It is 5:30 a.m. when Josephine Nalugo rises and begins her day. Her first priority is getting her daughters off to school-a 1-hour journey fighting traffic through the crowded streets of Kampala. Josephine, who holds a BA in Sociology, was drawn into healthcare after struggling to maintain breastfeeding when she returned to work following the birth of her first child. Breastfeeding is the cultural norm in Uganda; however, a lack of healthcare provider support has led to lower initiation rates and early weaning. This is significant in a country where, according to the World Health Organization (2011), maternal mortality rates from postdelivery complications remain high, the infant mortality rate is 60/1,000 live births, and 50% of child deaths under 5 years of age occur from malnutrition, infection, and diarrheal illness-all conditions that are reduced by extended breastfeeding. In her desire to improve the health of women and children, Josephine earned a certificate in Infant and Young Child Feeding through the Ugandan Ministry of Health authorizing her to work with mothers and young children.
Josephine is involved in multiple programs focused on improving the welfare of women and children living in rural villages. This is an overwhelming task with more than 8 million rural Ugandans living in poverty. However, she remains undaunted in her efforts to improve the life circumstances of these women-believing each woman she impacts will reach out to another, amplifying her message. Some days Josephine coordinates immunization clinics; other days she visits mothers in their homes helping women create small business opportunities. Today Josephine is leading a mother/child support group focusing on nutrition and other health issues. She begins the 1-hour journey from Kampala to her rural hometown of Nkokonjeru. Josephine uses family connections in her village for mobilizing women to attend the home-based support groups. Today Josephine travels by car with a driver, holding her 16-month-old in her lap throughout the jarring ride. The poorly paved and pitted roads pass long stretches of farmland, past fields of plantains, yams, corn, and other subsistence crops. Women can be seen tending the fields, stooped at the waist with infants tied to their backs in traditional slings, which pull heavily at their lower backs. Other women walk the dusty roads carrying supplies and yellow jerry-cans of water balanced on their heads, infants strapped to their backs.
Josephine's first stop is at a community center to drop off supplies for a nutrition class she will be teaching to parents of children with developmental disorders. After delivering food and educational material, the driver turns off onto a poorly maintained dirt road, half washed out by recent heavy rains. Today is hot and dry; red dust surrounds the car as it bumps down the rutted road. Josephine meets Cate, a local resident and participant in the support group. Every morning Cate walks 5 km from her home, infant strapped to her back using an ergonomically designed baby carrier, to tend her plot of land. Today Cate is harvesting food to sell in the local markets, as well as vegetables to bring for Josephine's group lunch. Cate cuts down kasava (a starchy root); picks small green eggplant, sugar cane, and sweet potato; and ties it all into a bundle, which she balances on head as she walks back to the car. She is grateful for the ride-generally she walks the return distance heavily laden with her 9-month-old infant and harvested produce.
When Josephine arrives in Nkokonjeru, a group of women have gathered on the grass of her mother's home-a space large enough to host the class. The women are seated on large woven mats. The atmosphere is informal and relaxed, with mothers nursing their infants and children crawling or running through the garden. During initial meetings the women were reluctant participants because attendance meant giving up a half day of work, something they could ill afford. They were lured by the promise of a meal, and on occasion a bar of soap and a kilo of sugar. These gifts are still offered to the women as a continued enticement, and group participation has increased through word of mouth.
As the women settle in, Josephine begins the class, and her objective is to focus on breastfeeding challenges and toddler nutrition. She uses a free-standing flip chart with photos to lead the discussion. Many of the participants are illiterate, so the pictures are helpful in facilitating communication. The discussion is steered by the interests and needs of the women, and soon moves from feeding and nutrition to a variety of other health-related topics including immunizations, domestic abuse, and family planning. Many women confide they are in abusive relationships; others have been abandoned by their partners, left alone to raise large families without the means to provide for them. To address some of the difficulties the women face, Josephine includes a discussion about how to improve their economic situation. She uses Cate as an example-a woman who farms her own plot of land, growing enough food to both sell in the market as well as feed her family. Josephine introduces the concept of entrepreneurship and bartering, encouraging the women to consider sharing skills and resources to meet each other's needs. She believes the path to healthier lives is teaching the women how to become independent and self-sufficient. What begins as a lesson on nutrition ultimately leads to a broader discussion of personal growth and empowerment.
Late in the afternoon, the vegetables provided by Cate are cooked by Josephine's mother and lunch is served. Rather than lecture on hygiene, Josephine models hand washing in a bucket of water prior to serving the food. The plates are heaped high with matoke (cooked, mashed plantains), boiled kasava root, steamed eggplant, and G-nut sauce made from ground peanuts. All become quiet as mothers and children settle in to eat what may likely be their only full meal of the day. Only after every morsel of food has been consumed are the women ready to head home. With full stomachs, they receive their gifts of soap and sugar, strap infants onto their backs, and begin the long walk home, toddlers in tow. Josephine takes the luxury of spending a few minutes with her mother, whom she will not see for many days. She has a busy week ahead; home visit to mothers who are unable to travel, the community feeding workshop, a mass immunization clinic, and continued work on her baby carrier project (Happy Baby, n.d.) that spreads the message of safe and ergonomic baby carrying to Ugandan women. It is late in the day as she carries her exhausted toddler to the car and begins the long journey home. Tomorrow Josephine will continue her work of improving the lives of rural families in Uganda, one woman at a time.
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