Improving sanitation in Ugandan schools

Teams4U is a charity that brings volunteers from the UK to make a difference in children’s lives in countries including Bosnia, Belarus, Romania, Sierra Leone and Uganda. This was my third visit with Teams4U to the Mukongoro district of Kumi Region, Uganda, to participate in their work with schools to improve public health. In recent months Teams4U’s attention has focused on reducing the days missed from school due to sickness and diarrhoea. An intervention to improve hygiene and sanitation has been developed.

Teams4U volunteer with school children

 

 

 

Basic sanitation

There is no water supply or electricity supply to the public schools, although there is typically a hand pump installed at the perimeter of the school grounds, which is shared resource for the school and the local public. There are usually three or four pit latrines for the children to use. The latrines often have no doors for privacy and used by around 1000 children, making the smell and flies unbearable. There is no source of water nearby for hand washing.

Open pit latrine

 

When children are at home, there are also often no hand washing facilities. Each day water is carried from the nearest hand pump and stored in water containers for cooking and washing, but many homesteads lack a drum with a tap for easy hand washing. Some families are not aware of the importance of hand washing to prevent disease.

 

A typical homestead

 

 

 

 

Sanitation solutions

A ‘Tippy tap’ is a contraption that is simple to make with a small water container, rope and wooden supports. A child can easily tip the drum to let the water out by using the foot operated lever. They are suitable for use at a homestead. Some schools have been using them, although a single tippy tap is inadequate for the typical school which has over 1000 children.

 

Demonstrating the tippy tap

 

 

 

 

With support from the Welsh Government, Teams4U have begun to install simple hand washing facilities, comprising a large tank with two taps and bars of soap on string. These tanks can store sufficient hand washing water for a whole school. They still require filling by hand, but schools arrange teams of children to carry water from the pump to the tank as part of their daily chores. The tanks can be drained during holidays to allow them to be cleaned. Some schools fill their tanks with soapy water to get over the problem of soap bars going missing.

 

Hand washing using a new tank supplied and installed by Teams4U

 

 

 

 

 

The Teams4U installation also includes ‘toilet flappers’ fitted to each of the long drop latrines and signage about hand washing on the walls. The toilet flappers are simple devices that remain closed to seal off the odours and stop flies from entering the long drop. They function similarly to the flaps in the portable toilets that are used in festivals in the UK.

 

Toilet flapper to fit to a pit latrine

 

 

 

 

Volunteers get involved

The whole school also watched as Teams4U volunteers acted out a hand washing story about a Ugandan boy who does not wash his hands and becomes ill. In the story he then learns about hand washing and when to wash hands. The story features the family’s naughty goat, who causes great hilarity amongst the children when he runs amok. The use of the tippy tap is demonstrated, and the boy learns how and when to wash his hands properly. He learns to wash his hands after handling animals, after using the toilet and before meals. He finds in the future he is no longer ill.

 

Volunteers performing the play for the whole school

 

As in previous trips, the Teams4U volunteers visit a school each day for seven days. The morning activity is a physical activity intervention where all 1000 or so children take part in simple team games. In the afternoon, there are sessions for the older children that focus on puberty, development and respect for women. These have been the subjects of my previous blogs. There is also an opportunity for volunteers to play with the children. The challenge is to think of activities that overcome the language barrier and can be done with hundreds of children at a time! Successful activities include simple face painting, balloons and bubbles.

 

Teams4U volunteer face painting to entertain the school children

 

 

 

 

 

 

Click here to see a film of a volunteer entertaining the children with bubbles

https://www.facebook.com/penny.cook.75436/videos/10156365190389821/?t=1

 

The interventions with the children are supported by an education programme for the key church leaders, health care workers and senior women teachers. This is supported by funding from the Department for International Development (DFID). The training aims to provide a legacy for the ongoing education of the children in hygiene and disease prevention, dignity and respect, puberty, menstruation and sexual health.

 

Volunteers supporting the training of the teachers

 

 

 

How do we know it works?

The onus is on the charity sector to deliver an intervention that has a lasting impact. At schools we visited, there is evidence of previous well-meaning interventions that have had no impact. I asked why the schools needed Teams4U’s water drums when some had evidence of large water storage drums. I was told that the drums had been designed to collect rain water, but no one had ever installed the guttering to harvest the water. Boxes containing computers sit unopened in schools that have never had an electricity supply.

 

Volunteer in the classroom

 

In addition to the work to educate local leaders on how to sustain the benefits of the interventions, Teams4U will be collating data on school attendance in the coming weeks in order to determine whether the hygiene interventions have had an impact on absence due to diarrhoea. The aim will be to provide the intervention to all 150 primary/junior schools in the Mukongoro district. The charity has already demonstrated that its puberty and development sessions (‘Develop with Dignity’) are effective: knowledge of menstruation increased after the education sessions, and fewer girls miss school because of their periods.

 

Girls receiving washable sanitary ware as part of the Teams4U intervention

 

Get involved 

You can join in and help run the sports, ‘Develop with Dignity’ and sanitation programmes. Read more about volunteering opportunities on the Teams4U website. If you come as part of the University of Salford’s BSc Public Health and Health Promotion, you can also help us do research to evaluate the programme during a heavily subsidised 10 day trip (the students pay £200 towards the cost of the trip).

 

A powerful experience for the volunteers

It is difficult to describe the pure pleasure that these children get from a little attention from the visitors. The impact on the volunteers is also profound as we experience the simple joy that children get from a hand shake or a stream of bubbles. It is also humbling to think how we take our children’s education for granted. In Kumi, there are no staff to clean the school. The sweeping of the classrooms, the fetching of the water and the cleaning of the toilets is all done by the children. Some of the forward thinking schools grow their own vegetables, and the children also tend to these. In several of the schools we are greeted with songs of welcome. The children also sing songs that describe how seriously they take their learning in order to better their lives. We found this truly humbling.

 

Children playing team ball games as part of the Teams4U intervention

 

 

Day three and four in Uganda–training the teachers

By Penny Cook

Team work

The Teams4U motto is ‘real people making a real difference’, and one of the aims of the programme is to give the volunteers a life-changing experience. Some of the volunteers already knew each other and have done this trip before; others, like me, are new. It is amazing how quickly everyone has bonded and started to work as a real team. See my previous post for more information about the interventions. The games that we play with the children during the morning continue to be enormous fun, both for the volunteers and the children. The ‘Develop with dignity’ element has been refined and developed as we go along. The team members that deliver this element include a doctor, a nurse, a teacher as well as me. The final team member is a social worker from the local area. Fortuitously between us we have a combination of relevant skills, knowledge and experience.

Training the teachers
On day three, our usual format of our day was to be extended–after the main school programme, we went to a different school where we delivered a training session to all the senior female Primary 6 teachers in the district. The Head of Education in the district is a big supporter of the programme, and has strongly encouraged the teachers to come and facilitated their journey to the school where the training is to take place. P6 children are the target of the intervention–they can range in age from 12 up to 17 (because those who do not pass their exams do not move up to the next class). Whilst this was going on, other Team4U members did games, stories and face painting with the school children.

In the classroom with the teachers
In the classroom with the teachers

For the train the trainer session we decided to give an overview of our aims and then present the same material as we present to the children to the teachers, so that they could see exactly how we delivered the intervention. It seemed to go well and was enjoyable from my perspective. At the end we asked the teachers for their views and feedback. We had a long discussion about the other contexts of the child’s life, and how for some children there is a lack of encouragement to go to school. Some are given no money to buy the necessary equipment, many have no food for the middle of the day. Teachers commented that some children were spending the time away from school, with neither the school nor the parents knowing where they are. This potentially puts girls in situations where they are at risk of rape. Teachers often saw their school girls alone after dark–again this is risky. The teachers felt that we needed an intervention for parents, a suggestion that we agreed to take back for consideration. We had a long discussion about whether the intervention was aimed at the right age, and while there was a feeling that some children at that age were innocent (and it was tempting to ask why they needed to know about sex and condoms), there was general acceptance that children of this age can and do get pregnant. We heard a shocking story of a 9 year old girl who had given birth recently.

 

Mud huts
On the way home we stopped and visited one of the little mud hut settlements in a very rural area. A father showed us around. He allowed us to see into each hut: the smallest was where there was a simple fireplace made of stones on the floor. The cook pot rests upon stones, and the smoke is chokingly thick. Three children were in one of the other huts and the father had his own hut. His wife and baby slept in a different hut.

Children wearing gifts of school dresses brought by one of the volunteers © Penny Cook
Children wearing gifts of school dresses brought by one of the volunteers © Penny Cook
Cooking pot © Penny Cook
Cooking pot © Penny Cook

 

 

 

 

 

 

 

 

 

Day four and a Ministerial visit

The Games in the morning were great–the smile and excitement on the girls’ faces when they had a ball in their hands was just a picture, and it is so hard to put into words the satisfaction that we get from doing this. It seems to be reciprocated! The headmaster of today’s school made a special effort to tell us how important this visit was for him and the school, and a senior teacher told us that they will be adopting the games to play with the children every Monday from now on. I loved the pink uniforms in this school!

Playing games
Playing games

 

 

 

 

 

 

In this school many children received a school lunch, for which the parents have to make a modest payment. We learned that in some schools parents do not pay for lunches, and nor do they send food from home. School days are from 8am until 5pm in Uganda, which is a long time to go without food.

School dinners
School dinners

 

 

 

 

 

 

 

Other Team activities proceded as usual including the HIV counselling and testing. We have tested hundreds of people this week, both school children and their parents, and it is really good to be able to report that we have found very few people with HIV. About 7% of adults are estimated to be living with HIV in Uganda. Substantial progress has been made with testing and treating HIV, so that between the years of 2005 and 2013 the number of Aids-related deaths dropped by 19%.

Taking a small drop of blood for HIV testing
Taking a small drop of blood for HIV testing

 

 

 

 

 

 

 

In the afternoon were were honoured with a visit from Vaughan Gethin (Cabinet Secretary for Health, Wellbeing and Sport, Welsh Government) and Jon Townley (from Wales for Africa).  They were able to see Teams4U at their best, with an action-packed afternoon of HIV/AIDS & TB testing, Reproductive & Sexual Health Education, our Develop with Dignity programme; and of course, the smiles of hundreds of children having enormous fun with our enthusiastic volunteers!

L to R: Ben Omoding (T4U), Vaughan Gething (Welsh Gov), Penny Cook, Jon Townley (Wales for Africa), Ciara O'Donnell (volunteer), Father Deogratias Tembo, Sarah Sankey (volunteer), Dave Cooke (T4U founder)
L to R: Ben Omoding (T4U), Vaughan Gething (Welsh Gov), Penny Cook, Jon Townley (Wales for Africa), Ciara O’Donnell (volunteer), Father Deogratias Tembo, Sarah Sankey (volunteer), Dave Cooke (T4U founder)