Amanda Jones was raised in the Elora area, attended high school in Fergus, and studied at the University of Guelph. She is now attaining her Master’s of Science, and is working to become a health researcher. During her education, she worked in Uganda to teach health and sex education to the children of a country that is rife with AIDs. The Advertiser asked her to offer a report of her work.
My name is Amanda Jones. I’m 27 years old. My family has lived in Elora for the past 22 years and I am a graduate from Centre Wellington District High School.
From a young age I remember my parents reading me stories about foreign countries across the globe and the people who lived in them and visited them. As a teenager, I was privileged to go on three missions trips to Guatemala, Eastern Europe and Peru. Those trips confirmed my interest in international work, but I didn’t know what my role would be.
In university I did my Bachelor of Science in Biomedical Science at the University of Guelph. Since I was interested in health studies that degree seemed like it would provide a good foundation for future schooling and opportunities.
The perfect opportunity came when I was accepted on an internship in Kenya, funded by the Canadian International Development Agency (CIDA), in partnership with Crossroads Christian Communications Inc.
For eight months, I lived in a rural children’s home in Kenya, isolated from all the comforts of home – familiar foods, internet, hot water, a car, family and friends. However, the inspiration that I received from the staff and leadership of the Mully Children’s Family (a charitable street children’s rescue organizations that helps over 1,200 children) made the sacrifices worthwhile and challenged me to grow beyond the material comforts of our society.
While I lived there I taught HIV and AIDS education to young women receiving vocational training.
Ugandan research
Currently I am a Masters of Science student in Global Health at the University of Alberta’s School of Public Health. This degree is the perfect combination of my interests in health and international work. My degree is a research-based program meaning that I conduct an extensive research project on a topic related to global health.
Since my department, the Department of Public Health Sciences, has close ties with a particular district in Uganda, they encouraged me to go there and continue in the contribution to the community.
A landlocked country in East Africa, Uganda has a history of British colonization, conflicts, and dictatorship. In 1986, Yoweri Museveni became president and brought some stability to the devastated country.
The Human Immunodeficiency Virus (HIV) infection has had a devastating impact on Ugandans. In the late 1980s and early 1990s, Uganda had the highest HIV prevalence rate in the world. Due to a multisectoral approach spearheaded by the Ugandan government, the HIV infection rate has decreased drastically.
Despite that tremendous accomplishment, the nation’s HIV prevalence rate is still high at 5.4%, placing a significant burden on Uganda’s fragile health system, not to mention the social and economic destruction caused by the disease. Uganda also faces other challenges with the one of highest number of orphans and teenage pregnancies in the world.
In fall 2008, I made my first trip to Uganda. For four months, I lived in the district capital of Fort Portal in Kabarole District. Surrounded by beautiful mountains in lush greenery and approximately 300km from the nation’s capital, Fort Portal is a trading centre with a population of about 10,000 people. Some of the high schools in the community had expressed an interest in having peer education programs started in their schools as a way of helping students get more information about essential topics such as HIV, AIDS, sexually transmitted infections (STIs) and pregnancy.
Peer education is about teaching information, values or behaviour by members of a similar age or status group. Since students have ongoing contact with each other and regularly use one another as an information source, that approach was appropriate for the schools.
Ugandan young people are particularly vulnerable to such health problems, with sexual activity starting at a young age, teenage marriage being common, and the high prevalence of the HIV infection among the general population.
Young women are often pressured to engage in “transactional relationships” with men older than them. In that relationship, he meets her material needs, which may as simple as providing soap, to as luxurious as providing her with a car. In return, she participates in a sexual relationship with him.
Such relationships and other factors contribute to young women being nine times more likely than young men to get infected with HIV. Parents are virtually silent about topics related to sex, sexuality, and sexual health. Discussing such topics is generally considered taboo. Furthermore, parents fear that if they talk with their children about sex, it will encourage them into early sexual activities. Many parents also lack basic knowledge about HIV, STIs, and similar topics.
The project
In Uganda I worked with a group of students at two schools in the Fort Portal area. The students were selected by the schools’ teachers, based on their leadership skills, interest in sexual health, and capacity to share information with their peers through various methods.
A dozen boys and 12 girls from each school, the majority of which were in the grade 10, met with me on a regular basis to discuss and plan. We began by talking about how students get information about sexual health, what their information needs are, and how they thought a peer education program should be set up in their school.
Then, together, we worked to create their school’s program. That involved extensive training by myself and other health and youth educators in the community. The training activities incorporated numerous methods aimed to promote creativity, interaction, group work, and critical thinking among the peer educators.
These are approaches not frequently used in the Ugandan education system. Each peer educator was provided with a training manual filled with information on sexual health.
Ugandan young people do not have the same easy access to the Internet and libraries that Canadian adolescents do. Thus, the manual was their primary reference tool. The peer educators worked together to design T-shirt,s complete with a logo and motto. The T-shirts had the unexpected benefit of creating increased awareness about the peer education program, further providing opportunities for the peer educators to be able to share accurate information with people in the community.
At each school, the peer educators selected a male and female teacher that they respected and trusted to provide good sexual health information. Those teachers were set up as program coordinators, to assist the peer educators with organizing activities and liaising between the peer educators and the administration.
The schools’ administrations were in full support of the program.
Overall, a participatory approach was taken with developing the peer educator program. That meant that the students were involved in the entire process, providing a significant contribution to the formation of the program.
The program would be customized to their needs and interests. The peer education program would only be successful if the students felt that it was their own program and knew how they wanted to direct it. I would not be able to remain in Uganda forever to run it, so it was essential that the students would have the motivation and initiative to keep it going.
Unfortunately, sometimes programs are created with little input from the target populations. Those programs are placed within the population and fail to thrive because either they do not meet the needs of the population, or the population feels no ownership of the project.
Before the end of my time in Uganda, the peer educators initiated a meeting between the two schools and spoke passionately about how the peer education program needed to be expanded to other schools in the district.
They discussed how they could collaborate in the future and what activities they would like to engage in. I left Uganda having confidence in the continuation of the program.
Undoubtedly the peer educators were demonstrating remarkable dedication and enthusiasm toward the peer education program. That did not go unnoticed by the school administration, which felt strongly that the program would be successful because of the students’ commitment.
Living, working in Uganda
While I was in Fort Portal, I lived in a comfortable house with my colleague and an American friend. The house was quite luxurious by local standards, but still not up to Canadian standards. Living and working in a low-income country is not without significant and unique challenges. Some of these challenges are expected, such as:
– different concepts of time;
– accent and differences in language use;
– necessity of flexibility and always having a backup plan;
– vague, conflicting, changing information (for example, several times I asked the students what day they were finishing their classes and every time I got a different response);
– slow internet connections,
– frequent electricity outages,
– standing out in the community, and
– expectations on us as a westerner.
Other challenges are not so expected, and people have to deal with them as they arise:
– unsuccessful money withdrawals but your account is still debited;
– difficulties downloading computer virus protection software;
– the computer unexpectedly dying;
– the computer unexpectedly coming back to life;
– having to hire and train replacement research assistants;
– the weather, and delays collecting research data because we could not travel by motorcycle due to rain;
– the weather, where participants arrive late because they could not walk until the rain had stopped;
– the weather, because of rain on a tin roof during a group discussion;
– no place to buy a rain coat in Fort Portal;
– changes in the research study design; and
– “spontaneous” public holidays that people fail to tell westerners about
And then there are times when westerners have done everything right and still something crazy and unexpected happens:
– I was required by the university to place my Ugandan cell phone number on the information letters I gave out to students. That led to frequent phone calls from them and their friends and their family at all times of the day and night. Often they were just calling to say hello.
– To help protect the identify of the students in the study, they each created a fake name, which they wore on a name tag and used during the group discussion. At one school I arrived a week after the first discussion – and saw the students walking around the school grounds with their name tags for all to see.
Then there are times when people just have to go with the flow: The students initiated prayers before and after group discussions.
There were also moments when I certainly was reminded that I wasn’t in Canada anymore:
– rodent control using sticky “gum”;
– avoiding angry mobs;
– discovering the greatest threat to health really is traffic;
– arguing with the power company to get electricity reconnected;
– trying to get a second set of keys cut (the new key didn’t work and the key cutting process damaged the our original key);
– attempting to learn the local language;
– constantly bartering with motorcycle drivers over prices;
– discovering the hard way which local restaurant to avoid;
– learning about “yellows,” (ripe bananas) “Blue Band,” (margarine that doesn’t require refrigeration) the “Red Pepper” (tabloid newspaper) and a “special hire” (tax).
Return to Uganda
This past fall, I was fortunate to be able to return to Uganda to do some follow up work on the peer education program. I was astounded and delighted with what I found.
The peer educators had worked together to expand the peer education program from two schools to 14 schools. They had established a district peer education program, called Peer Education Kabarole, and had registered it at the district level. Their efforts had attracted the support of location political and cultural leaders, and several times they were guests on a radio station called Voice of Toro, which has a listening audience of three million people.
On that visit I helped the peer educators to run a training workshop for 100 students with representatives from the various peer education programs. We also established a partnership with a local radio station whereby each week four peer educators would appear on a two-hour youth radio show.
What next?
Presently I am finishing the requirements for my Masters of Science. In the new year, I will be returning to Ontario for a job in global health research. The peer education programs continue to run. I hope to be doing an evaluation of them in 2010. In the meantime, I’m working to secure funding to be able to continue to equip the peer educators with tools and training so that their work will be effective and productive.
Conclusions
I truly love working in global health. Being abroad provides so many interesting opportunities and beautiful relationships. In particular, the youth that I work with continue to overwhelm me with their dedication, courage and brilliance.
In comparison to Canadians, they have so little when it comes to material goods, but the hope and persistence that they radiant challenge me to examine my life and make positive changes.
