Category Archives: Maranatha Health

This Lopsided Earth

Ugandan baby

Scan after scan after just-to-be-safe scan

The Risk of just-born jeopardy,

Entirely absent from my pregnancy plan,

Concealed by the masters of modern medicine.

Launching oft-futile guerrilla assaults;

Striking in response to the misstep of man

Rebellion against the promised assurances

of midwives and monitors and surgeries and scans;

But rarely a success in battle.  If it occurs:

there is shock, and shame, and blame, and a cry

That ‘no child should die’!

No baby should lie

Without a life to satisfy

 

But in the occupied territory, where risk reigns in little lives:

Over the great chasm of access and supply

Faintly, if you have ears eager to listen to the cry

And block out the lapping of luxury at your heels

And make room for what this dystopia reveals

And pierce through the privilege that cocoons your truths…

 

With each live birth, each safe passage to our world;

Comes the quiet grief of a mother’s tears

Sidelined by other-ness and foreign fears

Whispering of sweet promises unkept

Until, with un-lived memories; she wept

Wept for the babe, their newness now gone

Wept for a health system she cannot depend on

Wept for the vacuum of drugs, staff and cars

Wept for tiny hands, now safe in the stars.

 

Geography seals fates for these babes, and thus;

They’re torn from women who, despite the distance, are like us…

But with sad acceptance of their world;

Where children do die

Where babies do lie

Without a life, to satisfy…

In a world where risk is always nigh

 

No just-to-be-safe scans, no monitors, no available staff

The certainty of risk beyond our comfortable grasp

A gamble for mothers, who bet on their own hearts;

A gamble unseen, unheard by us; their counterparts

A gamble, in Uganda, which mothers’ lose,

If only there were other choices to choose….

On this lop-sidedly serviced earth,

For every 19 Ugandan babes?  1 ill-fated birth*

 

A little story behind the poem:

I started writing this poem a few years ago, when a staff member at MH lost his newborn baby. It was him and his wife’s first baby, and the grief seemed to swallow up our team for a few days. I remember the jarring nature of the baby’s death, some 12 hours after birth, when staff were still celebrating the original message that he and his wife had welcomed new life into the world.

It was tragic, and mainly left unexplained. There was deep sadness. One of the things I love and find frustrating about Ugandan culture – in equal measure – is the passive acceptance of, and embracing of the world as it is with all its suffering. It seems to allow Ugandans the ability to grieve well, and then rise up out of the ashes, resilient as ever. In the same breath, this acceptance often prevents a critique of the source of the suffering; so often relinquishing the possibility for questioning and change.

This particular little baby died in a big hospital; all seemed fine until it wasn’t. MH doesn’t offer maternity – we don’t have space or resources to do so – though we hope to in the future. But the lack of quality maternity services in our region, juxtaposed against the incredible obstetric/neonatal care available in Australia that I have been lucky enough to access with my own births, will always stay with me, and drives much of our passion in the journey of MH.

*based on 2017 infant mortality rate of 54.6/1000 live births

The Update

I’ve spent a month or so avoiding writing on my blog about ‘the obvious’ – the issue of the factory and any resolution we have or have not reached – but thought it might be a good time to update all of my faithful readers. So, for those who don’t follow MH on facebook or receive the newsletter, I thought I would post a synopsis/Q&A that Michael and I wrote on the issue a few weeks ago. As always, things have changed a little bit since then, but the crux of the message is the same as it was then.

So, click here to read the Q&A.

Once I can wrap my head around all the changes happening in my little world (although I need to start being honest with myself, when is life NOT changing?!) I will let you know my thoughts on life!

Until then, happy reading 🙂

 

‘…the fainting energies of your soul’

I dread going into Kamwenge town at the moment.

Why?

Because I am sick of talking to the torrent of people who enquire about Maranatha Health. About the factory. About why we are STILL not back at work.

I love that people care. If anything this entire drama has just made it blatantly, 100%, no-way-around-it obvious that the health service we provide in Kamwenge is an absolute necessity. We have the support of the community. No issue there. Whatsoever.

But on entering every shop the conversation plays out something like this:

Interested friend/acquaintance/random stranger who knows me: How is Maranatha?

Me: We are really suffering, all of us are seated. You know it’s tricky.

Friend: Eh, Sorry, I know. These leaders of ours. [shakes head] And we really need Maranatha.

Me: I know. We are trying. But you know, these leaders in Kamwenge, they don’t even care.

Friend: They are too corrupt! They have really eaten money from this thing. And now it is taking long. Why don’t people come and shut this factory down! I have heard that [insert ridiculous rumour here]. Is it true?

Me: No. That one is not true, this is what is happening [explain what is happening].

Friend: But really, how far? It is taking long. We can’t manage without Maranatha. People are dying.

Me: I wish you would tell that to your leaders, to the district. They need to hear that from all of you people!

Friend: Ah, but why? They can’t even listen to us. They will just laugh….

This is followed by a detailed story of a relative/friend/child who they know has either died in Kamwenge recently because Maranatha is no longer working, or has paid ridiculous amounts of money to get the treatment from outside the district.

Then I do the obligatory shaking of the head and clucking of the tongue to express my disappointment at the situation. Then the conversation moves on to other things.

This happens in every shop. I even went to buy a phone charger the other day and the boy in his late teens in the electrical shop who looks way-too-cool-for-school in his chains and muscle top had this same conversation with me.

It gets tiring witnessing an injustice like this up close – with all of its ugliness and corruption and stupidity and unblinking carelessness thrust into my life. The frustration of being so tightly woven into the fabric of the issue; knowing that I have to keep watching no matter what, because I can’t just shrug my shoulders and walk away when it gets too hard.  The vulnerability that it’s my fight, my story, my life that is affected, as much as the lives of the people of Kamwenge.

Michael and I can’t imagine our life without Maranatha, without Kamwenge, without Africa. It has been a part of our journey, our identity, our purpose for so long now…

Whilst there have been steps made, meetings had and reports written from several key ministries that express self-evident truths about the illegality of the factory, no-one has yet provided Maranatha Health with exactly what we want (and need) to be able to return to work:

ACTION.

A willingness for someone to stand up and pronounce that, yes, it is within my authority and jurisdiction and responsibility to force this factory to shut and move. Well, we may still succeed. We will know, either way, within the next 2 weeks.

However, our greatest sadness comes from the state of the Kamwenge district leadership.

Since we have moved here, we’ve heard story after story of district officials eating money. Of serious all encompassing corruption. Government money in Kamwenge often does not get to its intended recipient – that much is clear. The average citizen in Kamwenge town will tell anyone who will listen that Kamwenge District is more corrupt than others – that there is a culture of entitlement and a lack of accountability within the leadership, and has been for many years.

But somewhere, in the back of my mind, I have always hoped that perhaps I am simply being too cynical. Believing too many of the rumours. Missing out on the opportunity to hear the positive stories.

But now I have sat in a room and heard the top leaders in the district, telling us that we should just go to another district, that it isn’t their business what happens to Maranatha. I have had conversations relayed to me about technical staff within Kamwenge bragging with others that they have the money to take their children to the next district for treatment, so what do they care if Maranatha leaves.

This is one of the greatest evils I have ever been confronted with: Individuals accepting leadership positions that are charged with the responsibility of representing and protecting the citizens of an area. Draining every last drop of finances and power and hero-worship and VIP treatment and personal benefit available from that position. Then taking even more – that which is not legally and rightfully theirs to take. And then, at the end of all that, knowingly making decisions that will bring suffering for the community, against the will of those they are representing.

One of my strongest character traits is empathy. But there is no way I can empathise with some of the characters we have been dealing with in Kamwenge. Because it is not humane, and I am human.

And so whether we end up staying or have to pack up and re-invent our life somewhere new, whether Maranatha lives on for another 100 years or if next month we must pack our bags for Australia, the most difficult hurdle that is yet to come in this battle will be something I perhaps did not expect.

Grief

Grief for the people of Kamwenge, that their leadership continues to fail them on such a grand scale.

Grief that there is such evil that exists, that it is moving around and amongst us all the time, clawing its way ahead and swiping at the good endeavours in this world.

Grief that most of the time, injustice wins out, while a God whose quiet pleas for justice whispered into the hearts of men so often floats away, unacknowledged. It will only be because of this God and the stubbornness of a few of us that it may not win this time.

Grief that the church so often fails to be the voice of justice and truth when it is needed most.

Grief that I have no power to change most things in this world, this country, this district, this town. That there are a million more small battles like this one that happen every day, with people far more fatalistic and used to defeat than we are, who will give up much earlier.

But in the sadness that sits heavy on me when I witness the indifference of leaders to the plight of the poor, I have found comfort in knowing that I am not alone in this struggle against my own grief; many before me have experienced that same tiredness in their soul:

“Accustom yourself to look first to the dreadful consequences of failure; then fix your eye on the glorious prize which is before you; and when your strength begins to fail, and your spirits are well nigh exhausted, let the animating view rekindle your resolution, and call forth in renewed vigour the fainting energies of your soul.”

-William Wilberforce, leader of the movement to abolish the slave trade.

The enthralling exhilaration of the unknown…

Maranatha Health in Kamwenge has received a gob-smacking, hideously ridiculous, completely unexpected setback, and by way of association, so have I. Before I share my thoughts about it all, here is a link to a letter we sent to our supporters recently posted on FB on the MH page, to give you some context and information into the issue that has arisen. If you haven’t read this, the rest of the blog probably won’t make much sense. In summary, a maize mill factory has been constructed next to our health centre, and now chugs out noise and dust 24/7, forcing us to close the health centre and move off-site.

So, less than ideal, obviously. Frustrating. Unjust. Corrupt. I could think of some less-creative, four letter words as well, but will spare my readership the full brunt of my frustration.

To be honest, I don’t really feel like writing today. In fact, today I feel like crawling up into the foetal position, eating copious amounts of chocolate, lamenting the world and my place within it, and reading some of the more sinister of Shakespeare’s sonnets.

But alas, I write. Partly for therapy, partly to let everyone know that my world continues to spin, and partly to share this journey with all of you because the fate of Maranatha affects so many inside and outside of Kamwenge.

Once again, for the millionth time since being involved in this Organisation, I find myself uncomfortably squeezed into the enthralling exhilaration of the unknown.

Once again, I am reminded that I am a teeny-tiny person in this very big, very wide world and my comforting illusion of control has again been mocked and exposed by that same afore mentioned world.

Despite the dramatic dialogue in this blog, we are feeling quite positive, generally. Things are really looking up. We have had some extremely positive developments in the past few days. In addition, media is now splashing the story (albeit slightly inaccurate, tabloid-esque versions) around Ugandan newspapers and TV news.

I’m just having a bad day.

The first few weeks, when we discovered that yes, it was definitely a factory next door, and yes, they were running their machines 24/7 – things were tough. At that point we knew very little about Ugandan law, about industrial and residential zones, about environmental acts, and so had very little understanding of how we could challenge such a situation. We lacked voice and a platform. At least now we know what we are dealing with and the channels for redress. Of course, on a day-to-day level, that knowledge doesn’t make it much easier to manage the constantly oscillating situation and our parallel emotional response; one day we feel we are close to winning the battle and will be reopening the clinic in no time, and the next day we wander around our home listlessly wondering if we should start packing our bags for Australia.

Michael and I have prayed in the last month more than I think either of us has ever prayed before. Not that it’s a very noble prayer these days – most of my prayers consist of a repeated request to finish my season of ‘character building’ and a demand for life to get easier, speckled with a less selfish appeal for justice for the poor of Kamwenge.  But I have never before been so aware of how frustrating it must be, for God to continue calling people to love, when the world is so interested in other sinister motivations and agendas.

Every time we think we are moving closer to a solution, we face serious set-backs and suffocating scenarios, reminding us again of the complexity of Ugandan concepts of justice. In a conversation with our Ugandan father, we discussed concepts of justice in Africa, and how the law is applied. Justice here is tangled and twisted with power and relationships, with desires for peace and amicability, with political and business motivations confusing responsibilities. Often it feels as if justice is a negotiation process between parties towards a resolution, rather than a direct application of law. The problem with this, of course, is that unless someone wise and fair is mediating this negotiation, those with more bargaining power and a louder voice will always win. The poor, thus, will always lose*.

Since this issue has arisen, we have found so few people outside Maranatha in a place of authority – a leader, an MP, a government technical worker – who immediately recognises or assumes the position of the law. Time and time again, we are required to remind those involved in resolving this issue exactly what Ugandan law states about residential vs industrial zones, about factories and Environmental Impact Assessments, and the simple ethical and legal realities of our case. More likely, they are interested in what the district leadership ‘thinks’ about the issue, the identity of the investor behind the factory, the size of the two investments for comparison, and what the political ramifications are.

Instead of the acknowledgement that I crave – that we did all the right things, that this project is necessary for the community, and through no fault of our own we are experiencing a grand injustice – many leaders patronisingly explain that this situation is ‘complex’ and ‘politically sensitive’.

It doesn’t FEEL politically sensitive to construct/approve a massive maize mill factory that pumps out dust and noise 24/7 next to the only decent health-centre-soon-to-be-hospital in Kamwenge district. To me, it just FEELS really, really, really stupid. Politically. Ethically. Environmentally. Legally. Everything-ly.

Of course, we have come across many compassionate Ugandans over the past 2 months who hear the story and immediately get behind our plight – who have offered so much of their own knowledge, networks and resources to help us fight this. Our Ugandan family have been a core support to us (we joke that we are currently Kamwenge refugees seeking asylum from the noise, residing in their home in Kampala), and our father, as the chairperson of our board, has wisely led us through the decisions we have had to make.

A few weeks ago I was sitting with some of our staff, after we called a meeting with all of them to discuss the issue. Annet, our receptionist and a compassionate woman who has grown up in Kamwenge, was sharing with me that she was called to help a relative in town. The relative’s child had severe malaria, and needed a blood transfusion. Since we have been closed to patients, the only way to get such a transfusion is to travel 1.5 hours in a vehicle to the next district. The 2 ambulances, owned privately by the churches, both charge fees of $40+ to transport people out of Kamwenge. The average wage per month in Kamwenge would be below this figure. Annet shared how she had to find the money immediately, to save the child. But she clicked her tongue and sadly asked “what do others do, those who can’t manage to pay?” then shook her head and quietly ushered to no one in particular “they take the child home to die”.

We have experienced some really tough stuff in Uganda to date. Some big challenges. But this one is a doozy. This one feels like one of those life-defining-moments, where until you see it resolved, there aren’t many answers to life’s questions, and the future looks like a blank canvas.

I honestly wish I could write a blog that stated that I know 100% that Maranatha Health will still be in Kamwenge in 1 year. I wish I could write that the district will fight long and hard to keep us here, since they know we are essential for this community.  I wish I could write that despite the corruption in Uganda, I still believe in the Ugandan legal system enough to say that we would win such a black and white case. I wish I could write that I am sure God will magically and miraculously end this problem.

I try to convince myself of those things every day.

But I don’t know.

All I CAN write is that we will give 100% to fighting for the poor of Kamwenge and their right to access quality health services– until we have won or lost.

And that God WILL be cheering us on, just like he has cheered on those who have challenged injustice throughout history, calling on those in this country that know him well, to act justly and righteously.

*On re-reading my description of justice in Africa, it occurred to me that this concept is more of a description of justice everywhere, at least at an international and corporate level.

The elephant in the room…

Money.

There. I said it. The inevitable subject has been raised.

I really like writing a blog. And there is a whole bunch of complicated reasons I write on here.

Writing for me is extremely therapeutic; I have written for this purpose my whole life. I love that people now read what I write; I like to make people ponder. I love being able to demystify every day existence in another part of the world. I love being able to champion social justice issues. I love being able to tell the stories of people I have the privilege of meeting in Uganda.

I do not write to raise money for Maranatha Health. In fact, although I regularly write about life within our organisation, this blog is not for the purpose of promotion at all. It is refreshing to have a forum to write, separate from the marketing and grant writing and articles that often have to be a little bit slick and a little less honest. This is my place to be Kim

But right at this moment, what Kim is thinking about a lot is money.

Not because I like money. In fact, I often feel quite a legitimate loathing for the stuff. I wish with every beat of my hopeful heart that this world was a socialist utopia, where we all could live happily (and equally) without it. Unfortunately, it’s not. Far from it. In fact, as I write this on my laptop computer plugged into a powerpoint providing electricity, drinking water that has come from a tap in my lovely home, I am acutely aware that most of the world – most of my neighbours for example – do not have the safety, the security, the basic necessities, the opportunities, the freedoms, the choices that I have had access to from birth.

They live their lives with intense vulnerability, trying to remain resilient to the shocks of life, often moving one step forward but then two back: lacking power over decisions that affect their lives and lacking power over and access to resources. For many this isn’t some extraordinary experience of ‘poverty’ that will pass – this is simply life. Many accept it without blinking.

My world view is changing rapidly as I live in this environment; particularly over the past few weeks as I have witnessed several children – one as young as 3 days old – die of simple things that nobody should ever die of. I have seen little bodies being covered with material then placed in boxes. I have seen mothers stricken with grief, but accepting with fatalistic resignation the harshness of life. I have witnessed a woman choose to go home to die despite our pleas, because she had so little faith in the health system. I have questioned again and again a God who sees all of these things, but seems to remain distant.

In those moments I have become acutely aware of my own anger, my own desperation to see things change, and my illogical hope in the transformation of culture and life in this place. Then I realise it is not my anger, not my desperation, not my illogical hope. It is the hope of my God, who has again and again chosen to express his love for this world through human beings. Regardless of how ridiculous I feel his choice was, we’re it.

And I am part of that. Part of that change, that re-creation, that hope, and that transformation of this world into one that is good.

So alongside of our team at Maranatha I am trying really hard – failing much of the time – but trying, to do what I can. My experiences over the past few years, and most acutely over the past few weeks, have meant that I am ruined for any other life.

The problem is, the one important thing I don’t have enough of to do this work is MONEY.  This is what I stupidly spend a lot of my time stressing about.

Money to treat more children at a subsidized cost

Money to pay more community workers to spend time in the village transforming attitudes

Money to set up agricultural co-operatives so people can demand a living wage

Money to keep our organisation running – to buy drugs and stationary and fuel and pay electricity and water bills and salaries.

Money to put up more staff houses

Money to buy more essential equipment

Money to conduct research so we can learn from what we are doing and make sure it is having an impact

Money to set up transport mechanisms to strengthen the health system in Kamwenge

Money to educate and improve health literacy in the community

Always I sense this limitation at Maranatha Health, like most NGOs do. I am constantly in discussion with people within our organisation about sustainability, about income generation, and about how to ensure funds. We are continually trying to figure how to do more, with less. Because we need at least $150,000 every year to run Maranatha Health Uganda.

Many of you already contribute to the work of Maranatha Health. Some of you contribute to other important work around the world. Thank you. Your generosity spurs me on, it humbles me, it encourages me and it allows me to live my calling.

Some of you may not be giving. Some of you may not think you have a lot of money. But I imagine that anyone reading this in Australia is most likely amongst the wealthiest fifth percentile of the world’s population. So I invite you to join Maranatha Health in making some very positive change in Uganda.

We need regular supporters, that we can count on to give each month. I invite you to contribute not only because it is amazing to make a real tangible difference in the lives of the world’s poor. Or because by a fluke of geography you ended up with opportunities and wages the rest of the world dream of. Or because it is good to give. Or because MH are doing transforming, quality work. Or because you get a tax break when you give.

But also, because the work of Maranatha Health cannot continue to impact the lives of people in Kamwenge without it.*

 

*If you want to give a tax-deductible donation and/or sign up for regular giving, visit http://www.givenow.com.au/maranathahealth

The end of the beginning…

Something occurred to me the other day.

We’ve made it.

It seems like an eternity since Michael and I were sitting opposite each other at a restaurant in Adelaide, sharing with each other our passion for Africa and our desire to move there and try to DO something one day. It was then that Michael mentioned his idea – then in the very initial stages – of ‘Kamwenge Maranatha’. I remember sitting there excitedly listening and sharing, ideas already swimming around in my head about the possibilities, about the logistics, about how to transform this vision into reality. And then, embarrassed, I sheepishly tried to bring myself back to reality. This was our first date – I didn’t even know Michael, let alone whether I could be a part of such a vision…

So here we are. Over 4 years later. I am writing this from my dining room table in our house, which is on the Marantha Health land, in Kamwenge. I spent the day out in a remote village with a colleague, meeting families and hearing their stories to build relationships which will form the beginnings of our community development program. Two weeks ago, we opened our ward, and now see many patients, many who are from far areas of Kamwenge. Our staff are working hard!

In the community...

And at the clinic...

Maranatha Health has well and truly begun.

I am a little in awe, to be honest. I think Michael and I have been so busy with our heads down working hard over the past year we have forgotten to look up and see what is growing up around us. We have so often missed the twisting and turning of our vision, the first breaths of this living thing, the grand achievements, the God-inspired moments and coincidences, and most importantly, the proud ownership of Maranatha Health Uganda by our staff.

But the other day I became intensely aware of it. Of this living, functioning organisation that is so much a part of Michael and myself but growing far beyond who we are. I am amazed. That it has all actually happened. That God has taken our humble efforts and naive youthfulness and turned it into something great.

Something that is so defined by the people within…

More than anything I am amazed by the MH staff. The kind of people we have found and the way many of them have caught the vision is rewarding. We have asked a lot of them, much more than some workplaces ask of their staff.

We ask them to have passion for what they do, and give above and beyond

We ask them to take initiative and dream big dreams with us

We ask them to show compassion to the communities we serve

We ask them to be counter cultural on issues that matter – like the treatment of women, and some traditional health practices

And most importantly we ask them to contribute and invest themselves into this vision, so that they become leaders in their community.

Last month all of us celebrated our record breaking day (50+ patients) with a soda. Everyone was included. Everyone celebrated. Everyone seemed proud of the part they had played in getting us to where we are.

Waiting to be seen at the MH clinic

Enjoying a soda at the end of a long day!

Our administration staff, who at times work long hours overtime to balance the books, count money at the end of the day, and are so committed to stretching MH funds as far as they can go…

Our clinical staff, who show the kind of care and compassion for patients that is a rarity in Ugandan health services, as well as high quality practice that sets a standard for other clinics in Kamwenge…

Our first community development worker, who has joyfully and skilfully accepted the challenge of trying relationally based community development, excited by the opportunity to employ creativity and innovation in our work…

Our grounds staff, our cleaners, our cook, our askaris, who are happy to work hard for an organisation where they have the opportunity to make a difference, to input and suggest and interact and have their say in an organisation that values each staff member…

I was talking to Kiiza the other day, a groundskeepers who was one of our first staff members, and helped build the clinic before that. He has now finished his 6 month probation. Like always, Kiiza’s positive outlook and appreciation re-energised me, as he pointed out how only 6 months ago, we had almost nothing to show for ourselves. He reminded me of how far we had come, and how much of a difference we are making.

He reminded me of the LIFE that is in Maranatha Health. God-breathed life.

They clapped…

Go to the people

Live with them

Learn from them

Love them

Start with what they know

Build with what they have

But of the best leaders, when the work is completed, the task accomplished, the people all remark:

‘We have done this ourselves’.

-Lao Tzu

This is a translation of a poem written over three thousand years ago. Its unwavering universalism and prophetic-like-power staggers me. If there is anything to learn about developing communities, it stems from these words. It is a pity so much of community work in the world today is the antonym to this poem.

The vice chairperson of the Maranatha Health board in Uganda gave me a copy of this poem around 4 years ago. He is a mentor to me in community development and advised me that this is the pathway to empowerment, seen from his own experience over decades. I have read books, articles, case studies and theoretical debates on ‘empowerment’ for the past 3 years, as part of my Masters in International Development.There are many contested definitions. These are some helpful insights from leaders in the field:

Social development is profoundly concerned with how individuals gain the strength, confidence, and vision to work for positive change in their situations: the process of empowerment. Empowerment is a measure of people’s capacity to bring about change. (Eade and Williams, 1995)

Empowerment cannot be defined in terms of specific activities or end results because it involves a process whereby women can freely analyse, develop and voice their needs and interests, without them being pre-defined, or imposed from above, by planners or other social actors. (Oxaal and Baden, 1997)

Honestly?

I can give you the spiel, but witnessing the process close up, right in front of me, in the community, is incredible. The small, slow-germinating seeds of hope being planted and seedlings sprouting; the steady fragile truth emerging that people may be able to have a say in the decisions that affect their lives – this is empowerment.

In this blog, I want to share what MH are doing so far in our community work because 1) I think it is so important for donors to be educated about empowerment and think about mechanisms for giving to the developing world that don’t create dependency, 2) I want to demystify ‘community work’ and show the enormous possibilities and 3) I don’t want others to miss out on the excitement and hope it has brought me through my involvement so far!

So far, the MH community development team have identified a poor, remote, resilient community that we will work in.  We visited each household on foot (160 households spread over a few K’s) and introduced ourselves as friends, as an organisation, as people who are seeking to partner with their community. They shared with us as much as they wished – about their family, their relationships, their day-to-day activities, and their challenges. They fed us if we needed to eat. We listened to their stories. We didn’t ask prescribed questions, write things on paper, or tick boxes in books. We just listened. And we learnt. A lot.

Now we are meeting with groups as a community. Most group meetings represent anywhere from 20-40 households. And it is at this stage – still at the very beginning – that I am seeing this incredible thing happening. This process called empowerment

In our groups meetings we spend a lot of time at the beginning reinforcing several important messages:

  • The community are the experts of this process – they are the ‘professors’ of their village. They know what they do and don’t have. They know the place intimately.
  • They are in control of the process, and have the freedom to tell us what is wrong and right. What is helpful and unhelpful.
  • They are also the ones that will do the work to improve their lives. We have nothing to offer in that regard.
  • We explain that we are not doing the group exercises for our own benefit, or for donors, or for research. It is for them only.

Then we share with them the challenges they shared with us, some of the key areas of their lives that they identified that they struggle with. Not just health – anything. We discuss. The community agrees or disagrees. Then on a big piece of paper, each issue/challenge is represented by a picture/symbol, decided on and drawn by the community (due to high rates of illiteracy).

Every single community member then has the chance to come up and vote for 2 issues that are most important and significant to them. We explain what democracy is, we explain what equality is, and we explain how each person has the right and the opportunity to have a say in decisions that affect them and their community. Every single person.

Seeing women who are normally pushed to the margins, standing up meekly and casting their vote

Men in volumes, voting for maternal health as the greatest challenge

Young men voting for the issue of food security –trying to feed their growing families

Almost everyone in the community marking child morbidity and mortality as a priority

Yesterday, in front of everyone in the group, an old woman walked up stubbornly, took the marker, and was the first one to vote for domestic violence as an issue. You know what the other women did?

They clapped.

Women who were shy and weary and when we visited their houses sat on woven mats on the ground behind their husband’s chairs, listening quietly while their men talked.

They clapped.

Then we take the number one prioritised issue. Not surprisingly, this is almost always child sickness. In most households we visited, they have lost at least a quarter of their children.

I share with them how there are other places in the world, other places even in Uganda, that you can find a community who have not lost any children. I tell them that I see their pain, their sadness, their shame. That there are women in the world who don’t have to face this sadness the way they do. But I explain that before this can change, we need to know why it is happening. And we have a lot of work ahead of us.

Then we conduct a ‘problem tree’ analysis. We explain how you can see the trunk of a tree if you look straight ahead; the problem. But to find out what is underneath, the reason the trunk exists you must dig deep into the soil – finding the roots: the cause. It takes thinking and work to do this. But it is important because if you pull a weed without the roots attached in your garden – the weed will grow back. So it is with problems, if you don’t address the causes beneath the surface.

We draw a tree, with the picture of the ‘problem’ on the trunk. We ask them about the causes of 1 problem. We ask them to draw a symbol on the roots of the tree, to symbolise each new cause they think of. We ask lots of why questions. Why malaria? Why no nets? Why no money for nets? Why no priority put on nets? Why don’t they go to the clinic? What’s wrong there? Would they go if there was this or that?

And the more they think, the more they discuss, the more they break down and analyse – the more they begin to realise that these issues don’t have to control them. That the issues won’t always have to exist. That there are multiple causes, that often they can do something about. They can see outside of their immediate experience. They gain confidence. They speak up. They think critically. They themselves begin to ask why. They see they have some power.

And it is one of the most exciting processes that I have had the privilege of being a part of!

Most importantly, what I have learnt over and over in my study and in my work with communities is that the process of discovering and meeting the need is as important to empowerment as the end result. That is why giving communities ‘stuff’, and meeting needs outside of the context of partnership and participatory processes DOES NOT WORK.

In community development, the end cannot justify the means. The means and the end are two sides of the same coin.

Of course, there is much work ahead. And not all groups we have worked with are interested and engaged like this. Next we are looking at what the community can bring to the table; their skills and resources. Then we will look at solutions. What an adventure!

www.maranathahealth.org

The tipping point…

One of the most rewarding, momentous steps so far for Maranatha Health Uganda took place about a month ago in Kamwenge.  The new MH Uganda Board of Directors met in Kamwenge for the first board meeting.

After 6 months of hard work, sweat and tears, putting together the MH Uganda board was easy.

At the first meeting, we began by each introducing ourselves and any role we have played with MH in the past. Before we have even officially begun MH activities, it dawned on me that this group of individuals – now a collective – have shaped this vision into what it now is. It was the people sitting around our dining room table at the board meeting that Michael and I have for so long now fleshed out this vision with, on our trips back and forth to Uganda. Ugandans, who time and time again we have listened to, leaned on, been mentored by, sought wise counsel from and prayed with about how this small intangible idea would come to pass, practically, in Kamwenge.

As we  discussed the vision, mission and strategies of MH, we were amazed by the way this board has been so clearly moulded and orchestrated by the One who is behind this vision.  Hearing our Ugandan colleagues speak so eloquently and wisely about the purpose and ethos of MH was truly remarkable. I felt as if they were taking the words straight from my mouth- only they weren’t my words. They were theirs. And they will safeguard the vision of this organisation better than any other group of people we could have dreamed of.

The Ugandan MH board from L to R: Michael and me, Rev Gensi, Rev Kwizera, George, Auria & Winnie

The reason I share this is because since coming here, it feels like not a lot has come easily.

It made me reflect on Michael and I starting Maranatha Health in Australia (which has a similarly amazing board!) over the past 4 years and how similar that process was to now starting in Uganda.  It seems that starting anything new is excruciatingly difficult but incredibly fulfilling and very fun. Often it feels like driving a car at night in the middle of a tropical storm, on a potholed dirt road, when the demister isn’t working (yes, an analogy from our life here!).

Exciting but bloody scary.

You drive along, having a rough idea of how far you have to go, and energised by the thought of your destination. But most of the way your vision is completely blurred. The constant loud splattering of rain makes it hard to listen to yourself think. You don’t see the potholes you know you will inevitably hit. The thunder is loud and threatening and makes you wonder if you should just pull over and give up for a while, but secretly you love the excitement and it makes you more determined to keep driving. And every now and again a strike of lighting lights up the sky and you can see the way ahead. But in that moment, you see the next set of potholes and more bends in the road. You’re grateful for the light, but don’t know if it’s better just to be in the dark…

That’s basically how it’s felt for me, anyway. So much unknown.

But then in every new venture, it seems there is a tipping point. When it no longer is just you in the car, but a big group of people. People who all know the destination, and are happy to take turns driving.

And it makes all of the challenges worth it!

In Australia this took a few years.  I’m still a little amazed and humbled by the fact that MH Australia is this fully functioning, professional organisation now, working separately from Michael and myself. That amazingly skilled, passionate individuals are owning Maranatha Health, investing in her, breathing new life into the original vision and growing her far beyond what we could have planned or hoped for.  Reaching that stage is rewarding and exciting and a reminder that God was behind all of it…

..and I can’t wait to keep sharing with you this exhilarating, addictive process that we are now stepping into for Maranatha Health Uganda.

Bring your blade, bedding and basin…

A good friend of mine who lives in Kamwenge town is pregnant with her second baby. During the birth of her first child, her labour became obstructed. Because there was no place in Kamwenge that could help her, she travelled 1.5 hours on a dirt road, in severe trauma, on public transport to reach the nearest clinic that could operate on her. Her and her beautiful boy survived, although she now has a great fear of childbirth. Every time I see her, she fervently asks for me to pray for the safe arrival of her baby due in August.

But she was fortunate enough to be able to afford the cost of transport to Fort Portal, and was able to get there in time.

In Kamwenge, where the population has reached at least 350,000, there is no district hospital. The two main clinics in the district do not offer Emergency Obstetric Care. There is no working theatre. No running water or electricity. Many of the health staff are hardworking, compassionate individuals who are tired of having so few drugs and equipment.

Being a woman in Africa is tough. And one of the toughest things of all is giving birth. I read lately, in a journal article written by an anthropologist (I can’t remember the name of the article!), that in an area of eastern Uganda, childbirth is sometimes referred to in vanacular as ‘the trap’ because of the risks involved.

The maternal mortality rate in Uganda is 506/100,000 live births. In Kamwenge it is unknown, but expected to be much higher. Every year, 1.5 million African children are left  without a mother because she dies trying to give birth to a brother or sister. The risks in child birth are a struggle faced almost exclusively by poor women, with 99% of maternal mortality in developing countries. It is astounding in this era of medical advancement, that so many women continue losing their lives giving birth, and it is for this reason that Maranatha Health have chosen to focus on improving maternal mortality in Kamwenge.

Despite what I know, every now and then I wonder if what we are doing is worth it – maybe the situation in Uganda’s health care system isn’t ALL that bad.

Then, I read an opinion piece by Frederick Golooba-Mutebi in this weeks East African:

Maternal deaths: Why Ugandans are victims of their own civic incompetence

Recent media reports detailing the tragic deaths of expectant women and their unborn or newly-born babies in referral hospitals and health centres across the country have laid bare the crisis in Uganda’s healthcare system and made a laughing stock of the NRM government and its extravagant but empty claims about being focused on service delivery.

The anger, despair and disgust the many preventable deaths have caused are captured in the decision, reported in this column last week, by activists to take the matter into their hands and drag the Museveni government to court.

Reports from the “grassroots” indicate that in some cases relatives of the victims take matters into their own hands and threaten health personnel with violence. Others, however, behave as if their experience were the natural order of things and simply return home to bury their dead.

Before the decision of activists to enlist the law, only in a few isolated cases had victims of Uganda’s shambolic maternal health services sought to enlist the help of the police or courts of law. Two cases stand out.

One involved the death in early May of one Joyce Nabatanzi at Nakaseke Hospital, allegedly because nurses had been negligent. I have no idea how or where the story ended. However, a senior officer who claimed his staff were hardworking attributed the incident to the hospital having run out of essential drugs and supplies without which lifesaving surgery could not take place. Several phone calls to the National Medical Stores had not led to the desired response. To make matters worse, the hospital did not have an ambulance to transfer the patient.

The other was of a couple who lost a baby at Jinja hospital, also because of alleged negligence by nurses. The bereaved woman spoke for herself: “These people should improve. I heard countless insults from the nurses using obscene language. They handled me like I was a thief, pulling me from all sides.”

Unwilling to accept what had happened, her husband filed a case with the police. Here, as in Nakaseke, the hospital lacked drugs and supplies, as the father pointed out: “I bought everything since the hospital did not have the needed items to facilitate delivery.”

To add insult to injury, he could not get a post-mortem without coughing up more money: “Now someone tells me if I want a post-mortem, I have to give the pathologist transport.” According to a police officer on the scene, this was not the first time incidents of this kind were happening at the hospital.”

With all this in mind, it is difficult not to equate going to give birth at a public health facility in Uganda to going to war. As with combatants in war, here too, there is no way to tell whether one will come out alive.

There is, however, a sense in which combatants going off to war are better-off: They do not buy their own uniforms, guns, bullets, bombs, boots, or even food.

Meanwhile, expectant mothers going into government facilities must carry their own food, gloves, razor blades, sugar, tealeaves, bedding, basins and even saucepans. You have to see it to believe it. You would be forgiven for thinking they are moving house.

It is all too easy to buy into stories of the by now legendary negligence of health workers in Uganda. That is until you learn a thing or two about the conditions many face at work. Consider these statistics, which appeared in a recent newspaper report: Hoima hospital has 97 staff out of the 197 required. It requires 56 nurses but has only 34. It is run by eight doctors out of the required 35.

A brave nurse summed up how things work over there: “There is no other option than doing what we can and leaving what we can’t. What do we do when things are beyond our reach?”

Construction!

With so many friend-of-a-friend disaster stories of African construction, we thought we could be in for a frustratingly futile effort, trying to get our building up, which will be used as a clinic and development hub for Maranatha Health. But alas, Uganda has surprised us once again, and left our patronising stereotypes of this place standing silently on the sidelines. Look at our amazing progress, brought to you by our building contractor who seemingly never sleeps!!

From the beginning.... our site.

Our hyperactive building contractor Alex - who we can never keep up with!

Digging, and me 'supervising'...

The slab - isn't our land beautiful?

We are almost at lock up stage now – the past few weeks they have put on the roofing and installed the doors and windows. Having to bargain for every bit of construction material that has ended  up on our site has meant we (especially Michael) has more insight into the construction than either of us thought possible.

Almost at roof level...

Roofing

Look how far we’ve come now!

Starting to look like a clinic ward!

Now, we just have electricity, plastering, flooring and finishings to do! We’re almost there!!