We started with the kids in P7. Primary school goes from P1 to P7, and since kids often miss a lot of school either due to illness, their menstrual periods (girls only, obviously), or having to come out of school to work for their parents in the fields and whatnot, kids can be a variety of ages in any of the grades. The P7's were mostly probably about 13 or 14. They were pretty easy to fit, since they were old enough to pretty much get the shoes on on their own.
The method we used was we took an empty classroom and set up in there. We had three desks (with bench seats attached) and sat on the bench side, with the desk behind us. We kept spares of a bunch of sizes on the desk, and then behind the desk were big grain sacks with all the sizes of shoes in them, lined up along the wall with the smallest at the left end (size 27), all the way up to size 48 at the far right side of the room. The TOMS shoes that they distribute are (luckily) a bit more sturdy than the ones you buy in the store at home.
They have a more durable rubber bottom. All of the shoes are black canvas slip ons, there are no choices for the kids regarding style. The shoes are pretty hard to slip on, however - they do loosen up over time but for this first fitting, it was kind of a battle to get the shoes on some of the kids. This is particularly so since many of these kids have never worn shoes, and they have all sorts of blisters, calluses, and boils on their feet, some have jiggers in their feet or other infections, so it can be a huge struggle for them.
After P7 went, then P1 came in. It was pretty tricky to get the little kids to uncurl their toes and to pull the shoes onto them. We all learned how to say "push!" to get them to push their feet into the shoes. In order to get the shoe on, they really had to push the toes all the way in, and then pull the heel part up around the heel. The little kids were really cute and super excited to get the shoes.
So once we fitted a kid, we used a permanent marker to write the shoe size on their hand, then they stand in line, where they have the class list and check off each kid. This is important to keep track of the number of shoes given out and the sizes, as well as to make sure kids don't get two pairs of shoes! Another issue is that even though the distribution point is kept a secret until the team arrives (the school administrators didn't even know, so its just kind of a surprise in their day, but that sort of stuff happens a lot more often here, so its not a big deal, and since its free shoes for their kids they welcome the intervention!), kids will run home and tell siblings or friends who don't attend the school to come and get free shoes. The usual way to tell if kids are "imposters" is to survey their classmates - kids are surprisingly honest and are willing to turn in the traitors (I think they're probably afraid if people who don't actually go to school there get the shoes, we'll run out and there won't be enough!)
Anyway, following P1 cam in order P2, P3, and P4. Then we took a break for lunch (one of the team members went into the village and got chapatis, and Cait and Lacey had brought sodas for everyone), and then did the nursery kids. Not every school has a nursery, so again its important to make sure its an actual program there and not just little kids that have shown up for free shoes! Then we did P5 and P6.
Here is me fitting some kids for shoes.
Left to right: Cait, Natalie, Mary, Rachel, me, and Lacey. It was a really cool event to take part in, and I'll be doing two more distributions, on Monday the 25th and Tuesday the 26th, when I'm staying in Bududa with Cait and Lacey. Of course, I don't know what school we'll be doing yet - its top secret!
Yesterday, Rachel and I went to the clinic run by Jan (woman whose hospice in Mbale we went to last Friday on the way to Jinja), at Basunguwyi (not sure on that spelling). Her clinic was just getting a fridge for vaccines and medicines that people brought from the UK, so we got roped into a little project for that. Since they couldn't turn it on for 24 hours after transit, they needed to turn it on this morning. However, these people had a flight to catch in Kampala or something and they couldn't wait so long for it to cool after they turned it on, so Rachel and I took a boda this morning at 6:30 to the clinic, so we got there just before 7, and turned on the fridge. That way, when they could get to the clinic from Mbale around 8:30, it would be well on its way to being cool, so they could make sure it worked before having to head back to Kampala. The clinic was just interesting to see how another set up runs. Jan (the doc from the UK) clearly gets infuriated with the level of her clinicians quite frequently - which I could understand since the residents here have expressed the same thing quite often.
Rachel examined some patients, including a girl with an umbilical hernia (she was 5, so it would need to be removed surgically) and a woman with mastitis of her breast (it was her first baby, and they waited 6 days for her to come in, so she probably needs a surgery now too, she was referred to Mbale Regional Hospital). The last patient we saw was a boy who had allegedly had convulsions, yet the father couldn't accurately describe how he had convulsed, what it had looked like, how long they lasted, when they were, how many he'd had etc. Jan got kind of mad, and wanted to know how he expected her to treat the boy when he wouldn't tell her a proper history! History giving and taking here is just a lot different than in the states/UK/etc, but it really does need to be brought up to speed in order to be effective.
Yesterday after clinic, we presented on articles. The girls need to do a certain amount of "academic" stuff for their residency while they are here, and so they have been doing presentations on different developing world health topics. I gave my talk yesterday, about international organizations and NGOs, and focused on the Millennium Development Goals, particularly goals 4 and 5 (focusing on maternal and child health and development).
Today was more presentations in the morning (I just had to do the one, since I don't have any specific requirements!), after Rachel and my trek to Jan's clinic to turn on the fridge! We were back by about 8, and this morning was unbelievably buggy. There were mosquitoes everywhere!! It rained last night (hadn't rained in a few days, everyone had said March would be the rainy season, but its not here yet. I guess its coming in late!) so maybe that contributed to the bug situation. I was lighting mosquito coils everywhere and spraying bug spray and even like the toxic spray that kills everything including you if you stay in the house with it! By the time we started presentations they had lessened a bit.
I went over the plans for Girls' Group with Lisa, and she really liked my ideas to have it meet bimonthly with one meeting a month to be a lecture/discussion, and the other meeting an activity (still with a health learning/self-esteem goal in mind, of course). The focus of the group will be more correctly shifted to be a health education group, and the funding (100,000 shillings/month, or about $45) will be used for supplies, speakers, and excursions, and not for gifts, as had been happening in the past. I spent most of the afternoon laying out my curriculum. In April after my trips (I'll pretty much be away from this Saturday, March 24 until April 11!) I'll be doing a lot of data entry of the baseline data from the clinic before Doug and Lisa arrived so we can tabulate more mathematically how the clinic and the population were doing before. Then we'll start collecting data on patients in the same manner to compare 2012 to the 2010 data that I'll be organizing on the computer. She said if it gets published, that my name would be on it, too, so that's pretty cool.
Then in the very late part of the afternoon, we showed these clinician training videos that a friend of Lisa's sent for part of a research project that she is doing. These videos were all about newborn medical care (care for the umbilical cord (it showed an umbilical hernia, so it was cool I just saw one in person the day before today!), physical exam stuff, weight and nutrition, etc.). We showed 5 of them (about 5-6 minutes each) to the staff, and then led a focus group for them to discuss the videos and give any suggestions, what they liked or didn't like, etc. In the video, whenever it mentioned referring to a larger health center, they showed this dillapidated old green van that caused all of the staff to laugh whenever they saw it. I thought this was pretty funny, since our only form of transport is a boda boda (like when the pregnant woman arrived here in labor at 8:30 PM, she had to take a boda to Migale Hospital), an old van is at least better than that! They all said they liked the videos, and I think that since video is pretty new and rare here, its a good learning tool for our staff.
Now I'm just sitting on our back porch, having a cup of tea and watching another uhhhhmazing Ugandan sunset. I wished I had my camera this morning on our boda ride, since the sunrise was just amazing (our sunrises here aren't so spectacular since they have to rise up over the HUGE mountain out our front door, so by the time you actually see the sun its already super bright, also because I'm usually still asleep when it happens since my room has a Westward facing window!). Tomorrow is the girls' last day here so we'll probably be in clinic and will also be showing more of the clinician videos for that project. When I'm in Bududa next week, part of my job will be showing the videos to the clinicians and the FIMRC clinic and leading the focus group there as well.
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I loved your account of the shoe distribution. Although a far cry from the days of buying shoes for YOU at Bernards, it sounds like it was pretty organized and SO EXCITING for the kids. Kids everywhere love new shoes, I guess.
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