~ AVSI ~ “Our method is presence.” -- Dr. Pippo Ciantia

“Centrality of the Person The person is the center of any development program, and the purpose of every project. This means, first of all, sharing the needs of the other, who as a unique human being desires happiness, truth, beauty, justice and freedom. The person cannot be reduced to a social category or a limitation such as poverty, disease or disability. Without this recognition of the human person—being moved by the destiny of the other—the answer to needs is merely an act of generosity or a political strategy. The very nature of the person implies relationships—first and foremost with the family and the community; consequently, AVSI assumes this context as the starting point.” * AVSI website, www.avsi-usa.org

AVSI began at the mission in Kitgum then grew to Kampala, Hoima, Gulu, and Pader, first by sustaining healthcare services then by agricultural activities, which remain the two principle pillars. “With the war, new challenges came: Sudanese refugees, displaced Acholi people, child soldiers, the hygienic conditions in the camps . . . We sustained a number of orthapoedic laboratories . . . To respond to the land mines introduced in those times and operated by the Ugandan guerillas who were arming themselves in Sudan. The hospital in Gulu thus became the main rehabilitation center for the wounded and for amputees. The presence thus responds to the various emergencies that arise. The answer does not arise from outside, but is already born there, from daily life.” -- Pippo

PMTCT training (Meeting Point and Giovanna)

Agricultural initiatives Land Mine Awareness Hepatitis E prevention

(Francesca) HIV/AIDS education

(Giovanna) Water and Sanitation (Matteo) Education/Schools (Anne) Library for Night Commuters

(Pupa, at Gov’t Hospital) Rehabilitation of child soldiers

(Lucia) Orthopoedic surgery (Giorgio

Salandini at SJH) OB/GYN (Dr. Francesca) Guinea Worm Eradication

(Pippo)

Recent History of Northern Uganda: --1971-79 – Idi Amin leads massacre of ~300,000 Acholi. Amin loses confidence after terrorist incident at Entebbe airport in 1976.-- 1979: Obote takes over-- 1985: Tito Okello (Acholi) leads coup against Obote while Yoweri Museveni of the NRA in the South organizes guerilla movement-- 1986: Museveni (from south) takes over Kampala gov’t. He is still the president of Uganda.-- 1986-2003: NRA troops from south terrorize Acholiland, while Sudanese guerillas (armed by Museveni for political reasons) make sporadic, unpredictable, and horrific attacks from the north. (Current rebel leader: Joseph Kony)2003-today: mostly stable, with little movement of rebels, but in 2005, 90% of Acholi still lived in IDP camps (Internally Displaced Persons).

“We have the person in mind, with all of his needs, even the most intimate… This is why we don’t just want to be a relief organization; we don’t just want to give aid. That isn’t our nature. . . Northern Uganda can’t remain crushed by a never-ending emergency. Even now it’s time to start setting up reconstruction.” -- Pippo

# of Meeting Point- Kitgum Clients:1990: 4 men, 12 women – all died2007: 74 men, 181 women – 4 men died; 8 women diedTotal # clients assisted: 1187 men, 2583 women

“Our method is friendship.”

“We open the office and the first thing we do is to ask God to help us live a day that will be terrible, we already know it. Somebody will die, somebody else will find out he’s sick, somebody will be orphaned. But we also discover that all this isn’t a burden. Things are lighter, more bearable, because of the friendship between us and the friendship and love between us and the sick. There is no distance, no separation. We’re all taken by the same Love… Often, without even becoming aware of it, the healthy are sick in the same way, even if not with the same virus. They’ve suffered amputations of their humanity even if they have hands and feet that are intact.” “We see the possibility of living happiness inside sickness, for however little or much time you have left.”

Health Centers Staged as 1-4, then hospitals

Community awareness (t-shirts, community events, “National Guinea Worm Day”, posters, meetings in camps, etc.)

IDP camps, re-localizations, agriculture, employment, … etc.

Healthcare is all-encompassing : work, sanitation, latrines, nutrition, hand-washing, cultural issues, polygamy (not accepted in Acholi culture but practiced anyway)

Community Health Awareness Day: Panykel Satellite Camp

Wards available: Outpatient, Maternity, Medical Ward, TB Ward, Pediatric, Surgical

Micro lab: really only tests for Malaria and does Hepatitis blood tests and TB sputum tests (but only in the mornings, 9am – Acid Fast stain for Bacilli). Other infectious diseases are a crapshoot.

Not available: anything involving technology greater than an Ultrasound or Chest X-ray, (ie, no EKG, cardiology ward, heart cath, MRI, CT, etc.)

Rufina with Mwaba John, a recent graduate of Gulu University, now with HIV complications, TB & Malaria

#1 = Malaria (mostly Plasmodium falciparan, but also p. vivax). Female anopholes mosquito

2) Hepatitis (A and E mostly, but also C?)

3) AIDS complications: TB, pneumonia (pneumocystis carinii)

Current Major Public Health Issues: Hepatitis E (Kitgum, Pader, and Gulu. Especially in

northeast. CDC and WHO are working on it along with other NGOs – AVSI is big here. Also UNHCR, NRC, MSF, etc.)

Cholera (Congo border)

Ebola (West Nile region)

Kaposi Sarcoma (22yo male with AIDS on HAART, cz: HHV8; poor thoracentesis performed)

Burkett's Lymphoma (12yo girl named Gloria, rapid development of multiple abdominal tumors. Died in 3 days)

8yo girl with severe Otitis Media with discharge and swollen lymph nodes

8yo girl, acute pyelonephritis in pediatric ward; given urinary catheter; very poorly monitored. No temp taken, no follow-up from ABs, IV drip was gone when I checked on her. (transferred to Gulu via Salandini)

Infectious diseases, probable: Salmonella typhi, Schistosomes (liver flukes), Cryptococcus (CNS entry)

Sickle cell anemia (facial malformations – look up?)

12yo girl with heart failure (dyspnea, edema). No available surgical correction, given digoxin

Peds ward: Ritual cutting on chest - infected, Mandibular abscess (infected toothache), Ringworm (tinea capita, on head),

Malaria: I.V. Quinine, Coartem, with supportive treatment: dextrose sol'n

Hepatitis E: support only, no treatment. Especially deadly for pregnant women

HIV: ARTs (a variety of combinations available)

A major project of AVSI and Meeting Point

Venues: St. Joseph’s Hospital and every village in the northern region

HIV testing, counselors, nurses

Week 1: Shadow at Meeting Point – observe PMCT training at SJH, travel to villages for follow-up visits, try to understand office management of adult HIV clients and OVC (orphans and vulnerable children) program

Week 2: Shadow Ugandan doctors and medical students in the Medical Ward at SJH; also pre-natal exams with Nurse Betty

Week 3: Attend training for “Faithful House” marriage seminar, promoting faithful marriages and strong families. Founded by Ugandan married couple (Gonzaga and Paskazia) Fantastic!

Week 4: Attend training for “Value of Life” seminar for secondary school students to be encouraged to recognize their own great dignity and to ask the most important questions about their life. The program is to promote abstinence until marriage and to continue to build up a culture torn by war. Also began data entry of ART clients on Excel for Meeting Point and visited clients

Week 5: Continue work at Meeting Point, home visits, school visits, and hospital visits for OVC and adult clients. Visit orphanage for handicapped, deaf, and former child soldiers.

Week 6: Back to AVSI-Kampala for a few days of meetings/work/seeing Kampala before leaving for US via AMS

AVSI hostel = L'Italiani, volleyball,

pasta, movies, Land Cruisers. Very bad roads –

difficult to move between villages

Locals living with fear of rebels and abduction (Joseph Kony, Sudanese border)

Youth still missing (ie, Gerald's brother)

Matteo… Karamajo (gunshots during Mr.H.O, explain)

(where real culture still exists…)

Bwola dance

War Dance -- a documentary movie on the conflict in Northern Uganda

Check out AVSI website: http://www.avsi-usa.org

Books: Irene's Eyes Kop Ango? Movie: “Great Things” documentary on Meeting

Point – Kampala Movie: The Last King of Scotland (?maybe…

gruesome, though. About the terror of Idi Amin) American NGO begun by ND grad/friend:

Resolve Uganda http://www.resolveuganda.org/