“-STOP! Don’t drink that water!” We said to a child in Kashongi getting ready to drink brown water…water that none of us would even dare to think of touching…”You can have our bottled one – here, please have it!” The child’s reply is probably something that I will keep with me for many years…”At home as well as in my school there is no clean water; myself and my friends are in the middle of an important soccer match and I have no time to walk 2 miles to a cleaner source of water, …you are here today, but I will be here tomorrow…so this is my best option and if you excuse me, I will drink this water. Thank you Sir.”
Duke Global Health Institute, Progressive Health Partnership, and Mayanja Memorial Hospital Foundation have been working together for the past 2 years in Uganda to build a comprehensive health care system in Kashongi district. I had the privilege to be part of this project this summer.
Their project initially focused on pre-natal assistance to women in rural areas. This year, in addition to this area of study, a significant effort was undertaken to meet the tremendous need of clean water among the population. The goal of the clean water project was to initially build 38 rainwater harvesting tanks in public buildings, and to later do a cost- benefit analysis of this intervention.
Uganda has been a stable country for the past 24 years. Besides that, it is probably one of the African countries where the decolonization process has left less “wounds” and therefore the local people are extremely nice and welcomed our presence the best that they could. “Bazungos Welcome” (white person in Runyankole) could very well be written at the entrance of the local villages!
In an office or inside a classroom, when planning a project like this, everything sounds quite easy…I can see myself thinking: well, not such a big deal…For the tanks, all we need is bricks, cement, sand, iron, some pipes…and a clear plan to combine all these pieces. A “few” items that I had forgotten: what about transportation to the public buildings? And…which buildings will get the tanks? The buildings that can provide water to more people (a humanitarian way of looking at this question) or the buildings where we can more easily separate treatment and control units (the research way of thinking)? And is there a list of public buildings? (in fact in my mind I had not only a list, but an Excel table with name of “school”, address, director’s name and phone contact…sure Jorge!) Which language will we use to communicate with the workers/contractors…English? Well, the local dialect is Runyankole and even after 2 months in Uganda I can only say “Nibanyeta Jorge kandi ebi nibyo bigambo bindi kubasa kugamba omulunyankole, nitubasa kugamba omurujungu bambi/Hati!” which means: ” My name is Jorge and these are the only words that I can say in Runyankole can we speak in English please!” Above all, I had forgotten that to make cement you need…water, probably the scarcest resource in that region!!!
Working in a developing country can be seen from several different perspectives. On one hand, this work can be seen as frustrating… “it will never be over; there is always something else that we should do, there is so much to address that I don’t even know where to start, etc, etc, etc…but from a different view, this work can be seen as the most exciting project in which to engage during your professional career.
From my perspective, including an animal health side to the project equation – Animals + Humans= One Health in Kashongi – certainly represents a huge task. At the same time it is quite interesting to realize the interrelatedness of an action: introducing (healthy!) animals in a community can lead to the use of the animal´s manure as an alternative source of energy (biogas) and, with this, children do not need to spend a significant part of their time getting firewood, avoiding deforestation and improving the academic/school success rate!
The best way to help developing countries has been a matter of controversy. It is the classic dilemma of offering the fish or teaching how to fish…(note: when I asked my own daughter Carolina what would she prefer she answered: – Can’t we just go to the bakery and buy a croissant!?!). It has also been said that well-intentioned projects often have unintended negative consequences. I personally did face some struggles: Do we have the right to stress a population making them be on time at 8:00, and at 9:30, and at 12:00, and at 17:45, and at 21:15? Are children surrounded by toys more happy than the ones that play with corn, rocks or sand? Is it correct to compensate our project helpers/workers using money, in an area that most people are so unfamiliar with money that they don’t even have or know what a bank account is?
History has taught us that Humanity takes time learning difficult lessons, and may repeat same mistakes over and over and over. Developing countries are in an excellent position to build their societies by learning from the mistakes that the so-called developed countries have already made. The list of things to avoid in setting a course for the future can be tedious but might include: avoiding bad credit habits, poor food choices, the over-dependence on technology, learning about the factors that lead to complex diseases/syndromes like depression, diabetes, and obesity…
Sustainability is another other big issue faced by those working in developing countries: what will happen once we leave? Education. Education seems to be the most logical and feasible answer to this question. Well-educated and empowered communities should be in good shape to run their villages and solve the future issues. At the same time, teaching institutions in developed countries must also stop and think: Are we really educating global (health) students? Are our students aware of the realities outside of our borders?
In one of my final field trips in Uganda, when we were driving on an asphalt road, I told the driver: – This is great! No more dust…Such a great road! And again his answer was a big surprise for me: “In fact, I find this the worst part of the road…before, people would drive slowly and get to their destination safely; now people drive too fast and many people have in fact died…We were better off doing things the old way.”
Addressing all the social determinants of health and, in broader terms, happiness is a complex task. But above all it is a matter of fairness. The Ugandan motto could be: Everything works out alright in Uganda! It is important to keep this optimism, even when facing a devastating global economic crisis that should only make countries and individuals rethink their priorities, investments, actions, decisions and policies.