Vol. 2, No. 5
22 June, 2009
Etop Takes Aim at Sanitation Problems in Soroti
f you believe that local media are only interested in lurid stories about sex or violence, you should visit Soroti. There, an ambitious newspaper editor and an enterprising reporter are taking on the biggest cause of disease in Uganda – poor sanitation. They began with a hard-hitting story that questioned Soroti’s reputation for being one of the cleanest jurisdictions in all of East Africa. But they didn’t stop there. Noting that sanitation practices have declined not only in town but in villages and right down to the level of individual households, they launched an ambitious project to teach readers the fundamentals of maintaining clean homesteads (See article, page 3). The two men behind these stories are Ibrahim Ogaram, editor of the New Vision newspaper Etop, and feature writer George Olupot. The two journalists disprove the perception that local media neglect health concerns and that local readers don’t care about them. “A community newspaper reader is preoccupied with health,” says Ogaram. “Every time we publish a health story, readers have treasured the information.” (For Ogaram’s views, see “Health and Community Journalism” on this page). High Stakes In his story on general sanitation, Olupot observed that Soroti has a national and international recognition for cleanliness. But beyond the main streets and public places, he reported, “decaying heaps of groundnuts shells stand like ant moulds, buveera of all colours and sizes litter the place, human dung by children and irresponsible adults is a familiar sight.” More is at stake than Soroti’s image. Unsanitary conditions directly threaten the health of residents. The city’s sewage system is in a “sorry state,” toilets are filthy, and people have trouble getting clean water, according to Ogaram. During the rainy season, Opulot wrote, “a thick dark slurry laden with maggots flows from beneath the decaying garbage to the doorsteps of the over 200 households of the nearby West cell of Kengere Ward.” In another part of town, he observed ladies dumping the dregs from drinking joints “in the middle of the road so that rainwater helps wash it away to the nearby swamp through Jerresar High School compound.” When Olupot’s story was published, “it was the talk of everybody,”
A pile of gabage in Soro/ (Photo courtesy of the New Vision).
Health and Community Journalism By Ibrahim Ogaram, Editor, Etop
hat really is the purpose of a community newspaper, especially when it is faced with challenges of circulation? How can a community newspaper stay afloat while performing its traditional roles of informing, educating, and providing a platform to readers? Etop Editor Ibrahim Ogaram
With all the challenges they face, many writers in the recent past have given up the chase for health stories. They believe health stories are boring, dull and do not sell. To them a health story is only newsworthy if it involves big personalities and is about scandals. Reporters shy away from health stories partly because editors shun them. Editors appreciate a health story if it has some sex because sex is perceived to sell papers. But when a reporter brings a tip on, say, malaria, editors tend to brush it aside. Most editors prefer political stories to health stories. (Con/nued on Page 2)
( Con/nued on Page 2)
Also in this issue: News: Model homes....................................................................................................Page 3 Resources: Nutri0on….............................................................................………………….Page 4
Uganda Health CommunicaFon Alliance P.O Box 28245, Kampala, Uganda Phone +256 414 669523
Sanitation in Soroti
Soroti Sanitation... (continued from page 1)
(continued from page 1)
Ogaram says. But people did more than talk. The residents of Soroti town now put pressure on their leaders to empty the garbage skips overflowing with refuse that accumulates uncollected for months, according to Ogaram. And Poul Omer, the LC 3 chairperson of Eastern Division in Soroti Municipality, thanked Etop for its initiative and challenged the leaders of Teso urban centers to plan sustainable garbage management systems in order to protect residents from preventable infections. Modeling Healthy Homes The answer to Uganda’s sanitation problems doesn’t lie with government alone. Reacting to the widely noted decline of cleanliness in private homes, Ogaram dispatched Olupot to find examples that would teach readers the lost art of maintaining households that keep people healthy. The reporter came back with a profile of Success Opio, a 48-year-old farmer who heads a fourhousehold compound in Opuyo Village. In vivid detail, Olupot described Opio’s immaculately maintained property and told how cleanliness has paid off for the farmer’s family. Unlike many of their neighbors, they have largely escaped preventable diseases like diarrhea and typhoid. (For Olupot’s description of Opio’s home, see “Finding the Cleanest Home in Soroti Subcounty,” page 3).
If neighbours and local leaders are forgetting the importance of cleanliness, a newspaper can help remind them The model home project recalls an earlier era when communities were more tight-knit and local leaders more effective in getting people to maintain clean homesteads. “In earlier rural communities, practice was quite different from now,” recalls Ogaram. “It was a shame and disgrace to lack a toilet, a bathroom and a clean compound. Local leaders enforced higher standards to the letter. Your health was the concern of the whole community.”
Community Journalism... Readers are fed up with too much political talk disguised as news. Yet newspapers continue to splash political stories on their front pages. Maybe this explains low newspaper readership. It is very rare for journalists to get down to communities and ask ordinary people about things that affect them directly.
A man walks past a dirty water trench in Soro/ (Photo courtesy of the New Vision)
Opio confirms that times have changed, according to Olupot’s story. “Young people no longer listen to the old people,” the farmer says. “They agree the idea of a model home is a good one but they are getting less attached to the village because of their income-generating activities based in town and the ever mushrooming trading centers.” If neighbours and local leaders are forgetting the importance of cleanliness, a newspaper can help remind them, Ogaram argues. He and Olupot are determined to keep on doing so. “The way forward is to continue writing profiles of clean homes in all the districts of Teso because when people read about a clean home they tend to do something about their not-so-well-kept-homes,” the reporter writes. “In this way the community newspaper can help move the community a step ahead in reducing the percentage of preventable-disease infections.” Olupot also plans to keep the pressure on government by exposing “the dirtiest places in town” in Amuria, Kumi, and Katakwi, just as he did in Soroti. And after that, he plans to take on the issue of nutrition; he began his preparations by traveling to Kampala to cover a recent UHCA workshop on the issue (See story, p. 4). “This is what the residents want to read, and they will directly or indirectly do something to improve the situation,” he predicts☻
Uganda Health Reporter - 22 June, 2009
Unanswered Questions A community newspaper reader is preoccupied with health. Is my feeding proper? Where will I get better health services? How do I remain healthy? How can I treat or avoid disease? Are my surroundings clean and safe? If one picked up a daily newspaper most of these questions are not answered, yet they remain the vital issues that community members want to know. Every time we publish a health story, readers have treasured the information. Sometimes health stories concerning service delivery have created emotions like fear, worry, disgust, anxiety and relief. Readers have taken on government officials to explain why drugs are lacking in their health facilities even though government has sent the money. Sometimes one has to sympathize with government officials as community members pour their frustrations on them. In most instances, our community readers are average people who have no basic information on health service provisions. We have to do a lot of explanations in our editorials clarifying certain issues and procedures to harmonize community members and their leaders. When we published a detailed health sanitation story in Soroti, it generated debate. Whether the authorities read our stories and chose to ignore or correct this anomaly is another issue. To us, we had achieved our objective to inform them. We said, “Look, there is a problem here.” At least now, there is a truck moving around collecting garbage at designated areas. Incredible! “Since we published that story, I keep wondering what more can we do for the community regarding sanitation. Well, George (Opulot) has come up with at least one model home story. Our original idea was to run many clean homes stories. I am yet to receive more from George. I am wondering whether there are any more. Trust George. He insists more are still coming☻
Sanitation in Soroti
Finding the Cleanest Home in Soroti Subcounty By George Olupot
kitchen itself as in many homes.
s I rode my old Roadmaster bicycle down the village path that leads to Success Opio’s home I noticed one unique thing. The approximately 80-meter stretch leading to the homestead had been thoroughly swept. The homestead is 20 km west of Soroti town. Opio, 48, the head of the homestead, is a widower and a peasant farmer of considerable repute in the village. Children, youth and adults all call him Mr. Smarts. Nobody remembers when exactly he was christened Smarts. All they care to know is his home is probably the cleanest in all the three parishes that constitute Soroti subcounty.
Every morning Opio collects the droppings of the poultry and pours them on the gardens as a fertilizer. The homestead’s twelve cattle are housed in a kraal three meters outside the live fence. The goats are tied to the verandah poles but are led to pasture early in the morning. Their droppings are collected every morning and poured into the rubbish pit. Etop journalist George Olupot interviews ci/zens in a village near Soro/Etop journalist George Olupot interviews ci/zens in a village near Soro/ (Photo courtesy of Interna/onal Center for Journalists)
I visited him after Knight International Health Journalism Fellow Christopher Conte organized a health journalism workshop last year to equip more than 40 journalists with skills to report accurately on health. During a field trip held as part of the workshop, Etop reporters identified many health concerns in the community. In our The perfectly swept compound is just one feature that has first meeting after the workshop, the made Success Opio’s homestead the best maintained in Teso features desk agreed to look more (Photo courtesy of the New Vision). closely at concerns about sanitation because we had learned that poor other huts. That way, everybody notices sanitation is the cause of more than 80% when somebody fails to clean up properly. of preventable infections that make people frequent health centers. We agreed that we Every Sunday morning is general cleaning. Everybody must participate. “When I say As the head of the homestead, so, nobody dares defy my directive,” says Opio remains behind to sweep Opio.
the verandahs and compound. would look at the challenges of garbage collection in Soroti town. We also decided to do profiles of model homes in the Teso region. That is what led me to Success Opio’s home. Opio’s Secret The compound is surrounded by a welltrimmed, live fence one meter high. As I stood at the two-meter opening used as a gate, I counted 15 typical African grassthatched huts. The huts were constructed forming a circle so that from any door of any hut one can see all the doors of the Uganda Health Reporter - 22 June, 2009
There are three pit latrines at the western side of the home. There are two bath shades. Their floors are made of burnt bricks laid in a pattern that allows water to flow away to a soak pit. Where the soak pit is not filled with stones it is surrounded with thorns to protect it from roaming pigs. The pit latrines and bath shades are cleaned daily. There are two urinal enclosures. One hut serves as a kitchen, and there is a rack for drying plates under the sun next to it. Several openings are punched through the wall to allow smoke to snake its way out of the kitchen. Hens are kept in a separate structure next to the kitchen, not in the
The Man of the Household As the head of the homestead, Opio does not go to the garden. Instead, as others go to weed crops, he remains behind to sweep the verandahs and compound. He carries the rubbish to its pit. “I concentrate a lot on cleaning the three pit latrines because human excreta are smelly and attract flies,” he notes. “Unless it is managed effectively, disease can spread quickly among people in the home and the community. Without a clean home and a safe latrine close to a home people are forced to live in unhealthy and unpleasant environment.”
Until about 20 years ago, ideal model homes existed in every village in Teso, according to one elder, Francis Adoput. The subcounty health inspector would regularly visit the homesteads to assess their hygienic practices and advise people on clean homes and personal hygiene. Prizes like rakes, gumboots, hoes were awarded to the cleanest homes. “Those days, people would listen to the health inspector and village elders, but these days the young people have grown less attached to the villages,” says Martine Amodoi, district health inspector. “The power of the young people challenges the influence of the elders. People are paying more attention to their incomegenerating activities.” I hope Etop can fill the gap and put hygiene back on the agenda for more households. I’m always faced with the challenge of lack of money for transport to go after such sweet-toread stories. But whether by my Roadmaster or other means, I aim to keep looking for them☻
Are We Eating Our Way Into Health Trouble? Nutrition Resources
People Dr. Robert Mwadime, Regional Senior Nutrition Advisor to the Food and Nutrition Technical Assistance Project (FANTA-2). email@example.com, 0772-517438
hen people talk about nutrition in sub-Saharan Africa, they usually focus on just one issue: under-nourishment. But in fact, malnutrition is a much more complex problem than that, and the solution will require much more than simply getting more food to more people.
Dr Geoffrey K. Bisoborwa, Country Advisor – Child and Adolescent Health and Nutrition, World Health Organization. firstname.lastname@example.org, 0772453375
That was one of the major lessons to emerge from UHCA’s 22 May workshop, “The Double Burden of Malnutrition in Uganda: Are we eating our way into health trouble?” As Dr. Robert Mwadime, Regional Senior Nutrition Advisor to the Food and Nutrition Technical Assistance Project (FANTA-2), explained it, Uganda has made slight progress against the familiar problem of under-nourishment: the percentage of stunted children has dropped only from 38% in 1995 to 35% in 2006. But a new malnutrition problem has emerged: the percentage of overweight children has jumped sharply, from 7% in 1995 to 16% in 2006. Declining under-nourishment and rising over-nourishment are parts of a “nutritional transition” that is common in developing countries. But Uganda has some unique – and discouraging – trends as well. In this country, health experts are starting to observe both stunting and over-nutrition within the same households – and even within the same people. The Uganda Puzzle In part, this paradoxical trend may simply reflect the speed of the nutritional transition. Experts also believe that as children eat more high-energy, carbohydrate-rich food and less fruit, vegetable and fiber, they are adding to their weight but not getting the nutrients they need to grow tall. Another theory may relate to “fetal programming.” When children don’t get enough nutrients in the womb and early infancy, their cells may be less able later in life to make good use of food; this may explain why stunted children are more likely than others to become obese as teenagers and adults. The observation that nutrition problems begin in the womb has important policy
Dr. Grace Nambatya Kyeyune, Director of Research, Ministry of Health. A chemist, Dr. Kyeyune is an expert on traditional medicine. gnkyeyune@yahoo. com, 041 250488.
implications, according to Dr. Mwadime. “Some of the things we ask mothers to do themselves they cannot deal with themselves,” he said. “This is a problem for the whole society.” Society is starting to step up its efforts to deal with the emerging nutrition challenges. Dr. Geoffrey Bosoborwa, country advisor – Child and Adolescent health and Nutrition for the World Health Organisation, noted that the health sector traditionally has focused on the problem of under-nutrition in children, but he said WHO is moving toward a “life course” approach that emphasizes nutrition issues at all ages. He said WHO is stepping up its efforts to monitor whether children are growing appropriately. Dr. Yusuf B. Byaruhanga, an expert in the Makerere University Department of Food Science & Technology, argued that nutrition needs to be treated as more of a mainstream issue, rather than a subject handled just by experts. “We need to take nutrition out of the clinics and universities where it is taught, the research institutions and NGOs…and make it a part of our lifestyle,” he said.
Yusuf B. Byaruhanga, PhD, Department of Food Science & Technology Makerere University. email@example.com, 0772445113 Articles Rebecca Harshbarger a journalist, reported on the rise of obesity in rural Uganda. http://www.newvision. co.ug/D/9/34/683905/rebecca%20nutrition Rachel Bahika, a nutritionist, gave basic principles of healthy eating which also applies to individuals who are HIV-positive. http://www.newvision.co.ug/D/9/ 34/680057 Rachel Bahika reported that one way to keep your immune system strong is to eat a diet rich in antioxidants. That is why eating plenty of fruits and vegetables can help you ward off infections like colds and flu. http://www.newvision.co.ug/D/9/34/ 679298/food%20and%20nutrition Dr C. Amherst Zigira Kirundo of Kisoro district, says that malnutrition crisis is looming because some parents fail to feed their children properly. http:// www.newvision.co.ug/D/8/21/644337/malnutriti on%20in%20uganda Web Sites The World Health Organisation: Calling good nutrition the “cornerstone of good health,” WHO provides general and technical information, publications, statistics, and links to topics related to health and nutrition. http://www.who.int/topics/nutrition/en/ European Community Poverty Reduction Effectiveness Program: Using case studies from Kenya, Zimbabwe and Mali, this study examines the links between basic education and food insecurity in rural areas, and gives suggestions on how basic education can be made relevant to the experiences of people in rural villages. http://www.id21.org/society/s2tn1g1.html
Dr. Grace Nambatya Kyeyune, Director of Research, Ministry of Health, echoed and expanded on those comments with an impassioned argument for taking a “wholistic” approach to health that incorporates nutrition ID21 Insights: This publication of the Institute of and traditional medicine as well as western Development Studies explores food security issues medicine☻ facing sub-Sarahan Africa, including whether African For copies of presenta/ons by Drs. Mwadime and Kyeyune, please contact us at firstname.lastname@example.org.
Uganda Health Reporter - 22 June, 2009
governments are doing enough to ensure food quality and supply, and whether international food aid programmes are effective. http://www.id21.org/ insights/insights61/index.html