MSF in Uganda


Let’s Talk About Menstruation

…putting menstrual hygiene management (MHM) on the development radar.

Menstruation is something I know very little about. As such, I decided to explore this taboo subject for a term paper in my MA Poverty and Development program at the Institute of Development Studies. I was tasked with thinking about:

Why and how is gender important in development?

For many issues, development workers may have a gender-insensitive view (i.e. treating men and women as if their experiences were the same; ignoring power dynamics) and they may get some positive results, but they will usually only go so far and miss out on making real transformation.

Take the topic of water and sanitation in schools in developing countries, which was the topic of my paper. After weeks of research, I was stunned by what I discovered.

???????????????????????????????Of the Millennium Development Goals, which have acted as the development agenda for the past 15 years, the components related to water, sanitation, and hygiene (WASH) have seen the slowest improvement. Even with the combined efforts to install latrine infrastructure at schools in developing countries, plus programs for gender inclusion and education promotion, access to education (especially for girls) remains hard to come by. Things are changing, luckily.

In recent years, menstrual hygiene management (MHM) is broadening the WASH debate beyond simply building a room with a hole in the ground. Research done by Marni Sommer of Columbia University and others at the London School of Hygiene and Tropical Medicine (LSHTM) have shown the inadequacy of how latrines were designed and implemented over the past 50 years. In fact, a whole list of problems exist for girls with current WASH systems in many developing countries, including but not limited to:

  • Lack of privacy for changing materials or washing the body.
  • Inconsistent supplies of water and lack of soap.
  • Water not located in a suitable place for washing stains from clothes and reusable menstrual materials.
  • Inadequate collection and unsafe disposal options for used menstrual material.
  • Limited access to and affordability of hygienic products.
  • Locked latrines or dorms during the day.
  • No tools for cleaning in toilets.

il_fullxfull_177629346…So What?

MHM matters because boys and girls are not seeing the same results. To get a real world case for my research, I focused on the countries in East Africa, such as Tanzania and Uganda, where girls finish with one to two years less schooling than boys.

This may seem like not a huge problem, but consider that boys across these countries average only five years of education; girls average only three-and-a-half school years. We can’t ignore this clear inequality in results.

Luckily, change is coming. Since 2012, conferences on MHM are being held globally and in countries, like Uganda. Handbooks have been created for development workers. Institutions like the Water Supply & Sanitation Collaborative Council (WSSCC) and Sanitation and Hygiene Applied Research for Equity (SHARE) at the LSHTM are adding great research of MHM to the literature.

(Listen to this podcast by two SHARE researchers for more insight: Menstrual hygiene: Breaking the silence)

The market is also catching up. Products like reusable sanitary products and Moon Cups are starting to make a difference in the lives of women and girls in resource-poor environments.

Schools in developing countries are also starting to add more sexual and reproductive health lessons. Starting in Tanzania and now in Ethiopia, Ghana and Cambodia, the Grow and Know book series, originating from Sommer’s PhD work, allows girls (and boys) to receive proper information on their changing bodies, rather than relying on guesses and misinformation.

The Menstruation Taboo

Unfortunately, even will all these amazing improvements, menstruation is still a taboo around the world. Long-standing religious and cultural views on menstruation have added stigma to an entirely natural bodily process, shared by billions of people.

In many cultures, when girls are on their periods, they must resort to staying home for upwards of a week. This causes serious losses in terms of their education, resulting in girls falling behind boys in achievement. Politicians and decision makers need to open the debate to include the needs of all genders, not just the male ones.

One of the major hurdles is involving men and boys in the discussion. By having accurate, appropriate education is schools, boys can grow up to become men and fathers who can support girls during their menarche and make sure they stay in school. Men need awareness to remove the stigma of menstruation and become active in solution-building. They are the community leaders that plans projects, the masons who build latrines and the teachers who mentor children. Although it would be great to have more women in these leadership roles, the reality is that men still are over-represented and must be involved in fostering change.

And, let us not think that this is an issue for only those nations facing high rates of poverty and underdevelopment. We, in the Global North, have our own taboos and prejudices.

…What About the “Developed” World?

The recent HuffPo article ‘For Homeless Women, Getting Their Period Is One Of The Most Difficult Challenges’ clearly outlines how MHM is not being made available, even within the countries that can afford it, like the United States.

In Canada, we have our own vulnerable groups. People outside mainstream politics. We ignore the needs of the homeless. We separate and look down about Aboriginal peoples and their heritage. I am ashamed of these current realities.

In the UK, women are fighting the “vagina tax” to keep tampons and other necessary sanitary products tax-free. A few years ago, they were categorized as “non-essential”, luxury products bringing with it a 17.5% tax rate. After much protest, that rate has been lowered to 5%, but should go down to zero.

By ignoring the wellbeing of its citizens, countries are missing the opportunity to harness the true potential of every member within it. Women within vulnerable groups are unable to access equality. Girls will miss school.

This topic highlights many of the existing problems in both developing and so-called developed countries: gender equality, sexual and reproductive rights, access to education, proper sanitation, and more. Unless we go outside of our intellectual comfort zones, we will never be able to tackle the most important challenges in our society.

If I ever work in WASH, regardless of the location, I will seriously question whether planners and donors have considered the needs of all genders. Not just some.

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.

Fish and Chips: How a Small Business Can Have Big Impact in Rural Uganda

Other Stories from Kabasheshe: Hills of Green | Ghost Water Taps | Money Loans and Satellite Dishes

IMG_3640At the end of a fun weekend, I was driving from Queen Elizabeth National Park back to Kabale. Along with a group of American and Canadian medical and public health students, I was returning from three days filled with safari and boat adventures in Southwestern Uganda. Before our weekend came to a close, we stopped at the Satellite Hotel for lunch. The hotel offers an impressive lookout for travelers along the Mbarara-Kabale Road and its restaurant was advertising a special of Fish and Chips. I jumped on the bandwagon and ordered a plate.

Fast forward two weeks and now I’m standing next to the pond where the fish I ate was raised. This fish breeding pond – one of four – is part of a business called Satellite Farmers Limited, located at the junction to Kabasheshe in the Ntungamo district. I originally decided to come here to see and learn about their first farms, but I ended up leaving with a much better understanding of how this small enterprise was playing a big role in the community.

My tour guide and teacher would be Godrey, a 20-year-old secondary school student, who was in charge of this facility. As we talked (or, more accurately, as I continually asked questions) he began to open up and seemed excited to share his work with me.

We started outdoors, walking along the trail that connects the fish ponds. Some filled with catfish and others of an unknown kind, these ponds were dug and filled only six months ago, but already had thousands of fish. To help me see their scope, as the water was murky and hid what lay underneath, Godrey went into the green, aluminum building nearer to the road to grab some feed. He threw it into the water and little mouths started to appear. Above the water were lines, closing each other in a grid formation and about 12 inches apart. These lines are used to prevent birds, which are abundant, from flying down and stealing a meal.

On top of the fish sold to the hotel down the road, Satellite Farmers Limited sells local eggs, handheld sprayers, building materials, and the animal feed (mostly for chickens and pigs) that Godfrey used earlier. But catfish are special. Instead of regular feed, they are given meat, chicken to be exact. I was fortunate to see a farmer come in and leave a bucket of future fish food. The blue plastic bucket contained slurry of meat byproduct. The innards of a chicken – heart, lungs, intestines – that people don’t consume and farmers can’t use can be brought here and sold, adding to their income and maximizing the usefulness of a single chicken.

Speaking of chickens, they have those too, both layers and broilers. Layers are the hens that produce eggs, while a broiler is a chicken raised for just the meat. An egg here sells for 250# (250 shillings, or 10 US cents), while the same egg at the rural market would sell for 400#. Say you’re the head of a household and you were looking for an affordable source of protein, this would be your best place to start. Or, if you are a market seller and looking for something to sell, this place could be your supplier, where you can buy and then sell eggs, making 150# profit on each one; you wouldn’t even need to own a chicken.

Godrey led me inside the Feed Mill, which has been in the community for over two years and was started by a man simply known as Chief.

“Who else works here?” I asked Godfrey, as we passed through the doors. “No one”, he responded, “just me.” I was perplexed. The feed mill is massive. It is similar to something I would find back home in Rural Canada. Inside, there were bags everywhere. Scales for weighing, office desks to handle paperwork, and an unorganized stack of water troughs in the corner took up more space inside this building.

It turns out that Godrey is the only full-time employee of the operation, selling eggs, equipment and bags of feed, and feeding the fish as needed. When animal feed needs to be mixed, he goes to the local trading center and hires up to five temporary workers. Together, they can produce one to two tons of feed each hour. This high level of productivity is probably the reason why Godrey can manage everything alone.

The animal feed they manufacture consists of various elements, including silverfish, maize bran, broken maize, cotton cake, shells, sunflower, and calcium. Some are sourced locally, while other bags come from the capital of Kampala. In either case, the concrete floor where these bags are tossed provides another destination for farmers to bring their grains.

It might not seem like much, but in a country where youth unemployment can reach 80%, it is nice to see a successful and growing business that is providing full- and part-time jobs to local residents. Not only that, they are providing tools to farmers to maximize their productivity and earn more, all within walking distance from their fields. Additionally, Satellite Farmers Limited is acting as a link from rural farmers, buying their excess grains, to outside markets, meaning a greatly level of economic stability in this community of a few thousand low-income farmers.

I left by thanking Godrey for his time and sharing so much knowledge with me. I also bought some eggs; it was too good of a bargain not to. This small business, invisible from the paved main roads, in Southwestern Uganda is quietly achieving what so many educated experts have failed to do – foster employment, assist farmers, and grow the local economy.

If you’re interesting in learning more about businesses in emerging markets or innovations in rural agriculture, feel free to contact myself. Questions are welcome and encouraged.

Ghost Water Taps

Other Stories from Kabasheshe: Hills of Green | Fish and Chips | Money Loans and Satellite Dishes

“One tap…two taps…three taps.”

This is what I was hoping to count to myself on Monday when I walked through town. Unfortunately, my optimism would be squashed.

IMG_3651The day before, Mzee, my host grandfather, described the water project he hoped to start in Kabasheshe. Currently, the closest water source is located at the very bottom of the valley; at least 30 minutes there and back, up and down hills. My host sisters (and me on a few occasions) make the journey at least once a day, but more commonly multiple times. Older sisters would carry 20-litre jerry-cans on their head. When full with water, these would weigh 20 kilograms or 44 pounds! I barely managed when I tried. Younger children carry 10- and 5-liter jugs; one or two, depending on their strength. These feats of strength are more impressive when considering that a 2-year-old toddler may also be on a woman’s back.

I should also point out for clarity that my household is somewhat lucky in that it is located directly uphill from the community spring. Other families have the dual challenges of living uphill and down the road from the water source, increasing their walking time.

IMG_3677If you walk 30 minutes up the road, towards the main junction, you find a completely different reality. The village of Rusoka seems to be an oasis of water projects – piped water, community boreholes, and others. On our way to see their current gem, my hosts and I passed a centrally placed hand pump. I was told that it was spoiled, not in use. I trust that this is true as I saw nearby pipes ripped out from the ground. After months of no more flowing water, the plastic pumps are commonly extracted; these can then be used by families to illegally smuggle power into their homes or any other use that they can come up with.

The Rusoka Primary School has another interesting feature – a
play pump; age unknown. Play pumps are water projects that replace the typical manual hand pump with a circular merry-go-round, one intended for children to play on. These work when kids are nearby and willing to use it, but are problematic for a woman by herself. It is also a sad part of development that many communities are conditioned to attract international donors, so children may come out to play for photos, but will stop once the abazungus (foreigners) leave. It was interesting to see one, though. If I had more time, I might have tried to uncover its history and current level of use.

IMG_3708After walking through town, passing orphanages, training centers, and hair parlors, we arrived at the pump house. This relatively large building provides piped water to the entire Rusoka community. It pumps water uphill to a storage tank and then downhill to several taps. This is the model that my village hopes for. Built many years ago, it has run flawlessly.

A cynic might propose that Kabasheshe’s mostly Muslim population missed out on the charity that Rusoka received from Catholic organizations that visited it, being a majority Catholic population itself.

A realist might say that Kabasheshe’s location further down the dirt road has left it with worse luck. Rusoka is closer to the main road, which also acts as a pathway between Uganda and Rwanda.

Either way, my host village finds itself without easy access to water.

IMG_3386Eight or maybe nine years ago, they did get a borehole, supplied by the local sub-county government. But, after 3 years of use, it broke down and was never fixed. It sits there today, a skeleton of its former self, with all removable components scavenged and probably sold.

This is the start of Mzee’s plan. Three years ago, Rusoka received electricity and thanks to a politician who lived here, the line was extended to Kabasheshe. Him, his brother, my host family, and a few others now have power.

Power is quite a life changer. It means that you can own a cellphone, as it needs to be charged regularly, and connect with others far away. It means a steady, cheap source of light. And it mean that you can own a TV and relax while watching it, as my host family regularly does.

But it also means one more thing, more options for community projects. Rather than the manual water pump that failed in Kabasheshe before, Mzee wants to install a motorized pump to provide piped water to his community. Just like Rusoka.

Going uphill, the water would be pumped to storage tanks, either polyurethane or concrete, and then downhill to various sources. Using storage tanks mean that water can still flow, even when there’s a power outage. Also, meters can be placed on the multiple tanks to track usage.

After seeing the borehole and location for future tanks, I was taken to see the community taps. There were three of them. Or, at least, that was what I was told.

One at the primary school. One at the trading center (local store and outdoor pool hall). And one near a home on the main road.

IMG_3571First, the school. Like what I saw in Rusoka, a plastic pipe was sticking out of the ground. After the borehole stopping providing water, someone dug up the line, cut it, and took it home. But, there was hope that a new line could be installed. It would be nice to see this school receive running water, as the alternative is children missing school to fetch water.

Next, the family home. We arrived at our destination, but I saw no tap. There was a hedge dividing two properties. A gated house on the left and a small business on the right. It turns out that this tap was demolished after the borehole broke and was in the way of the homeowner’s plan. All that is left is a memory of what was.

The third and final tap, at the trading center, had the same fate. It was demolished some time ago. Nothing left to signify that it was ever here.

This left me puzzled. Mzee told me about the three taps and my mind raced with possibility. But to have so much infrastructure missing, it would be a daunting project.

So, what can be done?

It is definitely possible to provide piped water to the community. The borehole is there. At least one tap (probably the most important one, in my view) is still in the ground and ready to be connected. And the community wants it.

How to do it?

As with most things, money is primary. Funding can come from one of three sources. It can be through the community, everyone pitching in and taking full ownership. The government could come in, but people have little to no trust in them. Or an outside source, like an international charity or aid organization, could be the one to manage the project.

In any case, some things would need to be bought and installed. A motorized pump at the borehole, connected to the power line. A house would need to be built to contain everything. A 200-meter trench would need to be dug, at least 5-feet deep to prevent the thievery of the past, and plastic piping laid. The hilltop would be leveled and a few tanks installed on concrete or other structure. More trenches and piping would go downhill. The school would be re-connected and new taps would need to be constructed elsewhere

All in all, this would be a massive project. Probably the biggest one Kabasheshe has every received. I want to make it happen but have my reservations.

Will the village be able to repair future breakdowns? Will they be able to prevent thievery? Is it better to wait and lobby the government to change its ways?

What do you think? Is there anything not considered or missing?