Written by Give Us Wings Volunteer, Hetal Dalal

January 21st, 2010

Hetal is on her first trip with Give Us Wings though she has been a supporter in Minnesota for many years. She wrote to us from Tororo, Uganda about the progress on the new clinic that is to be built in Kayoro, a community just on the outskirts of Tororo.

When this group of volunteers arrived in Kenya almost two weeks ago, one of our first meetings was with the architect for the clinic.  He showed us the clinic plans, and Mary Steiner and several other volunteers pored over them, trying to visualize the flow of patients through the building as designed: if one room led through another, would that mean that a patient needing to go to the laboratory would have to go through another patients room? Was the overhang of the roof big enough to shade those waiting in the reception area? Could the examination rooms be made big enough for a mother to wait with her children?  Could people access the pharmacy without having to come into the clinic?  Based on these considerations, and many others, he changed the plans, and delivered another set of drawings for us.  One of the volunteers, Rachel Schmerge, helpfully cut out a bed and a person that were sized to the scale of the drawings, to help figure out questions such as whether there would be room in the clinic hallway for the families to wait, and if a patient could be brought into the clinic on a hospital bed. Our commitment was to build a small clinic, staying within the budget so that there would also be funds remaining for furniture, pharmaceutics, and other needs in the first year of operation. Some desires to change things about the plans had to be let go in exchange for the small footprint. After much consideration, and a bit of confusion with the metric system, our conclusion was that the clinic plans were satisfactory to the USA team. We would take these drawings with us to present to the community in Kayoro.

Our full team arrived in Tororo yesterday, Wednesday, January 20, and the Kayoro community was the first group we planned to meet with.  Before our meeting we did an informal tour of three of the hospitals where members of the Give Us Wings community in Tororo and Kayoro currently go to receive care.  Mary Sue House, a Nurse Practitioner and dedicated volunteer  here with us on her fourth trip, prepared us well, warning that when she was last at St. Anthony, the Catholic  hospital, she saw blood on the walls, filth on the floor, and babies and adults lying two to a bed.

Even so, I left that tour sad, angry, and sick to my stomach.  Later, much later, I remembered to be glad that we were working with the Kayoro community to spare those folks the expense of travelling the many kilometers to get care at these hellholes.  At the district hospital, run by well-meaning government folks, and a grateful recipient of GUW medical donations, we saw the infants’ ward lined up with desperately sick babies.  To my uneducated eye, many were malnourished, and suffering from many other ailments. All the babies there received the same care: an IV for dehydration, and milk.  It was clear that this was a place where people came to die, and the medical interventions to prevent death were few, and stringently doled out. The fact that any of the babies, or adult patients, for that matter, emerged from the hospital alive is a testament to the tenacity with which we humans can cling to life, even the youngest and sickest among us.

Today the Kayoro community held a meeting to welcome the Give Us Wings visitors and review plans for the clinic.  About 80 adults from the Kayoro community attended, and six people from Give Us Wings (two USA staff, Mary Steiner and Ryan Foss, and two Uganda Staff, Danis Owili and Lawi Obonyo plus two US volunteers).  We were warmly received, with singing, dancing, and that ululating vocalization from the back of the throat that was instantly familiar to me, having heard it on videos taken by others who had been here before. We met at the site of the future clinic.  The community had kindly erected a makeshift awning, made from old tarps and poles they had cut.  The sun was glaringly bright, and we were all grateful to gather under their tarps.  The site of the Kayoro clinic is currently a simple field off the side of the road leading out to Tororo. Right now the field is fragrant with wild mint, and spans two acres.  While we met with the community at the clinic site, Mary Sue House was separately working with the Kayoro Community Health Care workers.  Her plan is to conduct 3-4 days of trainings on the questions that have come up for these folks since she was last here to teach them, 18 months ago.

We started the meeting with introductions, and Mary presented Ryan to the community as the new Executive Director.  As happened with the meetings in Nyaoga, there was some confusion about Ryan’s role, and the community expressed the feeling that they needed to see Mary again, because Ryan didn’t know the “four corners” of the group and the work.  After a lot of conversation, and a talk from Ryan about his thoughts and feelings on what he had seen so far in his travels in Kenya and Uganda, I think many people understood that bringing in a new director was part of Give Us Wings commitment to stay with this community “until they have their wings and can fly.”  But the barriers to understanding are multiple: language, culture, distance, and life experience, to name a few. So we’ll have to have many more conversations like this.

William is the leader of the Kayoro Small Farmers Association, the self-help group that pre-existed Give Us Wings presence in the area. Within the GUW community, he serves as the self-appointed godfather, keeping close tabs on all that happens.  He spoke next, and thanked Give Us Wings warmly for all that we have done for the community. As Mary said, “he didn’t forget a thing, not even the sauce pans we donated ten years ago.”

The Kayoro group has divided into seven subgroups, for many reasons including ease of operations. After William’s speech, the chair-person for each of the seven groups in Kayoro community spoke, telling us their group’s name, the number of people in it, and some of the issues that they are concerned about.  One group’s chairwoman reported on the results of the money they had been given to start businesses. Small successes appear—they can now buy oil to light their houses (which they call paraffin), and other small things. She expressed the group’s hope to continue and do more and be able to pay school fees.  Mary hugged her and said that we shared that hope.  In total, there are 116 people involved in the groups: the smallest group has 10, the largest 28.  Mary told everyone how pleased she was that seven groups had seven chair-women, a change for this community which has been used to letting the men lead and speak.

All the Ugandans speaking today thanked Give Us Wings profusely at the beginning and end of their short speeches.  One group’s chairperson was the most eloquent in her gratitude, stating: “Thanks for bringing us up from the ashes where we have been buried.

Next came a short and kind speech by a man who identified himself as the Area Chairman. Mary Steiner told me that it’s a role somewhat like a local mayor. His speech was benign and mostly kind. He told us many times that he had never registered a problem with this group.

Now the fun begins. As a group, we walked the perimeter of this plot of land for the clinic. The person who sold us the land “at a good price” led the way. For the security of the long-term future of the clinic, we wanted to purchase the land, rather than receiving a donation or a local person’s permission to build on unused land. Continuing in this careful way (which it seems may not be the cultural norm here), we will wait to have a final survey of the land before construction begins.  Danis estimates that the surveying will take another month.  There was more singing and dancing, and someone reported that the group had a song and dance created for St. John’s church. Eventually we returned to the work of the meeting.

We sat again under the tarps, and Mary presented the clinic plan. She reminded the group that GUW had asked the group whether they wanted to partner with the Ugandan government and get a bigger clinic, or work to create a smaller clinic that was entirely the community’s. They chose the small clinic that was their own. Mary then told them about the church called St. Johns, located in the town of St. Paul, Minnesota. This similarity (St. John, St. Paul), caused much hilarious confusion to the translator, who by then was in his third hour of translating. St. John’s Church, she said, has been very generous, but the money they have given must build the clinic, and must also train you the community so you can be good clinic managers, and buy all the drugs for the clinic when it opens, and also pay a part of the staff salary for the first year. So Mary held up the 8 ½ x 11 sheet of paper with squares showing the clinic layout, and explained each room and what would be in it. Everybody listened attentively, but anyone who was more than two or three feet away couldn’t see a thing on the paper she was holding up.  Then she created in impromptu reenactment of what it would be like to be in the clinic. Laughing community members played the roles of patient, receptionist, and doctor, and they went through the steps from a patient entering the clinic, waiting, being received by the receptionist, seen by the doctor, given an injection, some medications, and sent home.  We all laughed a lot when the “patient” lay down on the examination table and the “doctor” seemed to actually examine her abdomen. By the end it was clear that most people there understood what was in the clinic.  Danis then paced off the length and width of the clinic, to give us all a sense of the size.

Mary asked the community if they supported this plan for building the clinic. The reaction was very positive.  I believe the decision was made to sign a contract for construction.  This wasn’t all that happened, but I’ve told the best parts.  There’s much that remains to be done, and at present, anyone who gets sick beyond what the community health care workers can handle goes without care or needs to pay a good number of shillings to get to a bad hospital in town. And there are so many hard, hard facts in the lives of these very poor people.  But there’s excitement in the air at the promise of change in this one hard fact on the way, and in the truth of the dedicated relationship between these two communities, Give Us Wings USA and the Kayoro community.