I am working in the heart of Acholi-land in Northern Uganda. The flat, dense shrub land is now green with the summer rains. Cone topped thatch roofed huts blend seamlessly into this back drop. This is the area where the now infamous Joseph Kony led the LRA in a 20-year war against the Ugandan government; trapping the Acholi people in the middle. Villagers have only returned to their ancestral lands in the last five years and some just as recently as two months ago have been able to afford the move from the satellite Internally Displaced Peoples Camps (IDPCs).
The Acholi are an intelligent, resilient, hardworking people. They are painstakingly reclaiming the crop land with only hand hoes and a few ox-drawn plows. Waist high maize stalks now liter the grasslands. Sorghum, millet, peanuts and a local bitter green called “bo” are the main staples. Those who have been back longer earn income from cotton, sesame, cassava and teak wood cash crops. Protein comes from a robust supply of chickens, pigeons, goats and occasionally one of the cattle. Wealthier households have pigs, ducks and turkey. Bricks pulled from the earth and fired inhandmade kilns are a steady cottage industry during these rebuilding years. The Acholi are generous to a fault. I never leave a village with less than ten mangos but have successful avoided all attempts to pack my motorbike with a live chicken. They are a joyous people also as the only sound more constant than rooster crows are the sounds of laughter.
I am working with St. Joseph’s Hospital, a not for profit hospital serving the Kitgum district and surrounding areas as far as South Sudan, http://www.sjhkitgum.org/ and the Dr. Grau Albert Valencian Community Foundation, a Spanish NGO founded after the death of the beloved first medical superintendent of the hospital. My research is directly aimed at providing information to improve the village outreach program staffed by the hospital and sponsored by the foundation. Currently, I am surveying and living in 6 villages within the St. Joseph catchment area specifically chosen for the lack of past NGO intervention. I am looking at health seeking behaviors and barriers to preventable disease control. I am also conducting interviews with the village leaders, health team members and the hospital staff to understand the roles of key members in the outreach network. At exactly half way through my village survey collection it is clear that use and and access to Uganda’s system of free national health centers is pivotal to village health. Treatment is sought within one or two days of the onset of any fever or diarrheal incidence. The anti-natal care is exclusively used by nearly all pregnant mothers. The referral system sending those in greatest need to the better equipped hospitals in town is active and the message is heeded. St. Joseph’s has countless stories of HIV negative children born to positive parents that did not know their status before the pregnancy. Getting to the hospital is no easy task as it can take a full day walk or a week’s income for taxi fare. Indeed, many people sleep on the concrete hospital patios to be close to loved ones or before the next day’s journey home.
The village level knowledge of health risks and preventative measures is strong in most areas, which will allow us to tailor future education programs at specific knowledge gaps. The real problem is the access to and the affordability of life saving goods such as mosquito nets, water cleansing tablets and oral rehydration packets. After completing the survey and interview process, I will return preliminary results to each village and have an open discussion about their major needs, wants and concerns so I can be certain I am carrying their true message to the founders.
There are seldom many blessings from war, but the Acholi are keenly aware of the positive. Decades in IDPCs have monumentally spread preventable disease knowledge and health seeking behaviors across the entire region. The Uganda government and the international community have provided multiple borehole wells in each village providing easier access to relatively clean ground water. Years of the fallow fields has made the harvests bountiful. These points are praised by the local leaders for the betterment of their communities but more time and help is needed now. Agriculture profits come slow as reclaiming fertile land takes years. There is no easy work in Acholi-land but no one fears hard work. Indeed the Acholi are not looking for a hand out but a helping hand up as they rebuild their nearly wiped out culture.