Fieldwork in Uganda

I´m a part of the international community health masters program at the institute for health and society, at the University of Oslo. This autumn all of us are somewhere in the world doing fieldwork, i am doing mine in Uganda. My topic is well-being, mental health and health care among child brides in Amudat district in Uganda.

After three days in Uganda everything changed. As i should have expected, i guess, but i didn´t. I met Chris, my supervisor, and Shirlee, a former co-student from Makerere University. She was supposed to be my research assistant/interpreter. The minute before Shirlee enters the restaurant Chris says: why don´t you just join me in Karamoja? And i´m like YES! That´s perfect. And then Shirlee enters, and i realize that she would not be able to join due to language. How to break it to her?

I have a thousand questions i want to ask Chris, but i can´t. Until we almost finished eating and Chris asks if i have any questions. And i´m just: I really want to go to Karamoja! And luckily Shirlee thinks its a good idea. Chris is carrying out an ethnographic fieldwork on female genital modification (his own concept) and reproductive health. After the girls are «cut» they are at the “market” for marriage i.e my target group.

I was supposed to go to the west, but changing area makes the age group younger and a more relevant study. FGM is not that prevalent in Uganda, but in this area almost every girl have to undergo FGM, so this will add another health and rights issue to my target group. The best thing is that now everything is kind of settled, finally. Chris will most likely make it easier to build trust with the girls i want to interview, and the practical issues have already been sorted out when we changed area; housing, interpreter and ethical clearance.

So now I’m going to Karamoja sub region, Amudat district in mid September. People have poor sanitary conditions, its a semi dessert and there is a lack of water and food due to poor crops/drought. The region is one of the worst of in Uganda to live in, and when telling people in Kampala that I’m going to Karamoja they respond: «those people don´t even put on clothes», «its the only place in Uganda that still like the real Africa», «EH! your going to become a real Ugandan», shaking their heads. Many NGO´s is doing projects so i´m really not the only one. Since 2010 it has been peaceful in the area, before there were some instability due to the fact that the tribes in the area fought over who owned the cattle.

I have never been in these kinds of conditions before, so i am very excited, and hope i can cope with the poor conditions and all the horrible stories these girls will tell me about.

Waiting…

So how is my fieldwork and data collection coming along? Well, it isn’t… I’m waiting, sort of on stand-by, ready to leave for Okhaldhunga as soon as I can. First I was sick, then the hospital director at Okhaldhunga Community Hospital isn’t currently in Okhaldhunga, and he is my contact person. My only contact person there. So now we wait… I do have some good news though, I have finally acquired a length board, yay! Also, I still don’t have cholera even though the newspaper said 3 days ago that the outbreak had now spread to my neighborhood. Thrilled to not have cholera! (Doing my best to focus on the positive…)

Finding yourself in a new setting sometimes make you see things from a different perspective and ask yourself new questions. I have asked questions I have never asked before. Like is it a good thing to have a gecko in your closet? Does it eat spiders? Will it leave gecko-poo all over my clothes? I have never previously considered the diet or the digestive functions of geckos… My conclusion: The gecko can stay. I really do hate spiders… I am also considering my relationship to time. Should I care less about time or should I take greater care not to waste it? Probably both. I should probably care less about time as something that is running out and something that is working against me, and take more care not to waste the moments that make up time. Since I can’t really do anything about this waiting situation I am currently in, I’ve decided not to be stressed about it, and just go with whatever happens.

So, for now, I’ll just stay here I Kathmandu and continue my new little life here. Getting by in Kathmandu is easy as most people speak English fairly well. I love meeting the schoolchildren on their way home, they are simply adorable and often make use of the chance to talk to a foreigner and the standard is “Hello, how are you?” and then sometimes the follow-up “I’m fine, where do you live?” Then they giggle and move on. One day I walked through a different neighborhood than I usually do and it was right around the time school finishes. A 9-10 year old girl in a school uniform starts to speak and I expect the usual, but out comes “Hello sugarbaby, you beautiful girl”. Well, that was new. She must be learning her English from quite a different source than the majority of the kids… But hey, I don’t get called beautiful that often, and, nearing 40, I don’t get referred to as a girl very often either.

Expect the unexpected

Expect the unexpected was the advice we were given before departing to various locations for fieldwork and data collection. I’m still working on getting there… I definately had a few expectations when I arrived, I had for example heard that getting an approval from the ethical board in Nepal could take a really long time, so I thought it would and that I’d probably be delayed. It only took a month and to my great surprise was the first thing settled when I arrived, I guess I forgot to expect the unexpected… Also, I thought it would be a piece of cake to find and acquire a length/height board (to measure length/height of young children) and it has turned out to be my biggest struggle and is now threatening to delay my departure for Okhaldhunga. Surprises in the other direction are so much nicer…

Nepal is actually a pretty good place I think to practice expecting the unexpected. Several things happen here without giving much notice, like the earthquakes/aftershocks and the political strikes, and you do get used to it pretty fast. The last earthquake, though it wasn’t very big, broke my fridge. I guess it had finally had enough of being shaken… It is missed, it’s really warm here now and I just loved how my fridge would have cold drinks ready for me whenever I came home. The political strikes you do hear about the day before, but they are never completely certain until you get up in the morning and see if the strike is enforced or not. Strike means you stay at home, no work, no vehicles on the road etc.

So, I might not have a length board yet but I do now have a questionnaire in Nepali ready for piloting and I even know what it says! I think… I decided to do a back translation of my questionnaire. When you, as in my case, cannot read your translated questionnaire because you don’t speak that language it is difficult to make sure the questions are really asking what you want them to ask. With the back translation these little, easily overlooked nuances were made visible to me and I could tell my local supervisor specifically what I did NOT want the question to say.

My favorites changes through the two translations are “food insecurity access scale” becoming “instrument to measure access to unsafe food” and “our house was somewhat damaged but we believe it safe to live in” becoming “our house had a little loss but less than half”. Half a house..? Not quite what I had in mind for “safe to live in”. I should mention I have more than 90 questions and both my translators did an excellent job, there will always be some things that are lost in translation and when you do two consecutive translations, well, you have all played the whispering game right?

I’ll do my best to expect the unexpected, or maybe just not expect at all. Though even if the surprises do take you by surprise, I guess what really matters is how you handle it.

On finding a research assistant

So, all of us who go to a country where we do not speak the language to do our data collection, will inevitably be very dependent on a good assistant. We see our respondents and surroundings through that assistant and equally important, our respondents see us through that assistant.

I’m going to Okhaldhunga in Nepal. Okhaldhunga I feel is a fitting name for a place in the middle of nowhere or as we say in Norway “gokk”. Let’s just say people in the capital Kathmandu are in general not the least bit excited by the prospect of wandering from house to house in the mountains in Okhaldhunga/gokk. So, the line of research assistant applicants outside my little office in Kathmandu Medical College Hospital is not very long. On the first day it consists of two girls. The first one quickly decides Okhaldhunga is not for her after all, she doesn’t say so, but I can tell. I have not heard from her since. The second one enters the room dressed in a very nice purple dress, something you might see at an evening dinner party. The dress is matched by ample jewelry and of course, high heels. I can’t help but wonder if this is her normal every day attire? She has never visited the countryside and I am wondering if she realizes how incompatible high heels and Okhaldhunga will be? Purple princess, as I call her, sits in her chair nervously giggling and her eyes are getting bigger and bigger for every sentence she hears about the job I am offering. She keeps saying that she wants to do it, but by the end of the interview her eyes are the size of saucers. Needless to say I haven’t heard back from her either.

The next day there is only one girl coming for an interview. I only need to hear a few sentences to know that she is the research assistant I am looking for. I feel it all comes down to attitude, personality and communication skills, qualifications are of comparatively less interest to me. The other girls may be entirely right for another researcher but they were not a good match with me and my project. What you need mostly in the search for a research assistant I guess is luck, it’s as simple and as difficult as that. I really am excited and happy to have found an assistant, slightly against the odds.

On being all new

I love traveling, but what I love even more is trying out living in a totally different setting from my normal life. Though it’s challenging, sometimes very challenging, and when you add fieldwork to it, well, it’s almost too much. There is a quote saying “life begins at the end of your comfort zone” and I like that quote, it makes me feel a bit better out here, far from my comfort zone. More than once have I sat on a plane going somewhere new and asked myself “WHY do I do this to myself?” One month into fieldwork here in Nepal I believe I have asked myself this a hundred times. Though in between asking that, there are those awesome moments when I absolutely love it, like when I figure out how to do something, when people understand me, when I laugh with new friends, when I take the right bus or when the shopkeeper understands my brand new, broken and mispronounced Nepali language. Most of all I love it when I start to feel a bit at home and in place. On week six I ask the question of “why” less frequently.

I have now created new routines here in Kathmandu. I eat different foods, washing is different (whether it’s myself, laundry or dishes), power is out 7-8 hours a day, shopping is different and public transport is certainly different. Yet it all starts to feel familiar and function smoothly. This is my favorite feeling of short or long term living abroad, the feeling of having figured it out and doing just fine. Also, how nice it is with a bit of change!

Of course, falling asleep to the neighbors’ daily Bollywood movie took some getting used to. If you are not familiar with Bollywood movies I’ll give you a quick introduction. Though I have never actually SEEN one, I consider myself quite familiar with them. There is always shooting, though it sounds different from shooting in American movies, more like “puff puff”. Fist fighting is mandatory, as is women screaming at regular intervals, sometimes from distress and sometimes from jealousy. It’s topped off with Indian music and I picture beautiful women dancing and some romance to go with that. At first I did not find this soundtrack to be the least bit suitable as a lullaby, but when one evening after three weeks it was not on, I felt something was wrong and it was eerily quiet. I might have to bring a Bollywood soundtrack with me home to Norway!

Some of the Challenges to know when going for field work

In the end of June 2014, I left Oslo to Tanzania for my field work. I remember when the day of departure came, I couldn’t believe that I was going to rejoin my family again after 10 months stays in Norway. Yes, I can tell you, Ihave enjoyed my stay in Tanzania especially being closer to my wife Faraja and beloved daughters Alice-Elizabeth, Jane-rose and Doreen-Faith. I have also enjoyed the whole process of data collection here in Tanzania and I am still working on my data collection. I have learned many things so far and through this engagement, I have pointed out several challenges that one need to understand and try to see how he/she can overcome especially when doing field work in the home country.

  • Finding out research participants
  • Distraction from family-social issues around the community which may cause loose in focus
  • Time management especially from the study participants (Late arrivals) due to many factors including traffic jam etc
  • Long wait of clearance from the ethical committees in developing countries
  • Costs
  • Telephone Communication with study participants (Wrong numbers or using relatives ‘phone number)
  • Distance from where the study participants come from to the study sites

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Alick Kayange, Faraja, Alice-Elizabeth, Jane-Rose, Doreen-faith and their maid Fauster

I here urge my colleagues in ICH 2014 to carefully consider these challenges related to the field work and try to see how they can overcome them from June 2015.

Facts about Ebola virus disease (EVD)

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.

  • The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
  • The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
  • The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in west Africa has involved major urban as well as rural areas.
  • Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilization.
  • Early supportive care with rehydration, symptomatic treatment improves survival. There is as yet no licensed treatment proven to neutralize the virus but a range of blood, immunological and drug therapies are under development.
  • There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation.

Source: http://www.who.int/mediacentre/factsheets/fs103/en/