Update Summer

MERRY CHRISTMAS 2013 SUMMER ROOT, KARAMOJA UGANDA

THE NEED OF A SAVIOR Breaking of the "Etal" As the sun began to dip behind the western horizon, we found ourselves rumbling along dirt roads towards the village of Kassiapus. Ana Abong welcomed us to her home with great enthusiasm. She brought a cow skin and laid it on the ground, sweeping away the goat feces with a smile. We sat with the dignity of royalty amongst the clatter of goats, chicken, women and children. Once we had settled in Ana announced that she had a great treat for us. She had walked over an hour to town to buy a special food for her guests: macaroni! But the problem was she didn't know how to prepare it, so with an embarrassed smile she asked us if we could help her. We gladly pitched in and by the time the sun had set we had prepared a macaroni feast. We ate beneath the vast stars of Karamoja. Then, as the full moon rose and lit up the dark sky, other villagers began to gather around. Jerry cans and sticks were found and used as drums to accommodate the joyful voices of the villagers. Everyone stood around in a circle singing and dancing to the beat of the jerry cans.  After some time they settled down to listen to the story. PRAISES AND PRAYER · Praise for God's direction in showing us how to move forward with sharing the Bible stories · Praise for Loram Emmy who has been a faithful leader · Praise for the members of the local leadership team · Praise for the villages of Napoingae and Kassiapus who are open to receiving God's Word. · Praise the Pioneers East Africa Retreat will be held in Ethiopia this January, so I get two weeks to reconnect with all my Ethiopian friends! · Prayer for continued spiritual growth for the leadership team · Prayer for guidance and wisdom in all that we do · Prayer that God will speak his truth into the hearts of the Karamojong

This story, taken from Mark 7:1-23 was a story that the Lord laid on my heart for this night.  In the story, the religious leaders come to Jesus and asked him "why do your disciples break the tradition of the elders? They eat with unwashed hands!" And Jesus replied, "And why do you break the commands of God for the sake of human rules? Isaiah was right when he prophesied against you hypocrites. As it is written:  'you honor me with your lips but your heart is far from me. Your worship of me is in vain and your teachings are only human rules.'" Jesus goes on to teach them that nothing from the outside can defile them, but it is from the inside, from the heart that they are defiled. God laid this passage on my heart because the tradition of the elders is the religion of the people. The Karamojong adhere to the "etal" the traditions that have been handed down- the dos and don'ts of Karamojong society which create their moral standards of behavior. But the "etal" is more than just a set cultural tradition, it is the embodiment of belief systems that keep people bound to the rules of humans rather than the standards of God. Sin then, is not defined by the evils that reside within us, but rather by the act of breaking these traditions and going against the societal whole. The punishment of these sins is then only as deep as the society. Sin does not have any impact on the afterlife. You offend the elders, you receive punishment from the elders, make a sacrifice and receive remission for that offence. So as I was telling this story I was praying for conviction to penetrate into the hearts of the Karamojong. Without a right understanding of our own sinful condition and the eternal impact of sin in our lives, we cannot understand the purpose or work of Jesus Christ. Until we recognize our need, we cannot recognize our Savior. The "etal" is only a surface level cleanliness, before the Holy God, the heart remains unclean. This is why we needed Jesus to come. We needed a Savior that offers us a way to receive cleanliness of heart, not just traditions that make us accepted on a societal level. Where do our evil thoughts and actions come from? From the depths of our hearts, the sinful nature of our souls. According to Romans 6:23 "the wages of sin is death", eternal separation from God, eternal condemnation. Jesus' act of love and humility, His coming to earth as a baby to be the Savior who takes the punishment for our sins is the only hope that we have. Jesus came to break the traditions of the elders. He came to replace the surface level cleanliness with the heart cleanliness that ushers us into an eternal relationship with Him. Please pray with me that the Karamojong will see their need for a Savior and find the hope that Jesus Christ is offering them. UPDATE ON LOCAL LEADERS Thank you for your continued prayer Since landing back in Karamoja we have experienced many joys and challenges. The first couple of weeks were spent prayerfully assessing all that had happened while we were out. We were thrilled to find that Loram Emmy, our main leader had been faithful in doing the work while we were out. We were happy to find that five (out of nine) local leadership members had also been faithful in coming to the discipleship trainings (a commitment that involves a three hour walk). But in addition to these joys we found some challenges. The women were intimidated to share the Bible stories in their villages because of cultural pressures from their husbands. The men were asking for payment for attending the meetings. We found that many community members who had attended the Bible storying sessions in the village while we were there had stopped coming while we were out. Sadly we recognized that some of the enthusiasm we had experienced was merely skin deep. So we have faced many challenges. BUT we are not overcome! As we considered all these issues, we decided we needed to extend our story set. We needed to address these issues in Biblical ways and we needed to press forward, in prayer, in love and in faith. So that is what we are doing. I am happy to say that God has been directing us. God has been bringing correction and discipline in the lives of the members of the team. And has been drawing back some of the ones who had fallen away. God has been showing us which stories to share and who to work with. He has been faithful and is showing us the way forward. We want to remain adaptable to the changes that God wants us to make.

Update Summer

October 20, 2013 View this email in your browser My beautiful family at the coast near Ft. Bragg CA.

Dear Friends and Family, I sit on a hill overlooking the Nile River, marveling not only at the beauty of the scene before me, but also at the way the Lord has carried me back to the land of Uganda. Only a few days ago I was walking through Bidwell Park, shopping at Colliers Hardware, and eating a Thanksgiving feast with my family (I know, American Thanksgiving still hasn’t happened yet, but in celebration of the Canadian Thanksgiving and our family togetherness, we had it early!)… It is astounding to think about how much life changes in a few short days! Different continents, cultures, languages, seasons, people… everything is different, everything changes. It makes me grateful for a God who doesn’t change, a Lord who is sovereign over all, a Father whose love is steadfast. I am grateful for the five short weeks that I had at home. I treasure the people I was able to spend time with, and regret that time did not allow me to meet with all of you. It was a great joy to be able to share some of the things that the Lord is doing in my life and in Karamoja. Of course, for every story that I was able to share, there were a thousand more that I wasn’t able to. But thank you for listening, for your encouragement, for your prayers and on-going support. It is a blessing to be able to partner with you for the sake of the Gospel. We (Simon, Carina and I) leave Jinja on Tuesday, after dealing with government paper work and buying food/supplies for the next two and a half months. Please pray with us as we re-enter Karamoja. We have all been out of the area for the last month and a half. Pray for wisdom and discernment for us as we reengage in the ministries that we were doing. It is our hope that, while we were out, the stories of Jesus Christ continued to be shared by the local leaders whom we have been discipling since July. If that is the case, then we will return in time to share about the death and resurrection of Jesus Christ. This is potentially an exciting time as people have an opportunity to come to salvation. But this will also be a time that Satan will not want us to succeed. So please, please pray for us. Pray that the people will recognize that Jesus Christ is the FINAL sacrifice; that people will turn away from the traditional belief system of sacrifice and appeasement and follow whole-heartedly after Jesus Christ. Pray against syncretism (the mixing of belief systems). Pray that whole communities will make this decision to follow Christ and that they will be able to support and grow together as the body of Christ. Pray that this will be the beginning of the formation of an indigenous Karamojong church. Thank you for continuing to journey with me in the hope of seeing every people group worship the Lord in Spirit and in Truth. Summer PS- For those of you who were unable to come to one of my speaking engagements, I have attached some of the stories that I shared… and some pictures of my family, just ‘cuz I love ‘em!

Storying in Napoingae and Kassiapus In July, 2013, my team and I were reeling from some of the challenges of being on the mission field. We were wondering what exactly the Lord wanted us to do, and how we were to do it. We knew that we could not merely build upon the past (what was established by Tom and Dr Jean, KACHEP, or even what Melissa and I had done before), but had to establish the Lord’s plan for us in the present. We needed to have fresh vision for how to move forward. With this need firmly established in all of our hearts, we decided that as a team we would spend more time seeking the Lord in prayer. We believe in God’s promise, that when we seek Him, we will find Him. We asked the Lord to guide us to “people of peace”, people whom God had prepared to receive us, His Word and who would open doors in their communities for others to receive His Word as well. One Sunday I attended the Anglican Church in Nabilatuk (the township I live in) and saw four individuals whom I had never seen before. After the service I awkwardly introduced myself and asked them where they lived. They told me they came from the village of Napoingae, a place I had never heard of before. I felt myself oddly drawn to these people and wanted to engage with them further, but time and lack of language restrained me from doing so. In the days following this encounter I could not get these individuals off of my mind or heart. I prayed for them often and asked Simon and Carina to join me in prayer. Finally I told Emmy, our translator, that we needed to go to Napoingae to meet these people. So we jumped in the vehicle for an exploration trip to Napoingae. I fully expected to have to do some 4X4 driving, making roads out of footpaths, but as we followed Emmy’s directions we were pleasantly surprised that there was an actual dirt road all the way to Napoinga! Once we arrived in Napoingae I realized I didn’t know what to do next so we just prayed and got out of the truck and started walking around. Now, you need to understand that Napoingae is a cluster of villages. Each village is surrounded by tall, thick thorn fences. I didn’t know which specific village they lived in nor did I even know their names. But, as the Lord orchestrates all things, God directed our path to these specific people! I greeted them and we sat together beneath the community tree. I told them that we came because we follow Jesus Christ that that we would like to share with them the ways of Jesus. I told them that we did not come with programs or gifts, that we would not pay school fees, give out free medicines or hand out free clothing. We came with the most valuable thing we had: the story of God and we would freely share these stories with anyone who was willing to listen. They responded that they wanted us to come and share these stories with them. So we made arrangements to meet with them under the tree the following week. When we arrived the following week, I was shocked to see about fifty people gathered beneath the tree waiting for us. They eagerly welcomed us and enthusiastically sang several songs with us before I shared the story of Creation. I must admit that in the midst of telling the story, I was overwhelmed with gratitude and awe that the Lord gave me the privilege of sharing His Word with people who had not heard these stories before. I wish you could have experienced this with me- it was beautiful, the people’s enthusiasm for listening to the story and experiencing the power/authority that comes from speaking God’s Word. Each week that we have returned to Napoingae, the people continue to engage with the Bible stories. We are working our way chronologically through the Bible in order to give a firm foundation to who the Triune God is. It has been thrilling to look at the stories of the Old Testament through the lenses of the Karamojong. So much of their culture and world view is represented in the stories of shepherds, warriors and tribes. Meanwhile, we continued to meet in another village called Kassiapus, in the home of a lovely woman named Toto Joyce. She was one of the chicken project recipients last year. She opened her home for Melissa and I to do discovery Bible studies. Over the course of the year, we have seen a lot of maturing in Toto Joyce’s spiritual life, but the study remained small, consisting of Toto Joyce and a few other family members and was predominately focused on women. We were praying about how to reach the whole community of Kassiapus. One day, about a week or two after sharing the Creation story in Napoingae, Toto Joyce asked us if we would mind meeting under the community tree instead of in her home. She said that she wanted more people to hear about the Bible stories. We were thrilled with the way God answered our prayers, and enthusiastically moved to meet under the trees. But meeting under the trees did present some challenges. It was July and August, peek months of the rainy season. In speaking with the people, we discerned that the best time to meet with them was in the afternoon, after the garden chores were completed and before the evening chores began. The problem with this time slot was that this was also the time of rain. The mornings would usually start off sunny and hot and then by lunch time clouds would start to form and by mid to late afternoon the rains would come. This weather pattern directly infringed on our plans for evangelism. But, having joined with the people in prayer for rain (due to an abnormally dry April-June), we could not complain about the rain God had sent. We did, however, begin to pray that God would send the rain before and after we presented the Bible stories (preferably after, since we were sitting on the ground). I cannot tell you how many times during those months God intervened for us. Dark clouds would try to intimidate us as we sang songs and then the drizzle would start as we began to tell the story. Nervous glances would be cast about the circle. We would pray and without fail the drizzle would dissipate. Often times the rain would come as we were pulling away. We would go home rejoicing and praising God for His faithfulness and intervention. Our faith was tested on one particular day towards the end of August. We were planning on going to Napoingae to share prophesies concerning Christ from the book of Isiah. Dark clouds were forming overhead as we loaded the truck. Our national partners gave us weary glances as they considered us fools to go out in such weather. The first drops fell thick and heavy promising a drenching downpour. We looked at each other and questioned if we should proceed and with unity we felt we were to go ahead. By the time we reached the first river the rain was falling with force. By the time we reached the second river I began wondering if we would be able to get back, the rain was falling so hard. By the time we turned off on the dirt road that took us to Napoingae I could hardly see in front of me and I had to put the truck in four wheel drive to make it through the mud. At this point I questioned my sanity. Why in the world were we going to go sit under a tree in the middle of a downpour? No one would come anyways! Logically we should have turned back. However, we sensed that we were part of a spiritual battle and decided it was not time to turn back but rather push forward and see what God could do. But by this time, the road had become so muddy I was afraid of getting stuck if we drove the whole way, so it was decided that we would proceed on foot. We had mud up to our knees and hair plastered to our heads, but we kept going. As we went, we noticed that the rain got lighter and lighter. In fact, as we looked ahead at Napoingae we saw a circle of blue sky above the village. By the time we reached the village the rain had stopped completely and we stood in sunshine! The villagers were there to meet us, waiting for the story. As I shared the prophesies of Isaiah I looked around me and saw a wall of rain completely surrounding the village. But we stood in sunshine. “Holy, holy, holy is the Lord God Almighty. The whole earth is filled with His glory.” God honors His Word. He wants people to know Him, He wants His name to be lifted high and glorified above all other names. We serve a great and powerful God, and there is no greater privilege than to be able to share His Word with others. I also marvel at the sovereignty of God, who knew before we even began what would happen, and yet wanted us to walk out in faith to be able to experience His greatness. Local Leaders Our strategy for building an indigenous, multiplying church in Karamoja is to do everything in reproducible ways. We do not want the ministry to be dependent on us, but rather, we want the people to be empowered by the Word of God in such a way that they are able to share it with others. We want the truth of God’s Word and the power of the Holy Spirit to instruct people in righteousness, rather than teaching the people to rely on us for good preaching. This means that we present the Word of God as accurately to the Scriptures as possible, and instead of preaching, we dialogue with the people through asking questions. Sharing God’s Word orally and asking questions is something that the people can learn how to do. We have been praying for young men and women who have keen spiritual interest whom we can disciple and build up as local leaders. God has brought 9 such people to us. I would like to ask you to commit to pray for each local leader God has brought to us. Pray that they will be men and women of faith, who follow after God wholeheartedly. Pray that they will be able to learn the stories and be able to share them accurately with their people. Pray that the Holy Spirit will teach them and that they would learn to listen to His voice. Pray that when persecution, trials and difficulties come, they would stand firm in the truth rather than turning back to their traditions. Pray that God will use them powerfully in Karamoja.   I am including their pictures Please feel free to print them off and to use them as prayer cards

Name: Rapiiel Village: Napoingae Name: Samuel Village: Napoingae Name: Esther Village: Napoingae Name: Toto Joyce Village: Kassiapus Name: Loram Emmy Translator and leader for sharing God’s Word. Lives in Nabilatuk, but goes to all of these villages with us. Is also being trained as an animal health worker

A Face that we know

Submitted by admin on Fri, 01/06/2012 - 00:00

We are proud to support charities locally and international. Recently, we were able to provide a helping hand to the veterinary team KACHEP (Karamoja Christian Ethnoveterinary Project) in Uganda. Here is a touching letter sent in by one of the volunteers.

"Hi, my name is Melissa Graham and I have just finished the first three years of my Veterinary Science degree at Charles Sturt University in Wagga Wagga, NSW. This year I have taken a year off studies to live in the Karamoja region of Northeast Uganda to work with a Veterinary mission team called KACHEP (Karamoja Christian Ethnoveterinary Project). KACHEP is a non-governmental, non-profit charitable organisation with headquarters located in the Moroto District and field offices in Nabilatuk and Iriiri Bokora in the Karamoja region. It was started in 1998 under the auspices of the worldwide organisation, Christian Veterinary Mission.
The project focuses on livestock development with the goal of promoting the use of native medicinal plants as livestock medicine, because most of the people can't afford modern medicines. The aim is to improve thelivelihoods of the Karamojong people through re-establishment of a sustainable agro-pastoral society.
I arrived at the end of March and after a long and hot bus ride on very rough tracks, finally reached my home for the next 9 months. The Karamojong people are devoted to their animals and just after I arrived was the monthly gathering when KACHEP spray the local cows, sheep or goats for free, against ticks, and the dogs and cats get vaccinated against rabies. The sheep are nothing like the sheep I have ever seen before! The only way I can tell the difference between a sheep and a goat here is that the sheep have a down-turned tail and the goat's tail points up. The cows are gorgeous and tiny! Typically an adult weighs only 200kg and is so calm and docile (again nothing like most cattle I've been around) and they look completely different to what I know. Like a small Brahman (actually the breed is called Zulu) with the hump like a camel on their backs.

As well as this we treated any sick animals for a low cost (just to cover the medicine). Karina (a vet from Germany) and myself received sick cows into our “office” (under a shady tree) and we'd gather a history (name, signalment, symptoms, any treatment yet, etc) then do a physical exam from head to toe (TPR, check nose, mouth, ears (very important for ticks) check skin, feet- foot rot, around the udder/pisel, etc.) Almost every case was tick related which was cool because I have never had much to do with these little ectoparasites before and so learnt a lot! The most difficult case that day was a young steer which had been attacked by a hyena!
Last week we gave out female goats to vulnerable women, mostly widows and young unmarried mothers who have no one to support them. In this project each woman receives a 12 month old goat which is ear tagged. The first female kid the goat has she gives back to the project to be raised for another woman. Any male kids and subsequent females she can keep and sell or raise a small flock. It was very exciting to be part of giving them a helping hand.
I’d like to pass on the very grateful thanks to your practice for the equipment you donated including stethoscopes, surgical instruments, blades and even a portable operating table! (My checked in luggage limit was challenging!)
Uganda is on the equator and a cool thing that comes with that is that the sunsets and sunrises are quick and spectacular. Also, because we are on the equator we can see both the northern and southern hemisphere star constellations! So I can see the big dipper on one side of the sky (to the right of the moon) and then turn and see the Southern Cross on the other side!"

Uganda – NABILATUK – NGO KACHEP

ln Uganda engagiert sich unser Verein durch unser Mitglied Roland Gramenz zusammen mit Bea Reist aus der

Schweiz für die NGO KACHEP (Karamoja Christian Veterinary Programm).

Im Dreiländereck Süd-Sudan/Kenia/Uganda prägt die semiaride, savannenartige Landschaft – mit geringen

jährlichen Niederschlägen – das Leben der Stämme der KARAMOJONG, einer Ethnie, die den bei uns

bekannteren Massai in Kenia sehr ähnlich sind.

Die NGO arbeitet mit 6 Mitarbeitern in der Region und der Provinzhauptstadt MOROTO und dem 30 km

entfernt liegenden Dorf NABILATUK. Aus den umliegenden Dörfern kommen die einheimischen

KARAMONJONG mit krankem Vieh zu der von der Veterinärmedizinerin Frau Dr. Jean Grade geschaffenen

Anlaufstelle zur Untersuchung und Behandlung ihrer Tiere.

Zusätzlich sind dort verschiedene Entwicklungsprogramme, u.a. das NEEM-Projekt angesiedelt. Dabei geht es

um die Wiederaufforstung dieses selten gewordenen, aber für die Bevölkerung sehr wichtigen Baums.

Von dem Baum können wichtige Produkte für die Gesundheit der Menschen und für bessere Erträge in der

Landwirtschaft gewonnen werden:

Das NEEM-ÖI, ein Extrakt zur Prophylaxe gegen Malaria und zur Heilung, wenn bereits eine Infektion vorliegt,

wird aus den Samen des NEEM-Baumes gewonnen.

Die NEEM-Vaseline, eine Creme, welche bei Ringwürmern, offener Haut und anderen Krankheiten verwendet

werden.

Der NEEM-Fertilizer, ein pulvriger Dünger wird aus den Blättern gewonnen.

Der NEEM-Cake, wird ebenfalls aus den Samen gewonnen und als runder "Kuchen" getrocknet. ln Wasser

wieder aufgelöst, wird er als Pestizid in der Landwirtschaft verwendet.

Unserem Mitglied Roland Gramenz, Geschäftsführer der in Wiesbaden ansässigen Garten- und

Landschaftsbaufirma Gramenz- GmbH, liegt dieses Projekt naturgemäß besonders am Herzen.

Dieses neue Engagement wurde übernommen, nach dem in Uganda bereits einige aus eigenen Mitteln

finanzierte Fördermaßnahmen abgeschlossen werden konnten:

Im Dorf NANFUMBA

Seit 2010 unterstützte die Gramenz GmbH, gemeinsam mit einer Gruppe von Privatpersonen ein kleines Dorf

namens "NANFUMBA" in Uganda. NANFUMBA liegt im Süd-Osten von Uganda, ca. 1,5 Fahrstunden von JINJA

entfernt.

Das Dorf mit ca. 300 Einwohnern, erhielt in Abstimmung mit den Dorfältesten ein Hilfe-Zentrum, das 2010

fertig gestellt und an die Dorfgemeinschaft übergeben wurde.

Zusätzlich wurde für das Dorf ein Brunnen zur Verbesserung der Wasserversorgung gebaut, sowie die

Wiederaufforstung diverser Rodungsflächen durchgeführt.

·Zur Verbesserung der Bildungssituation der Kinder wurden mehrere Stipendien zum Besuch der

weiterführenden Secondary School vergeben.

Zur Verbesserung der wirtschaftlichen Lage der Dorfbewohner erhielten Personen, die eine tragfähige

Geschäftsidee vortragen konnten, denen aber das notwendige Startkapital fehlte, finanzielle Unterstützung

durch einen Mikrokredit.

Zum Abschluss des Projektes im Jahre 2012 wurden sämtliche für Mikrokredite ausgeliehene Gelder an die

Dorfgemeinschaft gespendet.

Zur Information: Agroforestry report January to June 2013

mit freundlicher Genehmigung:

Sagal Joshua Mark und Mukisa Ayub

more here 

UGANDA: Inadequate healthcare and rising HIV prevalence in Karamoja

Photo: Samuel Okiror/IRIN

A Karimojong woman demonstrates the use of a female condom

MOROTO, 30 April 2012 (IRIN) - The nomadic Karimojong ethnic group, once regarded as a low-risk HIV population because regional instability in northeastern Uganda and strong adherence to their culture kept them relatively isolated, have not been a priority on the country's HIV agenda, but recent statistics show prevalence among this community is now 5.8 percent, up from 3.5 percent five years ago.

Over the past decade large numbers of Karimojong have settled in urban centres, where business is flourishing and many NGOs have set up shop; there has also been heavy military deployment in the area as part of a disarmament exercise. These and other changes in a strongly traditionalist society have combined to push prevalence closer to the national average of 6.7 percent.

"The drivers of the pandemic that exist elsewhere are now occurring here. There is also a lot of alcoholism and [domestic] abuse here, which is one of the drivers of HIV/AIDS infection," Dr Michael Omeke, health officer for the Karamoja region's Moroto District, told IRIN/PlusNews.

Limited health services

Just five hospitals serve seven districts and a population of 1.2 million scattered over some 28,000 square kilometres. "In general, HIV treatment and care services are still low in the region," said David Wakoko, Karamoja area manager for the Mulago-Mbarara Teaching Hospitals' Joint AIDS Programme (MJAP).

Most health centres in the region do not have clinical officers trained to provide life-prolonging antiretroviral (ARV) drugs or offer HIV care and treatment. Kaabong District for example, has five health facilities, but only the district hospital has a medical officer authorised to treat HIV-positive patients, and the hospital does not have a CD4 machine to test blood samples and measure immune strength.

Few health workers are keen to live in the remote and underdeveloped region. "Human resources are a big challenge. You need someone who is qualified to help these people, but we are not attracting… personnel," said Dr John Anguzu, District Health Officer in Nakapiripirit. "Even the local people we try to train here to help, they leave."

The region has also not been spared the drug shortages that have occurred in other parts of the country. "We do experience ARVs stock-outs... We are trying to work with the Ministry of Health and National Medical Stores to see that these stock-outs are reduced," said Omeke.

A lack of food in the arid region and the long distances to health centres are major problems for people living with HIV. "These are weak people and can't move long distances to go for treatment and drugs. The health centres are too far," said Gabriel Lokubal, who lives in Moroto. "ARVs are very strong drugs, which require a lot of eating. However, most of us don't have food, so some people have stopped going for drugs."

Knowledge about HIV is also very low. A recently released preliminary report on the AIDS Indicator Survey shows that just 30 percent of women and 45 percent of men in the northeast are well-informed about HIV/AIDS.

A complex region

Spreading the word about HIV is not easy in Karamoja, where open discussions about sex are extremely unusual and the population is largely uneducated. According to MJAP statistics only 35 percent of Karimojong men have accessed HIV/AIDS services, compared to 65 percent of women.

Because of the nature of the society and tradition, the men remain in the kraals [communal cattle pens] and are on the move... They have little interest in seeking HIV services

"Because of the nature of the society and tradition, the men remain in the kraals [communal cattle pens] and are on the move in search of pasture and water for their cattle. They have little interest in seeking HIV services," said MJAP's Wakoko. "Most of those who access HIV/AIDS services are women, especially the pregnant ones, who visit health facilities for ante-natal services."

"The HIV patients also tie HIV services to food. If you don’t have food, people don’t come," Anguzu said in Nakapiripirit.

Stigma is highly problematic for health services trying to reach people living with HIV. "When you test a person and… [the result] is HIV-positive, he or she will never come back again for further… [treatment]," said a nurse at the ARV clinic at Moroto Regional Referral Hospital. "We are trying to sensitize the community to accept their status and learn to live positively."

In an effort to bring the services closer to the people, Uganda's Ministry of Health and MJAP are running a home-based HIV counselling and testing programme, but low staffing and occasional insecurity in the region are affecting the door-to-door campaign.

"The security situation remains fluid, as it changes any time despite general improvement in the sub-region, thereby affecting the implementation of programme in most of the catchment areas," said MJAP's Wakoko.

Health workers in the region say the nature of the causes and effects of HIV mean it cannot be tackled in isolation, and a holistic approach should be used.

"The interventions need to be shared among sectors - health is concept which is determined by social, economic and cultural aspects," said Samuel Enginyu, a health educator with the Ministry of Health. "We are working on an integrated and collaborative approach with the Minister of Gender and Culture and other stakeholders."

so/kr/he
more here