“Because I am a learned man, I feel that I must lead by example,” explains Paul. “When people come to visit and see some of the products I have bought from Harriet, my Living Goods Community Health Promoter, they always admire them and are encouraged to buy for themselves. Paul is Harriet’s best customer and a model client.  At a recent visit he told us about how the d.light solar lamp he bought from Living Goods is improving his health, household savings, and helping his children stay focused on their schoolwork.

“Power is a big problem here, we are on the national grid now but it is not very reliable. I am lucky that I have an inverter, but it is not very efficient because I have to drive for 5km to charge the battery. And the paraffin lamps are expensive to use and give off a lot of bad smoke. In fact, I am convinced it is because of those lamps that I have chest complaints and eye problems; they’re just not good for your health. But the d.light solar lamp is changing all that. I just leave it outside to charge in the day, put it on a hook inside in the evening and it lights up the whole room. I use it every day; it is a must-use product for us. I have five children and seven dependents, and they need a proper – and healthy – source of light to do their homework. With the solar lamp, they can read properly and it lasts for hours – they really like it, they want me to buy another one. Even though 110,000 UGX is quite an investment, I don’t think it is too expensive. Before, with the paraffin lamps, I would spend at least 15,000 UGX per week on fuel so the investment is quickly earned back. And most importantly, the room is no longer filled with bad smoke every night!”

Being the shrewd saleswoman that she is, Harriet brought along a sample of the Envirofit wood stove in the hope that Paul might be interested. And she is not wrong. Paul studies it with great interest and enthusiasm and immediately says, “I want one of these, the one we have now burns everything and leaves dirt and ashes in the food – it is not befitting of the standard of living that I wish to display as a role model. I have to think of my children; the example I am setting for them and what I will be leaving behind when I’m gone. I have a lot of fruit trees on my land, but if I keep cutting them all down for firewood and to make charcoal, there will be nothing left for them. I believe in efficiency, and I can tell that this stove will use a lot less wood because the way it has been designed. I have to be economical and think of he environment for my children.”

In Uganda, malaria is the main cause of maternal mortality and miscarriage – a sad statistic that came very close to including 17-year-old Faridah Nalugenge. Seven months into her pregnancy, Faridah was infected with the potentially fatal parasite and went to her local health centre for treatment. “I felt very sick,” she says. “I was shivering and had bad pains in my stomach. I was scared because I knew malaria is dangerous for pregnant women. At the health centre they gave me Lumartem and told me to take four tablets straight away, and another four in the evening, which I did.”

Lumartem, however, is not suitable for treating pregnant women; a shocking error all too common, especially in rural clinics where there is a lack of skilled medical professionals. Later that night, Faridah’s abdominal pain increased and she started bleeding. At 5am, with no signs of improvement, Faridah and her mother went to their local Living Goods Community Health Promoter, Joyce, who took them to Katende Health Centre, a better-equipped facility in town, and a Living Goods partner clinic.

Faridah was admitted and put on a drip to dilute the effects of the wrongly prescribed drug, after which she received the proper medication. “I immediately felt better,” says Faridah. “The pain, shivering, and bleeding stopped and I could feel the baby moving again. I felt safe at the clinic, I am very grateful that Joyce took me there.” After one week Faridah was discharged, relieved to be back home, the baby still safe in her womb. The relief, though, was short-lived. After just three weeks, now almost full term, Faridah felt contractions and started bleeding again. “The bleeding was too much, so I went to see Joyce, who got a midwife from another village to come and examine me.”

The midwife advised them to go to Kampala to one of the main hospitals as the complications were serious and she might need surgery. By 8pm Joyce, Faridah, and her mother arrived at Rubaga Hospital, where she was once again admitted and put on a drip to stop the bleeding. When the doctor examined her in the morning, he immediately performed an emergency C-section and the baby was rushed to intensive care. Mother and baby stayed in the hospital for 10 days, during which time Joyce stayed in touch with them via telephone. “She came to see us as soon as we were back home, and still comes to check up on us and monitor the baby. Thank God for Joyce, without her I fear I wouldn’t have gotten the help I needed.”

Like hundreds of thousands of Ugandans, Aisha Nalugo and her husband came to Kampala five years ago in the hope of finding work. Leaving behind four children with relatives in the village more than three hours drive away, Aisha only has her youngest, two-year-old Ryan, with her. “I feel very sorry that they are not with me,” says Aisha. “But there are no jobs in the village, and it’s too expensive for all of us to be in Kampala. It’s normal for parents to leave their children in the village; it’s not a good situation, but most people have no choice. I only see them maybe three times a year when I go back home with money for school fees. It’s not enough. I’m going to move back soon to be with them, while my husband stays in Kampala to earn money.”

Aisha’s husband works as a mechanic, and Aisha earns a modest income making colorful paper beads that she sells for 5,000UGX ($2 USD) per cup. It takes her about three days to make enough beads to fill one cup. Almost all of the money she earns is sent back to the village to pay for the children’s school fees and healthcare. But for Ryan, at least, Aisha has found a cheaper way of treating him when he’s sick.

“I met Zam two years ago when she visited my home, and since then I go to her whenever we get sick,” says Aisha. Zam Byakika is one of Living Good’s Community Health Promoters working in Kampala’s Bwaise slums. Looking after around a thousand households, Zam is also the local women’s leader, and as we move around her area she is stopped every few minutes by women asking for advice or wanting to buy her Living Goods products.

“Zam offers a very good service,” says Aisha. “The drugs she sells are very good quality. Whenever I call her, she comes to my house straight away and examines Ryan. The doctors from the clinics won’t come to your house unless you pay them a lot of money. Zam doesn’t charge any fees for the examinations, and her drugs are much cheaper. For example, when my children in the village get malaria, someone has to take them to the health centre, which is about one hour’s walk, and then they often wait for hours to be seen. When Ryan gets malaria – which he does every month – Zam is five minutes away, and she almost always comes straight away. In the village, the treatment costs around 10,000UGX; Zam’s drugs are less than 2,000UGX.

“Most of my friends and neighbours use Zam and everyone is happy with her service. Because she lives near to us, she is kind, and her drugs are cheap. I hope she can continue treating our community for a long time to come.”

Sarah Masajage and her fellow Community Health Promoters are waiting as local residents erect their communal tent. Used for a variety of community activities, today it will offer shelter for Living Goods customers attending the first ever Vision Camp in Bwaise, a huge slum settlement in the outskirts of Kampala.

During training sessions conducted by project partner VisionSpring, Sarah and her colleagues were trained in general eye health issues, vision screening, VisionSpring products, and were given guidelines on how to plan and promote a Vision Camp. The target audience for today’s event are people over 35, who will be tested for presbyopia – or near vision loss – an age-related condition that can be easily corrected with eyeglasses.

The morning starts off slowly with just a few residents gathering around. To the skeptics, this is hardly surprising. Eyesight doesn’t seem to figure much on most Ugandan’s healthcare agenda; in fact it is a rare sight to see a Ugandan wearing spectacles, especially among the poorer parts of the population. But it’s not long before the skeptics are proven wrong. As word spreads about free vision testing crowds start gathering, putting Sarah and her colleagues to the test.  The clients are organized into registration, testing and sales areas. Never one to miss an opportunity, two more CHPs have turned up, offering the standard selection of Living Goods healthcare products to the waiting customers.

The last customer to be seen before heavy showers abruptly put an end to the day is 53-year-old Nakyeyune Aisha and her grandson, Calvin. “I have had problems reading small letters for the past four years,” says Aisha. “I can’t even thread a needle to repair our clothes, and it is getting worse with time. I fear it could be really bad in the future. I know people who wear glasses, and I know they can help, but at the hospital they charge 25,000 UGX just for the testing. So it is very good that Living Goods came here to our community and do the test for free. I don’t even know how much glasses would cost at the hospital, but I’m sure they would be very expensive.” Aisha laughs when she tells of her surprise today. “Here they were only 14,000 UGX, and I could try on different pairs until one fit me. It’s really not expensive at all!”

Though the vision camp is aimed at adults, Sarah also checks on Calvin. “For months his eyes have been tearing, he says it feels like ‘a stone in my eye.’ We tried the medication, but it didn’t help,” says Aisha. “Now they’ve told us they have to charge 70,000 just for another test before they can even tell us how much the operation would be.” Sarah writes a referral note for Calvin to go to Mulago hospital and though it isn’t free it will be cheaper and with more experts on hand. As Aisha and Calvin make their way, she offers a big smile and says, “We have both been helped today. I am very happy!”

Sarah, too, is very happy. “It was wonderful,” she says with pride and a smiling face. “People in the community would always complain to me about their eyes, so I knew the problem was there, but I didn’t expect this many people to show up today. We learned a lot in the training, but practice makes perfect, so we’ll keep getting better.”

“Oh yes, I know Zam very well,” says Nalunkuma Shamim, as she and her friends enthusiastically interrupt each other to list all the services Zam provides to their community. “She’s a secretary for women,” says one. “And she sells good drugs” adds another. “She goes door to door with drugs for malaria, for children and for pregnant women. No one else brings medicine in to the community, she is the only one.”

Shamim first met Zam about a year ago, and has since then bought all her drugs from her. “She has good products and they sell at a very good price,” says Shamim. “I have three young children, who get sick a lot – I probably buy drugs from Zam four to five times a month. Before, I had to buy them at the clinics, but they are too expensive, so when I didn’t have money, I had to use traditional drugs instead. Sometimes they work, but not always.”

A few months ago, her daughter, Hadija, got very sick with malaria. Shamim tried treating her with some old drugs she had leftover, but they didn’t work – probably because they had either expired or the dosage was wrong for Hadija’s age and weight. As she quickly deteriorated, Shamim rushed her to the clinic. “I felt so bad, I thought she was about to die. Her skin was loose, her eyes were sunken, and she was so weak. The doctors at the clinic said it was malaria and wanted to admit her. But the drugs alone were 22,000UGX plus 5,000UGX per day she was admitted, and I didn’t have any money. I went to get Zam, because I knew she would help me.” After examining Hadija, Zam also diagnosed her with malaria. “She was very, very sick and very weak,” says Zam. “She couldn’t stand, she couldn’t eat, and had a very high temperature, she really was in a critical condition.” Even though Shamim didn’t have any money, Zam gave her Panodol to lower Hadija’s fever; Lumartem to treat the malaria; and Restors to rehydrate her. “As a Community Health Promoter, I am here to treat the sick and give health to the community. I can’t turn away a desperate mother because she has no money. I trusted Shamim to pay me back when she could, she always does.”

“I am very happy I took her to Zam,” says Shamim. “After just one week, she was back to normal. Now, when Hadija feels sick, she tells me to call Zam to make her better. All the children do, they like her very much.”

Today, Zam is on a mission to persuade Shamim to buy a Maama Kit. Due any day to deliver her fourth child, Shamim has yet to get enough money together for the kit which includes essentials such as soap, gloves, a surgical blade, and a sterilised chord for tying the umbilical cord. If she doesn’t, she will have to buy the items individually once she’s in labour at the hospital, where she will be charged many times the price Zam offers or, worst case scenario, risks being refused treatment if she can’t pay. After some gentle, but persistent, pressure from Zam – and with some help from her friends – Shamim scrapes together the 17,000UGX that will help her have a safe delivery and reduce the risk of infection to herself and her newborn baby.

“As soon as the baby is born, I will call Zam. She has been checking up on me and monitoring me throughout the pregnancy, so she will be like a proud grandmother,” Shamim laughs and hugs Zam, before adding. “She is a very, very good thing for our community.”

Pouline is 42 and lives with her 20-year-old twins in Mawonwe in Mpigi district. Pouline has been a Community Health Promoter (CHP) for one year. As she recently told us, “I always wanted to be a nurse or health practitioner, but never had money for the studies, so when this opportunity came about, I jumped at it.  Before, my income was never enough. So the extra income I get as a CHP of about $60 per month is very important.  I can now afford school fees, rent and food.  My job as a Living Goods CHP has helped me and my family so much.”

Pouline is a model CHP. She finds time every day to visit clients in her community. “Every day, I spend about two hours in the community, going door to door, checking on people, looking out for any sickness… Depending on the individual’s needs, I will provide health education or products such as ACTs, deworming treatment, soap, and fortified foods. People in the community know that if they buy the products from Living Goods they are cheaper. Many clients come to my home for advice and products.”

Pouline sees many economic benefits of Living Goods to her neighbors. “I save people money on their health care. Not only are the products I sell cheaper, but the fact that they have access to affordable health products means that they can treat the illness early on, whereas before they often left it too late and ended up in hospital, which is very expensive.“

As we hear from many CHPs, the respect these women receive in the community is often times as important as the income they earn. As Pouline told us, “I enjoy the health work very much.  It makes me very happy that I am able to nurse my own family, friends and neighbors. There was one family in particular who used to have a lot of health problems. The mother used to have a child every year. Her kids were malnourished and always sick. She fed them poorly and gave them to dirty water to drink. All her money was spent on treating her sick kids.  I spent a lot of time educating her on health issues. She now uses family planning and feeds her children fortified foods. Her children’s health is much better. Even her neighbors have noticed the difference, so they now come to me for advice. It gives me great respect in the community and it makes me so proud when I see the impact I have on my community.”

Erinah Nakimara is 23 years old and single. She joined Living Goods in late 2010. We spoke to Erinah after ten months on the job to learn more about how Living Goods was making a difference in her life and the lives of those she serves.

“I have been a Community Health Promoter for ten months now. People in my family and my community were spending so much money at the health centre before.  They were often admitted to the hospital when there was no need. Now, I am giving them basic treatments and medicine at home and in ten months, many haven’t been to the health centre even once.”

“During the week, I work from my little shop in the trading centre where clients come and see me. In 3-4 hours I normally see around 10-15 people. Saturdays I spend in the field, going door to door. The most common illnesses I see are malaria, diarrhea, and coughs – mostly among children.”

“I like the work because I get trust and respect from the community. I try to save most of my profits – I’ve opened a bank account since I started this job! And the community benefits because they get cheaper products and personal attention – you don’t get much attention from the nurses in the health centres. There really has been a change in the community since I became a Living Goods CHP.”

Living Goods launched a new cohort of directly managed Community Health Promoters (CHP) in August 2009. One of the bright lights of this new group is Zamin Nsibambi. Zamin lives in Bwaise, the heart of Uganda’s largest, densest slum in northern Kampala. She is 46 and is mother to seven children.

Zamin works in one of the toughest corners of this tough part of town, where many homes are made of sticks and mud and drug addicts wander narrow alleys. Less than two months into her work, a three‐day riot raged in Bwaise and several people were killed, one outside the Living Goods branch. Yet Zamin is fearless. She brings tremendous energy, service, commitment, and smarts to her work. Zamin was trained by the government more than 10 years ago as a volunteer village health worker. Despite her enthusiasm for the work, the government lacked the resources to effectively support the program. Zamin also found it difficult to invest her scarce time without pay. Today Zamin is thriving as a Living Goods CHP. Her recent sales are running over $100 per week, an annual run rate of close to $5,000, or more than twice the LG three‐year target!

In accordance with LG rules, Zamin conducted several weeks of home health education and data collection before starting to sell products. Now, three short months into her tenure, Zamin is becoming a well known and trusted caregiver. Zamin is happy to see positive changes in her clients. She counsels mothers on the importance of vitamins supplements, especially for children under two. She is selling a lot of fortified porridge and fortified cooking oil and can see the children with better nutrition are faring well. Her female customers like having a knowledgeable confidant with whom they can share sensitive health concerns in the privacy of their homes. It is clear that Zamin’s commitment to her community is driving her success. She participates in numerous local groups, including the women’s council of her parish, a post‐testing group for people with HIV, and a drama group. As a testament to her dedication and team spirit, Zamin is planning to write a musical anthem for Living Goods.