Ibuka gukaraba!

"Ibuka gukaraba," read the students in unison. Remember to wash your hands. Thirty pairs of hands clapped together and lathered pretend soap. As a class, they practiced proper hand-washing technique. 

April storm clouds hovered over the hills of up-country Burundi, but the sun still shone through the windows of the classroom. Students in beige uniforms leaned forward on their shared wood-plank desks.

Fresh from a two-week vacation, the students had filed into class to begin their new term with a health lesson from the IMO team. Even curious children without uniforms gathered in the doorways and open windows.

They learned about germs: how these tiny microscopic organisms can travel from the fields to their fingers and food and, eventually, into their body. They also learned how to prevent the spread of these germs, that open defecation increases the prevalence of this spread, and when and how to properly wash their hands.  

Some had heard the lesson the year before and were eager to answer questions; others listened with fresh ears – gaining insights which they would potentially go home to teach their brothers, sisters, and even parents. The insights may be simple, even to the youngest primary schoolers. Even so, the basic knowledge is the first step to leading healthy lives. 

Story and photos by Austin M. Price

Finding water in northwest Uganda

Uganda’s rain season may be long and plentiful, but access to clean water still doesn’t come as easily as the turn of a faucet. On a recent trip, the IMO team visited various water sources in a rural community in the isolated northwest corner of the country. Our intent was observation: to see the current state of this essential focal point in each community. 

A first glance shows the presence of water in abundance. The hills of this region are green and overpopulated with vegetation, even throughout the dusty dry season. Many have tapped into this supply with various degrees of efficiency. It’s not uncommon to see rain catchment systems or gravity-operated water pipes tapping into rain-fed springs. The government has installed boreholes near trading centers. And drainages flow like veins throughout the countryside. 

Yet even in a country that has more water than many of its arid neighbors, gathering that water remains an everyday concern for inhabitants of the area. Many boreholes break after only a few years of use, and the government often leaves it up to the villagers to raise funds for repairs (which they often cannot afford). Children then have to fetch water from the closest drainages, which can potentially be a three-kilometer hike away on steep and knotted terrain that must be traversed up to four times each day. The hours spent gathering water represents hours away from the classroom.

Among the several springs and water pumps we visited, two left long-lasting impressions. The first was a gravity-operated pipe that feeds clean water constantly, throughout the year. Even so, many of the young girls (who are often the family members tasked with collecting water) stood bare-foot in standing water as they waited for their jugs to fill. Though the water from the pipe may be clean, the drainage puddles at their feet may be host to bacteria and parasites that thrive in unsanitary, standing water. 

The second source holds a title that speaks to its current conditions: Angwii, “bad smell” in the local Alur. Though the water flows down the hillside from a probable clean source, the community fills its jugs where the water collects in a murky pool with muddy banks. Razor-sharp leaves of some sort of river cane block access to higher, cleaner banks. As we visited with some of the water-gatherers at this site, a boy led his cattle across the waters – upstream from where our hosts filled their jugs.

These days, the topic of water has entered the public discourse in a big way. In the western world, quantities may be depleting, and our habits of usage may be called into question. As our need for increased farm production grows larger, our water supply gets smaller. In the developing world, the topic of water quantity has been coupled with its quality. In light of unsanitary conditions and disease, the goal is drinking water that’s both clean and plentiful enough to sustain life.

As we work together to improve the holistic health of our world, this conversation has grown ever more necessary. This is a blue planet, after all.

Recent rapid appraisal shows what's left to be done in rural Malawi

Last month, the IMO team performed a rapid appraisal of primary and nursery school students in a rural community near Lilongwe, Malawi. In two days, local phlebotomists and employees of Child Legacy International helped the team collect over 200 blood and stool samples to ascertain the prevalence of intestinal parasites, anemia and malaria in the area. The height and weight of each child was also collected to find patterns in physical underdevelopment. 

At this time of year, the Lilongwe district pulses a vibrant green under daily thunderheads. The rains fill the fertile farmlands that stretch for miles to the mountainous border with Mozambique. But a rapid appraisal can reveal a lot about what lies beneath this verdant surface: a high percentage of intestinal parasites, which stunt growth and lead to malnutrition. Where crops may grow healthfully and quickly, children might not.

Our initial analysis showed that 60% of our sample carried some form of parasite. An appraisal marks only the beginning to IMO’s collaboration in these communities to decrease these levels and improve the standard of health. The data gathered will establish a baseline of information from which a sound strategy of intervention may be realized. Next year, IMO plans to repeat the appraisal to track the success and failures of whatever strategy may be developed.

Below are some photos showing the process of gathering and analyzing the information.

Beyond Mass Treatment

IMO's pursuit of health has manifested itself in Burundi, most recently in our fight against intestinal parasites in the rural hillside community in Bubanza that we have come to embrace.

Intestinal parasites are a major global issue. According to the World Health Organization (WHO), approximately two billion people worldwide are infected with intestinal parasites. Nearly 900 million pre-school and primary school age children live in areas where these parasites are intensively transmitted and are in need of treatment and preventive interventions.

In January of this year we performed our own testing within Bubanza to establish a baseline of information from which to plan our medical strategy and gauge its success. This Rapid Appraisal involved testing randomly selected primary school-aged children for intestinal parasites, anemia, malaria, and height-for-age and weight-for-age. The results, though alarming, were anticipated: nearly 65% tested positive for intestinal parasites, just shy of 90% were anemic, almost 35% had malaria, and on average these children were dramatically below the threshold of height and weight set by WHO.

Even more alarming than the results themselves, however, is that these same children received anthelmintic medication as part of the national anti-parasite program barely one month before our testing took place. This type of intervention – mass drug administration two or three times a year – falls in line with the current WHO recommendations towards control of intestinal parasites, but if two-thirds of the children have intestinal parasites a month after being treated for them, treatment alone is obviously not enough.

We have the unique opportunity here to go beyond mass repetitive treatment and have established the goal to do so. Our strategy is threefold:

  • Treatment of current infections with Albendazole together with vitamin A
  • Immediate prevention of (re)infection by providing each child registered in school with a pair of new, specifically-sized shoes
  • Sustained prevention of (re)infection by introducing and fostering behavioral changes through health education and instruction

This past week saw the launch of IMO's on-the-ground action towards reaching this goal in Bubanza. We started by hosting a meeting with the parents of the children registered in the hillside community's two schools. We shared the results of the testing specific to their children, we described the lifecycle of intestinal parasites and how they hinder health, and we spoke at length about the solution to this problem, including the power and ability that they themselves have to impact their health and the health of their children. The dialogue flowed both ways as the parents shared their realities of life, allowing us to turn our expertise into practical knowledge.

Saturday morning parent meeting.

Each of the 470 children in the two schools received the anthelmintic Albendazole along with vitamin A, were fitted for their new pair of shoes, and engaged in an introductory health and personal hygiene lesson. Every child also went home with a bar of soap, a hand towel, a bottle of water, and the awareness of each item’s significance.

Teaching about germs.

Teaching about the life cycle of  intestinal parasites, which includes open defecation.

Demonstrating and practicing proper hand washing technique.

Students receiving their fitted pair of shoes.

Students washing their feet before donning their new shoes.

Not only do the parents here have the desire and determination to see their children healthy, they now have the means and know-how to make it happen.

Thoughts on Sustaining Health

How does a hillside village in rural Burundi achieve health? It’s not through elaborate medical campaigns or massive treatment programs. Medical care, even of the highest quality, does not translate to sustained health. Health happens through desire, knowledge, and the means to do what is necessary.

The desire to be healthy is evident in a Saturday morning meeting we had with the parents of the schoolchildren in rural Burundi.

As they share the realities of life here, we turn our expertise into practical knowledge. As the relationship develops through this exchange, healthful behavior will evolve. 

Bunk Beds for Bethel Junior School

IMO’s “Bunk Beds for Bethel” project has finally come full circle! This project involved providing bunk beds, mattresses, pillows, blankets, and mosquito nets for the 86 boarded girls attending Bethel Junior School in Zombo, Uganda.

THANK YOU to every one who contributed to this project. Every cent given towards this project was spent directly on the purchase and transportation of the beds, mattresses and blankets.

The pictures below show the progression from empty dormitory, to the construction, painting, transportation, and delivery of these beds.