Wisconsin Public Television University Place Wednesday Nite at the Lab  Melissa Bruenig, HIV/AIDS Education Across America  March 23, 2011 UP570     cc >> Tom Zinnen: Welcome everybody to Wednesday Nite at the Lab. I'm Tom Zinnen. I work here at the University of Wisconsin-Madison Biotech Center and for UW Extension, Cooperative Extension. On behalf of our partners, the Wisconsin Alumni Association and Wisconsin Public Television, thanks for coming to Wednesday Nite at the Lab. We do this every Wednesday night 50 times a year. Tonight I'm delighted to be able to introduce to you Professor James Ntambi of the Department of Biochemistry, who is going to introduce our speaker. If you would like to come up and say hello. Yes, this is you now.  >> James Ntambi: Okay, thank you. >> If you stand right here. 

Three years of doing this, and this is the spot. >> That's the spot right here. Okay. My name is James Ntambi, professor in biochemistry, Department of Biochemistry here, and also Department of Nutritional Sciences. I'm very glad to introduce to you Melissa Bruenig. She was one of the students that traveled with us to Uganda in December/January of this year as part of our international program. So she's going to talk about her experience in Uganda, and I'll tell you a little bit more about this course. I think she's going to have to show you the first and second slides, I'm assuming. She's a major in genetics here in the College of Agriculture and Life Sciences. And she's also involved in the research, stem cell research, the Wisconsin Institute of Discovery. 

So she's doing both research, major in genetics and also, in addition, doing international experience. So why don't you show the first slide. >> Okay. [applause] >> Melissa Bruenig: Like James said, my name is Melissa. Tonight, we're going to talk about HIV/AIDS education across Uganda. So like he said, I was a part of the CALS Study Abroad program. What's interesting about this program is we don't just go to another university and take courses. It's more like a field study. And we get a chance to look at specific topics we're interested in. So that's what I'm going to be telling you about this evening. 

First of all, I thought we should look at, where is Uganda? So it is in Africa. You can see it is right here in the circled red dot. We'll do a little blow-up of it. So Uganda is central or the central eastern portion of Africa. So that's where we went. And you might be wondering why choose Uganda to study abroad in? One of the reasons is the university here has a really long-standing partnership with Makerere University, which is in Kampala, Uganda. It's actually where James did his undergrad and taught for a while, too. Also, the program gives us a better chance to understand the healthcare and nutrition that is in the country, and I specifically looked at HIV/AIDS. And the last is it's a life-changing experience. Once you go, you come back and you've witnessed things that you never would have seen before, and it's actually made me reconsider a little bit what I want to do with my life. 

Instead of just doing research and genetics, I've decided that I want to broaden my horizons a little bit more to the ideas of global health and it's sounding like CALS is going to have a certificate program in that, which I think I'm going to try and become a part of. And with that, James is going to give a little history of the program. >> Ntambi: Yes. Let me tell you how this program started. So we started this program about ten years ago when a Professor Ken Shapiro was the Associate Dean of International Programs. We decided that we should start a program so that we could provide international experience to our undergrads, undergraduate students. We established a course entitled "International Health and Nutrition." So the way we designed this course was to teach this course in the fall and then have it followed with a field experience, as Melissa mentioned. So we would talk about aspects of nutrition, public health, talk about HIV/AIDS, talk about agriculture. This is College of Agriculture and Life Sciences. Talk about culture. 

Talk about education. Talk about women issues. Talk about issues that affect the lives of people who live in developing countries. So when we started this course, we started off by recruiting 15 students at that time, and the idea was to take the course here locally initially as I described, and then during the winter break, take a field trip to Uganda. And since this course was focusing mainly on nutrition and public health, we would go in there, and we were more interested in things that were happening deep in the communities. So that's some kind of outreach activity. We have some understanding with Makerere University, the major university in Uganda, and we have collaborators over there. But when we go there, we don't really stay at the university. We stay in the guest house, but then we do extension work. We go deep into the villages to look at the real issues of nutrition. 

And mainly we are interested in looking at malnutrition. We visit our clinics, children under five who are malnourished. And so the idea is to show the students that I teach what we teach here, the real-life experiences. What is malnutrition? What is Kwashiorkor, which is a protein deficiency disease, what is Marasmus, which is an energy deficiency disease. These are some of the aspects of nutritional biochemistry that we talk about in the classroom. But I thought it would be a good idea if I took the students so they can see the real people who have these conditions. Should sit around and talk about the biochemistry or the nutritional biochemistry that is involved. So this was the intent, to try and give the students hands-on experiences. The other component, in addition to doing or visiting these places, is that the students would have a hands-on experience. So they would also participate in making the lives of the individuals that they see or they visit better. 

How do they design good diets for the kids who are malnourished. How do they improve the quality of water that the individuals that they see drink. So in the added parts of the course, I think in 2005, that group, when they came back here, they actually set up the nonprofit organization, which is called the Health Village Project, that sort of is interested in extending what, you know, the materials that we do over there. They go back in and build water tanks, make water filters to sort of improve or to -- so that the people over there can have access to good drinking water. So this project is a student organization. The students run this organization themselves. It's a nonprofit. They find ways, they write grants, and they support other students who are interested in going back to Uganda to look at these issues in public health. So that was the idea behind this course, and we've been running it for the last nine years. And it continues. 

It also -- it also takes -- an exchange going on between the faculty at Makerere University and the faculty here at UW, the students there. It is really in a way, it's a two-way traffic. So we're not only sending students from UW-Madison over there, but we also want the people over there to come here on short visits to see what this university is doing. And, of course, our intent is to sort of better the lives of people who live in developing countries. So you can continue with the presentation. >> Bruenig: Thanks, James. All right. So as he said, we get to look at the topics that interest us ourselves. So the reason why I chose HIV/AIDS education was because the transmission rate is still quite high and the epidemic is continuing. I just thought it would be good to see how developing countries are dealing with this. 

So the general question that I asked while I was over there was what kinds of educational or prevention programs are available to teach the public about HIV/AIDS. More specifically, I wanted to know what types of programs are they having. What are they doing? Do they just have handouts or posters? Are there group gatherings, counseling, different types of government programs, or is it more word-of-mouth between people? So they have these methods of sharing with people. What are they actually telling them? Were they talking about the ABCs, which I'll explain in a little bit, or what other type of prevention is actually being taught? First, I thought we could clarify, what is HIV/AIDS? According to the Mayo Clinic, AIDS is a chronic potentially life-threatening condition caused by the human immunodeficiency virus. That's where HIV comes from. And it works by damaging your immune system or your body's ability to fight organisms that cause disease or other infections. The disease is usually sexually transmitted, and it can even take years before HIV weakens your immune system enough until you get full-blown AIDS. I feel it's important to also discuss that sexual transmission is not the only way that HIV is spread. It can also be spread by contact with infected blood or even from mothers to child during pregnancy, childbirth and even through breast-feeding. So what is historic about HIV/AIDS education in Uganda? They were actually one of the first African countries to successfully implement an effective prevention program. 

This was done under still current President Museveni, who was re-elected this February. And what they did was they launched an aggressive campaign that involved the media, teachers and community leaders. The reasons why these all worked is because they emphasized the ideas of waiting before having sex, staying with a specific partner or no grazing, and for those who did not abstain, they were encouraged to use condoms, and that was actually targeted at the entire population and not just those specific people who really indulge in risky behavior. So one of the reasons why this campaign works so well is because all of the things that they incited in the people were ways to avoid risk or risk behaviors. And what was great about it is this helped reduce the rate of HIV in Uganda in the 1980s, which was a little greater than 30% to the national prevalence is down to about 6.2. So that's a really great reduction. I'd mentioned those ABCs before as one of the potential messages that they were sharing. This billboard I didn't see when I was over there in December. It's from Botswana, which is another African country. Is says, "Avoiding AIDS. 

As easy as ABC." A stands for abstain. B, be faithful and C, condomize. These are what some of the early billboards looked like when they were doing that first major push to help reduce the rate of HIV transmission. The message of ABC can sometimes be worded slightly different than what you see on the screen right now. But it's all generally the same message. It may depend on who is funding the billboard you're looking at, too. Before I get into looking at the different health centers and hospitals we went to, I thought I would mention what their healthcare system looks like because it's structured kind of different than our own. So you can see here that the arrows are all pointing upwards instead of down. So people start by going to their local village health center. Here it may just be one person, a nurse in a clinic that they can go to. 

If they can't be treated there, they get referred up and up. So we'll start the village health, and then you go up to a Health Center 2, which is the lowest, then 3, 4, and then finally you can be referred to a district hospital or regional referral hospital or finally the national referral hospital. The national referral hospital is in Kampala, the capital city. And at this hospital, they're going to see the worst of the worst cases. You'll get referred all the way up to the top if you can't be treated at any of the lower facilities. Also interesting to note that their healthcare system is free. When you go to the doctor, you're treated for free. Drugs are free if they're available. Some procedures may have a cost, but most everything is free. So the beginning of my experience. 

Where did we start? First, we flew into the city under the box that I have here. But then we drove to Kampala, which is where we spent the first few days. It's also home to Makerere University and the School of Public Health which we worked with closely and Mulago Hospital, the national referral hospital I was talking about is also in Kampala. So here's what Mulago looks like. You can see the front of it right here. And the view on the bottom corner here is from across the street at Makerere up on a hill looking across. So the facility is actually quite large. I think this was one of the only hospitals we saw that was multiple levels like this. >> Were they independent? >> James, is it built since independence? [inaudible] >> The question was, was this hospital built before independence? And yes, it was. Here we see a sign that says Makerere University School of Public Health, which they also have a medical school that partners with Mulago as well to train the upcoming medical students. 

Now, a little more information about Mulago. In the picture here, we see one of the senior nurses in the background with one of the doctors at the malnutrition clinic located there. And this is the national referral and so each physician sees about 500 patients at this facility. HIV is treated in part of the infectious disease ward here, and besides treatment, they also do testing and counseling. And then something else interesting to note about their healthcare system is that families come with the patient to the hospital, and they stay there and cook the meals and take care of them because hospitals and health centers in Uganda don't provide more than maybe a small porridge as a meal. So then after we visited Mulago, we went to our first health center, which is just outside Kampala. This is one of the main buildings at this health center complex. You notice that this one is quite a bit shorter than Mulago, smaller. The complex is outdoor, the buildings are separated. Thankfully, it's nice in Uganda most of the time. 

In Wisconsin, it wouldn't be nice to walk in between buildings in the winter. But over there, that's not a big problem. Inside of this building, they were doing immunizations. And they were weighing babies. We were lucky enough to speak with the one doctor at this facility. And he told us that, besides himself, they have six nurses. In the maternity ward, they have an extra one midwife and four nurses. They see about 100 to 230 patients, outpatients a day here, and they usually have about 10 to 20 inpatients at this facility. And they also serve a population of about 72,000 people in the area. So here we can see a picture inside of that main building. 

See the nurses in green and the blackboard behind them. You probably can't read on the screen, but it talked a lot about HIV counseling and testing and how these were free services available at this facility. And then we'll blow up a picture of that poster on the wall. These posters were quite common at all of the health centers. It says "parents: it's your role to educate your children about STD and AIDS. Talk to them now." It was quite common to see posters talking about facilitating a conversation about how you can prevent HIV/AIDS and what it actually is. The doctor also told us that the rate of HIV in this area was higher than the national average. It was 13%. And mothers are also screened for HIV whenever they come in for antenatal care during their pregnancies. So now we had our first road trip. 

So we started in Kampala and drove ten hours all the way across Uganda to Queen Elizabeth National Park, which is located in between or around, I guess, Lake George, Lake Edward and the Kazinga Channel. So this is a fishing region. A lot of these villages tend to have higher rates of HIV because they are fishing communities. The first health center we went to was in Kazini, a Health Center 2. So this is the smallest health center that you can find. It only had two nurses. There were no doctors. So a doctor would come from one of the local hospitals about once a month to visit, and during these visits they would bring HIV testing supplies and also do counseling. The counseling, they would do pre and post test counseling. And they would help the patients learn about how to use the anti-retroviral or the HIV medication. 

They would tell them to come in when they're sick. Since HIV weakens your immune system you're more likely to get infections. So they want people to come in when they get infections so they don't end up dying from the infection and not even HIV. They also provided condoms. Here are a couple pictures from inside of this health center. You can see in the bottom picture here this table. That was their pharmacy. Not quite what we would consider a normal pharmacy in the United States. But for a small health center, they actually had some of the drugs that they needed. So that was good. 

On top we can see some of the medical utensils and a sink in one of the examination rooms. Here's a picture of the fishing community that that health center is located in. And what they did for HIV/AIDS education beyond just the counseling was that there was an FM radio station that talked about the HIV/AIDS education. They focused on those ABC's once again, and they really promoted getting tested. Know your HIV status. There was a school across the street from the health center, and they had posters at the school that emphasized abstinence, don't get married too young and get tested. In that same region again, we have a Health Center 3. Again, it has sort of the open forum and a blackboard, and we see the senior medical officer who is leading this facility right there. Again, the blackboard, it may be hard to read from the crowd, but it focuses on positive living and positive prevention, which are topics used in HIV counseling. Here we can see the top left are some beds in the ward at this health center. 

The picture on the bottom corner, I wanted to point out. As we see right here, I told you that the health centers and hospitals don't provide much as far as meals go. So this is actually the kitchen where families can come. This is a stove that they can cook meals for their family that's in the health center. So a little bit more information about it. We see that they have one senior medical officer, one nurse and one midwife. They see about 20 to 30 patients per day. And for what I was interested in, this facility had family planning, HIV testing and counseling, both pre and post testing. Every Thursday they had an HIV/AIDS clinic. That's a big step up from maybe the once a month when a doctor would visit the Health Center 2. 

And then during these clinics, they would talk about positive living, how to cope with having the disease or someone in your family with it, taking your anti-retrovirals, that's what ARV stands for. Preventing infections and prevention in general. Then a doctor does come once a month to attend these as well. Then something I would like to note, when we visited this health facility, the medical officer told us that there was a box of condoms that was always set out at his office. So like okay, that's really good. The next day we stopped back at this facility to use the restroom, and the box of condoms was no longer sitting out. So we don't know if they only put them out because they knew we were coming or what happened. So something to keep in mind. Next we visited a Health Center 4. So this is the largest of the health centers. 

It's in Lugazi. We can see that this facility looked a little bit more rundown than the previous two we looked at. Here's a picture inside of one of the wards. The beds look a little more worn. However, we do note that they have bed nets at this facility. With malaria at such a high prevalence, mosquito nets are very useful in helping prevent malaria. Even though the windows have large holes in them, so that's not helping as much. But at least they have bed nets. So a little bit of information about this health center. It has a doctor. 

One medical officer. Four nurses, two clinical officers, which is a step down from a nurse, and one midwife. They also have an HIV clinic once a week where they talk about how to manage your disease, counseling and family planning. Then I thought it was interesting, this facility doesn't refer just to public systems. So far I've only talked about public health centers. But they also refer to a private hospital because it's closer. Over there, transportation can be a huge issue. All the hospitals may not have an ambulance. If they do have an ambulance, it may not have gas to get you. It may be expensive to use the ambulance, and not all people can afford that fee. 

So the closer a health center or a hospital to a person, the better. However, they would need to pay for their treatment at a private hospital compared to the public. And this center serves a district population of about 150,000 people. And, again, we see some posters at facility. The one on the left is from who, or the world health organization, and is four stages of HIV and what symptoms you should see in each stage. On the right there's a poster that says be a responsible man, talk to a friend about family planning. So they're really encouraging people to talk about HIV, not for it to be so stigmatized, and then get tested. Now we can't leave the national park without a few photos. They were so beautiful. I had to share with you what the country looks at. 

We just saw a picture of a not-so-nice health center. I want to make sure you left knowing that Uganda is a beautiful place. If you care to travel to Africa, you should visit Uganda. Our guide, Ronnie, liked to call Uganda the pearl of Africa. And I hope that these next couple pictures will help instill that in you. I know I believe it. This is looking out from our hostel and the national park over the lakes. This is one of the lakes. I believe this lake produced salt. He has another picture of the lake. 

These pictures can't do justice for what it actually looked like. It's just so beautiful. And you can't be in a national park without seeing some animals. So we saw lots of elephants. We've got a little baby elephant that is pretty cute. In the bottom corner, we see a lion. What you can't see in this photo is that the lion is actually hunting a warthog. Our first day leaving the national park, we sort of had a mini safari every time we left the hostel to go out. We saw a lion and all of a sudden we saw a warthog. I think we spent about a half hour in our bus sitting there watching to see what would happen. 

I can report the warthog did get away. The lion went hungry for that point in the day at least. And now we went to a different part of the national park to Maramagambo Forest. We walked around inside this forest, and here you can see it's also on a lake and the vegetation is just beautiful. It's time for another road trip. Now we're going from the national park right around here, we're heading down to Kabale. So we're going to one of the southernmost points of Uganda close to the Rwanda border. Now we finally come to a hospital. We see the Kabale Regional Referral Hospital. This is one step down from the National Referral Hospital. 

So it's quite large. And you see that this hospital has six doctors, but it should have 36. It has an estimated two million people in the four districts it serves. So it's quite a few people for not a lot of doctors. There are seven  Health Center 4s. These are the largest health centers that feed into this hospital. None of them have doctors. If these health centers are having, say, a once a month doctor come, it can either be coming from Kabale or there's a hospital lower than this, the District Referral, the doctor may be coming from that hospital to visit these four health centers. You'll see some pictures. Here's in the children's ward. 

Those are the beds, and they actually have bed nets and you can see that the windows don't look broken either. This facility is quite nice. Now, here we're talking about the family comes to stay with the patients and cook for them. We can notice all the people sitting outside, taking in the sun. For us, we liked it. It was warm, you could walk outside. It was a nice reprieve from the Wisconsin winter. Now, I'll take a brief tour of the laboratory at this facility probably a little messier than a laboratory you would see on campus or in a hospital. It was cool to see right here the purple and red stains. Those are for gram stains which are used in identifying the bacteria in malaria. 

The picture in the bottom right-hand corner, you can see that these are malaria tests. So I had the fortunate -- I was fortunate enough to be able to sit down with John, who was the coordinator of the chronic care clinic at this facility. And he basically told us his life story and how he became involved in HIV counseling, education here in Kabale. He lost both of his parents to AIDS. He told us that he had to drop out of high school in order to take care of his siblings. But his story improves in that in 2004, he was able to go back to school for counseling. Before he got the job as the coordinator of this clinic, he actually volunteered here and he's a pastor as well. He told us that by counseling at this facility and being involved with it, it actually taught him that people who have HIV aren't sinners. He's now better able to relate that to his parish community and other people that anyone can get HIV/AIDS, and it doesn't mean that you're a bad person because you have it. He said that this clinic, since its start in 2003, has served 6,782 HIV positive adults and children. 

More females than males. And he said this is because females are more likely to get tested, especially every pregnant mother gets tested when they go in for antenatal care. Males are more likely to partake in risky behaviors and then not tell their wives about it, so more women can get infected that way as well. They have nine staff here and 16 community volunteers. They serve approximately 30 people per day at this clinic. Some of the counseling activities that you could find here were group or individual counseling. In their group counseling, they could get as many as 250 people, and they come and they share health talks on different topics like tuberculosis or other infections you could get, also talk about positive living stories, how they're living their lives even though they're HIV positive. They share about family planning, condoms and STIs or sexually transmitted infections. They speak of the nutritional aspects of taking ARVs. When you're on the medicines, they work better if you have a nutritional or a balanced nutritional diet. 

They also talk about how to deal with testing results and, again, the aspect of positive living. This is a common sticker to see not only in this clinic but also around the hospital. Some of the outreach programs that this facility had was they shared a daily video. They had kind of a little lobby area with some benches and they had a TV. The video was playing throughout the day. And it talked about HIV in order to educate the people who came to watch it in sort of a fun way and to help them learn and to prevent spreading HIV themselves. What was really great about this is John said that all those family members we saw sitting outside, they would come over to the clinic, they may watch the video or at least part it. So the video is actually reaching a large audience to share the HIV/AIDS education. They also have a community drama or drumming group which I thought this was really exciting. They would go out to the more rural community areas who may not have a chance to get to the hospital and see the video. 

They would do this once a month, and they would do a song  and praise to mobilize the community and educate them about HIV/AIDS and try and reduce the stigma. And all of the members in this drumming group are HIV positive themselves. They're going as a positive influence of I'm living with this disease and you can too. They also have testing after the different drumming events that they have so that people can learn their HIV status as well. In downtown Kabale, since the hospital is up on a hill, they have an AIDS center and another ARV clinic to distribute the drugs. Funding for the education. It all comes down to money, right? So two of the bigger funding organizations were the AIDS support organization and reproductive Uganda. The latter of the two, funding just stopped when we were there in January. John was telling us the biggest problem is sustaining funding so all of the really great programming they have can continue. He told us that without aid from the united states and other developed countries, their programs wouldn't be able to continue. 

He also shared with us some of the testing numbers out of their clinic. I thought it would be interesting for you all to see tonight as well. In December of last year, they tested 1,183 people just at the hospital. This isn't including data from testing done after the drumming groups. They found 58 people to be HIV positive. 47 were female, and 11 were male. So of that group, the percentage was 4.9 people were HIV positive and 81% were female. In September of last year, they tested 1,509 people, found 90 people to be HIV positive or about 5.9%, and 61 were female, 29 male. So we had 68% were female this time. Again, we can't leave the hospital without seeing some posters. 

On the left we see one that says "tell your partner about your HIV status." they're really pushing getting tested and knowing your HIV status. And on the right, it says "keep your dreams alive, choose life." Then here, the man in the middle, that was John who graciously took an hour or so out of his afternoon to speak with us. And you can kind of see there's a calendar in the background. Probably a little hard from out there. But it's filled with black writing. That's a calendar for a month of all of the outreach and education programs that they were planning to do at that facility. So they were jam-packed, and they did everything they possibly could with the funding they had to help educate the community, and I thought that was really great. Time for a road trip again. We're going from Kabale and now we're moving further northeast. This is the district hospital. 

So this is the smallest hospital that you'll find. It also says on the sign right here, we see it has Uganda cares which is an NGO that funds their HIV/AIDS clinic. And they have an ARV clinic there as well. Little bit about this facility. It's a 100-bed hospital. It served a district population of about 70,000 people, and they only have 35% of the staff that they needed. They have 80 staff members, but they should have 181. They also do not have an ambulance. A little breakdown of the staff. The they have four doctors, 17 nurses and 18 midwives. 

They also have a partnership with something called COBIN or the Community Based Integrated Nutrition. What COBIN is, is it's a partnership that has community health workers that go out into the more rural communities, and they weigh babies and they track the weights from month to month so they can tell if the child is malnourished or not. If they find the child is malnourished, they can do what they can to get the child help or get them to the hospital. We also see this picture, this pot, a pinkish-purple porridge in it, that's used for refeeding for the malnourished children that come to the hospital there. Here we see some photos inside the clinic. Again, look at all the posters on the wall. This is our lovely group. We take up a good part of the hospital. Then on the bottom right-hand corner, we see one of the examining rooms. For what I was interested at this hospital, we see HIV/AIDS education. 

They talked about how to care for those with HIV, counseling, both pre and post testing. For prevention, they had outreach programs to take ARVs to the community, and they did specific outreach to sex workers at night. Lyantonde is located along a major truck route. So with that being said, the rate of HIV is higher in this community. So it's important that they reached out to that specific portion of the community, those at high risk. They did that by providing condoms. We can also see the rate of HIV in town along the major truck route is about 10%, which is higher than the national average of about 6.2. And in the village, it's quite reduced at about 3% to 4%. Again, we see another photo here from inside the outpatient clinic. And it says, meet HIV and CD 4. 

It went on to show about the different stages of HIV at this clinic, they provided drugs, that was in part funded by Uganda Cares, and they provide these five days a week. They said they usually had enough. Lyantonde is also situated in a portion of Uganda that can have a severe dry season and water become an issue. James talked about a group called Village Health Project. They work a lot with clean water. So they have donated bio sand filters and water tanks in this region. In the top photo we see one of the bio sand filters here. A can of water is being dumped in. This water in this water bottle came from a local water source, maybe a pond. It looks kind of brown, kind of yellow. 

I know I wouldn't want to drink that. Once it's gone through the bio sand filter, we can see in this bottle it looks pretty clean. I would maybe drink that if I wasn't used to United States water. It still may make me sick. But for them, that's a lot better. It's a huge improvement. So the hospital does have one of those bio sand filters for people to use. I'm not sure how often people actually use it, but it's there. And then we also got to see one of the water tanks being built. So these are a photo down on the bottom. 

The men are using a machine that compresses dirt and cement mix to make bricks, and what's cool about making these bricks is they don't have to be fired. So they're saving wood because they'll dry on their own and they have sort of the -- they're kind of circular in formation. So they can build the water tanks. They have a machine that makes the more rectangular bricks for more conventional building as well. We see that they're cementing it, putting it together. The top right-hand photo shows us moving bricks and them starting to build up the sides of the tank. Here's what one of the tanks actually looks like completed along with four of the students that came along with us this December and January who are also a part of the campus. The big photo we see is of a lake. And we notice the cow feces and the cattle around the outside edge of a lake. This lake actually tends to be a major water source in the area in the dry season when these water tanks dry up. 

And you might be surprised to hear that one of those water tanks can actually hold 10,000 liters of water and it still may dry up during the dry season. Another cool thing about the water tanks is that the community members who receive them do pay for a portion of it. So they feel a little more ownership towards it and take better care of it. A note on the local cuisine. We ate a lot of beans and rice and something called ground nuts. It's basically like peanut. For me, you could usually find fish, chicken, beef or goat. This yellow stuff right here is James' favorite. It's a steamed plant, kind of a form of banana. I didn't particularly like it. 

But James loves it. You see that there's a menu underneath our plate here. I thought I would point out that it may look like any menu you find in the United States. The big difference, however, not everything on that menu could be ordered. You could say I'd like this or that, they could say we don't have that available. You were safe to go with the buffet, which was the beans and rice, some form of meat and some kind of fruit. You weren't guaranteed they would have the food available at the restaurant for other things on the menu. The menu is more of a "I wish I could serve you this." Now for another road trip. Here's Lyantonde. We pass through Kampala and over to Jinja. 

Now we went to the primary school. This is actually where James went to school. It has about 750 students for Primary One through Seven. They can have as many as 100 students per class in P-1 or 2. They have about 18 teachers. You see the outside of the building here. The paintings on the wall actually show some different lessons that varied from math, geography, I saw some human organs on there. Over here is what the inside of that building looks like. It can be segmented into three chunks. You can imagine 100 students per chunk, 300 people in that small building. 

That could get kind of warm and be a little smelly and kind of hard to listen. Some more pictures. So myself and my friend Lauren on the trip sitting on a bench. Granted, we're larger than elementary school students. But they usually fit six to seven kids per bench. Here you see James showing us his humble beginnings doing lessons in the dirt. We also had the chance to talk with the headmaster of this school. You can see there are posters on the wall here. One poster in particular caught my eye. It said counseling and guiding pupils on HIV, to continue even if HIV/AIDS has affected family and to accept people with it or family members. 

So what they're trying to do is to teach some health and HIV prevention lessons in their class, and what they talk about varies based on the age of the students and what level they're in. And then, as some of you may recognize me, I also work for BioTrek with Tom. So the color change pencils and the DNA string that a lot of you have seen on the table outside made their way to Uganda as well. So here we're giving them to the headmaster. Our group also donated solar light bulbs, other books, pencils, pens, soccer balls and some money to help with building renovations that were going on there as well. And now, in Jinja is where you'll find the source of the Nile. This, again, is too beautiful for me not to share with you. You can see this cement block is the zero source of the Nile. You can kind of see the ripples in the water here showing where the Nile is spring-fed up. This is along kind of the border of Lake Victoria. 

And then further down the Nile we see the falls, which is a really large waterfall that you can sit and watch it because it's just amazing. You see all the water going all around. I have a few acknowledgments I would like to make. First, I would like to thank John Ferrick and James Ntambi who put together the program. Our guide in country, Ronnie. And professors from the Makerere University School of Public Health, Imelda and John. One of my fellow classmates, Chris, for some of the photos he took that I've used, and the Daughters of Demeter, who provided me with a portion of the scholarship to pay for my experience. And with that, I would like to ask for any questions. [applause]