People, not statistics: Health Heroes in a Ugandan Fishing Village

RTI | Int'l Dev
Jan 18, 2018 · 4 min read

By Katie G. Nelson, Guest Contributor.

A group of community drug distributors walk toward the banks of Lake Victoria in Katosi village, central Uganda. Photo Credit: RTI International/Katie Nelson.

In Katosi, a tiny fishing village in central Uganda, health volunteers, called community drug distributors, are fighting to protect their community from a harmful parasite that lurks in the rippling waters of Africa’s largest lake.

The shores of Lake Victoria in Entebbe, Uganda. Photo Credit: RTI International/Katie Nelson.

For those who call Katosi home, the threat of schistosomiasis — a parasitic infection transmitted in fresh water — is constant.

From fishing, to fetching water, to washing dishes and clothes, Lake Victoria is key to the lives and livelihoods of Katosi residents, making them more at risk for infection. Children are particularly vulnerable, leading to malnutrition, absenteeism, and impaired cognitive development. In some cases, schistosomiasis can also lead to organ damage, gastro-intestinal bleeding, and even death.

Beach cleaner Bob Shaban with a handful of freshwater snails pulled from the banks of Lake Victoria in Uganda. These small snails often harbor the parasitic flatworm that transmits schistosomiasis. Photo Credit: RTI International/Katie Nelson.

I sat down with community drug distributors in Katosi who are working to prevent and control schistosomiasis, locally known as bilharzia. With support from Uganda’s Ministry of Health and ENVISION, USAID’s global project to control and eliminate neglected tropical diseases (NTDs), they are educating their fellow neighbors about schistosomiasis prevention, and providing medicines to prevent and treat the illness.

Gerald Lutaaya

Gerald Lutaaya. Photo Credit: RTI International/Katie Nelson.

“Trainers from the [Ugandan] Ministry of Health taught us how bilharzia was transmitted, how it destroys the body and what the symptoms and signs are,” said Gerald Lutaaya. “Now, we teach the community about bilharzia.”

Lutaaya has spent the last three years as a community drug distributor, mobilizing his community to take medication for schistosomiasis and other NTDs found in Katosi.

Striking at the heart of poor and marginalized communities, NTDs are a group of diseases that affect over 1 billion people around the world. Yet these diseases can be controlled or even eliminated through multiple rounds of treatment delivered through mass treatment campaigns.

During each treatment campaign in the Katosi area, Lutaaya and his team distribute medication to between 600 and 700 people. For a sense of scale, in 2018 about 2.4 million people will be targeted for schistosomiasis treatment in 16 USAID-supported districts alone. It’s all part of an ambitious plan, led by Uganda’s Ministry of Health (MOH), to control and eliminate NTDs, including schistosomiasis, by 2020.

Dorothy Ndagire

Dorothy Ndagire. Photo Credit: RTI International/Katie Nelson.

Dorothy Ndagire has a very personal connection to schistosomiasis.

“My brother was a fisherman and stayed there,” she said, pointing toward the shoreline of Lake Victoria.

“One day, my brother had stomach pain. Then it became difficult for him to swallow. We took him to the hospital and he was just vomiting.” When she received training to be a community health worker, Ndagire realized her brother had likely died of bilharzia.

Schistosomiasis primarily affects the urinary or intestinal system, and can cause death as well as chronic illness. “We have so many who are affected [by bilharzia]. At first, they didn’t know about what they were sick with and some were dying because of the lack of medicine,” she said.

“But now, I feel very happy when I’m teaching others about bilharzia,” she said. “We are so proud of our work.”

Thanks to strong leadership from the Ministry of Health, generous donations of Praziquantel from Merck Serono, and support from partners RTI International and the Schistosomiasis Control Initiative, treatment for bilharzia is now reaching all districts at risk for the disease in Uganda.

Stanley Mayanja

Stanley Mayanja. Photo Credit: RTI International/Katie Nelson.

Stanley Mayanja said he is honored to be part of a team that is fighting schistosomiasis.

“We are taken very seriously as community health workers. We are trusted by the people,” he said.

“When people ask for our medicine, we feel we have a responsibility to provide them a service and that makes us proud, “said Stanley.

Stanley is one of more than 47,000 community drug distributors and teachers trained to support Uganda’s efforts to control and eliminate NTDs through the ENVISION project last year.

ENVISION is an eight-year project funded by the U.S. Agency for International Development (USAID) aimed at providing assistance to national NTD control programs for the control and elimination of seven targeted NTDs: lymphatic filariasis, trachoma, onchocerciasis, schistosomiasis, and three soil-transmitted helminths (roundworm, hookworm, whipworm).

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