Every time I visit a new place, I find myself seeking glimpses of Zimbabwe, my beautiful home country.
I was thinking of this last summer, when I traveled to Uganda with a Stanford research team. We were investigating ways to sustain a clean water supply and maintain safe hand hygiene practices in rural health facilities where funding is scarce and piping systems inadequate.
Uganda was the first African country besides my own that I had ever lived in. It's more than 1,400 miles away from Zimbabwe, with its own history, languages and cultures that are distinct from those of Zimbabwe. However, as with all of my travels, I felt flashes of familiarity.
My glimpses of home showed up at unexpected times. When interviewees assumed I was a fellow Ugandan and firmly shook my hand with the Runyankore greeting "Agandi!". When I debated with my Ugandan colleagues about political phenomena so similar to what I knew in Zimbabwe. And unexpectedly, when the Stanford team made dinner together while listening to the new Lion King album and making plans to watch the Disney hit.
Additionally, because I feel that our project is relevant to Zimbabwe, I was keen to acquire experiences and information that could help equip me to do impactful work at home.
As in Uganda, health centers in my country often must make do with untreated water and a lack of sterilization equipment, circumstances that lead to infections and disease that should otherwise be preventable.
During our two months of research, I came to understand some of the reasons behind these struggles in Zimbabwe, Uganda and other developing countries. These ranged from inadequate funding to logistical issues, like the distance of a health facility from a water treatment plant. I also learned a lot about different approaches for tackling the problems. These included local politicians advocating for their districts to government entities, demonstrating to communities the importance of hand hygiene and partnering with NGOs to apply novel water engineering techniques for accommodating difficult terrain.
One voice that has stayed with me is that of a midwife who works at a health facility in Mbarara district.
Although she and fellow midwives used to boil drinking water for patients at their homes, they stopped this practice because it was so fuel-consuming. Looking to the future, she suggested the inexpensive use of ultraviolet filtration as an alternative way of providing clean drinking water, a solution that would likely rely -- at least in part -- on foreign help.
As I left, she said, "Remember to advocate for us."
Her words have played over and over in my mind. In asking me to advocate for her clinic, she wanted my research team to use our influence as an organization from another country to bring about change -- to help secure better funding or equipment repairs or make something else important happen.
But I found myself thinking about other solutions described by our interviewees -- ways local communities could take more control and exercise more ownership when it comes to improving conditions. Sometimes their suggestions were as straightforward as empowering a good, reliable leader on clean water issues, or assigning locals to educate their peers about the impact handwashing can have on health.
In our research, we saw examples of how foreign funding for local initiatives can introduce a problem of sustainability. In one instance, health facilities in Mbarara district had received water filtration systems from foreign agencies; but within a year, the systems had fallen into disrepair because there were no trained personnel to maintain them or fix problems.
However, I also saw local efforts that could expand their scale with help from foreign funding. There was the small hospital in Kisiizi that makes its own alcohol-based hand rub rather than buying hand sanitizer. And there were the champions of HIV/AIDS and hygiene issues employed by the Uganda government to raise awareness in local communities. Why not capitalize on these types of existing features to better ensure sustainability of projects aimed at improving people's health?
As I prepare for a career in global health, I plan to continue examining these issues. My goal is to give back as much as I can to the health system of my home country, Zimbabwe; and in order to identify long-term solutions, I believe local needs must be honored and local voices must be heard.
Dumisile Mphamba is a junior at Stanford majoring in medical anthropology. Harika Kottakota is a senior at Stanford majoring in molecular biology with minors in human rights and African studies.
"Clean Water for Health in Uganda" is a series providing insights from a research project, the Sustainability of WASH Services in Rural Healthcare Facilities in Uganda, which is led by Stanford's Program on Water, Health and Development. Mphamba and Kottakota were supported by the Stanford King Center on Global Development's Summer Undergraduate Field Research Assistant Program.
Photo of Kisiizi Hospital in Uganda by Harika Kottakota