If you didn’t have the time to read through all our posts (though we highly encourage it), you can watch this short video that is a compilation of our entire trip! The video was compiled by one of the team members, Polly, and is a fun way for us to look back and remember our trip. Enjoy in HD!
For our last day in Jinja, we had some free time and decided to take advantage of the tourist attractions and activities .The girls left early in the morning to go white water rafting, while the boys finished up a couple of remaining interviews then went kayaking in the Nile.
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White water rafting down the Nile was great! During one of the rapids, the raft tipped so much that Rachel let go of the rope, flew across the raft, and tackled Polly into the water. There were many points along the river where we were able to jump out of the raft and just float along with the current. At one point, the guide yelled at us to jump off while we were in the rapids, which was slightly terrifying. The ride back from the river to the hotel was an added bonus, as we were able to stand on the back of an open truck and we sped along the countryside. When we got back to the hotel, we asked the staff for a clean towel, which somehow turned into an hour long photoshoot with the entire hotel staff. We’re still confused as to how or why this happened, but it was a fun experience.
The boys finished up interviews with a pediatrician and LC5 in the morning, then went down to the Nile River to partake in river activities (aka kayaking). Andrew and Mohit parked their kayak on a rock in the middle of the river, and Mohit made the mistake of letting Andrew man the kayak. The kayak ended up floating away, and they were stranded on the rock, shouting for help, as Matt just watched from the shore. A passing motorboat attempted to push their kayak back to the rock but failed, so a fisherman named Adam XXX (we’re not really sure about the XXX part either) gave Andrew and Mohit a ride to their kayak. On the short boatride to the kayak, he tried selling them flowers. Again, we’re still confused as to how or why this happened. The girls took a boda boda to the Black Lantern to meet up with the boys, where we all caught up with stories from our day and ate more banana crepes.
The next morning, we said goodbye to the staff at the hotel and left Jinja for Kampala. With Polly’s expert(?) navigation, we were able to find the airbnb home that we were renting for our stay in Kampala. The girls met up with Winnie at the African Village Craft Market, where they bought gifts for people back at home. Matt and Andrew went to a casino with the very few remaining shillings they had. Mohit, having learned that there was wifi in our rented home, decided to stay back and enjoy some time away from us.
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For dinner, we had planned to go to a restaurant called Carnivore, which is similar to a Brazilian steakhouse except with exotic meats such as crocodile, ox balls, and buffalo. We heard about Carnivore even before the trip and didn’t have time to go to the one in Kenya, so we were pretty excited to finally go in Uganda. However, miscommunication led us to a similar type of restaurant called Carnival. Although we were disappointed and convinced that the food at Carnivore was better, it was still an experience being able to try antelope, buffalo, and crocodile meat.
On Sunday, we went to Cafe Javas for lunch, where we were finally able to satisfy our craving for “American food”. As much as we enjoyed trying the local foods in Kenya and Uganda, we still missed the comfort foods of home. We met with Dr. Waiswa and updated him on all the insights we gathered during our week in Uganda. We had wanted to go to the RAN lab at Makerere University before we left for the States, but sadly schedules didn’t end up working out.
We stopped by the supermarket on the way back to the apartment to buy dinner, which ended up being old instant ramen that was on clearance because we were running low on money. The wifi in our apartment was limited to 1.5GB, so we had to ration our internet usage. It was stressful trying to count megabytes and prioritizing what was important enough to use our internet for, but it definitely made us appreciative of the unlimited internet back at home. We spent the rest of the night discussing insights from our time on the field, closing up our global trip, and planning the next few weeks when we get back to the States.
We will be flying out tomorrow to head back to Baltimore. We’re sad to leave, and we’ve definitely learned a lot during our past few weeks, but we’re also excited to head back to start translating our observations into design considerations for our device 🙂
Thanks to our guide Moses – who has the uncanny ability to find stakeholders for us to interview out of thin air – we’ve had a very busy and productive week in Uganda.
On Monday, we visited the Iganga Office and met with a group of VHTs who were supported by Makerere University. We gave a short presentation and demonstration of our system and received positive feedback from the VHTs. We then had meetings with the Residential District Commissioner of Iganga as well as a program manager from a local NGO to get feedback on different implementation and distribution strategies of interventions in Uganda. Our last visit of the day was to a private, not-for-profit Health Center level 3 (HCIII) facility, where we met with another big group of VHTs.
We came back to the hotel, where we had tilapia for dinner. The fish must not have come from Lake Victoria, though, because the fish was not as sweet as the one we had had right along in the lake in Kenya. Polly and I also tried to do laundry, which proved to be much more difficult than we expected. We ended up hand wringing soppy, not-so-clean clothes in the dark, wrapping them in towels, attempting to pummel the water out of the clothes, then laying them out to dry in the very limited free space in our rooms.
On Tuesday, we visited a public HCII facility and had a home visit with a group of moms and VHT in a nearby village. All the kids in the neighborhood came and joined the group, so there was a big group of people just watching us do the demo and interview. We went out for street food that night, where we had “Rolex” (pretty much a flat omelet in chapatti) and different meat skewers (including chicken neck and gizzards).
On Wednesday, we visited a HCIV, the Iganga District Office, and the Iganga District Hospital, where we got to see the maternity and pediatric wards. For dinner, we decided to go to the Black Lantern on the bank of the Nile River. We discovered the greatness that is chocolate banana crepes, and we made trips back to the restaurant/hotel just for those crepes.
Thursday was a busy day, as we went to seven different sites. We started by going to a private, not-for-profit hospital. The difference between private and public facilities was apparent, in both the quality of the facility as well as the number of patients (doctor to patient ratio). There were two medical students from Germany who were also observing the Ugandan healthcare system. We then went to Jinja Regional Referral Hospital, which was the highest level hospital that we saw. The pediatric ward was supported by Save the Children, and it was one of the nicest wards we saw in Africa. We then went to Bute Village to do home visits with two groups of mothers at the village. We happened to arrive when the children at a nearby school were on break, so they flocked around and stared at us (and of course, the NeoNatalie). We then went to a private, for-profit facility and the Iganga Office to meet the District Health Officer, then finished off the day at another private, for-profit facility.
The hotel we were staying at in Jinja had very limited wifi (as in no wifi), but thanks to that, we were able to discover dubbed Indian soap operas. Many of the nights we ended up gathering in the lobby to watch the next episode of “King of Hearts” along with one of the hotel staff members.
We only have another full day left in Jinja, and we will be heading back to Kampala for a couple days before we finally head back to the States.
After spending a few days in Uganda, we’ve noticed some differences and similarities to Kenya. Based on our brief experience and interactions, we’ve been able to observe these comparisons!
The Food
While many of the foods were similar, one of the great finds we discovered in Uganda was “The Rolex.” It is an omelette with tomatoes, onions, bell peppers, and lettuce wrapped in chapati, and is incredibly delicious. On the other hand, the experiences that we had with tilapia were far superior in Kenya, compared to Uganda. This was surprising, since both countries touch Lake Victoria, which is where the sweet tilapia comes from. In both countries, it’s easy to find mandazi (fried bread), chapati, and ugali. We were lucky enough to try street food from both countries, and so far, everyone’s stomachs and intestines have been able to manage it!
The Diversity
Where we were based in Kenya, there was not a huge diversity in ethnicity. Our group often stuck out like a sore thumb, everywhere we went. In comparison, Uganda has been much more varied in the types of people we see around. For example, as we pulled into Kampala, we noticed many signs written in Chinese and Korean. Apparently, there is a growing East Asian population in the parts of Uganda that we were in, which resulted in a lot more Asian culture. Even the supermarkets in Uganda we went to sold items that are commonly found in Asian American shops and stores, which brought a bit of nostalgia to the East Asians on the team.
The Health System
In Kenya, the volunteer health workers were called “Community Health Volunteers” but in Uganda they are called VHTs or “Volunteer Health Team”. In Kenya, the CHVs are trained and strongly linked to the government facilities, with support from partner organizations for additional training modules. However, in Uganda, the VHTs are split into three categories – those that are organized but the government, NGOs, and partners. While both sets of community health workers were originally trained by the government, we found that Kenya’s CHVs were more supported through additional trainings. Also, Kenya’s healthcare system is broken into 4 tiers, while Uganda’s is in 5 tiers. In both countries, the community health workers are the front-line care providers, and there is a large emphasis on maternal and child health outcomes.
The Sights and Sounds
In Kenya, the atmosphere is much more arid, with the most iconic sight being the Masai Mara. Uganda is much more tropical and green, and the Nile is the most iconic thing we’ve seen. In both countries, there is the unmistakable red dust that flies up when we drive along the bumpy roads. Goats and cows saunter along the road as boda bodas zip by, sometimes carrying up to 3 passengers. The heat and mosquitoes are inescapable in both countries, as are the thunderstorms that leave the city in a blackout.
Regardless of the country, everywhere we went, we’ve been treated with incredible kindness and generosity. There is a level of intimacy here that seems to be lacking in America, whether it’s the hotel owner treating you like her own family and offering tea every night, or a hospital administrator inviting you into their institution with a smile and a firm handshake. Even the prevalence of visitor’s books that we sign at every office or building we go to represents a personal touch that we rarely see back in the States. With only a few more days to go, we know we will definitely miss the wonderful people we’ve had the privilege to meet, though perhaps not the spotty wifi that makes it hard to blog!
Yesterday we flew out from Kenya and landed in Kampala, Uganda. Our host Winnie from Makerere University greeted us at arrivals with an adorable JHU sign. From the airport, we dropped our bags off at the hotel and went to an Asian restaurant at the mall and had ice cream. Winnie actually spent the last 4 years studying in China so she was well-versed in Asian cuisine and chopstick use. Her Chinese was also better than the actual Chinese people on our team.
After dinner, we rode boda boda motorcycles back to the hotel! In Uganda, they have a boda boda company called Safe Boda that provides safer rides and helmets for the passengers. It was super fun, as half the group had not ridden on motorcycles before.
Sunsets in Uganda are something else
Today, we met Dr. Peter Waiswa from Makerere University who is a well known public health professor, health advocate, and our connection in Uganda. After our meeting, we drove to Jinja, which is the city closer to the field sites. Our Jinja hotel is run by an incredibly kind woman who gave us a better room rate and threw on laundry (which was a huge break for us because we are quickly running out of clean clothes to wear) and transportation for free. After checking in, and another meeting with one of our field hosts, Moses, we headed to a different resort that had a pool, restaurant, bar, and amazing view of the Nile River.
Tomorrow, we start our Uganda field visits by meeting a group of Community Health Workers and introducing our device and solution!
Today is our last day in Kenya, and tomorrow we will be flying out to Uganda for the last week of our trip. We’ve spent this past week conducting more interviews in the field, and on Wednesday, we travelled to Kisumu to observe a county hospital and newborn intensive care unit. We also spent this week learning more about the implementation, scalability, and sustainability of our solution. This morning, we met with the county program manager of Reproductive Health at the National Hospital. She provided us with many insights about where to start looking for manufacturing and scaling up. We also met with a gynecologist who was very excited about our device and solution. She is not only a doctor, but also a member of the Jhpiego Kenya team, so she has a lot of experience with implementing programs at the county and community level.
After our morning meeting, we went to a Chinese restaurant for lunch and it was surprisingly delicious! It was our host’s first time having Chinese food, and he really enjoyed it. After lunch, we went to another outdoor market and bought a few scarves and trinkets, before heading home to rest up. Tonight, we’re hitting the town and getting to know the Nairobi night scene at a salsa club!
Our stay in Kenya has been amazing and definitely too short. From the people to the field visits to the food to the wild animals, we’ve enjoyed every part of the experience, and definitely hope to visit again in the future. We want to thank everyone from the Migori MCSP USAID office and Jhpiego Kenya branch for arranging the field visits and acting as amazing hosts and guides for us, as well as all the mothers, CHVs, administrators, and other community members that took time to speak to a bunch of students from Johns Hopkins. Without their support and kindness, we would not have gained the insights or had the experience that we did. We also want to give a huge shoutout to Levis Onsase from Jhpiego who put up with us for two weeks and was an amazing resource and translator. We are so proud and excited to announce that he will be joining our advisory board and acting as a point person for us in Kenya. We can’t wait to see what Uganda has in store for us next!
Long days in the field have been interspersed by long drives across rocky terrain. Late nights staying up documenting our insights and team bonding have made the drives prime times to catch up on sleep. This led to a series we call: “Sleeping and Creeping,” which is pretty self-explanatory. Enjoy!
This weekend, our team visited Masai Mara to go on a safari adventure. While all the animals we saw were incredible, the highlight was definitely the migration of wildebeests across the Mara River. Every year, millions of wildebeest migrate in East Africa, and in August, they end up in Masai Mara, which happened to only be a couple hours away from Migori where we were staying. Crossing the Mara River can be incredibly dangerous for the wildebeest because they can be snapped up by crocodiles or swept away in the current. Even if they successfully cross, they can still fall prey to the many predators in the region. While we did not see any casualties, we did come across many wildebeest carcasses.
At night, we stayed at a campground and lived in tents. It was an interesting experience, as the campsite did not have electricity and only turned on their generator for a few hours each night. That made charging out phones and cameras and even using the bathroom a challenge! Hot water was also only available for certain hours at night. It was definitely an ordeal walking back to our tent in the middle of the pitch black night and finding a little lizard and slug in your bathroom while you’re trying to shower. However, the staff was friendly and even lit a bonfire for us to enjoy, and we had a great time!
Sadly, we did not get to see all of The Big Five, because we missed the black rhino, but apparently there are only 15 of them in the entire Masai Mara region, so the chance of seeing one is really rare. The list of animals we saw were: zebras, wildebeest, lions, cheetahs, elephants, giraffes, baboons, monkeys, gazelles, antelope, water buffalo, hippos, ostriches, lizards, vultures, miscellaneous birds, and more!
Today, we visited a community unit that has been working hard to increase HIV awareness due to its extreme prevalence in the area. Like most of the other days, we started out with basic questions about their health system and newborn health danger signs. While most Community Health Volunteers and administrators spoke English, we struggled a bit with the language barrier when speaking to mothers from rural areas. However, we were lucky to have many in the crowd who could assist as translators. Interestingly enough, one thing we found out from our many interviews is that while rural mothers may not be fluent in conversational English, many could read basic words and say complicated English words related to health. For example, while we were unable to convey full questions in English, mothers could understand key words and phrases like “exclusive breastfeeding”, “convulsions”, “danger signs”, and more. This made the interviewing easier and allowed us to begin to pick up on the tone of what they were saying in Swahili.
The community we visited today was unique in that it had very well established and extensive community support groups, or as they called it “psycho-social support groups.” These groups meet to raise awareness about HIV transmission and provide support for HIV positive community members. When we arrived, there were over 30 people from support groups waiting to speak with us, which was an incredible privilege. It’s always astounding to see how many people are willing to take time out of their day to talk to bunch of students from Hopkins. As usual, the NeoNatalie was a huge hit and we had a fun time taking pictures at the end of each session!
After a long day of field visits, we went to dinner. As we sat down at the restaurant, it began to storm outside. Suddenly, the power went out and all the lights shut off. However, the restaurant carried on and continued to cook our dinner in the dark which was a fun surprise. It definitely “colored our experience in Kenya”, as Dr. Kanyuuru from Jhpiego would say. Tomorrow, we’re taking a break from babies and interviews to be one with nature, so we’ll catch up on our blog when we return! Here’s hoping we catch the Great Migration and see The Big Five (lions, rhinos, buffalos, elephants, and leopards)!
Our team spent the past two days in the field interviewing Community Health Volunteers (CHVs) and mothers. Kenya’s community health system is incredibly impressive and well organized. Their villages are organized into community units (CU), with about 5000 people per CU. Each CU has 10-15 CHVs that do household visits to deliver messages about health and sanitation and to check up on the families and refer them to health facilities if necessary.
During the interviews, we asked them questions about how health visits are conducted and how newborns are cared for. We also introduced them to our two NeoNatalies: Johns and Hopkins, which some of the CHVs and mothers renamed to Ochien and Arobi. Ochien means a boy born in the afternoon and Arobi means the first daughter of the family. While the interviews started out a little awkward, we all grew more comfortable as the sessions went on and were joking and laughing by the end! The NeoNatalies and prototypes were a huge hit and we received a lot of feedback that will help us better engineer our solution. We have another day of interviewing and home visits tomorrow and then we will hit Maasai Mara this weekend and see the wildlife!
CBID Neonatal Team 16-17 