People Reached in 2010

We recently reviewed progress for International Medical Foundation over 2010 and are pleased to note the following data:

  • 5,592 people were counselled and tested for HIV
  • 1,644 were enrolled on our treatment programmes for those living with HIV
  • 19 patients received treatment each month for Cancer
  • 9 received open heart surgery
  • 244 were admitted onto Hope Ward for surgery and complex clinical care
  • 89 received physiotherapy
  • 225 were tested for TB
  • 63 received treatment for TB
  • 5,688 local people received out-patient care in Pader
  • 3,045 had out-patient care in Lira
  • 28,818 attended preventative care presentations.

All of the above received care and treatment free of charge thanks to the generous on-going support of our sponsors.

Shortlisted for BMJ Group Awards

We are pleased to note that the TB project at IHK has been shortlisted for this year’s BMJ Group Awards under the “Getting Evidence into Practice” category.

Thanks to Dr. Richard for making the submission.

TB is a significant health issue in Uganda and our project, supported initially by Suubi Trust and then by Target TB, has implemented a new TB Lab and completed a clinical trail for the MOT/MODS diagnostic method. You can read more detail about this in the submitted report by clicking here.

Essentially this method enables the team to diagnose TB in about 7-10 days at a cost of just $5. This compares to either the gold standard MGIT test which can cost up to $70 per test or low cost methods that can take about 40 days for a result.

Our thanks to VSO for it’s support over the last few years, first with Dr. Mark who got us started and then Dr. Grania and Dr. Richard who between them managed the clinical trial and the integration of the TB Lab into IHK’s community based health programme Touch Namuwongo.

Read our other Blog posts about this project by clicking here.

Advent: Day 13 TB

The first project that Suubi Trust supported was the development of a level 2 bio-containment facility at International Hospital Kampala to provide a MODS TB culture and sensitivity service. That was back in July 2007.

Since then we have completed the clinical trial and are now using the method to help diagnose patients from IHK and from our community programmes such as Touch Namuwongo.

This work has been supported over the last 3 years by a number of dedicated volunteers including Dr. Mark Russell, Dr. Grania Brigden and Dr. Richard Feinmann. They have worked alongside the local team including Dr. Edith and Bosco, who can be seen in the photo working with some cultures.

TB killed an estimated 1.7 million people globally in 2009, it is the biggest killer of HIV/AIDS patients in Africa. This new method helps us to get an accurate and cost-effective diagnosis much more quickly than before; for our TB patients starting the right treatment quickly is very important. You can read more about our work with TB patients by clicking here.

Advent: Day 10 Dr. Richard

Photo by VSO/Ben Langdon

This is Dr. Richard as many of us will remember him, enjoying being with the kids on Hope Ward. He made a huge difference in his time with us as a voluteer with VSO. There are more photos of him on the VSO website here.

Even after their VSO stint was finished, Richard and Patricia continued to help, encourage and support us. They came back for an extra 3 months to help us move into a larger health facility in Lira, northern Uganda and are now helping to raise funds for our maternal and child health programme there.

Here’s what Dr. Richard says about working with VSO:

“I hadn’t realised VSO would want people of my age. All my VSO contacts went overseas straight out of university, so I was a little tentative when I contacted VSO and said “I’m an old git, I have reasonable health and these talents, are you interested?” And I really did expect them to say no but was pleasantly surprised.”

A Day with the CATTS (Part One)

Dr. Grania is a key member of our team working on the development of and clinical trial for a new (faster – cheaper) diagnostic method for TB. She was back in Kampala last month and has posted this update on her Blog.

A key aspect of our plan for the TB project has been to work with the resources available. Doctors and other highly-skilled professionals are a scarce and expensive resource in Uganda, and so for our project to be affordable (and sustainable) we had to use as few doctors as possible.

One of the biggest problems with TB detection and treatment in Uganda is the lack of knowledge about the symptoms and how the treatment works. In particular, patients with TB are usually unaware they need to complete the full course of tablets for the treatment to be successful. CATTS (Community ARV TB Treatment Supporters) are a vital part of addressing this.

CATTS are volunteers from the local community who are given basic training in TB detection and treatment. They are then sent out into the community to visit patients with TB who are on ARV medication. This proactive approach – visiting patients in their own homes, providing advice and guidance and answering the questions they have – helps to ensure they take their treatment correctly.

I had seen CATTS in action in my old job at ReachOut Mbuya, but they were mainly used to assist patients with HIV-AIDS to take their ARV medication. This is an established part of HIV treatment, but despite the “TB” in the acronym I had not seen CATTS provide much TB treatment.

My VSO successor at IHK, Dr Richard, had already delivered TB training sessions for the Touch Namuwongo CATTS – signs and symptoms, treatment, common myths and prevention. I was now going to spend the day with Rose, one of the CATTS, to see how she was incorporating this training into her work.

Rose is a very friendly lady who has been working with Touch Namuwongo for four years. She has 8-10 patients, who she sees at least once a week. Her patients are either on ARV medication, TB medication, or both. Today we were going to see two patients on ARV drugs.

We met at the hospital and set off into the Namuwongo slum that surrounds the hospital. Quickly I lost my bearings in the rabbit-warren of dirt roads and winding shortcuts… this was a world away from the manicured lawns of the hospital grounds. Thankfully, Rose knew where she was going, and soon we found ourselves at the home of her first patient.

Florence was a widow with AIDS who was on ARVs. She lives in a room she shares with her four children. Rose checked that she had access to clean water (to take her tablets), gave her some advice on hygiene and ensured that the mosquito net provided by the Touch Namuwongo project was being used correctly. As we sat down to count her tablets (to check that she is taking them correctly), Rose suddenly launched into a series of questions about how often Florence had sex.

Florence did not appear as shocked by this line of questioning as I was, and mentioned that she was a widow of five years and did not have sex. Not put off by this answer, Rose then asked, “But what about your sexual needs?”

Again Florence answered with a negative reply. Then Rose followed up with “what if you took a man to fulfil you?” My British prudishness was by now in overdrive…

It transpired that Rose was trying to find out if Florence knew how to use condoms if/when she was having sex. After a thorough grilling, Rose was satisfied that Florence was taking her treatment correctly and was doing well. Concerning TB, Rose spoke to her about the symptoms associated with TB and made sure she knew that if she developed a cough, or began to have night sweats or unexplained weight loss, she should let the doctor know at her next clinic visit. Regarding testing her children, Rose said that she had spoken at length to Florence about this in the past. The issue was complicated by the fact that Florence hadn’t actually told her children she has AIDS (because she didn’t want to scare them as they have already lost their father to the disease) but this was something as a CATTS she could continue to advise and support Florence with.

We had some time before our next appointment, so Rose decided it was time for some community education – CATTS are encouraged to educate the wider community on health matters while they are out and about. We entered a small compound where a group of ladies were washing clothes. After introducing ourselves Rose launched straight into finding out what they knew about HIV-AIDS, how it was spread, what to do if your husband is unfaithful, etc.

(I have noticed here that there is almost an expectation amongst Ugandan women that their husbands will have other women. Although Uganda claims to be a mainly Christian country, polygamy is widespread, and the practise of inheriting a brother’s wife if he dies is common. This is one of the reasons why it has been so difficult to control HIV-AIDS.)

Again Rose’s line of questioning quickly became very personal and I was impressed that these ladies didn’t seem to mind us walking unannounced into their compound, interrupting their work, interrogating them about their sex life and questioning their husbands’ faithfulness!

After chatting to these ladies for half an hour or so, we continued on to our next patient, stopping at a local shop for a soda. Rose takes her job as community educator very seriously, so even the shopkeeper was not spared from a grilling. After buying our sodas, Rose launched into the next round of personal questions, this time asking him if he knew how to put on a condom and could he please demonstrate on a pen. Thankfully for the shopkeeper, he passed the test.

Next she enquired if he was circumcised. (Can you imagine the response if you walked into your local newsagent, asked the person behind the counter for a Coke and then enquired about their sexual practises?) Wishing I was somewhere else, the shopkeeper informed us that he wasn’t circumcised but was looking into it. There is actually a reason behind asking about circumcision, as recent evidence has shown that circumcised men are less likely to transmit as well as contract HIV, so advising safe medical circumcision is now part of the HIV prevention message.

The next patient we saw was a refugee from the Democratic Republic of Congo (DRC) with HIV. According to Rose he was “stubborn”, which in Ugandan terms means he has been a challenge to treat. Rose has been working with him for six months, stressing the importance of taking his treatment correctly as well as how to prevent the spread of HIV. His current wife (it is unclear how many wives he may have in the DRC) is not infected, but unfortunately he is not keen to use condoms to prevent her becoming infected.

In the short time I had been with Rose, I sensed that she had a passion for her job and would be a force to reckon with if you didn’t do what she said. She did mention that after a number of forceful meetings with this patient she had improved his compliance with treatment and he was now asking for access to the free condoms provided through the Touch Namuwongo scheme.

My day with Rose provided me with many insights into how the CATTS operate. I was very impressed with her knowledge of various health matters (including TB) and the passion she has to help her community prevent illness and improve their wellbeing. I am glad, though, that I never knew entirely where I was, and that I’m unlikely to bump into the people we met – I am not used to knowing the sexual habits and circumcision status of the local shopkeepers!

Dr. Richard trains 83 volunteers.

This week Dr. Richard provided TB training for local volunteers in preparation for Phase 2 of our TB programme.


Interesting day yesterday. I have mentioned our HIV outreach clinic “Touch Namuwongo”.Since TB and HIV are interlinked the 110 community volunteer workers from Touch came for training about TB. I don’t think I’ve ever done a whole days training on my own with such big numbers.

83 turned up and what a fantastic group. They all stood at the beginning and sang the national anthem …all 3 verses…then prayers…then they got stuck in. Cheering and clapping all day especially when I told them they could save 500 lives if they found the 500 TB cases I think there are in Namuwongo.

Lovely Deborah, my TB nurse had been on duty the night before and I kept saying to her. “Go home Deborah” but she refused and really delighted me by saying “this is too interesting”

Quite a few did not understand all of what I was saying so Francis my other TB nurse translated key bits into Luganda. Quite good actually, as it gave me time to get my breath back. No idea what he said but he said it all with lots of passion

Amazing the work they did in small groups.Not like teaching medical students!. They were fighting to present first,they were funny and they desperately wanted prizes for the best presentations.

This is Florence and Charles. In her presentation she said the main thing the CVW’s should do is love all their clients. This wag in the audience called Charles asked her,”how was she going to love all her clients”! She said “come out here and I’ll show you”. Lots of cheering…great fun. Who said women are not empowered in Uganda.

They do love T shirts and they are important as it identifies them as a volunteer worker. They go house to house, speak in market places, go to churches and schools. Amazingly for no pay just 10,000 Ugandan shillings… £3… when they come to training days

You may recognise the gent modelling the Tshirts.He nearly got crushed in the rush when we were handing them out. Not too impessed with his posture!!

The Flip Side becomes a book

Dr. Grania Brigden (Price) worked at International Hospital Kampala as a volunteer, with VSO, for one year up to September 2008. She and her husband Dan kept their family, friends and supporters up to date on their experiences via their Blog, The Flip Side of the Coin.

The Blog has now become available as a book which you can buy for a very reasonable £10. This will include a £3 donation to Suubi Trust, to help raise funds for Hope Ward at IHK.

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If you would like to know what life is like here for volunteers, learn about our innovation in TB Diagnostics and read some very touching patient case studies then please let us know and we can arrange for a copy to be sent to you.

You can of course read more about this on their Blog, linked above.

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If you would like a copy then please use this form to let us know…

We will not give your email address to anybody else.

Richard Feinmann on volunteering in Hope Ward

Dr Richard and children on Hope Ward

Dr Richard and children on Hope Ward, (Lub Dup, the sound of our heart beat)

What to do when you are a sexagenarian physician who has retired from hospital practice with 40 years in the NHS under your belt and golf/Sudoku not really appealing? Well, my health visitor wife and I applied to Voluntary Service Overseas (VSO) and I am writing this from a hospital in Kampala, Uganda, where I have been working for five months.

VSO did seem to want us and so long as your health is good, age is not a bar; the average age of volunteers is climbing all the time. So, off to Uganda and although it was hard adjusting to a huge change of lifestyle and temperature I recommend it. It’s great to be blissfully unaware of crashing stock markets and to be in a continent where everyone thinks Obama is their president too.

I really believe VSO and Africa do need doctors of my age. 30+ years of general and chest medicine gives experience which is so useful to hospitals in Uganda who aspire to provide quality care. I can treat and manage TB which is useful and I am fast becoming expert in HIV, but Uganda needs experienced generalists. Senior doctors who can make decisions (usually right ones), can’t operate but know when you need a surgeon, can reasonably confidently manage sick kids, teach and mentor and bring management skills both clinical and general, are certainly needed.

My ward is Hope Ward, a charity ward at International Hospital Kampala, so I’m lucky to have good facilities, good nurses and doctors and a clean hospital. The patients are destitute and come from all over Uganda and they are very sick. I don’t think we’ve had a CD4 count over 10, and the TB presentations are extraordinary, not to mention extra pulmonary. This is a country where 58% of the population of 30 million is under 18, yet abortions are illegal, where the government hospitals are understaffed and oversubscribed. Even in government hospitals health care is not free. Life expectancy is under 50 and HIV may affect 10% of the population with half having TB. Uganda is a member of “the bottom billion club” and the sad stories of patients selling their HIV drugs to buy food are all too true.

Many of my patients are babies or young people. It’s very different to the average age of a UK medical ward. They mostly have HIV with complications, but they are remarkably resilient. Rehydrate, feed them with naso gastric porridge (works wonders), restart their TB and HIV treatment and they seem to get better even though they look at deaths door on admission. Initially as an adult physician I was scared stiff of managing the babies and although many still cry when I pick them up (I’m told it’s my white skin!), we seem to manage.

I’m really busy, and my range is from pneumocystis pneumonia (PCP) in a 9 month old to myasthenia gravis in an 82 year old…both survived!! Of course there are lots of lows, and you have to keep reminding yourself you can’t cure all of Africa. I get really tired because it’s hot and humid with unfriendly mosquitoes, but I think I’m making a difference. A year might be enough but we’d do it again.

It’s good to go with your wife and support each other through the ups and downs. She’s working with the National Community of Women Living with AIDS (NACWOLA), an organisation staffed by dedicated women many with HIV and giving help to women and children with the disease. Her role is to develop child protection policies and a youth strategy.

HIV has wiped out many parents and it’s elderly grandmas who often bring up the children. We are socially very busy both with locals and other volunteers. We have just been to our third wedding out here!

Winston Churchill called Uganda the “Pearl of Africa” and it is a beautiful country with lovely friendly people. Its only blemish is appalling roads and heavy smelly traffic in Kampala.

So, that’s it, I am a physician, paediatrician, house surgeon, TB and HIV specialist and a fundraiser. I teach, do appraisals and appointments, go to hospital meetings and have good friendly colleagues. Patients are universally grateful, even when I get it wrong, and I’m not being complained about or sued.

Come on you bulge-baby doctors…Africa needs you.

Richard Feinmann is a 62 year old general and chest physician who retired a bit early after a serious health scare. He felt he had more to give and jumped at the chance to work with his health visitor wife in Uganda.

World TB Day

Today is World TB Day.

TB is preventable, treatable and curable and yet
it kills close to two million people a year.

acidfastbacilli.jpg

Little red rods kill 2 million people every year and we can cure it!

Dr Richard, Bosco and the team at IHK continue their work to validate our implementation of MOT, a new, low cost, diagnostic method which we hope will significantly impact our work, especially among those living with HIV. We are hoping that the validation will be complete by this summer.

You can read more here…

WhyIAmInUganda

Dr Richard “This is why I am in Uganda…”

Grania: A Plan Comes Together

Grania, a VSO, is leading our work at the TB Lab; the following is taken from her blog…

Finally! It’s great when a plan comes together, and, after quite a bit of work and waiting, a Big Plan has finally come together…

A few months ago, official funding for our MOT validation study was cut. This meant that we couldn’t pay for the trial to prove that MOT (the new test for diagnosing TB) would work in Uganda, and especially if it would work in patients who also had HIV.

The importance of this is that TB in patients with HIV is harder to diagnose, and often the tests that work in non-HIV patients are not as good in HIV patients.

So, I decided to try my hand at fundraising.

But as I soon found out, without validation data it is hard to get people, especially the Ugandan Ministry of Health, to trust and start using the MOT test. The first attempt was fairly futile, wandering down Kampala’s UN Alley, sitting in lovely air-con offices, being told politely in various ways “No, Sorry!” So I began to look further afield and made some enquiries with a few UK TB charities. From this, I received some promising feedback from one called Target TB.

As a complete novice at fundraising and not knowing where to start when writing a proposal, I hooked up with the hospital’s fundraiser, Máiréad (a fellow Norn Irish lass – there’s a large Northern Irish mafia here.) She helped to show me how fundraising proposals should be approached, and on researching the Target TB goals we quickly realised we needed to expand our proposal beyond just the trial. Over a cup of tea we planned out an ambitious idea to try and revolutionise TB care here. Máiréad worked her magic and made these tentative plans written on the back of an envelope sound exciting and feasible and the proposal was sent.

I was feeling slightly pessimistic, expecting a letter saying “Thank you for your enquiry, but….” But instead we kept passing the phases of proposal acceptance, and at the end of April Target TB had their final meeting with the Board of Directors. We found out shortly after that they have accepted our grant proposal, want to come into partnership with the IMF TB project and even better are giving us the full amount we asked for… £46,600!

So what is all this money paying for? Well, to begin with it will cover the validation trial so that we can convince the Ministry of Health to accept the MOT culture method. And it will also contribute to the scientific evidence behind this method. Once the trial has been completed (which we are hoping will be by the end of the summer) the really exciting stuff starts – the plan on the back of an envelope to establish a dedicated TB nurse service.

In the UK, most TB care is administered by specialist TB nurses. These nurses ensure that every patient has a smooth path through the diagnostic period, is allowed time to have the diagnosis and the importance of taking the medication explained to them, and is given access to someone approachable to turn to if they encounter any difficulties. It has been consistently shown to improve the quality of TB patient care, and importantly reduces the amount of people who stop taking their medication (putting them at risk of multi-drug resistant TB).

We will be setting up this TB nurse service in line with the new IMF outreach project, which will be offering HIV testing, treatment and care to the underprivileged population of Namuwongo district living around the hospital.

I really feel that with this grant we have an opportunity to make a difference to TB care in Uganda, and importantly we’ll be pioneering a new method of managing TB, in the underprivileged first and then to the fee-paying patients in the hospital. It’s going to involve a huge amount of work (I am the principal investigator for the trial), so I’ve now got to get everyone organised and ready to go for July. Then I have to start the relevant nurse training as there is no equivalent here – we’ll be starting from scratch. I’m looking forward to the challenge!