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Interview: Sam Tushabe
HIV InSite Interview with Sam Tushabe

Sam Tushabe
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Listen to the interview
Photos from AOET
The AOET Web Site
Links: Orphans & Affected Families

Art Ammann, MD, HIV InSite: Tell us about AOET.

Sam Tushabe, AOET Director: AOET is a non-government organization that started seven years ago. AOET stands for AIDS Orphans Education Trust. We care for orphans and widows of HIV/AIDS.

AA: Where are you located?

ST: We are in Jinja, Uganda, which is two hours from Entebbe Airport and the capital city of Kampala

AA: Is the region you serve rural or metropolitan?

ST: The city of Jinja is quite big, but parts of the district are very rural.

AA: How many people live in the region?

ST: AOET operates in five districts including Ziganga, which has the largest population. So we are talking about two million people in five districts.

AA: What motivated you to start AOET?

ST: Well, it's a very long story but the whole issue of orphans of AIDS was the main motivation. It really began when I tried to help one orphan at a time on a personal basis and then it developed into something bigger.

AA: How did you go from small to big? What kind of resources did you have?

ST: I started with taking care of one child with my own money and then I took on a second child in the same way. We got 10 children and then 20 children. When it reached 40 funds and resources for the children became a very big issue. I started writing to as many people as I could - people I went to school with, people from my church - just about anyone I could get a hold of. I told them about what we were doing. I also set up a website for the project. Then I decided to have the government recognize what we were doing and so we registered as a non-government organization. We still depend on gifts and donations for support. We don't have a regular source of funding that we run the organization on.

AA: How do you go about getting the confidence of the community to begin your programs?

ST: First of all, we deal with the culture chiefs in the community. We talk to them, tell them why we want to come, and what we want to do. Then after that, we begin meeting with the civic chiefs. There are many chiefs that we work with as we're working with several cultures and several tribes in five districts. (Districts are like counties in the US.) We also let them know what the government is doing, and how we're going to be complementing what the government is doing. Then we bridge both the culture chiefs and the civic chiefs and once we know what to expect from each other, we bring a questionnaire to the people living in that area. We find out what they know about what we plan to do. If it's HIV-AIDS education, for example, we take the questionnaire to the people's homes, to find out what they know about what we're going to be teaching. After we provide the education we take another questionnaire to people in the community to evaluate what we achieved.

AA: How many orphans do you serve in your programs?

ST: We have 230 children that we directly sponsor into schools, provide for their medical care, food and other support. We have other orphans that are not part of the 230 children. These are children that we care for indirectly through the education of widows, teaching them different skills that they can use to care for their children. Altogether we care for about 600 orphans because some widows may have as many as 10 children, and we assist hundreds of widows.

AA: What would the life of an orphan child be like without your programs?

ST: It's different from village to village. In some villages they adapt to what is around them. For example, if the child is not able to go to school the child may get involved in caring for a neighbor's cows. Without that, orphans may roam the villages, the banana plantations, or go from home to home trying to get help. Really, they've got a hopeless situation if no one intervenes.

AA: Is education of children required by the government of Uganda?

ST: In principle the government requires that every child go to school but practically it's not possible. First of all, if parents want their children to go to a private school, they are very expensive because they are people's businesses. As far as government schools go, the parents still have to pay. They have to pay for school uniforms, which are very expensive. They have to pay for their books, and they have to pay regular school fees for each child. No matter what, it is expensive to go to school. So for orphans there is in effect no public education.

AA: How do you approach the education of orphans?

ST: We have two approaches. Some orphans go to an AOET school. That's about 100 children. Other children we send to different schools that are in the community.

AA: What does the daily life of an orphan who goes to school look like?

ST: For those orphans that we sponsor to go to schools other than our own, they get up early in the morning and may walk about four or five miles to go to the nearest school. They arrive around 8:00 or 8:30. Classes begin around 9:00 with a recess around 10:30. Some go home around lunchtime while others stay until about 4:00 and then they go back home. After they arrive at home, they start work such as collecting water from several miles away or collecting firewood from the brush for the evening meal.

For the AOET School, we looked for a region that had the highest concentration of orphans. They also need to walk to school, sometime several miles. School starts at 8:30. During their break time, they have something to eat and drink, and then go back to their classes. At 12:00 they all go home. We encourage them to help with chores at home. Most of the time, after they finish their chores, the children will go out and play with other kids.

AA: Have you had the opportunity to compare how well children do in your school compared to private schools?

ST: Yes. Our goal is to see that our children get quality education and get even more than children in public schools so we do evaluations. We found that we raised the standard of education. We've the best teachers around in our communities and when you look at what other children are doing in other schools, and what our children are doing in our schools, you wouldn't believe that they're in the same grade. Our children are doing much better because they are given much more attention and there are fewer children in the classroom. In some government schools and private schools, you might find 200 children in one classroom. But our classrooms are limited to about 50 children in each classroom. It is important to us to make sure that each child gets as much attention as possible, especially as an orphan, because they have fewer chances in life. We want to do the best for children like that.

We found that we raised the standard of education.

AA: Do you have just orphans in your schools?

ST: No. 75% of the children are HIV/AIDS orphans and 25% of the children are from healthy families. The reason we do this is to neutralize the stigma, so people don't consider it an all-orphan school. If this happened it would result in bad memories for the children, and especially for the orphans. Even as we look to the future, we want to build many schools, but we will always plan to have 25% of children from healthy families and 75% AIDS orphans.

AA: What happens to older children, such as teenagers in terms of education and training?

ST: We approach that by training older children and widows together. They come for training in tailoring, sewing clothes, computer training, and crafts using crops and local materials to produce pieces of art. We ask every widow to come with the eldest, like a teenager, whether a girl or a boy, and undergo the same training as the widow so that after the widow has died the eldest child is able to carry on and will be able to take care of the younger children. This may be a large undertaking as some widows may have 8 or more children.

AA: Who gets computer training?

ST: We have three categories of people. We have the orphans, the widows, and the general public, who come from around our community. The training is free for the orphans and widows. Members of the community pay a small fee to help us with the maintenance of the computers, the teacher's salary and so on.

AA: What do you teach in the computer training classes?

ST: We give them all sorts of skills from typing skills, computer operating systems, Windows 95, 98, 2000. We teach them Office 97, Office 98, Office 2000, Excel spreadsheets, Power Point and so on.

AA: Do you do HIV testing on the orphans or the widows?

ST: For the widows, HIV testing is a personal decision. They have to make the decision themselves; it's voluntary and so we don't go out and tell people they must be tested but we give them the options. What I've found is that after we've sensitized a community to HIV-they know what it is, they know what it's not, they know the importance of having an HIV test-the people will ask for an HIV test. We work deep in the rural areas where people in the villages have no access to HIV testing but after they've learned a lot about HIV/AIDS, they begin asking us for it.

For children, the government policy is that no child will be tested unless the child makes the decision itself. So the child has to come up and say, "I want to be tested for HIV."

AA: How do you deal with the medical needs and the care of so many individuals as they become sick with HIV infection?

ST: We started in small ways. Like caring for widows who had children who were in our program. For example, a child might not have gone to school because the child had to take care of their mother at home who was sick and so we decided to deal with that with a home-based care program, getting into different homes, treating the patients in their beds. Now we have developed a community-based program so we get into the community, where we set up a mobile clinic, and people come to get treated. We can see up to 100 to 150 patients in one day. The next day, we're in another place. We visit people that are not able to come to us, like those on their deathbeds. We go and visit them and talk to the people taking care of them.

AA: How close is the nearest clinic or hospital?

ST: For some of the communities, the nearest health facility might be 40 miles away from a specific village and the only mode of transportation may be a bicycle. So they put the person on a bicycle and by the time they get to the hospital, the patient may have died. That's the reason why we decided to develop a program to reach out to the rural areas and meet the people where they are. We set up in one village and treat the people. The next day or two days, we're in another village, and another day, we're in another village. Then we have another round to evaluate how our patients are doing. We have records for each patient that we treat and we go and see how they're doing. While we're visiting the villages, another team is doing home-based care for the people that are on deathbeds.

For some of the communities, the nearest health facility might be 40 miles away from a specific village and the only mode of transportation may be a bicycle.

AA: It seems like people have to travel a long distance for medical care. Going by bicycle would not be good for the health of the person. What kinds of solutions are you thinking about?

ST: We don't have the resources to be able to do everything that we want to do but we would like to have an ambulance. We are working in so many villages, five different districts, and there are lots of medical needs and an ambulance would be ideal.

AA: How would an ambulance work in your area?

ST: The roads are very bad in the rural areas. It would take long to get to the hospitals but shorter than a bicycle. We would hope for a 4-wheel drive truck or 4-wheel drive anything because we have a rainy season and without a 4-wheel drive you can spend a whole day pushing a car out of the mud.

AA: Have you encountered discrimination or opposition to HIV or to what you are trying to do?

ST: It really depends on where you are and what people know about AIDS and AIDS orphans. In some places there are no problems with discrimination at all. In other places some people don't want to have anything to do with HIV/AIDS. But in the villages and communities where we're working, HIV/AIDS is accepted. People are dying all the time and as more people have AIDS, it's accepted and people are beginning to learn how to deal with it.

AA: Are there groups other than the widows and the orphans that you provide HIV/AIDS education for?

ST: Yes. In addition to outreach to rural areas and schools we also have an outreach education program for the army and the police. Recently we have been recognized as a model program for education and so the army approached us and asked if we could do some training for them. At first it was an informal program but as they saw the quality of what we were doing, they asked us if we could provide a more structured program. In the army, in our area, we are dealing with second lieutenants. They come to the area for six months and then go elsewhere. During the six months we provide them with HIV/AIDS education.

Without a 4-wheel drive you can spend a whole day pushing a car out of the mud.

AA: I'm surprised that the army doesn't have its own training program. How did they hear about you?

ST: I don't know. Someone just came to us and said, "We've heard about what you are doing and would you consider coming and teaching us one morning?" And we said, "Sure!" After the first day, they called and said, "Would you be willing to do it again?" And we said, "Sure!" And that's how it all began, and now it's a big thing.

AA: If I wanted to start a program like AOET what advice would you give me?

ST: I strongly recommend that anyone trying to set up a program should get into the community and work with local people. You need to work to have the local people own the program. Otherwise when you leave, the program goes with you, and it is as if nothing happened. But when people in the village, or when people in a community, own the program, then it is likely to be sustained when you leave because the community people are going to carry on what was started. I also strongly recommend working at the grassroots level, with individuals like the local chiefs and influential people in the community. Then I would encourage electing people who are not chiefs, but people who are influential in other circles, and integrate them in into the team because they are the ones who are going to make the greater influence.

I strongly recommend that anyone trying to set up a program should get into the community and work with local people. You need to work to have the local people own the program.

AA: What do you dream of doing next?

ST: The biggest need that we have right now is a school. We want to build a school for the children. The school that we have now is in a rented place. Any time the owner says they want to use the house, it could mean a disaster for us. We would have to find another alternative. This is our greatest need because right now we really need to accommodate up to 1,000 children in a school.

AA: Thank you, Sam for all the information that you have given us.