Accompanying the home health visitors (HHV)

Last Tuesday, I had the chance to go to with the home health visitor (HHV) team to one of the community zones where our team is surveying chronic coughers. Kampala is divided into 5 divisions, 128 parishes, and many, many more zones. The main research project on which I work is surveying individuals in the Rubaga division. One this particular day, I accompanied the team – Hassard, Joyce, Kezron, Sheila, Joanna, Mustafa, Joseline, Esther, and Stella – to the field. We went into Wakaligga B zone in Rubaga division, Rubaga parish.

Let me tell you how the process for going to a new zone goes. Two weeks before starting in a new zone, someone from the project meets with a community leader (not quite mayor) for a particular zone to get permission to survey in that zone. (At the division and parish levels, permission has already been granted.) Community guides are then selected to accompany the research team. The first day in a new zone is an orientation day. The Ugandan HHV team goes out subsequently to interview the pre-calculated proportion of zone residents using a geographic sampling strategy to cover the zone.

Not knowing Luganda other than for a few phrases, my presence was more spectator than anything else. I had a great time spectating, though. First of all, a mzungu (me) knowing any Luganda usually shocks people, especially kids. So when kids asked me “how are you doing?” as we passed a school, and I responded with “I’m fine. Oli otya (how are you)?”, a roaring chatter and laugh ensued.

As I’ve written in mass emails from other trips, I then experienced being the Pied Piper of Hamelin. Kids followed me, daring each other to get to as close to me as possible and then running away or holding my hand while walking. The attention given warmed me up quickly given I probably was understandably met with some suspicion. Meanwhile, the HHVs were doing the hard work getting informed consent, explaining the survey, collecting sputum and performing rapid HIV tests on the spot.

One child humored me greatly. Probably near 2 years old, she kept chasing a chicken and hitting it until her mother kept reprimanding her. The chicken was not thrilled as the child still continued to harass it. I couldn’t stop laughing – the child was just so curious at the chicken’s response to her hitting it.

The whole HHV experience gave me insight into the data monitoring I do every morning on the template forms that the HHVs fill out the previous day. One woman, during the informed consent process, was hung up on the use of “East Africa” in the address of the project. Of all the potential issues needing explaining in the informed consent document, she was most concerned about whether or not she was going to be calling “East Africa” if there was a problem. The health literacy of those I saw surveyed varied, and the HHVs do a fantastic job explaining the trial and basic health information to the participants.

Sometimes people are shy about volunteering to be surveyed. Some mistrustful. Others wait until the HHVs have been here for awhile and then volunteer but usually after the cap has been met. Men are particularly difficult to interview because some are working during the day (ideal in the ultimate sense but not for research purposes), some may be lying about their incomes so that their wives/girlfriends do not find out, and some are shy about the process.

Wakaligga B does not see many mzungus I came to find out. It was moderately crowded for a place with lower socioeconomic status (as opposed to the “very crowded” distinction used in the project). Hassard said he wished I could have been at a previous site that was more “slummy.” I will in time, and I told him that I bought some furniture from some carpenters in one of the squatter community Katanga, near the hospital. I cannot say that I am morbidly curious to go to such an area after time spent in the Kibera, Mathare, Mukuru, and Kawangware squatter settlements in Nairobi. But, I was glad for the people we saw and interviewed that they had better living conditions than a left-behind squatter settlement. Make no mistake, the poverty still overpowers.

A few of the participants knew English a bit, so I talked with them when possible. One mother explained how her daughter had chicken pox. Happiest baby I have ever seen with the chicken pox as I took note of her skin lesions. The language of the body provided most of the conversation today. Smiles, laughter, a few phrases and the joy of children. I left to have a late lunch at a local joint with the HHV team after we all ate tangerines bought from a man riding a bike driving around a gigantic bag of them.

The HHV team took good care of me and included me whenever they could. I look forward to going to the field once each zone!


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