MSF in Uganda


A Shrinking, Changing World

My life has seen a number of important changes over the last four years. With each change in direction, my understanding of the world grows, shrinking the planet’s enormity.

In 2012, I took a leave from my job at the time to volunteer with Engineers Without Borders Canada (EWB) for four months in Ghana. This was my first time traveling outside North America. It was also my introduction to the field of international development, in concept and in practice. 

In 2013, I decided to leave my job. This was my first resignation from a full-time job. It was a big risk. I was full of zeal and attempted to shift careers but, when that didn’t work out, I found a new job. At the end of 2013, I also began volunteering with Ceiba Association, helping to lead a group of students as they prepared for their own adventure abroad. 

In 2014, I got accepted into graduate school in the UK to study international development. This gave me the freedom to resign again, to focus on my passion. This would be my first time in Europe. Before I started this second phase of university, I travelled to Nicaragua and Uganda, further learning about new societies. 

In 2015, I learned so much about the social, political, economic and cultural elements that make up our shared humanity on Earth. I also earned my master’s degree from the Institute of Development Studies (IDS) (I was very proud that IDS was ranked number one in the world in its field) and entered the world of consulting. This new role has allowed me to visit Kenya and Pakistan, while learning about renewable energy. 

In 2016 (more specifically, this week), I again left my job to begin working with Medecins Sans Frontieres / Doctors Without Borders (MSF). I’ve been working towards this goal since before I started the path described above, four years ago. 

Each of these decisions over the past four years has brought me closer to what I think I am destined to do: improving the lives of others and attempting to make the world a better place. I’ve learned so much about different countries and have been privileged to visit some of them. I feel more confident about who I am. I’m starting to see the world with a critical lens. I’m looking forward to my next adventure and to whatever comes after. 

‘Friends of Medecins Sans Frontieres’ UK National Conference

ayzf0blpvq6crijicbrrLast month, I was lucky to attend the Friends of Medecins Sans Frontieres (FoMSF) UK National Conference at Imperial College, London. You might know MSF by its English translation: Doctors Without Borders.

After a warm welcome from Vickie Hawkins, Executive Director of MSF UK, FoMSF student societies from all around England, Scotland and Northern Ireland presented their successes from the year. Groups held fundraisers, movie nights, guest MSF speakers and even a Map-a-Thon (more on this last one later).

Throughout the day, we attended a number of workshops on recent and future MSF initiatives. Each presentation gave us inside knowledge into how MSF operates and how they improve peoples lives. I will now share three of them.

1. Ebola Response

ebola_mapThe Ebola outbreak in West Africa filled much of the news last year. Throughout the response, MSF doctors, nurses, expatriate and local staff were at the forefront, treating the virus and preventing its spread.

Working in Guinea, Liberia and Sierra Leone, MSF filled the gap resulting from an underdeveloped health care system; see map. MSF nurse, Andy Dennis, described to us his work in Kailahun, Sierra Leone, treating and ultimately releasing Ebola-infected patients.

From children to the elderly, so many people had their lives changed. Some had to travel by moto-van for over a day to reach the nearest MSF center.

The medical staff, who treated patients, faced an almost unthinkable challenge – working with a deadly virus. Long days and extremely tight health and safety protocols were in store. Andy walked us through the personal protective equipment, or PPE, involved; see below. As MSF staff could only work in the quarantine zone for 60 minutes max, the process of suiting up then down, discarding used gloves and other non-reusable gear, and washing your hands at every possible interlude would be exhausting, even for the most fit person.

Another challenge is the cost. The total bill for one complete set of PPE cost £38.18. As MSF in an international NGO reliant on donations, these costs can add up. Hopefully, suppliers will think first about saving lives and not the profits to be reaped.

Andy also gave us a virtual tour of an Ebola Treatment Center, which includes several safety measure. Operating like a hospital, but with stricter rules and regulations (like absolutely zero physical contact with anyone), these centers are in some of the most remote areas of Western Africa.

2. Access to Medicines

logoThe Access Campaign was launched by MSF in 1999 and continues to fight to provide affordable medication to the most vulnerable and most in need. Their latest report, The Right Shot, sheds light on the rising costs of vaccines. Polly Markandya, MSF Head of Communications, walked us through the report and new campaign.

Among its revelations, the report notes that for the 16 essential immunizations that MSF uses the price between 2001 and 2014 has increased 68-fold! This is a startling finding and one that should shame many pharmaceutical companies who profit while children die because of lack of money.

The pharmaceutical sector has also faced public pressure for its views again generic drugs and more equitable patent laws. Going back to the days of $10,000 AIDS treatment, many organizations and patient groups fought Big Pharma for a better system. Together, they reduced costs and saved peoples lives. So, this fight is one that carries that same spirit.

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3. Missing Maps

missing_maps_screenshotMaps are the the last thing you think of, but the first thing you need when responding to emergencies.

I first heard of the idea of Open Street Maps during their use in the 2010 Haiti earthquake. Within hours, volunteers from around the world banded together and helped to map the streets, homes and infrastructure of this nation facing a major catastrophe (see video: This data and easy-to-read maps allowed humanitarian staff to be more successful during their response effort.

But Haiti isn’t the only country without proper maps.

Countries, and importantly governments, need maps to have accurate information on hand for planning projects and delivering services. Humanitarian and development organizations also need maps, like when they respond to emergencies or if they need to find a remote village and a hand-drawn map won’t do; see below. A good map can be the difference between life and death.


A comparison of a hand-drawn MSF map in Katanga, DRC, with a map of Lubumbashi, DRC, made with Open Street Map. The Lubumbashi map was plotted by students of the University of Lubumbashi and the Humanitarian Open Street Map Team.

Together, MSF and the Red Cross are working to improve the situation. Volunteers and students from the UK and around the world are going online, and with each keystroke of their computer, they turn satellite images into detailed, open-source maps. Unlike other online map, mostly limited to road information, these maps include items like homes, streams and other information critical for organizations.

I hope to attend a Map-a-Thon myself one day and help make a difference.

In all, the FoMSF Conference was an amazing day, filled with inspiring, amazing people, who do amazing things to make the lives of others better. One of the best organizations out there!

P.S. Thanks to Pam O’Brien and all the organizers, Imperial College for hosing, and everyone at MSF for all your work!

Bringing the Hospital to You: KIHEFO Health Camps in Rural Uganda

KIHEFO (Kigezi Healthcare Foundation) is providing health care to not only the urban residents of Kabale but also to people in the outlying villages. In many of these remote, rural areas someone might go months or more than a year without seeing a healthcare provider, due to the cost of seeing a doctor and the distance of travel.

In Uganda, health care covers a range of services. There are the Village Health Teams at the very bottom of the health pyramid; they do some public health services and coordinate with others if needed. Higher up, there are the Health Center II’s, III’s (might have beds), and IV’s which offer a wider range of services. And at the very top, there are the private and government hospitals, where doctors midwives, and all sorts of services are found.

KIHEFO bridges these gaps by bringing hospital-quality staff to the village level. At a major outreach, like the one I attended in Kakarisa, there was the General Clinic, where doctors check patients’ wide assortment of needs. If a patient requires blood work or other testing, they send it to the Laboratory. If they finish their examination but need medication before they leave, they will take their doctor’s note to the Dispensary. For anyone with Eye or Dental needs, there are separate areas with specialists on hand. Lastly, there is also Family Planning where women (and hopefully men) can come to receive guidance in their sexual and reproductive health.

In Kakarisa, our venue was the local primary school. This venue offered two major benefits to the KIHEFO team. Firstly, it was vacant, as students were on break. It had several rooms, which could be transformed into the health areas I noted above. It had a large grassed area in the middle, for a waiting area. And, lastly, it was centrally located in town and easy for everyone to find.

As someone without any medical background, I was unsure where to help. Some of the other students started in the Dispensary, helping to un-box medications and sort them for distribution later in the day. Some shadowed the doctors, while other assisted in the lab with testing. I was less eager, so I stood outside the makeshift hospital areas and eventually landed on a bench in the center of all the newcomers, in Intake.

Coordination was relatively simple. The administrators to my left created an information slip for every patient that arrived. It had their name, age, gender, village on the top. They were then asked to stand on a scale to acquire their weight, which was also added to the form. My role was to then hand them one of three sheets, each with a number on it to represent their place in line. There was one stack for general clinic, another for dental, and a final pile for eyes. In the end, we had seen over 200 patients for general clinic and over 30 for the dental and eye clinics each.

It was extremely fast-paced with commotion as people waited hours (not including their travel time walking) to see a doctor. But there was some humor during the day. One woman who wanted a second slip of paper pretended that she was a twin and had not received anything yet. As the level of English here was low to nonexistent, I heard many of these things after the fact, usually by asking why the women were laughing.

In the afternoon, after things began to slow down in Intake, I walked around and tried to peek inside the rooms to see what everyone else was up to. I eventually landed outside of the General Clinic, asking how I could help. One of the coordinators handed me about five of the information forms I had seen at the start of the day and told me to manage the queue. On the outset I was quite disoriented, mostly because there was no queue, everyone was sitting in front of me, like an audience.

I announced the name on the top of the stack as one of the three nurses inside released their current patient. After a while, one of the nurses pointed out where the queue starts – where the foot path cut the grass into two – and I began to enforce it vigorously. The men on the left were trying to jump the queue. I was having none of it. I would grab another five slips and politely ignore their attempts to thrust their papers into my hand. After a few cycles of this, they got the message and stood in line like all the other men, women, and children were doing. Order restored!

On my second outreach, to the village of Rubira, I would be working inside a clinic, not on the outside. I would spend the day with Joanne, a dentist, acting as her assistant. This was a much smaller outreach, as KIHEFO comes here monthly and the village is much closer to town than Kakarisa.

Our first patient was a girl of only 14 years whose mother requested two ‘extractions’. Due to a number of overlapping reasons – poor oral hygiene or just being poor – this girl was to have two teeth removed, permanently. Her fear was palpable. Simply looking inside her mouth with the traditional tool of a mirror caused her to wince and cry. It was not going to get easier. Joanne administered a local anesthesia to allow for the extraction to take place with a minimum level of pain. But this action – inserting a syringe into the gums and releasing the fluid – caused its own pain. A metal object with a pick at one end and a handle is then wedged on both side of the tooth removed. The last implement, a pair of dental pliers, pulls the tooth out. This required the mother to hold down the girl and Joanne to move quickly. I have never seen so much fear in a person’s eyes. Well, I was going to see a lot more of it.

Joanne and I saw 4 patients under the age of 18 who together lost 6 teeth that day. An older man also visited the clinic but didn’t actually need any dental treatments. Many of the teeth we removed that day could be saved, but the opportunity to receive a ‘free’ tooth extraction was too good of an offer to pass up – the cost of filling a tooth would be too much for anyone in Rubira. Sadly.

Money Loans and Satellite Dishes: A Short Introduction to SACCO

Other Stories from Kabasheshe: Hills of GreenGhost Water Taps | Fish and Chips

SACCO is the acronym for Savings And Credit Co-operative.

I had never heard of this acronym before coming to Uganda. While in Kabasheshe, on at least two occasions, I had seen signs with such a reference on them.

I had asked my family if there were any nearby and if they could take me. They told me of one in Rusoka, which a friend worked at. We planned to arrive there on Wednesday.

IMG_3663The walk through Rusoka was interesting. We passed a vocational training center and a primary school for orphans. There were some exposed water pipes next to a hand pump, indicating previous scavenging. Beside some business and across from a hair salon, we arrived at the Turibamwe SACCO in the center of town.

The building wouldn’t be that noticeable – one-story, concrete walls, with a small amount of white paint – if it wasn’t for the high level of security that comes with a high level of money changing hands. I walked under their slogan of “Save & Invest in the Future” to see the familiar sight of cashiers to the right and management to the left. There were four or five patrons sitting next to the SACCO’s armed security guard. They were busy but seemed to welcome the excuse to take a break and talk.

Judith, my host sister, spoke with Susan, one of the two cashiers behind the wooden and glass divider, and asked her if I could speak with someone to learn more about how this institution operates. We moved towards the back room.

Sitting there was Carol, an accountant and the person who was willing to answer my questions. After talking with her and feverishly writing down points into my iPhone, I learned nearly everything about this SACCO.

The SACCO began nearly a decade ago, back in 2006, and has already grown to have a second branch, opened 3 years ago. Unlike a typical bank, a SACCO consists of members who are, in effect, the owners. Rather than maximizing profits, it operates to serve the community. They are accommodating to a range of needs and often offer lower interest rates that normal moneylenders.

Although we have a similar financial structure in North America with credit unions, the thing that surprised me about this SACCO was that it was the only place where people could get credit. There were no banks in Rusoka or in Kabasheshe. Without a SACCO, people would be limited simply to what they could produce and sell, unable to ever lend money (at a reasonable rate) to improve their lives.

What services are provided by the SACCO?

At the most basic level, a person can deposit money into the SACCO without having to become a member; but this excludes them from accessing other services. The more common approach is to become an Individual Member. This requires depositing 26,000# (26,000 Uganda shillings, or about 10 US dollars). The money goes towards membership (10,000#), stationary to keep records (6,000#), and shares in the co-operative (10,000#). A group or pair can also open an account; this type is similar to the individual member with the membership fee costing an extra 10,000#.

For members with money to spare, the SACCO also offers a Fixed Account option. This allows a member to earn money by leaving money in the coffers. If a person can let some amount sit untouched they will get back 1% interest per month. Fixed accounts are as little as 2,000# or over a million shillings; it’s up to the member.

What can a loan be used for?

By having a membership with the SACCO, an individual, pairing, or group is now one step closer to acquiring a loan. I was quite astonished at the breadth of items that qualify for a loan. Taking a loan to buy farmland or to build a business make sense enough, but the co-operative also allows people to pay for their children’s school fee, make home improvements like solar power or piped water, and even for luxuries like satellite television. All of these come with a 3% monthly interest rate. The lower rate of 2% is for motorcycle loans, typically used for someone who will start a boda-boda moto taxi service. The loans are additionally unique in that a loan officer will be the one collecting the item, not the loan signer; cash is never exchanged. Whether your loan is for business or pleasure, the maturity will be between three and twelve months, depending on what the client wishes.

How much are the loans?

“It all depends on the number of shares”, Albert explained to me just after he entered the room. Albert is a loan officer and entered the room midway through my flurry of questions.

Shares are bought and sold by the members. To qualify for a loan, a member must have a minimum of 3,000# in shares. They must also have an active account, making deposits and withdrawals, and wait at least six months after opening their account. Once these requirements are met, a member can apply for a loan. The 10,000# in shares that each member receives initially are multiplied by a factor of eight, meaning that a loan of 80,000# is available. If a larger loan is needed, a member simply needs to buy more shares and will then be able to apply for a loan eight times in size.

Are there any risks?

This was the last question and one I thought was crucial to the co-operative’s success.

The SACCO has two methods to making sure re-payment of the loans is successful. The first, as Albert explained succinctly, is to have the member receiving the loan to put up collateral. This is normally some asset – land, livestock, or possession – of real value, usually near twice the value of the loan. But cows can move. This is problematic if a loan is based on a movable commodity as collateral. So, the SACCO has a second device. This is family.

In addition to the member signing the loan, a co-signer, usually a family member, with also attach their name. That way, if the original signer does anything shady, like sell some assets after receiving their new motorcycle or other item, the family will have to become involved. It means that the SACCO has more oversight and the most powerful kind in one’s own family.

I left by thanking everyone for their time and patience. They thanked me for coming by and let me know that I was always welcome to open an account, even in the future.

Susan walked me out to the front courtyard, reminding me that they are “open Monday through Friday, from 8:30 to 4:30” before saying goodbye.