Vol. 1, No. 5 ugandahealthcom@yahoo.com Sept. 27, 2008

What’s New? A Doctor’s View: What role do journalists play in the health system? In this issue, Emilio Ovuga, the dean of the Gulu Medical School, tackles that question and offers a critique of recent health-related articles in the Uganda media. Charles Wendo, the editor of Saturday Vision and chairman of UHCA, responds. Happy Birthday, NDA: In response to a suggestion by participants at a recent workshop, UHCA is working with the National Drug Authority to organize a workshop and tour of NDA to mark the regulatory agency’s 15th anniversary. Details will be coming soon. Training Trials: What is right, and wrong, about training programs for health journalists in Uganda? Rosebell Kagumire, a health reporter for the Independent, talks about her experiences in this issue. Population Explosion: Mark October 8 on your calendars. UHCA will hold a half-day workshop examining Uganda’s population explosion – its causes and implications. Experts on demographics, anthropology, public health and economic development will appear. Details will be coming by e-mail soon, or you can us at contact ugandahealthcom@yahoo.com. New Funding: The United States Embassy has awarded UHCA a grant totaling UgSh 17,866,800 to conduct workshops, continue publishing this newsletter and develop a web site over the coming year. We extend our warmest thanks to the Embassy, and to Public Affairs Officer Lisa Heilbronn in particular, for this support. Constitutional Review: UHCA’s steering committee is establishing a subcommittee to review our constitution, with an eye toward proposing amendments to a general assembly of members on October 28. If you would like to join these deliberations contact UHCA Coordinator Gayawa Tegulle at gtegulle@yahoo.com, or 0782 285999. Prescription Needed: Experts from government academia and the medical community analyzed Uganda’s ailing pharmaceutical drug system at a UHCA workshop on August 27. Contact information and copies of PowerPoint presentations by Dr. Mshilla Maghanga, pharmacist and lecturer from Gulu University Medical School; Dr. Myers Lugemwa, former General Secretary, Uganda Medical Association; Martin Oteba, Acting Assistant Commissioner for Health Services in charge of pharmaceuticals, Uganda Ministry of Health and Helen Ndagije – Byomire, Head, Drug Information Department, National Drug Authority, are available on request from ugandahealthcom@yahoo.com . Publications Planning: UHCA also named committees to plan future workshops and to develop our publications. Daily Monitor reporters Kakaire Kirunda and Grace Natabaalo are taking the lead on the newsletter and web site development, while Eve Mashoo already is working on our next workshop. We need your help! Contact Chris Conte at cconte@newvision.co.ug or 0754 121135. OH YEAH: Young, Empowered and Healthy (YEAH), the sexual and reproductive health initiative, is looking for a new media manager. Responses and questions should be sent to Anne Gamurorwa, YEAH director, at ann@cdfuug.co.ug .

A Critique of Health Stories in Uganda’s Media

By Emilio Ovuga Dean, Gulu Medical School

[Editor’s Note: In this article, Professor Ovuga analyzes a number of health-related articles that have appeared in recent editions of The New Vision. He stresses, however, that the articles were chosen simply to illustrate his points, and were not intended to single out New Vision for criticism. A response by Charles Wendo, the editor of Saturday Vision and chairman of UHCA, follows this article.]

During the year 2002, Gulu district was affected by the deadly haemorrhagic fever Ebola that left 16 health care providers in Lacor dead, including Dr Mathew Lukwiya. Early this year (2008) the disease hit Bundibugyo District, again claiming the life of health care providers including Dr Kuule. Currently the districts of Kitgum, Pader and Gulu are grappling with the problem of Hepatitis E Virus (HEV) infection, which has claimed more than 110 lives in Kitgum alone. Every year, the border districts of Arua, Moyo, Adjumani and Kitgum experience outbreaks of meningococcal meningitis. Plague affects the district of Nebbi (Okoro County) that borders Eastern Democratic Republic of Congo particularly during the rainy season. The tragedy about these infectious disease conditions is that they could be controlled, if not prevented if communities were equipped with appropriate knowledge and skills to take charge of their health needs. One group of allies in the fight against disease are journalists who are not in short supply in Uganda. This article provides hints on how Ugandan print and electronic journalists might contribute to the attainment of health for all Ugandans. In doing so the article examines a few news articles in the New Vision as a basis. The article will conclude with an outline of ten steps in health reporting that should be of value in community education and empowerment in health care matters.

Case Studies in Health Journalism Case 1: Cholera cases drop, The New Vision, Tuesday 22 July 2008. The news item quotes the District Health Officer (DHO) of one district who expressed optimism: “I am optimistic that within two weeks the disease will be a thing of the past…” However the article does not follow on this optimism by asking relevant and revealing questions such as: a) What measures have the DHO and his colleagues in the district put in place to assure his optimism? b) How permanent is the DHO’s prediction? Case 2: Men shun AIDS testing, The New Vision, Tuesday 22 Jul 2008. The article reports on the low uptake of HIV testing services in one district, citing the Declaration of Human Rights as a basis for the men not utilizing HIV testing services. The article then goes on to appeal for the enactment of by-laws to enforce HIV testing service use. The article is oblivious of the fact that the HIV/AIDS situation is as much a medical condition as a social, individual, cultural and psychological problem that will not be controlled with by-laws. Another question is whether the rural men being referred to know about the universal Declaration of Human Rights or this was being attributed to them by the journalist or other persons in authority. Do the men know about the advantages of utilizing HIV testing services? Has anyone ever put forward arguments to counter men’s refuge in the Declaration of Human Rights? For instance are men aware that they themselves have a right not to infect their wives and unborn children? Are the men or other members of society aware of their individual rights not to be infected by others? What alternative strategies can men take to safeguard their health and the health of others including that of their wives, and unborn children?

Case 3: Hepatitis E is linked to infected water, The New Vision, Monday 28 July 2008. The article links Hepatitis E viral infection to faecal contamination, garbage accumulation near water collection points, poor environmental sanitation and personal hygiene, and lack of water treatment services. The paper further reports assistance from UNICEF in the form of vaccination, and water quality testing to “ensure that drinking water is safe.” The problem is that water testing per se cannot assure safety of water. The article did not provide sound scientific evidence linking the presence of coliform bacteria in drinking water to the HEV epidemic. Even if this were stated, the article would need to explain in practical and simple terms what coliform bacteria are; how the presence of the bacteria in water is linked to fecal contamination of water; and how the presence of the bacteria or their absence in drinking water is linked to hepatitis E viral infection. The article did not report on measures that communities can themselves undertake to contain the spread of the HEV epidemic; namely: personal hygiene, house treatment of water by boiling, and maintenance of environmental sanitation and hygiene. Case 4: Child abuse tops abuse list, The New Vision, Wednesday 23 July 2008. The article provides a chart depicting the nature of human rights abuses in the country. However the article is misleading in relation to the heading of the news item; the author did not provide actual figures relevant to the heading in terms of child abuse in proportion to the overall magnitude of human rights violations, nor did the article break down the magnitude of child abuse by region, individuals or institutions in Uganda. A useful analysis of child abuse for policy, the promotion of child safety, and service development is therefore not possible.

What happens when we get sick? How can we stay well? How

can we, as individuals, prevent and control disease in our daily

lives? Child abuse is a complex and common tragedy affecting children in Uganda; sometimes I personally feel that it is a crime to be a child in this country. The factors perpetrating child abuse and neglect include marital discord, the mental health of parents or guardians, the number of children in a home, the position and relationship of the abused child in relation to other siblings, the health of the abused child, and poverty. The question then is what the article wished to achieve. Case 5: First Ladies tackle cervical cancer, The New Vision, Wednesday 23 July 2008. The news item reports an appeal to governments to make maternal health a priority, and to provide vaccination against cervical cancer. The paper correctly points out that cervical cancer treatment is expensive, and that women seek treatment when the disease is advanced. The article does not, however, make any suggestions to promote reproductive health service use, or explain what making the problem a priority means. Are there, for instance, personal lifestyle-change strategies that might be useful in cervical cancer prevention? What are the possible relationships between culture and sexual behaviour in predisposing to and in delaying access to reproductive health services?

What Should Be the Ultimate Objective of Journalism? The primary objective of print media is commercial. However, this objective is apt to be driven by political events and interests, and to promote insufficient search for information before going to press. Useful health journalism should aim to promote individual health and the health of communities. This is not a mean task. It requires an understanding of the complex links between individuals, their physical and social environments and the world of disease agents. The health news that are currently published in the Ugandan news papers fall far short of the target of achieving optimal health for individuals and communities in Uganda. It is perfectly alright to cover political or other functions sponsored by non-governmental development partners. However it might be useful to subsequently follow-up any health related statements made at public functions with the aim of providing educational feature articles that cover the specific topics in question. The next section provides the framework for educational health feature articles.

Steps in Health Journalism The sources of information in health journalism include health-care providers, members of the general public, community leaders, political leaders in the district, and health managers at the Ministry of Health Headquarters. In interviewing these persons, the journalist should go through the following set of themes:

a) Define the problem or issue simply to enable the lay person and or other stakeholder understand the nature of the problem.

b) Determine the magnitude of the problem in terms of numbers of affected persons per 100; 1,000; 10,000; or 100,000 of the general population. Another way to express this would be in terms of the economic cost of the problem to individuals, their families or the taxpayer, or the number of lives lost as a result of the health problem as has been done in case of Ebola and HEV epidemics.

c) Describe how the health problem is caused. This is sometimes not straightforward; consider the case of mental disorders. However, a simple description of current knowledge about causes might be useful; a useful source of information is health experts.

Useful health journalism should aim to promote individual

health and the health of communities. This requires an

understanding of the complex links between individuals, their

physical and social environments and the world of disease

agents.

d) Describe how the problem is maintained in individuals and at population level. Good examples include mental illness, schistosomiasis, river blindness and sleeping sickness, the maintenance all of which are closely linked to the nature and quality of environment from which patients come.

e) Describe how the condition might be recognized at household level or among acquaintances. Examples include plague, meningitis, diarrhoea and mental sickness.

f) Define what the public thinks or knows about the problem.

g) Identify current or available treatment to cure, control or halt the spread of the problem.

h) Define known measures that are used in preventing the condition.

i) Suggest what the community could do to prevent and control the problem and stay well.

j) Identify relevant policy issues that need to be addressed at local, national, regional and or international levels.

In writing health feature articles, the health reporter should avoid personal opinion other than providing objective analysis of the current state of affairs. When in doubt, it is often safer to present the facts as derived from investigative procedures prior to printing. Useful sources of information are a) the lay public b) health experts and c) medical literature.

For a response, see the next page…

Journalism is Bigger than Educating the Public

By Charles Wendo Editor, Saturday Vision

Prof Emilio Ovuga does well to give his views on the way we cover health in the media. Feedback is a very important aspect of communication, and when someone volunteers his energy, time as well as wisdom to respond to our stories, we have to be grateful. Whereas Prof Ovuga correctly points out a number of areas where we need to improve, some of his criticisms show that we have not helped the medical community to know the roles and limitations of the media. I will resist the temptation to give a point-by-point response to Prof Ovuga’s article, and instead discuss broad themes. Worldwide, the media provide citizens with information that they need for discussing and making personal as well as collective decisions. This includes information related to governance, investment, education, health, security, sports, career, safety, leisure, relationships, shopping, travelling, etc, etc. No media house has expertise on such a broad range of topics. Instead, we write stories based on information given to us by experts and stakeholders in the various fields. The successful journalist, therefore, is not the moving encyclopaedia, but the one who asks the right questions and knows where to find the right answers. Thus a journalist’s most important tool is a contact list of individuals who can readily give him information and opinions. Whereas stakeholders in the various fields competing for space in the media are keen to speak to journalists, our brothers in the medical profession have mostly shied away from the media. Typically we get information from the individuals affected by a problem, interested parties, government authorities and independent experts. If the top medical officer in a district predicts that a cholera epidemic will end in a few weeks, an up-country journalist is unlikely to detect that it is a false promise. Health experts who know that it is a false promise should correct their colleague by raising it in the same media, either through the journalist or directly, for example using the letters or opinion pages.

The successful journalist is not a moving encyclopaedia, but

one who asks the right questions and knows where to find the

right answers. A few of the criticisms raised by Prof Ovuga should have been directed to the individuals quoted in the articles rather than the reporter. Giving citizens a platform to air their views remains a cardinal role of the media. In a free and open media environment, superior views will defeat inferior ones. So when someone calls for a by-law on HIV testing, we should not suppress his views. Instead we should bring in different views from other people. With the fast pace of the news business, it may not be possible to get these different views in time for the next day’s paper or the next news bulletin. In that case, a journalist will file a story and do a follow-up later. However, experts or stakeholders who disagree with any view expressed in the media have a responsibility to challenge it by writing back or phoning in. They need not wait to be contacted by a journalist. The media is a public forum, and is increasingly becoming participatory.

Another misconception is to look at the media simply as an information conduit. Many times, health organisations invite journalists to cover their workshops. After the opening ceremony, they say ‘thank you very much, your job is done, you may now go and write what you have heard.’ When on our own initiative we to go to them for information or comment, they often turn down our requests. Unlike a brochure, the media have many other roles, such as exposing malpractice, setting the agenda, holding public officials accountable, moderating healthy debate and giving a voice to citizen. They should be engaged in a more meaningful way than just attending opening ceremonies of workshops. The medical community also overestimate the roles and power of the media. The media are good for raising awareness quickly and keeping health on people’s minds. When an issue is covered in the media, citizens become aware and consider it an important thing to talk about. However, the media should not be seen as the magic bullet. The bigger part of generating health knowledge is not the work of journalists. After journalists raise awareness about an issue, health communicators have to follow it up with carefully designed messages. These messages can be distributed through the media or face-to-face.

If health knowledge is the seed, then the media is the fertilizer

that creates a fertile ground in the form of individuals who are

aware of a health problem. Once the media raise awareness, face-to-face discussions with influential people such as community leaders, health workers, teachers, family members or friends can have lasting effects. If health knowledge is the seed, then the media is the fertiliser that creates a fertile ground in the form of individuals who are aware of a health problem. No one scatters fertilisers on his garden and then waits for a harvest without sowing the seed. As pointed out by Prof. Ovuga, in health journalism it is important to correctly define the problem, its signs, magnitude, causes, what maintains it in the community, views of the public and available solutions; clearly indicating what needs to be done by whom. I would guard against the preacher’s approach. Readers, listeners and viewers prefer that we give them information and they make decisions rather than instructing them. I would make every effort to tell the story through the experiences of human beings rather than abstract descriptions. In all this, journalists and health workers need each other. Let’s have more dialogue, and network so that we understand each other’s roles and benefit from mutual support.

Are Journalists Disconnected?/

Health reporters have trouble communicating with the readers, two U.S. professors have found. The scholars, professors in the University of Missouri School of Journalism, found after surveying 396 newspapers and conducting 35 in-depth interviews that many readers do not understand what they read – and that very few health journalists understand how little their readers comprehend. Indeed, the study showed that just over half of the journalists were even familiar with the concept of health literacy, which is defined as the ability to understand basic health information so as to make correct health care decisions. (http://www.themaneater.com/stories/2008/8/28/mu-journalism-professors-find-major-disconnect-bet/) If this is a problem in the U.S., where literacy is fairly high, how wide is the gap between journalists and readers in Uganda? And what are we going to do about it?

Training for Health Journalists in Uganda: Can’t We Do Better?

By Rosebell Kagumire

Training programs aimed at enhancing coverage of health issues in Uganda have taken a turn typical of UPE schools: they may have 100 percent attendance, or close to it, but they often offer little quality for students.

The problem, in part, is that most organisations are not careful about choosing who will attend. Money complicates the situation. Journalists in Uganda are poorly paid, so an organisation has to pay them the daily allowances or risk having a half-empty room. But while allowances may fill the room, they may not attract the journalists who are truly interested in the topic. In the end, some journalists may come mainly to collect their payments, taking part in less than an hour of actual training during programs that may last a week.

Sponsors need to recognize that strength is not in numbers when it comes to training. Two days of training for a group of 20 truly interested journalists might be worth more than a week of training for 100 people who are there mainly to collect some extra funds.

This is especially true since, when you have a smaller group, participants can ask questions and interact better with experts and colleagues.

Also, journalists who are truly committed need advance warning: Most workshops are poorly planned, giving little time for reporters to plan their attendance together with editors.

It may seem obvious, but sponsors often fail to appreciate that

workshops should be newsworthy.

Training should be geared to the needs of journalists in other ways, too. It may seem obvious, but sponsors often fail to appreciate that workshops should be newsworthy. One program that I found personally beneficial was conducted last year by the International AIDS Vaccine Initiative (IAVI), where experts on this rarely followed issue came to lecture to us about new developments. The session worked because it met the need of journalists for news.

Remember: journalists are supposed to set their own agenda, not follow the government’s or some nongovernment organisation’s agenda. As important as it is to cover functions that ministries and NGOs hold, the functions themselves rarely make news.

Unfortunately, organisations often are more interested in using journalists to get publicity than in helping journalists do their job better. The result is predictable: in spite of all the training journalists get, many times you hear them asking questions that they should have researched before entering a press conference room.

Uganda’s health system is weak and marred with corruption scandals. For us to write or broadcast these issues better we need more training in how and where to get our story clues.

We also need to learn how to navigate around news rooms’ love for politics to sell health stories. It’s difficult to get an editor to run health stories unless they’re about epidemics (which are quite many). Stories about bad policies or hints about how to deal with health problems that might not be immediate are hard to sell in many newsrooms.

Whoever seeks to give training to journalists must move from old ways of doing things. Training should make better use of the Internet, for instance. Groups can be maintained online where journalists can share contacts and resources. While few Ugandan have access to the Internet, a sizable number of journalists I know access Internet and have email addresses.

Journalists are supposed to set their own agenda, not the

government’s or some nongovernment organization’s agenda.

There also is a need for more follow-up. After most training programs, organizations go away happy with the feeling that the few days they have invested have given journalists something lasting. But training is only effective when what is learned can be practiced. To make training more relevant, efforts should be made to create a forum for constructive criticism of ongoing coverage of certain issues. This, too, could take place on the Internet.

If we are to change the way we cover the health system in Uganda, we also have to be able to look at how other media across the globe cover the same subjects. We also must be aware of how global health systems affect our own.

Finally, the educational institutions that produce most of our journalists also should be targeted for training. Most journalism schools do not offer courses on coverage of health stories. This has to be changed. After all, health is one of the hottest issues in countries like Uganda, which are faced with epidemics like AIDS, cholera and many others. We need to start early to produce journalists who can cover such issues.

Rosebell Kagumire is a reporter with The Independent.

Maybe We Aren’t So Different

In March, the Young Empowered and Healthy (YEAH) program reported that seven percent of Ugandans aged 15-49 have engaged in sex for gifts (http://www.newvision.co.ug/D/8/12/617178/transactional%20sex). Such widespread transactional sex is viewed as a serious contributor to spread of the HIV virus. That may be, but it turns out that Ugandans may not be all that different when it comes to using sex to acquire material goods. A recent U.S. study found that 27 percent of college men and 14 percent of women who weren’t in committed relationships had offered someone favors or gifts in exchange for sex (http://edition.cnn.com/2008/LIVING/personal/08/25/sex.for.stuff/index.html

Here’s to your health…and to the health of All Ugandans!