Uganda In Covid-19 Times: OVAAT’s Role During The Pandemic
“Empowering one village at a time, solving a problem at a time in a village, it can spread into total development of the society,” — OVAAT’s vision
Last year, SOGH brought you an article reporting the impact of Covid-19 on maternal health in Uganda. Today, we are traveling back to Uganda and we will be seeing the current situation through the eyes of one of SOGH’s partners, One Village At A Time (OVAAT). In today’s blog post, I interview Moses Kyangwa, a public health scientist and director of OVAAT, a non-governmental organization operating in Uganda. Moses, takes us on a journey, detailing OVAAT’s role during the pandemic in Uganda.
SOGH: Thank you for the opportunity to discuss about OVAAT’s role during the pandemic, Moses. Firstly, could you describe the Covid-19 situation in Uganda?
Moses Kyangwa: The pandemic in Uganda has been in different waves, just like other countries. Currently, we are in wave 3, getting to wave 4. Uganda Virus Research Institute has identified Indian, South African and UK variants of the virus in the country. The measures that the government has activated are according to WHO guidelines: lockdown measures, isolation, hand sanitizing, social distancing, avoiding of crowds. Recently, vaccination began but it has been faced with hesitancy. We are using Astra-Zeneca. I think the biggest challenge in Uganda is that Covid-19 was politicized. Most Ugandans thought it was political business. During the past wave, not many people died here, unlike UK and US, and this further fueled people’s disbelief. It was around May this year that the current wave began and there was a spike in cases. Nearly 80,000+ people in Uganda have been diagnosed with Covid-19. And the fatality is at 1.4%.
SOGH: You mentioned that many doubt the virus’ existence. Now that cases have started manifesting at a rapid rate in Uganda, has there been a change? Are people still in doubt?
MK: Yes, they are. I believe the challenge is information. Some communities, especially urban areas access information from televisions, newspapers, but the rural communities lack these. Some people who have not gotten information about the virus believe that it is witchcraft or something else. What worsens the situation is that, with this new wave, some people are dying without showing clinical signs of Covid-19. This makes the rural community think they are dying of other issues like stress or hypertension. Also, because of the lockdown, some people think people are dying from starvation. In summary, not everyone, especially in the rural communities have a clear understanding of what Covid-19 is and how it kills, much as they are dying.
SOGH: Considering how knowledge is important in the fight against the pandemic, what is the government doing to educate Ugandans?
MK: The government does not have the capacity to reach the most rural person. They have been working through the healthcare systems which include the village health teams (VHTs), but they have not been sensitized. This pandemic took the country unaware. It is now a year and half but the government has not yet recovered. We successfully managed Ebola but Covid-19 has been difficult because there are a lot of myths. The government has information but resources are lacking. Even having transportation to the rural communities is a challenge. Some health workers, volunteers, VHTs have left work because they feel insecure. Most facilities don’t have protective gears. The weight is now on the private sector. At OVAAT, we are trying to do whatever we can to bridge the gap, but it is too big to handle because of limited resources.
SOGH: Are there any obstacles to the vaccination process in Uganda?
MK: In Uganda, there are two challenges regarding vaccination. First, is vaccine hesitancy. A few Ugandans have access to information claiming that deaths in Europe are due to the vaccine. These Ugandans keep spreading this negative information, causing increased skepticism. Nonetheless, when the second wave began in Uganda, more people started responding to vaccination. The first priority group were the frontline workers and elderly. But the second wave started claiming young ones, so the priority group has expanded to teachers (who interact with pupils) and places of business, like hotels (where interaction is high). This brings me to the second challenge – The country does not have enough funds to vaccinate every Ugandan. Uganda got some support from China, but only a few of us have been vaccinated fully. Currently, we do not have enough vaccines.
SOGH: Thanks for the information about Covid-19 in Uganda. Can you tell us a little about OVAAT and the work that you do?
MK: OVAAT is One Village At A Time and it arose from our vision. We thought that by empowering one village at a time, solving a problem at a time in a village, it can spread into total development of the society. So, our aim was to have villages which take girl empowerment as a political issue. Our main focus is the girl, because she is the most vulnerable person in our country. We aim to transform the villages into centers where the community members can come to plan, but also, students from abroad can come to learn. And so, we started a health center, which implements maternal and child health interventions. The center is based in Luuka district. It is a sugarcane growing area and here, girls are constantly victims of gender-based violence. With this center, we thought to attend to some of these issues. At OVAAT, we have a training opportunity for girls and women in the area. We also offer STDs treatment, screenings and referral services. Most importantly, we have a vocational center where we impart girls with skills. Prior Covid-19, we held meetings monthly with girls. Nonetheless, the center under OVAAT continues to attend to girls who want our services which center around sexual and reproductive health (SRH). We have a nurse, health workers and we work with communities to serve the society. In summary, it is a referral and training center that provides healthcare and training services, to empower the community.
SOGH: You just mentioned that you have not been holding meetings due to the pandemic. What are the other ways the pandemic has affected your work?
MK: Our community has been affected by Covid-19 and most surrounding health facilities are not in operation. OVAAT health center has become the only center that is running. This means we have been overwhelmed by a lot of people, especially mothers coming to deliver from other centers. And with the facilities we have, we are not prepared for such a high influx. Because most of the girls are out-of-school, there is high occurrence of teenage pregnancy. This center is the place all of them run to, for examination and care. Those who have STIs also come to this center. This puts a lot of strain on the minimal facilities we have and we end up using most of our supplies in a very short time. Some of our regulars (girls who visit monthly for our services) have contracted Covid-19, and they have been on home care. They are being supported. Thankfully, some of them are waking up and the recovery is really high. But the main challenges are these: Some of the girls who have been getting treatment, those who come for HIV services, and other STDs treatments, they find it difficult to get to us because of the lockdown. Some of them cannot move from their homes to the center; And then, the community health workers (CHWs) and the VHTs, who connect us to the communities, are limited by the pandemic too.
SOGH: Due to the fact that most community health centers are closed, the OVAAT center is receiving a high influx of pregnant women and young girls. Is it right to conclude that currently, the sexual and reproductive healthcare system in Uganda is crippling and Covid-19 is taking its toll on the system?
MK: Yes, the system is crippled. But because this center was purely created for maternal and child healthcare, most of the people around this community come here because these are emergencies you can’t dodge. You can’t pretend about giving birth. You can’t postpone a child getting sick. Our target has been surpassed, so our capacity is really constrained. We cannot manage the numbers but again, our center is the only source of relief. Because the center has been known for taking care of girls, and because we have a youth resource center, the girls keep coming. We have also tried to engage the government. We recently got an extra nurse to help out with nursing care, counseling and also attend to girls during STIs screening.
SOGH: What measures have OVAAT been taking to manage Covid-19 while you are doing your work? What interventions do you have planned out or have you started implementing?
MK: The first thing we’ve done as OVAAT is training. We organized virtual trainings for our health workers with experts from the National Covid-19 task forces. We also supported the facilitation of the vaccination. When our district got vaccines, we provided transport for the vaccination team. Our center was one of the centers that offered the two rounds of vaccination. Unfortunately, the vaccines were not enough. People keep coming but we don’t have right now. We also provided equipment – hand washing facilities and soap to nearby communities. At one point, SOGH fundraised for us and the funds were used to purchase soap which we gave to the girls who seek care at the center. We’ve been able to teach them about protection according to the standard operating procedure, that is, putting on their masks, washing their hands, social distancing. Currently, while we continue the training, we have also talked to some of the district officers, to provide training materials and sign posters for some training centers, to educate people.
We want to keep educating about the virus. This is why the interventions we are planning are geared towards that. In the training centers, we want to put megaphones and community radios, through which we can disseminate information daily, using the local language, encouraging the community to follow the SOPs. We are currently trying to seek out support to do this. Since the country is on lockdown and people are at home, we want to start a mobile community clinic that will move around sensitizing the community. And I know the Ministry of Health and the district will join us in doing this. The government of Uganda has well-trained staff and the community members, but the challenge is sometimes facilitation of the activities to reach out and provide services to the community.
SOGH: Besides the pressure caused by the high influx of patients, have there been any more challenges? Has OVAAT been able to overcome them? If yes, how?
MK: We have faced quite a number of challenges. Firstly, we have a small maternity wing where we keep mothers who have delivered and those waiting to go for delivery. Now, with social distancing, we are not able to follow that. Also, we do not have protective gears for the patients. They mostly come in without masks and we need to give them disposable masks. We did not plan for this in our budget. Sometimes, we engage the nearby communities, the stakeholders, and we have tried to partner with the local organizations that may have sanitizers and hand-washing facilities to support. Some well-wishers have given us some sanitizers. Although they are not enough, they have been helpful in handling cases that we deem risky.
Another challenge is information. We have the information but the means to give it out without contact with people is nonexistent. We thought we would have opportunities like radios, phone calls to our clients, but we are limited in facilitating this particular intervention. We also try to talk to the VHTs, to reach out to these communities.
And another thing: The center was prepared for mild cases but we get patients with severe illnesses. Because of the situation, referral system has become a bit of a challenge. Luckily, in our area, there are honorable members of parliament who have helped out, enabling us to take some of these patients to higher-level facilities. This still poses a challenge sometimes because clients have no money to facilitate their treatment.
SOGH: The focus of OVAAT center is SRH. Still, now that other health centers are closed, do people with unrelated diseases come to the center?
MK: Yes. Although we are renowned for maternal, child health, sexual, reproductive and STI interventions, people also come to our center for other illnesses, especially since it is a Level three facility now. We try to manage them and give some support.
SOGH: How has your work evolved due to the virus? For instance, I am sure the vocational center is not open currently. So, what new areas have you focused on? What new methods have OVAAT explored?
MK: For now, we have introduced voucher engagements with some clients, especially for the girls who have been coming in routinely. We’ve collected some contacts. So, the nurses call those who miss an appointment. There are those who are bedridden at home, and they’re not able to come to the center, so, sometimes we send the drugs through their peers. Still, this is not a perfect method.
We have also resorted to holding sessions. We’ve categorized clients to reduce the people present at a time at the center. Mondays and Wednesdays are for teenagers, young girls and adolescent women, to visit the SRH clinic. We fixed Thursday for mothers who require antenatal care. There are things we can’t categorize like deliveries. These are emergencies you can’t postpone. We have a designated midwife for deliveries, and the clinical research supports.
The pandemic has not stopped us, We even got permission from the local authorities so we can travel and move in the rural areas.
SOGH: You mentioned a lack of PPE at the center. What other resources is OVAAT lacking that will assist your work?
MK: Yes, we need a lot of resources, such as, personal protection equipment, gloves, masks, special glasses for the midwives, hand wash, sanitizers and hand washing facilities.
For information dissemination, we also need information and communication materials, in the local language, which we can put in the center. And another thing is communication gadgets. As a facility we need to have our own Zoom account, so that we can have meetings and attend trainings. We need access to telecommunication services so that we can reach out to people.
Very importantly, we have to increase our space. It would be good to have, perhaps, a tent outside the center, where people could get treatment. This would reduce congestion.
Acquiring a loudspeaker or community radio would also be very helpful. We would be able to talk about the virus, with the community as an audience. I think it would be something that adds value to what we are currently struggling with.
Despite the difficult times Uganda is facing, organizations like OVAAT are still stepping up and trying their possible best to keep helping. The situation is not easy and resources are limited. This is why they need our help. It is in the same vein that our board members who are graduating this year have decided that the best way you can congratulate them is by donating to our fundraiser, in support of OVAAT:
We need to help the health workers in Uganda continue their work safely. We need to help each other. Distant but together.
If you have any inquiries about how to help out some more, send an email to firstname.lastname@example.org.
By: Avwerosuoghene Onobrakpeya