a global call upon everybody to join the fight against the HIV pandemic. Endowed with a vast friends’ network on my facebook account, I take this opportunity to post the True Manhood campaign message, ‘Be in charge of your life by protecting yourself and your partner from HIV’. I hope to meet you my good friends at the battle front!

Malnutrition; a wild beast trying to cross their compounds

Early this month, I had a random visit to the therapeutic center in Kituti Health center in Kyangwali. This is one of the clinical initiatives in place to curb the malnutrition that has remained a problem in the refugee settlement and as well in the hosting communities. The clinical services have however not been my biggest focus while working in the settlement. Certainly, it is not just about the phobia that I at times develop while in a hospital facility but I guess it just has to do more with my interest and training in  preventive community centered approaches. To give you a snap shot of the malnutrition burden in Uganda, over 38 percent of children below 5 years of age are stunted while over 22 percent are underweight for their age (UNFS, 2003)! There is a possibility that at times such figures on paper paint a blurred picture until you meet a severely malnourished child. On that day at the health center, I happened to meet some child patients admitted for severe malnutrition. This boy looked so pale and was as thin as un-imaginable. The other had third degree oedema (swollen from foot to face) and rash all over the body. You would not want to imagine what these patients looked like a few days earlier based on the news from the health worker that they had tremendously improved by the time of my visit!

Surprisingly, the refugee settlement and surrounding communities are endowed with fertile soils and favourable rains throughout the year. More interesting is that Kyangwali is the food basket of the Bunyoro region and beyond. Driving through the refugee settlement, you will witness green fields of maize, beans and other crops! So there comes the great question, “where is the malnutrition problem coming from then?”  There have always been talks on pre-assumptions and various factors that have been attributed to this situation in the settlement. Many interventions are in place to put the condition in proper shape. Some of these include; seed distributions, case management through therapeutic and supplementary feeding program, growth monitoring, food preparation demos, and sensitizations. However, case management has become a main focus area among the interventions. In my view, the challenge still lays with the failure to justify these pre-assumed factors and major contributors to the poor nutrition among these communities. Doing this would help in identifying what interventions to prioritize where, how, and when. I often get worried that case management could become an ‘in and out cycle’ that may fail to realize case reductions in a longer run.  Malnutrition is like a wild beast on the loose that one has to kill before crossing in to his compound.

Well, upon this backdrop, we are already in the process of running an assessment in the communities to have a clearer picture on the common contributors to the problem with in the refugee settlement. We tried making this survey custom-tailored to the households that have faced malnutrition issues. I know you will not ask about how we identified the households since you can guess that we have records of clients in the supplementary and therapeutic feeding programs. Since I am not defending a research thesis, I will not over emphasize the criteria, but truth be told, we tried making the assessment very basic and user friendly for even a community health worker to administer. We are hence looking forward to our findings by the end of May and then we shall hopefully work more smoothly in assisting the communities conquer the wild beast.

Are you part of the change you are causing!

Many a times have health professionals preached water and drank wine. With this, I imply the infamous notion of “do as I say not as I do!” I was nearly victim to this vice over the beet root project. While I read about the great dietetic values of beet root, I got the idea that it will be a viable and incredible project that would help avert the nutrition insecurity in the refugee settlement. I had as well heard stories and testimonies of the wonders of this tuber. Much as I was excited and optimistic about this new innovation, I couldn’t stop thinking about why I should not introduce beet root to my home too. First, I definitely had to figure out where I would purchase the seeds and then learn how to plant, harvest and prepare this delicacy. The journey began when I purchased a tin of seeds from one farm supply store in my home town in Masaka during the Christmas festive season. I then had to prepare a seed bed but had to leave it under the care of my parents while I returned to work. I had to learn more about how the preparation of this tuber for consumption is done. Actually, this ‘home project’ was yet to become an experiment ,I guess this is what they call action research. Story cut short, after 3 months when I returned home for the Easter holiday, guess what I found! I had to commend my parents for the great farming expertise they portrayed on this project work. I could not hide the excitement when I saw the green flourishing vegetable garden from a distance. Every inch I got closer to the beetroot garden, the wider my smile grew. That was my first ever moment to see live beetroot plants.

On Easter, we harvested 2 beets to experiment with them! We however woke up to the reality that our home blender had gotten damaged, the blending of the beets had to be mechanical. We trimmed the tuber in to smaller hand-crushable pieces and did it great service. This made a tasty deep-red coloured passion fruit-pineapple- beet cocktail. I am serious to say that even the last drop of that cocktail was drank; for it was the best juice we had ever had in decades. We obviously steamed the beet foliage after trimming it in smaller pieces. It was super-tasty! By the time I left home, no juice went without a beet punch! I had labored to inform my entire family about the values that come with the consumption of beet root and left everyone dumbfounded by the wonders of this plant. 

I am so happy that I have helped my family live the change I want to see in other people’s families. I guess it really is fulfilling to support and promote the change you are implementing by as well being part of it or lest you will “preach water and drink wine.”    

The beauty of unconditional service

Hearing impairment seemed to me of less public health importance till I had the opportunity of working with the team from Starkey Hearing Foundation for a few days during their outreaches in Gulu and Kampala districts this March 2012. Besides meeting some “deaf” kids from deaf school at my local church, I had just met a few of the kind elsewhere!

Definitely, it was really exciting that I was to take part in this new experience of fixing hearing aids and getting to know how the whole system works. In fact, on that Friday 9^th, I was amazed seeing such a big number of people scattered around the URA parking lot waiting to be fixed. It was a mix of age groups ranging from as young as one year to elderly people. My mind could not help wondering if there has been any researches conducted to establish the magnitude of this problem in Uganda. Beyond my imagination of such an awesome topic for my postgraduate research, I really felt the enthusiasm of impacting these people’s lives. You really want to think for a moment how beautiful it is for one that has never heard but watched people’s lips move up and down, seen people dancing to what he or she cannot hear… at last having the  hope and ability to enjoy life to the fullest!

Well, it turned out a great experience helping out at the counseling department (this is where the client gets to learn how to clean, maintain, properly use, fix new batteries and other issues of interest concerning the hearing devices) and latter at the department that did the real fixing of the device. While interacting with John, one of the experts from the Starkey Hearing Foundation, I was informed that not all kids that are in “deaf” school or even other people we see “deaf” are really deaf. Some people’s impairment is not that serious to render them completely deaf! In fact, there were some kids from “deaf” school that we fixed with the weakest hearing devices and were able to hear clearly- imagine they have been regarded as complete “deaf” and yet they are not. Such situations are still prevailing in Uganda and most likely other developing countries due to the inexistence or low coverage of such services to assist people with hearing problems. Poverty as manifested by low household incomes and inadequate government/private sector investments in healthcare services is still a big deal.

One of my most humbling moments was while in the counseling department on my first day of the outreach. Meeting and interacting with people I “didn’t know” seemed a hectic process especially that one had to talk almost the same words over again. I however enjoyed the excitement I saw on people’s faces when they felt confident and comfortable that they would ably use the hearing devices and how amazing it was that they would now hear clearer or completely perfect. One lady who seemed overwhelmed by my great service and by the newly acquired device happened to be through with the counseling session and ready to leave for home. Out of curiosity, I asked where she stayed! The name of the district (Masaka-my home district too) was a very familiar one. So I asked her where exactly she stays in Masaka and to my surprise, it was a 5 minute walk from my parents’ house. She drove the point home when I learnt from her that she attends to the same local church with my mum and knew her to the dot! While she bid farewell, she told me that in two days’ time, she would be telling my mum what an amazing son she has!

There has not been a moment when I stop asking myself what service matters to me. But there are always moments when I feel that it’s all about the satisfaction that comes when you see people love and appreciate what you do. But I do not fall for this feeling completely; because I know of moments, places and people where good service is never appreciated. I am starting to believe that service is what you enjoy doing, and that has a positive impact on people’s lives (regardless if they recognize that or not). It soon bears fruit in your life too, that is what we usually see inform of remuneration, promotions, friendships, networks, love, reputation…

I warmly appreciate and thank all those involved in providing good service to people around them. May your work bear good fruit.

What was your Valentine’s Day like?

Just like some other days that pass by without you really reflecting much about them; I guess this is an ideal description of my 14^th February 2012. However, I latter found out that it was indeed a ‘special’ day. On a cool Saturday at the ice cream parlour in Kampala, just about one and a half weeks after the Valentine’s Day, I had this sort of lovely meet up with “her” but I would rather you don’t confuse it for a date!  So in the middle of our chat, that question popped up! (So how was your Valentine’s Day?)

My mind quickly re-winded! I don’t have the right explanation as to why I was clad in my red t-shirt and black pair of trousers that morning. But I guess it was just the next set of clothes in line from my wardrobe, as it seems to be my method of choice for a day’s dress code. Of course everybody thought it was my jubilation style for a Valentines special! Much as I had a cold and fever, that day happened to be wonderful. It was one of the days for the Adolescent friendly clinic outreaches. This was a program that was planned to cover all the schools in Kyangwali refugee settlement. The target was for pupils aged 13 and above in the primary schools; meaning that the higher classes of P.5 to P.7 were enrolled for the program. In the secondary schools that happen to be only one in the settlement, all the students were targeted. Among the services we provided that day at Rwenyawawa primary school were; availing deworming tablets for the entire school, providing information materials (in form of exercise books with printed health messaged), holding talks on HIV/AIDS, Child rights, Reproductive health, Sanitation and hygiene with all the adolescents. We latter on screened the adolescent girls who were given a month long dose of Iron tablets (Ferrous sulphate and folic acid tablets), screened for pregnancy and were as well administered Tetanus Toxoid vaccine. The day was lovely as we chatted with these young boys and girls about various topics and their participation was wonderful! They raised their concerns, beliefs, fears and inquiries that we strongly believe are signs of advancement towards the behavior change process. I keenly noticed that this young generation is fairly informed on issues like HIV/AIDS, sexual behavior and other topics that we at times assume are unknown to them or at times we just fear to interact with them about. I guess that was partly an eye opener about sustainable and youth friendly services that can help to address and check on some health concerns in our communities. Protecting the “so far less affected but certainly highly at risk” populations really stood out for me on Valentines Day. It was such a perfect day to further my commitment towards the fight against the HIV/AIDS scourge in addition to other health and social burdens in the developing world and the globe at large! hygiene promotion T-shirt and

Of course I could not help playing some romantic Mariah Carey, Celline Dion, Corrs, Lionel Riche and West Life jams as we headed back to the field office in the van. For it was a romantic day spent purposefully!