Really?

Four of the top people in the Ministry of Health (two of whom we work closely with) just got fired - see article.  I wish I thought that meant things were going to get better.  Instead, I think it means the people who really have power are looking for scapegoats.
I try to write in this blog in such a way that if someone in the Ministry read it, I wouldn't get CHAI in trouble.  That is getting harder and harder every time a project we work on is undermined by politics or inaction.  It's not just the Ministry that is to blame for the way things are - far from it. President Museveni is responsible for his inaction and for allowing such rampant corruption to take place under his watch. The US government is responsible for paying workers in its aid agencies significantly better than the Ministry can pay its workers and thus siphoning off much of the talent in health to non-government roles.  The donor public as a whole is responsible for inefficiently allocating money and ignoring root causes of some key issues (interesting analysis of this).  Sadly, I don't have answers, just more questions.
I work with some really great people both in the Ministry and outside, and I wish the structures existed that would allow them to do more good more efficiently. 

Systems strengthening workshop

Picture from the MOH report on the recent training of trainers for Pima.... I have become "Mary from CHAI".  Sometimes I am Anna from CHAI. I've even gotten Annamria.  I have been asked a number of times when people hear my whole name if I am an extremely devout Catholic because apparently only an extremely devout Catholic would have a name like Ann Marie in Uganda.  

Statistics from Uganda

Sometimes plain statistics give a helpful reminder of sad realities:

Per capita total expenditure on health:  $74
Government spending on health as % of total govt spending: 10%
Density of health workers per 10,000 population: 14.3 (in the US, there are 27 doctors per 10,000 population -- in Uganda the 14.3 figure includes doctors, clinicians, nurses, nursing assistants).
Birth rate (children per women): 6.1
Under-five mortality rate: 135 per 1000 live births
Contraceptive prevalence rate: 24%
Lifetime risk of maternal death: 1 in 25
Life expectancy at birth: 54
Population: 33 million
HIV-infected population: 1.2 million
Literacy rate: 73%

Picture catch up

Between a trip to Tanzania to lead a Pima training of trainers, my family's wonderful visit to Uganda, and the beginning of the rollout of 250 Pima machines, the past month has been quite crazy.  To start the catch up, some pictures from the trip....
Lake Bunyonyi... I was trying to think of a prettier place I have been and having a really hard time.  Bunyonyi means place of little birds, and I've never seen so many amazing birds in my life.  We stayed at a wonderful community-run "resort" on an island in the middle of the lake, took a couple great hikes, and saw the best stars any of us have seen in years.

 

Gorillas in Bwindi... Ruhija (the town where we stayed) was also definitely one of the 5 prettiest places I have been.  Trekking down to the gorillas was crazy (at one point I was seriously concerned we weren't going to be able to get all 5 of us back up the jungle mountain we were trekking down), but somehow we all made it. The experience was amazing, and following around a group of enormous mountain gorillas for an hour was really unforgettable.

Murchison falls -- we got to see the spectacular waterfalls as well as the game park.  We had a lion sighting, spectacular giraffes, loads of elephants, hippos, and crocodiles a bit too close for Sam's comfort.  We could hear the hippos at night from our safari tents overlooking the Nile river.

We finished up with a couple days in Kampala shopping, eating, and hosting a party for some of my friends here.
Overall, it was a spectacular trip.  I'm not sure any of us envisioned Uganda as a great family vacation destination, but it certainly was.