Notes from the Field: Urban informal settlement, Kampala

‘We live with risk,’ he tells me, as we weave our way along the railway line that cuts through the informal settlement where we are studying the roles of antimicrobial medicines in everyday life. My informant, like many others, has lived in the ‘slum’ or ‘ghetto’ as he refers to his area of residence, for his whole life. The railway has recently been reoperationalised, requiring the removal of rows of houses lining the route, a reminder of the precarity of life in this area. ‘The government wants us to leave’ he explains, ‘but we don’t want to go back to the villages.’

Living in an informal settlement, once swamp land, the residents receive little support for the basics of life. They seem hesitant to ask – the government’s tolerance to their existence seems brittle. It’s been raining all night, and the area has flooded again. We approach a pair of men, hard at work scooping mud from the trenches besides the railway line to fill a fourth large sack of mud. Their labour will save the railway from being swept away. I ask who has paid them for this work? ‘No one,’ they reply, ‘we just decided to because otherwise they will come and move us out.’

As we move downhill from the railway towards the channel that carries water and waste through the city, the impact of the flooding becomes more apparent. Watermarks one to two feet up inside houses mark out this morning’s flood level. The few pit latrine toilets that have been built in the settlement have emptied and their contents have joint other debris circulating through the neighbourhood. People have been up since before light trying to empty the dirty water and sludge from their homes. One house has given way and emptied into the trenches.

As we slip and slide through the mud, we see trails from little children who have been openly defecating. Their diarrhoea is thin and yellow. Adults are more discrete. But diarrhoea is a significant problem, amongst other daily challenges. In our medicines survey work moving house to house speaking to 174 residents we’ve found around half of our respondents use the antibiotic metronidazole on a weekly basis for diarrhoea.

Our research in the Antimicrobials In Society (AMIS) Uganda project addresses antimicrobial resistance by understanding the ways in which antibiotics are entangled with everyday life and livelihoods. In this context it is hard to see how ‘rational use’ of antibiotics could reasonably be implemented. Next week we will meet with groups of our study participants to share our interim findings and hear their reactions. We are open to exploring the wider economic, social and political implications of antibiotic use as we progress with our ethnographic work in this area.

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